The following is a collection of congenital articles from the Journal of Thoracic and Cardiovascular Surgery (JTCVS). To read the latest issue and browse the Featured Video Library and other journal highlights please visit www.jtcvs.org
CONGENITAL: FONTAN
An in-vitro analysis of the PediMag™ and CentriMag™ for right-sided failing Fontan support
Phillip M. Trusty, MS; Mike Tree, PhD; Kevin Maher, MD; Timothy C. Slesnick, MD; Kirk R. Kanter, MD; Ajit P. Yoganathan, PhD; Shriprasad R. Deshpande3, MBBS, MS
PediMag and CentriMag right-sided support reduced vena cava pressure and supported cardiac output augmentation in an in vitro failing Fontan model.
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Commentary: Fontan assist device support: Road map to “stage 4” palliation
Christopher R. Broda, MD, Iki Adachi, MD
There is currently an unmet need for mechanical circulatory support devices specifically focusing on the right-sided hemodynamics to treat failing Fontan physiology.
CONGENITAL: SINGLE VENTRICLE
Determinants of Acute Events Leading to Mortality After Shunt Procedure in Univentricular Palliation
Tomislav Santro, MD, Yves d’Udekem, MD, PhD, Diana Zannino, MS, Ben Hobbes, MD, Igor E. Konstantinov, MD, PhD, Christian Brizard, MD, and Johann Brink, MD
Over one-fifth of patients shunted during univentricular palliation die before second stage. The majority of these deaths are associated with an acute event occurring early after surgery.
Commentary: Single ventricle patients and shunts—ACute event is not pretty
Ronald K. Woods, MD, PhD, FACS, FAAP, Viktor Hraska, MD, PhD
For patients with single-ventricle circulation and a systemic-to-pulmonary arterial shunt, an acute event is associated with worse survival.
Commentary: The shunt and the precarious physiology of the shunted circulation
Daniel Stromberg, MD, Carlos M. Mery, MD, MPH
A multiprong approach is necessary to reduce the complications and mortality in patients with a single ventricle with systemic-to-pulmonary-artery shunts.
CONGENITAL: TETRALOGY OF FALLOT
FEATURED VIDEO
Histopathology of the right ventricular outflow tract and the relation to hemodynamics in patients with repaired tetralogy of Fallot
Ujjwal Kumar Chowdhury, MCh, Diplomate NB, Aandrei Jha, MCh, Ruma Ray, MD, FRCP, Mani Kalaivani, MSc (Biostat), PhD, Suruchi Hasija, DM, Lakshmi Kumari, MCh, Abhinavsingh Chauhan, MS
A presentation of intracardiac repair of the tetralogy of Fallot using a trans-right atrial and transpulmonary approach.
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CONGENITAL: MECHANICAL CIRCULATORY SUPPORT
Computational Fluid Dynamics Simulations of a Cavopulmonary Assist Device for Failing Fontan Circulation
W.C. Patrick Lin, MASc, Matthew G. Doyle, PhD, S. Lucy Roche, MB ChB, Osami Honjo, MD, PhD, Thomas L. Forbes, MD, Cristina H. Amon, ScD
Computational simulations of a novel cavopulmonary assist strategy show potential as a temporary option for treating patients with a failing extracardiac Fontan.
Commentary: The Fontan paradox: A de Leval challenge
Tain-yen Hsia, MD, MSc
A device that can lower systemic venous pressure by 5 mm Hg and increase pulmonary arterial pressure by 5 mm Hg might solve the Fontan paradox.
Commentary: Mechanical support for the subpulmonary circulation of Fontan physiology—A step in the right direction
With few medical or surgical options available for patients with failing Fontan circulation, innovative solutions are needed to improve patient outcomes.
CONGENITAL: PERIOPERATIVE MANAGEMENT
High-dose heparin is associated with higher bleeding and thrombosis rates in pediatric patients following cardiac surgery
Carina N. Vorisek, MD, Lynn A. Sleeper, ScD, Breanna Piekarski, MPH, Minmin Lu, MS, Jenna Rogers, MPH, Olubunmi O. Oladunjoye, MBBS, Sitaram M. Emani, MD
Anticoagulation with high dose UFH is associated with significantly higher bleeding and thrombosis rates in children following cardiac surgery.
Commentary: Thromboprophylaxis after congenital cardiac surgery—Time for evidence-based guidelines
John P. Scott, MD
This study identifies potential complications related to high-dose heparin after pediatric cardiac surgery. High-quality prospective studies are needed to develop risk-stratified thromboprophylaxis guidelines.