The following is a collection of
featured congenital articles from the Journal of Thoracic and Cardiovascular
Surgery (JTCVS). To read the latest issue, or
browse the feature video library and other journal
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TETRALOGY OF FALLOT
ventricular flow organization following repair of
tetralogy of Fallot
Michal Schäfer, PhD, Lorna P.
Browne, MD, James Jaggers, MD, Alex J. Barker, PhD,
Gareth J. Morgan, MD, D. Dunbar Ivy, MD, Max B.
with repaired tetralogy of Fallot with mild-to-moderate
right ventricular (RV) dilation and significant
pulmonary regurgitation have abnormal left ventricular
(LV) inflow filling correlated with the degree of RV
dilation and impaired LV function.
Ventriculo-ventricular interaction: A bad neighbor
brings down the neighborhood
P. Bichell, MD
After tetralogy of Fallot repair,
compromise of the left ventricle occurs even with
only modest right ventricular enlargement.
Implications for pulmonary valve intervention deserve
Does right ventricular dysfunction cause left
ventricular dysfunction in tetralogy of Fallot? The
M. DeCampli, MD, PhD
Left ventricular dysfunction is
common after tetralogy of Fallot repair. The
challenge is to definitively determine the role of
the right ventricle in causing the dysfunction.
to Commentary: Can't flow down: More 4-dimensional flow
magnetic resonance imaging studies are needed in
congenital heart disease
Schäfer, PhD, D. Dunbar Ivy, MD, Alex J. Barker, PhD,
Max B. Mitchell, MD
Four-dimensional flow MRI studies in
congenital heart disease are scarce, yet they might
provide more information than current standard
a validated risk score for interstage death or transplant
after stage I palliation for single-ventricle heart
Humera Ahmed, MD, Jeffrey B.
Anderson, MD, Katherine E. Bates, MD, Craig E.
Fleishman, MD, Shobha Natarajan, MD, Nancy S. Ghanayem,
MD, Lynn A. Sleeper, ScD, Carole M. Lannon, MD, MPH,
David W. Brown, MD, for the National Pediatric
Cardiology Quality Improvement Collaborative
introduce a novel, validated risk score to be used
before discharge following S1P to assess the risk of
interstage death/transplant—greatest for patients with
TR and a supplemental O2 requirement.
Risk score for death or transplantation after stage I
Multiple factors contribute to
interstage mortality risk; however, many of those
might not be easily modifiable.
The over/under is set at 17? Let’s not gamble with
discharge after the Norwood operation
Meza, MD, MSc, Nicholas D. Andersen, MD, Joseph W.
Turek, MD, PhD
The NEONATE score is a first step
toward data-driven post-Norwood decision making.
Infants with a score of 17 or greater should remain
hospitalized, and modifiable risk factors should be
PULMONARY VALVE: BASIC SCIENCE
decellularized porcine small intestinal submucosa as a
heart valved conduit
Jan Willem van Rijswijk, MSc,
Hanna Talacua, MD, PhD, Khadija Mulder, MSc, Gerardus
P.J. van Hout, MD, PhD, Carlijn V.C. Bouten, PhD, Paul
F. Gründeman, MD, PhD, Jolanda Kluin, MD, PhD
of CorMatrix pSIS-ECM in heart valve surgery should be
considered with great care because of unreliable
outcomes due to inflammatory reaction and lack of
Pouring life into dead tissues: A brief history of the
porcine small intestine submucosa (SIS) in
cardiovascular surgery—success, failures, hype, and
Kalra, MD, Muralidhar Padala, PhD
Preclinical outcomes with porcine
small intestinal submucosa as cardiovascular
substitutes are limited and should be translated to
clinical use with caution.
Overpromised, understudied: The slippery slope of
pediatric cardiac device development
D. Fraser Jr., MD
Pediatric device development is
critical for children with cardiac disease.
Unfortunately, the pressure to introduce innovation
may, at important levels, result in inadequate
“CorMatrix: If it is too good to be true, …”
Formica, MD, Tain-Yen Hsia, MD
In animal studies, pulmonary valve
conduit made with CorMatrix showed a high incidence
of early valve failure and infection, with
corresponding histologic features of inflammation
and poor remodeling.
CEREBRAL PROTECTION: BASIC SCIENCE
dynamic brain metabolism during antegrade cerebral
perfusion versus deep hypothermic circulatory arrest
using proton magnetic resonance spectroscopy
Frank L. Hanley, MD, Hiroki Ito,
MD, Meng Gu, PhD, Ralph Hurd, PhD, R. Kirk Riemer, PhD,
Daniel Spielman, PhD
metabolism during deep hypothermic arrest is active and
abnormal, resulting in a buildup of lactate and loss of
energy substrates. Antegrade cerebral perfusion
prevents these abnormalities.
Elegantly confirming what we might predict
Austin III, MD
Proton MR spectroscopy provides an
elegant depiction of time-related changes in levels
of lactate and glucose in the brain of a neonatal
piglet. See how deep hypothermic circulatory arrest
compares with antegrade cerebral perfusion.
Please don't freeze my brain, perfuse it
Bachet, MD, FEBCTS
Either in piglets or in adult human
beings, antegrade selective cerebral perfusion
better protects the brain than deep hypothermic
assessment of technical performance during hands-on
surgical training of the arterial switch operation using
3-dimensional printed heart models
Nabil Hussein, MBChB (Hons), Osami
Honjo, MD, Christoph Haller, MD, John G. Coles, MD,
Zhongdong Hua, MD, Glen Van Arsdell, MD, Shi-Joon Yoo,
improves surgeons' performances during simulation of
the arterial switch operation. These methods are needed
to prepare the next generation of congenital heart
Print another heart, practice makes perfect
F. Ward, MD, Richard Lee, MD, MBA
Hands-on surgical training
quantitatively improves surgeons’ techniques;
continued demonstration of improved performance
will be needed for widespread adoption in
congenital heart surgery training.
Operate on my printed model—absolutely; my newborn
K. Woods, MD, PhD
Procedural training on 3D-printed
models may enhance knowledge and technical
performance of selected congenital cardiac surgical
Video clip demonstrating a CHS
fellow rehearsing the arterial switch procedure on the
3D-printed model (left) and performing the same
procedure on a patient (right). Steps include
transection of the aorta and pulmonary trunk, ligation
and division of the patent ductus arteriosus,
re-anastomosis of the neo-aorta, and implantation of
left coronary artery.