BDG was performed in 31 patients (55%) who met specific criteria.No early or late deaths occurred. One child required reoperation for recurrent RVOT obstruction and two required balloon pulmonary arterioplasty. There was a 62% rhythm disturbance-free survival rate, 89% reoperation-free survival rate, and 91% pacemaker-free survival rate. We conclude that cardiac interstitial adenosine concentration is not an important component in coronary autoregulation. Tracheal stenosis is frequently associated with congenital heart defects, which may further complicate the overall management strategy. The purpose of this study was to evaluate the fate of right ventricle to pulmonary artery conduits after complete repair of PA/VSD/MAPCAs.This was a retrospective review of 103 infants who underwent complete repair of PA/VSD/MAPCAs with insertion of an aortic homograft conduit. - repairs the complete defect with only one surgery, in the majority of patients. Thus, for the patients currently eligible, 280 (93.0%) have achieved complete repair. No error in either group resulted in surgical morbidity or mortality.This study suggests that echocardiography alone is an accurate tool for the preoperative diagnosis of major congenital heart defects in most children undergoing primary complete repair, and may obviate the need for routine diagnostic catheterization. In six ewes, percutaneous uterine closure after the procedure was attempted. Gestational age ranged from 90 to 120 days (0.6 of normal gestation). Siehr, S. L., Maeda, K., Connolly, A. View details for Web of Science ID A1995QG08100013. Preliminary results of fetal cardiac bypass in nonhuman primates. Our unique approach to the double-switch repair, based on years of experience and research, has been shown to prevent or delay known major complications of the traditional double-switch repair. Fifty-nine patients had preoperative symptoms of myocardial ischemia, including 56 with exertional chest pain or syncope and 3 sudden death events. Clinical outcomes were summarized from the start of the program in September 2003 through March 2007. View details for DOI 10.1016/j.jtcvs.2006.05.066. The purpose of this study was to review our experience in patients who underwent all three stages of the Fontan pathway without ever being exposed to bypass.A total of 52 patients with single ventricle underwent "off-pump" treatment at all three stages of their surgical management. La información más reciente sobre el nuevo Coronavirus de 2019, incluidas las clínicas de vacunación para jóvenes de 12 a 17 años. Antegrade cerebral perfusion is widely used in neonatal heart surgery, yet commonly used flow rates have never been standardized. In this report, we examined the long-term outcome of xenograft valved Dacron conduits and cryopreserved allograft valved conduits used for reconstruction of the right ventricular outflow tract in young patients with truncus arteriosus. It is recognized that PV insufficiency has serious deleterious effects. Mainwaring, R. D., Pirolli, T., Punn, R., Hanley, F. L. Surgical Results in Patients With Pulmonary Atresia-Major Aortopulmonary Collaterals in Association With Total Anomalous Pulmonary Venous Connection. Primary complete repair was performed in the other 8 patients at ages ranging from 2.5 to 16 months (median 4.6 months), and all but one were infants. CEO(2) was equal at HF and ACP and trended higher after CPB compared with baseline. Thus fetal cardiac bypass causes a redistribution of regional blood flow away from the placenta and toward the other fetal organs. Using a juvenile lamb model of superior cavopulmonary anastomosis that reliably produces pulmonary arteriovenous malformations, we performed echocardiography and morphological analyses to determine the anatomic site of shunting and to identify the vascular structures involved. Reinhartz, O., Reddy, V. M., MacDonald, M. J., Lamberti, J. J., Petrossian, E., Perry, S. B., Suleman, S., Hanley, F. L. Management of major aortopulmonary collateral arteries. The longer-term prognosis remains guarded on the basis of the multi-organ system involvement of Alagille syndrome. We used the routine median sternotomy incision in usual cases and the clamshell approach in previous sternotomy patients for unifocalization. Amir, G., Ramamoorthy, C., Riemer, R. K., Hanley, F. L., Reddy, V. M. Outcome Analysis for a Small, Start-up Congenital Heart Surgery Program. In 15 patients, pre-revision arrhythmias were improved. Midline one-stage complete unifocalization and repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals. Malhotra, S. P., Petrossian, E., Reddy, V. M., Qiu, M., Maeda, K., Suleman, S., Macdonald, M., Reinhartz, O., Hanley, F. L. Deep Brain Hyperthermia While Rewarming from Hypothermic Circulatory Arrest. 2019 Nov 5 Perfusion Methods and Modifications to the Cardiopulmonary Bypass Circuit for Midline Unifocalization Procedures. We hypothesized that the dimensions of the coronary arteries may correlate with symptomatic status after atrial inversion and may be an important factor when these patients are considered for the arterial switch operation.The proximal left and right coronary arteries were measured in 9 patients with transposition and failure of the systemic right ventricle after atrial inversion, 10 asymptomatic patients after atrial inversion, and 10 patients with normal hearts. In patients with free pulmonary regurgitation and right ventricular dilatation after transannular patch repair, we have observed that the pulmonary outflow tract can dilate and elongate craniad and rotate to the left, resulting in kinking and obstruction of the previously normal left pulmonary artery.Ten patients referred for reoperation after tetralogy repair with severe pulmonary regurgitation and right ventricular outflow tract dilatation were found to have left pulmonary artery kinking. I love my field, because a child can arrive with a 1 percent chance of survival and, because of my expertise, I can turn that into a 99 percent survival rate. Fetal cardiac bypass causes placental dysfunction, characterized by increased placental vascular resistance, decreased placental blood flow, hypoxia, and acidosis. Tricuspid regurgitation decreased from a mean grade of 2.3 to 1.2 after repair (P = .00002). During the period of the study there was no significant decline in preoperative risk factors. However, our current preference is to defer this procedure until after 2 months of age. An uncommon but important cause of respiratory insufficiency in such children is external airway compression.We operated on 5 patients (median age, 6 months) with significant respiratory distress attributable to compression of the central airways by a dilated ascending aorta before or after repair of concomitant cardiovascular defects. At follow-up of 20 months to 5 years, all patients are alive and well, with mild or moderate respiratory symptoms in the 2 patients who required tracheostomy, both of whom were decannulated within 13 months.External airway compression can cause significant morbidity in patients with congenital heart defects other than vascular rings. CMRO(2) at ACP was greater than that at HF (P=0.001). Turley, K., Vlahakes, G. J., Harrison, M. R., Messina, L., Hanley, F., Uhlig, P. N., Ebert, P. A. Visible light spectroscopy (VLS) is newer technology that measures real-time tissue oxygenation. But it wasn't too much for the team at Packard Children's. Fochler was treated with a surgery pioneered by pediatric heart surgeon Frank Hanley, MD, called unifocalization. Truncus arteriosus is now ideally repaired in the neonatal period with low morbidity and mortality. Crossref Medline Google Scholar; 24 Tchervenkov CI, Salasidis G, Cecere R, Béland MJ, Jutras L, Paquet M, Dobell ARC. View details for Web of Science ID A1996VQ16700007. Twelve (67%) of these 18 were seen with obstruction of the anomalous connection and underwent emergency operation. Proximal pulmonary artery stenosis associated with the ductal insertion site was diagnosed at catheterization in 33 infants (18 with PA, 5 with TOF, 6 with PS, 4 other diagnoses). "Swiss cheese" defects were present in 4. Children with visceral heterotaxy often present with total anomalous pulmonary venous drainage (TAPVD) associated with univentricular congenital heart disease. Conversion to an extracardiac cavopulmonary connection was performed with a nonvalved conduit from the inferior vena cava to the right pulmonary artery, with additional procedures as necessary.There have been 3 deaths. Results are especially encouraging in neonates. Given the highly variable anatomy of patients with a complicated cervical aortic arch, surgical considerations will vary in kind. In ten, coronary/great vessel anatomy was considered unfavourable and the trap-door approach was adopted primarily. Seven patients had an associated myocardial bridge.Surgical repair was accomplished by unroofing of an intramural coronary in 86, reimplantation in 9, and pulmonary artery translocation in 20. Umbilical venous endothelin 1 levels increased significantly in fetuses exposed to fetal bypass but did not change in control fetuses.The basal endothelial regulatory mechanisms of placental vascular tone were deranged after fetal cardiac bypass. Found inside – Page 2074Hanley F. MAPCAs, bronchials, monkeys, and men. ... Unifocalization for pulmonary atresia with ventricular septal defect and major aortopulmonary ... Patients who underwent bronchoscopy in the perioperative period were compared to a randomly selected cohort of 172 control patients who underwent unifocalization without bronchoscopy during the study period.Forty-three children underwent perioperative bronchoscopy at a median of 9 days postoperatively. Expression of pluripotency markers Oct-4 and Nanog was detected in the newly formed multinucleated cells but not in mature colonies. Coronary artery enlargement was seen in 2 patients only. View details for DOI 10.1016/j.athoracsur.2012.03.007, View details for Web of Science ID 000305801600033. He then guided a team of designers, artists and game developers to create an active model of a living, pumping heart that viewers can explore and interact with onscreen. J Thorac Cardiovasc Surg 1995;109:832-44. Reddy VM, Liddicoat JR, Hanley FL . We defined major errors as those that increased the surgical risk and minor errors as those that did not. No blood transfusion was performed. View details for Web of Science ID 000078353700030. One patient, aged 9.6 years at the time of repair, had previously undergone construction of a modified Blalock-Taussig shunt. Although the various approaches that have been used are appropriate and successful in many patients, there are many for which these approaches are suboptimal. There have been 2 subsequent mortalities (7%), with a median follow-up duration of 4 years. Heinemann, M. K., Hanley, F. L., VANPRAAGH, S., Fenton, K. N., Jonas, R. A., Mayer, J. E., Castaneda, A. R. HIGH-DOSE STEROIDS PREVENT PLACENTAL DYSFUNCTION AFTER FETAL CARDIAC BYPASS. Fetal injury was related to amnioinfusion or fixation of chorioamniotic membranes. View details for DOI 10.1067/mtc.2002.120346, View details for Web of Science ID 000177840600009. Although such approaches may represent an improvement on the natural history of this lesion, they remain inadequate for a substantial portion of patients born with tetralogy of Fallot and major aortopulmonary collaterals. To this purpose, we currently rely on 2 novel parameters: (1) preoperative total neopulmonary arterial index and (2) mean pulmonary artery pressure changes . In the setting of normal cardiac situs, a right-sided aortic arch is uncommon. Laboratory and clinical data have confirmed the deleterious effects of deep hypothermic circulatory arrest. “We think if the valve starts to lose cells, a small breach can bring about series of reactions that manifest as a big problem, like the tiles on the space shuttle,” Riemer added. Because unilateral obstruction caused by kinking may lead to asymmetric pulmonary flow, it can exacerbate pulmonary regurgitation and right ventricular dilatation, in effect accelerating the processes that led to kinking in the first place. It has been validated in detecting mucosal ischemia in adults. Four patients have undergone successful Fontan completion (18.3 +/- 2.9 months postoperatively), and one patient whose BCPS was taken down subsequently underwent successful restoration of a BCPS.Outcomes after BCPS in young infants are comparable to those in older infants and children. View details for Web of Science ID 000086808500059. Two patients had recurrent symptoms and underwent reoperation (one had revision of the initial repair and one had repair of a myocardial bridge).Surgical repair of AAOCA can be safely performed and is highly efficacious in relieving symptoms of myocardial ischemia. During this time frame, 113 patients underwent a Norwood procedure. Whether ACP maintains peripheral tissue perfusion in humans is not known.Five patients undergoing neonatal open heart surgery with hypothermic cardiopulmonary bypass (CPB) were studied using a VLS esophageal probe in addition to bilateral near infrared cerebral oximetry. The median age at operation was 11 months, and bidirectional cavopulmonary shunt was the first surgical procedure performed in 10 of these patients. McElhinney, D. B., Thompson, L. D., Weinberg, P. M., Jue, K. L., Hanley, F. L. Early and intermediate outcomes after repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries - Experience with 85 patients. Surgical reconstruction is the primary method of treating airway obstruction in children. The purpose of this study was to evaluate the surgical results in patients undergoing repair of PA/VSD/MAPCAs with absent pulmonary arteries.This was a retrospective review of 35 patients who underwent surgical repair of PA/VSD/MAPCAs with absent pulmonary arteries between 2007 and 2014. They were also less likely to need preoperative inotropic medications or bicarbonate (P:=0.005). View details for Web of Science ID 000083039200033. The median duration of antegrade cerebral perfusion was 34 minutes. One patient underwent urgent repair of severe aortic regurgitation after balloon aortic valvuloplasty.All patients survived and are doing well, with no further need for catheter or operative intervention, from 8 months to 6 years after operation. The distributions of cerebral blood flow and regional oxygen saturation were equal in each brain hemisphere at all antegrade cerebral perfusion rates.Cerebral blood flow increased with antegrade cerebral perfusion rate. "It's extremely rewarding to correct heart defects in young babies and children.". Levels of plasma biomarkers of alveolar epithelial and endothelial injury and lung inflammation were not increased in patients with RPE compared with those without RPE. Outcomes included achieving anatomic repair within 1year of assessment in patients with LVOT obstruction or within 1year of pulmonary artery banding and freedom from death, transplantation, or heart failure at last follow-up.Forty-one patients met the inclusion criteria. Find Dr. Mainwaring's phone number, address, insurance information, hospital affiliations and more. J Thorac Cardiovasc Surg 1995; 109: 832 - 845.Google Scholar View details for DOI 10.1177/2150135114536908. The autologous pulmonary valve function was excellent, with 1 (2.8%) patient having moderate insufficiency.Autologous pulmonary valve is an excellent option for aortic valve replacement in all age groups. There were no deaths. The hospital survival rate was 81% (50/62); survival rates for palliation (78%, 18/23) and for correction (82%, 32/39) were similar. One patient died 2 months after operation, despite good hemodynamics, of uncontrollable diffuse subcutaneous edema due to familial distichiasis lymphedema syndrome. Complications of the previous Fontan connection included atrial tachyarrhythmias (n = 20), progressive heart failure (n = 17), Fontan pathway obstruction (n = 10), effusions (n = 10), pulmonary venous obstruction by an enlarged right atrium (n = 6), protein-losing enteropathy (n = 3), right atrial thrombus (n = 2), subaortic stenosis (n = 1), atrioventricular valve regurgitation (n = 3), and Fontan baffle leak (n = 5). J Am Coll Cardiol 1995; 25:491â€"9. ACP provided sufficient oxygen to the brain at a total body flow rate of 100mL/kg/min at deep hypothermia. View details for DOI 10.1017/S1047951110001423, View details for Web of Science ID 000285981400005. GRATTAN, M. T., Hanley, F. L., Messina, L. M., Turley, K., Hoffman, J. I. Primary outcome variables included severe hypotension, bradycardia, and oxygen desaturation, defined as a 30% decrease in the resting mean arterial blood pressure or heart rate, or a 20% decrease in the resting arterial oxygen saturation, for at least 30 s. There were no differences in the incidence of these variables; however, patients receiving halothane experienced twice as many episodes of severe hypotension as those who received sevoflurane (P = 0.03). In 4 lambs, the aorta was completely transected and reanastomosed using interrupted nitinol sutures. Mainwaring, R. D., Patrick, W. L., Punn, R., Palmon, M., Reddy, V. M., Hanley, F. L. Left Ventricular Retraining and Late Arterial Switch for D-Transposition of the Great Arteries. Thompson, L. D., McElhinney, D. B., Culbertson, C. B., Hardy, C. E., Brook, M. M., Reddy, V. M., Hanley, F. L. Elective primary repair of acyanotic tetralogy of fallot in early infancy: Overall outcome and impact on the pulmonary valve. Reddy, V. M., McElhinney, D. B., Moore, P., Haas, G. S., Hanley, F. L. Long-term follow-up of truncus arteriosus repaired in infancy: A twenty-year experience. Pulmonary reperfusion injury after the unifocalization procedure for tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collateral arteries. For fetal heart surgery to be possible, a method to support the fetal circulation is necessary. Excellent functional midterm outcomes can be obtained with a selective one and a half ventricle approach to Ebstein's anomaly. To learn more about this treatment option, visit the heart transplant program's page and our Health Library. The contractility was not different between the two groups at their baseline heart rates and rhythms or when they were paced synchronously compared with asynchronously. An angiography revealed 2 MAPCAs supplying all segments of the right lung. Fifteen had congestive heart failure, 9 had a ductus plus MAPCAs, and 3 had hemitruncus plus MAPCAs. Current measured at voltage threshold with pulse width below 0.5 msec was lower for the screw-in lead (P < 0.048). Three of the patients with recurrent stenosis underwent secondary surgical valvuloplasty without improvement. View details for Web of Science ID 000086998800007. However, long-term follow-up on new approaches is not available. After complete repair, the average right ventricular to aortic pressure ratio was 0.33 0.07. These patients had a longer duration of mechanical ventilation, ICU duration, and length of hospitalization. The presence of aortic stenosis or insufficiency or both imposes an additional physiologic burden that complicates the management of PA/VSD/MAPCAs. View details for Web of Science ID 000168335900013. Cisco, M. J., Asija, R., Dubin, A. M., Perry, S. B., Hanley, F. L., Roth, S. J. Robotic-assisted endoscopic thoracic aortic anastomosis in juvenile lambs. Age < 1 month correlated significantly with early death and with early failure of the BCPS (death or take-down). Freedom from conduit replacement or transcatheter pulmonary valve replacement was 703% at 5years and was shorter in patients with smaller initial conduit size. Overall the 1-, 2-, and 5-year survival rate was 95% 4.5%. Repair of truncus arteriosus in the neonatal and early infant periods has become standard practice at many centers. View details for DOI 10.1016/j.athoracsur.2012.03.061. Avoiding cardiopulmonary bypass influenced intraoperative hemodynamics and the incidence of fenestration but did not have a significant impact on the early postoperative outcomes of children undergoing the Fontan procedure. Figure 3: Artists illustration of the anatomy following complete repair of PA/MAPCAs. In this study we evaluated the technical feasibility of cardiac bypass in the nonhuman primate fetus and the efficacy of different anesthetic approaches.Twelve baboon fetuses, average gestation 146 +/- 8 days and weight 696 +/- 184 g, were used. Successful valve repair should be aggressively pursued to avoid the morbidity of prosthetic tricuspid valve replacement. Rather than perform a difficult and potentially high risk coronary reimplantation in a patient with an aberrant right coronary artery coursing between the aorta and pulmonary artery, the main pulmonary artery was translocated toward the left pulmonary hilum to create additional space between the aortic and pulmonic trunks. Cases for which the repair is useful include those in which complete biventricular repair is unlikely to be achieved because of limited size or function of the right side of the heart and those in which a patient with a ventricle capable of supporting inferior vena caval return was previously placed on a Fontan track. At a median follow-up of 17 months, there were no late deaths and three patients had undergone reintervention. Three patients died early and 3 late after initial unifocalization to shunts. The boundary conditions for the computational simulations were chosen to achieve realistic flow and pressures in the control cases. A., Gulati, R., Hanley, F. L. Homograft valved right ventricle to pulmonary artery conduit as a modification of the Norwood procedure. This indicates that the placenta is a unique and sensitive capacitor in the fetal circulation. Though repair of complete atrioventricular septal defect in infancy has become routine at most centers, it is not unusual for very young infants to be managed medically because of concerns about the fragility of the atrioventricular valve tissue.Since July 1992, seventy-two infants have undergone primary repair of complete atrioventricular septal defects at a median age of 3.9 months (40% < 3 months). Algaze, C. A., Koth, A. M., Faberowski, L. W., Hanley, F. L., Krawczeski, C. D., Axelrod, D. M. Computational simulation of postoperative pulmonary flow distribution in Alagille patients with peripheral pulmonary artery stenosis. The importance of early definition of pulmonary blood . There has been a trend in recent years towards less invasive therapy for many congenital cardiac malformations. Monge, M. C., Mainwaring, R. D., Sheikh, A. Y., Punn, R., Reddy, V. M., Hanley, F. L. Computational fluid dynamic simulations for determination of ventricular workload in aortic arch obstructions. The outcome of 225 modified Fontan operations carried out between 1984 and 1990 at the Children's Hospital, Boston, for patients with defects other than tricuspid atresia was reviewed. In 1 patient, there was also a multi-lobed aneurysm of the aortic segment contiguous to the obstruction, and in 2 there was marked tortuosity of the arch. Dimensions of the pulmonary "anulus" and tricuspid anulus were measured on echocardiograms, and right ventricular cavity size was estimated. La información más reciente sobre el nuevo Coronavirus de 2019, incluidas las clínicas de vacunación para jóvenes de 12 a 17 años. Associated anomalies of the aortic root and adjacent structures were present in 23 patients. These early hemodynamic results are maintained at medium-term follow-up. There were no differences between groups in demographic, diagnostic, or hemodynamic factors. The cardiac workload of the patients with 25% narrowing type A and B hypoplasia was not appreciably different from that of the control. The peripheral coronary pressure and microsphere results indicate that these effects are mediated largely by arterial collateral flow. For neonates with atrioventricular septal defect and aortic arch obstruction including coarctation of the aorta, we sought to determine whether a difference in outcomes exists after a primary neonatal versus staged surgical repair (neonatal arch repair with delayed intracardiac repair).This retrospective cohort study included consecutive neonates with atrioventricular septal defect and aortic arch obstruction who underwent cardiac surgery before 28 days of age at six centers from 1990 to 2009. We used visible light spectroscopy to follow deep and superficial brain SgvO2 during cardiopulmonary bypass, regional low-flow perfusion, and deep hypothermic circulatory arrest.Visible light spectroscopy probes were inserted into the superficial and deep brain of neonatal (3.9-4.5 kg) piglets, targeting the caudate and thalamic nuclei. Carotti A, Albanese SB, Filleppelli S, et al. MRI was performed preoperatively, 1 to 2 days postoperatively, and 2 to 10 weeks postoperatively.
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