Associated atrial septal defects increase perioperative morbidity after ventricular septal defect repair in infancy

Ascending aortic dilation in adult patients with congenital ventricular septal defect: An observational study

Many adult patients with congenital ventricular septal defect (VSD) also developed ascending aortic dilation, but few report the clinical features and surgical management of these patients. This study was designed to study ascending aortic dilation in adult patients with congenital VSD, and summarized the treatment experience and prognosis.To assess the clinical features and surgical management, we performed a retrospective analysis on preoperative data, intraoperative data, and postoperative data from the adult patients with congenital VSD who developed ascending aortic dilation in our institution from February 2010 to December 2016.From February 2010 to December 2016, we operated on 13 adult patients (12 males, 92.31%) with VSD who developed ascending aortic dilation. Median age was 37 (interquartile range 14) years. All patients suffered from perimembranous VSD and received surgical treatment. Their symptoms were all improved after surgery, no deaths occurred.Surgery is feasible for the ascending aortic dilation in adult patients with congenital VSD. Both proper perioperative treatment and close monitoring are required for the successful surgery.

The Southern Thoracic Surgical Association 50th anniversary celebration: the impact of STSA pediatric cardiothoracic surgery manuscripts on surgical practice

BACKGROUND

Members of the Southern Thoracic Surgical Association (STSA) have presented important pediatric cardiothoracic surgery papers at the annual meetings over the last 50 years. In order to determine the influence of these presentations on the practice of surgery, a review was undertaken. Early papers were characterized by emerging advances in open-heart surgery, anatomic congenital heart studies, and electrophysiologic discoveries that extended life with pacemakers. Later years were characterized by innovative myocardial preservation methods, improved cardiopulmonary bypass techniques, expanded homograft availability, emphasis on accurate repairs, intraoperative transesophageal echocardiography, and cardiopulmonary transplantation.

METHODS

All but one of the scientific programs of the annual meetings (that of 1964) were located. The programs were reviewed and 180 presentations were identified on topics in congenital heart disease, pediatric thoracic disease, and pediatric thoracic wall abnormalities. Of those 180 oral presentations, 155 manuscripts (86%) were eventually published or in press and available for critical review and analysis. Manuscripts were grouped by diagnosis or therapeutic intervention. We determined a "cumulative citation frequency" (CCF), which measures the number of times an article is cited in the bibliography of related papers in the universe of participating journals. The selected manuscripts were compared with the historic landmark contributions and the existing trends at the time, and the number of articles both by individual authors and from institutions were tallied.

RESULTS

Grouping by authors and institutions showed that 100 of 155 pediatric cardiothoracic manuscripts (65%) originated from 13 institutions. The CCF for the 20 leading articles ranged from 26 to 93.

CONCLUSIONS

This historical STSA 50-year record of pediatric cardiothoracic advances was accomplished in a milieu of collegial respect and camaraderie. Our annual meetings over the years have provided a venue for thoracic surgeons to share their ideas, innovations, and scientific inquiry. These contributions have significantly affected the practice of pediatric cardiothoracic surgery. The STSA has worked for 50 years and we trust that it will work for another 50 years and beyond.

Preoperative evaluation and surgery in isolated ventricular septal defects: a 21 year perspective

OBJECTIVE

To study short and long term results after surgical closure of isolated ventricular septal defects (VSDs) from 1976 to 1996, especially in relation to changes in preoperative evaluation during this period.

DESIGN

Retrospective study.

SETTING

Tertiary referral centre for paediatric cardiac care.

PATIENTS

All children under 18 years of age who had corrective surgery for VSD between 1976 and 1996.

MAIN OUTCOME MEASURES

Preoperative evaluation, indications for surgery, diagnostic errors, and early and late results.

RESULTS

A significant decrease in the use of invasive preoperative studies in favour of non-invasive methods was found; from 1976 to 1990, a total of 109/110 patients had preoperative invasive study as compared to 43/167 from 1991 to 1996 (p < 0.001). Pulmonary hypertension in small children, without detailed information on Qp:Qs ratio, as well as small or modest shunts without pulmonary hypertension, were more frequent indications for surgery in recent years. Early mortality after surgery occurred in 10 patients, with a significantly lower mortality rate found between 1991 and 1996 than between 1976 and 1990 (0.6% v 8.2%, p < 0.001). Children with large VSDs experienced perioperative complications significantly less often between 1991 and 1996 than between 1976 and 1990 (16/105 v 28/96, p < 0.05). Diagnostic errors showed a tendency to decrease between the two time periods. No late deaths occurred.

CONCLUSIONS

Significant reductions in early mortality, perioperative complications, and diagnostic mistakes were seen during the study period, even though less invasive diagnostic procedures were being performed.