1
|
Bonello B, Issitt R, Hughes M, Carr M, Iriart X, Khambadkone S, Giardini A, Kostolny M, Marek J. Long-term outcome after neonatal intervention for congenital critical aortic stenosis. Int J Cardiol 2024; 405:131932. [PMID: 38437954 DOI: 10.1016/j.ijcard.2024.131932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/08/2024] [Accepted: 03/01/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND This study explored long-term outcome and functional status of patients born with critical aortic stenosis (CAS) following neonatal surgical or catheter interventions. METHODS A 40-year retrospective review of all consecutive patients within a large, single-center referral unit who required neonatal (<30 days) intervention for CAS. Additional detailed evaluation of surviving patients >7 years age was performed, with clinical assessment, objective cardiopulmonary exercise testing and state-of-the-art characterization of myocardial function (advanced echocardiography and cardiac MRI). RESULTS Between 1970 and 2010, ninety-six neonates underwent CAS intervention (mean age 9 ± 7.5 days). Early death occurred in 19 (19.8%) and late death in 10 patients. Overall survival at 10 and 30 years was 70.1% and 68.5%, freedom from reintervention was 41.8% and 32.9% respectively. Among the 25 long-term survivors available for detailed assessment (median age 15.7 ± 6.4 years), 55% exhibited impaired peak oxygen uptake. Mean left ventricle (LV) ejection fraction was 65 ± 11.2%, with a mean LV end-diastolic volume z-score of 0.02 ± 1.4. Mean LV outflow tract Vmax was 2.3 ± 1.02 m/s. CAS patients had reduced LV longitudinal and increased radial strain (p = 0.003, p < 0.001 respectively). Five patients had severe LV diastolic dysfunction associated with endocardial fibroelastosis (EFE) (p = 0.0014). CONCLUSION Despite high early mortality rate, long-term survival of patients with CAS is reasonable at the expense of high reintervention rate. With successful intervention, there remained long-term clinical and subclinical LV myocardial impairment, of which EFE was one marker. Long-term follow-up of all CAS patients is crucial, involving detailed myocardial functional assessment to help elucidate physiology and optimise management.
Collapse
Affiliation(s)
- Beatrice Bonello
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; University College of London, Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| | - Richard Issitt
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; University College of London, Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| | - Marina Hughes
- Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich NR4 7UY, UK.
| | - Michelle Carr
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK.
| | - Xavier Iriart
- CHU Bordeaux, Av. du Haut Lévêque, Pessac 33604, France.
| | - Sachin Khambadkone
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; University College of London, Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| | | | - Martin Kostolny
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; University College of London, Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| | - Jan Marek
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; University College of London, Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| |
Collapse
|
2
|
Bijral M, Rana M, Berra IG, Christov G, Charokopos N, Prodan ZL, Kostolny M, Belitsis G. Striving for physiologic coaptation: An experimental and innovative approach towards designing and implanting aortic neo-leaflets. Multimed Man Cardiothorac Surg 2024; 2024. [PMID: 38411164 DOI: 10.1510/mmcts.2024.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Aortic valve repair has emerged as the treatment of choice for congenital aortic valvular disease, avoiding the need for a reoperation associated with stented prosthesis overgrowth. The introduction of a leaflet implant represents a recent advancement in a field that originated early techniques, such as simple commissurotomies. In our experimental approach, we assessed two established leaflet-sizing techniques by analysing their resultant coaptation areas. Although both techniques produced competent valves, the large coaptation areas differed significantly from the native aortic valve. This observation prompted us to revisit the functional anatomy of the aortic valve, our goal being to refine leaflet design and implantation for enhanced efficacy and longevity in neo-leaflet procedures. We designed a novel aortic valvar neo-leaflet, utilizing porcine pericardium as our primary source material, and we implanted four tri-leaflet valves in four porcine hearts. All tri-leaflet valves were competent and closely resembled the coaptation area of the native aortic valve. This study serves as a pilot for further experimental aortic valve repair surgery using neo-leaflet implants.
Collapse
Affiliation(s)
- Mehar Bijral
- Medical School of University College London, London, United Kingdom
| | - Mannat Rana
- Medical School of University College London, London, United Kingdom
| | - Ignacio Guillermo Berra
- Pediatric Cardiac Surgery Department, Hospital nacional de Pediatria J P Garrahan, Buenos Aires, Argentina
| | - Georgi Christov
- Paediatric Cardiology Department, Great Ormond Street Hospital for Children, London, United Kingdom
| | | | - Zsolt Lorant Prodan
- Kids Heart Centre, Gottsegen National Cardiovascular Centre, Budapest, Hungary
| | - Martin Kostolny
- Cardiothoracic Surgery Department, Great Ormond Street Hospital for Children, London, United Kingdom
- Institute of Cardiovascular Sciences, Department of Children’s Cardiovascular Disease, University College London, London, United Kingdom
| | - Georgios Belitsis
- Institute of Cardiovascular Sciences, Department of Children’s Cardiovascular Disease, University College London, London, United Kingdom
| |
Collapse
|
3
|
Kanakis M, Kostolny M, Samanidis G, Kolovou K, Chatziantoniou A, Giannopoulos N, Kourtidou S, Petsios K, Vrachliotis T, Bobos D. Preoperative surgical planning for biventricular repair of double outlet right ventricle by using a 3D heart model. Quant Imaging Med Surg 2024; 14:2107-2113. [PMID: 38415113 PMCID: PMC10895106 DOI: 10.21037/qims-23-1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/28/2023] [Indexed: 02/29/2024]
Affiliation(s)
- Meletios Kanakis
- Department of Paediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Martin Kostolny
- Cardiothoracic Surgery Unit, Great Ormond Street Hospital, London, UK
| | - George Samanidis
- 1st Department of Cardiac Surgery, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Kyriaki Kolovou
- Department of Cardiac Surgery Intensive Care, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Nicholas Giannopoulos
- Department of Paediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Soultana Kourtidou
- Department of Paediatric Cardiology, Onassis Cardiac Surgery Centre, Athens, Greece
| | | | | | - Dimitrios Bobos
- Department of Paediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Centre, Athens, Greece
| |
Collapse
|
4
|
Kanakis M, Chatziantoniou A, Rorris FP, Chamogeorgakis T, Kostolny M, Bobos D. Converting the Fontan Circulation: Challenges and Evolution. Heart Surg Forum 2023; 26:E917-E923. [PMID: 38178331 DOI: 10.59958/hsf.6983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024]
Abstract
The Fontan operation, the final palliative step after a series of complex operations in patients with univentricular hearts, has undergone multiple modifications throughout the last decades, with the goal of finding the method which combines the optimal hemodynamic effects of the Fontan circulation with minimal long term side effects. An understanding of the operative evolution and subsequent side effects, as well as the management thereof seems imperative. Since its inception by Francis Fontan the, now obsolete, initial atriopulmonary connection has passed through several milestones into having now reached the era of total cavopulmonary connection. However, recently published results bring to light the new option of biventricular conversion which comes to challenge the management of Fontan patients as we know it. Currently, there is no consensus as to whether to continue with palliation in this challenging group of patients or proceed with heart transplantation. In this collective review, we provide a historic overview of the Fontan evolution as well as future insights, discussing the perspectives of options for patients with failing Fontan, including the latest addition of biventricular correction.
Collapse
Affiliation(s)
- Meletios Kanakis
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece.
| | | | - Filippos-Paschalis Rorris
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece.
| | - Themistokles Chamogeorgakis
- Department of Heart Transplantation and Mechanical Circulatory Support, Onassis Cardiac Surgery Center, 17674 Athens, Greece.
| | - Martin Kostolny
- Cardiothoracic Unit, Great Ormond Street Hospital, WC1N 3JH London, UK; Institute of Cardiovascular Science, UCL, WC1N 3JH London, UK.
| | - Dimitrios Bobos
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece.
| |
Collapse
|
5
|
Rudrappa SC, Beeman A, Ramaswamy M, Khambadkone S, Derrick G, Kostolny M, Calder A, Muthialu N. Impact of Tracheal Arborization and Lung Hypoplasia in Repair of Pulmonary Artery Sling in Combination With Long-Segment Tracheal Stenosis. World J Pediatr Congenit Heart Surg 2023; 14:134-140. [PMID: 36788380 DOI: 10.1177/21501351221145172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Background: Reimplantation of the left pulmonary artery (LPA) and slide tracheoplasty has been our standard approach of care for patients with pulmonary artery sling (PAS) and tracheal stenosis. We present our experience, with emphasis on tracheal arborization and hypoplastic lungs; and their impact on long-term outcome of children with PAS and tracheal stenosis. Methods: It is a retrospective comparative study. Data were classified and analyzed based on the type of tracheobronchial arborization and normal versus hypoplastic lungs. Results: Seventy-five children operated between January 1994 and December 2019 (67 with normal lungs and 8 with lung hypoplasia/agenesis) were included. Patients with hypoplastic lungs had higher rates of preoperative ventilation (87.5%), postoperative ventilation (10 vs 8 days, P = .621), and mortality (50% vs 9%, P = .009) compared with those with normal lungs. Nineteen patients had tracheal bronchus (TB) variety and 30 patients had congenital long-segment tracheal stenosis (CLSTS) variety of tracheobronchial arborization. Endoscopic intervention was needed in 47.4% of patients with TB type and 60% with CLSTS type. CLSTS patients had higher rates of preoperative ventilation (60% vs 47.4%, P = .386), longer periods of postoperative ventilation (13 vs 6.5 days, P = .006), and ICU stay (15 vs 11 days, P = .714) compared with TB type. Conclusion: Surgical repair of PAS with tracheal stenosis has good long-term outcomes. All variations of tracheal anatomy can be managed with slide tracheoplasty. Persistence of airway problems requires intervention during follow-up as tracheal stenosis continues to be the Achilles heel.
Collapse
Affiliation(s)
| | - Arun Beeman
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - Madhavan Ramaswamy
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - Sachin Khambadkone
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - Graham Derrick
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - Martin Kostolny
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - Alistair Calder
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - Nagarajan Muthialu
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| |
Collapse
|
6
|
Stoica S, Beard C, Takkenberg JJM, Mokhles MM, Turner M, Pepper J, Hopewell-Kelly N, Benedetto U, Nashef SAM, El-Hamamsy I, Skillington P, Glauber M, De Paulis R, Tseng E, Meuris B, Sitges M, Delgado V, Krane M, Kostolny M, Pufulete M. Formal consensus study on surgery to replace the aortic valve in adults aged 18-60 years. Heart 2023; 109:857-865. [PMID: 36849232 DOI: 10.1136/heartjnl-2022-321740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/12/2022] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE There is uncertainty about surgical procedures for adult patients aged 18-60 years undergoing aortic valve replacement (AVR). Options include conventional AVR (mechanical, mAVR; tissue, tAVR), the pulmonary autograft (Ross) and aortic valve neocuspidisation (Ozaki). Transcatheter treatment may be an option for selected patients. We used formal consensus methodology to make recommendations about the suitability of each procedure. METHODS A working group, supported by a patient advisory group, developed a list of clinical scenarios across seven domains (anatomy, presentation, cardiac/non-cardiac comorbidities, concurrent treatments, lifestyle, preferences). A consensus group of 12 clinicians rated the appropriateness of each surgical procedure for each scenario on a 9-point Likert scale on two separate occasions (before and after a 1-day meeting). RESULTS There was a consensus that each procedure was appropriate (A) or inappropriate (I) for all clinical scenarios as follows: mAVR: total 76% (57% A, 19% I); tAVR: total 68% (68% A, 0% I); Ross: total 66% (39% A, 27% I); Ozaki: total 31% (3% A, 28% I). The remainder of percentages to 100% reflects the degree of uncertainty. There was a consensus that transcatheter aortic valve implantation is appropriate for 5 of 68 (7%) of all clinical scenarios (including frailty, prohibitive surgical risk and very limited life span). CONCLUSIONS Evidence-based expert opinion emerging from a formal consensus process indicates that besides conventional AVR options, there is a high degree of certainty about the suitability of the Ross procedure in patients aged 18-60 years. Future clinical guidelines should include the option of the Ross procedure in aortic prosthetic valve selection.
Collapse
Affiliation(s)
- Serban Stoica
- Cardiothoracic Surgery, Bristol Heart Institute, Bristol, UK
| | - Chloe Beard
- Cardiothoracic Surgery, Bristol Heart Institute, Bristol, UK
| | | | - Mostafa M Mokhles
- Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mark Turner
- Department of Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - John Pepper
- Surgery, Royal Brompton Hospital, London, UK
| | - Noreen Hopewell-Kelly
- Health and Social Sciences, University of the West of England-Frenchay Campus, Bristol, UK
| | | | - Samer A M Nashef
- Cardiac Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | | | | | | | - Elaine Tseng
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Bart Meuris
- Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Marta Sitges
- Cardiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Markus Krane
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Martin Kostolny
- Cardiothoracic Unit, Great Ormond Street Hospital and Institute of Cardiovascular Science, University College London, London, UK
| | - Maria Pufulete
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
7
|
Belitsis G, Pajaziti E, Schievano S, Capelli C, Cook A, Kostolny M. Use of virtual reality in complex double outlet right ventricle cases. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 36503703 DOI: 10.1510/mmcts.2022.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Virtual reality has been incorporated into clinical practice for planning complex congenital cardiac operations at the Great Ormond Street Hospital for Children since 2018 [1]. Virtual reality allows for 3-dimensional exploration of patient-specific models, created through the segmentation of 3-dimensional imaging data sets. Along with 3-dimensional printed models and 3-dimensional PDFs, this technology has enabled a new approach in planning and reviewing surgical interventions. It is particularly important in intracardiac repairs involving ventricular septal defects [2] and double outlet right ventricle cases presenting with various phenotypes of interventricular communication [3,4]. We present the virtual reality environment of two complex cases of double outlet right ventricle, illustrating the potential of virtual reality as a clinical tool to aid anatomical understanding and surgical planning of complex congenital heart disease.
Collapse
Affiliation(s)
- Georgios Belitsis
- University College London and Great Ormond Street Hospital, London, UK
| | - Endrit Pajaziti
- Institute of Cardiovascular Science, Department of Children's Cardiovascular Disease, University College London, London, United Kingdom
| | - Silvia Schievano
- Institute of Cardiovascular Science, Department of Children's Cardiovascular Disease, University College London, London, United Kingdom
| | - Claudio Capelli
- Institute of Cardiovascular Science, Department of Children's Cardiovascular Disease, University College London, London, United Kingdom
| | - Andrew Cook
- Institute of Cardiovascular Science, Department of Children's Cardiovascular Disease, University College London, London, United Kingdom
| | | |
Collapse
|
8
|
Belitsis G, Aynetdinova R, Dent C, Kostolny M. Ductal arch decoded: the use of its spatial fingerprint to design a Norwood type of patch. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 36239124 DOI: 10.1510/mmcts.2022.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Reconstruction of the aortic arch for the Norwood procedure remains a focus of attention in terms of the management of the distal anastomosis [1,2], patch design and material [3,4], and fashioning the Damus-Kaye-Stansel itself [5]. The reconstructed aorta supplies the coronaries and the head and neck vessels and directs flow to the descending aorta. As the fetus develops, the right ventricle shunts to the aorta through the ductal arch, supporting a great percentage of the systemic and the placental circulation. We have developed a method of designing a Norwood patch by decoding the 3-dimensional geometry of the arterial duct and its arch.
Collapse
Affiliation(s)
- Georgios Belitsis
- University College London and Great Ormond Street Hospital, London, UK
| | | | | | | |
Collapse
|
9
|
Stoica S, Kreuzer M, Dorobantu DM, Kostolny M, Nosal M, Hosseinpour AR, Martinez FL, Generali T, Hasan A, Mair R, Hazekamp M. Aortic Root Translocation and En-Bloc Rotation of the Outflow Tracts Surgery for Complex Forms of Transposition of the Great Arteries and Double Outlet Right Ventricle – a Multicenter Study. J Thorac Cardiovasc Surg 2022; 164:1249-1260. [DOI: 10.1016/j.jtcvs.2022.05.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/27/2022] [Accepted: 05/08/2022] [Indexed: 11/30/2022]
|
10
|
Brown KL, Thiruchelvam T, Kostolny M. Extracorporeal membrane oxygenation after the Norwood operation: making the best of a tough situation. Eur J Cardiothorac Surg 2022; 62:6563075. [PMID: 35373830 DOI: 10.1093/ejcts/ezac221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Katherine L Brown
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust and Biomedical Research Centre, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Timothy Thiruchelvam
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust and Biomedical Research Centre, London, UK
| | - Martin Kostolny
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust and Biomedical Research Centre, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| |
Collapse
|
11
|
Milano EG, Kostolny M, Pajaziti E, Marek J, Regan W, Caputo M, Luciani GB, Mortensen KH, Cook AC, Schievano S, Capelli C. Enhanced 3D visualization for planning biventricular repair of double outlet right ventricle: a pilot study on the advantages of virtual reality. Eur Heart J Digit Health 2021; 2:667-675. [PMID: 36713107 PMCID: PMC9707861 DOI: 10.1093/ehjdh/ztab087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/27/2021] [Indexed: 02/01/2023]
Abstract
Aims We aim to determine any additional benefit of virtual reality (VR) experience if compared to conventional cross-sectional imaging and standard three-dimensional (3D) modelling when deciding on surgical strategy in patients with complex double outlet right ventricle (DORV). Methods and results We retrospectively selected 10 consecutive patients with DORV and complex interventricular communications, who underwent biventricular repair. An arterial switch operation (ASO) was part of the repair in three of those. Computed tomography (CT) or cardiac magnetic resonance imaging images were used to reconstruct patient-specific 3D anatomies, which were then presented using different visualization modalities: 3D pdf, 3D printed models, and VR models. Two experienced paediatric cardiac surgeons, blinded to repair performed, reviewed each case evaluating the suitability of repair following assessment of each visualization modalities. In addition, they had to identify those who had ASO as part of the procedure. Answers of the two surgeons were compared to the actual operations performed. There was no mortality during the follow-up (mean = 2.5 years). Two patients required reoperations. After review of CT/cardiac magnetic resonance images, the evaluators identified the surgical strategy in accordance with the actual surgical plan in 75% of the cases. When using 3D pdf this reached only 70%. Accordance improved to 85% after revision of 3D printed models and to 95% after VR. Use of 3D printed models and VR facilitated the identification of patients who required ASO. Conclusion Virtual reality can enhance understanding of suitability for biventricular repair in patients with complex DORV if compared to cross-sectional images and other 3D modelling techniques.
Collapse
Affiliation(s)
- Elena Giulia Milano
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK.,Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, P.le Scuro 10, 37134, Verona, Italy
| | - Martin Kostolny
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK.,Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, WC1N 3JH, London, UK
| | - Endrit Pajaziti
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK
| | - Jan Marek
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK
| | - William Regan
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, WC1N 3JH, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, Westminster Bridge Rd, SE1 7EH, London, UK
| | - Massimo Caputo
- Bristol Heart Institute, Bristol Medical School, Bristol Medical School, University of Bristol, St Michael's Hill, BS2 8DZ, Bristol, UK
| | - Giovanni Battista Luciani
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, P.le Scuro 10, 37134, Verona, Italy
| | - Kristian H Mortensen
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, WC1N 3JH, London, UK
| | - Andrew C Cook
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK
| | - Silvia Schievano
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK
| | - Claudio Capelli
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK
| |
Collapse
|
12
|
Kanakis M, Martens T, Kostolny M, Petsios K, Giannopoulos N, Muthialu N. Reappraisal of lung manifestations in the setting of Fontan circulation. Asian Cardiovasc Thorac Ann 2021; 30:627-634. [PMID: 34747207 DOI: 10.1177/02184923211056711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fontan circulation is a well-established palliation in patients with functional single ventricles. Absence of a sub-pulmonary pumping chamber creates a unique physiology in which blood flow is mainly guided by negative intrathoracic and elevated central venous pressures. Various pulmonary anatomic or pathophysiologic changes can jeopardize optimal Fontan circulation. Long-term survival of patients who have undergone the contemporary total cavopulmonary connection is satisfactory. Thorough literature review in conjunction with accumulated clinical experience can lead clinicians to extract conclusions regarding Fontan and lung interactions indicating the purpose of this review.
Collapse
Affiliation(s)
- Meletios Kanakis
- Department of Pediatric and Congenital Heart Surgery, 69106Onassis Cardiac Center, Athens, Greece
| | - Thomas Martens
- Department of Cardiac Surgery, 54498Ghent University Hospital, Gent, Belgium
| | - Martin Kostolny
- Cardiothoracic Unit, 4956Great Ormond Street Hospital for Children, London, UK.,Slovak Medical University, Bratislava, Slovakia
| | - Konstantinos Petsios
- Department of Pediatric and Congenital Heart Surgery, 69106Onassis Cardiac Center, Athens, Greece
| | - Nicholas Giannopoulos
- Department of Pediatric and Congenital Heart Surgery, 69106Onassis Cardiac Center, Athens, Greece
| | - Nagarajan Muthialu
- Cardiothoracic Unit, 4956Great Ormond Street Hospital for Children, London, UK
| |
Collapse
|
13
|
Kostolny M. My video is better than yours: a new chapter for perioperative assessment of function? Eur J Cardiothorac Surg 2021; 59:1337-1338. [PMID: 33564818 DOI: 10.1093/ejcts/ezab061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Martin Kostolny
- Cardiothoracic Unit, Great Ormond Street Hospital, London, UK.,Institute of Cardiovascular Science, UCL, London, UK
| |
Collapse
|
14
|
Bonello B, Kostolny M, Marek J. Enhanced Echocardiography Imaging in Reoperation for Complex Congenital Heart Disease in a Child. ACTA ACUST UNITED AC 2020; 5:81-85. [PMID: 33644520 PMCID: PMC7887613 DOI: 10.1016/j.case.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Evaluation of the mechanism of MR is essential for appropriate repair. 2D and 3D TEE are the gold standard for presurgical MV repair in children. Enhanced echo imaging improves benefits in complex congenital heart disease.
Collapse
Affiliation(s)
- Beatrice Bonello
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - Martin Kostolny
- Great Ormond Street Hospital for Children, London, United Kingdom.,Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Jan Marek
- Great Ormond Street Hospital for Children, London, United Kingdom.,Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| |
Collapse
|
15
|
Muthialu N, Martens T, Kanakis M, Bezuska L, Nakao M, Derrick G, Marek J, Khambadkone S, Kostolny M, Tsang V. Repair of pulmonary artery sling with tracheal and intracardiac defects. Asian Cardiovasc Thorac Ann 2020; 28:463-469. [PMID: 32659103 DOI: 10.1177/0218492320943342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pulmonary artery sling is commonly associated with tracheal stenosis and intracardiac anomalies. While surgical repair is standardized, coexistent anomalies often determine outcomes. With the paucity of risk stratification, this study aimed to review our experience and stratify risk factors for the surgical outcome of complex pulmonary artery sling repair in the presence of airway or intracardiac lesions. METHODS Seventy-nine consecutive children with pulmonary artery sling were evaluated retrospectively following surgical repair. Median age at surgery was 5 months (interquartile range 3-9). Surgical approaches included pulmonary artery sling alone (n = 10), pulmonary artery sling with tracheoplasty (n = 41), and pulmonary artery sling with both intracardiac and tracheal surgery (n = 28). RESULTS There were 7 early (8.8%) deaths. Two patients after left pulmonary artery reimplantation needed revision of the anastomosis. The median intensive care and hospital stay were 11 (interquartile range 9.2-24.8) and 17.9 (interquartile range 4.3-19.8) days, and considerably longer when associated tracheal surgery (p = 0.002). Follow-up was complete in 66/69 and 3 (3.8%) children died late: 2.7, 10.2, and 17 months after surgery. Univariate analysis showed abnormal lung and coexisting structural heart disease as risk factors. Multivariate analysis revealed total cardiopulmonary bypass time as an independent predictor of overall mortality. CONCLUSION Complex pulmonary artery sling repair can be performed with a good surgical outcomes even when associated with airway malformations or structural heart diseases. Lung abnormality and longer cardiopulmonary bypass time as a surrogate marker of complex surgery, are possible risk factors.
Collapse
Affiliation(s)
- Nagarajan Muthialu
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - Thomas Martens
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - Meletios Kanakis
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - Laurynas Bezuska
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - Masakazu Nakao
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - Graham Derrick
- Department of Cardiology, Great Ormond Street Hospital, London, UK
| | - Jan Marek
- Department of Cardiology, Great Ormond Street Hospital, London, UK
| | | | - Martin Kostolny
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - Victor Tsang
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| |
Collapse
|
16
|
Ramaswamy M, Yeh YT, Varman R, McIntosh N, McIntyre D, Fedevych O, Khambadkone S, Kostolny M, Hewitt R, Muthialu N. Staging of Surgical Procedures in Comorbid Congenital Tracheal Stenosis and Congenital Cardiovascular Disease. Ann Thorac Surg 2020; 109:1889-1896. [DOI: 10.1016/j.athoracsur.2020.01.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 12/28/2019] [Accepted: 01/13/2020] [Indexed: 10/24/2022]
|
17
|
Naqvi N, Babu-Narayan SV, Krupickova S, Muthialu N, Maiya S, Chandershekar P, Cheang MH, Kostolny M, Tsang V, Marek J. Myocardial Function Following Repair of Anomalous Origin of Left Coronary Artery from the Pulmonary Artery in Children. J Am Soc Echocardiogr 2020; 33:622-630. [PMID: 32122741 DOI: 10.1016/j.echo.2019.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 11/22/2019] [Accepted: 12/19/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We aimed to assess the change in global and regional myocardial function before and after surgical revascularization and their added value when compared with conventional measures in children with anomalous left coronary artery from the pulmonary artery (ALCAPA). METHODS Advanced echocardiographic assessment was performed pre- and postoperatively in 22 children with ALCAPA (eight male; median surgery age, 0.4 years; interquartile range, 0.21-1.05) and 22 healthy controls. Measurements included global and segmental longitudinal, radial, and circumferential two-dimensional speckle-tracking strain and postsystolic index. RESULTS Global strains were lower in preoperative patients than in controls (longitudinal: -9% vs -21%; P < .001; circumferential: -11% vs -21%; P < .001; radial: 18% vs 60%; P < .001) and improved postoperatively when compared with preoperative findings (longitudinal: -9% pre vs -16% post; P = .002, circumferential:-11% pre vs -17% post; P = .012, radial: 18% pre vs 53% post; P = .001). Preoperatively, patients with normal global systolic function on conventional echocardiography had significantly impaired global longitudinal and radial strain compared with healthy controls. Global mechanical dyssynchrony improved significantly postoperatively (longitudinal postsystolic index 43 pre vs 6 post, P < .001; circumferential 15 pre vs 2 post, P = .001; radial 48 pre vs 5 post, P = .003). Despite overall improvement in most segments, global longitudinal and circumferential and segmental peak strain in some of the segments supplied by the ALCAPA remained postoperatively abnormal. CONCLUSIONS This study shows that myocardial deformation indices were a more sensitive measure of LV dysfunction in patients before and after ALCAPA repair than conventional echocardiographic measures. We believe, therefore, they should be added to routine preoperative and serial postoperative follow-up assessment.
Collapse
Affiliation(s)
- Nitha Naqvi
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Sonya V Babu-Narayan
- Department of Adult Congenital Heart Disease, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sylvia Krupickova
- Department of Adult Congenital Heart Disease, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Nagarajan Muthialu
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Shreesha Maiya
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Prathiba Chandershekar
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Mun Hong Cheang
- Institute of Cardiovascular Sciences University College London, London, United Kingdom
| | - Martin Kostolny
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Victor Tsang
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom; Institute of Cardiovascular Sciences University College London, London, United Kingdom
| | - Jan Marek
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom; Institute of Cardiovascular Sciences University College London, London, United Kingdom.
| |
Collapse
|
18
|
Protopapas EM, Anderson RH, Backer CL, Fragata J, Hakim N, Vida VL, Sarris GE, Barron DJ, Berggren H, Hazekamp MG, Ilyin V, Kornoukhov OJ, Kostolny M, Lazarov S, Lo Rito M, Monge MC, Mykychak Y, Nosal M, Prêtre R, Polimenakos AC, Sojak V, Stellin G, Veshti A, Yemets I. Surgical Management of Aorto-Ventricular Tunnel. A Multicenter Study. Semin Thorac Cardiovasc Surg 2020; 32:271-279. [DOI: 10.1053/j.semtcvs.2020.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/31/2020] [Indexed: 11/11/2022]
|
19
|
Affiliation(s)
- Elena Giulia Milano
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK (E.G.M., K.H.M., A.M.T., J.M.)
| | - Endrit Pajaziti
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
| | - Emilie Sauvage
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
| | - Andrew Cook
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
| | - Silvia Schievano
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
| | - Kristian H Mortensen
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK (E.G.M., K.H.M., A.M.T., J.M.)
| | - Andrew M Taylor
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK (E.G.M., K.H.M., A.M.T., J.M.)
| | - Jan Marek
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK (E.G.M., K.H.M., A.M.T., J.M.)
| | - Martin Kostolny
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK (M.K.)
- Slovak Medical University, Bratislava, Slovakia (M.K.)
| | - Claudio Capelli
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
| |
Collapse
|
20
|
Milano EG, Pajaziti E, Sauvage E, Taylor AM, Marek J, Mortensen K, Cook A, Schievano S, Kostolny M, Capelli C. P358Taking surgery out of reality: a repair of double outlet right ventricle planned by means of virtual reality. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez109.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E G Milano
- University College London, Institute of Cardiovascular Science, LONDON, United Kingdom of Great Britain & Northern Ireland
| | - E Pajaziti
- University College London, Institute of Cardiovascular Science, LONDON, United Kingdom of Great Britain & Northern Ireland
| | - E Sauvage
- University College London, Institute of Cardiovascular Science, LONDON, United Kingdom of Great Britain & Northern Ireland
| | - A M Taylor
- University College London, Institute of Cardiovascular Science, LONDON, United Kingdom of Great Britain & Northern Ireland
| | - J Marek
- Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain & Northern Ireland
| | - K Mortensen
- Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain & Northern Ireland
| | - A Cook
- University College London, Institute of Cardiovascular Science, LONDON, United Kingdom of Great Britain & Northern Ireland
| | - S Schievano
- University College London, Institute of Cardiovascular Science, LONDON, United Kingdom of Great Britain & Northern Ireland
| | - M Kostolny
- Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain & Northern Ireland
| | - C Capelli
- University College London, Institute of Cardiovascular Science, LONDON, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
21
|
Redondo A, Davies B, Jones R, O’Callaghan M, Kostolny M. Durable mechanical circulatory support in paediatric heart failure: The experience at Great Ormond Street Hospital. Cirugía Cardiovascular 2019. [DOI: 10.1016/j.circv.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
22
|
Kostolny M, Kanakis M, Hsia TY. Anomalous origin of both the right and left coronary arteries: a singular anomaly†. Interact Cardiovasc Thorac Surg 2019; 28:640-641. [PMID: 30376066 DOI: 10.1093/icvts/ivy301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/21/2018] [Accepted: 09/29/2018] [Indexed: 11/14/2022] Open
Abstract
Herein, the case of an 8-year-old male child diagnosed with an extremely rare anatomical presentation of a single origin of both the left and right coronary arteries from the non-coronary sinus is presented. The surgical management is also described.
Collapse
Affiliation(s)
- Martin Kostolny
- Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, UK.,Slovak Medical University in Bratislava, Bratislava, Slovakia
| | - Meletios Kanakis
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Tain-Yen Hsia
- Pediatric Cardiac Surgery, Yale New Haven Children's Hospital, New Haven, CT, USA
| |
Collapse
|
23
|
Martens T, Kostolny M, Spencer H, Muthialu N. Technical challenges of lung transplantation in children after arterial switch operation. Interact Cardiovasc Thorac Surg 2019; 28:493-495. [PMID: 30107403 DOI: 10.1093/icvts/ivy253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/10/2018] [Accepted: 07/16/2018] [Indexed: 11/12/2022] Open
Abstract
Pulmonary arterial hypertension after arterial switch operation for transposition of the great arteries is rare. Lung transplantation can be the last option in cases of failed medical therapy. We report 2 paediatric patients who underwent lung transplantation for this indication. Altered hilar anatomy, mediastinal adhesions and haemostatic control represent the main technical challenges. Volume-reduction surgery is sometimes necessary to address altered cardiopulmonary relationships while expanding the donor pool.
Collapse
Affiliation(s)
- Thomas Martens
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - Martin Kostolny
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Slovak Medical University, Bratislava, Slovakia
| | - Helen Spencer
- Department of Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nagarajan Muthialu
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
24
|
Kanakis M, Kostolny M. Intracommissural and Intramural Left Coronary Artery in a Neonate With Common Arterial Trunk. World J Pediatr Congenit Heart Surg 2019; 10:101-102. [PMID: 30799712 DOI: 10.1177/2150135118800886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Meletios Kanakis
- 1 Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Martin Kostolny
- 1 Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, United Kingdom.,2 Slovak Medical University, Bratislava, Slovakia
| |
Collapse
|
25
|
Kanakis M, Muthialu N, Kostolny M. Staged surgery for an unusual combination of cardiac and tracheal anomalies. Interact Cardiovasc Thorac Surg 2018; 27:465-466. [PMID: 29579197 DOI: 10.1093/icvts/ivy088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/25/2018] [Indexed: 11/13/2022] Open
Abstract
Herein, the case of an infant initially diagnosed with left pulmonary artery sling, ventricular septal defect and a small atrial septal defect is described. Further diagnostic work-up revealed tracheobronchial anomalies and the presence of an anomalous origin of the left coronary artery from the pulmonary artery. The staged surgical management is described.
Collapse
Affiliation(s)
- Meletios Kanakis
- Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, UK
| | - Nagarajan Muthialu
- Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, UK
| | - Martin Kostolny
- Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, UK.,Slovak Medical University in Bratislava, Bratislava, Slovakia
| |
Collapse
|
26
|
Kalfa D, Belli E, Bacha E, Lambert V, di Carlo D, Kostolny M, Nosal M, Horer J, Salminen J, Rubay J, Yemets I, Hazekamp M, Maruszewski B, Sarris G, Berggren H, Ebels T, Baser O, Lacour-Gayet F. Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era. J Thorac Cardiovasc Surg 2018; 156:278-286. [DOI: 10.1016/j.jtcvs.2018.02.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 02/07/2018] [Accepted: 02/15/2018] [Indexed: 10/18/2022]
|
27
|
Kostolny M, Malik T, Bonello B. Infective Endocarditis Associated With Varicella Zoster Virus Following Aortic Valve Repair. World J Pediatr Congenit Heart Surg 2018; 11:NP148-NP150. [DOI: 10.1177/2150135118769322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe the management and clinical course of two children with congenital bicuspid aortic valve. Neo-tricuspidization was performed in one case using CardioCel leaflets and two cusps were formed from CardioCel and grafted alongside one native leaflet in the other. Both patients developed bacterial endocarditis associated with varicella zoster virus infection and required a second surgical procedure.
Collapse
Affiliation(s)
- Martin Kostolny
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
- Slovak Medical University, Bratislava, Slovakia
| | - Tom Malik
- The Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Beatrice Bonello
- Derpartment of Cardiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
28
|
Bailey FJ, Jivanji SGM, Kostolny M. Postoperative interventricular septal haematoma following tetralogy of Fallot repair and perimembranous ventricular septal defect repair. Interact Cardiovasc Thorac Surg 2017; 24:296-298. [PMID: 28364481 DOI: 10.1093/icvts/ivw337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/29/2016] [Indexed: 11/13/2022] Open
Abstract
Interventricular septal haematoma is a rare postoperative complication in congenital heart surgery. We present one case of a 6-month-old after tetralogy of Fallot repair and 1 case of a 10-month-old after ventricular septal defect repair. Both were noted to have interventricular septal haematoma on intraoperative transoesophageal and postoperative echocardiogram. Although multiple previous reports, mainly in adults, have suggested aggressive intervention, both these cases were managed conservatively, highlighting the management and evolution of a rare postoperative complication in the paediatric population.
Collapse
Affiliation(s)
- Fiona J Bailey
- Cardiac Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Salim G M Jivanji
- Cardiac Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Martin Kostolny
- Cardiac Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Cardiac Unit, The Harley Street Clinic, Congenital Heart Centre, London, UK
| |
Collapse
|
29
|
Padalino MA, Frigo AC, Comisso M, Kostolny M, Omeje I, Schreiber C, Pabst von Ohain J, Cleuziou J, Barron DJ, Meyns B, Hraska V, Maruszewski B, Kozlowski M, Vricella LA, Hibino N, Collica S, Berggren H, Synnergren M, Lazarov S, Kalfa D, Bacha E, Pizarro C, Hazekamp M, Sojak V, Jacobs JP, Nosal M, Fragata J, Cicek S, Sarris GE, Zografos P, Vida VL, Stellin G. Early and late outcomes after surgical repair of congenital supravalvular aortic stenosis: a European Congenital Heart Surgeons Association multicentric study†. Eur J Cardiothorac Surg 2017; 52:789-797. [DOI: 10.1093/ejcts/ezx245] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 05/29/2017] [Indexed: 11/12/2022] Open
|
30
|
Vida VL, Zanotto L, Zanotto L, Stellin G, Padalino M, Sarris G, Protopapas E, Prospero C, Pizarro C, Woodford E, Tlaskal T, Berggren H, Kostolny M, Omeje I, Asfour B, Kadner A, Carrel T, Schoof PH, Nosal M, Fragata J, Kozłowski M, Maruszewski B, Vricella LA, Cameron DE, Sojak V, Hazekamp M, Salminen J, Mattila IP, Cleuziou J, Myers PO, Hraska V. Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study. Ann Thorac Surg 2017; 104:899-906. [PMID: 28709661 DOI: 10.1016/j.athoracsur.2017.04.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/21/2017] [Accepted: 04/04/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND We sought to report the frequency, types, and outcomes of left-sided reoperations (LSRs) after an arterial switch operation (ASO) for patients with D-transposition of the great arteries (D-TGA) and double-outlet right ventricle (DORV) TGA-type. METHODS Seventeen centers belonging to the European Congenital Heart Surgeons Association (ECHSA) contributed to data collection. We included 111 patients who underwent LSRs after 7,951 ASOs (1.4%) between January 1975 and December 2010. Original diagnoses included D-TGA (n = 99) and DORV TGA-type (n = 12). Main indications for LSR were neoaortic valve insufficiency (n = 52 [47%]) and coronary artery problems (CAPs) (n = 21 [19%]). RESULTS Median age at reoperation was 8.2 years (interquartile range [IQR], 2.9-14 years). Seven patients died early after LSRs (6.3%); 4 patients with D-TGA (5.9%) and 3 patients with DORV TGA-type (25%) (p = 0.02). Median age at last follow-up was 16.1 years (IQR, 9.9-21.8 years). Seventeen patients (16%) required another reoperation, which was more frequent in patients with DORV- TGA type (4 of 9 [45%]) than in patients with D-TGA (13 of 95 [14%]). Late death occurred in 4 patients (4 of 104 [3.8%]). The majority of survivors were asymptomatic at last clinical examination (84 of 100 [84%]). CONCLUSIONS Reoperations for residual LSRs are infrequent but may become necessary late after an ASO, predominantly for neoaortic valve insufficiency and CAPs. Risk at reoperation is not negligible, and DORV TGA-type anatomy, as well as procedures on the coronary arteries, were significantly associated with a higher morbidity and a lower overall survival. Recurrent reoperations after LSRs may be required.
Collapse
Affiliation(s)
- Vladimiro L Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Lorenza Zanotto
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Lucia Zanotto
- Department of Statistical Sciences, University of Padua, Padua, Italy
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy.
| | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Georges Sarris
- Athens Heart Surgery Institute and Department of Pediatric and Congenital Cardiac Surgery, Iaso Children's Hospital, Athens, Greece
| | - Eleftherios Protopapas
- Athens Heart Surgery Institute and Department of Pediatric and Congenital Cardiac Surgery, Iaso Children's Hospital, Athens, Greece
| | - Carol Prospero
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Christian Pizarro
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Edward Woodford
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Thomas Tlaskal
- Children's Heart Centre, University Hospital Motol, Prague, Czech Republic
| | - Hakan Berggren
- Department of Molecular and Clinical Medicine, Children's Heart Center, The Queen Silvia's Children's Hospital, Göteborg, Sweden
| | - Martin Kostolny
- Great Ormond Street Hospital, Cardiothoracic Unit, London, UK
| | - Ikenna Omeje
- Great Ormond Street Hospital, Cardiothoracic Unit, London, UK
| | - Boulos Asfour
- Herma Heart Center, Medical College of Wisconsin, Wisconsin, USA
| | - Alexander Kadner
- Department for Cardiovascular Surgery, University of Bern, Bern, Switzerland
| | - Thierry Carrel
- Department for Cardiovascular Surgery, University of Bern, Bern, Switzerland
| | - Paul H Schoof
- University Medical Center Utrecht, Utrecht, Netherlands
| | - Matej Nosal
- Childrens Heart Centre Slovak Republic, Bratislava, Slovakia
| | - Josè Fragata
- Department of Cardiothoracic Surgery, Hospital de Santa Marta and Nova Medical School, Lisbon, Portugal
| | | | | | - Luca A Vricella
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, USA
| | - Duke E Cameron
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, USA
| | - Vladimir Sojak
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Mark Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Jukka Salminen
- Division of Pediatric Surgery, Department of Children and Adolescents, Helsinki University Hospital, Helsinki, Finland
| | - Ilkka P Mattila
- Division of Pediatric Surgery, Department of Children and Adolescents, Helsinki University Hospital, Helsinki, Finland
| | - Julie Cleuziou
- Department of Cardiovascular Surgery, German Heart Center Munich Technische Universität München, Munich, Germany
| | - Patrick O Myers
- Divison of cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Viktor Hraska
- Herma Heart Center, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
31
|
Kalfa D, Belli E, Bacha E, Lambert V, di Carlo D, Kostolny M, Salminen J, Nosal M, Poncelet A, Horer J, Berggren H, Yemets I, Hazekamp M, Maruszewski B, Sarris G, Pozzi M, Ebels T, Lacour-Gayet F. Primary Pulmonary Vein Stenosis: Outcomes, Risk Factors, and Severity Score in a Multicentric Study. Ann Thorac Surg 2017. [DOI: 10.1016/j.athoracsur.2017.03.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
32
|
Tran PK, Tsang VT, Cornejo PR, Torii R, Dominguez T, Tran-Lundmark K, Hsia TY, Hughes M, Muthialu N, Kostolny M. Midterm results of the Ross procedure in children: an appraisal of the subannular implantation with interrupted sutures technique†. Eur J Cardiothorac Surg 2017; 52:798-804. [DOI: 10.1093/ejcts/ezx113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/26/2017] [Indexed: 12/30/2022] Open
|
33
|
Bonello B, Carr M, Iriart X, Derrick G, Christov G, Kostolny M, Marek J. Long-term functional and myocardial assessment in patients with critical aortic valve stenosis. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30331-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
34
|
Mas-Stachurska A, Slieker MG, Rosner A, Bonello B, Cieplucha A, Almeida Morais L, Morillas Climent H, Nogueira MA, Guasch E, Sitges M, Batlle M, Meirelles T, Castillo N, Rudenick P, Bijnens B, Egea G, Meza JM, Mccrindle BW, Karamlou T, Tchervenkov CI, Jacobs ML, Decampli WM, Burch PT, Mertens L, Khalapyan T, Dalen H, Mc Elhinney D, Chen S, Haeffele C, Fernandes S, Bijnens B, Friedberg M, Lui GK, Carr M, Iriart X, Ciliberti P, Christov G, Sullivan I, Derrick G, Kostolny M, Tsang V, Bull C, Giardini A, Marek J, Trojnarska O, Pyda M, Kociemba A, Lanocha M, Barczynski M, Kramer L, Grajek S, Abreu A, Agapito A, De Sousa L, Oliveira JA, Viveiros Monteiro A, Modas Daniel P, Antonio M, Jalles Tavares N, Cruz-Ferreira R, Osa Saez A, Cano Perez O, Domingo Valero D, Igual Munoz B, Martinez-Dolz L, Serrano Martinez F, Montero Argudo A, Plaza Lopez D, Rueda Soriano J, Branco LM, Timoteo AT, Oliveira M, Agapito A, Portugal G, Sousa L, Oliveira JA, Cruz Ferreira R. Rapid Fire Abstract: Congenital heart disease470Impact of training on aortic and cardiac remodelling in a murine model of Marfan syndrome: an echocardiographic study471Pre-intervention morphologic and functional echocardiographic characteristics of 651 neonates with critical left ventricular outflow tract obstruction472Ventricular geometry and function in adult patients with Fontan surgery473Long term functional and myocardial assessment of patients with critical aortic valve stenosis474Late gadolinium enhancement and exercise capacity in adults with Ebstein's anomaly475Exercise echocardiography value in the evaluation of operated aortic coarctation patients476Functional evolution of the right ventricle after pulmonary valve replacement due to significant regurgitation. Implications in the surgical moment decision477Independent predictors of arrhythmias in adult patients with surgically corrected tetralogy of fallot: role of two-dimensional and speckle-tracking echocardiography. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
35
|
Kostolny M, Omeje I. Single-stage repair of Taussig-Bing anomaly and interrupted aortic arch-type A. Multimed Man Cardiothorac Surg 2016; 2016:mmw012. [PMID: 27422582 DOI: 10.1093/mmcts/mmw012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/21/2016] [Indexed: 11/14/2022]
Abstract
The surgical repair of Taussig-Bing anomaly and associated lesions has evolved over the years from palliative procedures to complete repairs-either in two stages or in one single stage. We present a video illustrating our preferred surgical option in the treatment of Taussig-Bing anomaly, in this case, with an associated type A interrupted aortic arch.
Collapse
Affiliation(s)
- Martin Kostolny
- Cardiothoracic Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Ikenna Omeje
- Cardiothoracic Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| |
Collapse
|
36
|
Mimic B, Tsang V, Owens CM, Thiruchelvam T, Kostolny M. An unusual case of left bronchial compression caused by a large patent arterial duct in a child with pulmonary atresia with ventricular septal defect. Eur Heart J Cardiovasc Imaging 2016; 17:480. [DOI: 10.1093/ehjci/jev347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
37
|
Jensen HA, Ntsinjana HN, Bull C, Brown K, Taylor AM, Kostolny M, Dominguez T, de Leval M, Tsang VT. Performance monitoring of the arterial switch operation: a moving target. Eur J Cardiothorac Surg 2015; 48:716-23. [DOI: 10.1093/ejcts/ezv003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/27/2014] [Indexed: 11/14/2022] Open
|
38
|
Abstract
In this document, we include under the heading of univentricular heart, complex cardiac malformations which have in common the presence of a functionally single ventricle. The evolution of the surgical management of univentricular hearts is discussed along with the indications, selection criteria, and operative approaches for staged palliation. Herein, we describe our technique for bidirectional cavopulmonary anastomosis and total cavopulmonary connection using an extracardiac conduit.
Collapse
Affiliation(s)
- Mahesh S Sharma
- Cardiothoracic Unit, Great Ormond Street Hospital for Children, London WC1N 3JH, UK
| | | | | | | |
Collapse
|
39
|
Abstract
The objective of the feasibility study was to gain European clinical experiences with REPEL-CV for reducing postoperative adhesions in pediatric patients undergoing cardiovascular surgery. The pediatric patient population included patients requiring staged cardiovascular sternotomy procedures where it was anticipated that the second sternotomy procedure would be performed 2-8 months subsequent to the initial procedure. At the time of the second sternotomy procedure, 13 out of 15 (86.7%) patients had no Grade 3 ('severe') adhesions. The mean percentage of the investigational surgical site with severe adhesions was 11%. There were five serious adverse events. All were anticipated (identified in the protocol and the investigator's brochure) and were considered by the investigators to be 'definitely not related' to the study device. Based on the incidence and extent of 'severe' adhesions and the safety profile for REPEL-CV as demonstrated in this study, the effectiveness and safety of REPEL-CV have been further demonstrated.
Collapse
Affiliation(s)
- Christian Schreiber
- German Heart Center Munich, Department for Cardiothoracic Surgery, Lazarettstrasse 36, 80636 Munich, Germany.
| | | | | | | | | | | | | |
Collapse
|
40
|
Gomide M, Furci B, Mimic B, Brown KL, Hsia TY, Yates R, Kostolny M, de Leval MR, Tsang VT. Rapid 2-stage Norwood I for high-risk hypoplastic left heart syndrome and variants. J Thorac Cardiovasc Surg 2014; 146:1146-51; discussion 1151-2. [PMID: 24128902 DOI: 10.1016/j.jtcvs.2013.01.051] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 12/10/2012] [Accepted: 01/11/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Preoperative comorbidities (PCMs) are known risk factors for Norwood stage I (NW1). We tested the hypothesis that short-term bilateral pulmonary arterial banding (bPAB) before NW1 could improve the prognosis of these high-risk patients. METHODS From January 2006 to October 2011, 17 high-risk patients with hypoplastic left heart syndrome (defined as having ≥4 of the following PCMs: prolonged mechanical ventilation; older age; sepsis; necrotizing enterocolitis; hepatic, renal, or heart failure; coagulopathy; pulmonary edema; high inotropic requirements; anasarca; weight <2.5 kg; and cardiac arrest) were identified. In addition to conventional treatment of PCMs, they underwent bPAB before NW1. bPAB was undertaken with Silastic slings and secured with ligaclips to a luminal diameter of approximately 3.5 to 4.0 mm. The patency of the ductus arteriosus was maintained with prostaglandin. NW1 was performed using a modified, right Blalock-Taussig shunt at a median interval of 8 days after bPAB. The data from these patients were retrospectively reviewed, and the 30-day mortality and 1-year survival were compared with the hypoplastic left heart syndrome population who underwent primary NW1 with <3 PCMs in the same period. RESULTS Of the bPAB patients, 5 (29.4%) died before NW1. All had ≥5 PCMs. Twelve patients (70.6%) survived to undergo NW1. One early death occurred after NW1 (8.3%). The 1-year survival rate for high-risk patients who underwent NW1 was 66.7%. The early mortality and 1-year survival for the 130 patients with <3 PCMs was 10% and 80%, respectively. CONCLUSIONS Optimizing the balance between the pulmonary and systemic blood flow with a short period of bPAB and ductal patency can improve the perioperative conditions of high-risk patients before NW1. Those who survived bPAB and underwent NW1 had early mortality and 1-year survival comparable to the standard risk category, despite the severity of their initial condition. A rapid 2-stage NW1 strategy with bPAB and prostaglandin to maintain ductal patency can avoid the risks of suboptimal palliation and vascular injuries associated with hybrid procedures.
Collapse
Affiliation(s)
- Marcello Gomide
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Jensen H, Muthialu N, Furci B, Yates R, Kostolny M, Tsang V. Direct implantation of scimitar vein to the left atrium via sternotomy: a reappraisal. Eur J Cardiothorac Surg 2013; 45:1066-9. [DOI: 10.1093/ejcts/ezt540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
42
|
Tuo G, Khambadkone S, Tann O, Kostolny M, Derrick G, Tsang V, Sullivan I, Marek J. Obstructive left heart disease in neonates with a "borderline" left ventricle: diagnostic challenges to choosing the best outcome. Pediatr Cardiol 2013; 34:1567-76. [PMID: 23479308 DOI: 10.1007/s00246-013-0685-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 02/21/2013] [Indexed: 10/27/2022]
Abstract
In most newborns with left heart obstruction, the choice between a single-ventricle or biventricular management pathway is clear. However, in some neonates with a "borderline" left ventricle, this decision is difficult. Existing criteria do not reliably identify neonates who will have a good long-term outlook after biventricular repair (BVR). The objective of this study was prospective assessment of the outcome after BVR for newborns in whom the left ventricle (LV) was considered "borderline" by an expert group. This study was a prospective follow-up evaluation of neonates with obstructive left heart disease related to a "borderline" LV who underwent biventricular management between January 2005 and April 2011. Of 154 neonates who required intervention for left heart obstruction, 13 (7.8 %) met the echocardiographic (echo) inclusion criteria. At the first and last echo, the z-scores were respectively -1.76 ± 1.37 and -0.66 ± 1.47 (p = 0.013) for the mitral valve, -1.02 ± 1.57 and -0.23 ± 1.78 (p = 0.056) for the aortic valve, and 13.77 ± 5.8 and 20.85 ± 8.9 ml/m(2) (p = 0.006) for the LV end-diastolic volume. At this writing, all 12 survivors are clinically well. However, LV diastolic dysfunction and pulmonary artery hypertension was present in 5 (36 %) of 12 patients. Endocardial fibroelastosis (EFE) was detected in five patients at the last follow-up echo, but only in two patients preoperatively. Cardiac magnetic resonance imaging did not confirm EFE in any of assessed patients. The study authors could not reliably predict the outcome after BVR for neonates with left heart obstruction and a "borderline" LV. The presence of EFE with consequent diastolic dysfunction is more important than LV volume in determining the outcome. Prospective identification of EFE remains challenging.
Collapse
Affiliation(s)
- Giulia Tuo
- Cardiothoracic Unit, Great Ormond Street Hospital for Children, WC1N 3JH, London, UK,
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Vida VL, Torregrossa G, De Franceschi M, Padalino MA, Belli E, Berggren H, Çiçek S, Ebels T, Fragata J, Hoel TN, Horer J, Hraska V, Kostolny M, Lindberg H, Mueller C, Pretre R, Rosser B, Rubay J, Schreiber C, Speggiorin S, Tlaskal T, Stellin G. Pediatric Coronary Artery Revascularization: A European Multicenter Study. Ann Thorac Surg 2013; 96:898-903. [DOI: 10.1016/j.athoracsur.2013.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 04/26/2013] [Accepted: 05/02/2013] [Indexed: 10/26/2022]
|
44
|
Mimic B, Brown KL, Oswal N, Simmonds J, Hsia TY, Tsang VT, De Leval MR, Kostolny M. Neither age at repair nor previous palliation affects outcome in tetralogy of Fallot repair. Eur J Cardiothorac Surg 2013; 45:92-8; discussion 99. [DOI: 10.1093/ejcts/ezt307] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
|
45
|
Murtuza B, Fenton M, Burch M, Gupta A, Muthialu N, Elliott MJ, Hsia TY, Tsang VT, Kostolny M. Pediatric heart transplantation for congenital and restrictive cardiomyopathy. Ann Thorac Surg 2013; 95:1675-84. [PMID: 23561807 DOI: 10.1016/j.athoracsur.2013.01.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 01/06/2013] [Accepted: 01/08/2013] [Indexed: 01/15/2023]
Abstract
BACKGROUND Recent reports suggest worse outcomes in pediatric orthotopic heart transplantation (OHT) for congenital heart disease (CHD) and restrictive cardiomyopathy (RCM). We examined early outcomes in these diverse groups of patients in comparison with patients with dilatated cardiomyopathy (DCM). METHODS From 2000 to 2011, 209 patients were included: 50 with CHD, 23 with RCM, and 136 with DCM. Early survival was studied, as was the occurrence of acute rejection, donor-specific antibodies (DSAs) and nondonor-specific antibodies (NSDAs), incidence of pulmonary hypertension (PHT), right ventricular failure (RVF), and the need for mechanical circulatory support (MCS). RESULTS The incidence of preoperative PHT was greatest in the RCM group (χ(2)p = 0.0006); the requirement for mechanical support before OHT was greatest in patients with DCM. Thirty-day survival was 92.0%, 97.1%, and 100% for patients with CHD, DCM, and RCM respectively. The incidence of RVF was highest for patients with RCM (43.5%; versus CHD, 26.0%; versus DCM, 14.7%). One-year survival estimates for patients with CHD, DCM, and RCM were 92.0%, 97.8%, and 82.6%, respectively (log-rank p = 0.165). Multivariable analysis revealed 4 significant risk factors for mortality: age, incidence of acute rejection, preoperative PHT, and the presence of NDSAs. The occurrence of DSAs was similar, although there was a significantly higher incidence of NDSAs in the CHD and RCM groups (36.0% and 30.4%, respectively, versus 14.0% in the DCM group; χ(2)p = 0.0024). CONCLUSIONS Equivalent outcomes are achievable in pediatric OHT despite marked heterogeneity in anatomic and physiologic complexity in recipients. Physiologic factors such as PHT are likely to be more important than anatomic complexities in determining survival. The potential relevance of NDSAs warrants further investigation.
Collapse
Affiliation(s)
- Bari Murtuza
- Department of Cardiac Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Ciliberti P, Muthialu N, Tann O, Kostolny M, Marek J. Multimodality imaging of a rare complex vascular ring in an infant: left pulmonary sling associated with aorto-pulmonary window, aberrant right subclavian artery, and with complete tracheal rings. J Am Coll Cardiol 2012; 60:e165. [PMID: 23257306 DOI: 10.1016/j.jacc.2012.05.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 05/25/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Paolo Ciliberti
- Cardiothoracic Unit, Great Ormond Street Hospital, London, United Kingdom
| | | | | | | | | |
Collapse
|
47
|
Atamanyuk I, Raja SG, Kostolny M. Bartonella henselae endocarditis of percutaneously implanted pulmonary valve. J Heart Valve Dis 2012; 21:682-685. [PMID: 23167236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Percutaneous pulmonary valve implantation (PPVI) has revolutionized the management of right ventricular outflow tract dysfunction after repaired congenital heart disease. Although the technology is considered to be safe with a relatively low complication rate, infection is a described complication, with five cases of culture-positive infective endocarditis of percutaneously implanted pulmonary valve having been reported to date worldwide. Herein is reported the first ever case of culture-negative endocarditis following PPVI, caused by Bartonella henselae, diagnosed five years after implantation in a 15-year-old patient with a repaired truncus arteriosus.
Collapse
Affiliation(s)
- Iryna Atamanyuk
- Department of Paediatric Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | | | | |
Collapse
|
48
|
Murtuza B, Dedieu N, Vazquez A, Fenton M, Burch M, Hsia TY, Tsang VT, Kostolny M. Results of orthotopic heart transplantation for failed palliation of hypoplastic left heart†. Eur J Cardiothorac Surg 2012; 43:597-603. [DOI: 10.1093/ejcts/ezs326] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
49
|
Muthialu N, Kostolny M, Rees PG. Phrenic Nerve at Greater Risk: Congenital Absence of Pericardium Exposing the Nerve. Ann Thorac Surg 2012; 94:e27. [DOI: 10.1016/j.athoracsur.2012.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 12/15/2011] [Accepted: 01/04/2012] [Indexed: 11/25/2022]
|
50
|
Ibrahim M, Kostolny M, Hsia TY, Van Doorn C, Walker F, Cullen S, Yacoub MH, Tsang VT. The Surgical History, Management, and Outcomes of Subaortic Stenosis in Adults. Ann Thorac Surg 2012; 93:1128-33. [DOI: 10.1016/j.athoracsur.2011.12.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 12/22/2011] [Accepted: 12/28/2011] [Indexed: 10/28/2022]
|