CHD Surgery Featured Articles of September 2015

1. Homograft reconstruction of the right ventricular outflow tract in adults with congenital heart disease: a systematic review.

Skoglund K, Eriksson P, Svensson G, Dellborg M.

Interact Cardiovasc Thorac Surg. 2015 Sep 27. pii: ivv264. [Epub ahead of print]

PMID: 26415536 Free Article

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abdulgani picComment from Dr. Hafil B. Abdulgani (Indonesia), section editor of Congenital Heart Surgery Journal Watch: The aim of this study is to report outcomes after surgical RVOT reconstruction with a homograft in adult patients with congenital heart disease. It is to make qualified and accurate decisions, event-free survival, perioperative mortality and morbidity and risk factors for homograft dysfunction in adult patients. The PubMed database was search with the terms ‘homograft AND pulmonary valve’, generating 665 hits. It included only studies involving more than 50 patients with a mean or median age >18 years. Six studies with a cumulative total of 560 patients were included. The study population included adult patients with congenital heart disease undergoing RVOT reconstruction with a homograft. The outcome measure was event-free survival, defined as freedom from mortality, reoperations and percutaneous interventions, as stated in each study. Perioperative or short-term mortality (<30 days) and long-term mortality were recorded. Morbidity, length of hospital stay, functional status and health-related quality of life were also included in the analysis, as well as data from echocardiography and magnetic resonance imaging (MRI). All systematic reviews and observational studies with over 50 patients and a mean or median age of at least 18 years at surgical procedure (either first homograft or reoperation) were considered eligible. No limitation regarding publication year was set, and only studies published in English or the Scandinavian languages were included. The long-term mortality rate was 2–8.8% at 8.1–10 years. Reintervention was common during patients’ life spans, with a 10-year event-free survival rate of 78–80%. Early postoperative echocardiographic or magnetic resonance imaging defects appear to predict rapid homograft degeneration. Further studies on various malformations and risk markers for degeneration are needed to make qualified and accurate decisions regarding lifetime management.

Figure 1:

Identification of studies included in the systematic review.

surg 1.1

 Table 1:

Overview of included articles

Publication author, year Diagnosis (n) Mean/median follow-up Mean age at operation
Hazekamp, 2001a TOF (51) Mean 1.7 ± 1.4 years 25.7 ± 11.9 years
Oosterhof, 2006 TOF (158) Median 4.2 years ‘Adult’
Troost, 2007 TOF (68) Median 8.4 years 24 years
Nordmeyer, 2009 Mixed (60) Mean 40 ± 10 months 21 ± 10 years
Scherptong, 2010a TOF (90) Mean 5.5 ± 3.5 years 31.4 ± 10.3 years
van de Woestijne, 2011 TOF (133) Mean 8.1 ± 5.6 years 28.1 ± 12.2 years

Mixed refers to various malformations involving the right ventricular outflow tract.

TOF: tetralogy of Fallot.

aHazekamp and Scherptong studied patients with pulmonary regurgitation only.

Table 2:

Type of homograft, diameter and method of preservation in the included articles

Publication author, year Type of homograft Mean diameter (mm) Method of preservation
Hazekamp, 2001 49 Pulm, 2 Ao 25 ± 1.8 Cryopreserved
Oosterhof, 2006 167 Pulm, 8 Ao 25 ± 2.1
Troost, 2007 65 Pulm, 3 Ao 24, range 18–29 Cryopreserved
Nordmeyer, 2009 22 ± 2 Cryopreserved
Scherptong, 2010 Pulm 25.6 ± 1.6 Cryopreserved
van de Woestijne, 2011 24 ± 2, range 14–28 Cryopreserved 130/133

Method of preservation was not stated in Oosterhof’s study.

Pulm: pulmonary homograft; Ao: aortic homograft.

Table 3:

Outcome data from the included studies

Publication author, year (n) Early mortality Late mortality Event-free survival
Hazekamp, 2001 (51) 2% 4% at 1.7 years
Oosterhof, 2006 (158) 2% at 5.1 years 88% at 5 years, 78% at 10 years, 68% at 15 years
Troost, 2007 (68) 2.9% 8.8% at 8.4 years 92% at 5 years, 79% at 10 years, 69% at 15 years
Nordmeyer, 2009 (60) 0% 0% at 3.3 years 95% at 3.3 years
Scherptong, 2010 (90) 0% 2% at 5.5 years 89% at 5 years, 78% at 10 years
van de Woestijne, 2011 (133) 1.5% 8% at 8.1 years 80% at 10 years, 67% at 15 years
  • Early mortality is defined as in-hospital or 30-day mortality. Event-free survival is defined as survival with freedom from reoperation or reintervention, as stated in the articles.

Take home points:

  1. Pregnancy after surgery was found to have no increased risk of homograft failure.
  2. Postoperative severe QRS prolongation (>180 ms) and absence of reduction in QRS after pulmonary valve replacement (PVR) were found to be a major determinant of adverse outcome up to 9 years after homograft surgery.
  3. Early mortality1.5-2.9%, late mortality 2% at 5 years; and, 9% at 8 years. Event free survival 90% at 5 years, 80% at 10 years, 69% at 15 years.
  4. Early postoperative high peak systolic gradient or PR in the homograft, demonstrated by echocardiography, could predict adverse events and accelerated degeneration. Asymmetrical geometry measured by MRI was associated with the development of valve incompetence.

 

2. Common arterial trunk: current implementation of the primary and staged repair strategies.

Sandrio S, Rüffer A, Purbojo A, Glöckler M, Dittrich S, Cesnjevar R.

Interact Cardiovasc Thorac Surg. 2015 Sep 10. pii: ivv261. [Epub ahead of print]

PMID: 26362626 Free Article

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Select item 26358473

Comment from Dr. Hafil B. Abdulgani (Indonesia), section editor of Congenital Heart Surgery Journal Watch: This is a retrospective analysis of a non-randomized uncontrolled patient population with a varying duration and intensity of follow-up. Only patients with common arterial trunk (CAT) were analysed in this series; patients presenting with hemitruncus, in which one PA branch arises from the aorta whereas the main PA with the other PA branch arises from the RV, were excluded. Although complete primary repair (PR) at 1–3 months postnatally represents the preferred strategy in straightforward CAT, a staged CAT repair was chosen in complex cases with poor preoperative status or coexisting interrupted aortic arch (IAA) that require surgery during neonatal period (within the first 28 days postnatally). Thus, two groups were formed according to the chosen treatment strategy: group PR and group SR. Staged CAT repair includes an initial aortic arch repair (AAR) and right ventricular-to-pulmonary artery (RV-PA) valveless conduit, followed by an intracardiac repair later in infancy (Fig. 1A–C).

Figure 1. Staged CAT repair.

surg 2.1

 

(A) CAT type A4 with IAA type A. (B) First-stage surgery: aortic arch repair AAR and RV-PA shunt (6 mm GoreTex valveless conduit). (C) Second-stage surgery: VSD closure and RV-PA valved conduit (12 mm Hancock® pulmonary conduit). CAT: common arterial trunk; IAA: interrupted aortic arch; AAR: aortic arch repair; RV-PA: right ventricular-to-pulmonary artery; VSD: ventricular septal defect.

Table 1. Patient demographics, procedural data and outcome

Case no. Sex Age (days) Weight (kg) Cardiac diagnosis Extracardiac abnormalities Surgery Postoperative hospital stay (days) Reoperation
Group PR
1 M 14 2.9 CAT-A1, dysplastic quadricuspid truncal valve with mild stenosis and regurgitation, PFO, right aortic arch, aberrant left subclavian artery DiGeorge syndrome, primary hypoparathyroidism, s/p ICH II°, bilateral intracranial ventriculomegaly Primary CAT repair with 14 mm Contegra valved RV-PA conduit 33 None
2 M 30 4.1 CAT-A2, dysplastic quadricuspid truncal valve with mild stenosis and regurgitation, moderate mitral valve regurgitation None Primary CAT repair with 12 mm Contegra valved RV-PA conduit 18 Truncal valve replacement (21 mm mechanical valved conduit)
3 M 30 3.8 CAT-A1, right aortic arch, multiple ASD II Epilepsy Primary CAT repair with 12 mm Contegra valved RV-PA conduit; delayed sternal closure 42 Pacemaker implantation, PA plasty, RV-PA conduit replacement
4 M 54 3.3 CAT-A1, right aortic arch, mild tricuspid valve regurgitation, PA hypertension None Primary CAT repair with 12 mm Contegra valved RV-PA conduit 14 None
5 F 39 3.3 CAT-A1, anteriorly malaligned outlet septum, ASD II, PDA None Primary CAT repair with 12 mm Contegra valved RV-PA conduit, septal myectomy; delayed sternal closure 18 RV-PA conduit replacement
6 M 34 3.7 CAT-A2, VSD, ASD II, right aortic arch, PA hypertension DiGeorge syndrome Primary CAT repair with 12 mm Contegra valved RV-PA conduit; delayed sternal closure 19 None
7 F 50 3.6 CAT-A1, bicuspid truncal valve, VSD, single coronary artery None Primary CAT repair with 12 mm Contegra valved RV-PA conduit 10 None
8 F 50 3.4 CAT-A1, moderate truncal valve regurgitation, VSD, PFO, mild TR, hypoplastic PA system None Primary CAT repair with 12 mm Contegra valved RV-PA conduit; delayed sternal closure 21 Truncal valve repair, PA plasty, RV-PA conduit replacement
9 M 19 3.6 CAT-A2, bicuspid truncal valve, VSD, ASD II, flow induced PA hypertension Sickle cell anaemia Primary CAT repair with 11 mm Labcor valved RV-PA conduit 11 None
10 F 46 3.9 CAT-A3, dysplastic quadricuspid truncal valve with moderate stenosis, VSD, right aortic arch, hypoplastic LPA arising from PDA, s/p LPA angioplasty Left lung hypoplasia Primary CAT repair with 10 mm Dacron valveless RV-PA conduit 20 Truncal valve replacement (16 mm aortic homograft), LPA plasty
11 F 91 4.3 CAT-A1, mesocardia, bicuspid truncal valve, VSD, ASD II, LPA hypoplasia, small MPA, supravalvar mitral ring, PA sling with tracheal stenosis, L-SVC Psychomotor retardation, muscular hypotonia, plagiocephalus, post-pyloric feeding due to recurrent aspiration and severe gastrooesophageal reflux Primary CAT repair with direct RV-PA anastomosis 167 Trachea slide plasty; redo trachea repair, RV-PA conduit placement, LPA plasty
12 F 34 2.9 CAT-A1, VSD None Primary CAT repair with 12 mm Hancock valved RV-PA conduit 16 None
13 M 30 4.0 CAT-A1, mild truncal valve regurgitation, right aortic arch, VSD, PFO Cleft palate, athymia Primary CAT repair with 10 mm Dacron valveless RV-PA conduit 17 Closure of residual VSD, RV-PA conduit replacement (12 mm Hancock)
Group SR
1 M 8 3.2 CAT-A4, IAA-A, dysplastic truncal valve, VSD, PFO, preoperative cardiogenic shock CHARGE syndrome, severe choanal stenosis, s/p omphalocele repair AAR, 6 mm Gore-Tex RV-PA shunt; delayed sternal closure 16 VSD closure, RV-PA conduit replacement (13 mm Matrix-P-Plus), LPA plasty
2 M 21 3.3 CAT-A1, bicuspid truncal valve, VSD, PFO, single coronary artery, aberrant right sub-clavian artery, truncus bicaroticus CHARGE syndrome, bilateral cleft lip and palate, bilateral hearing impairment, hydrocephalus, multiple cerebral dysgenesis, epilepsy, renal pelvis dilatation ARSA reimplantation, 6 mm Gore-Tex RV-PA shunt 38 Closure of VSD and PFO, RV-PA conduit replacement
3 M 7 2.8 CAT-A4, IAA-B, bicuspid truncal valve, mild truncal valve regurgitation, VSD, ASD II Premature birth AAR, 6 mm Gore-Tex RV-PA shunt; delayed sternal closure 23 Closure of VSD and ASD, truncal valve repair, RV-PA conduit replacement (12 mm Hancock)

Group PR: complete repair group; Group SR: staged repair group; M: male; F: female; CAT: common arterial trunk; IAA-A: interrupted aortic arch Type A; IAA-B: interrupted aortic arch Type B; VSD: ventricular septal defect; ASD: atrial septal defect; PFO: patent foramen ovale; PA: pulmonary artery; MPA: main pulmonary artery; LPA: left pulmonary artery; TR: tricuspid valve regurgitation; L-SVC: left superior vena cava; ICH: intracranial haemorrhage, RV-PA: right ventricle-to-pulmonary artery; AAR: aortic arch repair; ARSA: aberrant right subclavian artery; PDA: patent ductus arteriosus.

All neonates in group SR underwent initial surgery within the first 3 weeks of life. An SR strategy was chosen due to poor preoperative condition, the presence of IAA, where prolonged CPB time is expected for complete repair or both. Median age at initial surgery was 8 days (range: 7–21 days) in group SR and 34 days (range: 14–91 days) in group PR; the difference was statistically significant (P = 0.03). Mean Aristotle Comprehensive Complexity (ACC) score was 11 ± 0.6 (range: 11–13) in group PR and 18 ± 3.1 (range: 15–21) in group SR (P < 0.01).

In group PR, the RVOT was reconstructed with bovine jugular valve conduit (Contegra®, unsupported type; Medtronic, Inc., Minneapolis, MN, USA), stentless porcine valved pulmonary conduit (T07®, Labcor, Belo Horizonte, Brazil), and valveless Dacron tube, Hancock® porcine valved pulmonary conduit (Medtronic, Inc.). In 1 case, a direct RV-PA anastomosis was performed. In contrast, a GoreTex valveless conduit (W. L. Gore & Associates) was used for all cases in group SR. The sternum was electively left open after common arterial trunk (CAT) repair in both group. Subsequent delayed sternal closure was performed in the ICU at 1–11 postoperative days. In both groups, no postoperative extracorporeal life support was required. No postoperative pulmonary hypertensive crisis was observed in group SR. In group PR, postoperative pulmonary hypertensive crises requiring inhaled nitric oxide were observed in 23% cases. Follow-up was completed with a median duration of 3.6 years (range: 8 months to 11 years). There was neither early nor late mortality in both groups. 54% patients in group PR required reoperation for RV-PA conduit failure, truncal valve repair/replacement or both. Median interval to second surgery was 1 year (range: 5 months–8 years). RV-PA conduit replacement was necessary due to conduit stenosis, conduit regurgitation and RV dilatation after previous implantation of a valveless conduit. One valved conduit was secondarily implanted in a patient with free pulmonary regurgitation after direct RV-PA anastomosis at initial repair. Kaplan–Meier freedom from reoperation after 1, 2 and 8 years was 77 ± 12, 68 ± 13 and 20 ± 17% in group PR. Correspond to the staged strategy, all patients in group SR required reoperation to complete the anatomical correction (log-rank P < 0.01, Fig. 2A). In group SR however, there was no surgical reintervention of truncal valve, aortic arch or RV-PA conduit after the second stage procedure (Fig. 2B).

Figure 2. Kaplan–Meier analysis of time-related freedom from reoperation over follow-up period.

surg 2.2

 

(A) Freedom from reoperation after initial surgery; P < 0.01. (B) Freedom from reoperation after anatomical correction of CAT (after second stage surgery in group SR); P = 0.5. The numbers of patients still at risk of requiring reoperation as primary end-point are indicated. PR: primary repair; SR: staged repair; CAT: common arterial trunk.

Take home points

  1. In 23% of patients, a postoperative pulmonary hypertensive crisis occurred; it can be managed effectively with inhaled nitric oxide.
  2. Ventilation arrangement that kept arterial PaCO2 at about 30 mmHg, arterial PaO2 above 120 mmHg and arterial pH at 7.50 as well as controlled use of sedatives and muscle relaxants help to reduce the tendency for pulmonary vascular resistance to rise.
  3. Preventing pulmonary hypertensive episodes along with the availability of inhaled nitric oxide and iloprost has effectively reduced perioperative morbidity.
  4. A preoperative high pressure gradient across the truncal valve does not necessarily translate into significant stenosis
  5. Some degree of obstruction due to high blood flow across the truncal valve comprises both systemic and pulmonary flow. This increased amount of blood flow could be further exaggerated if truncal valve regurgitation is present.

 

3. Acquired Gerbode defect following endocarditis of the tricuspid valve: a case report and literature review.

Prifti E, Ademaj F, Baboci A, Demiraj A.

J Cardiothorac Surg. 2015 Sep 9;10(1):115. doi: 10.1186/s13019-015-0320-z.

PMID: 26353810 Free PMC Article

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Comment from Dr. Hafil B. Abdulgani (Indonesia), section editor of Congenital Heart Surgery Journal Watch: The Gerbode defect is a communication between the left ventricle and right atrium. It is usually congenital, but rarely is acquired, as a complication of endocarditis, myocardial infarction, trauma, or after previous cardiac surgery. This is a rare case of young woman, with endocarditis of the tricuspid valve and acquired Gerbode defect without previous cardiac surgery. She underwent successful surgical closure of the Gerbode defect and reconstruction of the septal leaflet of the tricuspid valve using an autologous pericardial patch.

Figure 1. A. Transesophageal echocardiography demonstrating the shunt between the left ventricle and right atrium. B. Transthoracic echocardiography demonstrating the vegetation inserted above the septal leaflet of the tricuspid valve. C. Cardiac magnetic resonance.

surg 3.1

 

Figure 2. A. Intraoperative view demonstrating the acquired Gerbode defect after removing the septal leaflet and part of the anterior leaflet of the tricuspid valve. B. A diagram representing the extension of the destructed valvular tissue. C. Hydraulic maneuver.

surg 3.2


Table 1. Patients with acquired Gerbode defect without prior cardiac surgery

Author Year Gender/Age Location Bacteria Diagnosis Treatment Outcome
1. Battin 1991 Male/15 na na TTE Surgery Survived
2. Saiki 1994 Male/42 MV,AV Streptococcus hemolyticus TTE, Surgery Survived
3. Katoh 1994 Male/58 TV na na Surgery Survived
4. Elian 1995 Male/64 TV Staphylococcus aureus TTE, TEE, CC Surgery Survived
5. Velebit 1995 Male/ 30 BAV Staphylococcus aureus TEE, CC Surgery Survived(AVB)
6. Winslow 1995 Male/ 30 AV Staphylococcus aureus TTE, TEE Surgery Survived
7. Michel 1996 Male/52 AV Streptococcus viridans TTE, TEE Conservative Survived
8. Alphonso 2003 Male/ 63 AV Culture negative TTE Surgery Survived
9. Raja 2006 Male/47 RA Staphylococcus aureus TTE, TEE Surgery Survived(RF)
10. Fukui 2007 Male/57 TV, AV, MV na TEE Surgery Survived
11. Tatewaki 2008 Female/7 TV, AV, MV Staphylococcus aureus TEE, CT Surgery Survived
12. Inouel 2009 Female/21 AV Culture negative TTE, TEE Surgery Survived
13. Cortez-Dias 2009 Male/59 MV Staphylococcus aureus TTE, TEE Conservative Died(AVB, RF)
14. Mendoza 2009 Female/52 AV Streptococcus mutans TTE, CT Surgery Survived
15. Hori 2010 Male/41 BAV na TTE Surgery Survived
16. Matt 2010 Male/35 AV Hemophilus aphrophilus TTE,TEE Surgery Survived(AVB)
17. Ota 2011 Male/71 AV Streptococcus pneumonia TTE,TEE Surgery Survived
18. Pillai 2011 Male/12 TV Culture negative TEE Surgery Survived
19. Carpenter 2012 Male/22 TV Staphylococcus lugdunensis TEE, CT Surgery Survived
20. Hsu 2014 Male/40 BAV Cardiobacterium hominis TEE, Surgery Died(RF)
21. Prifti et al. 2015 Female/40 TV Staphylococcus aureus TTE, TEE Surgery Survived
Area of myocardial infarction
22. Hole 1995 Male/63 Inferior myocardial infarction TTE Surgery Survived
23. Jobic 1997 Female/72 Inferior myocardial infarction TTE, TEE Surgery Died (RF)
24. Newman 1996 Male/72 Inferior myocardial infarction Trauma TTE, TEE Surgery Died
25.Venkatesh 1996 Male/16 Blunt trauma TTE, TEE Surgery Survived
26. Selinger 1998 Male/70 Bullet, trauma TTE,TEE,CC Surgery Survived

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Legend: TTE Transthoracic echocardiography, TEE Transesophageal echocardiography, CC Cardiac catheterization, CT Cardiac tomography, na not available, AV Aortic valve, BAV Bicuspid Aortic Valve, MV Mitral valve, TV Tricuspid valve, RF Renal Failure, AVB Complete atrioventricular block

 

Table 2. Patients with acquired Gerbode defect undergoing previous cardiac surgery

Author Year Gender Age Diagnostic tool Previous procedure Treatment Outcome
1. Katta et al. 1994 Male 54 TTE,TEE Endomyocardial biopsy Conservative Survived
2. Dzwonczyk et al. 1995 Male 25 TTE ASD repair na na
3. Dzwonczyk et al. 1995 Female 72 TTE AVR, VSD repair na na
4. Fukui et al. 2000 Male 53 TEE MVR x 2 Surgery Survived
5. Benisty et al. 2000 Male 72 TTE, TEE MVR Surgery n.a.
6. Benisty et al. 2000 Male 73 TTE, TEE MVR x 3, AVR Surgery n.a.
7. Weinrich et al. 2001 Female 58 TEE, CC MVRx 2 Surgery Survived
8. Wasserman et al. 2002 Male 78 TTE, TEE, AVR Surgery Survived
9. Cabalka et al. 2005 Female 70 TTE, TEE MVR x 2 Percutaneous Survived
10. Lorber et al. 2006 Female 78 TTE, CC MVR Percutaneous Survived
11. Ramasubbu et al. 2006 Male 41 TEE Aortic root reconstruction Surgery Survived
12. Ramasubbu et al. 2006 Female 44 TEE Aortic root reconstruction Conservative Survived
13. Trehan et al. 2006 Male 22 TTE, MRI, CC VSD + sinus Valsalva repair Percutaneous Survived
14. Martinez et al. 2007 Female 70 TTE MVR Percutaneous Survived
15. Martinez et al. 2007 Male 67 TTE AVR Percutaneous Survived
16. Uslu et al. 2007 Male 54 TTE MVR Surgery Survived
17. Hilberath et al. 2007 Male 68 TEE AVR + endocarditis Surgery Survived
18. Frigg et al. 2008 Female 77 TEE, CC AVR Surgery Survived
19. Moaref et al. 2008 Female 51 TEE MVR Surgery na
20. Aoyagi et al. 2008 Female 71 TTE, CC MVR, TV repair Surgery Survived
21. Rothman et al. 2008 Male 86 TTE, CC MVR Percutaneous Survived
22. Hansalia et al. 2009 Female 46 TTE AVR Surgery Survived
23. Yared et al. 2009 Male 60 TTE, TTE AVR+ endocarditis na na
24. Gorki et al. 2009 Female 69 na AVR + endocarditis na na
25. Subramanian et al. 2009 Male 60 TEE, CT AVR Surgery Survived
26. Amirghofran et al. 2009 Female 51 TEE MVR Surgery Survived
27. Silbiger et al. 2009 Female 30 TTE, CC VSD repair Conservative Survived
28. Cheema et al. 2009 Female 31 MRI VSD repair Conservative Survived
29. Can et al. 2009 Male 72 TTE AV nod ablation Conservative Survived
30. Can et al. 2009 Male 68 Autopsy AV nod ablation na Died
31. Dadkhah et al. 2009 Female 73 TEE TV repair Conservative Survived
32. Mohapatra et al 2009 Female 22 TEE MVR (RF) Surgery Survived
33. Sun et al. 2010 na na na MVR Surgery na
34. Sun et al. 2010 na na na MVR na na
35. Pursnani et al. 2010 Male 78 TTE, TEE AVR Surgery Survived
36. Sharma et al. 2011 Male 80 TTE AV nod ablation Conservative Survived
37. Kumar et al. 2011 Female 59 TEE AVRx2 + endocarditis Surgery Survived
38. Zhu et al. 2012 Baby 6 months TTE, TEE ASD, VSD repair Percutaneous Survived
39. Bochard-Villanueva 2012 Male 63 TEE, CT AVR+ endocarditis Surgery Survived
40. Vallakati et al. 2012 Female 53 TTE AVR Conservative Survived
41. Elmistekawy et al. 2012 Male 59 TEE AVR Surgery Survived
42. Dores et al. 2012 Male 50 TTE, TEE AVR, MVR Surgery Survived
43. Yurdakul et al. 2012 Male 68 TEE AVR Surgery Survived
44. Mousavi et al. 2012 Female 76 TEE, MRI AVR Conservative Survived
45. Ozdogan et al. 2012 Female 31 TTE, TEE MVRx2 + endocarditis Surgery Died
46. Anderson et al. 2012 na na na AVR na na
47. Toprak et al. 2013 Male 32 TTE, TEE AVR Conservative Survived
48. Notarangelo et al. 2013 n.a. 69 TTE, TEE MVR Percutaneous Survived
49. Sinisalo et al. 2013 Male 75 TTE, TEE, CC AVR Percutaneous Survived
50. Sinisalo et al. 2013 Female 23 TEE, CC VSD repair Percutaneous Survived
51. Sinisalo et al. 2013 Male 10 TEE, CC ASD, VSD repair Percutaneous Survived
52. Sinisalo et al. 2013 Male 8 TEE, CC VSD repair Percutaneous Survived
53. Dangol et al. 2013 Male 6 months TTE,TEE,CC ToF repair Percutaneous Survived
54. Lee et al. 2013 Male 3 months TTE, CC ASD, PDA, VSD repair Percutaneous Survived
55. Poulin et al. 2013 Female 75 TTE,TEE MVR Percutaneous Survived
56. Primus et al. 2013 Female 76 TTE,TEE AVR Conservative Survived
57. Chaturvedi et al. 2013 Male 62 TTE, MRI AVR Percutaneous Survived
58. Tayama et al. 2014 Male 75 TTE, CC MV and TV repair Surgery Survived
59. Hussain et al. 2014 Male 45 TTE, TEE AVRx2 Surgery Survived
60. Chamsi-Pasha et al 2014 Male 67 TTE, TEE MVR, TVR Surgery Survived
61. Taskesen et al. 2014 Male 74 TTE, TEE AVRx2 Percutaneous Survived
62. Fanari et al 2015 Female 50 TTE, CT AVR Percutaneous Survived

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Legend: TTE Transthoracic echocardiography, TEE Transesophageal echocardiography, CC Cardiac catheterization, CT Cardiac tomography, MRI Magnetic resonance, na-not available, AVR Aortic valve replacement, MVR Mitral valve replacement, TV Tricuspid valve, ASD Atrial septal defect, VSD Ventricular septal defect, ToF Tetralogy of Fallot, PDA Patent ductus arteriosum

Take home notes:

  1. The Gerbode defect is a communication between the left ventricle and right atrium.
  2. It is usually congenital, but rarely is acquired, as a complication of endocarditis, myocardial infarction, trauma, or after previous cardiac surgery.
  3. Percutaneous transcatheter closure techniques have been employed mostly in high risk surgical candidates due to previous valve replacement, advanced age, anticoagulation, and multiple comorbidities.
  4. Surgical treatment is always feasible, usually with excellent outcome.
  5. The percutaneous transcatheter closure remains an excellent option especially in high risk patients.
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CHD Surgery Articles of September 2015

  1. Vasoactive Inotropic Score (VIS) as Biomarker of Short-Term Outcomes in Adolescents after Cardiothoracic Surgery.

Garcia RU, Walters HL 3rd, Delius RE, Aggarwal S.

Pediatr Cardiol. 2015 Sep 30. [Epub ahead of print]

PMID: 26424215

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  1. [Monitoring of 4 patients with heparin-induced thrombocytopenia after complex congenital heart surgery].

Zhou J, Peng J, Li Q, Wei S, Wu W.

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2015 Sep 28;40(9):1039-42. doi: 10.11817/j.issn.1672-7347.2015.09.016. Chinese.

PMID: 26408627 Free Article

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Select item 26412859

 

  1. Homograft reconstruction of the right ventricular outflow tract in adults with congenital heart disease: a systematic review.

Skoglund K, Eriksson P, Svensson G, Dellborg M.

Interact Cardiovasc Thorac Surg. 2015 Sep 27. pii: ivv264. [Epub ahead of print]

PMID: 26415536 Free Article

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Select item 26408070

 

  1. Surgical management of congenital tracheal stenosis associated with tracheal bronchus and congenital heart disease.

Wang S, Zhang H, Zhu L, Zhen J, Liu J, Xu Z.

Eur J Cardiothorac Surg. 2015 Sep 15. pii: ezv317. [Epub ahead of print]

PMID: 26374867

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  1. Treatment Strategies for Primary Tumors of the Heart in Children: A 10-Year Experience.

Liu X, Hong H, Zhang H, Xu Z, Liu J, Qiu L.

Ann Thorac Surg. 2015 Sep 11. pii: S0003-4975(15)01038-3. doi: 10.1016/j.athoracsur.2015.06.030. [Epub ahead of print]

PMID: 26365674

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  1. Paediatric cardiac surgery in low-income and middle-income countries: a continuing challenge.

Nguyen N, Leon-Wyss J, Iyer KS, Pezzella AT.

Arch Dis Child. 2015 Sep 10. pii: archdischild-2015-308173. doi: 10.1136/archdischild-2015-308173. [Epub ahead of print]

PMID: 26359507

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Select item 26421632

 

  1. Common arterial trunk: current implementation of the primary and staged repair strategies.

Sandrio S, Rüffer A, Purbojo A, Glöckler M, Dittrich S, Cesnjevar R.

Interact Cardiovasc Thorac Surg. 2015 Sep 10. pii: ivv261. [Epub ahead of print]

PMID: 26362626 Free Article

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Select item 26358473

 

  1. Pharmacokinetics of Morphine and Its Metabolites in Infants and Young Children After Congenital Heart Surgery.

Elkomy MH, Drover DR, Glotzbach KL, Galinkin JL, Frymoyer A, Su F, Hammer GB.

AAPS J. 2015 Sep 9. [Epub ahead of print]

PMID: 26349564

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Select item 26363820

 

  1. Acquired Gerbode defect following endocarditis of the tricuspid valve: a case report and literature review.

Prifti E, Ademaj F, Baboci A, Demiraj A.

J Cardiothorac Surg. 2015 Sep 9;10(1):115. doi: 10.1186/s13019-015-0320-z.

PMID: 26353810 Free PMC Article

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Select item 26363941

 

  1. Prevention of vitamin D deficiency in children following cardiac surgery: study protocol for a randomized controlled trial.

McNally JD, O’Hearn K, Lawson ML, Maharajh G, Geier P, Weiler H, Redpath S, McIntyre L, Fergusson D, Menon K; Canadian Critical Care Trials Groups.

Trials. 2015 Sep 9;16(1):402. doi: 10.1186/s13063-015-0922-8.

PMID: 26353829 Free PMC Article

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  1. Management of hypoplastic left heart syndrome with intact atrial septum: a two-centre experience.

Sathanandam SK, Philip R, Gamboa D, Van Bergen A, Ilbawi MN, Knott-Craig C, Waller BR, Javois AJ, Cuneo BF.

Cardiol Young. 2015 Sep 8:1-10. [Epub ahead of print]

PMID: 26346529

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  1. Mannose-binding lectin (MBL) insufficiency protects against the development of systemic inflammatory response after pediatric cardiac surgery.

Pągowska-Klimek I, Świerzko AS, Michalski M, Moll M, Szala-Poździej A, Sokołowska A, Krajewski WR, Cedzyński M.

Immunobiology. 2015 Sep 8. pii: S0171-2985(15)30059-0. doi: 10.1016/j.imbio.2015.09.010. [Epub ahead of print]

PMID: 26382056

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  1. Mesenteric near-infrared spectroscopy and risk of gastrointestinal complications in infants undergoing surgery for congenital heart disease.

Iliopoulos I, Branco RG, Brinkhuis N, Furck A, LaRovere J, Cooper DS, Pathan N.

Cardiol Young. 2015 Sep 7:1-9. [Epub ahead of print]

PMID: 26343176

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  1. Reoperative double ventricular outflow tract reconstruction in grown-up congenital heart disease patients with conotruncal anomalies.

Kusajima K, Hoashi T, Kagisaki K, Ohuchi H, Shiraishi I, Ichikawa H.

Gen Thorac Cardiovasc Surg. 2015 Sep 5. [Epub ahead of print]

PMID: 26342696

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  1. Jarvik 2000 axial-flow ventricular assist device placement to a systemic morphologic right ventricle in congenitally corrected transposition of the great arteries.

Tanoue Y, Jinzai Y, Tominaga R.

J Artif Organs. 2015 Sep 4. [Epub ahead of print]

PMID: 26341249

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  1. [Surgery of grown up congenital heart disease. About 540 cases].

Haddad A, Bourezak R, Aouiche M, Ait Mohand R, Hamzaoui A, Bourezak SE.

Ann Cardiol Angeiol (Paris). 2015 Sep;64(4):241-8. doi: 10.1016/j.ancard.2015.02.005. Epub 2015 Mar 23. French.

PMID: 25813649

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Select item 26228604

 

  1. Changes in Risk Profile Over Time in the Population of a Pediatric Heart Transplant Program.

Reinhartz O, Maeda K, Reitz BA, Bernstein D, Luikart H, Rosenthal DN, Hollander SA.

Ann Thorac Surg. 2015 Sep;100(3):989-95. doi: 10.1016/j.athoracsur.2015.05.111. Epub 2015 Jul 28.

PMID: 26228604

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  1. Contemporary Results of Aortic Coarctation Repair Through Left Thoracotomy.

Mery CM, Guzmán-Pruneda FA, Trost JG Jr, McLaughlin E, Smith BM, Parekh DR, Adachi I, Heinle JS, McKenzie ED, Fraser CD Jr.

Ann Thorac Surg. 2015 Sep;100(3):1039-46. doi: 10.1016/j.athoracsur.2015.04.129. Epub 2015 Jul 21.

PMID: 26209490

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  1. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score.

Schmidt M, Burrell A, Roberts L, Bailey M, Sheldrake J, Rycus PT, Hodgson C, Scheinkestel C, Cooper DJ, Thiagarajan RR, Brodie D, Pellegrino V, Pilcher D.

Eur Heart J. 2015 Sep 1;36(33):2246-56. doi: 10.1093/eurheartj/ehv194. Epub 2015 Jun 1.

PMID: 26033984

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  1. Outcomes after aortic arch reconstruction for infants: deep hypothermic circulatory arrest versus moderate hypothermia with selective antegrade cerebral perfusion.

Kornilov IA, Sinelnikov YS, Soinov IA, Ponomarev DN, Kshanovskaya MS, Krivoshapkina AA, Gorbatykh AV, Omelchenko AY.

Eur J Cardiothorac Surg. 2015 Sep;48(3):e45-50. doi: 10.1093/ejcts/ezv235. Epub 2015 Jul 3.

PMID: 26141543

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  1. Safety and Efficacy of Ventricular Septal Defect Repair Using a Cosmetic Shorter Right Lateral Thoracotomy on Infants Weighing Less than 5kg.

Li G, Su J, Fan X, Li Z, Zhang J, Zhu Y, Liu A, Xu Y, Xu Y, Liu Y.

Heart Lung Circ. 2015 Sep;24(9):898-904. doi: 10.1016/j.hlc.2015.02.010. Epub 2015 Feb 23.

PMID: 25769663

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  1. Lower mini-sternotomy in congenital heart disease: just a cosmetic improvement?

Garcia Vieites M, Cardenas I, Loyola H, Fernandez Arias L, Garcia Hernandez I, Martinez-Bendayan I, Rueda F, Cuenca Castillo JJ, Portela Torron F, Bautista-Hernández V.

Interact Cardiovasc Thorac Surg. 2015 Sep;21(3):374-8. doi: 10.1093/icvts/ivv163. Epub 2015 Jun 20.

PMID: 26093954 Free Article

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  1. Predischarge Transthoracic Echocardiography after Surgery for Congenital Heart Disease: A Routine with a Reason?

Shoiab I, Danford DA, Li L, Abdullah I, Hammel JM, Kutty S.

J Am Soc Echocardiogr. 2015 Sep;28(9):1030-5. doi: 10.1016/j.echo.2015.04.009. Epub 2015 May 11.

PMID: 25977233

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Select item 25894077

 

  1. Development of a thermodynamic control system for the Fontan circulation pulsation device using shape memory alloy fibers.

Yamada A, Shiraishi Y, Miura H, Hashem HM, Tsuboko Y, Yamagishi M, Yambe T.

J Artif Organs. 2015 Sep;18(3):199-205. doi: 10.1007/s10047-015-0827-z. Epub 2015 Apr 18.

PMID: 25894077

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Select item 26198086

 

  1. The Use of Lidocaine Containing Cardioplegia in Surgery for Adult Acquired Heart Disease.

Yammine M, Neely RC, Loberman D, Rajab TK, Grewal A, McGurk S, Fitzgerald D, Aranki SF.

J Card Surg. 2015 Sep;30(9):677-84. doi: 10.1111/jocs.12597. Epub 2015 Jul 22.

PMID: 26198086

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  1. A Simple Technique for Closing Multiple Muscular and Apical Ventricular Septal Defects.

Talwar S, Bhoje A, Airan B.

J Card Surg. 2015 Sep;30(9):731-4. doi: 10.1111/jocs.12590. Epub 2015 Jun 28.

PMID: 26118439

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  1. Takeuchi repair of anomalous left coronary artery from the pulmonary artery.

Cramer JW, Cinquegrani M, Cohen SB.

J Cardiovasc Comput Tomogr. 2015 Sep-Oct;9(5):457-8. doi: 10.1016/j.jcct.2015.02.002. Epub 2015 Feb 17.

PMID: 25843240

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Select item 26144911

 

  1. Track Extubation in Pediatric Congenital Heart Disease Open Heart Surgical Patients in Pakistan.

Akhtar MI.

J Coll Physicians Surg Pak. 2015 Sep;25(9):708-9. doi: 09.2015/JCPSP.708709. No abstract available.

PMID: 26374375

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Select item 26263419

 

  1. Bridge to transplantation with long-term mechanical assist device in adults after the Mustard procedure.

Maly J, Netuka I, Besik J, Dorazilova Z, Pirk J, Szarszoi O.

J Heart Lung Transplant. 2015 Sep;34(9):1177-81. doi: 10.1016/j.healun.2015.03.025. Epub 2015 Mar 30.

PMID: 26023034

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Select item 26339942

 

  1. Reduced pleural drainage, length of stay, and readmissions using a modified Fontan management protocol.

Pike NA, Okuhara CA, Toyama J, Gross BP, Wells WJ, Starnes VA.

J Thorac Cardiovasc Surg. 2015 Sep;150(3):481-7. doi: 10.1016/j.jtcvs.2015.06.042. Epub 2015 Jun 26.

PMID: 26254747

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Select item 26071969

 

  1. Surgical Considerations in d-Transposition of the Great Arteries.

Hermsen JL, Chen JM.

Semin Cardiothorac Vasc Anesth. 2015 Sep;19(3):223-32. doi: 10.1177/1089253215584195. Epub 2015 Apr 26. Review.

PMID: 25918115

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  1. Preoperative Physiology, Imaging, and Management of Transposition of the Great Arteries.

Files MD, Arya B.

Semin Cardiothorac Vasc Anesth. 2015 Sep;19(3):210-22. doi: 10.1177/1089253215581851. Epub 2015 Apr 21. Review.

PMID: 25900899

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  1. Anesthetic Considerations and Management of Transposition of the Great Arteries.

Latham GJ, Joffe DC, Eisses MJ, Richards MJ, Geiduschek JM.

Semin Cardiothorac Vasc Anesth. 2015 Sep;19(3):233-42. doi: 10.1177/1089253215581852. Epub 2015 Apr 21. Review.

PMID: 25900898

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  1. HeartWare Ventricular Assist Device Placement in a Patient With Corrected Dextro-Transposition of Great Arteries: A Case Report and Its Clinical Challenges.

Sehgal S, Ramachandran S, Leff JD.

Semin Cardiothorac Vasc Anesth. 2015 Sep;19(3):243-7. doi: 10.1177/1089253214566886. Epub 2015 Jan 18.

PMID: 25601596

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  1. Inadvertent ligation of the left pulmonary artery during intended ductal ligation.

Tefera E, Bermudez-Cañete R, van Doorn C.

BMC Res Notes. 2015 Sep 30;8(1):511. doi: 10.1186/s13104-015-1467-3.

PMID: 26423273

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  1. Long-Term Mechanical Circulatory Support in Pediatric Patients.

Sandica E, Blanz U, Mime LB, Schultz-Kaizler U, Kececioglu D, Haas N, Kirchner G, Zu Knyphausen E, Lauenroth V, Morshuis M.

Artif Organs. 2015 Sep 28. doi: 10.1111/aor.12552. [Epub ahead of print]

PMID: 26411865

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  1. Risk factors for the development of donor-specific antibodies after pediatric heart transplantation.

Godown J, Slaughter JC, Fossey SC, McKane M, Dodd DA.

Pediatr Transplant. 2015 Sep 28. doi: 10.1111/petr.12606. [Epub ahead of print]

PMID: 26412798

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  1. Outcomes in Patients with Persistent Ventricular Dysfunction After Stage I Palliation for Hypoplastic Left Heart Syndrome.

Jean-St-Michel E, Chetan D, Schwartz SM, Van Arsdell GS, Floh AA, Honjo O, Conway J.

Pediatr Cardiol. 2015 Sep 22. [Epub ahead of print]

PMID: 26396116

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  1. Basiliximab treatment for autoimmune bowel disease in a pediatric heart transplant patient.

Puri K, Kocoshis S, Risma K, Perez L, Hart C, Chin C, Ryan TD, Jefferies JL, Schumacher KR, Castleberry C.

Pediatr Transplant. 2015 Sep 16. doi: 10.1111/petr.12584. [Epub ahead of print]

PMID: 26374667

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Select item 26239579

 

  1. Risk Factors for Semilunar Valve Insufficiency After the Damus-Kaye-Stansel Procedure.

Yamauchi S, Kawata H, Iwai S, Kayatani F, Matsuzaka M, Fukuda I, Kishimoto H.

Ann Thorac Surg. 2015 Sep 14. pii: S0003-4975(15)01106-6. doi: 10.1016/j.athoracsur.2015.06.070. [Epub ahead of print]

PMID: 26381756

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Select item 26369369

 

  1. Impact of Variability in Echocardiographic Interpretation on Assessment of Adequacy of Repair Following Congenital Heart Surgery: A Pilot Study.

Parthiban A, Levine JC, Nathan M, Marshall JA, Shirali GS, Simon SD, Colan SD, Newburger JW, Raghuveer G.

Pediatr Cardiol. 2015 Sep 10. [Epub ahead of print]

PMID: 26358473

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Select item 26358472

 

  1. Transposition Complex with Aortic Arch Obstruction: Outcomes of One-Stage Repair Over 10 Years.

Choi KH, Sung SC, Kim H, Lee HD, Ban GH, Kim G, Kim HY.

Pediatr Cardiol. 2015 Sep 10. [Epub ahead of print]

PMID: 26358472

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Select item 26350159

 

  1. Donor-specific HLA alloantibodies: Impact on cardiac allograft vasculopathy, rejection, and survival after pediatric heart transplantation.

Tran A, Fixler D, Huang R, Meza T, Lacelle C, Das BB.

J Heart Lung Transplant. 2015 Sep 3. pii: S1053-2498(15)01383-2. doi: 10.1016/j.healun.2015.08.008. [Epub ahead of print]

PMID: 26422083

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  1. Prosthetic Pulmonary Valve Stenosis: A Different Way to Solve the Problem.

Schroeter T, Lurz P, Kiefer P, Wehbe M, Dähnert I.

Ann Thorac Surg. 2015 Sep;100(3):1103-5. doi: 10.1016/j.athoracsur.2014.11.065.

PMID: 26354643

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  1. Changes in Risk Profile Over Time in the Population of a Pediatric Heart Transplant Program.

Reinhartz O, Maeda K, Reitz BA, Bernstein D, Luikart H, Rosenthal DN, Hollander SA.

Ann Thorac Surg. 2015 Sep;100(3):989-95. doi: 10.1016/j.athoracsur.2015.05.111. Epub 2015 Jul 28.

PMID: 26228604

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  1. Laboratory Evaluation of Hemolysis and Systemic Inflammatory Response in Neonatal Nonpulsatile and Pulsatile Extracorporeal Life Support Systems.

Wang S, Krawiec C, Patel S, Kunselman AR, Song J, Lei F, Baer LD, Ündar A.

Artif Organs. 2015 Sep;39(9):774-81. doi: 10.1111/aor.12466. Epub 2015 May 1.

PMID: 25940752

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  1. Non-invasive Measurements of Energy Expenditure and Respiratory Quotient by Respiratory Mass Spectrometry in Children on Extracorporeal Membrane Oxygenation-A Pilot Study.

Li X, Yu X, Cheypesh A, Li J.

Artif Organs. 2015 Sep;39(9):815-9. doi: 10.1111/aor.12465. Epub 2015 May 1.

PMID: 25940695

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Select item 25967955

 

  1. Continuous Flow Device Support in Children Using the HeartWare HVAD: 1,000 Days of Lessons Learned From a Single Center Experience.

Sparks J, Epstein D, Baltagi S, Mehegan ME, Simpson KE, Canter CE, Silvestry S, Eghtesady P, Boston US.

ASAIO J. 2015 Sep-Oct;61(5):569-73. doi: 10.1097/MAT.0000000000000253.

PMID: 25967955

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Select item 25593209

 

  1. Changes in Aortic Wall Structure, Composition, and Stiffness With Continuous-Flow Left Ventricular Assist Devices: A Pilot Study.

Ambardekar AV, Hunter KS, Babu AN, Tuder RM, Dodson RB, Lindenfeld J.

Circ Heart Fail. 2015 Sep;8(5):944-52. doi: 10.1161/CIRCHEARTFAILURE.114.001955. Epub 2015 Jul 1.

PMID: 26136459

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Select item 26025774

 

  1. Changes in the methodology of pre-heart transplant human leukocyte antibody assessment: an analysis of the United Network for Organ Sharing database.

O’Connor MJ, Keeshan BC, Lin KY, Monos D, Lind C, Paridon SM, Mascio CE, Shaddy RE, Rossano JW.

Clin Transplant. 2015 Sep;29(9):842-50. doi: 10.1111/ctr.12590. Epub 2015 Aug 6.

PMID: 26172275

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Select item 26317921

 

  1. Leukocytes Don’t Lie.

Tárnok A.

Cytometry A. 2015 Sep;87(9):791-2. doi: 10.1002/cyto.a.22737. No abstract available.

PMID: 26317921

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Select item 25813161

 

  1. Echocardiographic findings before and after surgical repair of Tetralogy of Fallot.

Noori NM, Mahjoubifard M, Alavi SM, Teimouri A.

J Pak Med Assoc. 2015 Sep;65(9):921-7.

PMID: 26338733 Free Article

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Select item 26165442

 

  1. Hybrid versus Norwood: “Fifty shades of grey”.

Karamlou T, Peyvandi S.

J Thorac Cardiovasc Surg. 2015 Sep;150(3):456-7. doi: 10.1016/j.jtcvs.2015.07.045. Epub 2015 Jul 20. No abstract available.

PMID: 26253879

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Select item 26118944

 

  1. Validation of a Simple Score to Determine Risk of Early Rejection After Pediatric Heart Transplantation.

Butts RJ, Savage AJ, Atz AM, Heal EM, Burnette AL, Kavarana MM, Bradley SM, Chowdhury SM.

JACC Heart Fail. 2015 Sep;3(9):670-6. doi: 10.1016/j.jchf.2015.04.014.

PMID: 26362445

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Select item 26413109

 

  1. The Role of Prophylactic Postoperative Steroids in Pediatric Cardiac Operations.

Graham EM.

Pediatr Crit Care Med. 2015 Sep;16(7):676-7. doi: 10.1097/PCC.0000000000000465. No abstract available.

PMID: 26335117

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  1. Challenging diagnosis and treatment of HIT in child with ventricular assistance device.

Weintraub L, Driscoll C, Aydin S, Lamour JM, Weinstein S, Manwani D.

Pediatr Transplant. 2015 Sep;19(6):E152-6. doi: 10.1111/petr.12540. Epub 2015 Jun 18.

PMID: 26087151

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Select item 26082342

 

  1. The effect of MMF dose and trough levels on adverse effects in pediatric heart transplant recipients.

Siddiqi N, Lamour JM, Hsu DT.

Pediatr Transplant. 2015 Sep;19(6):618-22. doi: 10.1111/petr.12542. Epub 2015 Jun 17.

PMID: 26082342

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Select item 25943967

 

  1. Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of complete atrioventricular septal defect.

Kozak MF, Kozak AC, Marchi CH, Hassem Sobrinho Junior S, Croti UA, Moscardini AC.

Rev Bras Cir Cardiovasc. 2015 Sep;30(3):304-10. doi: 10.5935/1678-9741.20150036.

PMID: 26313720 Free PMC Article

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