Prevention of respiratory viral infection in stem cell transplant patients is important due to its high risk of adverse outcome. This single-centre, mixed methods study, conducted before the severe acute respiratory syndrome coronavirus-2 pandemic, explored the barriers and facilitators to a policy of universal mask use by visitors and healthcare workers, and examined the impact of the first year of introduction of the policy on respiratory viral infection rates compared with preceding years, adjusted for overall incidence. Education around universal mask use was highlighted as being particularly important in policy implementation. A significant decrease in respiratory viral infection was observed following introduction.

Current evidence highlights the potential role of tumor-infiltrating lymphocytes (TILS) as a prognostic factor in many types of tumors; in non-small cell lung cancer (NSCLC), this relationship is not well determined. TILs are being studied with different methods such as immunohistochemistry and optical microscopy. The primary endpoint is to identify TILS in patients with NSCLC, classified as present or absent, and its relation to progression free survival (PFS). Retrospective and analytical case study of Instituto Oncológico de Córdoba. 187 patients with stage IIIB and IV NSCLC were analyzed. TILS are descriptively classified as present or absent. Survival curves were calculated using the Kaplan-Meier method. 63% of patients had adenocarcinoma and 37% squamous cell carcinoma. 72% were men. 82% were smokers. 65% of patients with squamous histology and % 58 with adenocarcinoma, showed TILS. Patients with adenocarcinoma with TILS present had higher PFS 13.3 months, compared to patients with absent, 8.8 months. These differences were statistically significant (PFS: p=0.004). The patients with squamous cell carcinoma with TILS had 10.8 months PFS. Those who had infiltrated absent had a PFS of 5.6 months. These differences were also statistically significant (PFS: 0.001). Our study shows that patients whose pathological samples presented inflammatory infiltrate had higher PFS. The presence of TILS could be used as an important prognostic factor in this patient population.

Objectives: Bronchogenic cyst (BC) is rare and indication for early invasive treatment for BC is still under discussion. Nevertheless, life-threatening complications due to compression, infection, hemorrhage, and rupture are outlined in the literature.

Objectives: Delayed sternal closure (DSC) is a well-established procedure to reduce postoperative hemodynamic and respiratory instability following neonatal or infant cardiac surgery. Though, DSC is thought to be associated with increased rates of sternal wound infection (SWI), sepsis and mortality. Indication and duration of DSC vary between pediatric cardiac centers worldwide. Therefore, we reviewed our experience with DSC to determine the incidence of SWI and to evaluate potential perioperative risk factors.

Objectives: Unilateral isolated absence of a pulmonary artery (UAPA) is a rare congenital lesion, which can lead to pulmonary hypoplasia and pulmonary hypertension. To avoid these complications, early surgical repair of UAPA is recommended. Surgical approaches include creation of an aorto-pulmonary shunt, direct anastomosis between pulmonary artery and main pulmonary artery (MPA) or bridging the “gap” with prosthetic interposition grafts. We present a novel surgical technique using a total autologous interposition tube graft using tissue from the roof of the MPA.

Objectives: Alpha-actin is an important contractile protein in vascular smooth muscle cells (SMCs). SMCs are found in walls of arteries and hollow visceral organs as well as in lacrimal ducts, hair follicles and the iris. Mutations in the most abundant form, α-actin2 (ACTA2), result in fixed dilated pupils, large dilated persistent ductus arteriosus and pulmonary hypertension. Surgical closure of a patent ductus arteriosus (PDA) in neonates, routinely performed via lateral thoracotomy, may not be advisable in patients ACTA2-mutations. We present the case of a patient referred to our institution for a giant arterial duct and pulmonary hypertension.

Objectives: Branch pulmonary artery (BPA) stenosis is a common finding in patients with congenital heart disease (CHD), particularly in patients after repair of tetralogy of Fallot (ToF)/pulmonary atresia (PA). In this subset of patients ~10% require re-intervention for recurrent BPA stenosis. Valuable treatment modalities for BPA stenosis include surgical patch angioplasty, percutaneous BPA stenting and hybrid stent placement. The purpose of this study was to report our institutional experience with hybrid stenting to treat BPA stenosis.

Objectives: Drowning is the second leading cause of accidental death in children aged 1–14 years and constitutes a major challenge for emergency care personnel. We report our experience with extracorporeal membrane oxygenation (ECMO) and cardiopulmonary bypass in pediatric drowning patients.

Objectives: Incision of the septal leaflet of the tricuspid valve is a technique to obtain complete visualization in cases where a ventricular septal defect (VSD) is obscured by the tricuspid valve. However, tricuspid valve incision bears the potential risk of causing relevant postoperative tricuspid valve regurgitation and higher degree AV block. We therefore evaluated patients who underwent VSD closure at our institution.

Introduction: For patients with morphological or functional univentricular hearts Fontan palliation is the treatment of choice. The unphysiologic and non-pulsatile pulmonary blood flow results in multiorgan complications. We evaluated the histomorphology of a pulsatile Fontan conduit generated from Engineered Heart Tissue (EHT) after implantation in a rat model.

Background: ECMO has emerged to a well-established means of circulatory support after complex neonatal cardiac surgery to treat postcardiotomy heart failure. Usually, immediate anticoagulation is intended to prevent from failure of the ECMO circuit due to thrombus formation and consecutively also from thromboembolic events to patients. However, postoperative bleeding is very common and is attributed to anticoagulation. We sought to present our experience with initial full coagulation after postcardiotomy ECMO.

Objectives: Reconstruction of the right ventricular outflow tract (RVOT) deemed necessary in many cardiac anomalies and is the most frequent surgical procedure in adults with congenital heart disease. RVOT reconstruction is often facilitated with a valved conduit; however, the type of conduit is still a matter of debate, as are the factors affecting its longevity.

Introduction: The incidence of congenital coronary anomalies in the general population is 0.2-1.2% and in most cases of no hemodynamic relevance. However, if coronary perfusion is altered, e.g. in large coronary fistulas, myocardial malfunction will develop over time. Thus, surgical or interventional therapy is generally warranted. We present an exceedingly rare case with right coronary artery (RCA) take-off from the left ventricular outflow tract (LVOT) and absent proximal ostium of the RCA.

Background. Organ transplant recipients with refractory rejection or intolerance to the prescribed immunosuppressant may respond to rescue therapy with tacrolimus. We sought to evaluate the clinical outcomes of children undergoing heart transplantation who required conversion from a cyclosporine-based, steroid-free therapy to a tacrolimus-based regimen.Methods. We performed a prospective, observational, cohort study of 28 children who underwent conversion from cyclosporine-based, steroid-free therapy to a tacrolimus-based therapy for refractory or late rejection or intolerance to cyclosporine.Results. There was complete resolution of refractory rejection episodes and adverse side effects in all patients. The incidence rate (X100) of rejection episodes before and after conversion was 7.98 and 2.11, respectively (P <= .0001). There was a 25% mortality rate in patients using tacrolimus after a mean period of 60 months after conversion.Conclusion. Tacrolimus is effective as rescue therapy for refractory rejection and is a therapeutic option for pediatric patients.

OBJECTIVE To analyze 34 patients submitted to surgical treatment of patent arterial duct with age beyond 18 years old. METHODS Retrospective data collected from patient's charts with more than eighteen years old, submitted to surgical correction of patent arterial duct between 1997 and 2008 at Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo. RESULTS The mean age was 28.7 (18 a 53) years and 22 (64.7%) were female. The more prevalent symptom was dyspnea (76.5%). Left lateral thoracotomy was used in 33 (97.1%); the DA was sectioned and sutured in 25 (73.5%) cases and one patient needed cardiopulmonary bypass support. There were eight (23.5%) calcified arterial duct and 12 (35.3%) previous treatment with transcatheter devices were performed. The complication rate was 32%, with one (2.9%) permanent vocal cord palsy. Two (5.8%) patients had residual shunt less than 2mm. Transient left cord voice palsy was observed in 3 (8.8%) The procedure improves functional class (P< 0.0001) and no mortality was observed. CONCLUSION In this series, the surgical treatment of patent arterial duct in adults could be done without mortality and low incidence of complications.

A 28-month-old boy, weighing 11 kg, with severe dilated cardiomyopathy, was transplanted on December 1995. Hypertension and supraventricular tachycardia were detected in the immediate post-operative period, with favorable outcome. After 5 months of clinically asymptomatic follow-up, a dilation in the ascending aorta was observed on routine echocardiogram. Nuclear magnetic resonance imaging (NMRI) confirmed an ascending aortic aneurysm, with a diameter of 38 mm. An operation was performed, a bovine pericardium patch was sutured with reconstruction of the aortic wall, excluding the aneurysm. Good recovery was obtained and the child was discharged on Day 7 postoperatively. A post-operative echocardiogram showed absence of the aortic aneurysm and good surgical results. Another NMRI was done 5 months later, showing an intact ascending aorta. After 64 months, the patients clinical condition was confirmed as normal by echocardiogram. Surgical treatment was successful and the positive results have been maintained. Copyright (c) 2005 by the International Society for Heart and Lung Transplantation.

AVSD and TOF is a rare combination, with a limited published experience in surgical repair. The aim of this study is to report our institutional experience of this uncommon lesion. Between July 1986 and December 2002, 38 patients with AVSD and TOF were submited to total correction: age ranged from 5 months to 15 years (median 56 mo), 25 had Down's Syndrome (65,7%), 35 were cyanotic at the hospital presentation (91,4%) and 11 had previous Blalock-Taussig shunt. Important associated lesions were DORV (5), abscense of ostium primum (3), single papillary muscle (2), total anomalous pulmonary venous connection (2) and origin of LAD from RCA (1). The VSD was closed with 2 patches in 23 patients (60,5% – RA/RV approach). A transannular patch was used in 27 patients (71,4%), 18 with a monocuspid valve. Associated procedures included VSD enlargment (2), left AV valve annuloplasty (3) and left AV valve replacement (2). There were 4 hospitalary deaths (10,5%) and no late deaths (follow up between 1 mo and 13yrs). Actuarial estimated survival 6 years after operation is 87,05%. Eighteen patients are in Functional Class I and 14 in Class II (NYHA). Late echocardiographic studies showed mild pulmonary incompetence in 13, moderated in 14 and severe in 3 patients; mild left AV valve incompetence in 23 and moderated in 6 patients; mild right AV valve incompetence in 25 patients.

Severe protein losing enteropathy occurred in 3 of our 128 patients undergoing the Fontan procedure in the period of 1982 to 1994. The complication occurred 4, 4.5 and 5 years after the procedure, respectively. One patient had double inlet left ventricle while the other two had tricuspid atresia. All had initially undergone an atrio-pulmonary connection, and the duration of the enteropathy was 12, 13,5 and 15 months. All patients were in functional class IV of the New York Heart Association. The presence of protein losing enteropathy was confirmed by determining levels of fecal alfa-1 antitrypsin, enteric clearance of 51 Cromo labeled albumin, and endoscopy with histopathological study of the small bowel.They underwent further surgery to convert the atrio-pulmonary to a cavo-pulmonary anastomosis which excluded all the hepatic veins. A bovine pericardial baffle was sutured in the inferior caval vein so as to leave the hepatic venous flow draining to the right atrium and thence through an atrial septal defect to the left atrium and systemic circulation. The inferior caval venous flow was directed through an intra-atrial tunnel to the right pulmonary artery, and the superior caval vein was anastomosed to the superior aspect of the right pulmonary artery, thus completing the total cavo-pulmonary anastomosis with exclusion of the portal venous flow.Postoperatively, there was total regression of the clinical and laboratory findings. All patients are now in functional class I or II of the New York Heart Association. They have mild to moderate cyanosis up to three and a half years from the reoperation. We recommend the technique as an alternative for patients with severe protein losing enteropathy occurring after the Fontan procedure.