We report the case of a 17 year-old girl who developed sepsis due to Methicillin-Resistant Staphyloccocus Epidermidis (MRSE) infection of Dacron patch 14 years after ventricular septal defect (VSD) closure and 4 years after pacemaker implantation. Although MRSE grew in many cultures taken and proper antibiotic regimen was administered, no improvement in patient's clinical status was observed. Disseminated intravascular coagulation and multi-organ failure developed. An operation, at which perforated Dacron VSD-patch was replaced with a new Gore-Tex one, was performed by cardiac surgery team. The patient's clinical status improved immediately after the procedure. The girl remained well 12 months after discharge.

Introduce: In 1975 Jaten and colleagues described the first successful arterial switch operation (ASO) for transposition of the great arteries (TGA), and practised it for more than thirty years. The ASO has become the treatment of choice in many centres. The purpose of this study was to assess short-term results after neonatal ASO.Aim: The aim of this study was to assess early and mid-term results of ASO in a single centre.Material and Methods: Between December 1997 and June 2009 at our centre 150 ASO were performed by one surgeon. Patients' charts, surgical reports and echocardiograms were retrospectively reviewed. Patients were divided into three groups according to years - first 4 years, second 4 years, and third 4 years - and each group was divided into two subgroups A and B, subgroup A consisting of simple TGA with intact ventricular septum (IVS), and subgroup B consisting of patients with complex heart defects: TGA with ventricular septal, defect (VSD), TGA with hypoplastic aortic arch or coarctation of aorta and Taussig-Bing heart. Group I consisted of 54 patients, group II 38, and group III 58.Results: Our study shows that 30-day mortality was higher in the first group. It is also noticeable that complex TGA confer elevated risk for early mortality. Coronary artery anatomy was not identified as a risk factor.Conclusions: Despite risks, the study shows that neonatal ASO can be performed with acceptable morbidity and mortality even in patients with complex heart defects.

Aim: Assessment of perimembroneous ventricular septal defects (VSD) treatment with the use of AMembrVSDO and evaluation of the early and late complication risk.Methods: In the period from June, 2003 to August, 2005, 17 patients were qualified for VSD transcatheter closure. Patients aged 1.2-18.0 years (mean 9.2 +/- 6.5), weighted 9.4-72.0 kg (mean 32.9 +/- 21.8). The follow-up period was 3-4 years.Results: The procedure was performed successfully in 15 out of 17 children. The left ventricle end-diastolic dimension decreased statistically after the procedure (p=0.00005). One child (6.7%) suffered from a complete atrioventricular block after the VSD closure. Minor complications were observed in 4 (26.7%) cases. Statistically significant differences were observed between the size of the device and the short diameter of the VSD (p=0.7600), the long diameter of the VSD (p=0.8152), the angiographic diameter of the VSD (p=0.9210) as well as the proposed device (p=0.9202). After VSD closure, the number of patients with Tl > I degrees decreased from 66.7% to 6.7% (p=0.0159) and, in case of those with MI, from 93.3% to 60% (p=0.0270).Conclusion: Percutaneous closure of the perimembranous VSD with AMembrVSDO is a promising method of treatment. Nevertheless, more frequent occurrence of the complete heart block following the above-mentioned procedure in comparison to surgery indicates that the qualification for AMembrVSDO implantation should be performed very carefully. More data is needed to verify safety of this procedure.

Objectives. The aim of the study was to verify whether the prediction of postoperative pulmonary hypertension (PH) based on preoperative data is feasible.Material and Methods. A total of 191 consecutive patients with diagnosed left-to-right shunting and preoperative pulmonary hypertension underwent surgery from Oct. 1, 1997, to Dec. 31, 2004. Their medical records were reviewed, including demographics, echocardiographic measurements (PulmAT, PulmaAT/RVET ratio, Qp:Qs, mean pulmonary artery pressures - PAP) and perioperative clinical data. The patients were divided into four PH groups: A with normal postoperative PAP and patients with a PH event: B1 with temporarily elevated PAP, B2 a PH crisis treated conventionally, and B3 a PH crisis treated with NO.Results. Postoperative PH was found in 126 patients (B1: 21.5%, B2: 24.6%, B3: 19.9%). There were no differences in sex, age, body surface area, or weight among the study groups. The median basic Aristotle Complexity Score (ACS) was significantly higher in group B1 than in group A (9 vs. 6, p < 0.001). PulmAT/RVET (0.32 +/- 0.1 vs. 0.25 +/- 0.9, p < 0.05) and PAP (48.2 +/- 8.1 vs. 53.7 +/- 10.5 mmHg, p < 0.05) were significantly different only between groups A and B3. The significant predictors of postoperative PH were basic ACS (OR: 1.42, 95%CI: 1.14-1.79, p = 0.002), year of operation (OR: 0.74, 95%CI: 0.61-0.80, p < 0.001), and inotropic support (OR: 1.1,95%CI: 1.03-1.17, p = 0.001).Conclusions. An accurate prediction of postoperative PH severity based on preoperative data only is not feasible. Perioperative factors other than demographic and echocardiographic variables influence the postoperative course and independently modify the risk of postoperative PH and its intensity (Adv Clin Exp Med 2008, 17, 3, 313-319).

Wstęp: Dotychczas nie ustalono optymalnej metody leczenia chirurgicznego dzieci z wadami zastawki aortalnej. Pod uwagę brane są dwie możliwości: wymiana zastawki na mechaniczną lub operacja sposobem Rossa. Pacjenci z bakteryjnym zapaleniem wsierdzia coraz częściej są operowani tą drugą metodą, by uniknąć ryzyka wegetacji bakteryjnej, która mogłaby się ponownie pojawić po wszczepieniu mechanicznej zastawki aortalnej. Cel: Prezentacja 4-letniego pacjenta operowanego sposobem Rossa i ocena skuteczności metody w tym przypadku. Materiał i metodyka: Prezentujemy 4-letniego pacjenta z dwupłatkową zastawką aortalną, u którego rozwinęło się bakteryjne zapalenie wsierdzia i doszło do epizodu krwawienia śródmózgowiowego. Dziecko operowano metodą Rossa i wszczepiono mu zastawkowy ksenograft wołowy Contegra w pozycję płucną. Wyniki: Pacjent został rozintubowany w 1. dobie po zabiegu. Wyniki badania echokardiograficznego: zastawka neoaortalna 1,6 cm; V maks. 0,86; V min 0,57; PG maks. 3,0 mmHg; PG min: 1,6 mmHg; VTI 0,112; śladowa niedomykalność. Zastawka neopłucna – ksenograft: 1,43 cm; MFV=1,3 m/s; V min 0,89 m/s; PG maks. 6,76; PG min 3,65 mmHg. Lewa komora: 3,0/2,16 cm, EF=58%. Wnioski: Wczesny wynik zabiegu Rossa przeprowadzanego u dziecka po przebytym bakteryjnym zapaleniu wsierdzia i krwawieniu do ośrodkowego układu nerwowego zachęca do stosowania takiej metody leczenia w podobnych przypadkach. Słowa kluczowe: operacja metodą Rossa, zakażenie zastawki mechanicznej, dzieci Summary

The case is presented of a 2710 g newborn female with prenatally diagnosed ectopia cordis. Postnatal transthoracic echocardiography showed the presence of a ductus-dependent intracardiac lesion. The neonate was treated surgically on the first day of life. Different surgical aspects of ectopia cordis are discussed.

Wstep : W ok. 60% przypadkow koarktacja aorty (CoA) wspolistnieje z innymi wadami wewnątrzsercowymi. Celem pracy byla retrospektywna ocena wczesnych wynikow chirurgicznego leczenia CoA wspolistniejącej z innymi wadami wewnątrzsercowymi u noworodkow. Material i metody : W okresie od marca 1998 r. do grudnia 2003 r. w klinice operacyjnie leczono 25 noworodkow - 14 chlopcow (56%) i 11 dziewczynek (44%) - z CoA wspolistniejącą z innymi wadami wewnątrzsercowymi. Pacjentow podzielono na 3 grupy: 1 - noworodki leczone radykalną metodą jednoetapową (9 przypadkow); 2 - pacjenci leczeni operacyjnie w 1 etapie z powodu CoA, u ktorych ze wzgledu na wystąpienie objawow niewydolności krązeniowo- oddechowej w okresie kilku tygodni konieczne bylo przeprowadzenie operacji radykalnej (korekcji wady wewnątrzsercowej) podczas tego samego pobytu w szpitalu (3 przypadki); 3 - pacjenci z operacyjnie leczoną CoA. Dalsze leczenie operacyjne wady wewnątrzsercowej zaplanowano (13 dzieci) w trybie planowego przyjecia do kliniki w poźniejszym terminie. Wyniki : Po zabiegu operacyjnym stan ogolny 19 pacjentow (76%) poprawil sie. U 3 dzieci z powodu utrzymujących sie objawow niewydolności krązeniowo-oddechowej jeszcze w trakcie pierwszego pobytu w klinice konieczne bylo przeprowadzenie drugiego zabiegu operacyjnego - wykonano korekcje radykalną wady w krązeniu pozaustrojowym. W poszczegolnych grupach odnotowano nastepującą śmiertelnośc: grupa 1 - 0, grupa 2 - 0, grupa 3 - 2 dzieci (15,3%). Wnioski : Wczesne wyniki chirurgicznego leczenia CoA wspolistniejącej z innymi wadami wewnątrzsercowymi u noworodkow wiązą sie z malą śmiertelnością. W Klinice Kardiochirurgii Dzieciecej AM w Poznaniu u tych pacjentow zaleca sie leczenie dwuetapowe, ale w niektorych przypadkach zlozonych wad serca ze wspolistniejącą CoA i hipoplazją luku aorty konieczne jest zastosowanie radykalnego leczenia jednoetapowego.

Background: There are two methods of operation in patients with aortic valve malformation: the Ross procedure, and aortic valve replacement (for instance: artificial valve). The Ross procedure is probably better in patients with endocarditis (to avoid reinfection of the artificial valve).Aim: Presentation of a 4-year-old patient after the Ross procedure and evaluation of this method. Material and methods: We present a patient with bicuspid aortic valve after endocarditis and cerebral bleeding. The Ross procedure with bovine Contregra conduit were performed.Results: The patient was extubated on a first day after surgery. In echocardiograhic examination: neoAV 1.6 cm; V max. 0.86, V min. 0.57; PG max. 3.0 mmHg; PG min. 1.6 mmHg; VTI: 0.112; residual AI. NeoPV -xenograft 1.43 cm; MFV= 1.3 m/s; V min. 0.89 m/s; PG max. 6.76; PG min. 3.65 mmHg. LV 3.0/2.16 cm; EF=58%.Conclusions: The Ross procedure in a child after endocarditis and cerebral bleeding is probably the best operation in a such situation.

Objective: Depressed cardiac function after aortoventriculoplasty is well known during the postoperative period. Little data exist concerning the lone-term follow-up. The aim of this study is to determine whether septal incision has any permanent effect on the left ventricle function. Methods: From 1988 to 2002, 45 patients received aortic mechanical prosthesis. These patients were divided into two groups. Group A consisted of 26 patients 5-18 years old, who underwent simple aortic valve replacement. Group B consisted of 19 patients 4-20 years old, who underwent the Konno procedure. Systolic and diastolic functions of the left ventricle were analyzed using echocardiography. For the systolic function, the following parameters were assessed: pressure gradient between left ventricle and ascending aorta, shortening and ejection fraction of the left ventricle. For the diastolic function, left ventricle-filling parameters were assessed: ratio of early to late filling velocity, deceleration slope of the early filling velocity and left ventricular isovolumetric relaxation time. Furthermore the percentage fraction of the aortic valve index (AOVI%) was calculated and compared between these two groups. Results: After the surgery in group A, AOVI% dropped from 110 +/- 21 to 98 +/- 11%, while in group B it increased from 82 +/- 16 to 114 +/- 11%. As a result a higher residual pressure gradient across the aortic valve was noted in group A: 21.26 +/- 15 as compared to 11.17 +/- 5 mmHg in group B. A mean pressure above 30 mmHg appeared in group A 2 years after the surgery, while in group B this was obtained after 6 years. As for the diastolic function no significant difference was noted between these two groups. Overall there was one late death in group A, and in group B two early deaths, two reoperations because of excessive drainage and in two patients permanent pacemakers had to be implanted. Conclusions: Improvement of the systolic function after the surgery was noted in both groups. In patients with low AOVI%, postsurgical pressure gradient, either residual or recurrent, appeared during the follow-up. As for the septal incision, it may have some transient effects on the left ventricle function in the postoperative period, but no permanent sequelae were observed in the long-term follow-up. (C) 2004 Elsevier B.V. All rights reserved.

The aim of the study was to search for changes in subpopulations of peripheral blood lymphocytes and in their activation as the manifestation of cellular immunity against xenograft in recipients of bovine valved conduit used for right ventricle outflow tract reconstruction. Between 24-06-1999 and 19-10-2000 35 children were operated in ECC, 19 had a xenograft implanted, the rest entered the control group. Immunophenotype of lymphoid cells and T cells activation was evaluated with use of flow cytometer: preoperatively and 3, 6 and 12 months after the operation in both groups. There were no differences in numbers of CD3+, CD4+, CD8+ and natural killer cells between groups. A significant rise of B-cells percentages (from 15.5% to 23%) between 3rd and 6th month was noted. The T-lymphocyte activation study revealed higher numbers of CD69+ (0.17 vs. 0.09 G/l) and CD71+ (0.23 vs. 0.11 G/l) cells one year after the implantation in xenograft recipients. Difference between groups in number of CD69+ and CD71+ cells in 12th month may suggest mild activation (<10%) of these subgroups in xenograft recipients. This data may hint the presence of cellular reactivity. Changes in numbers of B-cells may evidence humoral immunity activation. Influence of these phenomena on graft survival remains to be established.

The aim of the study was to analyze short-term results of the arterial switch operation in 29 neonates with simple transposition of the great arteries (group A) and 18 (group B) with complex heart defects: transposition with a ventricular septal defect (10), coarctation of the aorta (5), or Taussig-Bing anomaly (3). The operations were usually performed on the 7th day of life (2nd-30th day), after a Rashkind procedure when necessary. The mean weight was 3,530 +/- 780 g, body surface area was 0.219 +/- 0.032 m(2). Delayed sternal closure was necessary in 7 patients from group A (24%) and 8 from group B (44%) because of hemodynamic instability after weaning from extracorporeal circulation; these neonates had significantly lower body weights and smaller body surface areas. Perioperative mortality was 13.8% (4 patients) in group A and 27.8% (5 patients) in group B. Correction of complex transposition tends to be associated with a higher operative risk than simple transposition, but the difference was not significant.

Cardiac operations were preformed in 499 children from January 1998 through December 1999. Their median age was 263 days. A positive culture from blood, bronchoalveolar lavage, wound, or central catheter was obtained in 110 patients (22%). Age, sex, presence of pulmonary hypertension, body surface area, ratio of body surface area to oxygenator surface area, whether heart surgery was open or closed, and the duration of the operation, cardiopulmonary bypass, intubation, and intensive care were analyzed. Patients who developed infections were significantly younger, with smaller body surface areas and disparity with the oxygenator surface area, longer operative and bypass times, extended intubation, and prolonged intensive care. There was a significant correlation between infection and pulmonary hypertension. Sex and type of operation were not predictors of infection.