Severe pulmonary valve dysfunction in single-ventricle neonates presents significant surgical challenges, as fragile tissue, small annular dimensions, and hemodynamic instability often preclude conventional repair or prosthetic implantation. This case addresses the lack of viable operative strategies for pulmonary valve replacement prior to Stage I palliation in Hypoplastic Left Heart Syndrome

Manually modified microvascular plugs (M-MVPs) have emerged as transcatheter pulmonary flow restrictors (PFRs) in neonates and infants with complex congenital heart disease and pulmonary overcirculation. Standardized device modification methods and short-term outcomes remain limited. We performed a retrospective single-center clinical data review of consecutive patients who underwent transcatheter pulmonary flow restriction using M-MVPs from January 2023 through June 2025. Data collected included patient characteristics, procedural details, peri-procedural complications, surgical outcomes, device explantation, and mortality. Twenty-one neonates and infants (median age: 16 days (IQR 8–22); median weight: 2.8 kg (IQR 2.3–3.9) received 44 M-MVP devices. Femoral venous access was used in 20/21 cases, with carotid access required in one patient. Median angiographic branch pulmonary artery diameters were 5.1 mm (left) and 5.3 mm (right). Fifteen patients underwent surgical explantation at a median 43 days (IQR 37.5–58.5 days), with one patient supported for 236 days. All devices were surgically explanted without major intraoperative complications or device related stenosis requiring pulmonary arterioplasty. Three patients required additional device implantation for distal migration or incomplete pulmonary artery coverage, and two patients ultimately required conversion to surgical main pulmonary artery banding. Interval mortality was 29

Objective Protein-losing enteropathy is among the most debilitating complications of Fontan circulation. Central venous hypertension increases lymphatic pressure in the thoracic duct, potentially leading to significant intestinal protein loss. Current treatment options for recurrent or refractory protein-losing enteropathy are limited to complex lymphatic interventions, fenestration creation, and heart transplantation. We have implemented an alternative surgical approach—thoracic duct decompression—and report our early experience in pediatric Fontan patients. Methods We studied 5 Fontan patients, analyzing their preoperative history, treatment, and surgical approach tailored to their unique anatomy, postoperative course, and symptoms at their most recent Fontan clinic follow-up. Results Since February 2024, 5 Fontan patients aged 5 to 16 years diagnosed with recurrent protein-losing enteropathy underwent surgical thoracic duct decompression. The first 2 patients experienced mild anastomotic narrowing, which was successfully treated with transcatheter angioplasty. The remaining 3 patients had uneventful postoperative course and hospital stays of approximately 1 week. All patients were closely monitored with echocardiograms and laboratory testing. At 6 months postoperatively, all remained symptom-free and transplant-free (follow-up range, 7-12 months), and reported improved quality of life. No cases of turndown stenosis were observed. Additionally, all patients were successfully weaned off enteral steroids and aggressive diuretic therapy. A mild decrease in oxygen saturations (1%-3%) was noted with no clinical significance. Conclusions Thoracic duct decompression appears to be a feasible intervention for recurrent protein-losing enteropathy in Fontan patients, demonstrating a low rate of short-term complications. This procedure may serve as a viable alternative to heart transplantation in select cases; however, its long-term efficacy warrants further investigation.

ObjectivesMitral valve replacement in young children is a challenging situation due to limited options. In this study, we aimed to present the results of our patients who underwent mitral valve replacement using Melody (Medtronic Inc) and Sapien 3 (Edwards Inc) valves.MethodsWe performed a total of 18 mitral valve replacements at Phoenix Children's between 2017 and 2024. These include 12 Melody and 6 Sapien valves. The median patient age was 42.17 ± 38.9 (1.9–127.2) months and weight was 13.83 ± 9.38 (3.9–43.4) kg, respectively. The indications for implantation were mitral stenosis with or without regurgitation, following an atrioventricular septal defect (AVSD) repair, mitral valve dysplasia, and Shone's complex. Once positioned the valves were expanded using a balloon catheter to achieve the best diameter (16–30 mm).ResultsThe postoperative mean mitral gradient was 6 ± 2.91 (2–12) mmHg. A permanent pacemaker was implanted in one patient after Sapien 3 valve replacement. One patient who received a Sapien valve had to be re-intervened for tamponade in the early post operative period. Mild LVOT obstruction was observed in one patient who underwent Melody valve replacement. One Melody valve was dilated after one year after implantation. At 24 months after implantation, Kaplan–Meier analysis indicated that 80% of Melody valves and 83% of Sapien valves would be expected to be free from reoperation (Log-rank p = 0,56).The hospital stay was 18.72 ± 3.67 days, and no mortality was observed.ConclusionsMelody and Sapien valves contribute to the prognosis of patients as it shortens the operation time, is easily applicable, and provides opportunities such as postoperative redilation. The successful results we obtained show that both valves can be used reliably and effectively and can be an alternative to conventional methods.

Patients with dextrocardia, heterotaxy syndrome, and single ventricle physiology typically undergo multiple staged palliative operations culminating in a Fontan circulation. Despite these palliative procedures, heart transplantation may become the inevitable final option. We report the case of a 12-year-old female with dextrocardia, heterotaxy syndrome with right atrial isomerism, and single ventricle physiology who had previously undergone staged Fontan palliation. Due to progressive Fontan failure and clinical deterioration, she was evaluated and listed for OHT. She underwent successful OHT without intraoperative complications. Her postoperative course was uneventful, and she showed significant clinical improvement during follow-up. This case highlights that heart transplantation is a viable and life-saving treatment option for patients with complex congenital heart disease following Fontan failure. Although transplantation in patients with dextrocardia poses technical challenges, it can be performed safely with favorable outcomes.

The superior cavopulmonary anastomosis (SCPA) is a standard second stage procedure in single ventricle palliation. Exact timing in most single ventricle patients depends on clinical status, age, weight and in many centers a preoperative catheterization. In this study, we aimed to investigate the factors affecting the length of hospital stay after Kawashima procedure and present our center outcomes. We studied on our center’s database between 2011 and 2024. Patients who underwent Kawashima procedure were analyzed for weight, height, and age as factors that may affect outcomes such as hospital stay, complications, and mortality. The effect of surgical timing on postoperative outcomes was examined. The primary outcome was length of stay. We found that 15 (6.4

Mechanical circulatory support options for pediatric patients with acute heart failure are limited. These patients can be challenging to manage depending on their size and the type of extracorporeal support required including the need for a left ventricular assist device. We report the case of a 12-year-old child with severely depressed left ventricular function who did not respond to medical therapy. We successfully stabilized the patient and bridged him to a successful heart transplant by implanting an Impella 5.5 device via a 10-mm Hemashield graft to the right innominate artery.

Pulmonary artery sling (PAS) is an uncommon congenital anomaly in which the left pulmonary artery (LPA) originates abnormally from the posterior aspect of the right pulmonary artery (RPA). The LPA then traverses between the trachea and esophagus, resulting in compression of the lower trachea. This compression can lead to respiratory symptoms, including wheezing and stridor, and in some cases, airway obstruction. In addition, bronchial compression—commonly affecting the right bronchus—can result in air trapping, pneumonia, and atelectasis. In this report, we present postoperative rapid relief of a symptomatic case in which LPA transection and reimplantation to the main pulmonary artery were performed successfully on cardiopulmonary bypass.

To determine if pre-operative high-flow nasal cannula (flow > 2 L per minute) or mechanical ventilation impact post-operative outcomes after the superior cavopulmonary connection. A single-center retrospective review of single-ventricle patients who underwent the superior cavopulmonary connection procedure at a tertiary care center over a 10-year period. Patients who underwent the procedure at greater than 2 years of age were excluded. The groups of interest were those who were on mechanical ventilation or high-flow nasal cannula. Patients in room air or on nasal cannula oxygen served as the control group. A total of 269 consecutive patients were included, of which 44 required high-flow nasal cannula and 17 required mechanical ventilation prior to the superior cavopulmonary connection procedure. Thirty-day post-operative survival was high, with 1 death in both the high-flow nasal cannula and the mechanical ventilation groups. At 1-year post-procedure, the transplant-free survival was lower in the mechanically ventilated group when compared to the high-flow nasal cannula and room air groups (46

Objective To examine whether or not viral positive patients experienced worse outcomes and assess differences in surgical outcomes between viral-positive patients with and without viral symptoms within 30 days of surgery. Methods This retrospective study reviewed charts of pediatric patients who underwent congenital heart surgery and routine viral testing at a single institution over a consecutive 3-year period (2017-2019). Patients with a history of heart transplants, pacemaker changes, or implants, and mediastinal washouts were excluded from the study. Surgical outcomes were compared by viral status and viral symptoms, using the Fisher exact and Wilcoxon rank sum tests. Results Among 1041 patients, 374 patients underwent routine preoperative viral testing, with 107 patients testing positive and 267 testing negative for viral swabs before surgery. There were no significant differences observed in surgical outcomes by viral status, including no differences in mortality. Among the 107 patients with positive viral swabs before surgery, comparisons between 24 patients with viral symptoms and 83 without symptoms within 30 days of surgery detected no significant differences in mortality or complication rates. However, symptomatic versus asymptomatic patients had significantly longer postoperative stay (23.4 vs 13.4 days; P = .02) and intubation time (9.8 vs 4.9 hours; P = .004). Conclusions Patients who test positive before congenital heart surgery and are asymptomatic beyond the incubation period may proceed to surgery with no further delay. Patients who are viral positive and symptomatic have a longer postoperative stay and intubation time. A prospective study is needed to assess the importance of routine viral testing.

Here, we demonstrate the capability of implanting the MITRIS RESILIA mitral valve in pediatric patients with severe mitral valve disease requiring mitral valve replacement. The MITRIS RESILIA valve is a bioprosthetic valve with a unique design allowing for improved physiological flow dynamics (minimizing left ventricular outflow obstruction) and potential for future valve -in -valve intervention. We retrospectively analyzed two cases: a 9-year-old with rheumatic heart disease and a 12-year-old with juvenile idiopathic arthritis-related mitral valve deterioration. Both patients underwent successful mitral valve replacement with the MITRIS RESILIA valve, demonstrating significant postoperative improvement in valve function and symptom relief. Follow-up echocardiograms 1 year later showed stable valve function with no significant regurgitation or stenosis, indicating satisfactory short-term outcomes.

Citizens, organizations and institutions are increasingly making use of digital social networks such as Twitter as a means by which to express their position as regards political topics. However, an increasing amount of academic literature coincides, in that it highlights the emotive and expressive nature of these positions. In other words, for the most part, the political opinions that are publicized are more like backing based on support or rejection (without arguments or motives). In parallel, said expressions have a key emotional element (expressions of a positive or negative affective disposition). This article consists of an analysis that aims, on the one hand, to measure the affective disposition of US citizens as expressed on Twitter during the two most recent electoral campaigns (2016 and 2020). Similarly, we have generated a model that facilitates the measurement of the extent to which the content of the aforementioned messages demonstrates arguments or motives, or lack of. By way of the use of a database for the same Twitter accounts in both elections, we provide very consistent results that highlight the lack of argumentation of the public debate and the notably polarized profile of the affective dispositions shown by participants. We use the thesis of emotivism to give a more significant analytical weighting to this research.

Minimally Invasive Surgery for Congenital Heart DiseaseThe Annals of Thoracic SurgeryPreviewMinimally invasive cardiac surgery for congenital heart disease has gained increasing acceptance within the specialty. However, most suitable candidates are still treated with a conventional median sternotomy. Adoption of minimally invasive techniques has proven essential in the surgical repair of acquired heart disease to increase patient satisfaction and to remain competitive in an ever-changing medical field. We herein summarize the currently available literature on minimally invasive congenital heart surgery. Full-Text PDF