Faculty Bibliography

BACKGROUND/UNASSIGNED:Pediatric cardiac surgery in developing countries poses many challenges. The practice of referring patients from abroad via nongovernmental organizations has occurred for many years. We describe our experience with international referrals for pediatric cardiac surgery via Gift of Life Mid-South to the Heart Institute, Le Bonheur Children's Hospital in Memphis, Tennessee. METHODS/UNASSIGNED:We performed a retrospective descriptive review of data collected in our Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) along with data from our electronic medical record from January 1, 2007, to December 31, 2017. Available data included patient demographics, diagnoses, surgical procedure, entire inpatient length of stay (LOS), complications, and operative mortality. Cardiac surgeries were grouped according to the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Categories (STAT Mortality Categories). Complications were defined according to the STS CHSD. RESULTS/UNASSIGNED:In this retrospective descriptive study, case complexity level varied; however, 38% cardiac surgeries were in STAT Mortality Category 3 or 4. Honduras was the most common referral source with a total of 18 countries represented. Operative mortality remained very low (1 [1.4%] of 71 cardiac surgeries) despite patients being referred beyond infancy. There were an increasing number of complications and longer inpatient LOS (with greater variance) in STAT Mortality Category 4. CONCLUSIONS/UNASSIGNED:International patients referred for congenital heart surgery can be successfully treated with an acceptable mortality rate despite late referrals. Inpatient LOS is related to surgical complexity. Follow-up studies are needed to determine the long-term outcomes of these patients.

Cardiac tumours are relatively uncommon, particularly in children. Myofibroma is an extremely rare variety of cardiac tumour, which nearly always arises in the context of infantile myofibromatosis. Herein, we present a case of a solitary cardiac myofibroma causing right ventricular outflow tract obstruction in a 2-month-old male infant.

Congenitally corrected transposition of the great arteries (CCTGA) is a rare congenital heart lesion with varied morphological presentation and can often by asymptomatic. A failing systemic right ventricle (RV) or increasing tricuspid regurgitation are generally indications for surgical intervention. The surgical approach depends upon the age of the patient and morphology of the lesion. Anatomical correction is associated with satisfactory long-term results.

Open heart surgery on infants with congenital heart lesions can be challenging not only in terms of the surgical procedure itself but also for setting up ideal conditions for safe and smooth conduct of cardiopulmonary bypass (CPB). The surgeon has to deal with a variety of lesions in a subgroup of patients who offer little room for any error. Familiarity with the principles of CPB, check lists and protocols go a long way in improving outcome in this critical group of patients.

Objective: The objective of this experimental study was to test the underlying physical laws behind a proposed novel device for failing Fontan and to investigate whether the device could be implemented theoretically to improve hemodynamics in failing Fontan circulation.
Method(s): A 4-arm setup (Figure 1) was designed and fabricated to simulate an actual Fontan circuit in the form of a junction of the superior and inferior vena cava (SVC, IVC) and the right and left pulmonary arteries (RPA, LPA). A provision for placement of an oscillating ball along the RPA-LPA path to provide a push to the fluid away from SVC and IVC was created. The setup was designed to vary the rate of oscillation of the ball, and the initial pressure of the fluid on SVC and IVC limbs. The time for pressure drop at the SVC and IVC was measured at varying oscillations of the ball and varying resistances in the RPA-LPA pathway. The test was considered positive if increasing oscillations of the ball allowed for quicker pressure drop in the SVC and IVC (indicating quicker discharge of fluid through the LPA and RPA). A total of 48 different experiments were conducted to simulate different physical conditions including without the ball and a graph of the results was plotted and analyzed to conclude (Graph 1).
Result(s): The time required for pressure drop in the experiment without the ball was the least across all set of readings. This meant that placing an oscillating ball along the RPA-LPA path obstructed fluid flow rather than enhancing it. It was also observed that increasing the rate of oscillation of the ball increased the degree of obstruction to flow.
Conclusion(s): The proposed novel method for intervention is not a suitable option for improving hemodynamics in failing Fontan circulation. (Figure Presented)