Faculty Bibliography

BACKGROUND/UNASSIGNED:Polytetrafluoroethylene (PTFE), traditionally used for construction of Blalock-Taussig-Thomas (BTT) shunt, is associated with complications such as perioperative bleeding, thrombosis, and stenosis. Saphenous vein homografts (SVHs) are theoretically more hemostatic and less thrombogenic. METHODS/UNASSIGNED:A retrospective chart review was conducted of all infants who underwent BTT shunt placement between January 2015 and May 2023 to compare the use of blood and blood products in the operating room and within the first 24 hours after cardiac intensive care unit admission. Morbidity (unplanned reoperations, extracorporeal membrane oxygenation requirement, or dialysis) was also compared. RESULTS/UNASSIGNED:= .004) with SVH. There were no group differences in rate of shunt thrombosis or need for percutaneous intervention. Interstage mortality (8% vs 13%) and morbidity (8% vs 10%) were similar, as were hemodynamic data before shunt takedown. CONCLUSIONS/UNASSIGNED:SVH as BTT shunt is associated with significantly less perioperative bleeding compared with PTFE, with no differences in risk of thrombosis or need for percutaneous intervention.

The use of prostaglandin infusion to maintain patency of the ductus arteriosus in patients with critical coarctation of the aorta (CoA) to support systemic circulation is the standard of care. However, pulmonary overcirculation resulting from a patent ductus arteriosus in patients with critical CoA is not well described in the literature. We report two cases of critical CoA that required invasive measures to control pulmonary blood flow before surgical repair of the CoA. Both patients had signs of decreased oxygen delivery, hyperlactatemia, and systemic to pulmonary flow via the ductus arteriosus. One patient required surgical pulmonary artery banding and the second patient underwent pulmonary flow restrictor device placement for the control of pulmonary blood flow. A rapid improvement in oxygen delivery and normalization of lactate levels were observed after control of pulmonary overcirculation. Both patients underwent successful surgical repair of the coarctation A and were discharged home.

Extracorporeal life support (ECLS) therapy is increasingly being used to support children with refractory cardiorespiratory failure, but its use is occasionally associated with complications.1 Neonatal aortic dissection in association with ECLS is rare and the clinical sequelae of aortic dissection in neonates are poorly understood. We report a case of extensive type B aortic dissection in a neonate receiving ECLS therapy for refractory cardiogenic shock secondary to tachycardia-induced cardiomyopathy and Wolf Parkinson White (WPW) syndrome. The patient was noted to have aortic dissection along with multiple abdominal organ ischemic injury a day after ECLS arterial cannula position adjustment. The patient was rapidly decannulated from ECLS and the aortic dissection was managed conservatively with good outcome. We discuss our approach and rationale behind conservative management of this rarely reported complication associated with ECLS therapy and discuss available literature.

Myxomas are rare tumors in neonates and tend to have a different presentation compared to adults. We present an infant with a left atrial myxoma presenting with episodic tachycardia who underwent successful surgical excision. In addition, we performed a review of the literature, identifying 17 cases of neonatal myxomas. Unlike adults, neonatal myxomas are more common in males and occur more often on the right side of the heart. Constitutional symptoms such as fever or embolism are rare among neonates. Most patients have favorable outcomes following surgical excision, refuting earlier claims that neonatal myxomas are associated with poor outcomes.

We present the case of a 4-month-old, former 23-week premature baby who underwent patent ductus arteriosus device closure in the cardiac catheterisation lab with an Amplatzer Piccoloâ„¢ device at 12 weeks of life. This was complicated by late migration of the device into the aorta resulting in severe obstruction and requiring surgical intervention.