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Commentary: Awareness: The First Step to Change [Editorial]

Kumar, T K Susheel
PMID: 34610456
ISSN: 1532-9488
CID: 5061852

Periscopic technique in Norwood operation is associated with better preservation of early ventricular function

Bhatla, Puneet; Kumar, Tk Susheel; Makadia, Luv; Winston, Brandon; Bull, Catherine; Nielsen, James C; Williams, David; Chakravarti, Sujata; Ohye, Richard G; Mosca, Ralph S
Objective/UNASSIGNED:Although the right ventricle (RV) to pulmonary artery conduit in stage 1 Norwood operation results in improved interstage survival, the long-term effects of the ventriculotomy used in the traditional technique remain a concern. The periscopic technique (PT) of RV to pulmonary artery conduit placement has been described as an alternative technique to minimize RV injury. A retrospective study was performed to compare the effects of traditional technique and PT on ventricular function following Norwood operation. Methods/UNASSIGNED:A retrospective study of all patients who underwent Norwood operation from 2012 to 2019 was performed. Patients with baseline RV dysfunction and significant tricuspid valve regurgitation were excluded. Prestage 2 echocardiograms were reviewed by a blinded experienced imager for quantification of RV function (sinus and infundibular RV fractional area change) as well as for regional conduit site wall dysfunction (normal or abnormal, including hypokinesia, akinesia, or dyskinesia). Wilcoxon rank-sum tests were used to assess differences in RV infundibular and RV sinus ejection fraction and the Fisher exact test was used to assess differences in regional wall dysfunction. Results/UNASSIGNED: = .002). Conclusions/UNASSIGNED:The PT for RV to pulmonary artery conduit in Norwood operation results in better preservation of early RV global and regional systolic function. Whether or not this benefit translates to improved clinical outcome still needs to be studied.
PMCID:8350951
PMID: 34401829
ISSN: 2666-2507
CID: 4989292

Commentary: Partial Atrioventricular Septal Defects in Adults: A Different Beast! [Editorial]

Kumar, T K Susheel
PMID: 33223154
ISSN: 1532-9488
CID: 4684692

Surgical Management of Giant Intrapericardial Teratoma Encasing the Coronary Artery

Minocha, Prashant; Hodzic, Emina; Sharma, Madhu; Bhatla, Puneet; Nielsen, James; Ramirez, Michelle; Magid, Margret; Fisher, Jason C; Mosca, Ralph; Kumar, Tk Susheel
Intrapericardial teratomas are rare, predominantly benign tumors that warrant surgical resection in the neonatal period because of their potential detrimental effects on the cardiorespiratory system. Surgical resection can be a challenge when the tumor encases and obscures a coronary artery. Adherence to certain operative principles is necessary to achieve successful outcomes.
PMID: 33888026
ISSN: 2150-136x
CID: 4852092

Commentary: God is in the details! [Editorial]

Kumar, T K Susheel
PMID: 33309091
ISSN: 1097-685x
CID: 4807282

Ebstein's anomaly in the neonate

Kumar, T K Susheel
Ebstein's anomaly is a rare congenital heart defect characterized by apical displacement of the tricuspid valve and reduced volume of the true functional right ventricle. In its most severe form, the disease presents as right heart failure and cyanosis in the neonate. Although many of these neonates can be managed conservatively, surgical intervention may become necessary in the sickest of them. Surgical intervention in this subgroup can be challenging and requires meticulous appreciation of the anatomy and physiology on a case to case basis. Multicenter studies are required to define a uniform algorithm and approach towards these patients.
PMCID:7859144
PMID: 33603283
ISSN: 0970-9134
CID: 4823262

The failing Fontan

Kumar, T K Susheel
Nearly 50 years back, Francis Fontan pioneered an operation for tricuspid atresia that bears his name today. The operation has since undergone numerous modifications and continues to be widely applied to an array of single ventricles. Despite restoring normal oxygen levels in the body, the operation creates a neoportal system where adequate cardiac output can be generated only at the expense of increased systemic venous congestion. This results in slow but relentless damage to the end organ systems especially the liver. Continuous surveillance of the patient to monitor this circulation, that will ultimately fail, is of paramount importance. Timely medical and cardiac catheterization and surgical intervention can extend the life span of Fontan patients. Ultimately a change of the hemodynamic circuit in the form of heart transplantation or ventricular assist device will be required to salvage the failing Fontan circuit.
PMCID:7859165
PMID: 33603286
ISSN: 0970-9134
CID: 4823272

Femoral artery homograft for coronary artery plasty following arterial switch operation [Case Report]

Mosca, Ralph; Chen, David; Halpern, Dan; Ma, Charles; Feinberg, Jodi; Bhatla, Puneet; Kumar, T K Susheel
PMCID:8303055
PMID: 34318024
ISSN: 2666-2507
CID: 4965442

Modified Warden operation using aortic homograft [Case Report]

Kumar, T K Susheel; Chen, David; Halpern, Dan; Bhatla, Puneet; Saharan, Sunil; Argilla, Michael; Mosca, Ralph
PMCID:8305712
PMID: 34318041
ISSN: 2666-2507
CID: 4949602

Single Institution Experience With International Referrals for Pediatric Cardiac Surgery

Rebolledo, Michael A; Kumar, T K Susheel; Tansey, James B; Pickens, Bill; Allen, Jerry; Hanafin, H Jane; Boston, Umar S; Knott-Craig, Christopher J
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.
PMID: 33164680
ISSN: 2150-136x
CID: 4668772