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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

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

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

An unusual case of a solitary cardiac myofibroma causing severe right ventricular outflow tract obstruction in an infant

Minocha, Prashant K; Chen, Fei; Maleszewski, Joseph J; Ludomirsky, Achiau; Mosca, Ralph; Kumar, T K Susheel
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.
PMID: 33103641
ISSN: 1467-1107
CID: 4655742

Commentary: Tetralogy of Fallot: Will time tell? [Editorial]

Mosca, Ralph S
PMID: 31952823
ISSN: 1097-685x
CID: 4264642

Commentary: The Achilles' heel of the stage 1 palliation [Editorial]

Mosca, Ralph S
PMID: 31160107
ISSN: 1097-685x
CID: 3922552

Ubiquitin C-Terminal Hydrolase 1 and Phosphorylated Axonal Neurofilament Heavy Chain in Infants Undergoing Cardiac Surgery: Preliminary Assessment as Potential Biomarkers of Brain Injury

Lee, Timothy; Chikkabyrappa, Sathish M; Reformina, Diane; Mastrippolito, Amanda; Chakravarti, Sujata B; Mosca, Ralph S; Shaw, Gerry; Malhotra, Sunil P
BACKGROUND:There are no reliable markers to assess brain injury in neonates following cardiac surgery. We examine ubiquitin C-terminal hydrolase 1 (UCHL1) and phosphorylated axonal neurofilament heavy chain (pNF-H), neuronal-specific biomarkers released following axonal and cortical injury, in neonates undergoing cardiac surgery involving cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). METHODS:Twenty-six patients younger than three months were prospectively enrolled (CPB only, n = 12 and DHCA, n = 14). Healthy newborns (n = 22) served as the control. Blood samples were collected preoperatively and postoperatively upon intensive care unit admission (hour 0) and subsequently at 12, 24, 36, and 48 hours. Serum was tested for UCHL1 and pNF-H using enzyme-linked immunosorbent assay. Concomitant arterial blood gas, lactate, and cerebral near-infrared spectroscopy (NIRS) monitoring were performed. RESULTS:Ubiquitin C-terminal hydrolase 1 showed a significant rise at 0 hours in the DHCA group compared to baseline (74.9 ± 13.7 pg/mL vs 33.9 ± 37.3 pg/mL, P < .0001). Levels returned to baseline at 12 hours. There was an early rise in UCHL1 at 0 hours in the CPB group, P = .09. Phosphorylated axonal neurofilament heavy chain was decreased at 0 hours in both the CPB and DHCA groups compared to baseline, P = .06. There was no difference between control and baseline levels of UCHL1 ( P = .9) or pNF-H ( P = .77). Decreased NIRS was observed in the DHCA group at 0 hours (57.3 ± 10.5) versus baseline (64.2 ± 12.3), but not significant ( P = .21). There was no correlation between biomarkers and NIRS at 0 hours. CONCLUSION/CONCLUSIONS:A rapid rise in UCHL1 levels was observed in the DHCA group, suggesting that it may be a marker for acute brain injury. Follow-up with neurodevelopmental studies is ongoing.
PMID: 29945509
ISSN: 2150-136x
CID: 3162512

Anomalous aortic origin of a coronary artery: 90% of optimal therapy is 50% improved technology [Editorial]

Mosca, Ralph S
PMID: 29029818
ISSN: 1097-685x
CID: 2743272

Super Glenn: Able to Defeat Recalcitrant Pulmonary Vascular Adversaries? [Editorial]

Mosca, Ralph S
PMID: 29684550
ISSN: 1532-9488
CID: 3053002