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Aortic migration of Amplatzer Piccoloâ„¢ ductal Occluder

Minocha, Prashant K; Sutton, Nicole; Crawford, Maya T; Williams, David; Ramirez, Michelle; Chakravarti, Sujata; Mosca, Ralph; Kumar, T K Susheel
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.
PMID: 35199639
ISSN: 1467-1107
CID: 5172272

Preservation of Antegrade Pulmonary Blood Flow in Kawashima Procedure With Prior Right Ventricular Outflow Tract Stent

Bhansali, Suneet; Bhatla, Puneet; Argilla, Michael; Saharan, Sunil; Mosca, Ralph; Kumar, Tk Susheel
Surgical management of single ventricle with interrupted inferior vena cava and azygos continuation typically requires a Kawashima procedure with subsequent completion of Fontan. However, this group is at risk of development of pulmonary arteriovenous malformations. Evidence suggests preservation of hepatic venous flow into the pulmonary circulation can potentially delay this development. We hereby describe a method of preserving antegrade pulmonary blood flow during the Kawashima procedure in the setting of prior right ventricular outflow tract stents.
PMID: 35171728
ISSN: 2150-136x
CID: 5163502

Risk Stratification for Congenital Heart Surgery for ICD-10 Administrative Data (RACHS-2)

Allen, Philip; Zafar, Farhan; Mi, Junhui; Crook, Sarah; Woo, Joyce; Jayaram, Natalie; Bryant, Roosevelt; Karamlou, Tara; Tweddell, James; Dragan, Kacie; Cook, Stephen; Hannan, Edward L; Newburger, Jane W; Bacha, Emile A; Vincent, Robert; Nguyen, Khanh; Walsh-Spoonhower, Kathleen; Mosca, Ralph; Devejian, Neil; Kamenir, Steven A; Alfieris, George M; Swartz, Michael F; Meyer, David; Paul, Erin A; Billings, John; Anderson, Brett R
BACKGROUND:As the cardiac community strives to improve outcomes, accurate methods of risk stratification are imperative. Since adoption of International Classification of Disease-10th Revision (ICD-10) in 2015, there is no published method for congenital heart surgery risk stratification for administrative data. OBJECTIVES/OBJECTIVE:This study sought to develop an empirically derived, publicly available Risk Stratification for Congenital Heart Surgery (RACHS-2) tool for ICD-10 administrative data. METHODS:The RACHS-2 stratification system was iteratively and empirically refined in a training dataset of Pediatric Health Information Systems claims to optimize sensitivity and specificity compared with corresponding locally held Society of Thoracic Surgeons-Congenital Heart Surgery (STS-CHS) clinical registry data. The tool was validated in a second administrative data source: New York State Medicaid claims. Logistic regression was used to compare the ability of RACHS-2 in administrative data to predict operative mortality vs STAT Mortality Categories in registry data. RESULTS:The RACHS-2 system captured 99.6% of total congenital heart surgery registry cases, with 1.0% false positives. RACHS-2 predicted operative mortality in both training and validation administrative datasets similarly to STAT Mortality Categories in registry data. C-statistics for models for operative mortality in training and validation administrative datasets-adjusted for RACHS-2-were 0.76 and 0.84 (95% CI: 0.72-0.80 and 0.80-0.89); C-statistics for models for operative mortality-adjusted for STAT Mortality Categories-in corresponding clinical registry data were 0.75 and 0.84 (95% CI: 0.71-0.79 and 0.79-0.89). CONCLUSIONS:RACHS-2 is a risk stratification system for pediatric cardiac surgery for ICD-10 administrative data, validated in 2 administrative-registry-linked datasets. Statistical code is publicly available upon request.
PMID: 35115103
ISSN: 1558-3597
CID: 5153032

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