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Low Birth Weight and Very Low Birth Weight Neonates with Congenital Heart Disease: Timing of Surgery, Reasons for Delaying or not Delaying Surgery
Conventional management of low birth weight and very low birth weight neonates was composed of deferring corrective surgery by aggressive medical management or palliative surgery which does not require cardiopulmonary bypass. However, while waiting for weight gain, these neonates are at risk for various comorbidities. In the current era, this “wait and let the baby grow” approach has not been shown to result in better clinical outcomes. Early primary repair hence has become the standard strategy for congenital heart disease requiring surgery in these neonates. However, there still exist some circumstances, which are co...
Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual - September 19, 2013 Category: Cardiovascular & Thoracic Surgery Authors: V. Mohan Reddy Source Type: research

Pitfalls in Repair of Conotruncal Anomalies
Despite a wide anatomic diversity, the complete repair of all conotruncal anomalies includes two surgical steps. 1) An intracardiac tunnel is created to connect the left ventricle to one of the arterial orifices (usually the aortic, sometimes the pulmonary), through the conoventricular ventricular septal defect. Any conal septum should be resected to create a short, large, and straight tunnel. Abnormal insertions of the atrioventricular valves (tricuspid and mitral) on the conal septum should be preserved. “Intramural” residual ventricular septal defects must be avoided by anchoring the intracardiac patch directly to t...
Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual - September 19, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Olivier Raisky, Pascal R. Vouhé Source Type: research

Individualized Approach in the Management of Patients With Hypoplastic Left Heart Syndrome (HLHS)
Over the past decade new variations on the “classic” first stage palliation (the Norwood/BT shunt) for patients with Hypoplastic Left Heart Syndrome have emerged and been vetted by the medical community. A “one size fits all” approach may not be adequate anymore. In this review, the optimal indications for the various palliative options (Norwood/BT shunt, Norwood/RV-PA conduit, Hybrid Stage I with or without ductal stenting, heart transplantation) are reviewed from a standpoint of the initial anatomy and physiology of the patient, letting it guide clinical management. Current knowledge useful for decision-making is...
Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual - September 19, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Emile A. Bacha Source Type: research

Introduction
It is my pleasure to introduce the 2013 edition of the Pediatric Cardiac Surgery Annual. The overarching theme is “neonatal cardiac surgery.” While many pediatric cardiac surgical procedures have been well worked out and our overall outcomes have improved to the point that “mortality” is no longer useful as a statistical variable (because it occurs so rarely), neonatal cardiac repairs remain the last bastion of true surgical prowess. Nowhere is it truer that the technical outcome achieved by the surgeon at the time of exit from the operating room will determine the clinical outcome to an enormous degree. Perfection...
Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual - September 19, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Emile Bacha Source Type: research

Preface
The Pediatric Cardiac Surgery Annual of The Seminars in Thoracic and Cardiovascular Surgery includes topics from the 2012 AATS Congenital Post-Graduate Course and the Post-Graduate Skills Sessions. This year's Guest Editor, Dr Emile Bacha from Columbia University, has collected a number of important reviews on the complex areas of decision-making in congenital cardiothoracic surgery. Several of the papers discuss the options for management of patients with Hypoplastic Left Heart Syndrome, including the Hybrid Stage I as initial palliation or the right ventricle to pulmonary artery conduit versus the standard Norwood approa...
Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual - September 19, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Thomas L. Spray Source Type: research

Table of Contents
(Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual)
Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual - September 19, 2013 Category: Cardiovascular & Thoracic Surgery Source Type: research

In Favor of the Hybrid Stage 1 as the Initial Palliation for Hypoplastic Left Heart Syndrome
There are many reasons to consider using the Hybrid Stage 1 procedure as the initial palliation for hypoplastic left heart syndrome. It allows all options for treatment, including a delayed traditional approach, as well as a platform to evolve our overall approach to this challenging heart defect. (Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual)
Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual - April 12, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Mark Galantowicz Source Type: research

Neonatal Cardiopulmonary Bypass
Cardiac surgery with cardiopulmonary bypass is routinely used in neonates who require early repair of congenital heart diseases. However, the bypass temperature and use of deep hypothermic circulatory arrest, the composition of the priming and the acceptable degree of hemodilution, the prophylactic use of antifibrinolytic agents and steroids, the choice of myocardial protection, the best PaO2, and even the pump flow, are still subjects of debate, despite major improvements in neonatal bypass over the last decade. Nevertheless, there are some techniques that have reached a near-consensus and are highly recommended in neonat...
Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual - April 12, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Philippe Pouard, Mirela Bojan Source Type: research

The Norwood Procedure: In favor of the RV-PA Conduit
Evolution of the Norwood procedure has culminated in there currently being three treatment strategies available for initial management: the ‘classical’ Norwood (utilizing a Blalock-Taussig shunt), the Norwood with right-ventricle to pulmonary artery (RV-PA) conduit, and the ‘hybrid’ Norwood procedure utilizing bilateral pulmonary artery banding and ductal stenting. Each variant has its potential advantages and disadvantages, and this paper looks to examine the evidence in favor of each strategy, with emphasis on the supportive data for the RV-PA conduit. The ‘classical’ procedure has the benefit of the greatest...
Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual - April 12, 2013 Category: Cardiovascular & Thoracic Surgery Authors: David J. Barron Source Type: research

The Neonatal Hypoplastic Aortic Arch: Decisions and More Decisions
Neonatal patients with hypoplasia of the aortic arch constitute a heterogeneous group with a wide spectrum of severity. The milder end of the spectrum comprises patients with aortic coarctation and isthmus hypoplasia. At the other end of the spectrum are patients with severe transverse arch hypoplasia or hypoplastic left heart syndrome. The aim of this paper is to discuss the various strategies and surgical approaches available for this group of patients, focusing on the surgical decisions that influence individual patient management. Many of the things discussed are applicable to any neonatal arch problem. We also describ...
Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual - April 12, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Stephen M. Langley, Rachel E. Sunstrom, Richard D. Reed, Andrew J. Rekito, Rabin Gerrah Source Type: research

Strategies to Maintain Biventricular Circulation in Patients With High-Risk Anatomy
Although hypoplasia of left heart structures presents with a spectrum of severity, management decisions are typically dichotomous: single-ventricle palliation or biventricular repair. Since the long-term outcomes of single-ventricle palliation are sub-optimal, strategies to aggressively pursue biventricular circulation in patients with borderline left heart structures have been developed. Recent strategies and surgical techniques to rehabilitate the left heart in patients with borderline left heart are described. (Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual)
Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual - April 12, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Sitaram M. Emani, Pedro J. del Nido Source Type: research

Unbalanced Atrioventricular Septal Defect: Defining the Limits of Biventricular Repair
Unbalanced atrioventricular septal defect (uAVSD) is a challenging lesion with suboptimal outcomes in the current era. Severe forms of uAVSD mandate univentricular repair with well-documented outcomes. Determining the feasibility of biventricular repair (BVR) in patients with moderate forms of uAVSD is difficult. Ventricular hypoplasia has traditionally formed the cornerstone of defining uAVSD. However, malalignment of the atrioventricular junction and related derangements of the anatomy and physiology of the atrioventricular inflow play a central role in establishing and sustaining a biventricular end state. Atrioventricu...
Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual - April 12, 2013 Category: Cardiovascular & Thoracic Surgery Authors: David M. Overman, Kirsten B. Dummer, Francis X. Moga, David B. Gremmels Source Type: research

Neonatal Cardiac Care, a Perspective
Every year in the United States approximately 40,000 infants are born with congenital heart disease. Several of these infants require corrective or palliative surgery in the neonatal period. Mortality rates after cardiac surgery are highest amongst neonates, particularly those born prematurely. There are several reasons for the increased surgical mortality risk in neonates. This review outlines these risks, with particular emphasis on the relative immaturity of the organ systems in the term and preterm neonate. (Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual)
Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual - April 12, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Ganga Krishnamurthy, Veniamin Ratner, Emile Bacha Source Type: research

Low Birth Weight and Very Low Birth Weight Neonates with Congenital Heart Disease: Timing of Surgery, Reasons for Delaying or not Delaying Surgery
Conventional management of low birth weight and very low birth weight neonates was composed of deferring corrective surgery by aggressive medical management or palliative surgery which does not require cardiopulmonary bypass. However, while waiting for weight gain, these neonates are at risk for various comorbidities. In the current era, this “wait and let the baby grow” approach has not been shown to result in better clinical outcomes. Early primary repair hence has become the standard strategy for congenital heart disease requiring surgery in these neonates. However, there still exist some circumstances, which are co...
Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual - April 12, 2013 Category: Cardiovascular & Thoracic Surgery Authors: V. Mohan Reddy Source Type: research

Pitfalls in Repair of Conotruncal Anomalies
Despite a wide anatomic diversity, the complete repair of all conotruncal anomalies includes two surgical steps. 1) An intracardiac tunnel is created to connect the left ventricle to one of the arterial orifices (usually the aortic, sometimes the pulmonary), through the conoventricular ventricular septal defect. Any conal septum should be resected to create a short, large, and straight tunnel. Abnormal insertions of the atrioventricular valves (tricuspid and mitral) on the conal septum should be preserved. “Intramural” residual ventricular septal defects must be avoided by anchoring the intracardiac patch directly to t...
Source: Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual - April 12, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Olivier Raisky, Pascal R. Vouhé Source Type: research