Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual RSS feed: Current Issue. The Pediatric Cardiac Surgery Annual is a companion to Seminars in Thoracic and Cardiovascular Surgery . Together with the Seminars, the Annual provides complete coverage of the specialty by focusing on important developments in pediatric cardiac surgery. Each annual volume has an expert guest editor who invites prominent surgeons to review the areas of greatest change in pediatric cardiac surgery during the year. Topics include 1) Complete Atrioventricular Canal; 2) New Concepts of Cardiac Anatomy and Function -- The Helical Heart; 3) Valve Reconstruction (Replacement) in Congenital Heart Disease; 4) Evolving Developments in Congenital Heart Surgery. 2008 Topics: Expanding the Scope of Congenital Heart Surgery - A Global Imperative • Congenital Heart Surgery in Developing Countries • Birth of a New Pediatric Cardiac Surgery Programin Mexico City: The Kardias Experience Techniques in Pediatric/Congenital Heart Surgery • Management of Complex Aortic Problems in Children • Technique of Singel-Stage Repair of coarctation of the Aorta with Ventricular Septal Defect • Reconstructive Methods for Anomalous Systemic Venous Return: Surgical Management of Persistent Left Superior Vena Cava • Intracardiac Repair of Double Outlet Right Ventricle • Maze Procedure in Single Ventricle Patients Controversies in Pediatric/Congenital Heart Surgery • Perioperative Neuroprotective Strategies • Routine Continuous Perfusion for Aortic Arch Reconstruction in the Neonate • Principles of Antegrade Cerebral Perfusion during Arch Reconstruction in Newborns/Infants • The Fate of the Retrained Left Ventricle After Double Switch Procedure for Congenitally Corrected Transposition of the Great Arteries Pediatric Thoracic Transplantation • Pediatric Lung Transplantation: A Therapy in Its Adolescence • Mechanical Circulatory Support as a Bridge to Pediatric Cardiac Transplantation The Future of Congenital Heart Surgery • The American Board of Thoracic Surgery's Perspective on the Future of Congenital Heart Surgery Education • Prospectives on "Success" in Congenital Heart Surgery http://www.semtcvspeds.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual1092-91261512012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.semtcvspeds.com/article/PIIS109291261200021X/abstract?rss=yesTable of Contents10.1053/S1092-9126(12)00021-XSeminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 15, 1 (2012)Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual151S1092-9126(12)X0002-4iiiivhttp://www.semtcvspeds.com/article/PIIS1092912612000038/abstract?rss=yesThe 2011 Pediatric Cardiac Surgery Annual of the Seminars in Thoracic and Cardiovascular Surgery includes topics from the 2011 AATS Congenital Post-Graduate Course and Post-Graduate Skills Sessions. This year's guest editor, Dr. Pedro del Nido from Boston Children's Hospital, has collected an outstanding group of authors to focus on treatment of valvular heart disease. Techniques for valve repair in many forms of complex congenital heart disease are becoming increasingly important as efforts to avoid prosthetic valve replacement in children continue. The increasing number of patients with single-ventricle malformations and heterotaxy syndrome with common AV valves bring a large population who require valvular reparative techniques for optimum palliation with the Fontan operation. Aortic and mitral valve reparative techniques in adults have progressed rapidly and these techniques are becoming increasingly utilized in the pediatric population.PrefaceThomas L. Spray10.1053/j.pcsu.2012.01.002Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 15, 1 (2012)Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual151S1092-9126(12)X0002-411http://www.semtcvspeds.com/article/PIIS1092912612000026/abstract?rss=yesThe 2012 Pediatric Cardiac Surgery Annual of the Seminars in Thoracic and Cardiovascular Surgery is a collection of manuscripts derived from the presentations at the 2011 AATS Post Graduate Course in congenital heart surgery. The 2011 course was dedicated to the surgical management of congenital valve anomalies. The papers contained in this volume cover the range of valve abnormalities and surgical options for reconstruction or replacement alternatives. Emphasis was placed on techniques and the authors have provided a compendium of “how to” documents in their area of expertise.IntroductionPedro J. del Nido10.1053/j.pcsu.2012.01.001Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 15, 1 (2012)Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual151S1092-9126(12)X0002-422http://www.semtcvspeds.com/article/PIIS109291261200004X/abstract?rss=yes The introduction of effective and durable leaflet repair techniques have enabled repair of the regurgitant aortic valve. Aortic valve repair is favored to avoid the placement of a prosthesis that the patient will likely outgrow. Furthermore, repair has the potential to reduce the incidence of prosthesis-related complications, including endocarditis, thromboembolism, anticoagulant-related hemorrhage, and reoperation. The primary goal of all aortic valve repair is to restore a durable surface of coaptation to the regurgitant valve. The key to successful leaflet repair for aortic insufficiency is a thorough understanding of the mechanism of dysfunction. We have developed a systematic approach to the assessment and repair of aortic insufficiency because of leaflet disease. The combination of leaflet repair and functional aortic annulus annuloplasty can restore the proper geometry of the aortic valve complex and allow for successful repair of aortic insufficiency caused by both restriction and prolapse. Aortic Valve Insufficiency: Leaflet Reconstruction TechniquesJoel Price, Gebrine El Khoury10.1053/j.pcsu.2012.01.003Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 15, 1 (2012)Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual151S1092-9126(12)X0002-4The Aortic Valve38http://www.semtcvspeds.com/article/PIIS1092912612000051/abstract?rss=yes Considering the structure and function of the aortic root, changes in the aortic valve leaflets and changes in the geometry of the aortic root are the two primary causes of aortic valve dysfunction. In adults, aortic valve sparing reconstruction has a long history beginning in the 1970s, where tensor fascia was used for leaflet repair in patients with isolated aortic regurgitation and ascending aortic replacement was used in patients with ascending aortic aneurysms or aortic ectasia. Subsequent progress in the 1980s and 1990s led to pericardial leaflet replacement and aortic root re-implantation and remodeling. However, it has not been until the last decade that these concepts and techniques have been applied in younger patients focusing on the conotruncus, valvar apparatus, sino-tubular junction, and ascending aorta. Aortic Valve Reconstruction in the Young Infants and ChildrenChristopher W. Baird, Patrick O. Myers, Pedro J. del Nido10.1053/j.pcsu.2012.01.004Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 15, 1 (2012)Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual151S1092-9126(12)X0002-4The Aortic Valve919http://www.semtcvspeds.com/article/PIIS1092912612000063/abstract?rss=yes Aortic aneurysms are rare in children and are often associated with connective tissue disorders. Because prosthetic valves are problematic in the young, operations that preserve the native aortic valve are attractive. This article describes an operative technique for valve sparing aortic root replacement that is simple and reproducible, and has probvided durable results at mid-term follow-up. Valve-Sparing Aortic Root ReplacementDuke Cameron10.1053/j.pcsu.2012.01.005Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 15, 1 (2012)Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual151S1092-9126(12)X0002-4The Aortic Valve2023http://www.semtcvspeds.com/article/PIIS1092912612000075/abstract?rss=yes Given late outcomes of patients with tetralogy of Fallot repaired in the 1970s and 1980s, as well as a better understanding of the late deleterious effects of pulmonary regurgitation, there is a tendency toward preservation of the pulmonary valve function during primary repair of tetralogy of Fallot. The bar keeps moving downward, to include smaller and more dysmorphic pulmonary valves. This article reviews some useful indications and techniques for valve-sparing options, including intraoperative balloon dilation and cusp reconstruction using a patch. Just like other valve repair techniques, no one technique can be applied uniformly, and surgeons must master a wide armamentarium of techniques. Valve-Sparing Options in Tetralogy of Fallot SurgeryEmile Bacha10.1053/j.pcsu.2012.01.006Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 15, 1 (2012)Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual151S1092-9126(12)X0002-4The Pulmonary Valve2426http://www.semtcvspeds.com/article/PIIS1092912612000087/abstract?rss=yes Residual right ventricular (RV) outflow tract pathology is universal among patients with repaired tetralogy of Fallot, and pulmonary regurgitation (PR) is also commonly present. Although tolerated in early life, by the second decade of life PR is associated with an increased risk of death because of ventricular arrhythmias. Pulmonary valve replacement (PVR) is a safe procedure that will eliminate PR, but timing and indications are evolving. Patients with arrhythmias or prolonged QRS duration are candidates for PVR. Patients with symptomatic exercise intolerance are likely to have improvement in symptoms and quality of life and should be offered PVR. Cardiac magnetic resonance has become an essential component of the management of the patient with tetralogy of Fallot with PR, and has identified the potential for and limitations of RV remodeling following PVR. Among patients with severe RV enlargement, particularly those with diminished RV or left ventricular function, there is an increased risk of adverse events and even asymptomatic patients with severe PR should be considered for PVR. Valve replacement is accomplished with homografts or heterografts, either stented bioprosthetic valves or valved conduits. In a retrospective analysis of the Children's Hospital of Wisconsin experience with PVR, there was no difference in survival or freedom from reintervention between heterografts and homografts. Timing and Technique of Pulmonary Valve Replacement in the Patient With Tetralogy of FallotJames S. Tweddell, Pippa Simpson, Shun-Hwa Li, Jennifer Dunham-Ingle, Peter J. Bartz, Michael G. Earing, Andrew N. Pelech10.1053/j.pcsu.2012.01.007Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 15, 1 (2012)Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual151S1092-9126(12)X0002-4The Pulmonary Valve2733http://www.semtcvspeds.com/article/PIIS1092912612000166/abstract?rss=yes This article reviews current data on various prostheses utilized for pulmonary valve replacement. Durability data is reviewed and risk factors for deterioration are examined. Finally, the choice of prosthesis should be tailored to the specific clinical scenario based on existing data regarding durability and risk factors. Options for Prosthetic Pulmonary Valve ReplacementSitaram M. Emani10.1053/j.pcsu.2012.01.015Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 15, 1 (2012)Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual151S1092-9126(12)X0002-4The Pulmonary Valve3437http://www.semtcvspeds.com/article/PIIS1092912612000099/abstract?rss=yes Ebstein's anomaly is a cardiac malformation affecting the tricuspid valve and right ventricle with a wide range of anatomic and pathophysiologic presentations. The cone repair technique is described in detail, as applied to several types of this complex congenital heart disease. The importance of extensive mobilization of displaced and tethered tricuspid leaflets to permit a good leaflet-to-leaflet coaptation after the cone construction is highlighted. This technique was performed in 100 patients with a hospital mortality rate of 3.0%, good clinical outcome, and no need for tricuspid valve replacement. Echocardiograph results showed good anatomic and functional tricuspid valves at immediate and long-term postoperative follow-up. Ebstein's Anomaly of the Tricuspid Valve: The Cone RepairJose Pedro da Silva, Luciana da Fonseca da Silva10.1053/j.pcsu.2012.01.008Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 15, 1 (2012)Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual151S1092-9126(12)X0002-4The Tricuspid Valve3845http://www.semtcvspeds.com/article/PIIS1092912612000105/abstract?rss=yes Congenital tricuspid valve regurgitation (TR) is a relatively uncommon condition that includes a heterogeneous group of lesions with a unique management strategy. There are wide anatomic variations that lead to congenital TR in patients without Ebstein malformation. Possible etiologies may include primary valve abnormalities (eg, congenital absence of chordae) or other forms of tricuspid valve dysplasia as in congenitally unguarded tricuspid valve, and patients with pulmonary atresia and intact ventricular septum, which can be similar to Ebstein's valves or secondary regurgitation in association with other anomalies as in atrioventricular septal defects, right ventricular outflow tract obstructive lesions (pulmonary stenosis or atresia with ventricular septal defect [VSD]), tricuspid valve annular dilatation in association with right ventricular volume overload lesions as in congenital coronary arterial fistula with secondary right ventricular enlargement, and Uhl's anomaly. Iatrogenic etiologies in the congenital population include TR secondary to previous VSD closure (chordal or leaflet injury), pacemaker or internal cardiac defibrillator lead-induced TR, and traumatic TR (ruptured chordae). Presentation depends on the severity of the disease and may be apparent in infancy, childhood, or adulthood. Surgical Management of Congenital (Non-Ebstein) Tricuspid Valve RegurgitationSameh M. Said, Harold M. Burkhart, Joseph A. Dearani10.1053/j.pcsu.2012.01.009Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 15, 1 (2012)Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual151S1092-9126(12)X0002-4The Tricuspid Valve4660http://www.semtcvspeds.com/article/PIIS1092912612000117/abstract?rss=yes Tricuspid valve performance in the systemic circulation is known to have important implications for survival and functional status after univentricular palliation of hypoplastic left heart syndrome (HLHS). Moderate to severe tricuspid valve regurgitation is not an uncommon finding in patients with HLHS undergoing staged surgical reconstruction. It can result from either abnormal valve morphology or incomplete leaflet coaptation, or both. But first and foremost, any aortic arch re-obstruction must be excluded. Development of significant tricuspid regurgitation (TR) remains an obstacle in improving survival after the Norwood procedure and likely compromised functional health after the Fontan procedure. Thus, surgical intervention for minimizing tricuspid valve deterioration and significant TR seems pivotal to improving long-term outcomes for patients with HLHS. This article provides an overview of the etiology and mechanisms of development of significant TR, natural history, indications for surgical intervention, and focuses on timing, techniques, and clinical outcomes of tricuspid valve repair in the setting of single ventricle. Tricuspid Valve Repair in Single Ventricle: Timing and TechniquesVictor T. Tsang, Shahzad G. Raja10.1053/j.pcsu.2012.01.010Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 15, 1 (2012)Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual151S1092-9126(12)X0002-4The Tricuspid Valve6168http://www.semtcvspeds.com/article/PIIS1092912612000129/abstract?rss=yes Congenital mitral valve stenosis is a heterogeneous group of lesions that can occur as an isolated defect or, more commonly, in association with other left heart obstructive defects. Age at presentation, presence and severity of pulmonary hypertension, and location of the primary obstructing lesion have been shown to be important risk factors for survival and long-term outcomes. Anatomic features vary, and obstructing tissue or tethering structures can be present at all levels of the valve, including supra-annular, intra-leaflet, and sub-valvar. Surgical techniques aim to remove abnormal tissue that is causing the obstruction or impediment to adequate leaflet mobility, and improve the mobility of the sub-valve structures. We describe a series of surgical options for mitral valve reconstruction that address the specific pathologies frequently found in congenital mitral stenosis. Congenital Mitral Valve Stenosis: Anatomic Variants and Surgical ReconstructionPedro J. del Nido, Christopher Baird10.1053/j.pcsu.2012.01.011Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 15, 1 (2012)Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual151S1092-9126(12)X0002-4The Mitral Valve6974http://www.semtcvspeds.com/article/PIIS1092912612000130/abstract?rss=yes Mitral valve regurgitation (MR) is an important source of morbidity and mortality worldwide. While globally the primary etiology is rheumatic, the incidence of MR appears to be increasing in the United States as well. There are multiple etiologies for MR, and the specific pathologic anatomy varies widely. Similarly, there are a multitude of options for operative repair, and recent series report very good survival rates as well as freedom from re-intervention. Mitral Regurgitation in Congenital Heart Defects: Surgical Techniques for ReconstructionRichard G. Ohye10.1053/j.pcsu.2012.01.012Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 15, 1 (2012)Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual151S1092-9126(12)X0002-4The Mitral Valve7579http://www.semtcvspeds.com/article/PIIS1092912612000142/abstract?rss=yes The mitral valve is the most commonly affected valve in acute and chronic rheumatic heart disease in the first and second decades of life. Pure or predominant mitral regurgitation with non-significant stenosis (mitral valve area > 1.5 cm2 on echocardiography) is the most frequently encountered valvular dysfunction in children. In our experience, based on 428 children operated between 1993 and 2011 at our institution, functional classification based on leaflet motion assessed by echocardiography and reconfirmed peroperatively revealed pure annulus dilatation (type I) in 7% of patients, anterior leaflet prolapse (type IIa) in 33%, combination of anterior leaflet pseudoprolapse with restricted motion of the posterior leaflet (type pseudoIIa/IIIp) in 34%, and restricted anterior and posterior leaflet motion (type IIIa/p) in 26%. Patients with type III were older than those with type IIa and type pseudoIIa/IIIp. Different techniques can be used to repair rheumatic mitral valve lesions: prolapse of the anterior leaflet caused by chordal elongation or rupture can be treated by chordal shortening, chordal transfer, or artificial chordal replacement; restricted motion of the anterior and/or posterior leaflet can be treated by commissurotomy, splitting of the papillary muscles, resection of the secondary, or sometimes primary posterior chordae, posterior leaflet free edge suspension, leaflet thinning, and leaflet enlargement using autologous pericardium. Because mitral annulus dilatation is present in almost all patients with mitral regurgitation, concomitant ring annuloplasty offers more stability in valve repair, improving long-term outcome. The major causes for failure of rheumatic mitral valve repair are the presence of ongoing rheumatic inflammation at the time of surgery, use of inappropriate techniques, technical failures requiring early reoperation, lack of concomitant ring annuloplasty, and progression of leaflet and chordal disease further resulting in more leaflet retraction, thickening, and deformity. Freedom from reoperation depends on mitral regurgitation functional type, the type IIa and type pseudoIIa/IIIp having a better long-term outcome than type I and type III, in our series. In conclusion, mitral valve repair should be a preferred strategy in children with rheumatic heart disease whenever feasible, providing stable actuarial survival with fewer thromboembolic complications in a pediatric population noncompliant to anticoagulation. The Rheumatic Mitral Valve and Repair Techniques in ChildrenAfksendiyos Kalangos10.1053/j.pcsu.2012.01.013Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 15, 1 (2012)Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual151S1092-9126(12)X0002-4The Mitral Valve8087http://www.semtcvspeds.com/article/PIIS1092912612000154/abstract?rss=yes Heterotaxy syndrome is a mortality risk factor for patients with complex heart disease. These patients often have common atrioventricular valve (CAVV) morphology and significant atrioventricular valve regurgitation – yet another mortality risk factor in congenital heart disease. Thus, patients with both heterotaxy syndrome and atrioventricular valve regurgitation are at highest risk of mortality. A large number of patients with heterotaxy syndrome have CAVV and a functional single ventricle. These patients are more difficult to operate than patients with biventricular morphology because in the former, the CAVV is often less adapted to systemic afterload than the mitral valve. Herein, we present the results of atrioventricular valve repair surgeries performed at the Okayama University Hospital on patients with heterotaxy syndrome, atrial isomerism, and a functional single ventricle. In addition, we review the current literature in this typically challenging patient population. In-depth understanding of reasonable management strategies and resolution of technical issues will help guide surgeons during this procedure. Atrioventricular Valve Repair for Patient With Heterotaxy Syndrome and a Functional Single VentricleShunji Sano, Yasuhiro Fujii, Sadahiko Arai, Shingo Kasahara, Atsushi Tateishi10.1053/j.pcsu.2012.01.014Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 15, 1 (2012)Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual151S1092-9126(12)X0002-4The Mitral Valve8895