Arterial Switch Operation

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Editorial

Myocardial Bridge: Friend, Enemy, or Frenemy?

Biljana Parapid et al. Vladimir I. Kanjuh

First mentioned in 1737 by Reyman as an autopsy finding, described in 1922 by Crainicianu, named by Polacek in 1956, and angiographically shown by Portmann and Iwig in 1960, myocardial bridging encompasses the tunneled portion of a coronary artery, while the muscle band enveloping it is termed the myocardial bridge (MB). A myocardial bridge may remain silent lifelong or cause a myriad of clinical symptoms – from angina and ischemia, via syncope with arrhythmia^, and heart failure up to sudden death^, – however, not even children are spared irrelevant of the setting of the hypertrophic cardiomyopathy (HCMP).^,

From the mainly pathoanatomical standpoint, three main questions remain unanswered: (1) do ethnic differences render some corners of the world more susceptible to being born with this congenital coronary artery anomaly? (2) what are the implications of single or multiple MBs of single or multiple vessels even in the absence of HCMP? Furthermore, (3) what is the real atherosclerotic burden of the tunneled and peri-bridged segment?

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Transbaffle Puncture Using Multimodality Imaging and 3-D Mapping with CT Image Integration in a Patient with Atrial Flutter Post-Senning Procedure

Andreia Palma et al. Pedro A. Sousa Patrícia V. Silva António Pires

The complex post-surgical anatomy after the Senning procedure presents several challenges for catheter ablation. Transbaffle approach allows access to the pulmonary venous atrium and better catheter manipulation. However, this modified transseptal puncture can be challenging to perform.

The authors present the case of a 29-year-old woman who underwent a Senning procedure for dextro-transposition of the great arteries. The patient had recurrent episodes of atrial flutter despite adequate antiarrhythmic therapy and was referred for catheter ablation.

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ABC

Editorial

Coronary Arteries after Jatene Operation for Transposition of Great Arteries: The Role of CT Coronary Angiography on Follow-up

Antonio Joaquim Marinho-da-Silva

The correction of transposition of the great arteries (TGA) by the Jatene technique was one of the greatest achievements of cardiac surgery in congenital heart disease. By replacing the transposed arteries in their proper anatomical arrangement, this technique — atrial switch operation (ASO) – achieves a normal spatial arterial relationship. However, this new arrangement requires excision of the coronary artery buttons and their implantation in the new aorta. The difficulty of this step relates to the type of coronary origin and distance to the new insertion site.

Once this anatomical normalization step has been achieved, cardiac functional normalization is sought. The most common post-surgical complications are related to the complexity of associated anomalies (ventricular septal defect (VSD), coarctation of the aorta, valve stenosis, and others), suture sites of the neovessels, pulmonary ramification and dilation of the neoaorta, Not neglectable and object of concern, late complications of either congenital or acquired coronary circulation are well known. The actual incidence of such complications ranges from 0,8% to 27,5% according to reporting series and time of follow-up.^,

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Original Article

Evaluation of Coronary Circulation after Arterial Switch Operation

Mariana Nicoletti Ferreira Baldo et al. Henrique Simão Trad Tarcisio José da Silva Junior Paulo Henrique Manso

Abstract

Background

Coronary artery evaluation remains after arterial switch operation a clinical challenge.

Objective

This study aims to correlate anatomical changes diagnosed by cardiac computed tomography (CCT) with physiological alterations on clinical evaluation to diagnose coronary obstruction in late ASO patients.

Methods

This study included 61 consecutive patients with mean age of 9.4 years who underwent ASO. The patients were submitted to echocardiography, electrocardiography, cardiopulmonary exercise test, and cardiac computed tomography to evaluate functional capacity and coronary artery anatomy.

Results

Cardiac computed tomography revealed that only 3.3% of the patients had coronary stenosis. These patients were asymptomatic, and no signs of myocardial ischemia were detected by the tests.

Conclusion

The incidence of coronary abnormalities in late ASO patients was 3.3% in our cohort. There is no clear guideline as to why, when, and how these patients should be screened or what to propose when a coronary obstruction is diagnosed in asymptomatic patients.

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IJCS

Editorial

Risk Factors for Mortality in Pediatric Cardiac Intensive Care Unit

Cristiane Martins et al. Bruna M. N. Gama

Congenital heart defect commonly requires care in pediatric intensive care unit (PICU). They are a heterogeneous group of disorders with an annual incidence of 25,757 new cases in Brazil, 12 cases per 1,000 inhabitants . In this paper, Guimarães et al., published a cross-sectional study to describe the epidemiology of patients admitted to PICU from a tertiary hospital in Brazil. In this editorial, we review recent progress in understanding the risk factors for mortality in PICU. The editorial was produced by searching Pubmed and Scielo, using the terms “PICU”, “RACHS”, “CHD”, and “mortality”.

Congenital heart defects (CHD) are serious and common conditions that have a significant impact on morbidity, mortality and healthcare costs in both children and adults. It is estimated that at least 32,000 infants in the United States will be affected each year by CHD. Of these, approximately 25%, or 2.4 per 1,000 live births require invasive treatment in the first year of life. While advances in treatment in the last decades have decreased infant mortality, they have also led to an increase in the number of children and adults with CHD. Despite these advances and developments in interventional and surgical techniques, heart disease in children remains an important cause of morbidity and mortality.

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Myocardial Bridge: Friend, Enemy, or Frenemy?

Transbaffle Puncture Using Multimodality Imaging and 3-D Mapping with CT Image Integration in a Patient with Atrial Flutter Post-Senning Procedure

Coronary Arteries after Jatene Operation for Transposition of Great Arteries: The Role of CT Coronary Angiography on Follow-up

Evaluation of Coronary Circulation after Arterial Switch Operation

Abstract

Background

Objective

Methods

Results

Conclusion

Risk Factors for Mortality in Pediatric Cardiac Intensive Care Unit

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