Objectives: We studied these predictors at a single cardiac center. Methods: A retrospective cohort study was carried out after obtaining approval from the institutional review board. All patients (age, 0-14 years) who underwent congenital heart disease (CHD) surgery from January 2014 to June 2016 were included. Prolonged mechanical ventilation (PMV) was defined as >72 hours of ventilation. Results: A total of 257 patients were included, among whom 219 (85.2%) were intubated for >72 hours and 38 (14.8%) were intubated for ≥72 hours. Age (29.9 versus 11.95 years), weight (9.6 versus 5.9 kg), cross-clamp time (CCT) (53.6 versus 71.8 min), cardiopulmonary bypass time (CBP) (80.98 versus 124.36 min), length of stay in the pediatric intensive care unit (PICU) (10.4 versus 27.2 days), infection (12.8% versus 42.1%), open sternum (0.9% versus 13.2%), re-intubation (19.2% versus 39.5%), pulmonary hypertension (10.9% versus 31.6%), and impaired heart function (10.1% versus 23.7%) were associated with PMV. In terms of Risk Adjustment in Congenital Heart Surgery (RACHS) classification, only patients with RACHS 4 (18.4%) were associated with the risk for PMV. Conclusions: Age, weight, CBP, CCT, pulmonary hypertension, impaired cardiac function, and sepsis are risk factors for PMV. These factors should be considered when deciding surgery and in providing PICU care.

The results of our study suggest that low-dose CT LVEF protocol is feasible, accurate, and fast while delivering a lower radiation dose than traditional RNA.

Mitral leaflet perforations after surgical aortic valve replacement may be iatrogenic or due to endocarditis. We present a 20-year-old female who underwent surgical mechanical aortic valve replacement 8 months prior to this presentation for bicuspid severe aortic valve stenosis. She presented with acute decompensated heart failure with dyspnea and New York Heart Association (NYHA) functional class of III-IV. Transthoracic (TTE) and transesophageal echocardiography (TEE) demonstrated severe mitral regurgitation (MR) through an anterior mitral leaflet perforation. The patient refused surgical repair and percutaneous closure of the perforation was decided and performed using both antegrade and retrograde approaches. In this report, we emphasize the details and challenges of the procedure.

BACKGROUNDTranscatheter aortic valve implantation (TAVI) has been recognized as a valid alternative to surgery for severe aortic valve stenosis (AS) in high-risk surgical patients.OBJECTIVEDetermine first-year clinical outcomes for TAVI at Madinah Cardiac Center (MMC) in Saudi Arabia.DESIGNRetrospective, analytical cross-sectional.SETTINGTertiary cardiac care center.PATIENTS AND METHODSAll patients who underwent TAVI for severe AS between February 2013 and December 2016 were included. Clinical, imaging, and laboratory information at baseline and at one year follow-up were analyzed.MAIN OUTCOME MEASURESClinical and echocardiography outcomes at discharge, at 1-month, and at end of follow-up; one-year mortality, complications and clinical response to TAVI procedure.SAMPLE SIZE AND CHARACTERISTICSN=80, mean (SD) age 79.5 (10.6) years, with severe AS and high-surgical risk.RESULTSFifty-five (69.2%) patients received Core valves, and 25 (30.8%) received Edward valves. Peri-procedure mortality was 3.8% and 1-year post-operative mortality was 13.8%. Ten patients (12.5%) had life-threatening or major bleeding. Nineteen (23.8%) patients had vascular complications, which were mostly minor. Fourteen patients (17.5%) developed acute kidney injury and 86% of these patients recovered. Five patients (6.25%) had pericardial effusion. Two patients (2.5%) developed endocarditis and another 2 patients (2.5%) had cerebrovascular accidents. Five patients (6.25%) received pacemakers. Mean aortic valve gradient significantly reduced from a mean (SD) 47.6 (19) mm Hg to 10.7 (6.0) mm Hg (P<.001). New York Heart Association functional class was significantly reduced (P<.001).CONCLUSIONThe TAVI experience at MCC is encouraging and comparable to international outcomes in terms of success, morbidity, and mortality rate.LIMITATIONSRetrospective, relatively small sample size. Rate of minor bleeding was overestimated.

The recommended anticoagulation regimen for continuous-flow left ventricular assist device (LVAD) systems is warfarin and aspirin with a targeted international normalized ratio (INR) of 2.0-3.0. Our patient is a 58-year-old male who underwent surgical HeartMate III continuous-flow LVAD implantation 3 months ago outside the country. The patient mistakenly stopped taking warfarin for 1 month prior to presenting to our center for a routine visit. Luckily, the patient was doing very well without any complication despite the fact that his INR was 1.0.