Background: Bi-directional Glenn shunt is a well-established procedure performed as a part of the single ventricle palliation pathway. The Bi-directional connection may also provide definitive palliation in certain patients. A major advantage of the cavopulmonary connection is that it diminishes the extent of the inevitable pulmonary recirculation, thereby resulting in a decrease in the workload of the functionally single ventricle. Objective: To compare the short-term outcome of Glenn operation in patients aged between 3 to 6 months and patients aged 6 months above. Patients and methods: Our study was a retrospective randomized trial, carried out in Cairo University Hospitals, in the period between October 2018 and May 2020. Study Population had been randomized into two groups. Group I: 20 patients who underwent Bi-directional Glenn aged 3 to 6 months & Group II: 20 patients who underwent Bi-directional Glenn aged more than 6 months. Results: There were significant differences between both groups regarding preoperative evaluation including age, weight, sizes of RPA & LPA and McGoon index. Unbalanced AV canal and DILV are most common diagnoses after tricuspid atresia as explained by their natural incidence in single ventricle diseases. There was significant increase in the O2 saturation in each group. There was insignificant difference between both groups regarding post-operative mortality and morbidity that met with many other similar studies. Conclusion: This approach had a number of advantages where it eliminates the need for the traditional first-stage procedures, such as systemic arterial shunting and PA banding, which minimizes PA manipulation and subsequent distortion. The reduction in the number of procedures will also have a favorable impact on cost.

Background: The multifactorial nature of pathologies causing mitral valve insufficiency in children along with the anticipated child's growth make mitral valve repair in such age group a complex procedure. The main cardiac surgeon's consideration in repairing insufficient mitral valve is to rgestore the valve's geometry and motility using the simplest possible technique. Objective: This study assessed mid-term feasibility and durability of mitral posterior annuloplasty using pericardial patch in patients aged less than 18 years as a simple technique of mitral valve repair. Patients and Methods: Data from Cairo University Hospitals on total number of 100 children who underwent successful mitral valve repair (without need for valve replacement) were gathered from their records, including postoperative and follow-up echocardiographic studies. Results: there were no in-hospital mortalities nor early postoperative significant mitral regurgitation (MR). Follow-up echocardiographic studies revealed moderate mitral regurgitation in 8 patients (8%) and only one patient (1%) required re-operation for severe mitral regurgitation where mitral valve replacement (MVR) was done. Conclusion: MV repair (MVr) in children using pericardial patch for posterior annuloplasty showed excellent survival, acceptable re-operation rate and satisfactory valve function at short and mid-term follow-up.

Background: Despite a wide variety of mitral prosthesis suturing, pledgeted annular sutures are preferred to lower the incidence of para-valvular leakage (PVL). However, there is limited evidence in the literature on the effect of non-plegeted sutures on such serious complication. Objective: The purpose of this study was to determine the safety and practicality of employing non-pledgeted sutures for Mitral valve replacement (MVR), especially regarding postoperative PVL. Patients and methods: Data on 100 patients with MVR were gathered from Cairo University Hospitals. Cases were split into two groups: group 1 underwent surgery using non-pledgeted horizontal sutures where in group 2 we used Teflon-pledgeted sutures. Preoperative, operative, and postoperative factors including follow-up echocardiographic examination one year following discharge, were compared between the two groups. Results: Both groups had similar preoperative characteristics, with group 1 including 49 patients compared to 51 patients in group 2. Data showed significantly shorter cross clamping (AXC) time in group 1 (p value < 0.05), intraoperative TEE has never observed para-prosthetic leakage in both groups, there was no significant difference regarding both mean ICU and hospital stay.

Background: Despite being controversial, left ventricular venting is still used to facilitate valvular heart surgeries and prevent distention. The classic way to vent the left ventricle is via the right superior pulmonary vein, which has many reported complications. Objective: We aimed to evaluate the effectiveness of pulmonary artery venting in patients undergoing mitral valve surgery who have elevated pulmonary artery pressure. Patients and Methods: 100 patients undergoing isolated mitral valve replacement, and having elevated pulmonary artery pressure were recruited in Cairo University Hospitals. They were divided into 2 groups; group 1 had pulmonary artery venting, and group 2 had no plmonary artery venting. Both groups were compared for preoperative, operative and postoperative variables. Results: Patients were divided into 2 groups; group 1 comprised 51 patients and had pulmonary artery venting, and group 2 comprised 49 patients and had no pulmonary artery venting. Both groups had similar preoperative characteristics, with group 1 having 14 minutes shorter cross clamping time (p value = 0.001), and 0.6 days shorter ICU stay (p value = 0.002), mean hospital stay was 6.4 ± 1.7 in group 1 and 8.7 ± 2.2 in group 2 (p value = 0.001). Conclusion:Using pulmonary artery venting during open heart surgery for mitral valve replacement, in patients with elevated pulmonary artery pressure is beneficial, facilitates the surgical procedure, and is associated with shorter ICU and hospital stay.

Background: Among the complications noted after debanding is those related to residual pulmonary stenosis. Removal of band without repairing pulmonary artery could be enough. Others recommend patching pulmonary artery at the site of band during debanding because of possibility of residual gradient caused by a residual shelf or narrowing and distortion of the arterial wall. This may necessitate re-operation especially if it leads to pressure over-load on the right ventricle.Objective: To compare between simple band removal and band removal with pulmonary artery repair using pericardial patch, at time of debanding; concerning early postoperative pressure gradients across the main pulmonary artery. Patients and methods: This retrospective observational study included 40 patients who underwent pulmonary artery debanding in the period between January 2016 and January 2020 at the Cardiothoracic Surgery Department, Cairo University hospitals and Atfal Masr Hospital. Patients were divided into two groups; group A, which included 20 patients who underwent simple band removal and group B, which included 20 patients who underwent pulmonary artery debanding with pericardial patch repair. Results:The median pressure gradient across the main pulmonary artery postoperatively was 15 mm Hg for group A (mean 22.58±18.0) and 10 mm Hg for group B (mean 11.3±8.0) with statistically significant value (p=0.020). 40.0% of cases in Group A had significant residual pressure gradient compared to only 10.0% of cases in Group B, and that difference was statistically significant (p=0.028). The median pressure gradient across the band immediate preoperatively was 60mmHg for group A (mean 62.0±9.8) and 70mmHg (mean 64.2±10.6) with statistically insignificant value (p=0.065). Conclusion: Pulmonary artery repair with pericardial patch showed the advantage of reducing the risk of significant residual pressure gradient across the band site over simple band removal in pulmonary artery debanding.