The Norwood procedure for hypoplastic left heart syndrome was successfully accomplished with complete avoidance of circulatory arrest by means of cerebral perfusion through the innominate artery combined with cannulation of the descending aorta. A conduit between the right ventricle and the pulmonary artery seems an excellent alternative pulmonary blood source, although right ventricular function needs to be carefully monitored.

No abstract

In neonate open-heart surgery, cardiopulmonary bypass (CPB) with extreme hemodilution induces an increased capillary permeability and accumulation of extravascular fluid, resulting in organ dysfunction. We evaluated the effects of a reduced priming volume for CPB and dilutional ultrafiltration (DUF) during neonatal open-heart surgery. Nineteen consecutive neonates with complete transposition of the great arteries who underwent an arterial switch operation were retrospectively assigned into two groups: the high-priming-volume circuit group (group A, n = 9) and the low-priming-volume circuit group (group B, n = 10). Patients in group B underwent surgery with a miniaturized CPB circuit and using the DUF technique. The priming volume of group B was nearly two-thirds that of group A. The water balance value after CPB and surgery was significantly lower in group B (-126 +/- 118 ml, -116 +/- 116 ml) than in group A (88 +/- 218 ml, 83 +/- 165 ml). Systolic blood pressure just after CPB was higher in group B (67.9 +/- 9.1 mmHg) than in group A (55.4 +/- 10.3 mmHg). Postoperative ventilatory support was shorter in group B (45 +/- 19 h) than in group A (68 +/- 27 h). In neonatal cardiac surgery, low-priming-volume CPB circuits and DUF improve the water balance during surgery and may attenuate any inflammatory reaction, which would help preserve postoperative organ function.

Mitral valve repair with expanded polytetrafluoroethylene sutures in children demonstrated favorable midterm outcome. The procedure is safe and effective, with potential for patients' growth.

lthough myxomas are the most common primary tumor of the heart, only a few cases are complicated by atrial septal defect (ASD) or patent foramen ovale. 1 Tumors involving both atria are also rare and found in less than 2.5% of all cases of myxoma. 2 We describe a case of a myxoma originating in the left atrium and growing through a secundum ASD into the right atrium. Case ReportA 55-year-old man was referred for urgent surgical resection of a right atrial tumor. Over the previous 3 months he had noticed mild shortness of breath on exertion. Physical examination revealed a blood pressure of 144/100 mmHg and pulse rate of 90 beats/min. Cardiac examination disclosed no pathological murmur. Laboratory analysis showed an elevated C-reactive protein concentration, and normal gamma globulins. A chest roentgenogram showed no cardiac enlargement with a 45.7% cardiothoracic ratio. Electrocardiography showed a normal sinus rhythm without right bundle-branch block. Transthoracic echocardiography demonstrated a 40-mm diameter, round tumor in the right atrium, but was unable to identify the point of attachment of the mass or the ASD. Transesophageal echocardiography (TEE) clearly demonstrated a large mass in the right atrium, which was attached by a pedicle to the base of the right pulmonary vein via a secundum ASD (Fig 1). Color flow mapping also showed a left-to-right shunt through the ASD. Coronary angiography showed 50% luminal narrowing of the left anterior descending artery and left circumflex artery which was feeding the tumor.At operation, cardiopulmonary bypass with moderate hypothermia was established, and the heart was arrested with cold blood cardioplegia. The right atrium was opened wide and a darkish brown gelatinous mass was found attached by a pedicle through a secundum ASD (12 mm in diameter) onto the lateral wall of the left atrium near the right pulmonary vein. The tumor was completely excised