NIV-NAVA has advantages compared with NIPPV as the NIV for premature infants after extubation. NIV-NAVA can also be used safely without a significant difference in the rate of complications compared with NIPPV.

Background: The condition of pulmonary vasculature is a key to determine the outcome of Fontan candidates. The previous reports described no significant growth of pulmonary arteries (PA) after having bi-directional Glenn shunt (BDG), which may influence peri- and post-operative management of Fontan procedure. Aim: We hypothesized the pulmonary vasodilators (PVDs) facilitate to grow small PA even after BDG in Fontan Candidates. Method: The twenty-one cases after BDG, whose PA index (Nakata index) were less than 140 mm 2 /m 2 , were enrolled. The enrolled cases were divided into two group: 15 with PVDs treatment ( PV+) and 6 without (PV-). PVDs used in this study were PDE5 inhibitor, Endothelin-receptor-blocker, oral prostacyclines , and their combination. In addition to measure the hemodynamic parameters ( mean PA pressure(mPAp), indexed pulmonary vascular resistance (Rp), Pulmonary flow (Qp) ), PA index and PA branch index ( a sum of cross-sectional area of first PA branches at both side indexed by body surface area) were measured and compared at the timing of after BDG and at after Fontan completion, respectively. Result: PA index and PA branch index after BDG of (PV+) and (PV-)were 104±33 vs 104±17 mm 2 /m 2 : 151±33 vs 194±45 mm 2 /m 2 . PA index in both groups after Fontan procedure was increased up to 153±42 vs 152±56 mm 2 /m 2 in same fashion, while PA branch index of (PV+) was significantly increased up to 199±60 than that of (PV-) 226±65 mm 2 /m 2 (% increase was 131% vs 116%). Rp and mPAp in both groups were not changed , while Qp in (PV+) was significantly more increased (140%) than that in (PV-)(107%). In conclusion, PVDs facilitates the growth of PA branches by increasing Qp, which brings a favor outcome of Fontan patients.

Introduction: Although the management of body water balance on cardiac surgery with cardiopulmonary bypass (CPB), especially in children, is essential, little is known how body water composition changes around CPB. We aim to evaluate a change of intracellular (ICW), extracellular (ECW), and total body water composition (TBW) before and after CPB, using bioelectrical impedance analysis (BIA). Hypothesis: There is a possibility that the fluid distribution and water balance change depends on intraoperative water balance management and age. Then we investigate the impact of (1) intraoperative water balance management and (2) age at operation on changes of body water composition. Methods: The forty-five children weighing over 5Kg (Age ranges 3mo-11yo) were enrolled to this study. The body water balance was measured at before, at immediately after CPB, at 1 day, and at 2 days, respectively. Each parameter was compared by the factor of intraoperative water balance and that of age at operation. Results: The minus water balance during CPB results in significant shortage of ICW which not fully recovered by 2 days after CPB (Figure A). Cases >2yo developed a decrease of ICW and ECW 2 days after CPB, while those <2yo increased (Figure B). Conclusions: The body water composition significantly changes along CPB than expected. Care must be taken to prevent a harmful dehydration by controlling intraoperative water balance management and by age on the basis of BIA.

Background Atrioventricular valve (AVV) regurgitation enormously affected the survival outcome of the patients with congenital heart disease (CHD). However, the image quality by use of transthoracic echocardiography has not reached a level that is sufficient, and also, three-dimensional echocardiography, which is useful to clarify complex AVV anatomy, cannot be applied for the patients less than 15kg, to guide for the AVV repair in pediatric patients. We try to show surgeons more precise three-dimensional images about an AVV by using intraoperative pericardial three-dimensional echocardiography (IP3DE) and improve the surgical outcome. Purpose To determine the efficacy of IP3DE by assessing the surgical outcome of an AVV repair and re-intervention rate. Method Eighty-five patient with CHD who underwent atrioventricular repair with significant regurgitation (Grade 2–4+) before operation were divided into two groups imaged IP3DE or not, in our hospital from 1993 to 2020. We assessed the surgical outcome and re-intervention rate between two arms and re-evaluate AVV images before surgery compared to the IP3DE. Result IP3DE was performed in forty-six patients (IP3DE group) and thirty-nine patients were not (control group). Median age at AVV repair was 3.0/2.8 years, respectively. The AVV was tricuspid (n=25), mitral (n=41), or common (n=19). The IP3DE group had a significantly higher improvement in regurgitation of AVV (IP3DE: Grade 3.2±0.3 → 1.7±0.3 vs Control: Grade 2.8±0.3 → 1.8±0.3, p&lt;0.05). Fifty-nine percent of the IP3DE group was successful outcome (Grade&lt;1+ after repair). There was no significant difference in the rate of re-intervention after surgery between two groups. In multivariate analysis, using IP3DE contributed to successful outcome for AVV repair (OR: 4.66, 95% CI: 1.46–14.8, p&lt;0.01). The different and/or additional anatomical AVV findings were obtained in sixty-one percent of patients by the IP3DE. Conclusion IP3DE contributes to successful outcome for AVV repair by obtaining further information on complicated AVV anatomy in congenital heart disease. IP3DE also enables both cardiovascular surgeons and cardiologists to share the accurate and detail “surgeon's view” in the operating room for planning of AVV repair. FUNDunding Acknowledgement Type of funding sources: None.