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Background:In patients with a functional single-ventricle, coil embolization is commonly performed to avoid complications after the Fontan procedure. The position for coil embolization should be determined after considering the postoperative changes in the aortopulmonary collateral arteries (APCAs). Methods:The study involved 163 patients who underwent the Fontan procedure between 2009 and 2015. The amount of APCA was assessed using a 3-point scale based on the aortogram in the cardiac catheterization. The total score for the five sites (bilateral internal thoracic artery, bilateral subclavian artery, and descending aorta) was calculated and compared in patients with and without coil embolization and before and after the Fontan procedure. Results: The mean scores for the APCAs ranged from 6.1±1.5 to 4.5±1.8 points in patients with coil embolization ( ) and from 4.4±1.7 to 3.6±1.7 points in those without coil embolization (−), indicating a significant decrease. The scores of 35 patients at ≥5 years after the Fontan procedure had decreased as compared to those at 6 months postoperatively (mean 4.2±2.0 to 1.3±1.2 points). The APCA flow of 30 patients measured using a magnetic resonance imaging similarly decreased after the Fontan procedure (mean 1.4±0.6 to 0.8±0.6 L/min). When APCA scores before the Fontan procedure were ≤5 points, there were no significant differences between the coil embolization ( ) and coil embolization (−) groups as to the incidence of prolonged pleural effusion. Conclusion: After the Fontan procedure, the APCA tended to decrease with or without coil embolization. Routine coil embolization is not necessary, which is indicated only when APCA scores are ≥6 points.

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A recipient twin with twin-twin transfusion syndrome (TTTS) exhibited 6 15 mitral regurgitation (MR), and hence, a poor prognosis. Fetoscopic laser photo (FLP) coagulation was performed on the recipient twin who presented with cardiomegaly and hydrops fetalis, after which severe mitral and tricuspid regurgitation and cardiomegaly failed to resolve. Here, we present the case of a recipient twin with TTTS. The mother, at 19 weeks and 4 days of gestation, was referred for fetal hydrops. Ultrasonography indicated severe MR. FLP was performed at 19 weeks and 5 days, after which the hydrops fetalis resolved gradually. At 27 weeks, we noted cardiomegaly and severe MR in the recipient. The patient was delivered by an emergency caesarian section, which had to be performed because of premature rupture of the membranes at 32 weeks and 4 days. Postnatal cardiac ultrasonography indicated severe mitral regurgitation, with the anterior leaflet of the mitral valve prolapsed and thickened. Despite the presence of pulmonary hemorrhage at the age of 1 day, the patient was treated with indomethacin to close the ductus arteriosus, thereby improving MR and the respiratory state, while resolving pulmonary hypertension. We concluded that the cause of MR was volume overload in the left atrium and mild abnormalities in the mitral valve. MR did not worsen later during infancy.

Background Aortic valve neo‐cuspidization (AVNeo), a procedure wherein the aortic valve is reconstructed utilizing an autologous pericardium, has recently been more commonly performed in children. However, the postoperative morphological changes in the aortic valve of pediatric patients remain unknown. The current study aimed to describe the intraoperative and postoperative findings of aortic regurgitation (AR) and stenosis (AS) after AVNeo in children. Methods This case series describes the morphological changes in AR and AS, and their severity, between the perioperative period and 3 months postoperative period after AVNeo in children (<18 years) who underwent AVNeo between April 2016 and March 2020. Data were collected at two measurement points: (i) intraoperative transesophageal echocardiography after weaning from cardiopulmonary bypass (io‐TEE); (ii) postoperative transthoracic echocardiography 3 months after the procedure (po‐TTE). Results Seven patients were included in this case series. The number of postoperative AR sites and the ratio of AR jet area to the left ventricular outflow tract area showed a tendency to decrease between io‐TEE and po‐TTE. All AR sites were integrated during the postoperative period. One patient identified developed intraoperative AS, which maintained its severity after AVNeo. Conclusions Most cases exhibited spontaneous improvement in AR, while one developed postoperative AS. Further prospective investigation is, therefore, needed to explore surgical outcomes following AVNeo among children.