Coronary artery fistula (CAF) is an uncommon anomaly that is usually congenital but can be acquired. Although most patients are asymptomatic, some may present with congestive heart failure, infective endocarditis, myocardial ischemia or rupture. In the past, surgical ligation was the only option in the management of CAF, but since 1983, transcatheter closure of CAF has been increasing as an alternative to surgery. We report a 3-year-old boy, presented in Queen Alia Heart Institute, who underwent successful transcatheter closure of a large fistula communicating the distal part of the right coronary artery to the right ventricle. Our case differs from other CAFs in that the fistula was communicating the right coronary artery itself to the right ventricle.

Background: Recoarctation of the aorta may occur in infants after the primary surgical repair. Several risk factors were suggested in the literature, with controversial results among the studies. Objective: This study was conducted to evaluate the predictors for reintervention after surgical coarctation repair by different techniques through left thoracotomy. Patients and Methods: A retrospective analysis was performed for patients who underwent isolated surgical coarctation repair or with pulmonary artery band between Sep 2014 and December 2018. All primary intervention was through thoracotomy. Reintervention was defined as the need for balloon angioplasty or reoperation. Results: A total of 47 patients with median age at repair of 7 days. The median duration of follow-up was 18 months (95% CI=14 to 22 months). Only 7 (14.9%) patients required reintervention. No mortality was recorded during the follow-up period. Cox proportional hazard analysis showed that only postoperative pressure gradient was an independent risk factor for reintervention. Receiver operating characteristic curve showed that postoperative pressure gradient was an excellent indicator (AUC = 0.948, 95% CI: 0.841 to 0.992, p<0.001), with the optimal cut-off value >25, sensitivity of 100% and specificity of 80%. Conclusions: Repair of aortic coarctation through thoracotomy has an overall good outcome. However, reintervention is required in some patients and elevated pressure gradient on echocardiographic assessment <25 can exclude recoarctation.

Background: Ventricular septal defect (VSD) is the most frequent congenital cardiac defect. Conventionally, openheart surgical repair through cardiopulmonary bypass (CPB) is the primary approach for many years. Objective: Given the absence of a reliable evidence on the optimal suture technique regarding the efficacy and morbidity, this study aimed to compare the postoperative complication rates and the outcomes of the interrupted and continuous suture techniques for the surgical VSD closure. Patients and Methods: This retrospective cohort study included 140 consecutive children who underwent surgical closure of congenital VSD of any type with or without associated congenital heart diseases. Patients with associated major cardiac anomalies were excluded. Preoperative, operative, and long-term outcomes data including VSD residual and heart block that needed permanent pacemaker (PPM) were collected from medical files. The closure was performed using interrupted sutures in 76 (54.3%, group 1), and by continuous sutures in 74 (45.7%, group 2) patients. Results: Three (3.9%) patients in group 1 and four (6.3%) patients in group 2 developed heart block that needed PPM, with no significant difference (p=0.702). Four (5.3%) patients in group 1 compared with two (3.1%) patients in group 2 had clinically and sizable (by echocardiography) significant residual, with no significant differences between both groups (p=0.688). Conclusion:The present study indicates that interrupted and continuous VSD closure techniques have comparable success and postoperative complication rates. Thus, the optimal suturing technique for VSD closure cannot be standardized, and their predilection depends on the experience and the comfort of the surgeons.

Background Ventricular septal defect (VSD) is the most common congenital cardiac defect for which outcomes are not uniform. There is a lack of consensus on the risk factors for the unfavorable outcomes following surgical VSD closure. Aim The aim of this study was to determine the risk factors and the predictors of major adverse events (MAEs) and complications following surgical closure of VSD in children weighing less than 10 kg. Methods This retrospective cohort study included children less than 10 kg who underwent surgical closure of congenital VSD of any type with or without associated congenital heart diseases. Patients with associated major cardiac anomalies were excluded. Preoperative, operative and postoperative data were collected from medical records. Results This study included 127 patients 52.8% were males, the median age was 8.0 months (IQR = 6.0–11.0 months), and their median weight was 5.7 kg (IQR = 4.8–7.0). Mortality was in one patient (0.8%) Multivariable logistic regression analysis revealed that male sex group (observational data), previous pulmonary artery banding (PAB), and significant intraoperative residual VSD were significant risk factors for the development of MAEs (odds ratios were 3.398, 14.282, and 8.634, respectively). Trisomy 21 syndrome (odds ratio: 5.678) contributed significantly to prolonged ventilation. Pulmonary artery banding (odds ratio: 14.415), significant intraoperative (3 mm) residual VSD (odds ratio: 11.262), and long cross-clamp time (odds ratio: 1.064) were significant predictors of prolonged ICU stay, whereas prolonged hospital stay was observed significantly in male sex group (odds ratio: 12.8281), PAB (odds ratio: 2.669), and significant intraoperative (3 mm) residual VSD (odds ratio: 19.551). Conclusions Surgical VSD repair is considered a safe procedure with very low mortality. Trisomy 21 was a significant risk factor for prolonged ventilation. Further, PAB, significant intraoperative residual of 3 mm or more that required a second pulmonary bypass, and a greater cross-clamp time were significant predictors of MAE and associated complications with prolonged ICU and hospital stay.