The prevalence of EF is relatively high in neonatal cardiac surgery. The etiologies can be diverse. Extubation of neonates at high risk after cardiac surgery, based on these possible risk factors, requires more diligent approaches.

Objective: To investigate the risk factors associated with prolonged ventilation after Fontan surgery. Design: Retrospective case series. Setting: Tertiary childrens hospital. Patients: We included 123 children who underwent Fontan surgery without delayed sternal closure or extracorporeal membrane oxygenation between 2011 and 2017. Intervention: Fontan surgery. Measurements and main results: Prolonged ventilation was defined as intubation for more than 24 hours after surgery. Preoperative, intraoperative, and perioperative data were collected retrospectively from medical records. Multivariate logistic regression analysis was used to identify risk factors for prolonged ventilation. The median age and weight of patients were 2.2 years and 10.0 kg, respectively. Seventeen per cent of the patients (n = 21) received prolonged mechanical ventilation, and the median intubation period was 2.9 days. There were no 90-day or in-hospital deaths. The independent predictors of prolonged ventilation identified were fenestration (p < 0.01), low pulmonary artery index (p = 0.02), and advanced atrioventricular regurgitation (p < 0.01). The duration of ICU stay was significantly longer in the prolonged ventilation group than in the early extubation group (10 days versus 6 days, p < 0.01). Conclusion: Fenestration, low pulmonary artery index, and significant atrioventricular regurgitation are risk factors for prolonged ventilation after Fontan surgery. Careful preoperative and perioperative management that considers the risk factors for prolonged ventilation in each individual is important.

Abstract：Large colonies of native rhododendrons are usually well maintained on Naoshima Island in Western Japan. Human disturbances such as logging for fuel in salt manufacturing before the 1960s and frequent accidental fires after the 1960s have maintained these colonies. To determine how to preserve the colonies in the future, we compared effects of cutting and burning followed by planting on native rhododendrons. Plant biomass, except that of native rhododendrons, decreased in both treatments, and the light environment under the canopy of native rhododendrons became brighter. We also found that the flower bud ratio of Rhododendron kaempferi increased, and the flowering position of Rhododendron reticulatum and R. kaempferi expanded toward the ground in both treatments. However, treatment differences were observed in soil the nitrogen ratio, amount of sprouting, and cover of flowering colonies. Cutting caused these values to increase to a larger extent compared to burning followed by planting.Based on these results, we propose that cutting is more effective than burning followed by planting when attempting to extend the flowering landscape. In addition, cutting is the effective treatment for improving the landscape during the season when only R. reticulatum blooms. Keywords：amount of sprouting, flower bud ratio, flowering position, flowering landscape index キーワード：萌芽数，花芽率，開花位置，開花景観指数

Background EXCOR® Paediatric is used worldwide as a bridge-to-transplant treatment. It provides improved patient stability during the waiting period compared with previous ventricular assist device (VAD). However, investigations into complications which may occur among the paediatric population during long waiting periods are still sparse. Case summary We describe the case of a 7-year-old girl who presented with severe heart failure due to dilated cardiomyopathy. She also had a skin lesion which appeared soon after birth. She had received an EXCOR® implant and was waiting for heart transplant. Her skin lesion worsened after implantation and she suffered recurrent infections. Multiple bleeding episodes from the cannulation site occurred; therefore, surgical exploration of the bleeding was performed. She passed away during the procedure due to massive bleeding caused by rupture of a pseudoaneurysm caused by blood-stream infection. Discussion Patients with skin disease may be at increased risk of infection when on a VAD. Infections that occur during VAD therapy may cause serious complications such as pseudoaneurysm. The possibility of pseudoaneurysm should be considered when bleeding occurs in a patient on VAD.

Background: Lesions of congenital heart disease require stereoscopic understanding, which can be enhanced by three dimensional imaging. In Shizuoka Children s Hospital, three-dimensional rotational angiography (3DRA) is in use since 2013. Purpose: To report the efficacy of 3DRA in congenital heart disease. Objective and Methods: We evaluated the advantage of 3DRA in 24 patients. Secondly, we reviewed 15 patients who had a single target lesion in the pulmonary artery after Rastelli procedure, visualized on 3DRA (n=5) or CT (n=10) at the time of intervention, between 2010 and 2016. Procedural parameters were compared between the two groups. Results: All reconstructed 3DRA images provided adequate diagnostic quality and by Likert scale, classified as either essential or very useful for pre-operative or interventional planning in 75% of patients, especially in complex vascular lesions. No complications occurred. There was no significant difference with respect to procedure time, fluoroscopy time, radiation dose of angiography between 3DRA and CT. Total contrast media used in 3DRA group (3.9mL/kg) was significantly lower than that in the CT group (5.9mL/kg; p=0.003). Conclusions: 3DRA is a safe and effective modality in pediatric cardiovascular area. Wide-angled, stereoscopic image reconstruction allows for a more objective evaluation. Use of 3DRA was comparable to that of CT with respect to procedure time, fluoroscopy time, and radiation dose. Total contrast media used was significantly less in the former.