We sought to evaluate the utility and safety of CoSeal Surgical Sealant (Baxter) for the prevention of cardiac adhesions in children. Seven cardiac surgery centers in Europe recruited consecutive pediatric patients requiring primary sternotomy for staged repair of congenital heart defects. Exclusion criteria included immune system disorder, unplanned reoperation, or reoperation within three months of primary repair. CoSeal was sprayed onto the surface of the heart at the end of surgery. Evaluation of adhesions took place at first reoperation. Data on safety, duration of surgery, and ease of CoSeal use were also collected. Seventy-nine pediatric patients were recruited between February 2005 and September 2007. Of these, 76 underwent major surgery to repair a wide range of congenital heart defects. Thirty-six patients underwent reoperation >3 months after primary repair, and were included in the efficacy analysis. Mean adhesions score was 8.3 (standard deviation [S.D.] 2.4; range 7-16). Six adverse events (5 serious) were possibly/definitely attributed to CoSeal. CoSeal's ease of use at primary operation was graded by surgeons as 12.1 mm (S.D. 9.8) on a visual analog scale of 0 ('very easy') to 100 mm ('very difficult'). Results of this prospective uncontrolled trial justify further investigation in a randomized, controlled trial.

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The use of 3-dimensional mapping system completely avoided the use of fluoroscopy in most cases, with very low fluoroscopy time in the remaining and high safety and effectiveness profiles. Achievement of ZFL was predicted by the type of arrhythmia, operator's experience, and patient's age.

The clinical management of ventricular failure after the Fontan operation presents a formidable challenge to surgeons. We report our experience with successful implantation of a Berlin Heart EXCOR ventricular assist device as a bridge to transplantation in a child with Fontan circulation.

drugs (AADs) after ablation. 2-6 A durable PV isolation (PVI) is optimized by continuity in the ablation lesion deployment along the circumferential isolation line. 7, 8 Adequate point-by-point information on lesions could be necessary to guarantee the transmurality, continuity, and durability of ablation. Recently, an automated ablation lesion tagging module has been developed. 9 It incorporates indirect parameters of lesion formation that can be indexed by the user, according to the ablation strategy. Our aim A blation strategies that target the pulmonary veins (PVs) are the cornerstone for most atrial fibrillation (AF) ablation procedures, and electrical isolation with at least evidence of entrance block should be the goal of the procedure. 1 A 12-month success rate, defined as the freedom from AF and/or atrial tachycardia (AT) events, appears to be related to the number of procedures and the optimal contact of the ablation catheter with the tissue, and only moderately to the maintenance of antiarrhythmic Fabrizio Guarracini, MD, PhD; Maria Grazia Bongiorni, MD Background: Our aim was to evaluate the clinical outcome of paroxysmal atrial fibrillation (AF) ablation with contact force technology, using an automated lesion tagging system (VISITAG TM module) with strict criteria of catheter stability.