Abstract Recent advancement of minimally invasive cardiac surgical procedures have prompted the ... more Abstract Recent advancement of minimally invasive cardiac surgical procedures have prompted the use of minimal incisions to perform operations on patients with congenital heart defects. In this report, we describe a new technique for closure of a patent ductus arteriosus, using an anterior extrapleural approach. We present our technique and results in five low-weight infants. This approach is safe and effective, shortens hospital stay, and is less invasive than classical approaches.
Journal of The American College of Cardiology, 2006
We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circula... more We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circulation. BACKGROUND Few data exist about the mid-term and long-term results of the extracardiac Fontan operation.
Abstract Recent advancement of minimally invasive cardiac surgical procedures have prompted the ... more Abstract Recent advancement of minimally invasive cardiac surgical procedures have prompted the use of minimal incisions to perform operations on patients with congenital heart defects. In this report, we describe a new technique for closure of a patent ductus arteriosus, using an anterior extrapleural approach. We present our technique and results in five low-weight infants. This approach is safe and effective, shortens hospital stay, and is less invasive than classical approaches.
Abstract Recent advancement of minimally invasive cardiac surgical procedures have prompted the ... more Abstract Recent advancement of minimally invasive cardiac surgical procedures have prompted the use of minimal incisions to perform operations on patients with congenital heart defects. In this report, we describe a new technique for closure of a patent ductus arteriosus, using an anterior extrapleural approach. We present our technique and results in five low-weight infants. This approach is safe and effective, shortens hospital stay, and is less invasive than classical approaches.
Journal of The American College of Cardiology, 2006
We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circula... more We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circulation. BACKGROUND Few data exist about the mid-term and long-term results of the extracardiac Fontan operation.
Abstract Recent advancement of minimally invasive cardiac surgical procedures have prompted the ... more Abstract Recent advancement of minimally invasive cardiac surgical procedures have prompted the use of minimal incisions to perform operations on patients with congenital heart defects. In this report, we describe a new technique for closure of a patent ductus arteriosus, using an anterior extrapleural approach. We present our technique and results in five low-weight infants. This approach is safe and effective, shortens hospital stay, and is less invasive than classical approaches.
Journal of The American College of Cardiology, 2006
We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circula... more We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circulation. BACKGROUND Few data exist about the mid-term and long-term results of the extracardiac Fontan operation.
Journal of The American College of Cardiology, 2006
We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circula... more We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circulation. BACKGROUND Few data exist about the mid-term and long-term results of the extracardiac Fontan operation.
Cardiac surgery with cardiopulmonary bypass (CPB) elicits an inflammatory response and has a mult... more Cardiac surgery with cardiopulmonary bypass (CPB) elicits an inflammatory response and has a multitude of biological consequences, ranging from subclinical organ dysfunction to severe multiorgan failure. Pediatric patients are more prone to have a reaction that can jeopardize their outcome. Cytokines are supposed to be important mediators in this response: limiting their circulating levels is, therefore, appealing. We investigated the pattern of cytokine release during pediatric operation for congenital heart anomalies in 20 patients, and the effect of hemofiltration. Tumor necrosis factor alpha (TNF-alpha) was elevated after anesthesia induction and showed significant decrease during CPB. Hemofiltration reduced its concentration, but the effect disappeared on the following day. Interleukin-1 (IL-1) increased slowly at the end of CPB and hemofiltration had no effect. Interleukin-6 (IL-6) showed a tendency toward augmentation during rewarming and hemofiltration did not significantly affect the course. Soluble interleukin-6 receptor (sIL-6r) had a pattern similar to TNF-alpha, but hemofiltration had no effect. On the other hand, interleukin-8 (IL-8) behaved like IL-6. Our findings suggest that baseline clinical status, anesthetic drugs, and maneuvers before incision may elicit a cytokine response, whereas rewarming is a critical phase of CPB. Hemofiltration is effective in removal of TNF-alpha, but its role is debatable for the control of IL-1, IL-6, sIL-6r and IL-8 levels.
The aim of this study is to evaluate the correlation between multidetector row helical computed t... more The aim of this study is to evaluate the correlation between multidetector row helical computed tomography (MDCT) findings and the histopathological characteristics of patients with invasive ductal carcinoma. We retrospectively reviewed MDCT findings and the corresponding histopathological features of 442 women with invasive ductal carcinoma. We received informed consent from the patients and the protocol was approved by the Ethics Committee at Tohoku University. The median age was 53 years (26-89 years). We examined the MDCT findings based on mass shape classified into well, moderate, poorly and scattered demarcated shapes, the enhancement pattern classified into homogenous, heterogeneous, rim and poor, and mass density classified into high, intermediate or low. We subsequently compared these radiological findings with the histological characteristics and clinical outcome. Poorly demarcated types were higher in ER+/HER2) (P = 0.008), while the well-demarcated type was higher in ER)/HER2) and ER)/HER2+ (P < 0.001 and P = 0.010). Rim pattern was higher in ER)/HER2) (P < 0.001). Intermediate or low density was higher in ER)/ HER2) (P < 0.001, respectively). Further analysis based on histological grade, mitotic counts and lymphovascular invasion demonstrated that the well-demarcated shape was higher in grade 2 and 3 (P = 0.006 and P < 0.001, respectively), and rim pattern was observed in grade 3 (P < 0.001). Regarding mitotic counts, poorly and scattered demarcated shapes were observed in score 1 (P = 0.008 and P = 0.014), while well-demarcated shape and rim enhancement were observed in score 3 (P < 0.001, respectively). Lymphovascular invasion correlated with a moderate demarcated shape (P = 0.029). Regarding recurrence rates, there were statistically significant differences between well and moderate, poorly or scattered demarcated shapes (P = 0.007, 0.028 and 0.035, respectively). These proposed MDCT diagnostic criteria based on biological characteristics contribute to more accurately predicting the biological behavior of breast cancer patients. (Cancer Sci 2012; 103: 67-72)
Objective: Evaluation of incremental risk factors for early mortality in children undergoing orth... more Objective: Evaluation of incremental risk factors for early mortality in children undergoing orthotopic heart transplantation (OHT) for failing single ventricle physiology. Methods: Between 1988 and 2002, 25 patients (mean age 9.3^7.1 years) underwent OHT for complex congenital heart disease (CHD) with a functional right (15 patients) or left (10 patients) single ventricle. Palliative staging towards Fontan completion had been previously accomplished in 22 patients (88%). Transition to OHT occurred from a shunt stage in 10, a bi-directional cavopulmonary anastomosis (BDG) stage in nine, and after Fontan failure in six patients. Results: Thirty-day survival was 68.0^9.3% with no additional mortality up to 14.1 years. OHT following BDG staging exhibited 100% long-term survival, as opposed to 66.7^15.7% for OHT after systemic-to-pulmonary shunt, and 33.3^19.2% for OHT following failing Fontan ðp ¼ 0:032Þ. Regression logistic modelling indicated failing Fontan circulation as predictor of higher mortality after OHT ðp ¼ 0:041Þ. Reintervention was necessary in four patients 40^11 months after OHT to address residual superior vena cava (two) and isthmic (two) stenosis. Overall freedom from reintervention was 88.3^8.1% at 5 years. Conclusions: OHT for structural CHD with single ventricle physiology entails substantial early mortality while BDG enables the best transition to heart transplant. OHT should be considered in the decision-making process as an alternative to Fontan completion in high-risk candidates, since rescue-OHT after failing Fontan seems unwarranted. q
Journal of The American College of Cardiology, 1989
The modified Fontan operation for complex cardiac anomalies associated with subaortic obstruction... more The modified Fontan operation for complex cardiac anomalies associated with subaortic obstruction entails a high surgical risk. It is likely that ventricular hypertrophy secondary to chronic pressure overload plays a significant role. This problem was approached with a new type of palliative operation comprising both a proximal pulmonary artery to ascending aorta anastomosis and a bidirectional cavopulmonary anastomosis.
The issue of the correct determination of the mechanical power dissipated by the blood flow in th... more The issue of the correct determination of the mechanical power dissipated by the blood flow in the circulatory system is very important. This parameter is particularly critical when the patient's circulation has to overcome structural impairments, such as, e.g., in the case of only one functional ventricle. The surgical palliation of such a condition, which is a relatively common form of congenital heart disease, calls for an optimization of the new connection's hydrodynamics. Starting from the general formulation of the energy dissipation rate in a given control volume, this paper discusses the critical assumptions of the formula usually employed to assess the power dissipation in complex connections, such as the total cavopulmonary connection (TCPC). A new formula is derived, in which the mean elevation of the outlet and inlet sections is shown to be relevant, through the use of the piezometric pressure. Moreover, the flow profile at the boundary of the control volume is also important, since the usual approach implicitly assumes that the flow is perfectly flat: this assumption is doubtful, especially in the venous return (as in the TCPC). In the experimental part of the study, the power dissipation was measured in a physical model of the TCPC, and a large difference was found between the usual method and the proposed one, especially at low regime (85% relative difference, at 1.5 l/min total cardiac output). The proposed approach should be adopted in order to improve the accuracy of the hydrodynamical performance's assessment of surgical connections (e.g., TCPC) or implantable devices (e.g., valved conduit).
A standard Glenn anastomosis between the superior vena cava and the right pulmonary artery has be... more A standard Glenn anastomosis between the superior vena cava and the right pulmonary artery has been the accepted mode of treatment for patients with complex cyanotic congenital heart disease. We report our experience in 18 patients with such disease who underwent a bidirectional cavopulmonary shunt because of increasing cyanosis and growth cessation. All patients were considered less than &amp;amp;amp;amp;quot;ideal&amp;amp;amp;amp;quot; candidates for a Fontan procedure. We divided the patients into two groups: group 1 had azygos continuation and group 2 did not. Fourteen patients required hypothermic cardiopulmonary bypass. Bidirectional pulmonary blood flow was achieved in all patients. Only 1 death occurred (group 2). The improvement in oxygen saturation and overall clinical condition of these patients, together with the low mortality and morbidity, is encouraging. However, long-term follow-up is mandatory for a comprehensive evaluation of this surgical approach as definitive palliation or as a first stage for a Fontan operation.
and Down's syndrome Better surgical prognosis for patients with complete atrioventricular septal ... more and Down's syndrome Better surgical prognosis for patients with complete atrioventricular septal defect http://ats.ctsnetjournals.org/cgi/content/full/78/2/666 located on the World Wide Web at: The online version of this article, along with updated information and services, is Print ISSN: 0003-4975; eISSN: 1552-6259. Southern Thoracic Surgical Association.
An adult patient presented with an anomalous right pulmonary artery arising from the ascending ao... more An adult patient presented with an anomalous right pulmonary artery arising from the ascending aorta with severe unilateral pulmonary vascular disease of the left lung due to a large left-sided patent ductus arteriosus. A stenosis in the right pulmonary artery protected the right pulmonary vasculature. Right ventricular pressure was suprasystemic. After ductal ligation and surgical repair, pulmonary artery pressures fell dramatically. An immediate postoperative angiography confirmed extremely poor perfusion of the left lung. At four-and-a-half years of follow-up, the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s quality of life had improved dramatically, main pulmonary artery pressure was one-sixth of systemic pressures, and there was vastly improved perfusion of the left lung at this lower perfusion pressure. The calculated pulmonary vascular resistance of the left lung was within normal limits. These findings suggested a significant degree of reversal of pulmonary hypertensive disease in the left lung sustained to 54 months postoperatively.
and Down's syndrome Better surgical prognosis for patients with complete atrioventricular septal ... more and Down's syndrome Better surgical prognosis for patients with complete atrioventricular septal defect http://ats.ctsnetjournals.org/cgi/content/full/78/2/666 located on the World Wide Web at: The online version of this article, along with updated information and services, is Print ISSN: 0003-4975; eISSN: 1552-6259. Southern Thoracic Surgical Association.
In our series of 27 children with various types of interruption of the aortic arch (IAA), deletio... more In our series of 27 children with various types of interruption of the aortic arch (IAA), deletion 22q11 is prevalent in patients with simple IAA type B, and is absent in patients with IAA type A and in those with associated additional major cardiac defects. Anomalies of the infundibular septum should be considered a characteristic aspect of children with IAA and deletion 22q11.
Journal of Thoracic and Cardiovascular Surgery, 2002
Objective: Total extracardiac cavopulmonary connection is an established procedure, but the best ... more Objective: Total extracardiac cavopulmonary connection is an established procedure, but the best spatial arrangement remains controversial. On the basis of our clinical experience with total extracardiac cavopulmonary connection, we performed quantitative and qualitative flow analysis on total extracardiac cavopulmonary connection models simulating the two most frequent arrangements applied to our patients to determine the most favorable hydrodynamic pattern.
Journal of The American College of Cardiology, 2001
The goal of this study was to evaluate percutaneous interventional and minimally invasive surgica... more The goal of this study was to evaluate percutaneous interventional and minimally invasive surgical closure of secundum atrial septal defect (ASD) in children. BACKGROUND Concern has surrounded abandoning conventional midline sternotomy in favor of the less invasive approaches pursuing a better cosmetic result and a more rational resource utilization.
Abstract Recent advancement of minimally invasive cardiac surgical procedures have prompted the ... more Abstract Recent advancement of minimally invasive cardiac surgical procedures have prompted the use of minimal incisions to perform operations on patients with congenital heart defects. In this report, we describe a new technique for closure of a patent ductus arteriosus, using an anterior extrapleural approach. We present our technique and results in five low-weight infants. This approach is safe and effective, shortens hospital stay, and is less invasive than classical approaches.
Journal of The American College of Cardiology, 2006
We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circula... more We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circulation. BACKGROUND Few data exist about the mid-term and long-term results of the extracardiac Fontan operation.
Abstract Recent advancement of minimally invasive cardiac surgical procedures have prompted the ... more Abstract Recent advancement of minimally invasive cardiac surgical procedures have prompted the use of minimal incisions to perform operations on patients with congenital heart defects. In this report, we describe a new technique for closure of a patent ductus arteriosus, using an anterior extrapleural approach. We present our technique and results in five low-weight infants. This approach is safe and effective, shortens hospital stay, and is less invasive than classical approaches.
Abstract Recent advancement of minimally invasive cardiac surgical procedures have prompted the ... more Abstract Recent advancement of minimally invasive cardiac surgical procedures have prompted the use of minimal incisions to perform operations on patients with congenital heart defects. In this report, we describe a new technique for closure of a patent ductus arteriosus, using an anterior extrapleural approach. We present our technique and results in five low-weight infants. This approach is safe and effective, shortens hospital stay, and is less invasive than classical approaches.
Journal of The American College of Cardiology, 2006
We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circula... more We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circulation. BACKGROUND Few data exist about the mid-term and long-term results of the extracardiac Fontan operation.
Abstract Recent advancement of minimally invasive cardiac surgical procedures have prompted the ... more Abstract Recent advancement of minimally invasive cardiac surgical procedures have prompted the use of minimal incisions to perform operations on patients with congenital heart defects. In this report, we describe a new technique for closure of a patent ductus arteriosus, using an anterior extrapleural approach. We present our technique and results in five low-weight infants. This approach is safe and effective, shortens hospital stay, and is less invasive than classical approaches.
Journal of The American College of Cardiology, 2006
We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circula... more We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circulation. BACKGROUND Few data exist about the mid-term and long-term results of the extracardiac Fontan operation.
Journal of The American College of Cardiology, 2006
We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circula... more We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circulation. BACKGROUND Few data exist about the mid-term and long-term results of the extracardiac Fontan operation.
Cardiac surgery with cardiopulmonary bypass (CPB) elicits an inflammatory response and has a mult... more Cardiac surgery with cardiopulmonary bypass (CPB) elicits an inflammatory response and has a multitude of biological consequences, ranging from subclinical organ dysfunction to severe multiorgan failure. Pediatric patients are more prone to have a reaction that can jeopardize their outcome. Cytokines are supposed to be important mediators in this response: limiting their circulating levels is, therefore, appealing. We investigated the pattern of cytokine release during pediatric operation for congenital heart anomalies in 20 patients, and the effect of hemofiltration. Tumor necrosis factor alpha (TNF-alpha) was elevated after anesthesia induction and showed significant decrease during CPB. Hemofiltration reduced its concentration, but the effect disappeared on the following day. Interleukin-1 (IL-1) increased slowly at the end of CPB and hemofiltration had no effect. Interleukin-6 (IL-6) showed a tendency toward augmentation during rewarming and hemofiltration did not significantly affect the course. Soluble interleukin-6 receptor (sIL-6r) had a pattern similar to TNF-alpha, but hemofiltration had no effect. On the other hand, interleukin-8 (IL-8) behaved like IL-6. Our findings suggest that baseline clinical status, anesthetic drugs, and maneuvers before incision may elicit a cytokine response, whereas rewarming is a critical phase of CPB. Hemofiltration is effective in removal of TNF-alpha, but its role is debatable for the control of IL-1, IL-6, sIL-6r and IL-8 levels.
The aim of this study is to evaluate the correlation between multidetector row helical computed t... more The aim of this study is to evaluate the correlation between multidetector row helical computed tomography (MDCT) findings and the histopathological characteristics of patients with invasive ductal carcinoma. We retrospectively reviewed MDCT findings and the corresponding histopathological features of 442 women with invasive ductal carcinoma. We received informed consent from the patients and the protocol was approved by the Ethics Committee at Tohoku University. The median age was 53 years (26-89 years). We examined the MDCT findings based on mass shape classified into well, moderate, poorly and scattered demarcated shapes, the enhancement pattern classified into homogenous, heterogeneous, rim and poor, and mass density classified into high, intermediate or low. We subsequently compared these radiological findings with the histological characteristics and clinical outcome. Poorly demarcated types were higher in ER+/HER2) (P = 0.008), while the well-demarcated type was higher in ER)/HER2) and ER)/HER2+ (P < 0.001 and P = 0.010). Rim pattern was higher in ER)/HER2) (P < 0.001). Intermediate or low density was higher in ER)/ HER2) (P < 0.001, respectively). Further analysis based on histological grade, mitotic counts and lymphovascular invasion demonstrated that the well-demarcated shape was higher in grade 2 and 3 (P = 0.006 and P < 0.001, respectively), and rim pattern was observed in grade 3 (P < 0.001). Regarding mitotic counts, poorly and scattered demarcated shapes were observed in score 1 (P = 0.008 and P = 0.014), while well-demarcated shape and rim enhancement were observed in score 3 (P < 0.001, respectively). Lymphovascular invasion correlated with a moderate demarcated shape (P = 0.029). Regarding recurrence rates, there were statistically significant differences between well and moderate, poorly or scattered demarcated shapes (P = 0.007, 0.028 and 0.035, respectively). These proposed MDCT diagnostic criteria based on biological characteristics contribute to more accurately predicting the biological behavior of breast cancer patients. (Cancer Sci 2012; 103: 67-72)
Objective: Evaluation of incremental risk factors for early mortality in children undergoing orth... more Objective: Evaluation of incremental risk factors for early mortality in children undergoing orthotopic heart transplantation (OHT) for failing single ventricle physiology. Methods: Between 1988 and 2002, 25 patients (mean age 9.3^7.1 years) underwent OHT for complex congenital heart disease (CHD) with a functional right (15 patients) or left (10 patients) single ventricle. Palliative staging towards Fontan completion had been previously accomplished in 22 patients (88%). Transition to OHT occurred from a shunt stage in 10, a bi-directional cavopulmonary anastomosis (BDG) stage in nine, and after Fontan failure in six patients. Results: Thirty-day survival was 68.0^9.3% with no additional mortality up to 14.1 years. OHT following BDG staging exhibited 100% long-term survival, as opposed to 66.7^15.7% for OHT after systemic-to-pulmonary shunt, and 33.3^19.2% for OHT following failing Fontan ðp ¼ 0:032Þ. Regression logistic modelling indicated failing Fontan circulation as predictor of higher mortality after OHT ðp ¼ 0:041Þ. Reintervention was necessary in four patients 40^11 months after OHT to address residual superior vena cava (two) and isthmic (two) stenosis. Overall freedom from reintervention was 88.3^8.1% at 5 years. Conclusions: OHT for structural CHD with single ventricle physiology entails substantial early mortality while BDG enables the best transition to heart transplant. OHT should be considered in the decision-making process as an alternative to Fontan completion in high-risk candidates, since rescue-OHT after failing Fontan seems unwarranted. q
Journal of The American College of Cardiology, 1989
The modified Fontan operation for complex cardiac anomalies associated with subaortic obstruction... more The modified Fontan operation for complex cardiac anomalies associated with subaortic obstruction entails a high surgical risk. It is likely that ventricular hypertrophy secondary to chronic pressure overload plays a significant role. This problem was approached with a new type of palliative operation comprising both a proximal pulmonary artery to ascending aorta anastomosis and a bidirectional cavopulmonary anastomosis.
The issue of the correct determination of the mechanical power dissipated by the blood flow in th... more The issue of the correct determination of the mechanical power dissipated by the blood flow in the circulatory system is very important. This parameter is particularly critical when the patient's circulation has to overcome structural impairments, such as, e.g., in the case of only one functional ventricle. The surgical palliation of such a condition, which is a relatively common form of congenital heart disease, calls for an optimization of the new connection's hydrodynamics. Starting from the general formulation of the energy dissipation rate in a given control volume, this paper discusses the critical assumptions of the formula usually employed to assess the power dissipation in complex connections, such as the total cavopulmonary connection (TCPC). A new formula is derived, in which the mean elevation of the outlet and inlet sections is shown to be relevant, through the use of the piezometric pressure. Moreover, the flow profile at the boundary of the control volume is also important, since the usual approach implicitly assumes that the flow is perfectly flat: this assumption is doubtful, especially in the venous return (as in the TCPC). In the experimental part of the study, the power dissipation was measured in a physical model of the TCPC, and a large difference was found between the usual method and the proposed one, especially at low regime (85% relative difference, at 1.5 l/min total cardiac output). The proposed approach should be adopted in order to improve the accuracy of the hydrodynamical performance's assessment of surgical connections (e.g., TCPC) or implantable devices (e.g., valved conduit).
A standard Glenn anastomosis between the superior vena cava and the right pulmonary artery has be... more A standard Glenn anastomosis between the superior vena cava and the right pulmonary artery has been the accepted mode of treatment for patients with complex cyanotic congenital heart disease. We report our experience in 18 patients with such disease who underwent a bidirectional cavopulmonary shunt because of increasing cyanosis and growth cessation. All patients were considered less than &amp;amp;amp;amp;quot;ideal&amp;amp;amp;amp;quot; candidates for a Fontan procedure. We divided the patients into two groups: group 1 had azygos continuation and group 2 did not. Fourteen patients required hypothermic cardiopulmonary bypass. Bidirectional pulmonary blood flow was achieved in all patients. Only 1 death occurred (group 2). The improvement in oxygen saturation and overall clinical condition of these patients, together with the low mortality and morbidity, is encouraging. However, long-term follow-up is mandatory for a comprehensive evaluation of this surgical approach as definitive palliation or as a first stage for a Fontan operation.
and Down's syndrome Better surgical prognosis for patients with complete atrioventricular septal ... more and Down's syndrome Better surgical prognosis for patients with complete atrioventricular septal defect http://ats.ctsnetjournals.org/cgi/content/full/78/2/666 located on the World Wide Web at: The online version of this article, along with updated information and services, is Print ISSN: 0003-4975; eISSN: 1552-6259. Southern Thoracic Surgical Association.
An adult patient presented with an anomalous right pulmonary artery arising from the ascending ao... more An adult patient presented with an anomalous right pulmonary artery arising from the ascending aorta with severe unilateral pulmonary vascular disease of the left lung due to a large left-sided patent ductus arteriosus. A stenosis in the right pulmonary artery protected the right pulmonary vasculature. Right ventricular pressure was suprasystemic. After ductal ligation and surgical repair, pulmonary artery pressures fell dramatically. An immediate postoperative angiography confirmed extremely poor perfusion of the left lung. At four-and-a-half years of follow-up, the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s quality of life had improved dramatically, main pulmonary artery pressure was one-sixth of systemic pressures, and there was vastly improved perfusion of the left lung at this lower perfusion pressure. The calculated pulmonary vascular resistance of the left lung was within normal limits. These findings suggested a significant degree of reversal of pulmonary hypertensive disease in the left lung sustained to 54 months postoperatively.
and Down's syndrome Better surgical prognosis for patients with complete atrioventricular septal ... more and Down's syndrome Better surgical prognosis for patients with complete atrioventricular septal defect http://ats.ctsnetjournals.org/cgi/content/full/78/2/666 located on the World Wide Web at: The online version of this article, along with updated information and services, is Print ISSN: 0003-4975; eISSN: 1552-6259. Southern Thoracic Surgical Association.
In our series of 27 children with various types of interruption of the aortic arch (IAA), deletio... more In our series of 27 children with various types of interruption of the aortic arch (IAA), deletion 22q11 is prevalent in patients with simple IAA type B, and is absent in patients with IAA type A and in those with associated additional major cardiac defects. Anomalies of the infundibular septum should be considered a characteristic aspect of children with IAA and deletion 22q11.
Journal of Thoracic and Cardiovascular Surgery, 2002
Objective: Total extracardiac cavopulmonary connection is an established procedure, but the best ... more Objective: Total extracardiac cavopulmonary connection is an established procedure, but the best spatial arrangement remains controversial. On the basis of our clinical experience with total extracardiac cavopulmonary connection, we performed quantitative and qualitative flow analysis on total extracardiac cavopulmonary connection models simulating the two most frequent arrangements applied to our patients to determine the most favorable hydrodynamic pattern.
Journal of The American College of Cardiology, 2001
The goal of this study was to evaluate percutaneous interventional and minimally invasive surgica... more The goal of this study was to evaluate percutaneous interventional and minimally invasive surgical closure of secundum atrial septal defect (ASD) in children. BACKGROUND Concern has surrounded abandoning conventional midline sternotomy in favor of the less invasive approaches pursuing a better cosmetic result and a more rational resource utilization.
Uploads
Papers by Roberto Donato