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OBJECTIVES Detailed anatomical information is essential for planning of surgical therapy in patients with congenital heart disease. We wanted to determine whether cinematic rendering, the novel 3-dimensional visualization technique, could help paediatric cardiac surgeons achieve better preoperative visualization of the extracardiac anatomy in patients with complex congenital heart defects. Therefore, cinematic rendering was compared to the traditional volume rendering technique by means of a questionnaire with predefined criteria. METHODS Picture sets from 20 infant patients (mean age = 17 days) were generated from computed tomography data with both the cinematic rendering and the volume rendering techniques. These were presented side by side in a digital high-resolution portfolio without labelling them. Three experienced paediatric cardiac surgeons were provided with these portfolios and a questionnaire. They were asked to evaluate the images individually in predefined categories on a 4-point Likert scale from 1 = 'fully acceptable' to 4 = 'unacceptable'. RESULTS Cinematic rendering scored significantly better values on the Likert scale in 7 of 9 categories, namely 'spatial impression in general', 'depth perception', 'delineation of the atrial appendages/pulmonary veins/peripheral pulmonary arteries', 'assessability of the anterior interventricular sulcus' and 'assessability of the aortic arch branches'. CONCLUSIONS Cinematic rendering is a valuable software tool, and our data suggest that it provides significantly better visualization than volume rendering. The surgeons appraised improved depth perception and delineation of structures adjacent to the heart as the most significant advantages.

Consensus paper of the German Society of Cardiovascular Engineering, the German Society for Thoracic and Cardiovascular Surgery, the German Society of Cardiology, the German Society of Pediatric Cardiology, the German Society of Anesthesiology and Intensive Care Medicine, the German Interdisciplinary Association of Intensive Care Medicine and Emergency Medicine and the German Society of Medical Intensive Care and Emergency Medicine.

Neutrophil gelatinase-associated lipocalin (NGAL) is an early predictive biomarker of acute kidney injury. Plasma NGAL was measured in 218 consecutive patients aged three days to 21.1 years after admission to the intensive care unit after cardiopulmonary bypass surgery using a commercially available point-of-care test to evaluate its diagnostic value in daily practice. Plasma NGAL was between 60 and 644 ng/ml in all patients [median 134 (interquartile range 94-194) ng/ml]. In 31% of patients, serum creatinine increased more than 50% within three days after surgery, but no patient needed renal replacement therapy. In the early neonatal period, NGAL was positively correlated to baseline serum creatinine (r=0.47; P=0.02). In patients aged more than 10 days, plasma NGAL was correlated to peak serum creatinine in the postoperative course (r=0.21; P=0.003), and to the severity of acute kidney injury (r=0.15; P=0.032). However, NGAL values were substantially scattered. Plasma NGAL levels early after congenital heart surgery are correlated to acute kidney injury, but the severity of kidney injury cannot be deduced from an individual NGAL value. Therefore, the value of one single plasma NGAL measurement performed early after cardiac bypass surgery for congenital heart disease is limited.

Superior vena cava (SVC)-thrombosis in a neonate after cardiac surgery is difficult to manage. This article reports on the successful treatment of SVC-syndrome in a critically ill newborn by surgical thrombectomy and reinsertion of the SVC in the right atrial appendage in the beating heart.

Postoperative arterial hypertension was treated with nitroprusside or esmolol in a prospective randomized study. If treatment failed, patients were first switched over to the other study drug, and then to a combination of both. Renin, angiotensin II, epinephrine, and norepinephrine were measured before, 1, and 17 h after operation. esmolol was effective in all cases of treatment (n=6) whereas nitroprusside was ineffective in two out of seven patients (not significant), who were finally treated effectively with the combination of the study drugs. Whenever monotherapy failed, both drugs together were effective in reducing the postoperative activation of the sympathetic and renin-angiotensin systems.

OBJECTIVES: In this study, we report our experience on the primary and staged surgical approaches for common arterial trunk (CAT) repair. METHODS: Between August 2003 and February 2015, 16 consecutive patients underwent CAT repair in our institution. Two different approaches have been followed: group ‘primary repair’ (PR) consists of patients suitable for straightforward CAT repair, who underwent surgery electively at 1–3 months of age (n=13); group‘staged repair’ (SR) consists of critically ill neonates with CAT and poor preoperative status or coexisting interrupted aortic arch (n=3). They underwent staged CAT repair with aortic arch repair and right ventricular-topulmonary artery (RV-PA) shunt within the neonatal period, followed byan intracardiac repair later in infancy. RESULTS: Median age at initial surgical treatment was 8 days (range: 7–21 days) in group SR and 34 days (range: 14–91 days) in group PR (P=0.03). Mean Aristotle Comprehensive Complexity score was 11±0.6 (range: 11–13) in group PR and 18±3.1 (range: 15–21) in group SR (P

We report on a 16-year-old boy after an event of cardiac arrest and initial treatment with a veno-arterial extracorporeal membrane oxygenator (ECMO). After a short stabilisation period a biventricular assist device (BVAD, Thoratec) was implanted. Although the BVAD was functioning well, the patient showed persisting hypoxemia. Transthoracic echocardiography revealed a patent foramen ovale with a high right-to-left shunt due to low aspiration pressures of the BVAD. The patient was successfully treated by interventional closure of the PFO with a 27-mm Amplatzer septal occluder and could easily be weaned from the respirator. Meanwhile the boy has successfully undergone heart transplantation. PFO has to be considered as a cause of arterial hypoxemia in patients supported with ventricular assist devices. The diagnosis of a PFO may be missed under ECMO-treatment. Interventional closure of a PFO can successfully be performed even if the patient is supported with a BVAD.