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Introduction : Creation of a fenestration during completion of a total cavo-pulmonary connection (TCPC) has been associated with a reduction in early mortality and morbidity. However, the long-term benefits are negated by an associated limitation in exercise tolerance and the potential risks of thrombo-embolic complications. We sought to describe the safety and efficacy of an Amplatzer Duct Occluder II (ADO II) for transcatheter fenestration closure following TCPC. Material and methods : Between January 2000 and July 2014, 102 patients underwent percutaneous closure of extra-cardiac TCPC fenestrations with a range of devices. Patients in whom fenestration closure was performed with an ADO II and who had at least 6 months of follow-up were included in this study. Results : Forty-seven patients had successful fenestration occlusion with an ADO II. The mean oxygen saturation and mean systemic venous pressures increased from 84.8 ±6.1% before to 97.6 ±2.9% (p < 0.001) after and from 14.2 ±2.15 mm Hg before to 15.6 ±2.2 mm Hg after closure (p < 0.001). Eight patients developed heart failure symptoms, managed by optimization of medical therapy, with 1 patient requiring device removal to reopen the fenestration. Color Doppler transthoracic echocardiography demonstrated residual flow across the device in 18 (38%), 10 (22%), 5 (11%) and 4 (9%) patients before discharge, at 1 and 6 months, and at the latest outpatient visit, respectively. Conclusions : The ADO II can be safely and effectively used to close fenestrations in extra-cardiac type Fontan completions. Many of the design features of this device confer potential benefit in this population.

The developments in surgical robotics suggest that it will be possible to entrust surgical robots with a wider range of tasks. So far, it has not been possible to automate the surgery procedures related to soft tissue. Thus, the objective of the conducted studies was to confirm the hypothesis that the surgery telemanipulator can be equipped with certain routines supporting the surgeon in leading the surgical tools and increasing motion accuracy during stereotypical movements. As the first step in facilitating the surgery, an algorithm will be developed which will concurrently provide automation and allow the surgeon to maintain full control over the slave robot. The algorithm will assist the surgeon in performing typical movement sequences. This kind of support must, however, be preceded by determining the reference points for accurately defining the position of the stitched tissue. It is in relation to these points that the tool's trajectory will be created, along which the master manipulator will guide the surgeon's hand. The paper presents the first stage, concerning the selection of movements for which the support algorithm will be used. The work also contains an analysis of surgical movement repeatability. The suturing movement was investigated in detail by experimental research in order to determine motion repeatability and verify the position of the stitched tissue. Tool trajectory was determined by a motion capture stereovision system. The study has demonstrated that the suturing movement could be considered as repeatable; however, the trajectories performed by different surgeons exhibit some individual characteristics.

Background: Hypoplastic left heart syndrome (HLHS) still remains a therapeutic challenge due to complex anatomical and haemodynamic abnormalities. The multistage treatment leads to consequences and complications limiting the efficacy of surgery and necessitating additional percutaneous interventions. Aim: To evaluate the type of necessary percutaneous interventions in patients after stage first Norwood operation for HLHS with a focus on different techniques and equipment and to determine the efficacy of interventional treatment. Material and methods: Between 2001 and 2010 we conducted 161 interventions in 88 patients with HLHS at all stages of palliation. We performed 47 interventions in 38 patients after stage first Norwood operation. The main reasons for percutaneous treatment in this group were as follows: stenosis of the aortic arch/isthmus (20 patients), stenosis of the Sano shunt (8), proximal pulmonary arteries stenosis (6) and secondary restriction of the atrial communication (4). Results: In the group of 20 infants with stenosis of the aortic arch/isthmus balloon angioplasty allowed widening of the stenosis from 2.87 ±0.82 mm to 5.15 ±0.82 mm (p < 0.05) and a decrease of the systolic pressure gradient between the aortic arch and the descending aorta from 29.38 ±15.40 mmHg to 7.14 ±4.28 mmHg (p < 0.05). In 1 patient a stent was implanted due to rapid recurrence of the stenosis. In the group of 8 patients with critical stenosis of the right ventricle to pulmonary artery shunt successful interventions were done in 7 infants (87%). In 5 cases (62%) percutaneous balloon angioplasty turned out to be a sufficient treatment. Two patients (25%) required implantation of a stent to the Sano shunt. Oxygen saturation increased from 52 ±12% to 75 ±4% (p = 0.002) and the diameter of the stenosis increased from 2.28 ±0.48 mm to 4.14 ±0.69 mm (p = 0.0025). Six patients after stage first of the surgical palliation required balloon angioplasty of the tight proximal pulmonary artery stenosis. The diameter of the stenosis increased from 2.33 ±0.51 mm to 3.58 ±0.49 mm (p = 0.0099); however, the decrease of the pressure gradient from 3.33 ±1.63 mmHg to 2.5 ±1.05 mmHg was statistically insignificant. Secondary restriction of the atrial communication was successfully treated in all 4 patients. The diameter of the connection increased from 4.2 ±1.15 mm to 9.9 ±3.17 mm (p = 0.0079) and left atrial pressure decreased from 19.4 ±4.1 mmHg to 13.8 ±2.4 mmHg (p = 0.0075). In half of the patients it was sufficient to perform static atrioseptostomy whereas the second half required stent implantation. Conclusions: Percutaneous interventions lead to haemodynamic stabilization prior to the next step of treatment, increase arterial oxygen saturation and decrease pulmonary arterial pressure, therefore lowering the number of required operations. Rescue interventions such as stenting of the interatrial septum or critically stenosed Sano shunt should be considered in deteriorating patients even despite the risk of complications.

Wstep Aktywacja nieswoistych mechanizmow ukladu odpornościowego stwierdzana u noworodkow i niemowląt z wrodzoną wadą serca predysponuje do czestszych zakazen i ich szybkiego uogolniania. W trakcie zabiegow kardiochirurgicznych z uzyciem krązenia pozaustrojowego, szczegolnie u najmlodszych dzieci, istnieje potrzeba wykonania cześciowej lub calkowitej tymektomii. Cel Celem pracy byla ocena wplywu zabiegu kardiochirurgicznego z wykorzystaniem krązenia pozaustrojowego wykonywanego w pierwszym roku zycia na dystrybucje populacji limfocytow krwi obwodowej. Material i metody Badaniami objeto 32 dzieci z wrodzonymi wadami serca operowanych w pierwszym roku zycia. Oceniano subpopulacje limfocytow krwi obwodowej za pomocą metody cytometrycznej i testu IMK-Plus. Ponadto u cześci dzieci wykonano badanie komorek pamieci immunologicznej. Oznaczenia wykonywano trzykrotnie: przed zabiegiem kardiochirurgicznym, we wczesnym oraz odleglym okresie pooperacyjnym. Wyniki W kolejnych badaniach wykazano obnizanie sie odsetka limfocytow CD3+ i CD4+ oraz wzrost odsetka limfocytow CD19+ w stosunku do wartości sprzed zabiegu. Istotne statystycznie roznice obserwowano porownując wartości uzyskane z drugiego i trzeciego oznaczenia (CD3+, CD4+) oraz wyjściowe z odleglymi (CD3+, CD4+, CD19+). Średni odsetek komorek CD45CD4RO+ w krotkim okresie pooperacyjnym byl nizszy w porownaniu z wartościami sprzed zabiegu, a w kolejnych miesiącach wzrastal istotnie statystycznie. Wnioski Wyniki dotychczasowych badan potwierdzają, ze zabieg kardiochirurgiczny z zastosowaniem krązenia pozaustrojowego powoduje zmiany odsetkow subpopulacji limfocytow krwi obwodowej oraz komorek pamieci immunologicznej w krotkim, a takze w odleglym okresie pooperacyjnym. Moze to wplywac na funkcjonowanie ukladu odpornościowego tych dzieci zarowno w okresie okolozabiegowym, jak i w dalszym zyciu. Konieczna jest kontynuacja badan w dluzszym okresie pozabiegowym oraz porownanie statusu immunologicznego dzieci operowanych z powodu wrodzonych wad serca z ich zdrowymi rowieśnikami.