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We report a 50-day-old infant with infective endocarditis and a large fungal vegetation on the tricuspid valve (TV) obstructing the right ventricular inflow. Emergency excision of the vegetation and TV reconstruction failed. Because of failure to wean off cardiopulmonary bypass support, a rescue bidirectional superior cavopulmonary anastomosis (BDG) was performed. Various management options with appropriateness and efficacy of this procedure are discussed.

Background The study aimed to analyze the outcome of congenital heart surgery in a subset of Indian patients, using the Aristotle Basic Complexity score, the Risk Adjustment for Congenital Heart Surgery categories, and the Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery mortality categories. Patients and methods 1312 patients 120 min), morbidity (intensive care unit stay >7 days), and mortality. Results The overall mortality was 6.85%, with mean a Aristotle Basic Complexity score, Risk Adjustment for Congenital Heart Surgery category, and Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery mortality category of 7.17 ± 2.04, 2.28 ± 0.78, and 2.24 ± 1.06, respectively. The mortality predictive capacity of the Risk Adjustment for Congenital Heart Surgery category (c = 0.76) was similar to that of the Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery mortality category (c = 0.75); both were better compared to the Aristotle Basic Complexity score (c = 0.66). The Risk Adjustment for Congenital Heart Surgery category and Aristotle Basic Complexity score correlated with morbidity and difficulty outcomes. Conclusion The study shows that the Aristotle Basic Complexity score, the Risk Adjustment for Congenital Heart Surgery category, and the Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery mortality category are tools of case mix stratification to analyze congenital heart surgery outcomes in a subset of the Indian population.

Objective This is a retrospective analysis of 94 patients who underwent aortic valve replacement for predominant aortic stenosis between January 1998 and December 2004.

Background B-type natriuretic peptide has been extensively studied in patients with cardiovascular disease, but its impact on the perioperative outcome of patients with cyanotic congenital heart defects is still unclear. We assessed the perioperative changes in B-type natriuretic peptide levels and their correlation with preoperative factors and clinical outcomes in a large homogenous group of patients with tetralogy of Fallot undergoing definitive repair at a tertiary care center. Methods A prospective study was undertaken in the cardiac operating room and intensive care unit at a single institution; 250 patients with tetralogy of Fallot undergoing intracardiac repair under cardiopulmonary bypass were studied. B-type natriuretic peptide levels were taken at 3 time points and correlated with clinical variables. Results Baseline B-type natriuretic peptide levels correlated with the degree of cyanosis in all 4 groups. B-type natriuretic peptide levels at 24 h after admission to the intensive care unit correlated with mortality in the adult subset of patients. B-type natriuretic peptide levels > 290 pg mL−1 in the intensive care unit predicted an increased probability of adverse clinical outcomes. Conclusions We demonstrated a rise in serum B-type natriuretic peptide levels in patients with tetralogy of Fallot undergoing definitive repair on cardiopulmonary bypass. B-type natriuretic peptide levels may be monitored to identify patients with cyanosis at increased risk of an augmented inflammatory response to cardiopulmonary bypass.

Background: this study was performed to assess the results of aortic valve replacement in children with biological substitutes including homografts, pulmonary autografts (Ross procedure), and aortic valve reconstruction with autologous pericardium (Duran technique). Methods: between March 1992 and July 2009, 73 children with aortic valve disease (mean age, 11.8 ± 2.7 years) underwent aortic valve replacement with biological substitutes including homografts, pulmonary autografts, and aortic valve reconstruction with autologous pericardium. Associated procedures were mitral valve repair in 32 and subaortic membrane resection in 3. Results: early mortality was 1.4% (1 patient). Median follow-up was 94 months. Sixty (83.3%) survivors had insignificant aortic regurgitation. Reoperation was required in 7 (9.6%) patients: for autograft dysfunction alone in 2, autograft failure and failed mitral valve repair in 2, autograft dysfunction with severe pulmonary homograft regurgitation in 1, severe homograft aortic valve regurgitation in 1, and right ventricular outflow tract obstruction in 1. There were 4 (5.4%) late deaths. Actuarial reoperation-free, event-free, and aortic valve dysfunction-free survival were 92.5% ± 4%, 93.4% ± 3.3 %, 94% ± 2.9%, 86.2% ± 4.3%, respectively, at 94 months. Conclusions: aortic valve replacement with biological substitutes is associated with acceptable hemodynamics and midterm results.

Objective: To assess the effects of preoperative administration of allopurinol in patients undergoing open-heart surgery (OHS) for valvular heart diseases. Methods: In this prospective randomised double-blind study, 50 consecutive patients undergoing OHS for valvular heart disease were randomised into two groups of 25 patients each: (a) control group received placebo and (b) test group received allopurinol prior to surgery. Serum troponinTandcreatinephosphokinase-MB(CPK-MB)isoenzymesweremeasuredpriortotheinductionofanaesthesia,atthetimeofaorticcross-clamp releaseand24 hfollowingterminationofcardiopulmonarybypass.Postoperativelyassessedparameterswereinotropicscore,rhythm,anddurationof mechanical ventilationand occurrence of a lowcardiac outputstate.Results: Significant differences were observed with respectto inotropicscore: median5((0—25)vs0(0—25)p = 0.027)andmean6.44 � 6.145versus3.4 � 5.54,meandurationofmechanicalventilation(11.1 � 4.9vs7.5� 2.5 h, p = 0.002, hospital stay (6.35 � 1.43 vs 5.04 � 0.611, p = 0.001) and maintenance of normal sinus rhythm (NSR) (18 vs 25, p = 0.004) between the controlgroupsversusthetestgroup,respectively.TherewerenosignificantdifferencesinthelevelsandtrendsoftroponinTandCPK-MBbetweenthe two groups. Conclusion: The administration of allopurinol prior to OHS for valvular heart diseases is associated with increased conversion and maintenancetonormal sinusrhythm,reducedinotropicscoreandareduction in the durationofmechanicalventilationandhospitalstay. Therewas, however, no significant difference in the blood levels of CPK-MB and troponin Tand a large sample size is required to assess this further. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.