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Background Right ventricle-to-pulmonary artery (RV-PA) shunt as a part of the Norwood procedure underwent many modifications. We present our experience with a commercially available polytetrafluoroethylene vascular graft with cobra-head cuff as an RV-PA shunt. Methods A consecutive series of 52 children with hypoplastic left heart syndrome (median age 8 [range, 2-68] days, median weight 3200 [range, 2060-4400] g) underwent the Norwood procedure with a cobra-head cuffed RV-PA shunt (6 mm). The cuffed end was used for the central PA reconstruction. A retrospective analysis of clinical results, PAs development, and shunt-related complications, interventions, and technique of Glenn operation was performed. The study endpoint was Glenn operation with shunt removal or interstage death. Results The hospital and late interstage mortality was 3.8% (n = 2 of 52) and 4% (n = 2 of 50), respectively, and was not shunt-related. During mean follow of 3.7 ± 2.5 years, 48 (92.3%) children underwent Glenn operation at a median age of 6 (range, 2.6-9.1) months. Angiography before the second stage revealed satisfactory branch PAs development (maximum and minimum McGoon ratio of 1.95 ± 0.36 and 1.38 ± 0.38, respectively). The mean maximal diameter of the left PA was smaller than that of the right PA (7.13 ± 2.1 mm vs 8.42 ± 2.2 mm; P = .017), without differences in mean minimal diameter. Two infants required stent implantation in proximal shunt end and 1 required urgent Glenn operation because distal shunt thrombosis. During Glenn operation, 11 (22.9%) children required patch reconstruction of central PAs. Conclusions The cobra-head cuffed graft allowed easy and reproducible reconstruction of the central PA during the Norwood procedure. Using this technique, the development of PAs is satisfactory, the rate of shunt-related complications and interventions is low, and the second stage can be performed without patch material.

Background Right ventricular outflow tract (RVOT) stenosis after repair of tetralogy of Fallot has been linked with favorable right ventricular remodeling but adverse outcomes. The aim of our study was to assess the hemodynamic impact and prognostic relevance of right ventricular pressure load in this population. Methods and Results A total of 296 patients with repaired tetralogy of Fallot (mean age, 17.8±7.9 years) were included in a prospective cardiovascular magnetic resonance multicenter study. Myocardial strain was quantified by feature tracking technique at study entry. Follow‐up, including the need for pulmonary valve replacement, was assessed. The combined end point consisted of ventricular tachycardia and cardiac death. A higher echocardiographic RVOT peak gradient was significantly associated with smaller right ventricular volumes and less pulmonary regurgitation, but lower biventricular longitudinal strain. During a follow‐up of 10.1 (0.1–12.9) years, the primary end point was reached in 19 of 296 patients (cardiac death, n=6; sustained ventricular tachycardia, n=2; and nonsustained ventricular tachycardia, n=11). A higher RVOT gradient was associated with the combined outcome (hazard ratio [HR], 1.03; 95% CI, 1.00–1.06; P =0.026), and a cutoff gradient of ≥25 mm Hg was predictive for cardiovascular events (HR, 3.69; 95% CI, 1.47–9.27; P =0.005). In patients with pulmonary regurgitation ≥25%, a mild residual RVOT gradient (15–30 mm Hg) was not associated with a lower risk for pulmonary valve replacement. Conclusions Higher RVOT gradients were associated with less pulmonary regurgitation and smaller right ventricular dimensions but were related to reduced biventricular strain and emerged as univariate predictors of adverse events. Mild residual pressure gradients did not protect from pulmonary valve replacement. These results may have implications for the indication for RVOT reintervention in this population.

OBJECTIVES The right ventricle-to-pulmonary artery (RV-PA) shunt provides stable haemodynamics after the Norwood procedure but can influence development of the central pulmonary arteries (PAs). The goal of this study was to analyse the geometry of the central PAs in children with hypoplastic left heart syndrome before the Fontan operation with respect to the RV-PA shunt site and the type of the second-stage operation. METHODS A total of 161 children with hypoplastic left heart syndrome, median age 2.7 (range 1.3–9.8) years and median weight 12.7 (range 7.6–26.1) kg, underwent the Fontan operation after having had the Norwood procedure with an RV-PA shunt. The patients were divided into 2 groups: left-sided RV-PA (L-RV-PA) (n = 129) with the shunt on the left and right-sided RV-PA (n = 32) with the shunt on the right side of the neoaorta. Angiographic data obtained before the Fontan and all cardiac catheterization interventions were analysed retrospectively. RESULTS Between the second and third stages, as well as directly before the Fontan operation, the L-RV-PA group required more PA catheter interventions (P = 0.001 and P = 0.03). In this group, the minimal left PA diameter was smaller than that in the R-RV-PA group (P = 0.021). Leaving the shunt open until the Fontan operation increased the rate of PA interventions in the L-RV-PA group (P = 0.001), but there is no evidence of the impact on the development of the left PAs (P = 0.075). There is also no evidence that the type of the second-stage procedure influences the intervention rate before the Fontan procedure (P = 0.14). CONCLUSIONS Children who have the L-RV-PA shunt require more PA catheter interventions. The right-sided RV-PA shunt and the subsequent Glenn anastomosis in the place of the shunt are associated with distortion-free and more symmetrical development of the central PAs.

The spherically symmetric steady accretion of polytropic perfect fluids onto a black hole is the simplest flow model that can demonstrate effects of backreaction (selfgravity). It has been discovered 16 years ago that backreaction does not influence some ("intensive") characteristics of sonic points, under suitable conditions. Herein we consider a wider class of equations of state, with polytropic indices in the range (1,2], and establish detailed boundary conditions that allow one to prove this fact. We find also numerical examples showing limits of our analytic criteria - if suitable analytic conditions are not satisfied, then selfgravity influences all characteristics of sonic points. That fact constrains the applicability of the recent proposal of Baumgarte and Shapiro to estimate the lifetime of black holes within compact stellar objects., 19 pages, 17 figures

Background Children with congenital heart defects (CHD) usually undergo elective surgical repair of haemodynamically relevant shunt lesions within the first year of life. Due to susceptibility for pulmonary arterial hypertension (PAH) in patients with Down syndrome, repair is usually aimed for no later than 6 months of life. However, with rising immigration from developing countries to Europe, more patients with unrepaired CHD are diagnosed at a later age. Anatomical repair may be precluded, when advanced pulmonary vascular disease has been established. Case summary We report a 39-month-old male patient with Down syndrome with a large non-restrictive perimembranous ventricular septal defect, a large patent ductus arteriosus, and a secundum-type atrial septal defect with a prominent left-to-right shunting. Haemodynamic assessment revealed only a mild increase of pulmonary artery pressures (mPAP) with low pulmonary vascular resistance index (PVRi). Vasodilator testing led to a further increase of the left-to-right shunt and decrease of PVRi, suggesting operability. After careful consideration, the patient underwent complete surgical repair with a good post-operative clinical outcome. Cardiac catheterization 6 months after corrective repair showed a normal mPAP. No signs of PAH have been detected in the medium-term follow-up. Discussion Expertise, increased physician awareness, and a thorough pre-operative multidisciplinary evaluation are paramount to determine the best treatment approach for patients, who may present late with multiple shunts, and—in our case—underlying Down syndrome. Long-term close post-surgical follow-up in an expert centre is warranted to promptly diagnose and treat a possible late presentation of PAH appropriately.

OBJECTIVES Currently, Contegra® grafts (processed bovine jugular vein conduits) are widely used for reconstructive surgery of the right ventricular outflow tract in patients with congenital heart disease (CHD). We analysed explanted Contegra conduits from 2 institutions histologically to get a possible hint at the underlying pathomechanisms of degenerative alterations and to find histological correlations of graft failure. Additionally, we compared the explants with a non-implanted processed graft and a native jugular vein obtained from a young bull. METHODS The explanted Contegra grafts were gathered during reoperations of 13 patients (male: n = 9, 69.2%; female: n = 4, 30.8%). After standardized histological preparation, samples were stained with dyes haematoxylin and eosin and Elastica van Gieson. Additionally, X-ray pictures revealed the extent of calcification and chelaplex (III)-descaling agent was used to decalcify selected explants. RESULTS Processing of the native jugular vein leads to tissue loosening and a loss of elastic fibres. For graft failure after implantation, 2 pathomechanisms were identified: original graft alteration as well as intimal hyperplasia. Elastica degeneration and rearrangement with interfibrillary matrix structures were the main developments observed within the graft itself. Intimal hyperplasia was characterized by fibrous tissue apposition, calcification and heterotopic ossification. CONCLUSIONS Regression of the elastic fibre network leads to rigidification of the conduit. In Contegra grafts, atherosclerosis-like changes can be considered the leading cause of graft stenosis and insufficiency. We conclude that both observed mechanisms lead to early reoperation in CHD patients.

We model self-gravitating disks in Keplerian motion around the primary black hole, in the binary black hole system OJ 287 with a torus, employing a consistently general-relativistic approach. They satisfy geometric and/or mass density requirements found by Sillanpaa, Valtonen, Lehto and their coworkers. It is plausible that essential observational features of OJ 287 can be obtained via the general-relativistic description of the Bondi-Hoyle-Lyttleton transits through these tori, within the framework of radiation hydrodynamics., Comment: 7 pages, 7 figures

We study stationary and axially symmetric black hole-disk systems, assuming a combination of the DD2 and Timmes-Swesty equations of state and a three-parameter family of rotation laws. There exist two branches of solutions that are shown to bifurcate, for a suitable specific entropy and a parameter in the rotation law. Low entropy nuclear matter allows for the existence of moderately massive Keplerian disks., 13 pages, 12 figures

We numerically investigate the validity of recent modifications of the Penrose inequality that include angular momentum. Formulations expressed in terms of asymptotic mass and asymptotic angular momentum are contradicted. We analyzed numerical solutions describing polytropic stationary toroids around spinning black holes., Comment: Revised and expanded: a new Section 3 on numerical integration; misprints corrected; minor stylistic changes. Conclusions are unchanged

The IPCCC is a standardized international system of paediatric and congenital cardiac nomenclature that should be used in all registries, databases and research studies in the domain of paediatric and congenital cardiac care, including those related to HLHS. This recommendation is level 1 class C [15, 16, 700]. Multi-institutional databases and registries allow benchmarking of data concerning death, patterns of practice, morbidity and postoperative length of stay [540]. As a level 1 class C recommendation, all paediatric and congenital cardiac teams should routinely assess their own data against national and international benchmarks using multi-institutional databases and registries [540, 697–699, 701].

Cardiac myxomas are rare occurrences in pediatric populations, as are pulmonary artery aneurysms. We report a 17-year-old adolescent with right atrial cardiac myxoma and concomitant multiple peripheral pulmonary artery aneurysms. Histological examination indicated infiltration of the pulmonary artery wall through the embolic cardiac myxoma cells, thereby weakening it. This report highlights the probable causal relationship between these two entities, proposes the possible pathomechanism and presents the diagnostic and therapeutic dilemmas in the management of this condition.

We obtain rotation laws for axially symmetric, selfgravitating and stationary fluids around spinning black holes. They reduce --- in the Newtonian limit --- to monomial rotation curves. For spinless black hole, one obtains in the first post-Newtonian (1PN) approximation the hitherto known results, that can be interpreted as the geometric dragging and material antidragging. We find new 1PN effects, that are due to spins of black holes., Comment: 6 pages

Background: The Fontan operation has undergone several modifications and today is the primary way to treat a broad spectrum of congenital heart defects. Aim: The purpose of this study is to present the results of treatment of children with a single ventricle operated by the same surgical team and managed according to a uniform strategy. Methods: In the years 2007–2015, in 248 children aged 3.7 ± 2.6 years and weighing 14.6 ± 6.1 kg with a single ventricle, Fontan surgery was performed. In 56 (22.6%) children surgery was based on the creation of an intra-atrial lateral tunnel, and in 192 (77.4%) patients extracardiac modification was performed. In most patients, the operation was carried out with the normothermic cardiopulmonary bypass, on a “beating heart” without aortic cross-clamp. The average cardiopulmonary bypass time was 53.9 ± 23.9 min. The most common indication for surgery was hypoplastic left heart syndrome (53.6%). All patients with a single ventricle referred to our hospital for the Fontan procedure were enrolled into the surgery programme. Results: All patients survived the operation and were discharged home. Thirty-six (14.5%) patients were extubated in the operating room, in other patients the mean duration of the mechanical ventilation was 9.7 ± 16.1 h (median 7 h). The average time of hospitalisation in the whole study group was 17.5 ± 18.5 days (median 15 days). After surgery, in four children transient seizures occurred, and three patients had an ischaemic stroke. Conclusions: Developing and obeying a fixed perioperative protocol is crucial for low mortality and small number of complications after Fontan operation.

The goal of the study was to compare the early postoperative course after fenestrated lateral atrial tunnel (LT) and non-fenestrated extracardiac conduit (EC) Fontan operation (FO) in a single center where both techniques were parallelly used. Between 2004 and 2012, 56(32.7%) children underwent LT and 113(66.1%) EC FO. The mean age was 3.7 ± 2.9 years and mean weight was 14.6 ± 7.3 kg. The most common malformation was hypoplastic left heart syndrome (50.9%). The general approach was to perform LT in children after hemi-Fontan operation and EC in patients after Glenn anastomosis. Medical records were retrospectively reviewed. The hospital survival was 100%. In EC group, cardiopulmonary bypass time (CPB) was shorter (p = 0.004) and less patients needed aortic cross-clamping (p

We describe a newborn with single-ventricle malformation and anomalous origin of both coronary arteries from single ostium in the middle portion of the right pulmonary artery whose coronary anatomy was discovered during the operation and who underwent successful staged operative management. This report presents a unique anatomic association, proposes a means of management, and highlights the importance of intraoperative analysis.

In recent years, ultrafast-track anesthesia with on-table extubation and concepts of accelerated postoperative care have gained increasing support in pediatric congenital cardiac surgery. It is believed that such approaches might ideally combine economic benefits with a striving for continuous improvement of patient outcomes. The present review summarizes the role of dexmedetomidine (DEX) in this setting.DEX is a clinical multipurpose drug that mediates its diverse responses through the activation of α2-adrenoreceptors. In pediatric cardiac surgery it has various applications. Used as a premedication, DEX provides arousable sedation and anxiolysis. As an intraoperative adjunctive agent of balanced general anesthesia the primary objectives for its administration are attenuation of the neuro-humoral stress response and facilitation of early extubation. During ICU treatment DEX spares opioids, prevents the risk of postoperative delirium or emergence agitation and impacts on important patient-centered outcomes, such as duration of mechanical ventilation, restart of enteral nutrition or length of ICU stay.Due to a favorable mix of beneficial physiologic actions and a limited adverse effect profile, DEX is established in the perioperative pediatric cardiac surgery setting. However, evidence from high-quality randomized controlled trials on the effects of supplemental DEX on meaningful patient outcomes is scarce, and research on the role of DEX in providing cardioprotection, neuroprotection, or renoprotection is still at its beginning. DEX has developed to one of the main agents in the armamentarium of cardiac anesthesiologists and pediatric intensivists, but it should not be regarded as the new 'magic bullet'.

We analyze stationary self-gravitating disks around spinning black holes that satisfy the recently found general-relativistic Keplerian rotation law. There is a numerical evidence that the angular velocity, circumferential radius and angular momenta yield a bound onto the asymptotic mass of the system. This bound is proven analytically in the special case of massless disks of dust in the Kerr spacetime., 8 pages, 5 figures

After more than 40 years of treatment of single-ventricle heart with the Fontan pathway there is a large group of patients exposed to poorly known complications, such as a protein-losing enteropathy. The article discuses contemporary theories regarding the etiology and pathomechanisms of this syndrome, presents the clinical picture and available diagnostic and therapeutic methods.

Pulmonary artery sling (PAS) is a rare disease frequently associated with severe malacia and stenosis of the trachea. We present a two-day-old newborn that underwent urgent surgery for PAS and needed prolonged respiratory support afterward. Temporary airway stenting above the level of the tracheal bifurcation was performed five days after surgery to overcome severe airway obstruction caused by tracheomalacia and laceration of the tracheal mucosa after diagnostic bronchoscopy. Two days after the procedure, the child could be extubated and after two weeks the stent was removed without complications. Temporary tracheal stenting after PAS repair can be an effective therapeutic strategy in newborns with tracheal obstruction and allows timely weaning from ventilator support.

OBJECTIVESRight ventricular pressure overload, which can result in restrictive right ventricular physiology, predicts slow recovery after biventricular repair of congenital heart defects. The goal of the study was to assess how extubation in the operating room influences the postoperative course in these patients.METHODSBetween January 2013 and June 2017, a total of 65 children [median age 0.96 (0.13–9.47) years; median weight 8 (3.05–25.8) kg] with right ventricular pressure overload underwent an intracardiac correction. The most common malformations were tetralogy of Fallot (n = 34) and double outlet right ventricle with pulmonary stenosis (n = 11). The patients were divided into 2 groups: the first (n = 36) comprised late extubated (LE) and the second (n = 29), early extubated (EE) children, immediately after chest closure in the operating room. Preoperative, perioperative and postoperative records were analysed retrospectively.RESULTSChildren who had EE had a lower heart rate (EE 124.2 vs LE 133.6 bpm; P = 0.03), higher arterial blood pressure (systolic: EE 87.9 ± 9.35 vs LE 81.4 ± 12.0 mmHg; P = 0.029; diastolic: EE 51.1 ± 6.5 vs LE 45.9 ± 6.64 mmHg; P = 0.003), lower central venous pressure (EE 8.6 ± 1.89 mmHg vs LE 9.9 ± 2.42 mmHg; P = 0.03), fewer pleural effusions in the first 6 postoperative days (EE 1.38 ml/kg/day vs LE 5.98 ml/kg/day; P = 0.009), shorter time of dopamine support ≥3 μg/kg (EE 7.29 ± 12.26 h vs LE 34.78 ± 38.05 h, P CONCLUSIONSExtubation in the operating room of children with right ventricular pressure overload undergoing biventricular correction is feasible and safe and has a beneficial effect on the postoperative course.

The ultrafast track protocol describes in detail the pre-, intra-, and postoperative procedures, which in their entirety aim to extubate all children, who have undergone pediatric cardiac surgery, on the operating table. The knows only a few exceptions from this general rule, e.g. the Norwood-stage I operation or premature infants, who are on mechanical ventilation before surgery. The concept of early extubation with its advantages and disadvantages is critically questioned from a pathophysiological perspective. In addition, the effects of the ultrafast track concept on important patient-centered outcomes and on patient safety are discussed in detail. Another focus of the chapter is the characterization of the pharmacokinetic and pharmacodynamic properties of the centrally acting substances used for anesthesia and postoperative analgesia.

The clinical experience with Loeys-Dietz syndrome (LDS) reveals fateful natural history with intracerebral incidents and aortic dissections. A newborn child was referred to our hospital with significantly dilated aortic root and clinical signs of LDS phenotype later genetically confirmed as LDS type I. A therapy with antihypertensive medicines was initiated to postpone the surgery. Despite that, aortic root dilatation progressed to 33 mm (z-score +9.3). To avoid aortic rupture, a valve sparing aortic root replacement was performed at patient age of 8 months. The purpose of this report is to share our dilemmas and experience in the treatment of this child.

Early extubation appears to have beneficial effects on the Fontan circulation. The goal of this study was to assess the impact of extubation on the operating table in comparison with extubation during the first hours after Fontan operation (FO) on the early postoperative course. Between 2013 and 2016, 114 children with a single ventricle heart malformations (mean age, 3.8 ± 2.3 years) underwent FO: 60 patients were extubated in the operating room (ORE) and 54 in the intensive care unit (ICUE) in the median time of 195 min (range 30–515 min) after procedure. Pre-, peri-, and postoperative records were retrospectively analyzed. The hospital survival rate was 100%. One patient from the ORE group needed an immediate reintubation because of laryngospasm. The ORE group showed lower heart rate (106.5 vs. 120.3 bpm; p

We integrate numerically axially symmetric stationary Einstein equations describing self-gravitating disks around spinless black holes. The numerical scheme is based on a method developed by Shibata, but contains important new ingredients. We derive a new general-relativistic Keplerian rotation law for self-gravitating disks around spinning black holes. Former results concerning rotation around spin-less black holes emerge in the limit of a vanishing spin parameter. These rotation curves might be used for the description of rotating stars, after appropriate modification around the symmetry axis. They can be applied to the description of compact torus--black hole configurations, including active galactic nuclei or products of coalescences of two neutron stars., Misprints corrected, this version matches the published paper

Objectives Somatic development is impaired in children with congenital heart defects (CHDs), and head circumference seems to be a strong predictor of neurodevelopmental prognosis. The aim of this study was to generate up-to-date reference values for the somatic development (head circumference, body weight, and length/height) of children with CHDs. Study design Our study population consisted of all patients included in the PAN study (Pravalenz angeborener Herzfehler bei Neugeborenen in Deutschland), which was conducted prospectively over a 3-year study period by the Competence Network for Congenital Heart Defects. All children with mild, moderate, and severe CHDs born in 2006-2009 in Germany were enrolled. For computing of z-scores, only children with the following characteristics were included: appropriate for gestational age, nonsyndromic disease, term or post-term delivery, and no cardiac surgery. Results There were 2818 patients included. New z-scores for the described somatic measures of children with mild, moderate, and severe CHDs were computed. Comparisons with the KiGGS study (Gesundheit von Kindern und Jugendlichen in Deutschland) and the Berlin Longitudinal Study revealed significantly lower measurements for all measures—most notably in children with severe CHDs and/or cardiac surgery. In our cohort, no catch-up growth was seen after cardiac surgery. Conclusion Children with severe CHDs demonstrated the most abnormal pattern in growth, including head circumference before and after cardiac surgery, which is indicative of accompanying brain pathology unrelated to operative injury.

Aortic atresia with interrupted aortic arch is a rare anatomical and physiological combination. Survival is possible if there is blood flow in the ascending aorta supplying the coronary circulation from coexisting malformations. We present a newborn with aortic atresia, interrupted aortic arch type B, ventricular septal defect and a pulmonary artery to left coronary artery fistula as a source of blood flow to the coronary circulation, ascending aorta and proximal aortic arch, successfully treated with neonatal biventricular repair. To our knowledge, this is the first patient described in the literature with coronary blood flow dependent on a pulmonary-coronary arterial fistula.

We analytically construct an infinite number of trapped toroids in spherically symmetric Cauchy hypersurfaces of the Einstein equations. We focus on initial data which represent "constant density stars" momentarily at rest. There exists an infinite number of constant mean curvature tori, but we also deal with more general configurations. The marginally trapped toroids have been found analytically and numerically; they are unstable. The topologically toroidal trapped surfaces appear in a finite region surrounded by the Schwarzschild horizon., 4 pages

We obtain from the first principles a general-relativistic Keplerian rotation law for self-gravitating disks around spinning black holes. This is an extension of a former rotation law that was designed mainly for toroids around spin-less black holes. We integrate numerically axial stationary Einstein equations with self-gravitating disks around spinless or spinning black holes; that includes the first ever integration of the Keplerian selfgravitating tori. This construction can be used for the description of tight black hole-torus systems produced during coalescences of two neutron stars or modelling of compact active galactic nuclei., Comment: Matches published version

We analyze propagation equations for the polar modes of gravitational waves in cosmological space-times. We prove that polar gravitational waves must perturb the density and non-azimuthal components of the velocity of material medium of the Friedman-Lemaitre-Robertson-Walker spacetimes. Axial gravitational waves can influence only the azimuthal velocity, leading to local cosmological rotation. The whole gravitational dynamics reduces to the single "master equation" that has the same form for polar and axial modes. That allows us to conclude that the status of the Huygens principle is the same for axial and polar gravitational waves. In particular, this principle is valid exactly in radiation spacetimes with the vanishing cosmological constant, and it is broken otherwise., Comment: misprints corrected, matches version published in Classical and Quantum Gravity

Hintergrund Die Beurteilung, ob Wachstum zeitgerecht verlauft, ist eine wichtige Aufgabe bei der Behandlung von herzkranken Kindern, da Therapieentscheidungen davon abhangig sind. Die in der Padiatrie ubliche Dokumentation von Wachstum mit Perzentilenkurven ist fur kinderkardiologische Belange zu wenig sensitiv.

Background. Small pulmonary arteries (PAs) are often considered as a contraindication for the Fontan operation (FO). The aim of this study was to evaluate if the PA size is still one of the major impact factors on the postoperative early outcome. Methods. Data of 146 patients, with a median age of 2.0 years (range, 1.5 to 18 years) and a median weight of 12.45 kg (range, 7.7 to 64.7 kg) who underwent a modified FO in the same center between 2007 and 2012 were retrospectively analyzed with respect to the traditional McGoon ratio, Nakata index, and modified indices (measuring the narrowest diameters). Results. Patients with a McGoon ratio of 1.6 or less (modified £ 1.2) or a Nakata index of 150 mm 2 /m 2 or less (modified £ 100 mm 2 /m 2 ) were not at a higher risk of longer mechanical ventilation (p [ 0.87 [0.1] and p [ 0.68 [0.52], respectively), longer stay (p [ 0.52 [0.18] and p [ 0.54 [0.38], respectively) in the intensive care unit, prolonged hospital stay (p [ 0.08 [0.26] and p [ 0.22 [0.29], respectively) or effusions (p [ 0.25 [0.37] and p [ 0.13 [0.06]), respectively). Younger and smaller children tended to have smaller PAs, but younger age (

We consider stationary, axially symmetric toroids rotating around spinless black holes, assuming the general-relativistic Keplerian rotation law, in the first post-Newtonian approximation. Numerical investigation shows that the angular momentum accumulates almost exclusively within toroids. It appears that various types of dragging (anti-dragging) effects are positively correlated with the ratio $M_\mathrm{D}/m$ ($M_\mathrm{D}$ is the mass of a toroid and $m$ is the mass of the black hole) - moreover, their maxima are proportional to $M_\mathrm{D}/m$. The horizontal sizes of investigated toroids range from c. 50 to c. 450 of Schwarzschild radii $R_\mathrm{S}$ of the central black hole; their mass $M_\mathrm{D} \in (10^{-4}m, 40m)$ and the radial size of the system is c. 500 $R_\mathrm{S}$. We found that the relative strength of various dragging (anti-dragging) effects does not change with the mass ratio, but it depends on the size of toroids. Several isoperimetric inequalities involving angular momentum are shown to hold true., Comment: Revised and corrected, 14 pages, to appear in Physical Review D

Die Fallot-Tetralogie (TOF) ist mit einer Pravalenz zwischen 0,26 und 0,8‰ aller Lebendgeburten der haufigste Herzfehler mit primarer Zyanose. Durch verbesserte Operationstechniken erreichen heute nahezu alle Patienten das Erwachsenenalter. Bei fast allen Patienten tritt eine postoperative Pulmonalinsuffizienz (PI) auf, die entscheidenden Einfluss auf die langfristige Morbiditat und Mortalitat hat. Die kardiale Magnetresonanztomographie (MRT) ist fur Quantifizierung von Ventrikelfunktion und Klappeninsuffizienzen etabliert und aufgrund ihrer fehlenden Invasivitat und Strahlenexposition sehr gut fur regelmasige Verlaufskontrollen der heranwachsenden Patienten geeignet. Insbesondere der Zeitpunkt fur einen Pulmonalklappenersatz darf nicht verpasst werden, da sich die rechtsventrikularen (RV) Volumina nur normalisieren, wenn das praoperative enddiastolische Volumen unter 170 ml/m2 und das endsystolische Volumen unter 85 ml/m2 liegen. Stenosen der Pulmonalarterien betreffen bis zu 15% der Patienten nach der Korrekturoperation. Distale Stenosen konnen eine vorbestehende PI verstarken und uber eine kombinierte Druck- und Volumenbelastung zu einer Rechtsherzinsuffizienz fuhren. Sie mussen daher fruhzeitig erkannt und mit einer Ballondilatation und eventuell einer Stenteinlage behandelt werden.

We estimate the minimal mass of self-gravitating polytropic discs using the famous Sobolev inequality. This resembles the well-known mass formula for Lane–Emden stars. For ideal gas with the polytropic index n= 3, the minimal mass is not smaller than the Jeans mass. The accuracy of the estimate is verified in a number of numerical examples. The bound works well for heavy self-gravitating discs and is less useful for light discs.

The aim of this study was to evaluate experience and predictors of early mortality in patients with hypoplastic left heart syndrome (HLHS)–type defects undergoing Norwood procedure (NP) with right ventricle-to-pulmonary artery (RV-PA) shunt. Between 2001 and 2009, a consecutive series of 229 children with HLHS-type single ventricle underwent NP with application of RV-PA shunt. Demographic, echocardiographic, and clinical perioperative data were retrospectively analyzed. The mean duration of follow-up of survivors was 4.5 ± 2.1 years (60 days to 8.1 years). Follow-up was complete for 92.1% of patients. Major early postoperative complications included sepsis/generalized infection in 40 (17.5%), pericardial effusion in 9 (3.9%), and wound infection in 8 (3.5%). The early (30-day) survival was 87.8% (n = 201). In the late postoperative period, 12 (5.9%) died. Early nonsurvivors were more frequently older than 14 days ( P = .045) at initial surgery, had lower operative weight ( P = .024), had more frequent associated cardiac ( P < .001) and/or extracardiac anomalies ( P < .001), and were more likely to have a restrictive interatrial communication before operation ( P = .024). Use of the right RV-PA shunt has helped to mitigate some previously described predictors of early death after NP. Longer follow-up will be required to determine whether the RV-PA shunt modification confers an important survival benefit.

The ventricular assist device (VAD) is a life-saving option for patients in heart failure refractory for conventional therapy. The aim of study was to assess the influence of VAD on heart transplantation (HT) outcome in children

Stationary flows of gas accreting onto a compact center are analyzed in the framework of general-relativistic radiation hydrodynamics, under assumptions of spherical symmetry and thin gas approximation. Numerical investigation shows that gas must be abundant in sources with luminosities approaching the Eddington limit. The gas abundance decreases with the increase of compactness of the central core and it can vary from almost 0.03 to 1/3.

Scimitar syndrome is a rare congenital cardiopulmonary anomaly. We describe a 1.5-year-old boy with this uncommon malformation and an unusual hepatic venous drainage, which allows atypical surgical repair.

We discuss the relation between the concentration of the Brown-York mass and the formation of trapped surfaces in non-spherical massive systems. In particular, we formulate and prove a precise version of the Thorne hoop conjecture in conformally flat three-geometries sliced by equipotential foliation leaves. An intriguing relationship between the total rest mass and the Brown-York mass is shown. This is a further investigation of the previous work on the Brown-York mass hoop conjecture in spherical symmetry.

Recent general-relativistic extensions of Newtonian rotation laws for self-gravitating stationary fluids allow one to rederive, in the first post-Newtonian approximation, the well known geometric dragging of frames, and two new weak-field effects within rotating tori. These are the recently discovered anti-dragging and a new effect that measures the deviation from the Keplerian motion and/or the contribution of the fluids selfgravity. They can be applied to the study of the existence of the (post-)Newtonian limits of solutions and in investigations of inequalities relating parameters of rotating black holes., Comment: A talk presented by Edward Malec at MG14 conference in Rome

We formulate new general-relativistic extensions of Newtonian rotation laws for self-gravitating stationary fluids. They have been used to re-derive, in the first post-Newtonian approximation, the well known geometric dragging of frames. We derive two other general-relativistic weak-field effects within rotating tori: the recently discovered dynamic anti-dragging and a new effect that measures the deviation from the Keplerian motion and/or the contribution of the fluids selfgravity. One can use the rotation laws to study the uniqueness and the convergence of the post-Newtonian approximations, and the existence of the post-Newtonian limits., Comment: 5 pages, to appear in the Physical Review D

We evaluate general-relativistic effects in the motion of stationary self-gravitating accretion disks around a Schwarzschild black hole, assuming the first post-Newtonian (1PN) approximation. There arises an integrability condition that leads to the emergence of two types of general-relativistic corrections to a Newtonian rotation curve. The well-known geometric dragging of frames accelerates rotation, but the hitherto unknown dynamic term, that reflects the disk structure, decelerates rotation. The net result can diminish the Newtonian angular velocity of rotation in a central disk zone, but the geometric dragging of frames dominates in the disk boundary zone. Both effects are nonlinear in nature, and they disappear in the limit of test fluids. Dust disks can only be geometrically dragged, while uniformly rotating gaseous disks are untouched at the 1PN order. General-relativistic contributions can strongly affect rotation periods in Keplerian motion for compact systems.

New rotation laws have been recently found for general-relativistic self-gravitating stationary fluids. It was not clear whether they apply to systems rotating with a constant linear velocity. In this paper, we fill this gap. The answer is positive. That means, in particular, that these systems should exhibit the recently discovered general-relativistic weak-field effects within rotating tori: the dynamic anti-dragging and the deviation from the Keplerian motion induced by the fluid selfgravity.

Background Despite significant improvement in survival after stage 1 Norwood, interim mortality before the second-stage operation remains significant. On the basis of reports of improved circulatory stability associated with the use of a right ventricle to pulmonary artery conduit, the difference between two physiologically different sources of pulmonary blood flow on interim mortality was investigated. Methods Data collection of 96 consecutive hospital survivors after stage 1 Norwood surgery was undertaken. The source of pulmonary blood flow was a modified right Blalock-Taussig shunt in 46 (BTS) and a right ventricle to pulmonary artery conduit in 50 patients. The same follow-up protocol was used in both groups. Data analysis was performed to identify variables associated with interim mortality. Results Analysis of patient-related and procedure-related variables revealed no differences in age, weight, diagnosis, presence of aortic atresia, lowest perioperative pH, duration of cardiopulmonary bypass, circulatory arrest, length of mechanical ventilation, or hospital stay at the time of stage 1 Norwood between groups. Respiratory rate and systolic blood pressure were the only differences detected between groups at the time of discharge. Interim mortality was higher in the Blalock-Taussig shunt group. Statistical analysis identified aortic atresia, a modified Blalock-Taussig shunt, and the presence of perioperative dysrhythmias to be associated with interim mortality. Conclusions The use of a right ventricle to pulmonary artery shunt decreases the incidence of interim mortality among hospital survivors after stage 1 Norwood for hypoplastic left heart syndrome. Aortic atresia, the use of a modified Blalock-Taussig shunt, and perioperative dysrhythmias are independently associated with a higher mortality before superior cavopulmonary connection.