597 results on '"Richard A Jonas"'
Search Results
2. Cardiac surgical outcomes of patients with heterotaxy syndromeCentral MessagePerspective
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Manan H. Desai, MD, Nicolle M. Ceneri, MD, Zaenab Dhari, MD, Aybala Tongut, MD, Mahmut Ozturk, MD, Steven J. Staffa, MS, David Zurakowski, MS, PhD, David Schidlow, MD, MMus, Pranava Sinha, MD, Richard A. Jonas, MD, and Can Yerebakan, MD
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biventricular ,heterotaxy ,single ventricle ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Objectives: The study objectives were to analyze the outcomes of pediatric patients with heterotaxy syndrome undergoing cardiovascular surgery and to determine the predictors of mortality. Methods: A retrospective analysis of 82 patients diagnosed with heterotaxy syndrome who underwent cardiovascular surgery between January 2008 and December 2017 was performed. Univariate and multivariable Cox regression analyses to determine risk factors for mortality and Kaplan–Meier analysis for survival were performed. Results: Patient mortality in the cohort was 34% (28/82), including 36% (20/55) for single ventricle palliation and 30% (8/27) for biventricular repair. At 5 years, the probability of survival did not differ between the groups by log-rank testing (P = .829). Multivariable analysis found extracorporeal membrane oxygenation support (hazard ratio, 10.4; 95% confidence interval, 4.3-25.4; P
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- 2023
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3. Fate of aortic regurgitation after isolated repair of ventricular septal defect with concomitant aortic regurgitation in childrenCentral MessagePerspective
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Syed M. Bukhari, MD, Manan Desai, MD, David Zurakowski, MD, Adam Christopher, MD, Aybala Tongut, MD, Mahmut Ozturk, MD, Richard A. Jonas, MD, Pranava Sinha, MD, and Can Yerebakan, MD
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aortic regurgitation ,congenital heart disease ,ventricular septal defect ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Objectives: The aim of the study was to evaluate the course of aortic valve regurgitation in patients with preoperative aortic valve regurgitation and ventricular septal defect who underwent repair of the ventricular septal defect without aortic valve repair. Methods: A total of 37 consecutive patients with a ventricular septal defect and aortic regurgitation who underwent surgery between April 2007 and March 2016 were included in the study. Demographic, echocardiographic, operative, and clinical data were reviewed. Early and late mortality and morbidity were analyzed. Aortic regurgitation grade, left ventricular function, and dimensions were compared between the preoperative transesophageal echocardiography and postoperative transthoracic echocardiogram at last follow-up. Multivariate logistic regression analysis was performed to determine factors associated with improvement of aortic valve function. Results: There was no early or late mortality. No reoperations or reinterventions were required. A total of 17 patients had mild or greater aortic regurgitation preoperatively. Only 5 patients had mild or greater aortic regurgitation at follow-up of 4.3 years (0.5-10.1). Twenty-eight (76%) of the 37 patients showed an improvement in their aortic regurgitation grade. Left ventricular end-systolic and end-diastolic diameter z-scores were significantly lower at follow-up (P = .007 and P = .001, respectively). Multivariable logistic regression identified low preoperative left ventricular ejection fraction as the only predictor of nonimprovement of aortic regurgitation (95% confidence interval, 0.732-0.999, P = .002). Conclusions: Repair of a ventricular septal defect with accompanying aortic regurgitation can be performed with excellent results without surgical intervention on the aortic valve. Accompanying aortic regurgitation, especially trivial to mild, at the time of ventricular septal defect repair improves in the majority of cases. Low preoperative left ventricular ejection fraction is predictive of nonimprovement of aortic regurgitation grade.
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- 2023
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4. Influence of administration of mesenchymal stromal cell on pediatric oxygenator performance and inflammatory responseCentral MessagePerspective
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Takuya Maeda, MD, PhD, Casey M. Briggs, BS, Anushree Datar, MS, Christine A. Brantner, PhD, Patrick J. Hanley, PhD, Richard A. Jonas, MD, and Nobuyuki Ishibashi, MD
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cardiopulmonary bypass ,congenital heart disease ,cerebral protection ,cell transplantation ,mesenchymal stromal cells ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Objective: Mesenchymal stromal cells have important immunomodulatory and neuroprotective properties. The aim of this study was to evaluate the feasibility of mesenchymal stromal cell administration into a cardiopulmonary bypass (CPB) circuit, including a pediatric oxygenator, and to assess the immunomodulatory response of the circulating blood prime. Methods: A bypass circuit with a pediatric oxygenator, including integral filter was primed with bank whole blood. Normal saline (control) or 120 × 106 mesenchymal stromal cells were injected into the venous reservoir after 80 minutes of perfusion. To assess oxygenator function, immune reaction, and cytokine/chemokine levels, the ex vivo circulation was maintained for 300 minutes after administration. Results: There were no differences in flow rate, trans-oxygenator pressure gradient, blood oxygen, and carbon dioxide levels between control and cell delivery groups. No adhesion of mesenchymal stromal cells was observed on the filter mesh by scanning electron microscopy. Lymphocyte surface marker assay found no difference in the number of B cells, T cells, or natural killer cells between the 2 groups, indicating no immunogenicity of allogeneic mesenchymal stromal cells under ex vivo CPB conditions. CPB significantly changed the level of interleukin (IL) 4, IL-6, IL-8, IP-10, macrophage colony stimulating factor, macrophage inflammatory protein-1β, monocyte chemoattractant protein-1, and IL-1α over time. IL-6 level was significantly increased after cell administration. Conclusions: The administration of mesenchymal stromal cells does not interfere with oxygenator function. Allogeneic mesenchymal stromal cells show no immunogenicity, and increase plasma IL-6 level during ex vivo circulation. Further investigation is necessary to determine the effect of mesenchymal stromal cell delivery through CPB during pediatric cardiac surgery.
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- 2021
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5. Cryopreserved valved femoral vein homografts for right ventricular outflow tract reconstruction in infantsCentral MessagePerspective
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Lok Sinha, MD, Lucas Mota, BS, Mahmut Ozturk, MD, Steven J. Staffa, MS, David Zurakowski, MS, PhD, Richard A. Jonas, MD, and Pranava Sinha, MD
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pulmonary valve ,homograft ,CHD—valve lesions ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Background: We have previously reported use of cryopreserved valve femoral vein homograft (FVH) conduits for biventricular repairs in infants needing right ventricular outflow tract (RVOT) reconstruction. This study aims to compare FVH conduits with aortic (A) and pulmonary (P) homografts with regards to intermediate- and long-term outcomes. Methods: Retrospective review was conducted of all infants between 2004 and 2016 who underwent biventricular repair with RVOT reconstruction using homograft conduits. Patients were divided into A, P, and FVH groups based upon type of conduit received (N = 57 [A = 13; P = 21, FVH = 23]). Groups were compared using univariate and multivariable Cox regression analyses. The Nelson–Aalen estimator of cumulative hazard and Kaplan–Meier curves were used to identify differences in freedom from catheter reintervention and reoperation. Results: The 2 groups were comparable except for greater incidence of delayed sternal closure and longer hospital length of stay in the FVH group. The follow-up was longer for A and P groups compared with the FVH group (P
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- 2020
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6. Interrupted Aortic Arch
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Dilip S. Nath and Richard A. Jonas
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- 2023
7. AN INVITATION TO THE MEDICAL STUDENTS OF THE WORLD TO JOIN THE GLOBAL COALITION TO IMPROVE CARE FOR CHILDREN AND ADULTS WITH CONGENITAL HEART DISEASE ACROSS THE WORLD
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Pierre-Luc Bernier, Noritaka Ota, Christo I. Tchervenkov, Jeffrey P. Jacobs, Giovanni Stellin, Hiromi Kurosawa, Constantine Mavroudis, Sertac Cicek, Zohair Al-Halees, Martin Elliott, Marcelo Jatene, Richard A. Jonas, Rob Kinsley, Christian Kreutzer, Juan Leon-Wyss, Jinfen Liu, Bohdan Maruszewski, Graham Nunn, Samuel Ramirez-Marroquin, Nestor Sandaval, Shunji Sano, George Sarris, Rajesh Sharma, Thomas Spray, Ross Ungerleider, Hervé Yangni-Angate, and Gerhard Ziemer
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congenital heart disease ,pediatric ,Medicine - Abstract
N/A
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- 2020
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8. The Current Status of Neuroprotection in Congenital Heart Disease
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Kei Kobayashi, Christopher Liu, Richard A. Jonas, and Nobuyuki Ishibashi
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congenital heart disease ,neuroprotection ,brain ,cardiac anomalies ,neurological deficit ,Pediatrics ,RJ1-570 - Abstract
Neurological deficits are a serious and common sequelae of congenital heart disease (CHD). While their underlying mechanisms have not been fully characterized, their manifestations are well-known and understood to persist through adulthood. Development of therapies to address or prevent these deficits are critical to attenuate future morbidity and improve quality of life. In this review, we aim to summarize the current status of neuroprotective therapy in CHD. Through an exploration of present research in the pre-operative, intra-operative, and post-operative phases of patient management, we will describe existing clinical and bench efforts as well as current endeavors underway within this research area.
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- 2021
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9. Defining the optimal historical control group for a phase 1 trial of mesenchymal stromal cell delivery through cardiopulmonary bypass in neonates and infants
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Kei Kobayashi, Tessa Higgins, Christopher Liu, Mobolanle Ayodeji, Gil Wernovsky, Richard A. Jonas, and Nobuyuki Ishibashi
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Pediatrics, Perinatology and Child Health ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Objective: The Mesenchymal Stromal Cell Delivery through Cardiopulmonary Bypass in Pediatric Cardiac Surgery study is a prospective, open-label, single-centre, dose-escalation phase 1 trial assessing the safety/feasibility of delivering mesenchymal stromal cells to neonates/infants during cardiac surgery. Outcomes will be compared with historical data from a similar population. We aim to define an optimal control group for use in the Mesenchymal Stromal Cell Delivery through Cardiopulmonary Bypass in Pediatric Cardiac Surgery trial. Methods: Consecutive patients who underwent a two-ventricle repair without aortic arch reconstruction within the first 6 months of life between 2015 and 2020 were studied using the same inclusion/exclusion criteria as the Phase 1 Mesenchymal Stromal Cell Delivery through Cardiopulmonary Bypass in Pediatric Cardiac Surgery trial (n = 169). Patients were allocated into one of three diagnostic groups: ventricular septal defect type, Tetralogy of Fallot type, and transposition of the great arteries type. To determine era effect, patients were analysed in two groups: Group A (2015–2017) and B (2018–2020). In addition to biological markers, three post-operative scoring methods (inotropic and vasoactive-inotropic scores and the Pediatric Risk of Mortality-III) were assessed. Results: All values for three scoring systems were consistent with complexity of cardiac anomalies. Max inotropic and vasoactive-inotropic scores demonstrated significant differences between all diagnosis groups, confirming high sensitivity. Despite no differences in surgical factors between era groups, we observed lower inotropic and vasoactive-inotropic scores in group B, consistent with improved post-operative course in recent years at our centre. Conclusions: Our studies confirm max inotropic and vasoactive-inotropic scores as important quantitative measures after neonatal/infant cardiac surgery. Clinical outcomes should be compared within diagnostic groupings. The optimal control group should include only patients from a recent era. This initial study will help to determine the sample size of future efficacy/effectiveness studies.
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- 2022
10. Professional Volunteerism among Social Work Students as a Response to the Pandemic Crisis
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Elsa Mary Jacob and Richard A. Jonas
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- 2022
11. Fate of aortic regurgitation after isolated repair of ventricular septal defect with concomitant aortic regurgitation in children
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Syed M. Bukhari, Manan Desai, David Zurakowski, Adam Christopher, Aybala Tongut, Mahmut Ozturk, Richard A. Jonas, Pranava Sinha, and Can Yerebakan
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Pulmonary and Respiratory Medicine ,Surgery ,Congenital: Ventricular Septal Defect ,Cardiology and Cardiovascular Medicine - Abstract
OBJECTIVES: The aim of the study was to evaluate the course of aortic valve regurgitation in patients with preoperative aortic valve regurgitation and ventricular septal defect who underwent repair of the ventricular septal defect without aortic valve repair. METHODS: A total of 37 consecutive patients with a ventricular septal defect and aortic regurgitation who underwent surgery between April 2007 and March 2016 were included in the study. Demographic, echocardiographic, operative, and clinical data were reviewed. Early and late mortality and morbidity were analyzed. Aortic regurgitation grade, left ventricular function, and dimensions were compared between the preoperative transesophageal echocardiography and postoperative transthoracic echocardiogram at last follow-up. Multivariate logistic regression analysis was performed to determine factors associated with improvement of aortic valve function. RESULTS: There was no early or late mortality. No reoperations or reinterventions were required. A total of 17 patients had mild or greater aortic regurgitation preoperatively. Only 5 patients had mild or greater aortic regurgitation at follow-up of 4.3 years (0.5-10.1). Twenty-eight (76%) of the 37 patients showed an improvement in their aortic regurgitation grade. Left ventricular end-systolic and end-diastolic diameter z-scores were significantly lower at follow-up (P = .007 and P = .001, respectively). Multivariable logistic regression identified low preoperative left ventricular ejection fraction as the only predictor of nonimprovement of aortic regurgitation (95% confidence interval, 0.732-0.999, P = .002). CONCLUSIONS: Repair of a ventricular septal defect with accompanying aortic regurgitation can be performed with excellent results without surgical intervention on the aortic valve. Accompanying aortic regurgitation, especially trivial to mild, at the time of ventricular septal defect repair improves in the majority of cases. Low preoperative left ventricular ejection fraction is predictive of nonimprovement of aortic regurgitation grade.
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- 2023
12. Commentary: Emergent arterial switch for critically ill babies with transposition
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Richard A, Jonas
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
13. Periocardiophrenic Release to Prevent Conduit Compression After Neonatal Truncus Arteriosus Repair
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Karthik Ramakrishnan, Syed Murfad Peer, Aybala Tongut, Can Yerebakan, Pranava Sinha, Manan Desai, and Richard A. Jonas
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Pulmonary and Respiratory Medicine ,Truncus Arteriosus ,medicine.medical_specialty ,Heart Ventricles ,Pulmonary Artery ,Truncus arteriosus ,Hemodynamic compromise ,Electrical conduit ,medicine.artery ,Humans ,Transplantation, Homologous ,Medicine ,cardiovascular diseases ,business.industry ,Infant, Newborn ,Infant ,musculoskeletal system ,Compression (physics) ,Truncus Arteriosus, Persistent ,Surgery ,body regions ,surgical procedures, operative ,medicine.anatomical_structure ,Ventricle ,Pulmonary artery ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business - Abstract
Sternal approximation post-cardiac surgery in neonates can sometimes be challenging. Neonatal truncus arteriosus repair using a right ventricle to pulmonary artery homograft conduit is one such surgical procedure wherein there is a risk of developing conduit compression after sternal closure. We describe our technique of pericardio-phrenic release at the time of delayed sternal closure to prevent hemodynamic compromise and conduit compression after sternal approximation in such cases.
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- 2022
14. Impact of Cardiopulmonary Bypass on Neurogenesis and Cortical Maturation
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Arianna Prince, Stephen Lin, James Howick, Zaenab Dhari, Camille Leonetti, Richard A. Jonas, David Zurakowski, Paul C. Wang, and Nobuyuki Ishibashi
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Pathology ,medicine.medical_specialty ,Swine ,Neurogenesis ,Subventricular zone ,Inhibitory postsynaptic potential ,Article ,law.invention ,Neural Stem Cells ,law ,Lateral Ventricles ,Fractional anisotropy ,medicine ,Cardiopulmonary bypass ,Animals ,Progenitor cell ,Gyrification ,Neurons ,Cardiopulmonary Bypass ,business.industry ,Magnetic Resonance Imaging ,Frontal Lobe ,surgical procedures, operative ,medicine.anatomical_structure ,Animals, Newborn ,nervous system ,Neurology ,Frontal lobe ,Neurology (clinical) ,business ,circulatory and respiratory physiology - Abstract
OBJECTIVE Neurodevelopmental delays and frontal lobe cortical dysmaturation are widespread among children with congenital heart disease (CHD). The subventricular zone (SVZ) is the largest pool of neural stem/progenitor cells in the postnatal brain. Our aim is to determine the effects of cardiopulmonary bypass (CPB) on neurogenesis and cortical maturation in piglets whose SVZ development is similar to human infants. METHODS Three-week-old piglets (n = 29) were randomly assigned to control (no surgery), mild-CPB (34°C full flow for 60 minutes) and severe-CPB groups (25°C circulatory-arrest for 60 minutes). The SVZ and frontal lobe were analyzed with immunohistochemistry 3 days and 4 weeks postoperatively. MRI of the frontal lobe was used to assess cortical development. RESULTS SVZ neurogenic activity was reduced up to 4 weeks after both mild and severe CPB-induced insults. CPB also induced decreased migration of young neurons to the frontal lobe, demonstrating that CPB impairs postnatal neurogenesis. MRI 4 weeks after CPB displayed a decrease in gyrification index and cortical volume of the frontal lobe. Cortical fractional anisotropy was increased after severe CPB injury, indicating a prolonged deleterious impact of CPB on cortical maturation. Both CPB-induced insults displayed a significant change in densities of three major inhibitory neurons, suggesting excitatory-inhibitory imbalance in the frontal cortex. In addition, different CPB insults altered different subpopulations of inhibitory neurons. INTERPRETATION Our results provide novel insights into cellular mechanisms contributing to CHD-induced neurological impairments. Further refinement of CPB hardware and techniques is necessary to improve long-term frontal cortical dysmaturation observed in children with CHD. ANN NEUROL 2021;90:913-926.
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- 2021
15. Dose Effect of Mesenchymal Stromal Cell Delivery Through Cardiopulmonary Bypass
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Kei Kobayashi, Takuya Maeda, Mobolanle Ayodeji, Shao Ching Tu, Alice Chen, May Rajtboriraks, Chao-Hsiung Hsu, Tsang-Wei Tu, Paul C. Wang, Patrick J. Hanley, Richard A. Jonas, and Nobuyuki Ishibashi
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Neurologic impairments are a significant concern for survivors after pediatric cardiac surgery with cardiopulmonary bypass (CPB). We have previously shown that mesenchymal stromal cell (MSC) delivery through CPB has the potential to mitigate the effects of CPB on neural stem/progenitor cells. This study assessed the dose effects of MSCs.Piglets (n = 20) were randomly assigned to 1 of 4 groups: control, CPB, or CPB followed by MSC administration with low and high doses (10 × 10By magnetic resonance imaging, approximately 10 times more MSCs were detected within the entire brain after high-dose delivery than after low-dose delivery. No adverse events affecting hemodynamics, various biomarkers, and neuroimaging were detected after high-dose MSC delivery. High-dose MSCs significantly increased circulating levels of interleukin 4 after CPB. Both MSC groups normalized microglia activation after CPB, demonstrating MSC-induced reduction in cerebral inflammation. There was a significant increase in neuroblasts in the subventricular zone in both treatment groups. The thickness of the most active neurogenic area within the subventricular zone was significantly increased after high-dose treatment compared with CPB and low-dose MSCs, suggesting dose-dependent effects on the neurogenic niche.MSC delivery through CPB is feasible up to 100 × 10
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- 2022
16. In Memoriam: Aldo R. Castañeda, July 17, 1930 – April 30, 2021
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Marshall L. Jacobs, Giovanni Stellin, Richard A. Jonas, and Christo I. Tchervenkov
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business.industry ,Pediatrics, Perinatology and Child Health ,Medicine ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine ,business ,Humanities - Published
- 2021
17. In Memoriam: Aldo R. Castañeda, July 17, 1930–April 30, 2021
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Richard A. Jonas, Giovanni Stellin, Christo I. Tchervenkov, and Marshall L. Jacobs
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business.industry ,Pediatrics, Perinatology and Child Health ,Medicine ,General Medicine ,Cardiology and Cardiovascular Medicine ,business ,Humanities - Published
- 2021
18. Current Status of Training and Certification for Congenital Heart Surgery Around the World: Proceedings of the Meetings of the Global Council on Education for Congenital Heart Surgery of the World Society for Pediatric and Congenital Heart Surgery
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Morten Helvind, Bohdan Maruszewski, Emile A. Bacha, Kisaburo Sakamoto, Christo I. Tchervenkov, Susan Vosloo, Cheul Lee, James S. Tweddell, Christian Kreutzer, Attilio A. Lotto, Hani K. Najm, Giovanni Stellin, Nguyen Ly Thinh Truong, Piya Samankatiwat, Jeffrey P. Jacobs, Joseph A. Dearani, Drissi Boumzebra, Miguel Arboleda, Krishna S Iyer, Pedro Becker, Tae-Gook Jun, James D St Louis, Valdano Manuel, Claudia Herbst, Bistra Zheleva, George E. Sarris, Richard A. Jonas, Frank Edwin, Kirsten Finucane, Sivakumar Sivalingam, Hafil B Abdulgani, Hao Zhang, David M. Overman, Marcelo B. Jatene, Vladimiro L. Vida, David J. Barron, Zohair Al-Halees, José Fragata, Adel Elgamal, Budi Rahmat, Elizabeth H. Stephens, Jorge Cervantes, Nestor Sandoval, Darshan Reddy, James K. Kirklin, and Justin T. Tretter
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Heart Defects, Congenital ,Nonprofit organization ,medicine.medical_specialty ,Certification ,Heart disease ,education ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Cardiac Surgical Procedures ,Quality of care ,Child ,Societies, Medical ,business.industry ,Thoracic Surgery ,General Medicine ,medicine.disease ,Surgery ,Cardiac surgery ,030228 respiratory system ,Cardiothoracic surgery ,Pediatrics, Perinatology and Child Health ,Cardiology and Cardiovascular Medicine ,business - Abstract
The optimal training of the highly specialized congenital heart surgeon is a long and complex process, which is a significant challenge in most parts of the world. The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) has established the Global Council on Education for Congenital Heart Surgery as a nonprofit organization with the goal of assessing current training and certification and ultimately establishing standardized criteria for the training, evaluation, and certification of congenital heart surgeons around the world. The Global Council and the WSPCHS have reviewed the present status of training and certification for congenital cardiac surgery around the world. There is currently lack of consensus and standardized criteria for training in congenital heart surgery, with significant disparity between continents and countries. This represents significant obstacles to international job mobility of competent congenital heart surgeons and to the efforts to improve the quality of care for patients with Congenital Heart Disease worldwide. The purpose of this article is to summarize and document the present state of training and certification in congenital heart surgery around the world.
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- 2021
19. Compression Device-Assisted Extracorporeal Cardiopulmonary Resuscitation Cannulation in Pediatric Patients-A Simulation Study
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Syed Murfad Peer, Syed Bukhari, Manan Desai, Aybala Tongut, Anthony Ho, Can Yerebakan, Karthik Ramakrishnan, Pranava Sinha, Richard A. Jonas, Greg Yurasek, and Kevin Cleary
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Chest Pain ,Pediatrics, Perinatology and Child Health ,Pressure ,Humans ,Infant ,Surgery ,Computer Simulation ,General Medicine ,Cardiology and Cardiovascular Medicine ,Child ,Manikins ,Cardiopulmonary Resuscitation ,Catheterization - Abstract
Background: Surgical neck cannulation for pediatric extracorporeal cardiopulmonary resuscitation (ECPR) requires multiple interruptions of manual chest compressions to facilitate the procedure. Effective uninterrupted CPR is essential to prevent neurological injury. We hypothesized that an automated chest compression device can be used to provide effective and uninterrupted chest compressions during pediatric neck ECPR cannulation. The feasibility of surgically cannulating the right carotid artery and right internal jugular vein in an infant during ongoing automated chest compressions was tested in a simulation study. Methods: A working prototype of a pediatric chest compression device was designed to provide automated chest compressions on an infant CPR manikin at the rate of 120 compressions/minute. A feedback device attached to the manikin was used to monitor the effectiveness of CPR. A synthetic artery, vein along with carotid sheath and skin was utilized to simulate surgical neck exploration. ECPR simulation was conducted using the compression device to provide chest compressions. Results: Four ECPR simulations were conducted during which vessel sparing (n = 2) and non-vessel sparing (n = 2) cannulation of the right internal carotid artery and right internal jugular vein were performed during ongoing mechanical chest compressions. All four cannulations were successfully performed without the need to interrupt chest compressions. Conclusions: In a simulated environment, pediatric ECPR neck cannulation with uninterrupted chest compressions may be accomplished using an automated chest compression device. The strategy of compression device-assisted ECPR cannulation requires further study and could potentially reduce the neurological complications of ECPR.
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- 2022
20. Interposition Technique for Pulmonary Valve Replacement
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Richard A. Jonas, Josue Chery, Pranava Sinha, and Lok Sinha
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Adult ,Cardiac Catheterization ,medicine.medical_specialty ,Percutaneous ,Adolescent ,030204 cardiovascular system & hematology ,Bioprosthetic valve ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pulmonary Valve Replacement ,Humans ,Medicine ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,Pulmonary Valve ,business.industry ,General Medicine ,Pulmonary Valve Insufficiency ,Surgery ,Treatment Outcome ,030228 respiratory system ,Heart Valve Prosthesis ,Pediatrics, Perinatology and Child Health ,Tetralogy of Fallot ,Implant ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Stented bioprosthesis implant at surgical pulmonary valve replacement (PVR) ideally should be 25 to 27 mm to facilitate future percutaneous PVR. This often requires accommodating 35 to 37 mm diameter sewing ring in the pulmonary position and requires anterior patch augmentation of the right ventricular outflow tract (RVOT). We present a novel “interposition” technique of PVR that allows upsizing the valve without RVOT patch augmentation. Methods: Using standard cardiopulmonary bypass, the main pulmonary artery (MPA) is dissected and transected at an appropriate level. The remnants of pulmonary valve leaflets are excised. The valve stent posts are telescoped into distal MPA, the MPA continuity is restored by end-to-end anastomosis of the proximal and distal MPA, with the interposed prosthetic valve sewing ring in the suture line between the two edges of the MPA with the bulk of the sewing ring extravascular. Result: A total of seven patients (tetralogy of Fallot, three; congenital pulmonary stenosis, four; age range: 15-33 years) underwent the procedure. No patient required RVOT patch augmentation, all patients were extubated in the operating room and were fast-tracked to recovery. Our proposed technique of PVR has the following advantages: accommodate larger size valve, eliminates risk of a paravalvar leak, coronary compression, and anterior tilting of the prosthesis. Conclusion: The valve interposition technique avoids the need for RVOT patch, allows implantation of an adequate sized prosthetic valve, maintains native geometry of the pulmonary artery without the risk of tilting of the prosthesis, and eliminates the risk of paravalvular regurgitation and left coronary compression.
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- 2021
21. LV outflow obstruction after repair of atrioventricular septal defect: an uncommon but challenging problem
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Richard A Jonas
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Pulmonary and Respiratory Medicine ,Heart Septal Defects ,Humans ,Surgery ,Cardiology and Cardiovascular Medicine ,Ventricular Outflow Obstruction - Published
- 2021
22. Lasso or BART: Both Miss the Point
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Richard A. Jonas
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2021
23. Hybrid strategy in neonates with ductal-dependent systemic circulation and multiple risk factors
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Nicolle M. Ceneri, Manan H. Desai, Aybala Tongut, Mahmut Ozturk, Karthik Ramakrishnan, Steven J. Staffa, David Zurakowski, Mary T. Donofrio, Tacy Downing, Yves d’Udekem, Richard A. Jonas, Can Yerebakan, Sarah Clauss, Kathleen Kalinger, Joshua Kanter, Ricardo Munoz, Syed M. Peer, Pranava Sinha, and Gil Wernovsky
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Pulmonary and Respiratory Medicine ,Treatment Outcome ,Risk Factors ,Hypoplastic Left Heart Syndrome ,Palliative Care ,Infant, Newborn ,Prostaglandins ,Humans ,Surgery ,Pulmonary Artery ,Norwood Procedures ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
The study objective was to analyze outcomes of the hybrid strategy for ductal-dependent systemic circulation consisting of bilateral pulmonary artery banding with or without ductal stenting followed by delayed Norwood-type palliation or comprehensive stage II operation in high-risk neonates.A retrospective analysis was performed between December 2017 and March 2021. Thirty high-risk neonates underwent palliation with bilateral pulmonary artery banding: 11 with prostaglandin therapy and 19 with ductal stenting. Median (range) age and body weight of patients at hybrid stage I were 3 days (0-43) and 2.9 kg (1.1-4.2), respectively. Operative and interstage mortality, morbidity, and reintervention rates were assessed.Overall survival was 70% (21/30) at a median follow-up time of 9 months (range, 0-37) from hybrid stage I. Operative survival for hybrid stage I was 90% (27/30), of which 2 patients received palliative care, and there was 1 interstage death (4%, 1/27). After hybrid stage I, 37% of patients had a reintervention, and 3% (n = 1) used extracorporeal membrane oxygenation before the next stage of repair. Five patients are awaiting second-stage operation, and 9 patients are awaiting Fontan completion.High-risk neonates with hypoplastic left heart syndrome or its variants can be successfully palliated using the hybrid strategy and bridged to a delayed Norwood or comprehensive stage II operation with satisfactory survival. This operative approach is a promising alternative pathway for neonates deemed to be high risk due to multiple preoperative risk factors.
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- 2022
24. The evolution of cardiac care for children in Washington, DC
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Gerard R. Martin and Richard A. Jonas
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Heart Defects, Congenital ,medicine.medical_specialty ,business.industry ,Staffing ,Thoracic Surgery ,General Medicine ,Hospital employees ,Hospitals, Pediatric ,humanities ,Cardiac surgery ,Family medicine ,Pediatrics, Perinatology and Child Health ,Pediatric surgery ,District of Columbia ,medicine ,Humans ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine ,business ,Child ,Surface cooling - Abstract
Cardiac surgery for CHD was pioneered in Washington, DC by Charles Hufnagel and Edgar Davis working at Georgetown University and Children’s Hospital of the District of Columbia. Children’s Hospital, now Children’s National Hospital, had been established just 5 years after the end of the Civil War. In the 1950s, Davis and Hufnagel undertook many open-heart operations using the technique of surface cooling, hypothermia, and circulatory arrest. Hufnagel and Lewis Scott, who founded the cardiology department at Children’s, were trained in Boston by Gross and Nadas. Judson Randolph, also a trainee of Gross, introduced cardiac surgery using cardiopulmonary bypass and established the General Pediatric Surgery department at Children’s in the 1960s. The transition of hospital staffing from community-based private physicians to full-time hospital employees was often controversial but was complete by the turn of the millennium. The 21st century has seen continuing growth of the new Children’s National Heart Institute and consolidation of several congenital cardiac programmes in Washington, DC.
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- 2021
25. Failing Fontan
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Om Prakash Yadava and Richard A. Jonas
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Pulmonary and Respiratory Medicine ,surgical procedures, operative ,cardiovascular system ,Surgery ,Video Article ,Cardiology and Cardiovascular Medicine ,humanities - Abstract
Dr. O.P. Yadava, CEO & Chief Cardiac Surgeon, National Heart Institute, New Delhi, India, and Editor-in-Chief, Indian Journal of Thoracic and Cardiovascular Surgery, in conversation with Prof. Richard Jonas, Paediatric Cardiac Surgeon from Washington DC, USA, on Failing Fontan.
- Published
- 2021
26. Modified Yasui Operation Using Cryopreserved Femoral Vein Homograft
- Author
-
Richard A. Jonas, Karthik Ramakrishnan, Pranava Sinha, and Manan Desai
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Femoral vein ,Aorta, Thoracic ,Pulmonary Artery ,030204 cardiovascular system & hematology ,Anastomosis ,Ventricular Outflow Obstruction ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Ascending aorta ,Humans ,Medicine ,Cryopreservation ,Aorta ,business.industry ,Interrupted aortic arch ,Infant, Newborn ,Femoral Vein ,Allografts ,medicine.disease ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,030228 respiratory system ,Ventricle ,Descending aorta ,Pulmonary artery ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures - Abstract
The Yasui operation is indicated in an interrupted aortic arch and a posterior malaligned ventricular septal defect with a narrow subaortic region. We present a modification of the Yasui procedure in which the aortic reconstruction was simplified using a nonvalved cryopreserved femoral vein homograft to connect the pulmonary artery to the descending aorta. A side-to-side anastomosis was performed between the femoral vein homograft and ascending aorta to complete the neoaortic reconstruction. After baffling the left ventricle to the pulmonary artery with a patch, a valved segment from the same femoral vein homograft was used to restore continuity of the right ventricular outflow.
- Published
- 2020
27. The evolution of surgical technique of the fenestrated Fontan procedure
- Author
-
Maxwell F. Kilcoyne, Patrick Gray, Richard A. Jonas, and Chi Chi Do-Nguyen
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Fontan Procedure ,Surgery ,Fontan procedure ,Treatment Outcome ,Humans ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Fenestration - Published
- 2020
28. Modified Warden Operation With the Use of Femoral Vein Homograft for Repair of a Variant of Right-Sided Partial Anomalous Pulmonary Venous Connection
- Author
-
Karthik Ramakrishnan, Richard A. Jonas, Josue Chery, and Russel Cross
- Subjects
Male ,Pulmonary Circulation ,Superior Vena Cava Syndrome ,medicine.medical_specialty ,Vena Cava, Superior ,Partial anomalous pulmonary venous return ,Femoral vein ,030204 cardiovascular system & hematology ,Heart Septal Defects, Atrial ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Superior vena cava ,medicine ,Humans ,cardiovascular diseases ,Cardiac Surgical Procedures ,Child ,Superior vena cava syndrome ,business.industry ,Scimitar Syndrome ,General Medicine ,Femoral Vein ,Allografts ,Venous Obstruction ,Surgery ,030228 respiratory system ,Pulmonary Veins ,Azygos Vein ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,Drainage ,Pulmonary Veno-Occlusive Disease ,medicine.symptom ,Azygos vein ,Cardiology and Cardiovascular Medicine ,business - Abstract
Surgical repair of right-sided partial anomalous pulmonary venous return (PAPVR) involves baffling the pulmonary vein across a naturally occurring or surgically created atrial septal defect without causing pulmonary venous or superior vena cava obstruction. A nine-year-old male presented to us with an unusual anatomical variant of right-sided partial anomalous pulmonary venous connection. The pulmonary veins draining the right upper and middle lobes connected to the azygous vein that drained in the usual fashion into the superior vena cava. The Warden operation was modified, with the use of femoral vein homograft, to avoid pulmonary venous obstruction.
- Published
- 2020
29. Commentary: Measurement of Regional Blood Flow in the Brain by Magnetic Resonance Imaging Raises New Questions for Adolescents With Congenital Heart Disease
- Author
-
Richard A. Jonas
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.diagnostic_test ,Heart disease ,business.industry ,Magnetic resonance imaging ,General Medicine ,Blood flow ,medicine.disease ,Internal medicine ,Cardiology ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2022
30. Refining The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model With Enhanced Risk Adjustment for Chromosomal Abnormalities, Syndromes, and Noncardiac Congenital Anatomic Abnormalities
- Author
-
Peter J. Gruber, Christian Pizarro, Sean M. O'Brien, Richard A. Jonas, James M. Meza, James D. St. Louis, Kevin D. Hill, Sara K. Pasquali, Jeffrey P. Jacobs, Erle H. Austin, S. Ram Kumar, David M. Shahian, J. William Gaynor, Dylan Thibault, John E. Mayer, and Marshall L. Jacobs
- Subjects
Adult ,Heart Defects, Congenital ,Male ,Pulmonary and Respiratory Medicine ,Canada ,medicine.medical_specialty ,Down syndrome ,Time Factors ,Adolescent ,Databases, Factual ,Chromosome Disorders ,030204 cardiovascular system & hematology ,Logistic regression ,computer.software_genre ,Risk Assessment ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk of mortality ,medicine ,Humans ,Hospital Mortality ,Cardiac Surgical Procedures ,Young adult ,Child ,Societies, Medical ,Retrospective Studies ,Models, Statistical ,Database ,business.industry ,Infant, Newborn ,Infant ,Thoracic Surgery ,Retrospective cohort study ,Odds ratio ,medicine.disease ,United States ,Surgery ,030228 respiratory system ,Cardiothoracic surgery ,Child, Preschool ,Atrioventricular canal ,Female ,Cardiology and Cardiovascular Medicine ,business ,computer ,Follow-Up Studies - Abstract
Background The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model adjusts not only for procedure and age group pairings but also for additional patient factors, including the binary presence or absence of a chromosomal abnormality (CA), syndrome (S), and/or a noncardiac congenital anatomic abnormality (NCAA). This analysis refines case-mix adjustment by adding more granular adjustment for individual conditions (CA, S, and NCAA), consistent with a hypothesis that associated risk of mortality differs between individual conditions. Methods CA/S corresponding to the same condition were merged to a single condition code. Odds ratios were estimated for all CA/S. For CA/S associated with at least 10 deaths in neonates and infants and at least 10 deaths in children and adults, odds ratios were estimated for the effect of the CA/S separately in neonates/infants and in children/adults. In addition to these condition/age interactions, condition/age/procedure interactions were explored (eg, effect of Down syndrome was estimated based on age and procedure subgroups, including atrioventricular canal repair and single-ventricle palliation). Bayesian modeling was used to create 5 maximally homogeneous groups of CA/S from 81 candidate CA/S variables. A standard logistic regression model then incorporated indicator variables for the 5 categories of CAs/Ss, 7 unique NCAAs, and all other covariates in the previously published Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Model. Results Analysis included 107,062 operations in 100 centers (2010 to 2015). Operative Mortality was 3,629 (3.4%). In the development sample, the C statistics of the original nonaugmented model and the augmented model were 0.872 and 0.875, respectively. Conclusions The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model has been augmented by addition of covariates representing individual CAs, Ss, and NCAAs.
- Published
- 2019
31. Proceedings From the 3rd Symposium of the World Database for Pediatric and Congenital Heart Surgery
- Author
-
Zohair Al Halees, Kirsten Finucane, Jeffrey P. Jacobs, Nestor Sandoval, James D. St. Louis, Christo I. Tchervenkov, James K. Kirklin, Hao Zhang, Richard A. Jonas, and Sachin Talwar
- Subjects
Heart Defects, Congenital ,medicine.medical_specialty ,Databases, Factual ,Outcome analysis ,Heart defect ,030204 cardiovascular system & hematology ,computer.software_genre ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Cardiac Surgical Procedures ,Child ,Societies, Medical ,Database ,business.industry ,Thoracic Surgery ,General Medicine ,Congresses as Topic ,Surgery ,030228 respiratory system ,Pediatrics, Perinatology and Child Health ,Cardiology and Cardiovascular Medicine ,business ,computer - Abstract
The World Database for Pediatric and Congenital Heart Surgery was created to provide a resource for centers to be able to perform complex outcomes analyses of children undergoing repair of a congenital heart defect. In just under two years, the World Society for Pediatric and Congenital Heart Surgery (WSPCHS) has amassed over 13,000 procedures from 55 centers into the database. This Proceedings of the 3rd World Database Symposium held at the 6th Scientific Meeting of the WSPCHS summarizes the presentations of international experts in the fields of outcomes analysis and care of children with congenital heart surgery.
- Published
- 2019
32. The Arterial Switch Operation in 2019: How to Do It and How to Teach It
- Author
-
Richard A. Jonas
- Subjects
business.industry ,Transposition of Great Vessels ,General Medicine ,030204 cardiovascular system & hematology ,Coronary Vessels ,Arterial Switch Operation ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Pediatrics, Perinatology and Child Health ,Cardiac procedures ,Humans ,Medicine ,Surgery ,Operations management ,Child ,Cardiology and Cardiovascular Medicine ,business ,Competence (human resources) - Abstract
This article presents technical aspects of the arterial switch procedure. The arterial switch procedure is a technically reproducible operation that involves less three-dimensional judgment and fewer difficult sequencing decisions than many other complex cardiac procedures. Hemostasis is the most important principal that must be adhered to mainly through meticulous surgical technique. Meticulous technique will also lead to successful transfer of the coronary arteries. Teaching a surgical trainee how to manage a child who requires an arterial switch procedure requires instruction in the technical aspects of the procedure. However, this is just one component of the overall management of babies requiring this procedure. Attention and training should be directed at all areas of competence that have been emphasized by bodies such as the American College of Surgeons. Simulation is playing an increasingly important role in the instruction of surgical trainees within the domain of congenital heart disease.
- Published
- 2019
33. WJPCHS Presidential Address: Threats to the Continuing Globalization of Early Primary Repair
- Author
-
Richard A. Jonas
- Subjects
business.industry ,General Medicine ,030204 cardiovascular system & hematology ,Public relations ,03 medical and health sciences ,Globalization ,Primary repair ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Presidential address ,Pediatrics, Perinatology and Child Health ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
The outgoing presidential address presented by the author at the July 2018 meeting of the World Society for Pediatric and Congenital Heart Surgery focuses on forces threatening the movement toward single-stage repair of congenital heart anomalies in the young. Issues that are of particular importance in the United States are challenges in training the next generation of surgeons, an increasing percentage of premature neonates, and the use of data analytics by hospital administration which incentivizes inflation of procedural numbers. However, the most important factor is the ranking of hospitals by the lay press with heavy emphasis on early procedural mortality rather than patient survival. In contrast to current databases used for such rankings, the new World Society database is planning to collect patient admissions rather than procedural number as the key denominator to allow accurate calculation of patient survival. The current heavy weighting of procedural success (ie, early hospital mortality) in establishing rankings of hospitals is encouraging centers to undertake palliative procedures in high-risk patients or avoiding a surgical procedure altogether.
- Published
- 2019
34. The World Database for Pediatric and Congenital Heart Surgery 'A Call to Service for North American Congenital Heart Surgery Programs'
- Author
-
Viktor Hraska, James D. St. Louis, Erle H. Austin, Christo I. Tchervenkov, Pranava Sinha, Kristine J. Guleserian, Mark D. Plunkett, Nick Timkovich, Jeffery P. Jacobs, Marshall L. Jacobs, James E. O'Brien, John L. Myers, James K. Kirklin, Susanna Lenderman, and Richard A. Jonas
- Subjects
Pulmonary and Respiratory Medicine ,Service (business) ,medicine.medical_specialty ,Quality management ,Database ,business.industry ,Heart defect ,General Medicine ,030204 cardiovascular system & hematology ,computer.software_genre ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,medicine ,Cardiology and Cardiovascular Medicine ,business ,computer - Abstract
The World Society for Pediatric and Congenital Heart Surgery has endorsed the establishment of an international platform for the exchange of knowledge and experience for those that treat patients with a congenital heart defect. On January 1, 2017, the release of the World Database for Pediatric and Congenital Heart Surgery opened a new era in evaluation of treatment with congenital heart defects. The contribution of data from countries with established congenital surgical databases will greatly enhance the efforts to provide the most accurate measure of overall surgical outcomes across the globe.
- Published
- 2019
35. A New Management Algorithm for the Two-Stage Arterial Switch
- Author
-
Richard A. Jonas
- Subjects
Pulmonary and Respiratory Medicine ,business.industry ,Transposition of Great Vessels ,Ventricular Function, Left ,Management algorithm ,Arterial Switch Operation ,Humans ,Medicine ,Surgery ,Operations management ,Stage (hydrology) ,Cardiology and Cardiovascular Medicine ,business ,Algorithms - Published
- 2022
36. Influence of administration of mesenchymal stromal cell on pediatric oxygenator performance and inflammatory response
- Author
-
Richard A. Jonas, Casey M. Briggs, Christine A. Brantner, Nobuyuki Ishibashi, Patrick J. Hanley, Takuya Maeda, and Anushree Datar
- Subjects
Macrophage colony-stimulating factor ,Chemokine ,Stromal cell ,biology ,business.industry ,Lymphocyte ,Monocyte ,medicine.medical_treatment ,cerebral protection ,Mesenchymal stem cell ,congenital heart disease ,Article ,law.invention ,medicine.anatomical_structure ,Cytokine ,law ,Cardiopulmonary bypass ,biology.protein ,medicine ,Cancer research ,cardiopulmonary bypass ,cell transplantation ,mesenchymal stromal cells ,business - Abstract
Objective Mesenchymal stromal cells have important immunomodulatory and neuroprotective properties. The aim of this study was to evaluate the feasibility of mesenchymal stromal cell administration into a cardiopulmonary bypass (CPB) circuit, including a pediatric oxygenator, and to assess the immunomodulatory response of the circulating blood prime. Methods A bypass circuit with a pediatric oxygenator, including integral filter was primed with bank whole blood. Normal saline (control) or 120 × 106 mesenchymal stromal cells were injected into the venous reservoir after 80 minutes of perfusion. To assess oxygenator function, immune reaction, and cytokine/chemokine levels, the ex vivo circulation was maintained for 300 minutes after administration. Results There were no differences in flow rate, trans-oxygenator pressure gradient, blood oxygen, and carbon dioxide levels between control and cell delivery groups. No adhesion of mesenchymal stromal cells was observed on the filter mesh by scanning electron microscopy. Lymphocyte surface marker assay found no difference in the number of B cells, T cells, or natural killer cells between the 2 groups, indicating no immunogenicity of allogeneic mesenchymal stromal cells under ex vivo CPB conditions. CPB significantly changed the level of interleukin (IL) 4, IL-6, IL-8, IP-10, macrophage colony stimulating factor, macrophage inflammatory protein-1β, monocyte chemoattractant protein-1, and IL-1α over time. IL-6 level was significantly increased after cell administration. Conclusions The administration of mesenchymal stromal cells does not interfere with oxygenator function. Allogeneic mesenchymal stromal cells show no immunogenicity, and increase plasma IL-6 level during ex vivo circulation. Further investigation is necessary to determine the effect of mesenchymal stromal cell delivery through CPB during pediatric cardiac surgery.
- Published
- 2021
37. A comparison of autologous pericardium with Dacron™ for closure of ventricular septal defect in infants
- Author
-
Manan H Desai, Skander Hachana, Syed M Bukhari, Andrea Stough, David Zurakowski, Richard A Jonas, and Karthik Ramakrishnan
- Subjects
Pulmonary and Respiratory Medicine ,Heart Septal Defects, Ventricular ,congenital, hereditary, and neonatal diseases and abnormalities ,Polyethylene Terephthalates ,Infant ,General Medicine ,Treatment Outcome ,Glutaral ,Humans ,Surgery ,Cardiology and Cardiovascular Medicine ,Child ,Pericardium ,Follow-Up Studies ,Retrospective Studies - Abstract
OBJECTIVES Glutaraldehyde-treated autologous pericardium (GtAP) and Dacron™ are 2 patch materials commonly used to repair ventricular septal defects (VSDs) in children. The primary objective of this study was to test the hypothesis that GtAP is as effective as Dacron for the repair of isolated VSD in infants. METHODS Data were collected retrospectively from all infants who underwent repair of isolated VSD at our institution between January 2009 and April 2017. A total of 156 patients were divided into 2 groups: 99 underwent repair with Dacron patch and 57 with GtAP. The primary end point was the need for reintervention for significant residual VSD. Adjusted hospital charges were also compared. RESULTS The 2 groups were comparable in their baseline characteristics. There was no significant difference in postoperative morbidity indicators. One patient in each group underwent reintervention for the closure of residual VSD. The GtAP group had a higher incidence trivial and small residual VSD at discharge than the Dacron group (65% vs 39%, P = 0.007). The median duration of follow-up was 37 (15–75) months with no difference between the 2 groups. Forty-five percentage of the residual VSDs in the Dacron group (19/42) and 54%in the GtAP group (21/39) had closed. There was no difference in hospital charges and clinical outcomes. CONCLUSIONS GtAP for the closure of isolated VSD in infants is comparable to Dacron. Although the incidence of trivial or small residual VSD is higher with the use of pericardium immediately after surgery, this difference disappears over time.
- Published
- 2021
38. Surgical experience makes a difference: but what is surgical experience?
- Author
-
Richard A. Jonas
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Surveys and Questionnaires ,General surgery ,medicine ,Humans ,Surgery ,General Medicine ,Surgical procedures ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
39. Commentary: Nitric oxide: An important contributor to neuroprotection during pediatric cardiac surgery
- Author
-
Nobuyuki Ishibashi and Richard A. Jonas
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Brain development ,Heart disease ,Hypertension, Pulmonary ,030204 cardiovascular system & hematology ,Nitric Oxide ,Bioinformatics ,Neuroprotection ,Article ,Nitric oxide ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,medicine ,Humans ,Cardiac Surgical Procedures ,Child ,business.industry ,Heart ,medicine.disease ,Cardiac surgery ,030228 respiratory system ,chemistry ,Surgery ,Animal studies ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVE: Dysregulation of local nitric oxide (NO) synthetases occurs during ischemia and reperfusion associated with cardiopulmonary bypass, deep hypothermic circulatory arrest (DHCA), and reperfusion. Rapid fluctuations in local NO occurring in neonates and infants probably contribute to inflammation-induced microglial activation, and neuronal degeneration after these procedures, eventually impairing neurodevelopment. We evaluated the anti-inflammatory efficacy of inhaled NO (iNO) in a piglet model emulating conditions during pediatric open-heart surgery with DHCA. METHODS: Infant Yorkshire piglets underwent DHCA (18°C) for 30 minutes, followed by reperfusion and rewarming either with or without iNO (20 ppm) in the ventilator at the onset of reperfusion for 3 hours (n = 5 per group, DHCA-iNO and DHCA). Through craniotomy, brains were extracted after perfusion fixation for histology. RESULTS: Plasma NO metabolites were elevated 2.5 times baseline data before DHCA by iNO. Fluoro-Jade C staining identified significantly lower number of degenerating neurons in the hippocampus of the DHCA-iNO group (p = 0.02) compared with DHCA group. Morphologic analyses of ionized calcium-binding adapter molecule-1 stained microglia, evaluating cell body and dendritic process geometry with Imaris imaging software, revealed subjectively less microglial activation in the hippocampus of pigs receiving iNO. CONCLUSIONS: Using DHCA for 30 minutes, consistent with clinical exposure, we noted that iNO reduces neuronal degeneration in the hippocampus. Additionally, iNO reduces microglial activation in the hippocampus after DHCA. The data suggest that iNO reduces neuronal degeneration by ameliorating inflammation and may be a practical mode of neuroprotection for infants undergoing DHCA.
- Published
- 2021
40. Cryopreserved valved femoral vein homografts for right ventricular outflow tract reconstruction in infants
- Author
-
David Zurakowski, Lucas Mota, Pranava Sinha, Richard A. Jonas, Lok Sinha, Steven J. Staffa, and Mahmut Ozturk
- Subjects
Retrospective review ,medicine.medical_specialty ,Proportional hazards model ,business.industry ,Femoral vein ,Length of hospitalization ,Surgery ,body regions ,Catheter ,surgical procedures, operative ,cardiovascular system ,medicine ,Ventricular outflow tract ,cardiovascular diseases ,Cumulative hazard ,business - Abstract
Background We have previously reported use of cryopreserved valve femoral vein homograft (FVH) conduits for biventricular repairs in infants needing right ventricular outflow tract (RVOT) reconstruction. This study aims to compare FVH conduits with aortic (A) and pulmonary (P) homografts with regards to intermediate- and long-term outcomes. Methods Retrospective review was conducted of all infants between 2004 and 2016 who underwent biventricular repair with RVOT reconstruction using homograft conduits. Patients were divided into A, P, and FVH groups based upon type of conduit received (N = 57 [A = 13; P = 21, FVH = 23]). Groups were compared using univariate and multivariable Cox regression analyses. The Nelson–Aalen estimator of cumulative hazard and Kaplan–Meier curves were used to identify differences in freedom from catheter reintervention and reoperation. Results The 2 groups were comparable except for greater incidence of delayed sternal closure and longer hospital length of stay in the FVH group. The follow-up was longer for A and P groups compared with the FVH group (P Conclusions Valved femoral vein homograft conduits are comparable with aortic and pulmonary homografts for RVOT reconstruction in infants undergoing biventricular repairs.
- Published
- 2020
41. Challenges for Adult Survivors of Simple Congenital Heart Disease
- Author
-
Richard A. Jonas
- Subjects
Heart Septal Defects, Ventricular ,Male ,Pediatrics ,Complications ,Heart disease ,Magnetic Resonance Imaging (MRI) ,Intelligence ,neuropsychology ,Child Behavior ,Neuropsychological Tests ,neurodevelopmental outcomes ,Heart Septal Defects, Atrial ,Executive Function ,Child Development ,Clinical Studies ,Survivors ,Prospective Studies ,Child ,Original Research ,Simple (philosophy) ,septal defects ,Quality and Outcomes ,Cardiovascular Surgery ,Congenital Heart Disease ,Age Factors ,neurodevelopmental outcome ,Brain ,Magnetic Resonance Imaging ,Editorial ,Treatment Outcome ,Child, Preschool ,Female ,Cardiology and Cardiovascular Medicine ,Heart Defects, Congenital ,Adult ,medicine.medical_specialty ,Adolescent ,Neuroimaging ,adult survivors of congenital heart surgery ,Young Adult ,Memory ,medicine ,Humans ,atrial septal defect ,Cardiac Surgical Procedures ,Social Behavior ,business.industry ,Editorials ,Infant, Newborn ,Infant ,Adolescent Development ,medicine.disease ,ventricular septal defect ,Cross-Sectional Studies ,Adolescent Behavior ,Neurodevelopmental Disorders ,Case-Control Studies ,business - Abstract
Background Neurodevelopmental impairments are common in survivors of complex congenital heart defects (CHD). We report neuropsychological and brain imaging assessments in adults operated for isolated septal defects. Methods and Results Patients (mean age 25.6 yrs) who underwent childhood surgery for isolated atrial septal defect (n=34) or ventricular septal defect (n=32), and healthy matched peers (n=40), underwent a standard battery of neuropsychological tests and a 3.0T brain magnetic resonance imaging scan. Patient intelligence was affected with lower scores on Full‐Scale intelligence quotient (P
- Published
- 2020
42. Right Atrial Cannulation via Thoracotomy for Emergent Extracorporeal Membrane Oxygenation in Pediatric Patients with Prior Sternotomy
- Author
-
Manan Desai, Syed Murfad Peer, Syed Bukhari, Richard A. Jonas, and Can Yerebakan
- Subjects
Male ,Cardiac output ,medicine.medical_specialty ,Cardiac Catheterization ,medicine.medical_treatment ,Biomedical Engineering ,Biophysics ,Bioengineering ,030204 cardiovascular system & hematology ,Right atrial ,Biomaterials ,03 medical and health sciences ,0302 clinical medicine ,Extracorporeal Membrane Oxygenation ,Catheterization procedure ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Thoracotomy ,Venous anatomy ,business.industry ,Cardiogenic shock ,Infant ,General Medicine ,medicine.disease ,Sternotomy ,Surgery ,030228 respiratory system ,Child, Preschool ,Circulatory system ,Female ,business - Abstract
Extracorporeal membrane oxygenation (ECMO) is the most common mechanical circulatory support strategy used to treat pediatric patients presenting with low cardiac output or cardiogenic shock. While transthoracic central cannulation is feasible and mostly utilized for early postoperative support, peripheral cannulation is preferred as a primary strategy in the late postoperative period. Redo-sternotomy and venous cannulation are difficult to achieve in patients with occluded peripheral veins or complex venous anatomy like Glenn circulation. In pediatric patients with multiple prior sternotomy and catheterization procedures, vascular access for cannulation is frequently limited. Peripheral cannulation for venoarterial ECMO (VA-ECMO) may be challenging or even impossible. In our case series, four pediatric patients with prior sternotomy underwent right atrial cannulation emergently in patients to secure venous drainage for ECMO support. Extracorporeal membrane oxygenation support could be established rapidly with adequate venous drainage in all cases. We conclude that right atrial cannulation via right thoracotomy can be a useful technique for venous cannulation in cases with prior sternotomy and is particularly useful in cases with Glenn circulation.
- Published
- 2020
43. Modified Damus-Kaye-Stansel Connection for Systemic Outflow Tract Obstruction After Fontan Operation
- Author
-
Katherine Klein, Lok Sinha, Karthik Ramakrishnan, and Richard A. Jonas
- Subjects
Difficult problem ,Adult ,Heart Defects, Congenital ,medicine.medical_specialty ,Transposition of Great Vessels ,030204 cardiovascular system & hematology ,Pulmonary Artery ,Fontan Procedure ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,Pulmonary Trunk ,Damus kaye stansel ,cardiovascular diseases ,Aorta ,Pulmonary Valve ,business.industry ,Connection (principal bundle) ,Anastomosis, Surgical ,Anticoagulants ,General Medicine ,Surgery ,medicine.anatomical_structure ,030228 respiratory system ,Pulmonary valve ,Heart Valve Prosthesis ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,Outflow ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Late systemic outflow tract obstruction following completion of the Fontan palliation is rarely seen and is a difficult problem to treat. Absence of the main pulmonary trunk and pulmonary valve at this stage makes a conventional Damus-Kaye-Stansel connection difficult to achieve. We report the case of a 37-year-old female who underwent Fontan completion as an adult and subsequently presented with systemic outflow tract obstruction. A valved conduit was interposed between the native pulmonary annulus and the ascending aorta to create a modified Damus-Kaye-Stansel type connection.
- Published
- 2020
44. Symptomatic Tetralogy of Fallot in Young Infants: Primary Repair or Shunt—Pediatric Health Information System Database Analysis
- Author
-
William Pastor, Richard A. Jonas, Karthik Ramakrishnan, Pranava Sinha, and David Zurakowski
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Pediatric health ,Database analysis ,Treatment outcome ,030204 cardiovascular system & hematology ,Health informatics ,Young infants ,Health Information Systems ,03 medical and health sciences ,Primary repair ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,Cardiac Surgical Procedures ,Tetralogy of Fallot ,business.industry ,Infant, Newborn ,Infant ,General Medicine ,medicine.disease ,Hospital Charges ,United States ,Shunt (medical) ,Treatment Outcome ,030228 respiratory system ,Pediatrics, Perinatology and Child Health ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Compare the early outcomes and hospital charges of early primary repair and systemic-to-pulmonary artery shunt for neonates and young infants (≤90 days of age) with tetralogy of Fallot using data from the Pediatric Health Information System database. Methods: The Pediatric Health Information System database was queried for patients Results: Comparison of unmatched groups revealed younger age and higher incidence of extracardiac anomalies ( P = .02) and prematurity ( P = .04) in group 2. Mortality was comparable between the groups (group 1: 20 [4%] of 554 vs group 2: 11 [4%] of 267, P = .74). Irrespective of the type of procedure, prematurity (odds ratio [OR] = 3.3, 95% confidence interval [CI]: 1.5-7.4) and extracardiac anomalies (OR = 2.5, 95% CI: 1.2-5.3) were independent risk factors for mortality. Propensity score–matched analysis revealed no significant differences in patient mortality ( P = 1), duration of ventilation ( P = .64), hospital length of stay ( P = .69), or hospital charges ( P = .08) between the two groups. Conclusion: Outcomes and hospital charges associated with nonelective early primary repair are comparable to systemic-to-pulmonary artery shunt in symptomatic patients
- Published
- 2018
45. La base de datos mundial de cirugía cardíaca pediátrica y congénita: una colaboración con el Registro Nacional de Cirugía Cardíaca Pediátrica (RENACCAPE)
- Author
-
James E. O’BrienJr., Nestor Sandoval, Jeffery P. Jacobs, Alejandro Bolio-Cerdán, Jorge Cervantes-Salazar, Hiromi Kurosawa, James D. St. Louis, Christo I. Tchervenkov, Alexis Palacios-Macedo, James K. Kirklin, and Richard A. Jonas
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
46. The world database for pediatric and congenital heart surgery: A collaboration with the Registro Nacional de Cirugía Cardiaca Pediátrica
- Author
-
Jeffery P. Jacobs, James E. O'Brien, Hiromi Kurosawa, Christo I. Tchervenkov, Nestor Sandoval, Alejandro Bolio-Cerdán, Alexis Palacios-Macedo, Richard A. Jonas, Jorge Cervantes-Salazar, James D St-Louis, and James K. Kirklin
- Subjects
Heart Defects, Congenital ,medicine.medical_specialty ,Internationality ,Heart disease ,Databases, Factual ,Heart Diseases ,computer.software_genre ,03 medical and health sciences ,0302 clinical medicine ,Cardiopatia congenita ,medicine ,Humans ,030212 general & internal medicine ,Registries ,Cardiac Surgical Procedures ,Child ,Mexico ,Database ,business.industry ,General Medicine ,medicine.disease ,Cardiac surgery ,Surgery ,030228 respiratory system ,National registry ,business ,computer - Abstract
Following the notable work accomplished by the Mexican Association of Specialists in Congenital Heart Disease (Asociación Mexicana de Especialistas en Cardiopatías Congénitas) with the development of a national registry for congenital cardiac surgery, the World Society for Pediatric and Congenital Heart Surgery has implemented an international platform to collect data and analyze outcomes of children with congenital heart disease.This manuscript proposes a possible collaboration between Mexico's national congenital cardiac database (Registro Nacional de Cirugía Cardíaca Pediátrica) and the World Database for Pediatric and Congenital Heart Surgery.Such a partnership would advance the countries' desire for the ongoing development of quality improvement processes and improve the overall treatment of children with congenital heart disease.Siguiendo el notable trabajo realizado por la Asociación Mexicana de Especialistas en Cardiopatías Congénitas (Asociación Mexicana de Especialistas en Cardiopatías Congénitas: AMECC) con el desarrollo de un registro nacional para la cirugía cardíaca congénita, la Sociedad Mundial de Pediatría y Cirugía Cardíaca Congénita ha implementado una plataforma internacional para recopilar datos y analizar los resultados de los niños con cardiopatía congénita.Este manuscrito propone una posible colaboración entre la base nacional de datos cardiacos congénitos de México (RENACCAPE) y la Base de Datos Mundial para la Cirugía Cardíaca Pediátrica y Congénita (WDPCHS).Esta asociación promovería el deseo de los países de seguir desarrollando procesos de mejora de la calidad y mejorar el tratamiento general de los niños con cardiopatía congénita.
- Published
- 2019
47. Strengthening International Collaboration in Congenital Heart Surgery
- Author
-
Richard A. Jonas
- Subjects
Heart Defects, Congenital ,medicine.medical_specialty ,Databases, Factual ,Heart disease ,International Cooperation ,media_common.quotation_subject ,education ,Certification ,030204 cardiovascular system & hematology ,Global Health ,03 medical and health sciences ,0302 clinical medicine ,Excellence ,Presidential address ,medicine ,Global health ,Humans ,Mission statement ,Societies, Medical ,health care economics and organizations ,media_common ,Health economics ,business.industry ,Thoracic Surgery ,General Medicine ,medicine.disease ,Surgery ,030228 respiratory system ,Cardiothoracic surgery ,Pediatrics, Perinatology and Child Health ,Cardiology and Cardiovascular Medicine ,business - Abstract
This paper was presented by the author at the 2016 biannual scientific meeting in Abu dhabi of the World Society for Pediatric and Congenital Heart Surgery as his incoming presidential address. In addition to listing the accomplishments of the World Society including several successful international scientific meetings and regional meetings, the Society has established the only journal devoted to congenital heart surgery and is in the process of establishing the new World Society database. The mission statement of the World Society emphasizes equitable global management of patients with congenital heart disease and includes an emphasis on excellence in education, research and community service. The Society will promote international exchange of trainees in congenital heart surgery, the facilitation of international teaching and treatment missions as well as a system for global certification of congenital heart surgeons to facilitate international movement of surgeons to areas of greatest need.
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- 2018
48. Pump in Parallel—Mechanical Assistance of Partial Cavopulmonary Circulation Using a Conventional Ventricular Assist Device
- Author
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Nina Deutsch, Gerald T. Mikesell, Erin Montague, Mark M. Nuszkowski, Dingchao He, Murfad Peer, Kanishka Ratnayaka, Pranava Sinha, Richard A. Jonas, Mustafa Kurkluoglu, and David Zurakowski
- Subjects
Male ,medicine.medical_specialty ,Cardiac output ,Swine ,medicine.medical_treatment ,Atrial Pressure ,Biomedical Engineering ,Biophysics ,Bioengineering ,030204 cardiovascular system & hematology ,Heart Septal Defects, Atrial ,Biomaterials ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Internal medicine ,medicine.artery ,medicine ,Animals ,Balloon septostomy ,business.industry ,Hemodynamics ,General Medicine ,medicine.anatomical_structure ,030228 respiratory system ,Ventricle ,Ventricular assist device ,Circulatory system ,Pulmonary artery ,Cardiology ,Female ,Heart-Assist Devices ,business - Abstract
Mechanical assistance of systemic single ventricle is effective in pulling blood through a cavopulmonary circuit. In patients with superior cavopulmonary connection, this strategy can lead to arterial desaturation secondary to increased inferior caval flow. We hypothesized that overall augmentation in cardiac output with mechanical assistance compensates for the drop in oxygen saturation thereby maintaining tissue oxygen delivery (DO2). Bidirectional Glenn (BDG) was established in seven swine (25 kg) after a common atrium had been established by balloon septostomy. Mechanical circulatory assistance of the single ventricle was achieved using an axial flow pump with ventricular inflow and aortic outflow. Cardiac output, mean pulmonary artery pressure (PAP), common atrial pressure (left atrial pressure [LAP]), arterial oxygen saturation (SaO2), partial pressure of arterial oxygen (PaO2), and DO2 were compared between assisted and nonassisted circulation. Significant augmentation of cardiac output was achieved with mechanical assistance in BDG circulation (BDG: median [interquartile range {IQR}], 0.8 [0.9-1.15] L/min versus assisted BDG: median [IQR], 1.5 [1.15-1.7] L/min; p = 0.05). Although oxygen saturations and PaO2 trended to be lower with assistance (SaO2; BDG: median [IQR], 43% [32-57%]; assisted BDG: median [IQR], 32% [24-35%]; p = 0.07) (PaO2; BDG: median [IQR], 24 [20-30] mm Hg; assisted BDG: median [IQR], 20 [17-21] mm Hg; p = 0.08), DO2 was unchanged with mechanical assistance (BDG: median [IQR], 94 [35-99] ml/min; assisted BDG: median [IQR], 79 [63-85] ml/min; p = 0.81). No significant change in the LAP or PAP was observed. In the setting of superior cavopulmonary connection/single ventricle, the systemic ventricular assistance with a ventricular assist device (VAD) leads to increase in cardiac output. Arterial oxygen saturations however may be lower with mechanical assistance, without any change in DO2.
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- 2018
49. The World Database for Pediatric and Congenital Heart Surgery: Use of an International Congenital Database in South Korea
- Author
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Sakamoto Kisaburo, Hiromi Kurosawa, James K. Kirklin, James D. St. Louis, Christo I. Tchervenkov, Richard A. Jonas, Jeffery P. Jacobs, and Cheul Lee
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,lcsh:Surgery ,MEDLINE ,lcsh:RD1-811 ,030204 cardiovascular system & hematology ,Brief Communication ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
50. One Truncal Valve or Two Semilunar Valves: An Unusual Case of Truncus Arteriosus
- Author
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Russell R. Cross, Laura J. Olivieri, Yue-Hin Loke, David N. Schidlow, Richard A. Jonas, and Lok Sinha
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Aortic arch ,congenital, hereditary, and neonatal diseases and abnormalities ,Persistent truncus arteriosus ,030204 cardiovascular system & hematology ,One Trunk or Two? Unusual Anatomy ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Ascending aorta ,medicine ,Semilunar valves ,ComputingMethodologies_COMPUTERGRAPHICS ,Congenital heart disease ,Arterial trunk ,business.industry ,General Medicine ,Anatomy ,medicine.disease ,Truncal valve ,Hypoplasia ,Coronary arteries ,medicine.anatomical_structure ,Truncus arteriosus ,030228 respiratory system ,cardiovascular system ,business - Abstract
Graphical abstract, Highlights • Truncus arteriosus is generally considered a failure of septation in the ventricular outflow tracts, the semilunar valves, and the aorta and pulmonary arteries. • This case involved the unusual finding of a partially septated truncal valve. • This case highlights the embryologic aberrations resulting in this disease.
- Published
- 2018
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