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We used a suture-and-open technique with a biatrial incision for primary sutureless repair of total anomalous pulmonary venous connection (TAPVC). With this technique, the common pulmonary venous sinus and its branching pulmonary veins are opened after completion of suturing of the left atrial incision to the pericardium around the common pulmonary venous sinus and its branching veins. The technique allows the primary sutureless repair of TAPVC to be done in a less bloody field under full-flow cardiopulmonary bypass. We have performed this technique in our recent 5 consecutive TAPVC patients without significant complications.

Background Conduit survival without significant dysfunction is important when selecting the right ventricular outflow tract conduit. We made an expanded polytetrafluoroethylene tricuspid valved conduit using a simplified technique. We aimed to investigate the midterm functional results and longevity of this conduit. Methods Between November 2008 and December 2016, four hospitals in Korea implanted 145 valved conduits. We retrospectively analyzed their functional results and longevity. Results The patients' median age at operation was 36.6 months; the median body weight was 11.3 kg. The mean follow-up duration was 32.3 ± 24.5 months. There were four inhospital deaths and three late deaths, but there were no conduit-related deaths. The mean peak systolic pressure gradient across the conduit was 14.7 ± 8.3 mm Hg and 31.6 ± 17.7 mm Hg at discharge and last follow-up, respectively. Six patients (4.4%) had moderate or more conduit valve regurgitation at last follow-up. Conduit dysfunction was observed in 30 patients (21.9%), mainly caused by increased pressure gradient (24 of 30, 80%). Freedom from conduit dysfunction was 88.1% and 58.5% at 3 and 5 years, respectively. Lower freedom from conduit dysfunction was observed in small conduits. Eleven patients (7.8%) underwent conduit explantation, and freedom from explantation was 94.8% and 81.7% at 3 and 5 years, respectively. The main cause of explantation was conduit stenosis. Small conduits tended to have lower freedom from explantation. Conclusions Functional results and longevity of our expanded polytetrafluoroethylene tricuspid valved conduit are acceptable. Although our conduits tend to have increasing pressure gradient over time, especially in small conduits, they have low incidence of moderate or more regurgitation.

Background Airway compression caused by an enlarged right pulmonary artery (RPA) in patients with a large shunt can usually be managed with intracardiac repair and concomitant anterior aortopexy. However, anterior aortopexy can be less effective or even dangerous in patients with coexisting arch anomaly due to excessive tension at the arch repair site. We have adopted anterior translocation of RPA without aortic transection in the group of patients with a high risk of postoperative airway compression. We reviewed the early and midterm results of this technique. Methods From February 2006 to January 2013, 8 patients underwent RPA anterior translocation as a concomitant procedure in one-stage repair of ventricular septal defect (VSD) and aortic arch anomaly to avoid postoperative airway problems. The enlarged RPA was disconnected from the main pulmonary artery (MPA) at its origin and was relocated anterior to the ascending aorta, and subsequently reimplanted to the U-shaped trapdoor incision at the anterolateral MPA wall. The mean age at operation was 34 days (median, 14 days, 6 to 77 days), and the mean body weight was 3.6 kg (2.15 to 5.5 kg). All patients had coarctation of the aorta and VSD except 1 who had aortic arch interruption. Five patients were dependent on a ventilator preoperatively. Six patients had evidence of preoperative bronchial compression (left; 4, right and left; 2), and 2 had a high probability of postoperative bronchial compression due to unusual anterior location of the descending aorta. Results There was no early or late death. There were no postoperative airway problems such as reintubation or left lung atelectasis. Widely patent RPA was confirmed on postoperative computed tomographic angiography in all patients. The mean follow-up duration was 54.0 ± 17.1 months. One patient required balloon angioplasty for mild stenosis at the clamping site 3 years after the operation. All patients had no RPA stenosis at the latest follow-up evaluation. Conclusions Anterior translocation of the RPA as a concomitant procedure in one-stage repair of VSD and arch anomaly is a safe and effective procedure to avoid postoperative airway problems in high-risk patients.

Background Reconstruction of branch pulmonary arteries (PAs) can be demanding in redo congenital cardiac surgeries. Sutureless patch angioplasty could be a useful method to solve this problem, and we evaluated the feasibility of sutureless patch angioplasty for postoperative PA stenosis in patients who underwent congenital cardiac surgery. Methods We retrospectively reviewed 28 patients (19 males and 9 females) who underwent sutureless patch angioplasty for postoperative PA stenosis between November 2004 and April 2015. The median age was 7.3 months (range, 4.3 to 54.7), and the median weight was 7.2 kg (range, 5.3 to 12.2 kg). Right PA angioplasty was performed in 5, left PA angioplasty in 10, and both sides in 13 patients. The most common original diagnosis was hypoplastic left heart syndrome (n = 18 of 28, 64.3%). Concomitant surgeries were the bidirectional cavopulmonary shunt in 24 patients, the Fontan operation in 3, and the Rastelli operation in 1 patient. Results No operative death occurred. However, 2 late deaths were recorded, and both were unrelated to PA angioplasty. Mean follow-up duration was 60.9 ± 33.1 months. None of the patients had postoperative bleeding or thrombotic occlusion. No reoperation for PA restenosis was performed, and only 1 patient (3.6%) had a PA balloon angioplasty with a good result 12.9 months after the operation. Echocardiography or computed tomography angiography at the recent follow-up showed good branch PAs in all patients. Conclusions Sutureless patch angioplasty for postoperative PA stenosis could simplify PA angioplasty, and be a safe and effective method for PA reconstruction in patients who undergo congenital cardiac surgery.

Background Accurate coronary reimplantation is the most important component in the arterial switch operation. It is especially demanding for the less experienced surgeons. We compared the result of the technique of coronary reimplantation after neoaortic reconstruction with that of the open trap door technique. Methods From March 1994 to June 2004, 103 consecutive patients underwent the arterial switch operation by one surgeon. Patients who underwent coronary artery transfer with other modified techniques were excluded. Diagnoses of 94 patients were transposition of the great arteries with intact ventricular septum (n = 50), transposition of the great arteries with ventricular septal defect (n = 26), and the Taussig-Bing anomaly (n = 18). An aortic arch anomaly was present in 13 patients. The median age of the patients was 12 days and the mean body weight was 3.5 kg. Coronary reimplantation after neoaortic reconstruction was applied to 34 patients (group I), and the open trap door technique was applied to the rest (group II). Results Preoperative data were similar in both groups. Four patients in group II required intraoperative revision of a transferred coronary artery, and 1 patient with an intramural left coronary artery in group I had a conversion to free grafting using the left subclavian artery. Overall early mortality was 17.0% (16 of 94). Mortality in group I (1 of 34; 2.9%) was significantly lower than in group II (15 of 60; 25.0%) ( p = 0.008). The leading cause of death in group II was low cardiac output (n = 9). During the follow-up, an aortic regurgitation of greater than mild was detected in 2 patients in group II. Conclusions Coronary reimplantation after neoaoartic reconstruction is an attractive method to minimize coronary artery transfer-related mortality or morbidity.

Background The reimplantation of the coronary arteries from a single aortic sinus (single sinus coronary artery) in an arterial switch operation remains a technically challenging procedure. The technique of coronary transfer in this situation should be individualized depending on coronary ostial anatomy. We reviewed our techniques of coronary reimplantation with early and midterm results. Methods Among 103 patients who underwent arterial switch operations from March 1994 to June 2004, 16 (15.5%) had single sinus coronary artery (median age, 9 days; mean body weight, 3.5 kg). Fourteen patients (14/16, 87.5%) had coronary arteries from right facing sinus (sinus 2). Of these 14 patients, 11 had separate ostia including intramural course of the left coronary artery (n = 9) and 3 had single ostium. Two patients (2/16, 12.5%) had coronary arteries from left facing sinus (sinus 1) with single ostium. Aortic arch obstruction was associated in 5 patients. Results All 5 single sinus coronary arteries with single ostium were reimplanted with the trap-door technique. Of the 11 patients with separate ostia, 8 underwent coronary transfer with the aortocoronary flap technique and 3 with the double-button technique. Two of the 3 patients who underwent the double-button technique required left coronary artery bypass using left subclavian artery free graft as the salvaging procedure. There was one early death (1/16, 6.3%), which occurred during our earlier experience, in a patient who had arch anomaly and intramural left coronary artery. There was no late death. All but one patient had good ventricular function. Conclusions All single sinus coronary artery with single ostium can be transferred with the trap-door technique with excellent results. The aortocoronary flap technique in those with separate ostia with or without intramural left coronary artery may be a good option. However, reimplantation of the intramural left coronary artery using separate coronary buttons should be performed with great care.

Airway compression by dilated right pulmonary artery (RPA) in infants with congenital heart disease can cause severe respiratory insufficiency and increase postoperative morbidity. Anterior aortopexy can be a good solution. However, in a case in which aortic arch repair is required, anterior aortopexy might not be effective or can be dangerous. Anterior translocation of the RPA can be a good option to avoid postoperative airway obstruction. We adopted this technique in a one-stage complete repair of distal aortopulmonary window, aortic origin of the RPA, interrupted aortic arch, and ventricular septal defect in a neonate with compression of both main bronchi. After 37 months of follow-up, no problem was encountered with her airway or RPA. We describe the technique used and the results obtained.

Several methods of making expanded polytetrafluoroethylene valved conduit have been reported, but these techniques are complicated and less reproducible. We have developed a new simplified technique for making a tricuspid expanded polytetrafluoroethylene valved conduit for right ventricular outflow tract reconstruction and have been using this conduit for approximately 3 years with excellent results. Our technique is straightforward and reproducible, and the cusps in the conduit are durable due to the use of a specialized suturing technique.

We describe a new technique of mitral valve replacement in an 11.5-month-old, 5.5 kg baby whose native mitral annulus was only 14 mm. We successfully implanted a 16-mm mechanical valve in the supra-annular position by sewing it into a short polytetrafluoroethylene graft that was then sutured to the native annulus.