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Orthotopic heart transplantation is definitive therapy for infants with failing staged palliation after univentricular repair. Although the surgical management of these patients may be quite straightforward, the actual cardiac and vascular anatomy is sometimes unpredictable. To overcome this problem, we developed a new technique to fabricate a custom made replica from 128-slice computed tomographic (CT) and magnetic resonance imaging (MRI) angiography to create a realistic model of the anatomic situation for preoperative assessment and intraoperative orientation in 2 patients with failed staged palliation. In such situations, solid replicas may be helpful in choosing surgical treatment strategies before heart transplantation, for intraoperative orientation, and in demonstrating the planned procedure to patients and parents with lifelike models.

Objectives Improvement in health-related quality of life is a major object of cardiac surgery. However, high stress exposure during the perioperative period of cardiac surgery can result in the formation of traumatic memories and symptoms of chronic stress or even posttraumatic stress disorder, which can have negative effects on health-related quality-of-life outcome. In this controlled study we examined whether exogenously administered stress doses of hydrocortisone during cardiac surgery reduce perioperative stress exposure and the long-term incidence of chronic stress symptoms and improve health-related quality of life after cardiac surgery. Methods Thirty-six high-risk patients undergoing cardiac surgery were prospectively randomized to receive either stress doses of hydrocortisone or placebo. Of 28 available patients at 6 months after cardiac surgery, 14 had received hydrocortisone, and 14 had received placebo. Traumatic memories, chronic stress symptoms (posttraumatic stress disorder scores), and health-related quality of life were measured by using validated questionnaires. Results Compared with patients from the placebo group, patients from the hydrocortisone group had a significantly shorter duration of intensive care unit treatment, required lower doses of the stress hormone norepinephrine during cardiac surgery, and had significantly fewer stress symptoms and a better health-related quality of life regarding physical function, chronic pain, general health, vitality, and mental health during follow-up. The groups did not differ with regard to the number or type of intensive care unit–related traumatic memories. Conclusions The use of stress doses of hydrocortisone in high-risk cardiac surgical patients reduces perioperative stress exposure, decreases chronic stress symptoms, and improves health-related quality of life at 6 months after cardiac surgery.