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Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Institutional ethcial comittee approval [MOH/CSR/CR/24/12] was obtained for this publication.

Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.

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Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Competing Interests: Declaration of Competing Interest None.

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Competing Interests: Declaration of Competing Interest Patient consent and Institutional Scientific Research Committee approval [SRC#CR3812021] were obtained.

Objectives: The primary objective of the study was to identify the incidence of catheter tip malposition as determined by postoperative radiography after central venous cannulation by right and left internal jugular venous routes in pediatric cardiac surgical patients. The secondary objective was to determine the relative risk of malposition between the 2 approaches into specific major thoracic veins other than the right superior vena cava., Design: A prospective observational study., Setting: A tertiary cardiac care center., Participants: Pediatric patients undergoing cardiac surgery INTERVENTIONS: Internal jugular vein cannulation with ultrasound guidance., Measurements and Main Results: Two hundred pediatric patients undergoing cardiac surgeries for cardiac anomalies with Risk Adjustment in Congenital Heart Surgery scores of 1- to-6 were included in the study. After anesthetic induction, 50% of the patients were cannulated via the right internal jugular vein (RIJV group, n = 100), and the other 50% via the left internal jugular vein (LIJV group, n = 100). The position of the catheter tip was ascertained by a plain chest x-ray. The central venous catheter tip was deemed to be malpositioned if the tip was in the ipsilateral or contralateral subclavian vein or in the contralateral internal jugular vein. In the RIJV group, 4% of the patients had the central venous catheter tip in a malposition (4/100). In the LIJV group, 6 of the 100 patients had a left superior vena cava and were excluded. In the rest of the LIJV group, the central venous catheter tip was in a malposition in 22.3% of patients (21/94, relative risk: 6.90, p < 0.001). Malposition into the right subclavian vein was more frequent with the left internal jugular vein access (11/94, 11.7%) compared with the right internal jugular vein access (relative risk: 13.12, p = 0.015)., Conclusions: The incidence of a malposition of a central venous catheter tip after either right or left internal jugular vein approach was ascertained. The relative risk of a malposition occurring with the left internal jugular approach was higher, and the most common site of malposition was in the right subclavian vein., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: The study was directed toward documentation of the effect of transesophageal echocardiography (TEE) probe insertion on the endotracheal tube cuff pressure (CP) in adult patients undergoing on-pump coronary bypass surgery. The primary objective of this study was to assess whether CP reaches supranormal pressures during the different stages of intraoperative TEE examination. The secondary objective was to observe the effect of TEE probe placement on the ventilation parameters., Design: A prospective observational study., Setting: At a tertiary care cardiac center., Participants: Thirty-four cardiac surgical patients older than 18 years of age who required intraoperative TEE examination., Interventions: TEE probe insertion., Measurements and Main Results: Following the induction of general anesthesia and tracheal intubation, a TEE probe was introduced. The endotracheal tube CP was recorded at 5 time zones: Before TEE probe insertion, during the insertion of the probe, during probe manipulation, probe in the transgastric position, and during removal of the probe. A nonparametric test was used for comparing intracuff pressure between pairs of time zones. There was a statistically significant difference in CP values between the baseline and those during different time zones (chi-square test = 134.77, degrees of freedom = 4, p = 0.001). There was a statistically significant difference in the peak pressure between different time points compared to baseline (p = 0.0001)., Conclusions: TEE probe placement in patients with tracheal intubation may be associated with a significant increase in CP well above the baseline pressure. With the possibility of the mean arterial pressures during cardiopulmonary bypass being substantially lower than expected, the findings of the current study raised the concern of predisposing the tracheal mucosa to hypoperfusion, with subsequent temporary or permanent tracheal damage. Hence, at least a baseline estimation of the endotracheal tube CP at the time of tracheal intubation, with the help of a pressure gauge in the operating room, may be considered as a safe practice., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Objectives: The primary objective was to compare the rate of first-pass radial arterial cannulation using out-of-plane ultrasound guidance with in-plane imaging. The secondary endpoints were a comparison of the number of times the cannula was redirected, the number of attempts, the number of skin punctures, the incidence of hematoma, the time to completion of the cannulation procedure, and the number of failed attempts between the 2 ultrasound imaging techniques., Design: A prospective, randomized, observational study., Setting: A tertiary cardiac care center., Participants: Adult patients undergoing elective cardiac surgery., Interventions: Radial artery cannulation with ultrasound guidance., Measurements and Main Results: Eighty-four adult patients scheduled for elective cardiac surgery were randomly assigned to the out-of-plane ultrasound group (group I, n = 42) or the in-plane ultrasound group (group II, n = 42) for left radial artery cannulation. A linear ultrasound probe was used to identify the radial artery. In each approach, the number of times first-pass success was achieved, the number of times the cannula was redirected, the number of skin punctures, the incidence of hematomas, and the number of failed attempts were recorded. The first-pass success rate was greater in the in-plane ultrasound group and was statistically significant (p = 0.007). In the out-of-plane ultrasound group, a larger number of patients needed redirection of the cannula (p = 0.002). The number of patients in whom the skin needed to be punctured more than once was greater in the out-of-plane ultrasound group compared with the in-plane ultrasound group (p = 0.002). The incidence of hematoma formation and time to completion of the technique were similar in both groups (p = 0.241 and p = 0.792, respectively)., Conclusions: In-plane ultrasound guidance appeared to be superior for achieving a higher first-pass success rate more often with minimal redirections and skin punctures compared with out-of-plane ultrasound guidance., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: The primary objective was to identify the best among 4 techniques that could predict the length of central venous catheter insertion through the right internal jugular vein, which, in turn, would ensure the ideal placement of the catheter tip in pediatric cardiac surgical patients. The techniques evaluated were those based on operator experience, topography/landmark methods, and one that relied on a patient's height-related formula. Based on the outcome of the study, the possibility of arriving at a formula was investigated that would predict with reasonable certainty the ideal length of catheter to be inserted for the correct catheter placement through the right internal jugular vein in pediatric cardiac surgical patients belonging to the authors' geographic area., Design: A prospective observational study., Setting: Tertiary care cardiac center., Participants: Children younger than 5 years of age undergoing cardiac surgery., Interventions: Right internal jugular vein cannulation by the Seldinger technique method., Measurements and Main Results: A total of 120 children aged younger than 5 years undergoing cardiac surgery were included in the study. The participants were randomized to 4 groups: group 1 (n = 30), the length of the central venous catheter was determined empirically by the operator based on clinical experience; group 2 (n = 30), the depth of insertion of the catheter was determined by the distance from the site of skin puncture to the second intercostal space; group 3 (n = 30), the depth of insertion of the catheter was determined by the distance from the skin puncture site to the third intercostal space; and group 4 (n = 30), the length of catheter was determined by a height-based formula that was followed routinely at the authors' institution. Central venous catheterization through the right internal jugular vein was performed according to out-of-plane ultrasound guidance in all patients. The ideal catheter tip location was assumed to be at the level of the carina or within 1.5 cm proximal to it. The number of patients who had ideal catheter tip placement were recorded from postoperative chest radiograph in all groups. Any relationship between acceptable catheter tip and demographic data (mean ranks of age, height, weight, and body surface area) of the patients were studied., Results: The central vein catheter tip was at the level of the carina or within 1.5 cm in more patients in group 2 (39%, p = 0.02) compared with the other groups. This was followed by group 4 (40%), group 3 (30%), and group 1 (23%). There was a statistically significant difference in the mean distance between catheter tip and carina, with group 2 patients having the tip closest to the carina (p = 0.03). There was a significant correlation between acceptable catheter tip positioning and a patient's height (p = 0.04). A new formula was developed based on this correlation., Conclusions: A landmark-based topographic method in which the length of insertion of the catheter was determined by the distance from the skin puncture site to the second intercostal space for achieving correct placement of the catheter tip was found to be more reliable compared with other techniques. Height-based formula has the disadvantage of being affected by the skin puncture site. Assuming that a skin puncture at the midpoint between the right mastoid process and clavicular insertion of sternocleidomastoid muscle insertion is ensured, a new formula based on height has been proposed., Competing Interests: Conflict of Interest The authors affirm that no potential conflict of interests exists., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Competing Interests: Conflict of Interest The authors have no interests to declare.

Aortic atresia with interrupted aortic arch (IAA) is an exceptional condition. In absence of associated lesion, the flow to the brain and the retrograde flow to the coronary arteries can only come from vessels on the descending aorta. This flow needs to be large enough to supply the brain and the myocardium. The only IAA type compatible with survival is type C where the flow from descending aorta could be insured by the left carotid and the left vertebral artery, branch of the left subclavian artery. Only one such a case was described in the literature. All the other surviving cases had an associated lesion including: a double aortic arch, an aorto-pulmonary window (AP window), an aberrant right subclavian artery or a bilateral patent ductus arteriosus (PDA). We report a case of aortic atresia with IAA type B associated with a double aortic arch that underwent a successful bi-ventricular one-stage neonatal Norwood-Rastelli repair and is doing well after 18 months., (Copyright © 2018 Elsevier Inc. All rights reserved.)