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Abstract Background To propose a new diagnostic algorithm for candidates for Fontan and identify those who can skip cardiac catheterization (CC). Methods Forty-four candidates for Fontan (median age 4.8 years, range: 2-29 years) were prospectively evaluated by trans-thoracic echocardiography (TTE), Cardiovascular magnetic resonance (CMR) and CC. Before CC, according to clinical, echo and CMR findings, patients were divided in two groups: Group I comprised 18 patients deemed suitable for Fontan without requiring CC; group II comprised 26 patients indicated for CC either in order to detect more details, or for interventional procedures. Results In Group I ("CC not required") no unexpected new information affecting surgical planning was provided by CC. Conversely, in Group II new information was provided by CC in three patients (0 vs 11.5%, p = 0.35) and in six an interventional procedure was performed. During CC, minor complications occurred in one patient from Group I and in three from Group II (6 vs 14%, p = 0.7). Radiation Dose-Area product was similar in the two groups (Median 20 Gycm2, range: 5-40 vs 26.5 Gycm2, range: 9-270 p = 0.37). All 18 Group I patients and 19 Group II patients underwent a total cavo-pulmonary anastomosis; in the remaining seven group II patients, four were excluded from Fontan; two are awaiting Fontan; one refused the intervention. Conclusion In this paper we propose a new diagnostic algorithm in a pre-Fontan setting. An accurate non-invasive evaluation comprising TTE and CMR could select patients who can skip CC.

Objective: To assess and record the response to continuous infusion of the phosphodiesterase inhibitor enoximone during weaning from mechanical circulatory support (MCS) and to verify the possibility of success with this indication in pediatric patients., Design: Retrospective study., Setting: Pediatric cardiac surgery intensive care unit., Patients: Two pediatric patients operated for complex congenital heart disease with low cardiac output syndrome in the immediate postoperative period, evolved in cardiocirculatory arrest despite massive inotropic pharmacological support, and then assisted by mechanical circulatory support., Interventions: Weaning from mechanical circulatory support with continuous infusion of enoximone, only in one case preceded by a loading dose and associated with catecholamine infusion., Measurements and Main Results: During weaning hemodynamic parameters (LAP, CVP, MAP, HR), SvO2, diuresis, rectal and cutaneous temperatures were assessed and recorded. A serial echocardiographic assessment of left ventricular systolic and diastolic diameters and ejection fraction (EF%) has also been performed every 12 hours. Weaning from MCS using enoximone as inotropic support was possible in both cases., Conclusions: Enoximone proved to be useful in weaning from MCS in two pediatric patients, despite the difficulty to assess its effect in one of the two cases in which enoximone was used together with high dosages of other inotropic drugs. These initial positive results urge us to further investigate applications of this drug in pediatric patients.

Objective: To assess the relationship between the age of pediatric patients and the likelihood of difficult intubations and to confirm the importance of Down Syndrome causing difficult intubations., Design: Retrospective study., Setting: Pediatric cardiac surgery operating room., Patients: 627 pediatric patients, suffering from congenital heart disease, operated in our hospital from 1992 to 1994, divided in three age groups (under 1 month, between 1 month and 1 year, over 1 year of age)., Interventions: Translaryngeal intubation performed in the operating room before the operation., Measurements: The percentage of difficult intubations was assessed in the three age groups and the association with Down syndrome was also considered. The likelihood of orotracheal intubations in each of the preceding groups was also examined., Conclusions: The percentage of difficult intubation in our experience was estimated to be 4.62%. Intubation's difficulty increases with decreasing age of non Down patients. The risk of difficult intubation in Down patients is, irrespectively of age, nearly 27% higher than in non-Downs (5.77% versus 4.52). However Down Syndrome seems to be important only in the age group between one month and one year. The percentage of orotracheal intubations in the preceding groups, even if indirectly, seem to confirm this observation.

Comparison is made between 45 cases treated with d-tubocurarine and 60 with pancuronium bromide in open-heart surgery. Pancuronium displayed unmistakable advantages in the form of a more potent action, rapid commencement and long duration, dose flexibility and an almost complete absence of undesirable side-effects. In addition, it offered stability with respect to the cardiovascular system and enabled risk-free, deep muscle relaxation to be achieved even in subjects with complex cardiopathies, such as those with pulmonary hypertension, extreme hypoplasia or aplasia of the trunk of the pulmonary artery and patent ductus arteriosus, for whom a very high operative mortality risk exists when even minimal changes in cardiovascular parameters occur.