Ali Can Hatemi

Introduction: Transposition of the great arteries (TGA) is one of the most common cyanotic congenital heart diseases in the neonatal period, and arterial switch operation (ASO) is the standard surgical treatment. Postoperative low cardiac output syndrome remains an important cause of morbidity. This study evaluated the association between serial vasoactive–inotropic score (VIS) measurements and postoperative intensive care unit (ICU) length of stay in neonates with TGA undergoing ASO. Methods: This retrospective study included neonates with TGA who underwent ASO and were followed in a tertiary Pediatric Cardiac Intensive Care Unit between 1 August 2020, and 1 August 2022. ICU length of stay was analyzed as a continuous primary outcome. Prolonged ICU stay, defined as the upper quartile of ICU length of stay in the study cohort (≥9 days), was evaluated as a secondary exploratory outcome. VIS values were recorded at ICU admission and at 24, 48, and 72 h after surgery. Associations between VIS parameters and continuous ICU length of stay were assessed using Spearman’s rank correlation. ROC analysis and logistic regression were performed for prolonged ICU stay. Results: A total of 60 neonates were included, and 15 patients (25%) had a prolonged ICU stay. Admission VIS values were similar between groups. However, VIS values at 24 and 48 h were significantly higher in the prolonged ICU stay group (p = 0.005 and p = 0.001, respectively), whereas no significant difference was observed at 72 h. VIS at 48 h showed the strongest correlation with ICU length of stay (Spearman’s r = 0.52, p < 0.001), followed by ΔVIS48 (r = 0.48, p = 0.001) and VIS at 24 h (r = 0.44, p = 0.002). In secondary exploratory analyses, VIS at 48 h demonstrated a numerically higher AUC than VIS at 24 h (0.82 vs. 0.74). ΔVIS48 was associated with prolonged ICU stay in multivariable logistic regression (OR, 1.18 per unit increase; 95% CI, 1.05–1.33; p = 0.006). Firth’s penalized logistic regression yielded a similar estimate (OR, 1.15; 95% CI, 1.03–1.30; p = 0.012). Conclusions: In neonates with TGA undergoing ASO, higher VIS during the first 24–48 postoperative hours, particularly an increase from admission to 48 h, was associated with longer ICU stay. These findings support serial VIS assessment as a marker of early postoperative clinical trajectory. Cohort-derived VIS thresholds should be considered exploratory and require external multicenter validation before clinical application.

The thymus is central to T-cell development and immune tolerance. In congenital heart disease (CHD), especially cyanotic types, chronic hypoxia may alter t

Background: In congenital heart disease patients with single-ventricle physiology, accurate anatomical and hemodynamic evaluation prior to the Fontan completion procedure is critical for surgical planning and long-term outcomes. Although conventional catheter angiography (CCA) remains the reference standard for hemodynamic evaluation, cardiac computed tomography angiography (CTA) has emerged as an increasingly valuable tool for anatomical assessment in the preoperative evaluation of Fontan candidates. Objective: To compare the anatomical and hemodynamic information provided by CTA and CCA before Fontan completion and to evaluate their complementary roles in the preoperative assessment of pediatric patients with single-ventricle physiology. Methods: This single-center, retrospective study included 32 patients with single-ventricular physiology who underwent staged palliation and Fontan completion. All patients underwent TTE and CCA. Twenty-three patients also underwent cardiac CTA with three-dimensional reconstruction. Anatomical and hemodynamic findings obtained from CTA and CCA were compared, with particular focus on extracardiac anatomy, collateral vessels, and findings relevant to surgical planning. Results: Cardiac CTA showed concordant detection of clinically significant anatomical findings identified by CCA, while providing a more comprehensive assessment of extracardiac anatomy. While CCA remained superior for hemodynamic assessment, CTA provided more comprehensive evaluation of extracardiac anatomy. In this cohort, catheterization findings did not alter the planned surgical strategy (0%, 95% CI 0–10.9%). Conclusions: CTA may provide valuable anatomical information for preoperative assessment and surgical planning; however, larger prospective multicenter studies are required before less invasive pre-Fontan evaluation strategies can be considered.

Background: Extracorporeal membrane oxygenation (ECMO) is lifesaving in pediatric patients with respiratory and/or cardiovascular failure. Cardiac catheterization is an important diagnostic and therapeutic tool in patients with congenital heart disease supported by ECMO, allowing the assessment of residual lesions, hemodynamically significant anatomical abnormalities, and unexplained indications for ongoing ECMO support. The timing and clinical contribution of cardiac catheterization in these patients are still debated. Objective: This study aimed to evaluate the indications, safety, and impact of cardiac catheterization on clinical management in pediatric patients receiving postoperative ECMO support. Methods: This single-center, retrospective study examined 39 pediatric patients under the age of 18 who underwent postoperative cardiac catheterization with ECMO support between January 2022 and December 2025. Demographic data, procedure characteristics, and clinical outcomes were analyzed. Results: Of the 190 patients under postoperative ECMO support, 39 underwent catheterization. The median age of the patients was 2.5 months (range, 6 days–180 months) and median weight was 4.2 kg (range, 2.8–57 kg). The most frequent diagnoses were ventricular septal defect-pulmonary atresia (VSD-PA) in 20.5% (n = 8) and transposition of the great arteries (TGA) in 15.3% (n = 6). The indication for catheterization was to investigate the reason for ECMO placement in 26 patients (66.6%). Most patients underwent catheterization within the first 24 h after ECMO initiation. Patients who underwent catheterization represented a higher-risk subgroup, with a greater proportion of STAT 4-5 procedures (59% vs. 40%) compared with the overall ECMO cohort. Cardiac catheterization resulted in a change in clinical management in 25.6% of patients through catheter-based intervention or surgical revision. Survival in the catheterized subgroup was 12.8%, reflecting the high-risk nature of this population. Conclusions: Cardiac catheterization in pediatric patients on postoperative ECMO support can be performed with a low complication rate and can significantly alter clinical management. Cardiac catheterization should be considered an important diagnostic and therapeutic modality, particularly in the presence of suspected residual lesions or unexplained hemodynamic instability. Additionally, we recommend that cardiac catheterization be performed promptly within the first 24–48 h in this patient group on ECMO support.

Lymphatic complications are associated with increased morbidity and mortality in single-ventricle patients. T2-weighted magnetic resonance lymphangiography is an imaging modality of increasing importance both to identify the risk status before Fontan palliation and to reveal lymphatic complications that may occur in the postoperative period. In this article, we present the management of a pediatric case who was followed and treated for prolonged chylothorax after Fontan palliation and discuss the use of magnetic resonance lymphangiography in this process.

Background: This study aims to evaluate our experience with magnetic resonance lymphangiography in single-ventricle congenital heart disease patients and to examine the association between imaging findings and clinical outcomes and postoperative outcomes. Methods: Between November 2022 and May 2025, a total of 33 patients (22 males, 11 females; median age: 44 months; range, 37 to 57.5 months) with single-ventricle congenital heart disease who underwent T2-weighted magnetic resonance lymphangiography at our center were retrospectively analyzed. The T2-weighted sequences were chosen for their high-resolution depiction of lymphatic structures without the need for contrast agents. The imaging findings were analyzed for preoperative risk evaluation or suspected postoperative lymphatic complications. Results: Lymphatic abnormalities were categorized into types 1 to 3 based on the extent and distribution of T2-hyperintense signals. No patients in this cohort exhibited type 4 abnormalities. Among 33 patients, 11 (33%) were classified as type 1, 18 (55%) as type 2, and four (12%) as type 3. Although not statistically significant, patients with type 3 patterns had the longest median pleural effusion duration (27.5 days) and length of hospital stay (61 days). One patient showed early postoperative progression from type 2 to type 3, which resolved clinically and radiologically after fenestration ballooning. In the late period, two patients developed protein-losing enteropathy, and one had Fontan failure. Conclusion: Magnetic resonance lymphangiography provides critical information about structural lymphatic abnormalities. It also aids risk stratification prior to the Fontan procedure and guides individualized management of postoperative complications, ultimately guiding treatment and improving outcomes.

Background: Arterial switch operation (ASO) is the standard surgical treatment for dextro-transposition of great arteries (d-TGA). Long-term complications affecting pulmonary arteries, coronary arteries, and aortic root necessitate detailed surveillance, but the optimal imaging strategy remains undefined. Methods: We retrospectively analyzed 47 patients with d-TGA who underwent ASO between January 2023 and June 2025 with at least six months postoperative follow-up. All patients underwent both transthoracic echocardiography (TTE) and ECG-gated cardiac CT angiography (CTA). Anatomical measurements, functional parameters, and diagnostic completeness were compared between modalities. Results: Median age at follow-up was 37.2 months. CT detected pulmonary artery stenosis in 31 patients (65.9%) and aortic root dilatation in 31 patients (65.9%). TTE provided incomplete pulmonary artery assessment in 11 patients (23.4%) and incomplete coronary evaluation in 13 patients (27.6%), while CT successfully evaluated all patients (100%). Strong correlation was found between left pulmonary artery bending angle and aortic root dimensions (r = 0.65, p = 0.016), suggesting mechanical interdependence of post-surgical anatomical changes. Median radiation exposure was 2.684 mSv (IQR: 1.5–4.6). During follow-up, 10 patients (21.3%) required cardiovascular interventions, with CT providing complete pre-intervention assessment in all cases. Conclusions: TTE alone is insufficient for complete anatomical assessment following ASO. An integrated imaging approach utilizing TTE for functional assessment and CT for anatomical evaluation optimizes post-ASO surveillance.

Objectives: The objective of this study was to evaluate the impact of combining near-infrared spectroscopy (NIRS) and bispectral index (BIS) for monitoring cerebral oxygenation and detecting ischemia during pediatric cardiac surgery with cardiopulmonary bypass (CPB). Methods: A prospective, single-center study was conducted between March 01, 2024, and July 01, 2024, involving 50 pediatric patients undergoing congenital heart surgery. Cerebral oxygenation was continuously monitored using NIRS and BIS at 6 time points during surgery: T1 (entry), T2 (immediately after CPB initiation), T3 (deepest hypothermic temperature), T4 (post-rewarming), T5 (end of surgery), and T6 (postoperative intensive care unit [ICU]). Central venous saturation, hematocrit (Htc), temperature, mean arterial pressure (MAP), and lactate levels were also monitored. The primary outcomes included correlations between cerebral oxygenation parameters and neurological outcomes within 3 months. Results: The study was conducted with a total of 50 children cases, of which 56% (n=28) were male, and 44% (n=22) were female. The age of the cases ranged from 6 to 200 months, with a mean 42.4±52.7 months. Weight measurements ranged from 14.2 to 65 kg, with a mean of 16.3±14.3 kg. The average CPB duration was 96.1±34.8 min. The cases had an average ICU stay of 3.2±2 days. Upon reviewing the final status, it was found that there were no mortality among the patients and only three patients experienced transient neurological complications, which resolved without long-term deficits. NIRS values remained stable between 55% and 65% during surgery. BIS monitoring detected no significant decreases, supporting the absence of severe ischemia. Conclusion: Combining NIRS and BIS in pediatric cardiac surgery enhances cerebral perfusion monitoring and enables early detection of ischemic events, potentially reducing postoperative neurological complications. Larger studies are needed to validate these findings and further assess the role of intraoperative parameters such as Htc and MAP in preventing cerebral ischemia.