Cristian Bulescu

Introduction: In the congenital population, particularly in young adults, the best strategy for aortic valve surgery has not been clearly established. This study investigates the mortality, perioperative morbidity and echocardiographic evolution of complex aortic valve repair techniques.Material and methods: We performed a retrospective monocentric descriptive study of patients operated at the Louis Pradel Hospital (Lyon) from 2017 to 2023. We included patients operated for complex aortic valve repair by the congenital heart surgery team, excluding simple commissurotomies. The primary endpoint was postoperative survival. The secondary endpoints were freedom from surgical reintervention and echocardiographic evolution of aortic regurgitation, aortic stenosis and annular diameter. The analysis was performed using Kaplan Meier methods.Results: Twenty-eight patients were included. The mean age was 11.1 years (range 1–35 years) and the mean weight was 37.5 kg (range 8.2–79 kg). The postoperative survival rate was 96.4% at discharge (27/28 patients). The mean follow-up interval was 35 months (range 14–79 months). At the end of the follow-up, the freedom from reoperation was 85.7%. Four patients underwent reoperation for worsening aortic valve and/or ventricular function (1 heart transplantation, 2 Ross procedures, 1 aortic valve replacement). Results on secondary endpoints showed a trend towards improvement in annular diameter postoperatively between pre- and postoperative echocardiography for each patient, with no statistically significant difference for aortic insufficiency, but for aortic stenosis (p = 0.02).Conclusion: This study shows an excellent survival rate, and a similar risk of reintervention compared with literature data. All the data described above argue in favor of an aortic valve repair surgery as a first line procedure in case of congenital heart disease.

Objective: To compare the effectiveness and safety of Celsior® crystalloid solution to St Thomas® solution as cardioplegia in pediatric arterial switch surgery.Methods: A retrospective study was conducted on 180 patients who underwent arterial switch operation (ASO) between 2005 and 2019. The patients were divided into two groups: the St Thomas group receiving St Thomas solution and the Celsior® group receiving Celsior® solution. The study aimed to assess myocardial protection while evaluating clinical outcomes of patients between groups.Results: Baseline characteristics not different between groups. The postoperative troponin release trends and blood lactate levels were not different between groups. However, the Celsior® group had a significant lower incidence of delayed sternal closure (9.7% vs. 19.5%; p = 0.09) and mechanical circulatory support (ECMO) (4.9% vs. 24.7%; p < 0.001) compared to the St Thomas group. The length of stay in the intensive care unit (ICU) was significantly shorter in the Celsior® group (4.6 ± 3.36 days vs. 8.72 ± 5.08 days, respectively; p < 0.001). There was no significant difference in 30-day mortality between the two groups (2.9% vs. 2.6%; p = 0.147).Conclusion: The study suggests that Celsior® solution is effective and safe for myocardial protection in pediatric arterial switch surgery. It may offer potential benefits such as reduced need for delayed sternal closure and ECMO support, as well as shorter ICU stay. However, the study has limitations including its retrospective design and the use of different cardioplegic solutions during different time periods. Further prospective randomized trials are needed for confirmation. Clinical Registration Number: ClinicalTrials.gov, ID: NCT04616222.

First described in 1760 by the anatomist Morgagni, coarctation of the aorta (CoA) is a congenital heart defect characterized by narrowing the aorta, typically distal to the left subclavian artery. It accounts for approximately 5–8% of all congenital heart diseases, with an incidence estimated at 4 per 10,000 live births. In 1944, the Swedish surgeon Clarence Crafoord achieved the first successful surgical CoA repair by performing an aortic end-to-end anastomosis on two patients aged 12 and 27 years old. Presently, the most prevalent techniques for surgical repair, particularly in infants and neonates with isolated coarctation, involve resection with end-to-end anastomosis (EEA) and the modified Crafoord technique (extended resection with end-to-end anastomosis (EEEA)). Subclavian flap aortoplasty (SCAP) is an alternative surgical option for CoA repair in patients under two years of age. In cases where the stenosis extends beyond resection and end-to-end anastomosis feasibility, patch aortoplasty (PP) employing a prosthetic patch can augment the stenotic region, especially for older patients. Despite advances in pediatric cardiology and cardiac surgery, recoarctation remains a significant concern after surgical or interventional repair. This comprehensive review aims to provide a thorough analysis of coarctation management, covering the pioneering techniques introduced by Crafoord using end-to-end anastomosis and now extending to the contemporary era marked by percutaneous interventions as well as the recoarctation rate associated with each type.

First described in 1760 by the anatomist Morgagni, CoA is a congenital heart defect characterized by narrowing the aorta, typically distal to the left subclavian artery. It accounts for approximately 5-8% of all congenital heart diseases, with an incidence estimated at 4 per 10,000 live births. In 1944, the Swedish surgeon Clarence Crafoord achieved the first successful surgical CoA repair by performing an aortic end-to-end anastomosis on two patients aged 12 and 27 years old. Presently, the most prevalent techniques for surgical repair, particularly in infants and neonates with isolated coarctation, involve resection with end-to-end anastomosis (EEA) and the modified Crafoord technique (extended resection with end-to-end anastomosis (EEEA)). Subclavian flap aortoplasty (SCAP) is an alternative surgical option for CoA repair in patients under two years of age. In cases where the stenosis extends beyond resection and end-to-end anastomosis feasibility, patch aortoplasty (PP) employing a prosthetic patch can augment the stenotic region, especially for older patients. Despite advances in pediatric cardiology and cardiac surgery, recoarctation remains a significant concern after surgical or interventional repair. This comprehensive review aims to provide a thorough analysis of coarctation management, covering the pioneering techniques introduced by Crafoord using head-to-tail anastomosis and now extending to the contemporary era marked by percutaneous interventions as well as the recoarctation rate associated with each type.

The association of an ostium primum-type defect with a cleft anterior mitral valve is known in the medical literature as the partial form of an atrioventricular canal. We present a case report about a 20-year-old woman with minimal symptomatology that discovered her pathology on routine echocardiography. Today, surgical operation remains the gold standard in such pathologies, especially mandatory when there is important valvular regurgitation and left-to-right shunt. Currently living in the era of fast and good cosmetic outcomes, minimally invasive and endovascular approaches should be developed and more often practiced. This scientific presentation is the first step in showing our department steps in performing minimally invasive surgeries as a routine.

Rationale: Noonan syndrome is a genetic disorder with variable clinical manifestations that affects different systems. Among the multitude of clinical findings, the main characteristics are unique facial traits, low height, and congenital cardiac abnormalities. Recognizing such a syndrome is of great importance because of its involvement of multiple organs. Therefore, a systematic and thorough evaluation according to the guidelines for the assessment and management of Noonan syndrome is needed. Patient concerns: A female infant, 3 months old, presented with a difficult neonatal period (respiratory distress, generalized cyanosis), typical facial dysmorphia, evolutionary height hypotrophy, persistent leukocytosis, factor VII deficit, and severe pulmonary stenosis. Diagnosis: Echocardiography showed severe pulmonary valve stenosis, mild pulmonary regurgitation, a 6.5 mm ostium secundum atrial septal defect, and a persistent ductus arteriosus. Laboratory reports revealed leukocytosis with monocytosis, anemia, and thrombocytopenia, but no infectious source was found. Interventions: In this context, a pulmonary balloon valvuloplasty was performed, with a significant decrease of the transpulmonary gradient. Outcome: The patient was genetically tested, and the reports were positive for Noonan syndrome (mutation in exon 13 of PTPN 11). At 3years of age, she underwent open-heart repair of the atrial septal defect and significant recurrent pulmonary stenosis. The postoperative course was uneventful, and the patient remained asymptomatic at 6months follow-up. Conclusions: The diagnosis was initially suggested by the characteristic unique clinical events associated with cardiac involvement and confirmed later through genetic molecular testing. Prompt treatment of the severe life-threatening pulmonary valve stenosis was important, and the patient underwent additional interventions, after which she remained stable.

Background: Anomalous aortic origin of the right coronary artery is known to be a cause of sudden cardiac death in athletes. There are no specific guidelines concerning treatment strategy in the literature. The aim of this study is to describe and report our experience of direct reimplantation technique in the treatment of this anomaly. Methods: This was a retrospective single center study of 30 patients who underwent surgery in the congenital heart disease unit of Louis Pradel Heart and Lung Hospital between January 2003 and December 2016. The mean follow-up was seven years (3 months-17 years). Results: Thirty patients underwent surgery. The median age was 17 years (0.2-52 years). There were 24 males. The median weight was 58 kg (3.6-118 kg). Fourteen patients were actively engaged in sports. Twenty-six patients had exertional chest pain or syncope. The median time lapse between diagnosis and intervention was 4.5 months (0.5-179 months). Twenty-seven (90%) patients underwent reimplantation of the anomalous coronary artery without transverse aortotomy, while in 3 (10%) patients transverse aortotomy was used to facilitate reimplantation to avoid tension at the anastomosis. There was no early death; one late death occurred in the third postoperative month. At the last follow-up, all patients had returned to normal physical activity without evidence of ischemia. Conclusions: Direct reimplantation allows for a complete restoration of the coronary anatomy and enables patients to return to normal physical activity. Our study shows encouraging results using a direct reimplantation technique without aortotomy.

We present the case of a 50-year-old male, with no cardiovascular risk factors other than smoking, that presented with acute chest pain, revealed to be an acute myocardial infarction with a large thrombus located in the ascending aorta. Such findings are rare in a patient with no other afflictions, such as atherosclerosis, aortic aneurysm, or aortic wall injury (surgical or traumatic). There is no specific pathway regarding the management of ascending aorta thrombus in such a patient; therapeutic options include surgical, interventional, or medical methods. Surgical thrombectomy was performed in this case, considering the high risk of systemic embolism and stroke and the hemodynamic stability of the patient.

Congenital heart disease (CHD) is the most common birth defect, with a reported prevalence of 5–12 per 1000 live births. Very recently, the American Institute of Ultrasound in Medicine published a guideline recommending the use of the four-chamber and the three-vessel and trachea views to screen for CHD in the first trimester of pregnancy. Our aim is to present abnormal image patterns that are seen in the four-chamber, three-vessel, and trachea views of the fetal heart in the first trimester and to describe their association with specific CHD types. We used a total of 29 cases of CHD from the archives of Filantropia Hospital and the Maternal and Child Health Institute (INSMC) fetal medicine units. We selected cases with a clear and well-documented diagnosis of the CHD type. We identified a series of repeating color doppler flow patterns seen in the four-chamber, three-vessel, and trachea views of the studied cases. Our observations could be developed into a diagnosis algorithm to orientate the examiner to the most likely type of CHD in individual cases.