Cirugía congénitos

Int J Surg Case Rep. 2025 Sep 4;136:111915. doi: 10.1016/j.ijscr.2025.111915. Online ahead of print.

ABSTRACT

INTRODUCTION: Moebius syndrome is a rare congenital condition involving underdevelopment of cranial nerves VI and VII, often causing facial palsy. Also rare, bronchial stenosis may cause recurrent respiratory infections. There is scarce evidence on the outcomes of pediatric patients undergoing open surgical repair for congenital bronchial stenosis.

PRESENTATION OF CASE: An eight-year-old male with Moebius syndrome and tracheostomy-dependent since infancy, presented with fever, severe respiratory compromise and left lung atelectasis. Bronchoscopy revealed severe stenosis of the left main bronchus and the right upper lobe bronchus. Despite two bronchoscopic balloon dilations, the obstruction recurred. The patient successfully underwent bronchoplasty under extracorporeal membrane oxygenation (ECMO) with resection of the stenotic segment and end-to-end anastomosis. After 97 inpatient days, he was discharged home with usual nocturnal ventilation support.

DISCUSSION: The diagnosis of congenital bronchial stenosis (CBS) is difficult because of its rarity and nonspecific presentation. Severe cases may warrant definitive surgical repair and ECMO provides critical support to ensue oxygenation and hemodynamic stability while the airway procedure takes place. Open bronchoplasty offers a safe and effective option when bronchoscopic management fails.

CONCLUSION: Early recognition of CBS in children with complex comorbidities such as Moebius syndrome is key for prompt management. Multidisciplinary efforts are crucial for optimal patient outcomes.

PMID:40972128 | DOI:10.1016/j.ijscr.2025.111915

Interdiscip Cardiovasc Thorac Surg. 2025 Sep 15:ivaf207. doi: 10.1093/icvts/ivaf207. Online ahead of print.

ABSTRACT

OBJECTIVES: When tricuspid valve repair is unfeasible due to extensive damage or a complex congenital malformation, surgeons consider tricuspid valve replacement (TVR). However, it is still controversial and challenging to choose the best substitute. We aimed to introduce the innovative intra-operatively valve construction using the native right atrial appendage (RAA) tissue for TVR and investigate the short-term outcomes.

METHODS: This study recruited paediatric and adult patients with unrepairable severe tricuspid regurgitation (TR) who needed TVR. The patient's right atrial appendage tissue was harvested and used to reconstruct a native bileaflet valve during surgery. Trans-thoracic echocardiography was conducted before operation, 6, and 12 months after surgery.

RESULTS: The procedure was successfully executed on three patients with valve destruction as a result of infective endocarditis (IE), and three patients who had severe TR due to congenital anomalies. There was no mortality or related morbidity. All the constructed valves had proper function with no complications after the surgery. Follow-up echocardiographic studies showed stable and satisfactory valve function with no regurgitation or significant stenosis.

CONCLUSIONS: The novel tricuspid valve operation using native RAA tissue demonstrates promising short-term results. Further studies with larger cohorts and longer follow-ups are required to confirm the technique's reliability and long-term effectiveness.

PMID:40971856 | DOI:10.1093/icvts/ivaf207

Pediatr Cardiol. 2025 Sep 19. doi: 10.1007/s00246-025-04028-8. Online ahead of print.

NO ABSTRACT

PMID:40970946 | DOI:10.1007/s00246-025-04028-8

Ann Pediatr Cardiol. 2025 Mar-Apr;18(2):105-111. doi: 10.4103/apc.apc_79_25. Epub 2025 Aug 29.

ABSTRACT

OBJECTIVE: Ventricular assist device (VAD) implantation is an established treatment for infants with severe heart failure (HF), serving as a bridge to heart transplantation or enabling myocardial recovery. This study aims to evaluate the probability of ventricular recovery following VAD support in infants with severe HF secondary to myocarditis. In addition, we analyze clinical experiences focusing on the weaning process, challenges during explantation, and outcomes, with special attention to a small cohort (n = 4) to highlight specific findings.

PATIENTS AND METHODS: From 1988 to 2024, 63 consecutive pediatric HF patients were supported with VAD systems. This retrospective descriptive study includes four patients (2016-2024) who achieved myocardial recovery and underwent VAD explantation. Weaning assessments included heart catheterization and echocardiography to determine suitability for VAD removal. One patient with congenital heart disease and severe HF was excluded due to prior reporting.

RESULTS: Four patients diagnosed with cardiomyopathy - three with parvovirus B19 confirmed by polymerase chain reaction and one with arrhythmogenic cardiomyopathy - received Berlin Heart® Excor left VADs. Two children developed frequent valve thrombosis requiring pump replacement. All patients experienced mild-to-moderate neurological complications postimplantation. Renal and hepatic functions normalized by follow-up.

CONCLUSIONS: Myocardial recovery during VAD support is possible, particularly in children with severe myocarditis and cardiomyopathy. Concurrent HF medications alongside VAD support appear to promote recovery. Furthermore, VAD therapy improves systemic hemodynamics, contributing to normalization of renal and hepatic functions. These findings support the use of VADs for recovery in selected pediatric patients.

PMID:40969969 | PMC:PMC12443395 | DOI:10.4103/apc.apc_79_25

Ann Pediatr Cardiol. 2025 Mar-Apr;18(2):151-154. doi: 10.4103/apc.apc_227_24. Epub 2025 Aug 29.

ABSTRACT

We describe a 7-day-old newborn who presented with arterial desaturation and respiratory distress. The evaluation showed a duct with a continuous right-to-left shunt and an anomalous origin of the right pulmonary artery from the aorta. We discuss the hemodynamics leading to continuous right-to-left ductal flow and the subsequent intraoperative evaluation that resulted in a successful single-stage surgical repair of this interesting case.

PMID:40969962 | PMC:PMC12443391 | DOI:10.4103/apc.apc_227_24

Ann Pediatr Cardiol. 2025 Mar-Apr;18(2):87-92. doi: 10.4103/apc.apc_223_25. Epub 2025 Aug 29.

ABSTRACT

Grown-up with congenital heart disease (GUCH) represents an emerging but under-recognized public health challenge in India. With an estimated 3.5 million adults living with congenital heart disease (CHD), the country has one of the world's largest GUCH populations. Despite improving pediatric cardiac surgery outcomes, adult CHD care remains fragmented, with critical gaps in infrastructure, training, transition protocols, and national policy. This editorial explores the epidemiological burden, systemic challenges, and recent progress, including the growth of pediatric cardiac programs, the emergence of GUCH clinics, and increased use of transcatheter interventions for the Indian GUCH patients. We need a structured, level-based care model, development of specialized centers, dedicated GUCH training, and the creation of national registries and India-specific guidelines. Bridging the divide between pediatric and adult cardiology is essential to ensure lifelong, coordinated care for this vulnerable population.

PMID:40969956 | PMC:PMC12443409 | DOI:10.4103/apc.apc_223_25

Ann Pediatr Cardiol. 2025 Mar-Apr;18(2):119-123. doi: 10.4103/apc.apc_248_24. Epub 2025 Aug 29.

ABSTRACT

CONTEXT AND AIM: Absent pulmonary valve syndrome (APVS) in association with tetralogy of Fallot (TOF) is a rare congenital heart disease characterized by the aneurysmal dilatation of pulmonary arteries and associated major airway anomalies. Postoperative outcomes have been suboptimal, especially concerning dependency on positive pressure ventilation and the need for repeated cardiac reinterventions. This study aims to describe the postoperative course of these patients and to identify the risk factors associated with poor outcomes.

METHODS AND RESULTS: A retrospective review of 38 patients who underwent surgery for TOF with APVS between 2001 and 2021 at a single cardiac center was conducted. There were 16 (42%) patients in the young infants group. They required longer postoperative mechanical ventilation, 77 (interquartile ranges [IQR] 22-306) versus 17 (IQR 6-67) hours for the older children (P-0.009); longer inotropic support, 127 (103-285) versus 60 (20-108) hours for older children (P-0.000); longer intensive care unit (ICU) stay, 12 (4-29) versus 4 (2-7) days (P-0.01), and longer hospital stay 23 (14-64) versus 15 (11-20) days (P-0.02). Seven (43%) of the younger infants' group required readmission, whereas 4 (18%) of the older children needed to be readmitted (P < 0.04). Bloodstream infections (BSIs) occurred more frequently in the infants' group (31%) compared to older children (4.5%) (P < 0.03). The need for redo surgeries and the incidence of hospital-acquired infections other than BSIs did not show differences between the groups.

CONCLUSIONS: Age <3 months or weight <4 kg is associated with a more difficult postoperative course, characterized by longer ventilation days, a higher inotropic score, longer ICU and hospital stays, and more readmissions.

PMID:40969954 | PMC:PMC12443394 | DOI:10.4103/apc.apc_248_24

Ann Pediatr Cardiol. 2025 Mar-Apr;18(2):131-141. doi: 10.4103/apc.apc_58_25. Epub 2025 Aug 29.

ABSTRACT

BACKGROUND: Breastfeeding is recognized as optimal for infants with congenital heart disease (CHD). We sought to evaluate breastfeeding practices among mothers of infants with CHD and identify key modifiable barriers to breastfeeding.

METHODS: Initially, a cross-sectional telephone survey was conducted among 100 mothers whose infants had undergone cardiac surgery in the past year. Based on the results of this survey, a structured interview questionnaire was designed and administered to 50 mother-infant dyads who were prospectively recruited from the inpatient population and followed postoperatively.

RESULTS: Fifty infants were included (median age: 4.5 months [interquartile range (IQR): 2-7]; weight: 4.01 kg [IQR: 3.5-5.1]). Before surgery, 40 mothers (80%) were breastfeeding, whereas ten mothers (20%) were not. Notably, 17 mothers (34%) had stopped breastfeeding at some point before surgery, primarily due to perceived inadequate milk supply (82%). Additional reasons for the interruption of breastfeeding included difficulties with infant sucking or latching (35%), the belief that breast milk alone was insufficient (23%), and sore or cracked nipples (17%). Postoperatively, 39 mothers (78%) resumed breastfeeding after 3 days (IQR: 2-4). A postoperative feeding delay, defined as a delay in resuming breastfeeding beyond the anticipated timeframe of 4 days (as determined by the initial telephonic survey), was observed in 8 (16%) cases.

CONCLUSION: This study identifies the gaps and challenges in breastfeeding practices among mothers of infants with CHD. Targeted interventions are needed to support and sustain breastfeeding practices in these infants, addressing challenges and promoting continued breastfeeding during the postoperative period and beyond.

PMID:40969951 | PMC:PMC12443399 | DOI:10.4103/apc.apc_58_25

Front Oncol. 2025 Sep 3;15:1320679. doi: 10.3389/fonc.2025.1320679. eCollection 2025.

ABSTRACT

Situs inversus totalis (SIT) is a rare congenital anatomical variation. This case report describes the first instance of a patient with both lung and esophageal cancer along with SIT. Additionally, it presents the first successful radical radiation therapy for esophageal carcinoma with SIT. The patient underwent a left upper lobectomy with lymph node dissection using video-assisted thoracic surgery (VATS) for lung cancer in 2021 and radical radiotherapy for esophageal cancer in 2023.

PMID:40969271 | PMC:PMC12440748 | DOI:10.3389/fonc.2025.1320679

Clin Exp Pediatr. 2025 Sep 19. doi: 10.3345/cep.2025.00836. Online ahead of print.

ABSTRACT

BACKGROUND: Open cardiac surgery involving cardiopulmonary bypass (CPB) triggers a systemic inflammatory response that significantly affects clinical outcomes. However, the dynamics and specific roles of cytokine release after CPB in the pediatric population remain unclear.

PURPOSE: To evaluate the dynamics of cytokine levels and their association with low cardiac output syndrome (LCOS)-related outcomes.

METHODS: A prospective observational cohort study was conducted of 32 children who underwent elective open cardiac surgery with CPB at Songklanagarind Hospital, Thailand. Levels of interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor (TNF)-α were analyzed preoperatively and immediately (T0), 6, 12, and 24 hours after intensive care unit admission. LCOS-related outcomes were defined with at least two of the following criteria being met within 24 hours postoperative: clinical and laboratory parameters, vasopressor-inotropic score ≥20, ejection fraction <50% on echocardiography; and requirement for a serious postoperative intervention. Statistical analyses utilized linear mixed models and multivariate logistic regression to identify the independent predictors of LCOS.

RESULTS: The mean patient age was 34.8±34.4 months; 56.2 % were male. Roughly one-third (37.5%) had a history of previous cardiac surgery, while one-quarter (28.3%) had a Risk Adjustment for Congenital Heart Surgery score ≥3. LCOS-related outcomes occurred in 37.5% of patients. IL- 6, IL-8, and TNF-α levels differed significantly between patients with and without LCOS outcomes. An increase in IL-8 of >56 pg/mL from baseline to T0 showed the strongest association with LCOS (odds ratio, 37.34; 95% confidence interval, 4.53-836.53).

CONCLUSION: An elevated postoperative IL-8 level is a robust predictor of LCOS-related outcomes in pediatric patients undergoing cardiac surgery. These findings emphasize the importance of monitoring cytokine dynamics to guide interventions and improve patient outcomes.

PMID:40968612 | DOI:10.3345/cep.2025.00836

J Perinatol. 2025 Sep 18. doi: 10.1038/s41372-025-02392-0. Online ahead of print.

ABSTRACT

OBJECTIVE: Survival outcomes are shifting in trisomy 18 as cardiac disease is being repaired in infancy reminiscent of trisomy 21. The landscape of prenatal counseling related to cardiac disease and trisomy 18 is unknown.

STUDY DESIGN: A survey was distributed to pediatric cardiologists presenting two scenarios of cardiac disease varying by genetic diagnosis: trisomy 18 vs 21. Respondents were asked if cardiac surgery would be offered and ranked the importance of various factors in decision-making.

RESULT: Sixty three percent described surgery as an option in trisomy 18 compared to 97% in trisomy 21. Genetic diagnosis was most important in trisomy 18 compared to neonatal survival in trisomy 21. Quality of life and survival to discharge were least important in trisomy 18 compared to genetic diagnosis in trisomy 21.

CONCLUSION: Significant variability in prenatal counseling exists for trisomy 18. Indecision may be influenced by the genetic diagnosis, survival, and quality of life.

PMID:40968138 | DOI:10.1038/s41372-025-02392-0

J Cardiothorac Vasc Anesth. 2025 Aug 27:S1053-0770(25)00732-3. doi: 10.1053/j.jvca.2025.08.053. Online ahead of print.

ABSTRACT

BACKGROUND: Perioperative management of congenital heart disease (CHD) surgery presents a unique challenge due to significant pathophysiological alterations, with pulmonary hypertension contributing substantially to morbidity and mortality. Although pulmonary vasodilators and inodilators are commonly used, evidence of their efficacy and safety remains limited.

OBJECTIVES: To evaluate the effectiveness and safety of vasodilators and inodilators in pediatric patients undergoing CHD surgery.

DESIGN: Systematic review with network meta-analysis.

DATA SOURCES: PubMed, CENTRAL, and Embase.

ELIGIBILITY CRITERIA: We included single- or double-blind, parallel-group, randomized controlled trials comparing the perioperative use of vasodilators and inodilators in pediatric CHD surgery. We selected only English-language studies. We excluded crossover, non randomized trials and trials comparing the same drugs in all study arms.

RESULTS: We included 28 randomized controlled trials involving 3118 patients. Intravenous levosimendan ranked highest in decreasing postoperative mortality, although the effect was not statistically significant. Intravenous sildenafil and inhaled nitric oxide (NO) significantly reduced the duration of mechanical ventilation, and inhaled NO also significantly shortened the length of intensive care unit stay. Inhaled iloprost, NO, and enteral sildenafil reduced mean pulmonary artery pressure. No intervention significantly affected the incidence of acute kidney injury.

CONCLUSIONS: Vasodilators and inodilators did not significantly decrease perioperative mortality in pediatric CHD. Some agents, such as intravenous sildenafil and inhaled NO, demonstrated modest benefits of questionable clinical significance regarding duration of mechanical ventilation, intensive care unit stay, and pulmonary pressure. The results are limited by small sample sizes, study heterogeneity, variability in standard care, and risk of bias, requiring cautious interpretation.

REGISTRATION: CRD42024552531.

PMID:40968005 | DOI:10.1053/j.jvca.2025.08.053

Mil Med. 2025 Sep 12:usaf442. doi: 10.1093/milmed/usaf442. Online ahead of print.

ABSTRACT

A 64-year-old male veteran with a history of aortic valve (AV) replacement for severe bicuspid AV regurgitation from infective endocarditis was diagnosed with acute decompensated heart failure. Initial transthoracic echocardiogram evaluation demonstrated a dilated cardiomyopathy with a suspicious mass. Multimodality imaging evaluation, including cardiac computed tomography and cardiac magnetic resonance imaging, confirmed the diagnosis of a Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa. Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa may be a potential congenital abnormality or a rare, life-threatening complication of aortic surgery or infective endocarditis. Recognition via multimodality imaging is essential to ensure adequate treatment.

PMID:40966691 | DOI:10.1093/milmed/usaf442

Echocardiography. 2025 Sep;42(9):e70297. doi: 10.1111/echo.70297.

ABSTRACT

BACKGROUND AND OBJECTIVES: Patients with single-ventricle physiology undergoing Fontan operations face high morbidity and mortality risks. While classic-pattern dyssynchrony (CPD) and protein-losing enteropathy (PLE) are known predictors of adverse outcomes, the role of global longitudinal strain (GLS) as an independent predictor of heart failure remains unclear.

METHODS: A retrospective cohort study of 135 Fontan-operated patients from 2014 to 2015 evaluated the predictive value of GLS alongside PLE and CPD on mortality and transplantation after 9 years. Echocardiographic data, including GLS, were analyzed using speckle tracking strain analysis in 132 patients. The primary endpoint was transplant-free survival.

RESULTS: Among 132 Fontan patients, 15 had classic-pattern dyssynchrony, 29 had protein-losing enteropathy, 37 had moderately reduced global longitudinal strain (GLS ←8% ≥-16%), and 18 had severely reduced GLS (≥-8%). Cox regression analysis showed moderately reduced GLS increased mortality risk (HR 5.8, 95% CI 1.27-26.5, p = 0.023), with severely reduced GLS showing an HR of 10.3 (95% CI 2.18-48.6, p = 0.003). These results were comparable to CPD (HR 11.5, p = 0.002) and PLE (HR 14.9, p < 0.001).

CONCLUSION: Global longitudinal strain emerged as the best independent factor for predicting long-term transplant-free survival in Fontan patients, highlighting the importance of GLS assessment in routine follow-up to identify high-risk individuals for early intervention.

PMID:40965765 | DOI:10.1111/echo.70297

Pediatr Transplant. 2025 Nov;29(7):e70180. doi: 10.1111/petr.70180.

ABSTRACT

PURPOSE: Pre-transplant (PreTX) diagnoses of congenital heart disease (CHD), including single ventricle (SV) CHD, are known to be associated with immediate post-operative morbidity and mortality. However, the impact on post-discharge health and morbidity has not been elucidated.

METHODS: The Pediatric Health Information Survey (PHIS) data was used to identify patients undergoing orthotopic heart transplantation (HT). We assessed hospital encounters for readmission, ICU care, and interventions within 1 year of heart transplantation after discharge from HT.

RESULTS: A total of 4087 patients were included in the analysis with the median age of 5.2 years. PreTX diagnosis was CHD in 28%, single ventricle CHD (SV) in 31%, cardiomyopathy, and other causes in 41%. A total of 2698 patients (66%) required hospital readmission within 1 year of discharge, of which 569 required more than two readmissions. The reason for readmission was cardiac in 22%, infectious in 35%, and non-cardiac in 43%. Using multivariable modeling, younger age, CHD, SV, Hispanic race, government insurance, longer post-TX hospital stay, longer ventilation needs, and dialysis use were associated with readmission risk (all p < 0.05). CHD and SV diagnosis, younger age, and longer post-TX stay were also risk factors for ICU-level readmission (all p < 0.05). Regression analysis showed that CHD (HR 2.7) and SV (HR 5.3) were highly predictive of reinterventions within 1 year. Lastly, the morbidity burden was calculated as days alive and outside hospital (DAOH) post TX. Younger age, SV, current era for transplantation, prolonged ventilation, and hospital stay post TX were all associated with lower DAOH.

CONCLUSION: CHD and SV have a significant impact on continued morbidity post-TX, including the need for ICU-level readmission and reinterventions. The study also identifies race and post-TX morbidities as other important risk factors for readmissions and reinterventions. We need to study and improve the optimization of patients pre-and post-TX to mitigate this significant and continued risk.

PMID:40965286 | PMC:PMC12445256 | DOI:10.1111/petr.70180

Pediatr Transplant. 2025 Nov;29(7):e70179. doi: 10.1111/petr.70179.

ABSTRACT

BACKGROUND: Advances in donor organ preservation can potentially improve pediatric lung transplant outcomes. The ISHLT recommends that organ temperatures remain between 4°C and 6°C and that inflation pressures remain between 10 and 15 cm H2O during organ preservation. During traditional ice storage, temperature and inflation pressures rapidly fall below these suggested ranges. A recently developed preservation device, the Paragonix BAROguard Donor Lung Preservation System (BG) provides precise hypothermic and barometric control, ensuring that lung inflation pressure and tissue temperatures remain stable and within the ISHLT recommended range for the duration of storage. Here, we report the first clinical use of BG in a pediatric lung transplant case.

METHODS: A lung transplant was performed on a high-risk pediatric recipient after lung preservation using the BG system. We evaluated the recipient for 187 days posttransplant during hospitalization.

RESULTS: Despite multiple significant risk factors, including neuroblastoma and hemolytic uremic syndrome complicated by thrombotic microangiopathy resulting in persistent coughing, shortness of breath, and poor oral intake, the lung transplant was successful, and the patient was discharged after 187 days.

CONCLUSIONS: The BG system can be safely utilized in pediatric lung transplantation, and BG preservation can be safely implemented in high-risk cases with poor clinical prognosis.

PMID:40965263 | DOI:10.1111/petr.70179

Cardiol Young. 2025 Sep 18:1-7. doi: 10.1017/S1047951125100541. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate school-age neurodevelopmental outcomes among children with single ventricle heart disease who underwent neonatal Norwood operation with regional cerebral perfusion compared to deep hypothermic circulatory arrest. Additionally, we aimed to identify predictors of school-age development, including early developmental measures.

STUDY DESIGN: Patients enrolled in a prospective randomised trial of infants with single ventricle heart disease undergoing the Norwood operation with either regional cerebral perfusion or deep hypothermic circulatory arrest were included. For the same cohort of patients, this study performed neurodevelopmental testing at 5 years and 10 years of age. At 5 years, a comprehensive neuropsychological evaluation was performed. At 10 years, parent report instruments were used to measure participants' behaviour and executive function.

RESULTS: Forty-one patients at 5 years of age and 33 patients at 10 years of age completed neurodevelopmental evaluation. There were no significant differences in neurodevelopmental scores between the regional cerebral perfusion and deep hypothermic circulatory arrest groups at either 5 or 10 years. At 5 years of age, the average full scale intelligence quotient (IQ) was 93.4 ± SD18.8. The Bayley Scale of Infant Development Psychomotor Developmental Index (r = 0.68, p < .0001) and mental developmental index (r = 0.64, p < .0001) at 1 year positively correlated with the full scale IQ at 5 years.

CONCLUSIONS: Neurodevelopment is delayed in patients with single ventricle heart disease. Neurodevelopmental outcomes at school age did not differ based on the perfusion strategy for the Norwood operation. Mental and psychomotor developmental indices at 1 year are predictive of early school-age measures.

PMID:40964849 | DOI:10.1017/S1047951125100541

J Cardiothorac Vasc Anesth. 2025 Aug 22:S1053-0770(25)00676-7. doi: 10.1053/j.jvca.2025.08.029. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the efficacy and safety of retrolaminar block (RLB) with erector spinae plane block (ESPB) for perioperative analgesia in pediatric cardiac surgery.

DESIGN: Prospective, randomized, double-blinded, controlled, noninferiority trial.

SETTING: A pediatric cardiac surgical unit at a tertiary care referral center in South India.

PARTICIPANTS: Children aged between 1 day and 18 years who were scheduled for elective cardiac surgery (Risk adjustment for congenital heart surgery categories 1-6) were enrolled in the study. A total of 298 patients were randomly assigned to receive either an ESPB or RLB, with 149 patients in each group.

INTERVENTION: Myofascial blocks were performed by one of four anesthesiologists, each administering either ESPB or RLB under ultrasound guidance according to the assigned group. The treating anesthesiologist and intensive care unit (ICU) intensivist were blinded to group allocation.

MEASUREMENTS AND MAIN RESULTS: This study compared RLB, a safer and less commonly used posterior myofascial block, with ESPB, a widely adopted technique with few reported complications, to establish the noninferiority of RLB. The primary outcome was hemodynamic response to surgical incision, defined as a greater than 10% rise in heart rate. Secondary outcomes included block administration time; intraoperative inhalational anesthetic; dexmedetomidine and opioid use; postoperative pain and sedation scores at 2, 6, and 12 hours; and ICU outcomes such as duration of mechanical ventilation, ICU length of stay, reintubation rate, and cost of ventilator disposables and oxygen. The groups were comparable in baseline characteristics. A rise in heart rate of more than 10% was observed in 46% of patients in the ESPB group and 50% in the RLB group (p = 0.3). Intraoperative drug consumption, pain and sedation scores, as well as ICU outcomes, were similar between the groups.

CONCLUSIONS: RLB is noninferior to ESPB in pediatric cardiac surgery, providing comparable analgesic efficacy, safety, and postoperative recovery outcomes.

PMID:40962665 | DOI:10.1053/j.jvca.2025.08.029

Interv Cardiol Clin. 2025 Oct;14(4):521-534. doi: 10.1016/j.iccl.2025.07.004. Epub 2025 Aug 19.

ABSTRACT

Upper extremity vascular access has become an essential alternative to transfemoral access for structural and congenital cardiac interventions. This section outlines the expanding role of radial and subclavian/axillary approaches across procedures such as TAVR, aortic balloon valvuloplasty, aortic paravalvular leak closure, adult congenital defect interventions, and cardiac mechanical circulatory support placement. Compared with femoral access, upper extremity approaches offer lower complication rates, enhanced safety, and earlier ambulation, but present unique anatomic and technical challenges. With accumulating evidence and operator experience, these strategies are increasingly favored in selected patients and procedural contexts for optimized outcomes in structural heart disease management.

PMID:40962389 | DOI:10.1016/j.iccl.2025.07.004

Thorac Cardiovasc Surg. 2025 Sep 17. doi: 10.1055/a-2695-2498. Online ahead of print.

ABSTRACT

Minimally invasive repair of pectus excavatum (MIRPE) creates an iatrogenic communication between the pleural cavities, known as a "buffalo chest." Patients with pectus excavatum are also at increased risk of spontaneous pneumothorax due to congenital apical blebs. When these two conditions coexist, the risk of bilateral spontaneous pneumothorax becomes potentially life-threatening. This study aims to evaluate the incidence and characteristics of spontaneous pneumothorax following MIRPE, with particular attention to the presence and role of congenital blebs.We retrospectively reviewed patients who underwent MIRPE between 2005 and 2024 to identify cases of spontaneous pneumothorax. Only cases occurring at least 1 month postoperatively and unrelated to intraoperative thoracoscopy were included. Patients were followed for at least 10 months. We analyzed laterality, clinical presentation, presence of blebs, treatment, and outcomes. A systematic literature review was also conducted to explore the relationship between buffalo chest, pneumothorax, and pectus excavatum.Among 795 patients, 7 developed spontaneous pneumothorax: 4 unilateral, 3 bilateral. In six cases, blebs were identified and treated with thoracoscopic bullectomy and pleurodesis. Two patients with bilateral pneumothorax experienced cardiac arrest: one recovered after emergency drainage; the other died in a peripheral hospital, where blebs were suspected but not confirmed. The literature review identified nine similar cases in five reports.Bilateral spontaneous pneumothorax after MIRPE can be a life-threatening emergency due to the buffalo chest. Patients and families should be informed of this rare but serious risk to enable early recognition and prompt treatment. Preoperative detection of apical blebs may help reduce this risk.

PMID:40962257 | DOI:10.1055/a-2695-2498