Cirugía congénitos

Tomography. 2025 May 28;11(6):62. doi: 10.3390/tomography11060062.

ABSTRACT

Aortic valve stenosis (AS) is a valvular heart disease that imposes a high afterload on the left ventricle (LV) due to restricted opening of the aortic valve, resulting in LV hypertrophy. Severe AS can lead to syncope, angina pectoris, and heart failure. The number of patients with AS has been increasing due to aging populations, the growing prevalence of lifestyle-related diseases, and advances in diagnostic technologies. Therefore, accurate diagnosis and appropriate treatment of AS are essential. In recent years, transcatheter aortic valve implantation (TAVI) has become feasible, and the number of procedures has rapidly increased, particularly among elderly patients. As treatment options for AS expand and diversify, detailed pre-procedural evaluation has become increasingly important. In particular, diagnostic imaging modalities such as computed tomography (CT) have advanced significantly, with notable improvements in image quality. With recent advancements in CT technology-such as increased detector rows, faster gantry rotation speeds, new image reconstruction methods, and the introduction of dual-energy imaging-the scope of cardiac assessment has expanded beyond the coronary arteries to include valves, myocardium, and the entire heart. This includes evaluating restricted AV opening and cardiac function using four-dimensional imaging, assessing AV annulus diameter and AS severity via calcium scoring with a novel motion correction algorithm, and detecting myocardial damage through late-phase contrast imaging using new reconstruction techniques. In cases of pre-TAVI evaluation or congenital bicuspid valves, CT is also valuable for assessing extracardiac structures, such as access routes and associated congenital heart anomalies. In addition, recent advancements in CT technology have made it possible to significantly reduce radiation exposure during cardiac imaging. CT has become an extremely useful tool for comprehensive cardiac evaluation in patients with aortic stenosis, especially those being considered for surgical treatment.

PMID:40560008 | PMC:PMC12196544 | DOI:10.3390/tomography11060062

Open Vet J. 2025 May;15(5):2259-2264. doi: 10.5455/OVJ.2025.v15.i5.43. Epub 2025 May 31.

ABSTRACT

BACKGROUND: Peritoneopericardial hernias (PPHs) are congenital malformations characterized by continuity defects between the diaphragm and the peritoneum that allow the transposition of abdominal organs into the thoracic cavity. These malformations can lead to clinical, gastroenterological, and respiratory problems, such as vomiting, dyspnea, and tachypnea. They can be congenital, and patients develop clinical signs at a young age or can be diagnosed as incidental when no complications occur. Furthermore, other malformations, such as cryptorchidism and cardiac interventricular communication, can present with congenital HPP.

CASE DESCRIPTION: This article reports a case of PPH in association with a ventricular septal defect (VSD) in a pediatric canine patient. The dog, a female Shih Tzu, aged 2 months, presented with cyanosis, low weight, decreased body condition score (3/9), and underdevelopment in comparison with other puppies of the same litter. At physical examination, all parameters were within the normal range; however, there was a sound at the base of the heart during auscultation, and echocardiographic examination displayed VSD. Due to the dyspnea, thoracic radiography was performed, and the suspicion of PPH was confirmed. Peritoneopericardial hernioplasty surgery was indicated for a 2-month-old patient. During the surgical procedure, it was not necessary to enter the thoracic cavity in order to close the defect, and suture surgery was performed through the abdominal cavity accessed in the subxiphoidal region. Despite the high risks associated with the procedure, no intraoperative or anesthetic complications occurred.

CONCLUSION: The hernioplasty procedure was considered successful, and the patient's development and body condition score improvement, with the surgical procedure resolving all signs of respiratory distress.

PMID:40557092 | PMC:PMC12184471 | DOI:10.5455/OVJ.2025.v15.i5.43

Cardiol Young. 2025 Jun 25:1-7. doi: 10.1017/S1047951125001969. Online ahead of print.

ABSTRACT

OBJECTIVE: The Pediatric Acute Care Cardiology Collaborative (PAC3) previously showed decreased postoperative chest tube duration and length of stay in children undergoing 9 Society of Thoracic Surgeons benchmark operations. Here we report how these gains were sustained over time and spread to 8 additional centers within the PAC3 network.

METHODS: Patient data were prospectively collected across baseline and intervention phases at the original 9 centres (Pioneer) and 8 new centres (Spread). The Pioneer baseline phase was 6/2017-6/2018 and Spread was 5/2019-9/2019. The Pioneer intervention phase was 7/2018-7/2021 and Spread 10/2019-7/2021. The primary outcome measure was postoperative chest tube duration in hours, with the aim of 20% overall reduction. Balancing measures included chest tube reinsertion and readmission for pleural effusion. Statistical process control methods and traditional statistics were used to analyse outcomes over time.

RESULTS: Among 5,042 patients at 17 centres, demographics were comparable. The Pioneer cohort (n = 3,383) sustained a 22.6% reduction in mean chest tube duration (from 91.9 hours to 70.5 hours), while the Spread cohort (n = 1,659) showed a 9.7% reduction (from 73.1 hours to 66.0 hours) in the first 13 months following intervention. Across both cohorts, rates of reinsertion (2.0% versus 2.1%, p = 0.869) and readmission for effusion did not change (0.3% versus 0.5%, p = 0.285).

CONCLUSIONS: This multicenter prospective quality improvement study demonstrated sustained reduction in chest tube duration at 9 centres while successfully spreading improvement to 8 additional centres. This project serves as a model for post-operative multicentre quality improvement across a large cohort of congenital cardiac surgery patients.

PMID:40556264 | DOI:10.1017/S1047951125001969

Eur J Pediatr. 2025 Jun 25;184(7):440. doi: 10.1007/s00431-025-06187-5.

ABSTRACT

The role of intrarenal Doppler parameters in predicting postoperative acute kidney injury (AKI) has been increasingly emphasized, but remains underexplored in children undergoing cardiac surgery. This study aimed to investigate the association between intrarenal venous Doppler patterns and the occurrence of postoperative AKI in children after congenital cardiac surgery. This retrospective study included 338 pediatric patients who underwent elective cardiac surgery between June 2019 and December 2021. Intrarenal blood flow Doppler measurements were performed before and after surgery. The primary outcome was the difference in postoperative renal venous Doppler patterns between patients with and without AKI according to the Kidney Disease: Improving Global Outcomes criteria. Multivariate logistic regression analysis was performed to identify factors associated with AKI. Of the 338 patients, 12.1% developed postoperative AKI. Patients with AKI had a higher prevalence of biphasic and monophasic renal venous flow patterns than those without AKI (63.5% vs. 19.9%, p < 0.001). The AKI group had higher pre- and postoperative renal resistive index than the non-AKI group. Discontinuous renal venous flow pattern, preoperative intensive care unit admission, higher Risk Adjustment for Congenital Heart Surgery-1 score and intraoperative vasoactive-inotropic score, and lower preoperative albumin levels were associated with postoperative AKI. Conclusion: Abnormal postoperative intrarenal venous Doppler patterns were associated with AKI in pediatric patients after congenital cardiac surgery. Intraoperative Doppler assessment of renal venous flow may help identify children at a higher risk of AKI, allowing for early interventions.

PMID:40555869 | PMC:PMC12187880 | DOI:10.1007/s00431-025-06187-5

Leg Med (Tokyo). 2025 Jun 22;76:102661. doi: 10.1016/j.legalmed.2025.102661. Online ahead of print.

ABSTRACT

Stab injuries involving the vertebral region are rare and pose significant challenges during forensic autopsy due to the complexity of the surrounding anatomical structures. Radiological techniques, such as post-mortem computed tomography (PMCT) or micro-CT, have shown great potential for detecting and detailing sharp bone lesions. We herein present a fatal case of homicidal stab wound involving the left vertebral artery and the homolateral surface of the axis. PMCT identified a fracture of the left lateral mass of the axis (C2), and micro-CT revealed a cortical discontinuity of the left transverse process of C2, nearly separating the transverse process from the body of the axis. Based on micro-CT data, a 3D model of the first three cervical vertebrae was printed in a clear material on a Formlabs Form 3L printer, and a fit-matching analysis was conducted with two potential weapons. The billhook seized by the Police demonstrated a precise fit with the fracture pattern when its handle was positioned posteriorly, and the tip penetrated laterally in a left-to-right trajectory. In conclusion, to the best of our knowledge, this is the first report of vertebral stab wound analysis using a combined micro-CT and 3D printing approach. Although 3D printing is not yet a fully validated forensic method, and further research is needed for identifying any potential errors occurring during production, segmentation, stereolithography data generation, and post-processing, this report highlights the high potentiality of micro-radiology and 3D printing as promising tools for the morphometric analysis of vertebral injuries.

PMID:40554891 | DOI:10.1016/j.legalmed.2025.102661

Gen Thorac Cardiovasc Surg. 2025 Jun 24. doi: 10.1007/s11748-025-02172-9. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary sequestration (PS) is a rare congenital lung malformation often requiring surgical resection due to recurrent infections or hemoptysis. Traditionally treated via open thoracotomy, recent advancements have made minimal-invasive approaches like robotic-assisted thoracoscopic surgery (RATS) increasingly viable. This study compares outcomes between RATS and open resection for PS in a high-volume center.

METHODS: In this retrospective cohort study, 23 adult patients who underwent surgical resection of PS between 2010 and 2023 were analyzed. Fifteen patients were treated via open thoracotomy (THKT), while eight underwent RATS using the DaVinci-X system. We compared preoperative findings, intraoperative variables, and postoperative outcomes.

RESULTS: The patients in the RATS group were younger (median age: 36 vs 47 years) and had a shorter median hospital stay (5 vs 10 days, p < 0.001) compared to the THKT group. The RATS group also experienced earlier chest drainage removal (3 vs. 4 days, p = 0.016). However, the median duration of surgery was longer for RATS (118 vs. 75 min, p = 0.018). A trend towards less postoperative complications was observed in the RATS group (33% vs. 0%).

CONCLUSIONS: RATS provides a safe and effective alternative to open surgery for PS resection, with benefits including reduced hospital stay and earlier chest tube removal. Despite longer operative times, the minimally invasive approach may offer enhanced recovery and fewer complications. Continued accumulation of experience with RATS is likely to improve operative efficiency, making it a valuable option in the surgical management of pulmonary malformations.

PMID:40553225 | DOI:10.1007/s11748-025-02172-9

Front Pharmacol. 2025 Jun 9;16:1633008. doi: 10.3389/fphar.2025.1633008. eCollection 2025.

ABSTRACT

[This corrects the article DOI: 10.3389/fphar.2024.1449831.].

PMID:40552163 | PMC:PMC12183511 | DOI:10.3389/fphar.2025.1633008

Pediatr Rheumatol Online J. 2025 Jun 23;23(1):68. doi: 10.1186/s12969-025-01117-z.

NO ABSTRACT

PMID:40551202 | PMC:PMC12186311 | DOI:10.1186/s12969-025-01117-z

Ann Thorac Surg. 2025 Jun 21:S0003-4975(25)00544-2. doi: 10.1016/j.athoracsur.2025.05.046. Online ahead of print.

ABSTRACT

BACKGROUND: Gender disparities are well described in cardiothoracic surgery (CT). However, qualitative data highlighting women's lived experiences are lacking. We aimed to explore women's experiences with mentorship, sponsorship, and leadership in CT.

METHODS: We conducted virtual semi-structured interviews with surgeons who were women in practice for ≥5 years across the United States from 9/2024 to 12/2024. The interview asked questions pertaining to women's experiences with mentorship, sponsorship, leadership pathways, and leadership roles. Interviews were transcribed, coded, and analyzed using the thematic analysis approach.

RESULTS: Participants (n=25) included thoracic (40%), adult cardiac (36%), and congenital (16%) surgeons with 13 median years in practice. Most (84%) currently practiced in an academic setting. There were six main themes: 1) Losing Mentorship and Never Finding Sponsorship - mentorship wanes after early career and sponsorship often is never found; 2) Looking Elsewhere - women look outside their home institutions for sponsorship; 3) Needing He-for-She - men have an important role to play as sponsors; 4) Breaking Imposter Syndrome with Sponsorship - sponsorship helps overcome leadership imposter syndrome; 5) Circling the Service Drain - an overburden of work without title or compensation impedes leadership attainment; and 6) Being the Boss, but Not Bossy - women face double standards as leaders that may increase the challenges of leadership.

CONCLUSIONS: These findings suggest the need to increase cross-gender sponsorship, create support systems for career development within institutions, provide transparency in pay and promotion structures, and develop leadership training tailored to the unique obstacles women may face in order to combat identified barriers.

PMID:40550316 | DOI:10.1016/j.athoracsur.2025.05.046

Gen Thorac Cardiovasc Surg. 2025 Jun 23. doi: 10.1007/s11748-025-02174-7. Online ahead of print.

ABSTRACT

BACKGROUND: Reinterventions after congenital heart disease surgery include not only reoperations but also medical catheter interventions, and the details of these treatment realities are often unclear. This study aimed to elucidate the medical and surgical reinterventions and associated medical costs after the tetralogy of Fallot (TOF) repair using Japanese health insurance claims data.

METHODS AND RESULTS: We analyzed reinterventions and medical costs from insurance claims data of patients who underwent TOF repair between 2005 and 2021. Of 174 patients who underwent TOF repair, 23 (13.2%) received a total of 34 reinterventions. These included 23 percutaneous catheter interventions and 11 reoperations. The 5-year reintervention-free rate was 87.5% overall, 94.9% for surgeries with right ventricular outflow tract reconstruction (N = 130), and 65.6% for surgeries with peripheral pulmonary artery plasty (N = 44). The median (interquartile range) medical cost for patients without reintervention was ¥5.33 million (4.62-7.14 million) and the cost for the patients with reintervention was ¥ 10.59 million (7.73-13.97 million).

CONCLUSION: Using Japanese insurance claims data, we analyzed the reoperation and catheter intervention after the TOF repair. The reintervention-free rate after TOF repair differed significantly by surgical procedure with a tendency for poorer postoperative prognosis, particularly in cases involving the peripheral pulmonary artery plasty. These analysis results may contribute to predicting outcomes after TOF repair for healthcare professionals.

PMID:40549276 | DOI:10.1007/s11748-025-02174-7

A A Pract. 2025 Jun 23;19(6):e01983. doi: 10.1213/XAA.0000000000001983. eCollection 2025 Jun 1.

ABSTRACT

This case report describes an infant with congenital esophageal atresia who underwent thoracoscopic surgery and experienced a tension pneumothorax following the application of a fibrin glue product spray, resulting in critical hemodynamic deterioration close to circulatory arrest due to sudden and extreme elevation of intrathoracic pressure. Prompt action and adequate instruction to the surgeon by the clinical engineer in charge to reduce thoracic pressure facilitated a quick recovery from this critical hemodynamic situation. It is essential to understand the structure of the insufflation unit and manage accidental increases in closed cavity pressure during thoracoscopic or laparoscopic surgery.

PMID:40548758 | DOI:10.1213/XAA.0000000000001983

Ann Cardiothorac Surg. 2025 May 31;14(3):218-224. doi: 10.21037/acs-2025-ravr-0003. Epub 2025 May 29.

ABSTRACT

BACKGROUND: The natural history of aortic valve disease commonly eventuates in percutaneous or open surgical treatment. Percutaneous treatment has been expanding its indication from high-risk patients to low- and moderate-risk patients; however, there are certain groups of patients who are not good candidates for percutaneous treatment, such as those with bicuspid valve disease or pure aortic regurgitation patients. Robotic surgery, as an evolution from traditional approaches, has been gradually expanding its indications in cardiac surgery. The use of a lateral approach, common to robotic mitral procedures, may become a valid alternative for several patients undergoing aortic valve procedures. The aim of the present study was to evaluate and discuss the characteristics, challenges and early results of a newly created robotic aortic valve replacement program.

METHODS: This was a retrospective study analysing prospectively collected data of all patients who have undergone robotic aortic valve replacement (RAVR) in Hospital Clínic Barcelona from December 2021 to October 2024.

RESULTS: Since December 2021, 25 consecutive patients have undergone RAVR. Sixty-eight percent of the cohort were males and the median age was 66 years [interquartile range (IQR), 58.5-71.8 years]. Severe aortic stenosis was the predominant lesion in 76% of patients, and degenerative calcification was the aetiology in 52% of patients. Median cardiopulmonary bypass time was 129 minutes (IQR, 113-145.5 minutes) and median ischemic time was 91 minutes (IQR, 78-105 minutes). Three patients required a re-exploration for bleeding, which was performed through the same approach, and one patient suffered an ischemic cerebro-vascular accident (CVA) with complete recovery. Median intensive care unit (ICU) length of stay and hospital length of stay were 1 and 4 days, respectively.

CONCLUSIONS: Our initial experience shows that expanding a robotic program to include RAVR is feasible, safe, and can provide excellent clinical outcomes in selected patients.

PMID:40547431 | PMC:PMC12177757 | DOI:10.21037/acs-2025-ravr-0003

Front Pediatr. 2025 Jun 6;13:1579212. doi: 10.3389/fped.2025.1579212. eCollection 2025.

ABSTRACT

BACKGROUND: The incidence of parvovirus B19 (B19 V)-associated myocarditis progressing to dilated cardiomyopathy (DCM) is on the rise. We hypothesize that a comprehensive treatment regimen enables cardiac regeneration in young patients with life-threatening B19 V myocarditis.

METHODS: Four patients with clinical and imaging evidence of DCM were referred due to suspected myocarditis. An endomyocardial biopsy (EMB) confirmed the diagnosis. The diastolic dysfunction associated with heart failure and reduced left ventricular ejection fraction (HFrEF) was established invasively. Before surgical pulmonary artery banding (PAB), a transcatheter procedure was performed to create a restrictive atrial defect (rASD).

RESULTS: The drug-treated patients (ages 15-26 months) had a mean LV-EF of 22.5% (20%-25%), a left ventricular end-diastolic diameter (LVEDD) of 49 (45-51) mm (Z-score >5), and elevated LVED pressures (>18 mmHg). EMB revealed B19V-associated acute/subacute or chronic active myocarditis with characteristics of DCM. Drug therapy, including immunoglobulins and creating a rASD, resulted in clinical improvement and enhanced right ventricular function. However, LV enlargement and dysfunction persisted. Four weeks after surgical PAB, all patients showed improvement and were discharged home. The pressure gradient across the PAB ranged from 40 to 45 mmHg, and LVEDD decreased to a mean z-score of +3.5. Within three to six months, LVEDD normalized, and LV-EF increased to a mean of 63% (range: 57%-68%). Clinical and cardiac improvements were sustained over a median follow-up of 7.5 years.

CONCLUSION: A holistic treatment approach allows functional regeneration in B19 V myocarditis with obvious end-stage DCM. Restrictive ASD creation is required before surgical PAB when HFrEF is associated with a diastolic dysfunction component.

PMID:40547134 | PMC:PMC12179178 | DOI:10.3389/fped.2025.1579212

Front Pediatr. 2025 Jun 6;13:1610035. doi: 10.3389/fped.2025.1610035. eCollection 2025.

ABSTRACT

INTRODUCTION: Guillain-Barré syndrome (GBS) is an important cause of flaccid paralysis in children and is mainly associated with antecedent infections. Surgery as an additional trigger for GBS is a well-documented phenomenon in adults, but is significantly less reported in pediatric patients. This case report describes an infant with post-surgical GBS following cardiac surgery, highlighting the diagnostic challenges and differential diagnoses of post-surgical GBS in the pediatric intensive care setting.

CASE DESCRIPTION: A former extremely preterm infant with congenital cytomegalovirus (CMV) infection underwent a second surgery for re-coarctation of the aorta with aortic arch hypoplasia at the chronological age of six months. While requiring extracorporeal membrane oxygenation postoperatively, the girl presented with flaccid paralysis of the lower extremities. Magnetic resonance imaging of the brain, spine, and nerve conduction studies demonstrated findings consistent with acute motor-sensory axonal neuropathy-type GBS. She was treated with intravenous immune globulin and ganciclovir due to CMV reactivation (plasma 14,000 copies/ml). Gradual neurological improvement was noted over the following months, while persistent motor deficits remained, suggesting potential disease transition into chronic inflammatory demyelinating polyneuropathy.

CONCLUSIONS: This case report emphasizes the importance of considering post-surgical GBS in critically ill children with postoperative paralysis. Recognition may be delayed due to variable initial presentations and accompanying factors such as sedation and extracorporeal life support.

PMID:40547133 | PMC:PMC12179211 | DOI:10.3389/fped.2025.1610035

Cureus. 2025 May 22;17(5):e84605. doi: 10.7759/cureus.84605. eCollection 2025 May.

ABSTRACT

Tracheoesophageal fistula (TEF) is a rare, pathological connection between the trachea and esophagus that can be acquired or congenital. Acquired TEF typically occurs due to iatrogenic injuries. There is often a delay in diagnosis due to the rare nature of this condition. These patients have a very high mortality rate, and a multidisciplinary strategy is required for the management of TEF involving specialists from interventional pulmonology, gastroenterology, and thoracic surgery. The clinical features, diagnosis, and management of nine patients with TEF are covered in this article. Eight patients were diagnosed with acquired TEF and one with a recurrence of congenital TEF. Our experience shows that, when patients develop TEF, it is usually a terminal event, and major procedures cannot be tolerated due to multiple comorbidities and ventilator dependency. Thus, these patients are managed with palliative treatment to improve their quality of life. Although surgical intervention is the gold standard for patients with acquired TEF, it is considered feasible in very few cases, so this article focuses primarily on interventional therapy rather than surgery.

PMID:40546474 | PMC:PMC12181819 | DOI:10.7759/cureus.84605

BMJ Case Rep. 2025 Jun 22;18(6):e265337. doi: 10.1136/bcr-2025-265337.

ABSTRACT

Congenital tracheobronchomegaly, also known as Mounier-Kuhn syndrome (MKS), is an uncommon illness characterised by dilatation of the major bronchi and recurrent chest infections. Tracheobronchomegaly may also be accompanied by tracheal and bronchial diverticula. We report the case of a middle-aged woman with a complaint of uterine prolapse for which a hysterectomy is planned. The patient complained of recurrent cough with expectoration for the last 6 years; hence, a radiograph of the chest and CT of the thorax were advised. A radiograph of the chest and thoracic CT showed dilation and numerous diverticula of the trachea and bronchi that suggested MKS. Management of MKS in symptomatic patients is supportive but is only used to treat contagious exacerbations with antibiotics and respiratory exercise to clear secretions. Here is an attempt to reach out to the cause of uterine prolapse in this patient with MKS and correlating these two conditions.

PMID:40545290 | DOI:10.1136/bcr-2025-265337

J Thorac Cardiovasc Surg. 2025 Jun 20:S0022-5223(25)00535-5. doi: 10.1016/j.jtcvs.2025.06.015. Online ahead of print.

ABSTRACT

OBJECTIVE: Orthotopic heart transplant is the definitive option for pediatric patients with end-stage heart failure. Unfortunately, the greatest contributor to waitlist mortality has been a shortage of available hearts for transplant. Donation after circulatory death with normothermic regional perfusion may mitigate this supply-demand mismatch.

METHODS: Donation after circulatory death with normothermic regional perfusion recipients were matched to similar donation after brain death recipients. Primary end points included 1-year survival, and episodes of primary graft dysfunction at 1 year. Secondary end points included treated rejection at 1 year and ventricular systolic and diastolic function on echocardiogram at time of discharge. Elevated filling pressures or decreased cardiac output were also examined via cardiac catheterization data at time of endomyocardial biopsy at 1 year.

RESULTS: Twelve donation after circulatory death procurements were attempted and nine hearts procured. Donor cardiac arrest and cardiac function prior to procurement were similar in both groups. Donation after brain death recipients spent more time on the waitlist. Following transplant, biventricular function was similar in both groups at time of discharge and at 1-year follow-up. There were no differences between groups with regard to primary graft dysfunction or instances of treated rejection at 1 year.

CONCLUSIONS: This study represents the largest single-institution cohort of pediatric recipients of hearts obtained following donation after circulatory death with normothermic regional perfusion compared to demographically similar donation after brain death cardiac transplant recipients. These results are indicative of equivalent outcomes at 1-year, suggesting that donation after circulatory death with normothermic regional perfusion is a viable method to expand the pediatric cardiac donor pool.

PMID:40545233 | DOI:10.1016/j.jtcvs.2025.06.015

Arch Cardiovasc Dis. 2025 Jun 12:S1875-2136(25)00325-0. doi: 10.1016/j.acvd.2025.04.056. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the widespread adoption of percutaneous pulmonary valve implantation, there remains a lack of consensus on the optimal management of peri-interventional and long-term antithrombotic therapies because of a lack of evidence.

AIM: To clarify current practices in peri/postprocedural antithrombotic strategies for percutaneous pulmonary valve implantation.

METHODS: An online survey was submitted to the Interventional Working Group of the Association for European Paediatric and Congenital Cardiology, and was completed by 76 congenital interventional cardiologists in 2023-2024.

RESULTS: Overall, 86% had standardized protocols for anticoagulation/antiaggregation. Intraprocedural heparin administration of 100IU/kg was common (83%), and postprocedural strategies mostly included acetylsalicylic acid (aspirin) (45%) or a combination of antiaggregation and anticoagulation (29%). Long-term strategies comprised antiaggregation (88%), no therapy (11%) and anticoagulation only (1%). Acetylsalicylic acid monotherapy was prescribed by 91%, whereas 9% used dual antiaggregation therapy. Dual antiaggregation therapy was continued for suspicious medical history of thrombotic complication or microthrombi for 3-6 months. Testing for acetylsalicylic acid resistance was infrequent (36%), and only if clinically indicated. When patients had pre-established anticoagulation therapy, 59% changed their strategy. Treatment changes based on valve type were rare (8%). The primary reasons for anticoagulation/antiaggregation were to increase valve longevity (26%) and for both longevity and endocarditis prophylaxis (68%). Acute valve thrombosis was reported in 11 cases.

CONCLUSIONS: The survey reveals variability in practices after percutaneous pulmonary valve implantation. Most interventional cardiologists prefer acetylsalicylic acid for postprocedural and long-term management, whereas dual antiaggregation therapy is sometimes used in specific cases. Anticoagulation is limited to pre-existing therapy cases or isolated experiences for 3 months.

PMID:40544108 | DOI:10.1016/j.acvd.2025.04.056

J Am Soc Echocardiogr. 2025 Jun 19:S0894-7317(25)00332-3. doi: 10.1016/j.echo.2025.06.006. Online ahead of print.

ABSTRACT

BACKGROUND: Current guidelines recommend annual or biennial transthoracic echocardiograms for patients with d-transposition of the great arteries (d-TGA) who have undergone an arterial switch operation (ASO), but optimal imaging frequency is unknown. We sought to determine the utility of annual surveillance echocardiograms for asymptomatic patients.

METHODS: Clinical documentation from 2011-2023 for asymptomatic patients > 18 years old with history of d-TGA and ASO at a single large tertiary care center was reviewed to determine if routine surveillance echocardiograms resulted in changes in clinical management (ΔMGMT), categorized as procedures (surgery or catheterization) or noninvasive changes (medication changes, additional imaging, etc.). Echocardiograms obtained for symptoms or completed before age 18 were excluded from analysis. Data was evaluated with chi-square and Kruskal-Wallis tests, Kaplan-Meier analysis, and Cox proportional hazard analysis.

RESULTS: Of 416 echocardiograms from 127 patients, the median time from ASO to final echocardiogram was 22.2 years (IQR 19.1-25.7 years; range 15.2-34.1 years). Eighteen echocardiograms (4.32%) resulted in ΔMGMT for 12 patients including 8 (1.92%) medication changes, 7 (1.68%) cardiac CT or MRI studies, and 1 (0.24%) each for cardiac catheterization and surgery. A significantly larger proportion of patients with ΔMGMT underwent ASO at age >1 year compared to patients without ΔMGMT (36.36% vs 6.14%, P<0.01). Patients with a history of hypertension, arrhythmia, >2 sternotomies, or neo-aortic valve replacement had a significantly greater risk of ΔMGMT, as did those with neo-aortic root dilation >4.5cm and/or moderate or greater neo-aortic insufficiency.

CONCLUSIONS: Routine surveillance echocardiograms are low yield in asymptomatic adults up to 30 years after ASO for d-TGA, suggesting it may be reasonable to increase the time interval between routine echocardiograms without adversely impacting care. Higher risk sub-populations including those with ASO at older ages, >2 sternotomies, neo-aortic valve replacement, and/or neo-aortic valve/root pathology may benefit from continued frequent surveillance.

PMID:40543855 | DOI:10.1016/j.echo.2025.06.006

Ann Thorac Surg. 2025 Jun 19:S0003-4975(25)00530-2. doi: 10.1016/j.athoracsur.2025.05.038. Online ahead of print.

ABSTRACT

BACKGROUND: Gender-based pay disparity in compensation is widespread. In cardiothoracic surgery, women earn between 71-84% of men's salaries at comparable ranks. Limited data exist on how factors like subspecialty, practice type, and work efforts contribute to these disparities.

METHODS: The Society of Thoracic Surgeons (STS) conducted the Compensation Survey in 2023 among practicing members with at least a 0.5 full-time equivalent role. Collected data included compensation sources, predominant subspeciality of cardiothoracic surgery, work relative value units (wRVUs) generated, and demographics. Comparisons on gender-based salary across subspecialties, years of experience, and wRVUs were included.

RESULTS: Among 838 respondents, gender disparities were present in both base salary and total compensation across all subspecialties, with women earning 64-93% of men's salaries. Income disparity was greatest in cardiac surgery with 11-20 years of experience, where women earned 63-70% of men's compensation. Similarly, in thoracic surgery, women earned 59-72% of the compensation of men with 21-30 years of experience. Women with 11-20 years of experience earned less than both men and women colleagues with 6-10 years of experience. Women reported more compensation from teaching, while men reported more from call coverage.

CONCLUSIONS: Gender pay disparities exist among cardiothoracic surgeons, even when accounting for experience and productivity. Reasons for these disparities, including parenthood penalty, need to be further studied and corrections proposed.

PMID:40543696 | DOI:10.1016/j.athoracsur.2025.05.038