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John Lamberti

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Christine Hendon (Fleming)

Columbia University

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Washington University in St. Louis

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King's College London

Josep Aguiló-Regla

University of Alicante / Universidad de Alicante

Luis Miguel Marques Pires

University of Coimbra

Stanislaw Bartus

Jagiellonian University in Krakow

Benito Navarrete Prieto

Universidad Complutense de Madrid

Yoshikazu Ugawa

FMU

David Schanzlin

University of California, San Diego

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Papers by John Lamberti

Implantable Cardioverter-Defibrillators in Children: A Single-Institutional Experience

The Annals of Thoracic Surgery, 1998

Background. Implantable cardioverter-defibrillators have been infrequently used in children as th... more Background. Implantable cardioverter-defibrillators have been infrequently used in children as therapy for resuscitated sudden death and syncope due to ventricular arrhythmias unresponsive to antiarrhythmics.Methods. The medical records of 5 children with implantable cardioverter-defibrillators were retrospectively reviewed. All patients had experienced syncope and 3 (60%) an out-of-hospital cardiac arrest. Underlying pathology included hypertrophic cardiomyopathy in 2, long QT syndrome in 2,

Epicardial Intraoperative Three-Dimensional Mapping of Wolff-Parkinson-White Syndrome in a Child With Ebstein’s Anomaly

The Annals of Thoracic Surgery, Oct 1, 2018

Catheter ablation of arrhythmias in small patients has inherent significant risk due to patient, ... more Catheter ablation of arrhythmias in small patients has inherent significant risk due to patient, catheter, and lesion size. Heart block, perforation and coronary damage may occur. This report shows adaptation of a 3-D electroanatomic mapping system for intraoperative use in a small patient with Ebstein&amp;amp;#39;s anomaly undergoing Cone procedure and bidirectional Glenn. Use of this technique gave clear identification of the epicardial insertion points of two accessory pathways causing Wolff-Parkinson-White and resistant episodes of supraventricular tachycardia. Successful 3-D mapping and cryoablation were performed with short procedure time and no complications. The patient remains without preexcitation or arrhythmia 6 months postoperatively.

Collateral Deception: A Unique Presentation of an Anomalous Coronary Artery

CASE (Philadelphia, Pa.), 2018

Esophageal Bronchus

The Annals of Thoracic Surgery, 2017

207 Pre- and Postoperative Pulmonary Vascular Response to Breathing 15% O2

Pediatric Research, 1981

Congenital aortico-left atrial tunnel

Pediatric Cardiology, 1980

SU MMARY. A newborn baby with heart failure had ventricular septal defect and aorto-left atria/ c... more SU MMARY. A newborn baby with heart failure had ventricular septal defect and aorto-left atria/ communication. Aortography demonstrated a large funnel-shaped vessel originating from a dilated left aortic sinus and opening into the base of the left atrial appendage. Open heart surgery was unsuccessful. Histological examination (750 serial sections) of the vessel including the adjoining aorta and left atrial appendage showed no evidence of coronary artery structures. To our knowledge, this represents the first case of congenital aortico-left atrial tunnel. KEY WORDS : Aortico-left atrial tunnel-Neonatal heart failure C ongenital aortico-left atrial communication has not previously been reported. This anomaly was discovered in a newborn infant who had associated atrial and ventricular septa/ defect. The aortic "tunnel" Was mistaken for a dilated and elongated left coronary artery opening into the left atrium in the form of a coronary artery-left atrial fistula. Histolo gical studies, however, indicated that this was not a c oronary artery but a tunnel-like extension of the aorta into the left atrium. Case Report A 3 .5-k g male was delivered spontaneously of a gravida 2, para I mother after a full-term, uncomplicated pregnancy. Apgar scores were 6 and 9 at I and 5 minutes, respectively. Chest x-ray films during the first day revealed bilateral infiltrates compatible with aspiration pneumonia. Cardiac enlargement was also present .

Effects of hemodilution on acute myocardial ischemia

Journal of Surgical Research, 1975

Agents or therapeutic interventions which decrease the extent of myocardial ischemia could be use... more Agents or therapeutic interventions which decrease the extent of myocardial ischemia could be useful in limiting myocardial necrosis after occlusion of a major coronary artery [3, 131. Such agents should either lower myocardial oxygen consumption [3,4] or increase the rate of oxygen delivery to ischemic areas [4, 91. Since the rate of oxygen delivery to organs and tissues is maintained or enhanced after moderate systemic hemodilution [ 12, 141, it has been suggested that hemodilution might protect the myocardium during ischemia after coronary occlusion. This study was undertaken to assess the effect of hemodilution on experimental myocardial ischemia. Several diluent solutions were compared with emphasis on the effects of clinical and lowmolecular-weight Dextran. EXPERIMENTAL METHODS Adult mongrel dogs of either sex, weighing between 20 and 30 kg, were the experimental subjects. Anesthesia was carried out with pentobarbital (3 mg/kg), and the dogs were ventilated with 100% oxygen via a Harvard respirator. Arterial blood gases were measured in most cases. Rectal

Mitral Valve Reconstruction for Mitral Regurgitation

Journal of Cardiac Surgery, 1986

Observations on the Regulation of Arterial Blood Pressure in Unanesthetized Dogs

Circulation Research, 1968

Aortic pressure rises as a dog's head is raised and falls as it is lowered. Systemic pressure... more Aortic pressure rises as a dog's head is raised and falls as it is lowered. Systemic pressure change was 49%±3% of the hydrostatic pressure change at the carotid sinus, chosen as an arbitary reference, so that pressure at the carotid sinus changed only 51% as much as it would have if systemic pressure had not changed. The responses to head raising and lowering were dynamically asymmetrical, in a way which permits them to be described as being dependent on the rate of head lowering as well as on vertical position. When chloralose-anesthetized dogs maintained with positive-pressure breathing were studied under water, the response was abolished, suggesting its hydrostatic basis. Chronic carotid baroreceptor deafferentation or carotid sinus excision only diminished the response to changes in head position in most animals, and a transient response to head lowering persisted in all. An apparent CNS adaptation to the disruption of baroreceptor afferents makes it impossible to judge the...

Ventriculographic features predictive of surgical outcome for left ventricular aneurysm

Circulation, 1978

Although clinical and hemodynamic stability predicted outcome very well when left ventricular ane... more Although clinical and hemodynamic stability predicted outcome very well when left ventricular aneurysm was electively resected in 25 patients (95% survival), more discriminate criteria were essential for 20 patients undergoing urgent operation for severe myocardial decompensation (50% survival). Three methods of ventriculographic analysis primarily sensitive to the function of the non-aneurysmal left ventricle were evaluated. These methods separated patients undergoing urgent operation into a population with high operative risk (less than 18% survival) and a population with low operative risk (greater than 82% survival). These criteria also separated 15 patients undergoing operation within three months of myocardial infarction into a group with excellent prognosis (greater than 85% survival) and a group with poor prognosis (less than 15% survival). The high operative risk in patients undergoing urgent operation or operation within three months of myocardial infarction, when non-aneu...

Malignant fibrous histiocytoma of the heart presenting as an atrial myxoma

Cancer, 1978

A 37-year-old woman presented with signs and symptoms suggestive of mitral stenosis and insuffici... more A 37-year-old woman presented with signs and symptoms suggestive of mitral stenosis and insufficiency. Subsequent evaluation demonstrated a left atrial tumor which was suspected clinically and at the time of initial surgery to be an atrial myxoma. Histologic examination revealed that the tumor was actually a malignant fibrous histiocytoma. Despite near total removal at surgery and subsequent radiotherapy, the tumor recurred within six months in the left atrium. Re-excision was followed by a third recurrence in the same site.

Surface Cooling (20 °C) and Circulatory Arrest in Infants Undergoing Cardiac Surgery

Archives of Surgery, 1978

ABSTRACT During a six-year period, 46 severely symptomatic infants (average age, 5.1 months) unde... more ABSTRACT During a six-year period, 46 severely symptomatic infants (average age, 5.1 months) underwent correction of ventricular septal defect (22 patients), total anomalous pulmonary venous connection (13 patients), and complete atrioventricular canal (11 patients), with the use of surface cooling to 20 degrees C. Cardiac repair was performed during circulatory arrest, and rewarming was performed with a pump oxygenator. Ten patients undergoing repair of ventricular septal defects were studied hemodynamically at 21 degrees C, before repair and at 37 degrees C after rewarming. Heart rate, left ventricular systolic pressure, maximum dp/dt, cardiac index, stroke work, and oxygen consumption were reduced substantially at 21 degrees C. Systemic vascualr resistance was increased at 21 degrees C. All changes were reversible with repair and rewarming. A protocol for hemodilution and crystalloid volume loading was devised to maintain urine output after early patients were noted to demonstrate renal dysfunction. With this protocol, survival rates were 89% for patients with ventricular septal defects, 67% for those with atrioventricular canal defects, and 85% for those with total anomalous pulmonary-venous connection.

Ventricular Fibrillation during Cardiopulmonary Bypass: Long-Term Effects on Myocardial Morphology and Function

The Annals of Thoracic Surgery, 1979

Mongrel dogs were subjected to hypothermic (28" to 30°C) cardiopulmonary bypass with hemodilution... more Mongrel dogs were subjected to hypothermic (28" to 30°C) cardiopulmonary bypass with hemodilution by 50%. In two groups of 8 dogs each, ventricular fibrillation was induced for 60 and 90 minutes, respectively, while the dogs were on bypass. A group of 6 dogs with the heart beating but nonworking served as control. Seven weeks after operation, hernodynamic measurements were made in the suMvors (6 in each group) and the heart was fixed by perfusion with glutaraldehyde. Multiple transmural samples were taken from both vent+ cles. Light microscopy revealed solitary left ventricular scars (0.5 to 3 mm wide) in 2 hearts each from Groups 2 and 3. None of the hearts exhibited diffuse subendocardial fibrosis indicative of healed ischemic injury. All animals were hernodynamically normal. We conclude that in the nonhypertrophied heart, ventricular fibrillation up to 90 minutes with continuous bypass-sustained coronary perfusion (perfusion pressure at or above 70 mm Hg) offers protection from permanent myocardial injury. Ventricular fibrillation is an attractive method of cardiac arrest during cardiopulmonary bypass (CPB) since it offers a quiet operative field with apparent myocardial protection due to continuous coronary perfusion with oxygenated blood. Extensive experimental evaluation of ventricular fibrillation during CPB has been

Long-Term Follow-Up Shows Excellent Transmural Atrial Lead Performance in Patients With Complex Congenital Heart Disease

Circulation-arrhythmia and Electrophysiology, Aug 1, 2014

M any patients with postoperative congenital heart disease require permanent pacing for sinus nod... more M any patients with postoperative congenital heart disease require permanent pacing for sinus node dysfunction or AV block. These concerns can occur immediately after reparative surgery or over time as a result of extensive scarring and fibrosis. Patients with single ventricle physiology, in particular, are at high risk of postoperative brady-and tachyarrhythmias and mostly require multiple surgical interventions as part of their management. 1-4 Using traditional epicardial leads, extensive epicardial scar and difficult access often result in an elevated pacing threshold both at time of implantation and chronically, as well as inadequate sensing of intrinsic atrial activity. 2-7 Implantation of new leads may then be hindered by further epicardial scar formation, and favorable sites for epicardial lead placement diminish with repeated thoracotomy procedures, leading to repeated lead failures. 2,8 Lead placement is frequently concomitant with surgical procedures optimally performed when a patient is too small to be amenable to a transvenous pacing system. Furthermore, many patients with congenital heart disease are not candidates for transvenous lead deployment because of postoperative venous anatomy. 9,10 Transmural atrial (TMA) lead pacing has the potential to reduce these epicardial pacing issues using an epicardial-to-endocardial approach. A similar approach and initial results were previously described in a series of 18 patients, 11 of whom had Fontan physiology. 11 This analysis represents the first description of long-term lead performance using this TMA lead technique. Clinical Perspective on p 657 Methods Medical records were reviewed for 58 consecutive patients with congenital heart disease who underwent placement of TMA pacing leads. The study period from 1998 to 2004 was chosen from the onset of use of TMA leads at Rady Children's Hospital San Diego and ended at a time to allow analysis of long-term lead performance. Demographic data were reviewed, including age at time of lead implantation,

Surgical Approaches to Epicardial Pacemaker Placement: Does Pocket Location Affect Lead Survival?

Pediatric Cardiology, 2010

Per-Ventricular Insertion of Melody Valve-in-Valve in the Neoaortic Position in a Single-Ventricle Patient

Innovations (Philadelphia, Pa.), Jan 9, 2018

Percutaneous therapies for congenital heart disease have been evolving rapidly despite limited in... more Percutaneous therapies for congenital heart disease have been evolving rapidly despite limited investment from industry. The Melody transcatheter pulmonary valve (Medtronic, Inc, Minneapolis, MN USA) replacement therapy represents an important advancement in this arena. It has been approved in the United States for use in the pulmonary position, on a Humanitarian Device Exemption status. Off-label use of the Melody transcatheter pulmonary valve has extended to the mitral, pulmonary, and aortic valves, especially in previously implanted valves with prosthetic valve degeneration. The single-ventricle patient poses additional challenges. However, there exists one report in the English literature of a patient undergoing Melody transcatheter neoaortic valve replacement after the patient developed severe neoaortic regurgitation after Fontan palliation. Here, we describe a patient with hypoplastic left heart syndrome, palliated with a Norwood modified Blalock-Taussig shunt, with a progress...

Tetralogy of Fallot repair results in activation of the renin-angiotensin-aldosterone system

European Heart Journal, 1996

Epicardial Intraoperative 3-D Mapping of Wolff-Parkinson-White in a child with Ebstein's Anomaly

The Annals of thoracic surgery, Jan 3, 2018

Catheter ablation of arrhythmias in small patients has inherent significant risk due to patient, ... more Catheter ablation of arrhythmias in small patients has inherent significant risk due to patient, catheter, and lesion size. Heart block, perforation and coronary damage may occur. This report shows adaptation of a 3-D electroanatomic mapping system for intraoperative use in a small patient with Ebstein's anomaly undergoing Cone procedure and bidirectional Glenn. Use of this technique gave clear identification of the epicardial insertion points of two accessory pathways causing Wolff-Parkinson-White and resistant episodes of supraventricular tachycardia. Successful 3-D mapping and cryoablation were performed with short procedure time and no complications. The patient remains without preexcitation or arrhythmia 6 months postoperatively.

Intraoperative Three-Dimensional Mapping of Supraventricular Tachycardia in a Young Fontan Patient

The Annals of thoracic surgery, 2017

Preoperative tachycardia is uncommon before an initial Fontan procedure. Catheter intervention ca... more Preoperative tachycardia is uncommon before an initial Fontan procedure. Catheter intervention can risk complications in small patients. A patient with fetal tachycardia and double inlet left ventricle underwent Norwood and bidirectional Glenn procedures. She had persistent tachycardia. A three-dimensional electroanatomic mapping system was modified for the operative procedure; it was used to identify the arrhythmia substrate and cryoablate an atrioventricular nodal tachycardia. Mapping added 20 minutes to the operation. She is arrhythmia-free and off medication after 4 months. This three-dimensional system was successfully adapted for an intraoperative SVT ablation in this small patient, and it may be useful in other settings.

Containing costs in the treatment of congenital heart disease

The Western journal of medicine, 1984

In the Congenital Heart Program at San Diego Children's Hospital, alterations in medical prac... more In the Congenital Heart Program at San Diego Children's Hospital, alterations in medical practice have reduced costs without impairing quality or access. Pediatric cardiac catheterization was done in 483 consecutive elective patients without overnight hospital stay. Hospital readmission was required in one patient for psoas tendinitis. Avoiding overnight hospital stay minimized attendant risks of hospital care, lessened psychosocial trauma and reduced the average hospital bill by $493 (29%). Hospital stay was also reduced for elective surgical correction of congenital heart disease on a case-by-case basis. Review of 151 consecutive cases (1978 through 1982) showed a decrease in both preoperative days in hospital and postoperative days in an intensive care unit. The duration of the postoperative stay was shortened from 6.8 days in 1978-1979 to 4.4 days in 1982 (P <.05). No increase in morbidity and no mortality resulted from the shortened perioperative hospital stay. Financial...

Implantable Cardioverter-Defibrillators in Children: A Single-Institutional Experience

The Annals of Thoracic Surgery, 1998

Background. Implantable cardioverter-defibrillators have been infrequently used in children as th... more Background. Implantable cardioverter-defibrillators have been infrequently used in children as therapy for resuscitated sudden death and syncope due to ventricular arrhythmias unresponsive to antiarrhythmics.Methods. The medical records of 5 children with implantable cardioverter-defibrillators were retrospectively reviewed. All patients had experienced syncope and 3 (60%) an out-of-hospital cardiac arrest. Underlying pathology included hypertrophic cardiomyopathy in 2, long QT syndrome in 2,

Epicardial Intraoperative Three-Dimensional Mapping of Wolff-Parkinson-White Syndrome in a Child With Ebstein’s Anomaly

The Annals of Thoracic Surgery, Oct 1, 2018

Catheter ablation of arrhythmias in small patients has inherent significant risk due to patient, ... more Catheter ablation of arrhythmias in small patients has inherent significant risk due to patient, catheter, and lesion size. Heart block, perforation and coronary damage may occur. This report shows adaptation of a 3-D electroanatomic mapping system for intraoperative use in a small patient with Ebstein&amp;amp;#39;s anomaly undergoing Cone procedure and bidirectional Glenn. Use of this technique gave clear identification of the epicardial insertion points of two accessory pathways causing Wolff-Parkinson-White and resistant episodes of supraventricular tachycardia. Successful 3-D mapping and cryoablation were performed with short procedure time and no complications. The patient remains without preexcitation or arrhythmia 6 months postoperatively.

Collateral Deception: A Unique Presentation of an Anomalous Coronary Artery

CASE (Philadelphia, Pa.), 2018

Esophageal Bronchus

The Annals of Thoracic Surgery, 2017

207 Pre- and Postoperative Pulmonary Vascular Response to Breathing 15% O2

Pediatric Research, 1981

Congenital aortico-left atrial tunnel

Pediatric Cardiology, 1980

SU MMARY. A newborn baby with heart failure had ventricular septal defect and aorto-left atria/ c... more SU MMARY. A newborn baby with heart failure had ventricular septal defect and aorto-left atria/ communication. Aortography demonstrated a large funnel-shaped vessel originating from a dilated left aortic sinus and opening into the base of the left atrial appendage. Open heart surgery was unsuccessful. Histological examination (750 serial sections) of the vessel including the adjoining aorta and left atrial appendage showed no evidence of coronary artery structures. To our knowledge, this represents the first case of congenital aortico-left atrial tunnel. KEY WORDS : Aortico-left atrial tunnel-Neonatal heart failure C ongenital aortico-left atrial communication has not previously been reported. This anomaly was discovered in a newborn infant who had associated atrial and ventricular septa/ defect. The aortic "tunnel" Was mistaken for a dilated and elongated left coronary artery opening into the left atrium in the form of a coronary artery-left atrial fistula. Histolo gical studies, however, indicated that this was not a c oronary artery but a tunnel-like extension of the aorta into the left atrium. Case Report A 3 .5-k g male was delivered spontaneously of a gravida 2, para I mother after a full-term, uncomplicated pregnancy. Apgar scores were 6 and 9 at I and 5 minutes, respectively. Chest x-ray films during the first day revealed bilateral infiltrates compatible with aspiration pneumonia. Cardiac enlargement was also present .

Effects of hemodilution on acute myocardial ischemia

Journal of Surgical Research, 1975

Agents or therapeutic interventions which decrease the extent of myocardial ischemia could be use... more Agents or therapeutic interventions which decrease the extent of myocardial ischemia could be useful in limiting myocardial necrosis after occlusion of a major coronary artery [3, 131. Such agents should either lower myocardial oxygen consumption [3,4] or increase the rate of oxygen delivery to ischemic areas [4, 91. Since the rate of oxygen delivery to organs and tissues is maintained or enhanced after moderate systemic hemodilution [ 12, 141, it has been suggested that hemodilution might protect the myocardium during ischemia after coronary occlusion. This study was undertaken to assess the effect of hemodilution on experimental myocardial ischemia. Several diluent solutions were compared with emphasis on the effects of clinical and lowmolecular-weight Dextran. EXPERIMENTAL METHODS Adult mongrel dogs of either sex, weighing between 20 and 30 kg, were the experimental subjects. Anesthesia was carried out with pentobarbital (3 mg/kg), and the dogs were ventilated with 100% oxygen via a Harvard respirator. Arterial blood gases were measured in most cases. Rectal

Mitral Valve Reconstruction for Mitral Regurgitation

Journal of Cardiac Surgery, 1986

Observations on the Regulation of Arterial Blood Pressure in Unanesthetized Dogs

Circulation Research, 1968

Aortic pressure rises as a dog's head is raised and falls as it is lowered. Systemic pressure... more Aortic pressure rises as a dog's head is raised and falls as it is lowered. Systemic pressure change was 49%±3% of the hydrostatic pressure change at the carotid sinus, chosen as an arbitary reference, so that pressure at the carotid sinus changed only 51% as much as it would have if systemic pressure had not changed. The responses to head raising and lowering were dynamically asymmetrical, in a way which permits them to be described as being dependent on the rate of head lowering as well as on vertical position. When chloralose-anesthetized dogs maintained with positive-pressure breathing were studied under water, the response was abolished, suggesting its hydrostatic basis. Chronic carotid baroreceptor deafferentation or carotid sinus excision only diminished the response to changes in head position in most animals, and a transient response to head lowering persisted in all. An apparent CNS adaptation to the disruption of baroreceptor afferents makes it impossible to judge the...

Ventriculographic features predictive of surgical outcome for left ventricular aneurysm

Circulation, 1978

Although clinical and hemodynamic stability predicted outcome very well when left ventricular ane... more Although clinical and hemodynamic stability predicted outcome very well when left ventricular aneurysm was electively resected in 25 patients (95% survival), more discriminate criteria were essential for 20 patients undergoing urgent operation for severe myocardial decompensation (50% survival). Three methods of ventriculographic analysis primarily sensitive to the function of the non-aneurysmal left ventricle were evaluated. These methods separated patients undergoing urgent operation into a population with high operative risk (less than 18% survival) and a population with low operative risk (greater than 82% survival). These criteria also separated 15 patients undergoing operation within three months of myocardial infarction into a group with excellent prognosis (greater than 85% survival) and a group with poor prognosis (less than 15% survival). The high operative risk in patients undergoing urgent operation or operation within three months of myocardial infarction, when non-aneu...

Malignant fibrous histiocytoma of the heart presenting as an atrial myxoma

Cancer, 1978

A 37-year-old woman presented with signs and symptoms suggestive of mitral stenosis and insuffici... more A 37-year-old woman presented with signs and symptoms suggestive of mitral stenosis and insufficiency. Subsequent evaluation demonstrated a left atrial tumor which was suspected clinically and at the time of initial surgery to be an atrial myxoma. Histologic examination revealed that the tumor was actually a malignant fibrous histiocytoma. Despite near total removal at surgery and subsequent radiotherapy, the tumor recurred within six months in the left atrium. Re-excision was followed by a third recurrence in the same site.

Surface Cooling (20 °C) and Circulatory Arrest in Infants Undergoing Cardiac Surgery

Archives of Surgery, 1978

ABSTRACT During a six-year period, 46 severely symptomatic infants (average age, 5.1 months) unde... more ABSTRACT During a six-year period, 46 severely symptomatic infants (average age, 5.1 months) underwent correction of ventricular septal defect (22 patients), total anomalous pulmonary venous connection (13 patients), and complete atrioventricular canal (11 patients), with the use of surface cooling to 20 degrees C. Cardiac repair was performed during circulatory arrest, and rewarming was performed with a pump oxygenator. Ten patients undergoing repair of ventricular septal defects were studied hemodynamically at 21 degrees C, before repair and at 37 degrees C after rewarming. Heart rate, left ventricular systolic pressure, maximum dp/dt, cardiac index, stroke work, and oxygen consumption were reduced substantially at 21 degrees C. Systemic vascualr resistance was increased at 21 degrees C. All changes were reversible with repair and rewarming. A protocol for hemodilution and crystalloid volume loading was devised to maintain urine output after early patients were noted to demonstrate renal dysfunction. With this protocol, survival rates were 89% for patients with ventricular septal defects, 67% for those with atrioventricular canal defects, and 85% for those with total anomalous pulmonary-venous connection.

Ventricular Fibrillation during Cardiopulmonary Bypass: Long-Term Effects on Myocardial Morphology and Function

The Annals of Thoracic Surgery, 1979

Mongrel dogs were subjected to hypothermic (28" to 30°C) cardiopulmonary bypass with hemodilution... more Mongrel dogs were subjected to hypothermic (28" to 30°C) cardiopulmonary bypass with hemodilution by 50%. In two groups of 8 dogs each, ventricular fibrillation was induced for 60 and 90 minutes, respectively, while the dogs were on bypass. A group of 6 dogs with the heart beating but nonworking served as control. Seven weeks after operation, hernodynamic measurements were made in the suMvors (6 in each group) and the heart was fixed by perfusion with glutaraldehyde. Multiple transmural samples were taken from both vent+ cles. Light microscopy revealed solitary left ventricular scars (0.5 to 3 mm wide) in 2 hearts each from Groups 2 and 3. None of the hearts exhibited diffuse subendocardial fibrosis indicative of healed ischemic injury. All animals were hernodynamically normal. We conclude that in the nonhypertrophied heart, ventricular fibrillation up to 90 minutes with continuous bypass-sustained coronary perfusion (perfusion pressure at or above 70 mm Hg) offers protection from permanent myocardial injury. Ventricular fibrillation is an attractive method of cardiac arrest during cardiopulmonary bypass (CPB) since it offers a quiet operative field with apparent myocardial protection due to continuous coronary perfusion with oxygenated blood. Extensive experimental evaluation of ventricular fibrillation during CPB has been

Long-Term Follow-Up Shows Excellent Transmural Atrial Lead Performance in Patients With Complex Congenital Heart Disease

Circulation-arrhythmia and Electrophysiology, Aug 1, 2014

M any patients with postoperative congenital heart disease require permanent pacing for sinus nod... more M any patients with postoperative congenital heart disease require permanent pacing for sinus node dysfunction or AV block. These concerns can occur immediately after reparative surgery or over time as a result of extensive scarring and fibrosis. Patients with single ventricle physiology, in particular, are at high risk of postoperative brady-and tachyarrhythmias and mostly require multiple surgical interventions as part of their management. 1-4 Using traditional epicardial leads, extensive epicardial scar and difficult access often result in an elevated pacing threshold both at time of implantation and chronically, as well as inadequate sensing of intrinsic atrial activity. 2-7 Implantation of new leads may then be hindered by further epicardial scar formation, and favorable sites for epicardial lead placement diminish with repeated thoracotomy procedures, leading to repeated lead failures. 2,8 Lead placement is frequently concomitant with surgical procedures optimally performed when a patient is too small to be amenable to a transvenous pacing system. Furthermore, many patients with congenital heart disease are not candidates for transvenous lead deployment because of postoperative venous anatomy. 9,10 Transmural atrial (TMA) lead pacing has the potential to reduce these epicardial pacing issues using an epicardial-to-endocardial approach. A similar approach and initial results were previously described in a series of 18 patients, 11 of whom had Fontan physiology. 11 This analysis represents the first description of long-term lead performance using this TMA lead technique. Clinical Perspective on p 657 Methods Medical records were reviewed for 58 consecutive patients with congenital heart disease who underwent placement of TMA pacing leads. The study period from 1998 to 2004 was chosen from the onset of use of TMA leads at Rady Children's Hospital San Diego and ended at a time to allow analysis of long-term lead performance. Demographic data were reviewed, including age at time of lead implantation,

Surgical Approaches to Epicardial Pacemaker Placement: Does Pocket Location Affect Lead Survival?

Pediatric Cardiology, 2010

Per-Ventricular Insertion of Melody Valve-in-Valve in the Neoaortic Position in a Single-Ventricle Patient

Innovations (Philadelphia, Pa.), Jan 9, 2018

Percutaneous therapies for congenital heart disease have been evolving rapidly despite limited in... more Percutaneous therapies for congenital heart disease have been evolving rapidly despite limited investment from industry. The Melody transcatheter pulmonary valve (Medtronic, Inc, Minneapolis, MN USA) replacement therapy represents an important advancement in this arena. It has been approved in the United States for use in the pulmonary position, on a Humanitarian Device Exemption status. Off-label use of the Melody transcatheter pulmonary valve has extended to the mitral, pulmonary, and aortic valves, especially in previously implanted valves with prosthetic valve degeneration. The single-ventricle patient poses additional challenges. However, there exists one report in the English literature of a patient undergoing Melody transcatheter neoaortic valve replacement after the patient developed severe neoaortic regurgitation after Fontan palliation. Here, we describe a patient with hypoplastic left heart syndrome, palliated with a Norwood modified Blalock-Taussig shunt, with a progress...

Tetralogy of Fallot repair results in activation of the renin-angiotensin-aldosterone system

European Heart Journal, 1996

Epicardial Intraoperative 3-D Mapping of Wolff-Parkinson-White in a child with Ebstein's Anomaly

The Annals of thoracic surgery, Jan 3, 2018

Catheter ablation of arrhythmias in small patients has inherent significant risk due to patient, ... more Catheter ablation of arrhythmias in small patients has inherent significant risk due to patient, catheter, and lesion size. Heart block, perforation and coronary damage may occur. This report shows adaptation of a 3-D electroanatomic mapping system for intraoperative use in a small patient with Ebstein's anomaly undergoing Cone procedure and bidirectional Glenn. Use of this technique gave clear identification of the epicardial insertion points of two accessory pathways causing Wolff-Parkinson-White and resistant episodes of supraventricular tachycardia. Successful 3-D mapping and cryoablation were performed with short procedure time and no complications. The patient remains without preexcitation or arrhythmia 6 months postoperatively.

Intraoperative Three-Dimensional Mapping of Supraventricular Tachycardia in a Young Fontan Patient

The Annals of thoracic surgery, 2017

Preoperative tachycardia is uncommon before an initial Fontan procedure. Catheter intervention ca... more Preoperative tachycardia is uncommon before an initial Fontan procedure. Catheter intervention can risk complications in small patients. A patient with fetal tachycardia and double inlet left ventricle underwent Norwood and bidirectional Glenn procedures. She had persistent tachycardia. A three-dimensional electroanatomic mapping system was modified for the operative procedure; it was used to identify the arrhythmia substrate and cryoablate an atrioventricular nodal tachycardia. Mapping added 20 minutes to the operation. She is arrhythmia-free and off medication after 4 months. This three-dimensional system was successfully adapted for an intraoperative SVT ablation in this small patient, and it may be useful in other settings.

Containing costs in the treatment of congenital heart disease

The Western journal of medicine, 1984

In the Congenital Heart Program at San Diego Children's Hospital, alterations in medical prac... more In the Congenital Heart Program at San Diego Children's Hospital, alterations in medical practice have reduced costs without impairing quality or access. Pediatric cardiac catheterization was done in 483 consecutive elective patients without overnight hospital stay. Hospital readmission was required in one patient for psoas tendinitis. Avoiding overnight hospital stay minimized attendant risks of hospital care, lessened psychosocial trauma and reduced the average hospital bill by $493 (29%). Hospital stay was also reduced for elective surgical correction of congenital heart disease on a case-by-case basis. Review of 151 consecutive cases (1978 through 1982) showed a decrease in both preoperative days in hospital and postoperative days in an intensive care unit. The duration of the postoperative stay was shortened from 6.8 days in 1978-1979 to 4.4 days in 1982 (P <.05). No increase in morbidity and no mortality resulted from the shortened perioperative hospital stay. Financial...