Papers by Nelson Alphonso
Intensive care medicine, Jan 10, 2015
Journal of Paediatrics and Child Health, 2015
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2006
A patient with preoperative pulmonary hypertension and a large left to right intracardiac shunt u... more A patient with preoperative pulmonary hypertension and a large left to right intracardiac shunt underwent surgical correction of a complex cardiac anomaly and required extracorporeal life support for unexplained ventricular dysfunction following the procedure. Following recovery, a fistulous connection between the right coronary artery and main pulmonary artery was demonstrated. Implications and management strategies of unsuspected coronary fistula in pediatric heart surgery are discussed.
The Annals of thoracic surgery, 2013
Cardiac surgery in patients with osteogenesis imperfecta is challenging as the friability of the ... more Cardiac surgery in patients with osteogenesis imperfecta is challenging as the friability of the tissues can be hazardous before, during, and after the operation. A multidisciplinary approach with a planned strategy is essential for the successful management of these patients. We present a 6-year old child with osteogenesis imperfecta, who underwent ventricular septal defect closure without any complication.
Frontiers in Pediatrics, 2013
Introduction: A multicenter prospective study was conducted to evaluate a new strategy for multip... more Introduction: A multicenter prospective study was conducted to evaluate a new strategy for multiple Ventricular Septal Defects (VSDs).
The Annals of thoracic surgery, 2014
Congenitally short trachea is an uncommon abnormality. It is characterized by a reduced number of... more Congenitally short trachea is an uncommon abnormality. It is characterized by a reduced number of tracheal cartilage rings. As a result, the carina is situated at a higher level than usual. That causes the left main bronchus to course abnormally behind the arch of the aorta, rendering it prone to compression. We report the case of an infant who underwent successful aortopexy of the aortic arch for this condition.
The Journal of Thoracic and Cardiovascular Surgery, 2006
Objective: Although homograft conduits are frequently used to establish right ventricle-to-pulmon... more Objective: Although homograft conduits are frequently used to establish right ventricle-to-pulmonary artery continuity, the limited availability of small-size homografts is a significant constraint in pediatric cardiac surgery. We compared the performance of standard homograft conduits with that of surgically reduced bicuspid homograft conduits in patients undergoing repair of truncus arteriosus.
The Journal of Thoracic and Cardiovascular Surgery, 2011
Objective: The present study evaluated the mortality and conduit failure in bovine jugular vein (... more Objective: The present study evaluated the mortality and conduit failure in bovine jugular vein (BJV) conduits.
The Journal of Heart and Lung Transplantation, 1999
This study describes a patient who developed decompensated liver disease secondary to reactivatio... more This study describes a patient who developed decompensated liver disease secondary to reactivation of hepatitis B infection 20 months after single lung transplantation following augmentation of immunosuppression to treat allograft rejection. Discussion focuses on the virologic and management issues of this case and reviews the approach taken when considering patients with chronic hepatitis B infection for lung transplantation.
European Journal of Cardio-Thoracic Surgery, 2005
The collection of fluid in the mediastinum after cardiac surgery is traditionally prevented using... more The collection of fluid in the mediastinum after cardiac surgery is traditionally prevented using underwater seal drains that may be connected to low-pressure suction. High-vacuum drains (redivac drains) are a potential alternative to this arrangement and have previously been utilized in areas of general surgery, as well as in the treatment of post-sternotomy mediastinitis. There has been no study to date addressing the safety and efficacy of these drains following pediatric cardiac surgery. Five hundred and forty-six patients were prospectively randomised to receive either the redivac drains or the conventional underwater-seal drains attached to low-pressure wall suction. We sought to test the null hypothesis that there was no difference in the incidence of residual pericardial or pleural collections requiring drainage between the 2 drainage systems. Secondary endpoints included time to drain removal, volume of drainage and drain size. Analysis was performed on an intention to treat basis. Two hundred and thirty-seven patients were allocated to the redivac group, while 241 were allocated to the conventional drain group. Age and gender distribution, the use of cardiopulmonary bypass, numbers of patients with univentricular morphology and number of drains utilized were similar in the 2 groups. The use of redivac drains resulted in a significantly lower incidence of residual pleural effusions requiring drainage (4 vs. 18, P=0.003). There was no difference in the incidence of pericardial effusion requiring drainage. Redivac drains drained an equivalent volume through smaller calibre tubes (12 Ch vs. 16 Ch, P<0.0001) over a shorter period of time (42h (IQR 22-45) vs. 43h (IQR 27-52), P<0.01) than the conventional drainage system. Redivac drains are as safe and effective as conventional drains in the pediatric setting, and resulted in a lower incidence of residual pleural effusions requiring drainage. Together with their ease of care, earlier mobilisation of patients and greater cost-effectiveness, the routine use of high-vacuum drains can be recommended following pediatric heart surgery.
European Journal of Cardio-Thoracic Surgery, 2006
Objective: To identify a large group of patients operated for absent pulmonary valve syndrome (AP... more Objective: To identify a large group of patients operated for absent pulmonary valve syndrome (APVS), and describe the outcomes of various subgroups and surgical strategies. Methods: Thirty-six consecutive patients operated during 1979-2004 were included. Thirty-one percent furthermore had other vascular abnormalities. Eighty-three percent had airway obstruction symptoms before surgery. Twenty-eight percent were ventilator dependent, while 72% underwent repair electively. The median age and weight at repair were 0.8 years (4 days-24 years) and 6.7 kg (1.8-56 kg). The surgical approach was modified several times, including the following: homograft conduit (14%), monocusp valve (39%), and no pulmonary valve (47%). All patients underwent ventricular septal defect (VSD) patching. Seventy-four percent underwent right ventricular outflow tract resection and 91% underwent transannular patching. Pulmonary artery reduction plasty was performed in 86%. Results: The followup was 94% complete. Nineteen percent had died. The median follow-up time was 9.2 years (1 day-20.5 years). Survival after repair was 82% at 1 year and 79% at 5, 10, and 15 years. Postoperative survival was strongly associated to preoperative ventilator dependency ( p = 0.002). The current New York Heart Association (NYHA) classification was established in 93% of survivors. Eighty-nine percent were in NYHA 1 or 2, 11% were in NYHA 3. No patient was in NYHA 4. Freedom from reoperation 1, 5, and 10 years after repair was 78, 65, and 55%, respectively. Conclusions: The surgical outcome of APVS was closely related to preoperative ventilator dependency. Efforts to improve the surgical outcome should be focused on identifying and correcting this. #
European Journal of Cardio-Thoracic Surgery, 2006
Carvalho, Paula, Shane R. Johnson, Nirmal B. Charan. Non-cAMP-mediated bronchial arterial vasodil... more Carvalho, Paula, Shane R. Johnson, Nirmal B. Charan. Non-cAMP-mediated bronchial arterial vasodilation in response to inhaled -agonists. J. Appl. Physiol. 84(1): 215-221, 1998.-We studied the dose-dependent effects of inhaled isoetharine HCl, a -adrenergic bronchodilator (2.5, 5.0, 10.0, and 20.0 mg), on bronchial blood flow (Q br) in anesthetized sheep. Isoetharine resulted in a dose-dependent increase in Q br. With a total dose of 17.5 mg, Q br increased from baseline values of 22 Ϯ 3.4 (SE) to 60 Ϯ 16 ml/min (P Ͻ 0.001), an effect independent of changes in cardiac output and systemic arterial pressure. To further study whether synthesis of endogenous nitric oxide (NO) affects -agonist-induced increases in Q br, we administered isoetharine (20 mg) by inhalation before and after the NO-synthase inhibitor Nnitro-L-arginine methyl ester (L-NAME). Intravenous L-NAME (30 mg/kg) rapidly decreased Q br by ϳ80% of baseline, whereas L-NAME via inhalation (10 mg/kg) resulted in a delayed and smaller (ϳ22%) decrease. Pretreatment with L-NAME via both routes of administration attenuated bronchial arterial vasodilation after subsequent challenge with isoetharine. We conclude that isoetharine via inhalation increases Q br in a dose-dependent manner and that -agonistinduced relaxation of vascular smooth muscle in the bronchial vasculature is partially mediated via synthesis of NO. bronchial circulation; -adrenoreceptor agonists; nitric oxide; adenosine 3Ј,5Ј-cyclic monophosphate
Cardiology in the Young, 2007
The Annals of Thoracic Surgery, 2006
Congenital absence of the pulmonary valve syndrome (APVS) is a rare cardiac defect characterized ... more Congenital absence of the pulmonary valve syndrome (APVS) is a rare cardiac defect characterized by aneurysmal pulmonary arteries, hypoplastic pulmonary valve cusps, and tracheobronchial abnormalities. Absence of the pulmonary valve syndrome usually occurs in conjunction with ventricular septal defect (VSD) and right ventricular outflow tract obstruction (RVOTO). Surgical mortality rates as high as 16% to 56% have been reported. Here, we describe the surgical results using the Lecompte maneuver, reduction pulmonary arterioplasty, and a valved right ventricle to pulmonary artery (RV-PA) conduit. Medical records and operative and echocardiography reports for all surgical APVS cases were retrospectively examined for pertinent clinical variables. A patient with left bronchial compression due to enlarged pulmonary arteries associated with totally anomalous pulmonary venous drainage (TAPVD) is included to illustrate the value of the Lecompte maneuver. From January 2002 to December 2004, 4 children with APVS had surgery at a median age of 5 months (range, 3 months to 3.5 years). Three had malalignment VSD and RVOTO. Four had respiratory signs (cough, wheeze, tachypnea, oxygen dependence, ventilator dependence), and all 5 had evidence of tracheobronchial compression by computed tomography or magnetic resonance imaging. Repair included a Lecompte maneuver, a valved conduit with reduction pulmonary arterioplasty, and VSD closure as necessary. The TAPVD patient had repair of the anomalous veins and a Lecompte maneuver. There have been no deaths, and all patients were discharged in good condition. Follow-up is complete at a median of 24 months (range, 9 to 35). Echocardiography has shown no progressive enlargement of the pulmonary arteries. Use of the Lecompte maneuver, reduction arterioplasty, and a valved conduit for repair of APVS provides favorable early and midterm results.
The Annals of Thoracic Surgery, 2005
Cor triatriatum sinister is a rare, surgically correctable, congenital cardiac anomaly. Fewer tha... more Cor triatriatum sinister is a rare, surgically correctable, congenital cardiac anomaly. Fewer than 250 cases have been reported. It can occur as an isolated defect (classic) or in association with other congenital cardiac anomalies (atypical).
The Annals of Thoracic Surgery, 2007
A coronary artery arising from the wrong aortic sinus, with or without a proximal course between ... more A coronary artery arising from the wrong aortic sinus, with or without a proximal course between the aorta and the pulmonary artery, may predispose to myocardial ischemia, myocardial infarction, or sudden death. We repaired this lesion in 5 symptomatic patients, all of whom had experienced exercise-related chest pain, dyspnea, or syncopal episodes. All patients underwent patch angioplasty of the proximal anomalous coronary artery with glutaraldehyde-treated autologous pericardium. When the coronary artery coursed between the aorta and the main pulmonary artery, the main pulmonary artery was translocated toward the left pulmonary artery to create additional space and prevent compression. All patients recovered well and to date have demonstrated no evidence of recurrent myocardial ischemia. The combination of coronary artery angioplasty and translocation of the pulmonary artery seems to effectively address all the mechanisms that can generate ischemia.
The Annals of Thoracic Surgery, 2015
Sternal osteomyelitis is extremely rare in neonates. We present the first report of a neonate wit... more Sternal osteomyelitis is extremely rare in neonates. We present the first report of a neonate with primary sternal osteomyelitis and an extensive mediastinal collection. Magnetic resonance imaging was used to delineate the extent of bony and soft tissue involvement. Serial ultrasound imaging proved useful for monitoring the response to treatment. The patient was successfully treated with antibiotics, surgical débridement, vacuum-assisted dressings, and delayed primary closure.
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Papers by Nelson Alphonso