The Annals of thoracic surgery
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In this study we report magnetic resonance imaging (MRI) brain injury and 12-month neurodevelopmental outcomes when regional cerebral perfusion (RCP) is used for neonatal aortic arch reconstruction. ⋯ Neonatal aortic arch repair with RCP using a neuromonitoring strategy results in 12-month cognitive outcomes that are at reference population norms. Language and motor outcomes are lower than the reference population norms by 0.8 to 0.9 standard deviations. The neurodevelopmental outcomes in this RCP cohort demonstrate that this technique is effective and safe in supporting the brain during neonatal aortic arch reconstruction.
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After repair of tetralogy of Fallot, some patients experience a low cardiac output state owing to right ventricular diastolic failure. Negative-pressure ventilation has been shown to improve cardiac output in these patients. What has not been evaluated is the effect of extubation and loading of the respiratory muscles on the distribution of cardiac output after repair of tetralogy of Fallot. ⋯ Cardiac output and cerebral oxygenation increased significantly during spontaneous respiration, the latter suggesting that the brain was in or approaching an oxygen supply-dependent state before extubation. Despite the increase in cardiac output, the presumed increase in respiratory pump perfusion, as well as the concurrent increase in cerebral perfusion, came at the expense of mesenteric perfusion. Renal oxygenation remained unchanged with extubation.
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Loeys-Dietz syndrome can present with cardiovascular complications in infancy. We report the successful surgical management in a 1-month-old infant with Loeys-Dietz syndrome of a ductus arteriosus aneurysm with an unexpected contained rupture found at the time of surgery.