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Erle H. Austin, MD Kosair Childrens Hospital Louisville, Kentucky

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Patient # 1 Newborn female 37 wks; 2.8 kg; Apgars 7/8 Heart murmur; pink with “blue spells” Echo: PA, VSD, right aortic arch, atypical PDA Cardiac cath at 4 days of age Discharged age 13 days

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Erle H. Austin, MD Kosair Childrens Hospital Louisville, Kentucky
A Few Examples Erle H. Austin, MD Kosair Childrens Hospital Louisville, Kentucky No Disclosures Patient # 1 Newborn female 37 wks; 2.8 kg; Apgars 7/8
Heart murmur; pink with blue spells Echo: PA, VSD, right aortic arch, atypical PDA Cardiac cath at 4 days of age Discharged age 13 days 4 Days Old-Cath 4 Days Old-Cath 7 Months Old- Cath 7 Months Old- Cath 10 Months Old - Surgery Median sternotomy
Unifocalization of central PAs and MAPCAs Small native LPA ( & tiny native RPA) Dissected off CPB L and R inferior MAPCAs; R superior MAPCA Dissected on CPB small fragile vessels; all probed at completion VSD closure 12mm RV-PA conduit (pulmonary homograft) Atrial septal fenestration 10 Months Old - Surgery cont.
Separated from CPB with good sats/BP TEE good function, no residual VSD RV pressure !!! % LV pressure !!! VSD patch fenestration Discharged POD#11 2 Years Old Qp/Qs = 0.52 7 Years Old Patient # 2 Newborn male Full term; 4.4 kg; Apgars 9/9
Heart murmur; 93% sats with desat episodes Echo: PA, VSD, right aortic arch, probable MAPCAs Cardiac cath at 4 days of age 4 Days Old- Cath 5 Days Old - Surgery Median sternotomy 4mm central shunt
Ascending aorta to native central PA Brizard et al. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 12: Still on the ventilator !!!
13 Days Old Still on the ventilator !!! 14 Days Old-Cath Qp/Qs = 8/1 14 Days Old - Surgery Left Thoracotomy
Banding of large branch right MAPCA Banding of large branch left MAPCA Patient #2 Extubated 2days later Discharged at 2 months of age 10 Months Old-Cath Qp/Qs = 1.3/1 12 Months Old - Surgery Redo left thoracotomy Redo median sternotomy
Identify left-sided MAPCAs Ligation origin MAPCA from left subclavian Redo median sternotomy Unifocalization of left-sided MAPCAs Patch angioplasty of native right PA Placement of 8mm RV-PA Gore-Tex conduit Discharged POD#8 21 Months Old-Cath Patient # 3 Newborn male 37 wk; 3.6 kg; Apgars 8/8 Fetal dx: TOF/PA
II/VI systolic murmur;Sats low 90s Echo: TOF/PA, typical PDA, confluent 4.2mm PAs; ?MAPCAs? PGE1 Cardiac cath at 2 days of age 2 Days Old-Cath 3 Days Old - Surgery Median sternotomy
Right modified BT shunt (3.5 mm) ?Ductus? Not ligated 22q11 deletion Discharged POD#23 5 Months Old-Cath