Lee JS, et al. Yonsei Med J. 2022 Nov;63:e24. https://doi.org/10.3349/ymj.2022.0111

OBJECTIVES The clinical outcome of children with severe acute myocarditis who require mechanical circulatory support is not well known. Therefore, we studied the survival and clinical courses of patients with acute fulminant myocarditis supported by extracorporeal life support (ECLS). METHODS We performed a retrospective chart review of 13 consecutive children with acute fulminant myocarditis who were treated with ECLS between April 2013 and April 2015. Demographics, initial symptoms, laboratory results, management, clinical courses and last follow-up status were investigated. RESULTS The median age was 25.8 months (range, 2.9 months to 11.5 years) and the median body weight was 10.3 kg (range, 5.3–47.5 kg). All patients received the ECLS procedure via peripheral approach (right neck). The median ECLS duration was 140 h (range, 51–425 h). The median intensive care unit stay was 16 days (range, 4–44 days). Viral pathogens were detected in 7 patients. Six patients underwent left-heart decompression using a catheter-based technique, which was performed using atrial septostomy and leaving a left atrial venting cannula. Eleven patients recovered from ventricular dysfunction, and 2 patients underwent successful orthotopic heart transplantation. Ultimately, 12 patients (92.3%) survived to discharge. The deceased patient succumbed to unrestored brain function due to enterovirus encephalitis, and the patient's parents chose to donate other organs. CONCLUSIONS Mechanical circulatory support using ECLS can be a first-line treatment that confers excellent clinical outcomes for children with acute fulminant myocarditis.

Ha Eun Kim, M.D., Jo Won Jung, M.D., Yu Rim Shin, M.D., Han Ki Park, M.D., Young Hwan Park, M.D., Hong Ju Shin, M.D.. Korean Journal of Thoracic and Cardiovascular Surgery 2016;49:203-6. http://dx.doi.org/10.5090/kjtcs.2016.49.3.203

OBJECTIVES We investigated the results of a revision of a previous Fontan connection to total cavopulmonary connection (TCPC) in patients with failing Fontan circulation. METHODS From July 1998 to April 2013, 21 patients who had failing Fontan circulation underwent revision of the previous Fontan operation to TCPC. The median age at TCPC conversion was 17.9 years (range, 4.6–38.1 years) and the median interval between initial Fontan operation and TCPC was 13.8 years (range, 2.1–25.4 years). There were 37 indications for Fontan revision in 21 patients. The indications were huge right atrium (n = 15), atrial arrhythmia (n = 8), intra-atrial thrombi (n = 6), protein-losing enteropathy (PLE) (n = 3) and more than mild atrioventricular valve regurgitation (n = 5). The previous Fontan operation was revised to extracardiac conduit replacement (n = 20) and intra-atrial lateral tunnel (n = 1). Concomitant surgery for atrial arrhythmia was performed in 8 patients. Fenestration was performed in 7 patients. The median follow-up duration was 7.1 years (range, 0.3–13.4 years). RESULTS There were no operative deaths and two late deaths occurred 7.9 and 8.1 years after operation. Actuarial 5- and 10-year survival rates were 92.3 and 83.1%, respectively. Postoperative complications included bleeding (n = 3), deep sternal infection (n = 1) and prolonged pleural effusion for more than 2 weeks (n = 5). During follow-up, atrial arrhythmia recurred in 6 patients, PLE recurred in 2 patients and pleural effusion recurred in 2 patients. All patients were classified as New York Heart Association Class I (n = 15) or Class II (n = 4). CONCLUSIONS Fontan conversion to TCPC in patients with failing Fontan circulation can be performed with low risk of morbidity and mortality. The procedure confers better quality of life and is functional for patients with failed Fontan circulation.

Hong Ju Shin, M.D., Seunghwan Song, M.D., Han Ki Park, M.D., Young Hwan Park, M.D.. Korean Journal of Thoracic and Cardiovascular Surgery 2016;49:151-6. http://dx.doi.org/10.5090/kjtcs.2016.49.3.151