OBJECTIVES To investigate the effects of intravenous iloprost on pulmonary artery hypertension (PAH) in infants undergoing congenital heart surgery. METHODS In this prospective, randomized study, the study group (n = 15) received a continuous infusion of iloprost (2.0 ng/kg/min) that was delivered immediately after weaning from cardiopulmonary bypass and continued for 72 h postoperatively. Patients in the control group (n = 12) were managed conventionally. The groups were compared in terms of postoperative data, including systolic and mean pulmonary artery (PA) pressures, PA/systemic pressure ratio, lactate level, PAH crisis, ventilation time, reintubation and lengths of intensive care unit (ICU) and hospital stay. Transthoracic echocardiography was used to assess PA pressures at 1 day, 7 days and 30 days after surgery. RESULTS No mortality occurred. PAH crisis occurred in 2 (16.6%) patients in the control group and 4 (26.7%) patients in the study group (P = 0.53). Postoperative PA pressures and PA/systemic pressure ratios were similar between the groups (P > 0.05). The durations of ICU (P = 0.40) and hospital (P = 0.98) stays were similar between the groups. Echocardiographic studies demonstrated a significant decrease in postoperative PA pressures in the control (P = 0.001) and study (P = 0.0001) groups. However, no significant change was observed between the groups (P > 0.05). The Tukey multiple comparison test showed a significant decrease in PA pressures at each follow-up in both groups (P < 0.05). CONCLUSIONS Intravenous iloprost demonstrated no additional benefit over the conventional management of infants with PAH after repair of intracardiac defects. Clinicians may prefer other alternative agents in infants with a high risk of PAH crisis.

Background: Tetralogy of Fallot with absent pulmonary valve syndrome (TOF-APVS) is a rare variant of tetralogy of Fallot marked by aneurysmal pulmonary artery dilatation and variable tracheobronchial compression. The identification of clinical indicators that predict perioperative risk in this patient population remains challenging. We aimed to review the surgical outcomes and reintervention requirements of patients with TOF-APVS over a 15-year single-center experience, with particular focus on two indicators of disease severity: preoperative mechanical ventilation (MV) and computed tomography (CT)-detected airway compression. Methods: We retrospectively reviewed 27 patients with TOF-APVS who underwent surgical repair at a single center between January 2010 and January 2025. Airway compression was assessed by CT in 20 patients. The primary outcome was the need for any reintervention during follow-up. Secondary outcomes comprised early and overall mortality and postoperative duration of intubation, ICU stay, and hospital stay. Subgroup comparisons were performed using the Fisher exact test and the Mann–Whitney U test. Results: The median age at surgery was 8 months (IQR, 4.5–16). Preoperative MV was required in 5 patients (18.5%), and CT revealed airway compression in 13 of 20 patients (65.0%). Early postoperative mortality was 7.4%, and overall mortality during follow-up was 18.5%. At least one reintervention was required in 9 patients (33.3%). Preoperative MV was significantly associated with early mortality (40.0% vs. 0%; p = 0.028) and with prolonged ICU stay (median 15 vs. 4 days; p = 0.008). CT-detected airway compression was not significantly associated with either mortality or reintervention. Conclusions: In this 15-year single-center experience with 27 patients, preoperative mechanical ventilation was associated with markedly higher early postoperative mortality and prolonged ICU stay, and may thus serve as a practical clinical indicator of disease severity in TOF-APVS. CT-detected airway compression was a frequent and often severe finding, but its association with early mortality and reintervention could not be statistically confirmed, likely reflecting the selective use of CT and small subgroup size. These findings support the integration of preoperative ventilation status into perioperative risk assessment and highlight the need for larger, preferably multicenter, studies with standardized airway assessment to clarify the prognostic role of anatomical airway compression.

Background Complete atrioventricular septal defects (CAVSD) include a variable spectrum of congenital malformations with different forms of clinical findings. We examined early and midterm outcomes, the need for reoperation, postoperative residual AV valve regurgitation, and other risk factors after various CAVSD repairs. Methods Between 2014 and 2018, we have performed 89 isolated CAVSD repairs. We retrospectively reviewed the patients' medical records. Patients were divided into three groups according to their repair techniques modified one patch repair (MP) (n = 16); two patch repair (TP) (n = 49); and left anterior leaflet augmentation (ALA) technique (n = 24). Results Eighty patients (89.8%) survived hospital discharge. Early mortality rates were three (18.8%) in the group MP, five (10.2%) in the group TP, and one (4.2%) in the group ALA. Thirteen patients died during the follow‐up period. Late mortality rates were three (18.8%) in the group MP, four (16.6%) in the group ALA, and six (12.2%) in the group TP. The mean follow‐up time was 35.9 ± 22.97 months (range: 0.3–77 months). The morbidity and mortality results were similar between‐group TP and ALA but worse in the MP group. Low body weight (<4 kg) and younger age at surgery (<4 months) were found to be risk factors on mortality by univariate and multivariate analysis. Surgical technic was not found to be an independent risk factor. Conclusion In our series, TP and ALA techniques had satisfactory results in early and midterm periods. Younger age and small bodyweight might increase early mortality and the need for reoperation.