DORV-Adequacy of distance between TV and PV for an intracardiac baffle vs. Rastelli

Figures from Aldo Castaneda's book.

Separation between TV and PV should at least the diameter of AoV. Otherwise, SubAS within the baffle will result either at surgery or later.
(DORV-"Normally-related" Great Arteries)


Neonatal Ebstein's Management - Annotation

How I Manage Neonatal Ebstein's Anomaly. Bove et al. (Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 2009;12:63-65)


U Mich Newborn Experience:
1988 - 2008 (20 yrs).
n=40 consecutive pts.
No intervention - 16
Neonatal intervention - 24

Mean age at surgery 6 days (1-7 days)
Mean weight 3.2 kg (2.5 - 4.1 kg)

24 surgeries:
TV closure - 11
Shunt only - 9 > 2 TV closure (one 2 days after & another during Glenn)
TV repair 4

Overall, 6 hospital deaths - 3 in TV closure group, 3 in TV repair group.

18 early survivors - 4 late deaths in 7.2 yrs mean f-up.

14 late survivors - 7 have had Fontan.

Outcome by surgery:
1) Shunt only (n=9)
All survived hospital discharge.
1 needed ECMO, had TV closure 2 days later.
2 - Fontan
1 - late TV repair & RV-PA conduit
1 - 1.5 ventricle repair
1 - TV closure at the time of Glenn.
2 - late deaths (1 died after Glenn due to hypoxia and low cardiac output and 1 died at Fontan from ventricular dysfunction).
2 - lost to f-up.

2) TV repair (n=4)
3 hospital deaths, 1 survivor is doing well at 12.5 yrs.

3) TV closure (n=11)
3 hospital deaths.
1 late death at 3 months (sudden death; unknown cause)
Remaining 7 had Fontan.

Overall survival:
All neonatal surgeries:
66.7% at 1 yr
62.2% at 5, 10 yrs
51.9% at 15 yrs

TV closure:
63.6% at 1, 5, 10 yrs
47.7% at 15 yrs

Shunt only:
88.9% at 1 yr
76.2% at 5, 10 yrs

TV repair:
25% at 1, 5, 10, yrs.

Comments: Review article. Not randomized. No clear indication as to equal disease severity of Ebsteins who underwent different interventions. Therefore, this should not be viewed as comparison of surgeries for the same severity of disease. Each patient would have been evaluated and the surgical option applied depending on disease features and institutional experience.



Erythromycin is used as a prokinetic for GI mobility. This is used in some postoperative cardiac patients when Metoclopromide is deemed to be not useful. What is the effect of Erythromycin on the heart? Why is it risky to use?

IV vs. Oral Propranolol

IV dose of Propranolol is much lower than Oral dose. What are the respective doses? Why does the dose differ between the two routes. Note: GI absorption problem is not the answer.


ICU: Cardiopulmonary Interaction - Spontaneous breathing vs. Positive Pressure Ventilation

Optimum PEEP in adult patients with ARDS:
(Figure from ICU book - Paul Marino 2nd ed)

PEEP vs. Cardiac output
[Ref: Fessler, HE. Effects of CPAP on venous return. J Sleep Res 1995;4 (Suppl 1):44-49]
Beware of this first figure...this is a study in Sleep Apnea patients...it is an important question to ask whether this is entirely applicable to our cardiac ICU babies/infants!

Useful reference: The use, abuse and mystique of positive end-expiratory pressure. Am Rev Respir Dis 1988;138:475-8.

Anesthetized Dog:
(Following figures are from AC Chang's textbook - Pediatric Cardiac Intensive Care)

LV afterload

Vertical Dotted Lines enclose Inspiration