Advocacy at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery

The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www.WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery.Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide.

Current Status of Training and Certification for Congenital Heart Surgery Around the World: Proceedings of the Meetings of the Global Council on Education for Congenital Heart Surgery of the World Society for Pediatric and Congenital Heart Surgery

The optimal training of the highly specialized congenital heart surgeon is a long and complex process, which is a significant challenge in most parts of the world. The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) has established the Global Council on Education for Congenital Heart Surgery as a nonprofit organization with the goal of assessing current training and certification and ultimately establishing standardized criteria for the training, evaluation, and certification of congenital heart surgeons around the world. The Global Council and the WSPCHS have reviewed the present status of training and certification for congenital cardiac surgery around the world. There is currently lack of consensus and standardized criteria for training in congenital heart surgery, with significant disparity between continents and countries. This represents significant obstacles to international job mobility of competent congenital heart surgeons and to the efforts to improve the quality of care for patients with Congenital Heart Disease worldwide. The purpose of this article is to summarize and document the present state of training and certification in congenital heart surgery around the world.

Challenges of Caring for Functionally Single Ventricle Patients in Africa

Surgical palliation has remarkably improved survival of functionally single ventricle (FSV) patients born in developed nations but such outcomes have not occurred in Africa. The poor care coverage for FSV patients in Africa exists within the larger sphere of deficient health care for children born with congenital heart defects (CHDs) in Africa generally. This review takes the position that to improve health-care coverage for CHD patients on the continent, political priority is paramount. This can be attained with cohesive leadership for the CHD agenda, a guiding institution, and the mobilization of civil society to drive advocacy at national and international levels.

Extended cardiopulmonary preservation: University of Wisconsin solution versus Bretschneider's cardioplegic solution

Application of the University of Wisconsin cold storage solution has rapidly expanded to include medium-term to long-term preservation of virtually all intraabdominal organs. Its use in intrathoracic organ transplantation has also been suggested. We therefore examined the efficacy of the University of Wisconsin solution in a primate allotransplantation model for preservation of hearts, and as a simple single-solution system for static preservation of heart-lung blocks, for periods of ischemia ranging from 6 to 24 hours. For comparison, we employed the histidine-tryptophane-ketoglutarate cardioplegic solution of Bretschneider. University of Wisconsin solution provided superior results with regard to clinical outcome and hemodynamic recovery of hearts after ischemic periods of up to 16 hours. This was in contrast to Bretschneider's solution, which allowed storage of hearts for periods of only up to 10 hours. Heart-lung blocks were equally well preserved with either University of Wisconsin or Bretschneider's solution after 6 to 12 hours, although the University of Wisconsin solution group exhibited a more notable increase in pulmonary water content. This was in accordance with histological data, which suggested that, although hemodynamic recovery of hearts stored for periods longer than 10 hours was poor, preservation of pulmonary ultrastructure was far superior using Bretschneider's solution as compared with University of Wisconsin solution after an ischemic period of up to 16 hours.

The feasibility of closed mitral valvotomy in pregnancy

Rheumatic mitral valve stenosis is an important nonobstetric complication of pregnancy in an African country. Between January 1965 and September 1985 41 closed mitral valvotomies with a Tubbs dilator were performed in 39 pregnant women (two first trimester, 22 second trimester, and 17 third trimester). All patients experienced symptomatic improvement from New York Heart Association Class 3.01 (average) preoperatively to 1.22 postoperatively. There were no deaths related to the operation and delivery. Fetal deaths were due to postoperative spontaneous abortion in two cases (4.9%) or premature labour in three cases (7.3%), for an overall survival of 36 babies (87.8%). Fetal morbidity was due to prematurity or dismaturity in three infants, all of whom survived. Thirty-three normal infants were delivered at term. Nine patients needed subsequent surgical procedures for mitral valve restenosis 5 to 17 years (mean 10.2 years) after the initial closed valvotomy: Repeat closed valvotomy was performed in three patients after 5, 8, and 10 years (the first two during subsequent pregnancies), an open procedure was performed in one after 6 years, and five patients underwent subsequent mitral valve replacement after 11 (two), 12 (two), and 17 (one) years. Two late deaths occurred; one after 10 years, as a result of pneumonia and meningitis, and the other after 12 years, before a mitral valve replacement for restenosis could be performed. None of the remaining patients has required further surgical procedures, but two have moderate symptoms. Closed mitral valvotomy gives satisfactory results in pregnant patients with severe mitral stenosis. When indicated during pregnancy, it should be performed at any stage of the pregnancy.

False aneurysm of the descending thoracic aorta caused by an inhaled foreign body. A case report

A case of traumatic false aneurysm of the descending thoracic aorta is reported. The aneurysm was caused by the inhalation of a needle into the left main bronchus. The diagnosis of a false aneurysm was made 42 days after inhalation. The aneurysm was repaired by direct suture without the need for circulatory assistance or a shunt. There were no intra- or postoperative complications.

Blalock-Taussig shunts and modified Blalock-Taussig shunts

Between January 1981 and December 1983, 53 systemic-to-pulmonary artery shunts, Blalock-Taussig shunts (BTSs) and modified Blalock-Taussig shunts (MBTSs) were carried out either as a preliminary procedure before complete correction of heart defects or as a means of permanent palliation. Central shunts continue to pose early and late problems and we seldom use them. Fifteen patients underwent a BTS and 38 an MBTS with a 5 mm polytetrafluoro-ethylene (PTFE) graft. Their ages ranged from 3 days to 11 years; 21 patients were less than 3 months old and of these 15 had an MBTS; 36 patients were less than 1 year of age and 27 of them had an MBTS. Three patients were receiving prostaglandin at the time of surgery. The overall early hospital mortality was 5,6% (3 cases); these were babies less than 2 months old. The late mortality was 3,7% (2 cases); these deaths were not shunt-related and were in babies less than 4 months old. There were 4 cases of shunt failure (7,5%) at 6, 22, 26 and 27 months after operation; a second shunt was performed in all these patients. The 48 survivors have been followed up for an average of 23 months (range 5-41 months); 6 have already undergone a complete repair. Long-term results are difficult to assess accurately because of problems with follow-up. Eight of the 53 patients had mild congestive heart failure which responded to digitalis. Because of the reliability and excellent late patency of the PTFE prosthesis, we consider it to be superior to the Waterston shunt for relief of cyanosis in the neonate and infant and as reliable as the BTS.

Pulmonary artery banding

Between January 1981 and December 1983 22 children underwent pulmonary artery banding at the Red Cross War Memorial Children's Hospital, Cape Town. The indications for banding in this group were control of pulmonary overperfusion and severe congestive cardiac failure. The underlying cardiac defects were tricuspid atresia with ventricular septal defect (VSD), transposition of the great arteries and univentricular heart, large or multiple VSDs, double-outlet right ventricle, atrioventricular canal defect, persistent truncus arteriosus and the VSD-patent ductus arteriosus-coarctation syndrome. Three children died (13,6%) in the first 30 days postoperatively and another 3 died 5-7 weeks after surgery.