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Replacement of a stenotic/irregular right ventricle to pulmonary artery Gore-Tex trileaflet graft with a novel KONECT RESILIA Aortic Valved Conduit. This is the only tissue valved conduit currently in use. This patient has d-transposition of the great arteries along with ASD, VSD, pulmonary stenosis, bovine left arch and aberrant right subclavian arteries.

His previous operations include MBTS 4mm Gore-Tex graft, urgent shunt revision secondary to thrombosis and subsequent conversion to a 4mm central shunt, right atrial thrombectomy secondary to indwelling right atrial catheter, takedown of central shunt, primary pledgeted closure of pulmonary valve, Gore-Tex patch closure of ASD/VSD, Rastelli procedure with 24mm Gore-Tex trileaflet with bulging sinuses graft.

Thoracoscopic pericardial window creation for chylous pericarditis in infant.

15 days old baby admitted on NICU for tachypnea. Rt hydrothorax was identified and pleural drainage was inserted. 3 weeks later thoracoscopic lymphatic duct ligation performed due to lack of conservative management. 1 month later he was admitted due to pericardial effusion and pericardial drainage was inserted. But 2 weeks later thoracoscopic pericradial window creation procedure was done because pericardial effusion continuously drained though pericardial tube. Uneventful recovery and there was no any complications during 1 year long-term follow-up.

Laparoscopic repair of Morgagni hernia in infant.

From the APSA 2016 Annual Meeting proceedings

ENDOSCOPIC MANAGEMENT OF A DUODENAL WEB
Lauren Wood, BS1, Zach Kastenberg, MD2, Tiffany Sinclair, MD2, Stephanie Chao, MD2,
James Wall, MD2.
1Stanford School of Medicine, Palo Alto, CA, USA, 2Lucile Packard Children’s Hospital
Stanford, Palo Alto, CA, USA.

Introduction:
Surgical intervention for duodenal atresia most commonly entails duodenoduodenostomy in the neonatal period. Occasionally, type I duodenal atresia with incomplete obstruction may go undiagnosed until later in life. Endoscopic approach to dividing intestinal webs has been reported in rare select cases.

Methods:
A two-year old female with a history of trisomy 21 and tetralogy of Fallot underwent laparoscopic and endoscopic exploration of intestinal obstruction as visualized on upper gastrointestinal series for symptoms of recurrent emesis and weight loss.
After laparoscopy confirmed a duodenal web as the cause of intestinal obstruction, endoscopic division of the membrane was carried out with a triangle tip electrocautery knife followed by dilation with a 15 mm balloon.

Results:
The procedure took 210 minutes and the patient tolerated it well. Post-op Upper GI showed rapid passage of contents without leak and a diet was started. The patient was discharged on post-operative day 2 without narcotics. The patient had gained 2 pounds at 4 week follow-up and remains asymptomatic six months after the procedure.

Conclusions:
Endoscopic management of a duodenal web is feasible in children. Pediatric surgeons are ideally suited to offer the hybrid approach including laparoscopy to confirm no extraluminal obstructive process or complication from endoscopy. Endoscopy enables minimal recovery time and should be embraced as another tool in the minimally invasive
toolbox of pediatric surgeons.

DOI: https://doi.org/10.17797/pknxvd91zf

The site for the first T-fastener is selected. The location should be a reasonable distance from the G tube site (2-3cm if possible). The needle (with T fastener inside) is placed through the skin under fluoro and directed to the gastric wall. As the needle pushes on the wall the indentation will be seen on fluoro if the c-arm is RAO 20-30 degrees. The needle is then advanced into the lumen of the stomach with a short controlled burst of pressure. Once the tip is in the lumen contrast is dripped through the needle under fluoro. The contrast should normally be seen to drip to the stomach wall and the rugal folds will be appreciated.

DOI: https://doi.org/10.17797/48sxirkbwp

This video highlights a pulmonary valve replacement in a patient with Tetralogy of Fallot.