https://www.um.edu.mt/library/oar/handle/123456789/8237 Wed, 06 May 2026 11:42:20 GMT 2026-05-06T11:42:20Z https://www.um.edu.mt/library/oar/handle/123456789/8253 Title: Right ventricular outflow tract stenting : effective palliation for Fallot’s tetralogy Authors: Bugeja, Justine; Grech, Victor E.; DeGiovanni, Joseph V. Abstract: Traditionally, the management of infants with Fallot’s tetralogy (TOF) with excessively reduced pulmonary flow and cyanosis has been palliation until or unless complete repair is feasible. Palliation involves a procedure that augments pulmonary flow. Most series recognise two subgroups of patients at high risk even in the current era: the cyanotic neonate/infant with small pulmonary arteries and those with complex anatomical variants of tetralogy and/or significant comorbidities such as additional congenital heart lesions (e.g associated Atrio Ventricular Septal Defect) or other congenital anomalies. There is an argument for palliation of these high-risk groups to allow for future potentially more effective elective repair Thu, 01 Jan 2015 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/8253 2015-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/8252 Title: “Bendy” stents help negotiate hairpin intracardiac curves Authors: Bugeja, Justine; Grech, Victor E.; DeGiovanni, Joseph V. Abstract: Simple transposition of the great arteries (TGA) occurs in 0.2 per 1000 live births. The condition is surgically repaired in the neonatal period by the arterial switch procedure (ASO) sometimes preceded by an atrial septostomy. The ASO involves transecting the great arteries and relocating them to the appropriate ventriculo-arterial (VA) connection with attachment of the disconnected coronary arteries to the aorta. In the process, the attachment of the pulmonary artery to the right ventricle involves the Le Compte manoeuvre and to achieve this the pulmonary arteries must be fully mobilised and sometimes the main pulmonary artery may require patch augmentation as well. Nevertheless, pulmonary artery stenosis (PAS) is one of the potential problems with the ASO. However, with improved surgical techniques, this has dropped from around 15% in the 1980s to less than 3%. Apart from surgical revision when PAS occurs, there are interventional options which include angioplasty and/or stent insertion. The latter is preferred in small children and works well in around 60% but may require repeat procedures. In older patients or when angioplasty fails, stent insertion can be considered. These procedures may involve negotiating tight bends in order to reach the site of stenosis. The passage of non-premounted stents may be problematic in such situations, especially with longer stents and tighter bends as they tend to slip off balloon. We describe several techniques that may facilitate such interventions, and these were utilised in an adolescent patient who had had ASO for TGA in the neonatal period. These included manually giving the mounted stent a slight bend in order to help the balloon-stent assembly negotiate hairpin bends. Thu, 01 Jan 2015 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/8252 2015-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/8251 Title: Brugada-type ECG associated with pectus excavatum Authors: Marchetti, Marco; Sierecki, M.; Oriot, Denis; Ghazali, Aiham Abstract: Brugada phenocopies (BrP) are new clinical entities characterized by an ECG pattern that is identical to type 1 or type 2 Brugada pattern, despite the absence of the true congenital Brugada syndrome (BrS). BrP are caused by various factors such as mechanical mediastinal compression, myocardial ischemia, pulmonary embolism, pericardial diseases and metabolic conditions. However, only few cases have been reported of patients with pectus excavatum and BrP. They have an ECG showing right bundle branch block, but also mild ST-segment elevation in the right precordial leads, mimicking the ECG patterns of type 2 Brugada syndrome. Thu, 01 Jan 2015 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/8251 2015-01-01T00:00:00Z