Thrombosis of Extra-cardiac Fontan, an Institutional Experience.

Background: Thromboembolism can complicate Fontan surgery. There are few well designed studies in the literature to determine the epidemiology of thrombosis after Fontan. Methods: We report the experience of King Faisal Specialist Hospital & Research Center- Jeddah, Kingdom of Saudi Arabia; regarding thrombosis of extra-cardiac Fontan pathways in 3 of our patients; two patients were post- Fontan operation and one patient was post- Kawashima procedure & hepatic vein incorporation. Results: The first and second patients developed thrombosis of Fontan pathways at one month & one year postoperatively respectively. In both patients, stenting of the extra-cardiac contegra reestablished the patency of Fontan circuit and saved the risks of redo-surgeries. In the third patient, conduit occlusion was diagnosed 5 months postoperatively. Several attempts of cardiac catheterizations failed to penetrate the thrombosed conduit. Surgical re-intervention was inevitable. Conclusions: The threshold for diagnostic and interventional cardiac catheterization should be lowered in post Fontan operation. Chronic oral anticoagulation may not prevent development of thrombosis despite therapeutic international normalized ratio (INR).

Comparative Study of the Efficacy of Brushless Surgical Hand Preparation Techniques Using Antiseptic Soap, Alcohol and Non-medicated Soap.

Background & Objectives: Preoperative hand preparation with a brush-less method is almost a common practice. The aim of this study was to compare the efficacy of brushless preoperative hand preparation using alcohol to antiseptic soap, and non-medicated soap in eliminating germs by standard proper pre-operative hand preparation. Methods: Twenty volunteers tried three different ways of surgical hand preparation with antiseptic soap, alcohol, and non-medicated soap-based preoperative hand preparation. Results: There was no positive bacterial growth sample in the alcohol-based scrubbing group while it was 2% with positive bacterial growth in the antimicrobial soap and 55% with positive bacterial growth in the non-medicated soap group. Conclusion: The alcohol-based pre-operative hand preparation was significantly more efficient than both the antimicrobial soap and the non-medicated soap.

Acute myocardial ischemia following accidental intravenous administration of epinephrine in high concentration.

Inadvertent and accidental epinephrine overdose might result in potentially lethal complications. We present a case of acute epinephrine toxicity resulting in acute myocardial ischemia in a young boy with combined variable immunodeficiency syndrome who developed severe allergic reaction to intravenous immunoglobulin, and was subsequently given epinephrine by mistake intravenously rather than subcutaneously. He developed significant ischemic changes in standard 12-lead electrocardiogram, transiently raised cardiac enzymes, reduced left ventricular systolic function, pulmonary edema and pulmonary hemorrhage. It is suggested that special precautionary measures should be taken regarding the dose and the route while administering epinephrine to avoid mishaps.

Successful percutaneous coil occlusion of a large pulmonary arteriovenous malformation

Pulmonary arteriovenous malformation is one of the rarest congenital anomalies of cardiovascular system. We present a case of 30-year-old female with a large pulmonary arteriovenous malformation [PAVM] arising from the right lower pulmonary artery and draining to the left atrium. She underwent successful embolization using three detachable Cook coils