Transcatheter closure of an atrial septal defect with single coronary artery and retro-aortic right coronary artery.

Isolated single coronary artery in the presence of an atrial septal defect (ASD) is a rare congenital anomaly. There are no clear guidelines regarding the management of ASD in these patients. Transcatheter closure of the ASD in the presence of a single coronary artery that has a retro-aortic course is a matter of concern because of the possible risk of coronary impingement by the left atrial disc. Here we report the first case of an ASD device closure in a patient with a retro-aortic right coronary artery. The immediate results were good; however, long-term follow up is warranted to look for late complications.

An unusual cause of cardiac arrest in a hospitalized patient.

We present an unusual case of 24 year old male who was hospitalized for dental procedure and developed cardiac arrest 2 days after the procedure. The patient presented with swelling of buccal cavity for which a biopsy was taken. Two days after the procedure, apparently normal patient suddenly presented at mid night with VT and VF, which were intractable requiring multiple DC shocks. During this period arterial blood gas analysis revealed severe acidosis. The circumstances led us to suspect poisoning as one of the cause for his medical condition. We looked for commonly available toxins. One of the commonly available toxins is hand sanitizer which contains Isopropyl alcohol, glycerin and perfume. Due to prolonged cardiac arrest and intractable arrhythmia patient had sustained hypoxic brain injury. Patient remained hemodynamically stable for next 9 days although his CNS status did not improve. Patient succumbed to sepsis on 9(th) day. Healthcare professionals should be aware of such possibilities and treat the patients at the earliest and put a check on the easy availability of IPA based hand sanitizers.