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1.
Cardiol Young ; 32(4): 656-657, 2022 Apr.
Article in English | MEDLINE | ID: mdl-34387176

ABSTRACT

Balloon dilatation of coarctation of aorta is a standard of care for the patients presenting with severe left ventricular dysfunction. It can be performed through femoral, carotid, and axillary arterial access. Very few case series were available in the literature through axillary arterial access, despite being its advantage as non-end artery and easily palpable in coarctation of aorta. We present our experience with five cases of neonatal coarctation of aorta with severe left ventricular dysfunction where successful balloon dilatation of coarctation of aorta was performed via axillary approach without adverse events.


Subject(s)
Angioplasty, Balloon , Aortic Coarctation , Ventricular Dysfunction, Left , Aortic Coarctation/diagnostic imaging , Aortic Coarctation/surgery , Arteries , Dilatation , Humans , Infant, Newborn
2.
Ann Pediatr Cardiol ; 15(3): 244-248, 2022.
Article in English | MEDLINE | ID: mdl-36589643

ABSTRACT

Background: Sternal clefts are rare congenital anterior chest wall defects created by a lack of midline thoracic fusion. Various surgical repairs have been proposed to provide protection to underlying viscera in these defects. Aim: This study aims to perform primary sternal cleft repair using techniques, leading to the provision of a complete bony cover and to assess their outcomes on follow-ups. Materials and Methods: During 2009-2020, seven patients were referred to our unit with sternal defects. Out of them, four infants with sternal clefts underwent primary repair using bilateral perichondrial flap creation of the sternal bars and sliding costal chondrotomy at our institute. In one of them with a wider defect, bilateral "intraperiosteal" sliding clavicular osteotomy was additionally performed to achieve tension-free closure. Results: Satisfactory surgical outcomes were achieved with an uneventful postoperative period. On follow-up, all four patients are thriving well and have a stable anterior chest wall. Those with follow-ups longer than 5 years showed evidence of bone formation. Conclusion: Bony cover to the heart can be provided in all varieties of sternal cleft defects using primary surgical repair early in infancy. The delay in surgical correction increases the complexity of the procedure and may require the use of prosthetic material which has its own disadvantages.

3.
Ann Pediatr Cardiol ; 15(3): 276-279, 2022.
Article in English | MEDLINE | ID: mdl-36589656

ABSTRACT

A 6-month-old boy, a case of Shone's complex, presented in decompensated state was found to have severe mitral stenosis along with multisystem inflammatory syndrome in children (MISC) warranting urgent surgical intervention. Various modalities including cytokine-adsorbing hemofilter were used to target inflammation. Postoperatively, the child recovered from low cardiac output accompanied by decrease in the levels of inflammatory markers, inopressors, and ventilatory requirements. Open heart surgery in itself is a proinflammatory process and is best avoided during the active inflammatory phase of MISC. In the rare and unavoidable circumstance exemplified by this index case, multipronged strategy targeting inflammation as described can be successfully implemented.

4.
World J Pediatr Congenit Heart Surg ; 12(3): 424-426, 2021 05.
Article in English | MEDLINE | ID: mdl-31072211

ABSTRACT

Anomalous origin of the subclavian artery from the pulmonary artery is a rare but well-described entity. We report a case of anomalous origin of the left subclavian artery from the left pulmonary artery in a patient with transposition of the great arteries. We discuss the safe intraoperative management of this anomaly in a patient in whom the diagnosis was made intraoperatively.


Subject(s)
Subclavian Artery , Transposition of Great Vessels , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Humans , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/surgery , Subclavian Artery/diagnostic imaging , Subclavian Artery/surgery , Transposition of Great Vessels/diagnostic imaging , Transposition of Great Vessels/surgery
5.
World J Pediatr Congenit Heart Surg ; 12(1): 61-69, 2021 Jan.
Article in English | MEDLINE | ID: mdl-33078664

ABSTRACT

BACKGROUND: There is a paucity of literature regarding the association of high oncotic priming solutions for pediatric cardiopulmonary bypass (CPB) and outcomes, and no consensus exists regarding the composition of optimal CPB priming solution. This study aimed to examine the impact of high oncotic pressure priming by the addition of 20% human albumin on outcomes. METHODS: Double-blinded, randomized controlled study was done in the pediatric cardiac intensive care unit of a tertiary care hospital. Consecutive children with congenital heart diseases admitted for open-heart surgery were randomized into two groups, where the study group received an additional 20% albumin to conventional blood prime before CPB initiation. RESULTS: We enrolled 39 children in the high oncotic prime (added albumin) group and 37 children in the conventional prime group. In the first 24-hour postoperative period, children in the albumin group had significantly lower occurrence of hypotension (28.2% vs 54%, P = .02), requirement of fluid boluses (25.6% vs 54%, P = .006), and lactate clearance time (6 vs 9 hours, P < .001). Albumin group also had significantly higher platelet count (×103/µL) at 24 hours (112 vs 91, P = .02). There was no significant difference in intra-CPB hemodynamic parameters and incidence of acute kidney injury. In subgroup analysis based on risk category, significantly decreased intensive care unit stay (4 vs 5 days, P = .04) and hospital stay (5 vs 7 days, P = .002) were found in the albumin group in low-risk category. CONCLUSION: High oncotic pressure CPB prime using albumin addition might be beneficial over conventional blood prime, and our study does provide a rationale for further studies.


Subject(s)
Albumins/administration & dosage , Cardiac Surgical Procedures/methods , Cardiopulmonary Bypass/methods , Heart Defects, Congenital/surgery , Child, Preschool , Double-Blind Method , Female , Follow-Up Studies , Humans , Infant , Infusions, Intravenous , Male , Postoperative Period
6.
Ann Pediatr Cardiol ; 12(3): 302-304, 2019.
Article in English | MEDLINE | ID: mdl-31516288

ABSTRACT

A 24-day-old apparently asymptomatic neonate was found to have complete transposition of great arteries with small patent ductus arteriosus and restrictive patent foramen ovale. The neonate was found to have relatively high saturations (saturations = 88%) despite inadequate mixing communications. Echo findings were suggestive of significant dilatation of right atrium and right ventricle and left ventricular (LV) mass regression. Further echo interrogation revealed coexisting total anomalous pulmonary venous connection (TAPVC) as the cause of relatively high saturations and early LV mass regression. The patient was planned for follow-up and underwent successful Senning repair at the age of 8 months. Hemodynamics and echo findings of this association of TGA with TAPVC have been described in this case report.

7.
Ann Thorac Surg ; 107(5): e311-e312, 2019 May.
Article in English | MEDLINE | ID: mdl-30359594

ABSTRACT

Giant left atrium (GLA) is a rare entity in the pediatric population. GLA carries a significant mortality risk; once its existence is established, it needs to be evaluated with intention to treat. We report a 14-month-old boy with GLA presenting with symptoms of cough and stridor because of compressed airways. The child underwent successful surgical resection for the same.


Subject(s)
Cardiomegaly/complications , Cardiomegaly/surgery , Heart Atria/abnormalities , Respiration Disorders/etiology , Cardiomegaly/diagnostic imaging , Humans , Infant , Male , Respiration Disorders/diagnostic imaging
8.
Indian Pediatr ; 54(6): 503-504, 2017 Jun 15.
Article in English | MEDLINE | ID: mdl-28667725

ABSTRACT

BACKGROUND: Atrial flutter not responding to medications could be secondary to structural malformations of heart. CASE CHARACTERISTICS: A 5-year-old child with resistant arrhythmia, with onset in neonatal period. OBSERVATIONS: Multiple right atrial diverticuli were detected on CT angiography and cardiac catheterization. Patient reverted to sinus rhythm following surgical excision of diverticuli. MESSAGE: In cases of intractable supraventricular tachycardia, structural anomalies of atrium should be suspected.


Subject(s)
Arrhythmias, Cardiac , Diverticulum , Heart Atria , Heart Diseases , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/physiopathology , Child, Preschool , Diverticulum/diagnostic imaging , Diverticulum/physiopathology , Electrocardiography, Ambulatory , Heart Atria/diagnostic imaging , Heart Atria/physiopathology , Heart Diseases/diagnostic imaging , Heart Diseases/physiopathology , Humans , Male
9.
Ann Card Anaesth ; 19(4): 744-746, 2016.
Article in English | MEDLINE | ID: mdl-27716711

ABSTRACT

Repair of congenital heart disease in the presence of high pulmonary pressure has always been a contentious issue. Pulmonary vascular resistance (PVR) is considered important for establishing operability in these patients. However, PVR estimation is not always accurate and cannot solely be relied upon to make critical decision of operability. Clinical examination, chest X-ray, and echocardiography are also important indicators of pulmonary vascular disease. Knowledge of pits and falls of each investigation is important for appropriate management in these patients. We present a case report of successfully operated, 6-year-old child with anomalous origin of the right pulmonary artery from aorta, deemed inoperable on the basis of PVR estimation.


Subject(s)
Clinical Decision-Making , Heart Defects, Congenital/complications , Heart Defects, Congenital/surgery , Hypertension, Pulmonary/complications , Pulmonary Artery/abnormalities , Child , Echocardiography , Female , Humans , Hypertension, Pulmonary/physiopathology , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/physiopathology , Radiography , Vascular Resistance/physiology
10.
Indian Heart J ; 67 Suppl 3: S85-7, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26995443

ABSTRACT

INTRODUCTION: A 3-year-old child, weighing 8 kg, presented with patent ductus arteriosus (PDA) and interrupted inferior vena cava (IVC). The patient underwent successful PDA device closure via transjugular route after failing attempt at femoral venous route. CASE SUMMARY: PDA device closure was attempted via femoral venous route but could not be accomplished due to difficult curves to negotiate. Following this, PDA could be closed by device from jugular venous route with ease. DISCUSSION: Interrupted IVC poses challenges for PDA device closure and various alternative routes are described like internal jugular, transhepatic, or femoral venous - azygous route. Our case describes difficulties associated with femoral venous route and advantages of jugular venous route in such cases. CONCLUSION: Internal jugular access is a safe and feasible method of PDA device closure in cases of interrupted IVC even in smaller children.


Subject(s)
Ductus Arteriosus, Patent/diagnosis , Ductus Arteriosus, Patent/surgery , Septal Occluder Device , Vascular Malformations/diagnosis , Vascular Malformations/surgery , Vena Cava, Inferior/abnormalities , Child, Preschool , Female , Humans , Jugular Veins
11.
World J Pediatr Congenit Heart Surg ; 6(1): 111-4, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25548356

ABSTRACT

Coronary artery aneurysm (CAA) is defined as dilatation of a coronary artery segment to a diameter of more than 1.5-fold normal size. Rupture of CAA is a catastrophic event and may result in sudden death or myocardial infarction. We report this unusual case of contained rupture of the left circumflex CAA.


Subject(s)
Aneurysm, Infected/diagnosis , Aneurysm, Ruptured/microbiology , Coronary Aneurysm/microbiology , Staphylococcal Infections/diagnosis , Aneurysm, Ruptured/diagnosis , Coronary Aneurysm/diagnosis , Female , Humans , Infant
12.
World J Pediatr Congenit Heart Surg ; 6(1): 130-4, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25548361

ABSTRACT

Being a reflection of the degree of global tissue anoxia, serum lactate levels therefore can be used as a marker of organ damage and eventual outcome. A statistically significant association was observed between serum lactate levels and subsequent mortality and morbidity in critically ill adults, children, and neonates. In cardiac critical care, hyperlactatemia is usually multifactorial in origin, resulting from a combination of etiologies. Many centers are using serial lactate levels in conjugation with other parameters of cellular oxygen delivery, consumption, or extraction to monitor prognosis after pediatric cardiac surgery. A single initial lactate level has a lesser predictive value for morbidity and mortality after pediatric cardiac surgery than its failure to fall within 48 hours of surgery. In case of persistently high lactate levels with no other evidence of cellular hypoperfusion, other possibilities must be considered. There has been an established association of lactic acidosis with thiamine deficiency, but this has not yet been reported in newborns undergoing congenital cardiac surgery. We present one such rare case.


Subject(s)
Acidosis, Lactic/etiology , Cardiac Surgical Procedures , Postoperative Complications/etiology , Thiamine Deficiency/diagnosis , Acidosis, Lactic/diagnosis , Cardiopulmonary Bypass , Humans , Infant, Newborn , Male , Postoperative Complications/diagnosis , Thiamine Deficiency/complications
13.
Indian J Pediatr ; 76(7): 755-6, 2009 Jul.
Article in English | MEDLINE | ID: mdl-19475350

ABSTRACT

Systemic hypertension is not usually a complication following repair of total anomalous pulmonary venous connection (TAPVC). We report an infant with supracardiac TAPVC with hypertensive crises post-operatively resulting in pulmonary edema. We feel this might have been related to the pre-operative hemodynamics as described. Beta-blockers improved the hypertensive crises.


Subject(s)
Antihypertensive Agents/administration & dosage , Cardiac Surgical Procedures/adverse effects , Hypertension, Malignant/drug therapy , Hypertension, Malignant/etiology , Scimitar Syndrome/diagnosis , Blood Pressure Determination , Cardiac Surgical Procedures/methods , Cardiopulmonary Bypass/adverse effects , Cardiopulmonary Bypass/methods , Cyanosis/diagnosis , Cyanosis/etiology , Drug Therapy, Combination , Emergency Treatment , Follow-Up Studies , Humans , Hypertension, Malignant/physiopathology , Infant , Male , Postoperative Complications/diagnosis , Postoperative Complications/drug therapy , Pulmonary Veins/abnormalities , Risk Assessment , Scimitar Syndrome/surgery , Treatment Outcome
14.
Paediatr Anaesth ; 16(2): 178-81, 2006 Feb.
Article in English | MEDLINE | ID: mdl-16430416

ABSTRACT

Regional cerebral oxygenation can be monitored using near-infrared spectroscopy (NIRS). Inadequacy of collateral cerebral circulation and regional cerebral ischemia during cardiac and vascular surgery may be detected by the use of NIRS monitoring. We report a 2-year-old child who underwent surgical repair of vascular ring and subclavian reimplantation, where use of NIRS helped in early detection and timely intervention to prevent prolonged cerebral ischemia.


Subject(s)
Brain/metabolism , Cardiac Surgical Procedures/methods , Cerebrovascular Circulation/physiology , Monitoring, Intraoperative/methods , Oxygen/metabolism , Spectroscopy, Near-Infrared/methods , Child, Preschool , Female , Humans
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