ABSTRACT
Pulmonary atresia with restrictive ventricular septal defect is a rare congenital cardiac anomaly. A Blalock-Taussig shunt and surgical perforation of the atretic pulmonary valve is often performed as the initial palliation. We present our experience of utilizing both transesophageal and epicardial echocardiography during surgical pulmonary valvuloplasty in a 22-day-old neonate with pulmonary atresia with restrictive ventricular septal defect. The atretic pulmonary valve was perforated using a sheath introduced through the pulmonary artery.
Subject(s)
Abnormalities, Multiple , Balloon Valvuloplasty , Heart Septal Defects/therapy , Pulmonary Artery/abnormalities , Pulmonary Atresia/therapy , Pulmonary Valve/abnormalities , Coronary Circulation , Echocardiography, Doppler, Color , Echocardiography, Transesophageal , Heart Septal Defects/diagnosis , Heart Septal Defects/physiopathology , Humans , Infant, Newborn , Male , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/physiopathology , Pulmonary Atresia/diagnosis , Pulmonary Atresia/physiopathology , Pulmonary Circulation , Pulmonary Valve/diagnostic imaging , Pulmonary Valve/physiopathology , Punctures , Treatment OutcomeABSTRACT
We describe an incident of development of acute pulmonary edema after the device closure of a secundum atrial septal defect in a 52-year-old lady, which was treated with inotropes, diuretics and artificial ventilation. Possibility of acute left ventricular dysfunction should be considered after the defect closure in the middle-aged patients as the left ventricular compliance may be reduced due to increased elastic stiffness and diastolic dysfunction. Baseline left atrial pressure may be > 10 mmHg in these patients. Associated risk factors for the left ventricular dysfunction are a large Qp:Qs ratio, systemic hypertension, severe pulmonary hypertension and paroxysmal atrial fibrillation.
