RESUMO
A rare window type of patent ductus arteriosus is reported that was large (15 mm in maximal transverse dimension) but had virtually no length and hence was externally invisible. The smaller aortic isthmus (4 mm in diameter), which was intrapericardial, was mistaken for the ductus and was inadvertently clip-occluded, leading to death. After a specific diagnosis is made, the large window ductus should be patched on cardiopulmonary bypass with a transpulmonary approach.
Assuntos
Permeabilidade do Canal Arterial/classificação , Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Ponte Cardiopulmonar , Constrição , Coração Triatriado/cirurgia , Vasos Coronários/cirurgia , Permeabilidade do Canal Arterial/patologia , Permeabilidade do Canal Arterial/cirurgia , Evolução Fatal , Comunicação Interatrial/cirurgia , Humanos , Hipertensão Pulmonar/cirurgia , Lactente , Masculino , Pericárdio/patologia , Pericárdio/cirurgia , Artéria Pulmonar/anormalidades , Artéria Pulmonar/cirurgia , Veia Cava Superior/anormalidades , Veia Cava Superior/cirurgiaRESUMO
Two patients clinically diagnosed with Kawasaki disease were found to have a coronary artery to pulmonary artery fistula. The dilemma of deciding the etiology of coronary artery dilatation in these patients is discussed along with management.
Assuntos
Anomalias dos Vasos Coronários/complicações , Síndrome de Linfonodos Mucocutâneos/complicações , Pré-Escolar , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico , Ecocardiografia , Ecocardiografia Doppler , Feminino , Seguimentos , Hemodinâmica/fisiologia , Humanos , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/diagnósticoRESUMO
We describe the use of balloon atrial septostomy to decompress the left ventricle in four patients receiving extracorporeal membrane oxygenation for acute intractable myocardial failure. These patients were becoming clinically worse and had evidence of left ventricular and left atrial hypertension either by direct measurement or echocardiography. Atrial decompression was accomplished by blade septostomy in one patient and by balloon atrial septostomy under echocardiographic guidance at the bedside in three patients. Three of four patients improved after balloon atrial septostomy and survived. This procedure may be helpful in selected patients receiving extracorporeal membrane oxygenation for myocardial failure with evidence of increased left atrial pressure as a result of increased ventricular pressure.
Assuntos
Baixo Débito Cardíaco/terapia , Cateterismo , Oxigenação por Membrana Extracorpórea , Função Ventricular Esquerda , Baixo Débito Cardíaco/diagnóstico por imagem , Baixo Débito Cardíaco/etiologia , Baixo Débito Cardíaco/fisiopatologia , Pré-Escolar , Ecocardiografia , Humanos , Recém-Nascido , Miocardite/complicaçõesRESUMO
We describe for the first time the use of transesophageal echocardiography to guide cardiac catheterization performed at the bedside in the pediatric cardiac intensive care unit. The procedure was performed on a 2.6-kg infant with ventricular and atrial septal defects after repair of coarctation of the aorta. Poor hemodynamic status prevented obtaining the required hemodynamic information from cardiac catheterization in the cardiac catheterization laboratory. Transesophageal echocardiography provided cardiac and vascular imaging, which helped guide catheter placement where the small size of the infant and the extensive thoracic postoperative bandages prevented obtaining the echocardiographic information from other windows.