RESUMO
Congenital aneurysms of the sinus of Valsalva are uncommon abnormalities that are usually silent and slowly progressive without symptoms of cardiac dysfunction unless catastrophic rupture occurs. However, in rare cases, unruptured aneurysms can produce symptoms resulting from compression of adjacent structures, ventricular outflow tract obstruction, heart block, and coronary and valvular insufficiency. We report a case of a single unruptured sinus of Valsalva aneurysm producing left ventricular outflow tract obstruction in an 8-year-old boy who presented with chest pain on exertion.
Assuntos
Aneurisma Aórtico/complicações , Seio Aórtico/anormalidades , Obstrução do Fluxo Ventricular Externo/etiologia , Aneurisma Aórtico/congênito , Aneurisma Aórtico/diagnóstico , Procedimentos Cirúrgicos Cardíacos/métodos , Criança , Ecocardiografia , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Obstrução do Fluxo Ventricular Externo/diagnóstico , Obstrução do Fluxo Ventricular Externo/cirurgiaRESUMO
We report a rare case of infective endocarditis caused by Corynebacterium diphtheriae in an 8-year-old boy, 2 years after a right ventricular outflow tract reconstruction with a bovine Contegra valved conduit. The patient recovered well after an RV-PA conduit enblock explantation and replacement with an aortic homograft with antibiotic treatment. All bacteriological cultures of excised tissue and blood were negative. The aetiological agent was identified as C. diphtheriae subsp. gravis by 16s rDNA sequencing.
Assuntos
Técnicas Bacteriológicas/métodos , Infecções por Corynebacterium/diagnóstico , Infecções por Corynebacterium/microbiologia , Corynebacterium diphtheriae/isolamento & purificação , Endocardite/diagnóstico , Endocardite/microbiologia , Análise de Sequência de DNA , Antibacterianos/uso terapêutico , Criança , Infecções por Corynebacterium/tratamento farmacológico , Infecções por Corynebacterium/cirurgia , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Endocardite/tratamento farmacológico , Endocardite/cirurgia , Humanos , Masculino , Dados de Sequência Molecular , RNA Ribossômico 16S/genética , Obstrução do Fluxo Ventricular Externo/cirurgiaRESUMO
Telemedicine allows face-to-face interaction between the medical specialist and the patient. We present our experience of 102 pediatric telecardiology consultations between a tertiary care cardiac center and a remote rural hospital located 120 miles away, between July 2000 and December 2003. The connection was through a Very Small Aperture Terminal satellite bandwidth provided by the Indian Space Research Organization. An S-video link between the echocardiographic and videoconferencing equipment at the remote center allowed the specialist to view images in real time. Pathology was ruled out in 50 (49%) children by tele-echocardiography. Cardiac problems were diagnosed in 52 children (51%), of whom 30 (29%) required surgery. Successful cardiac surgery following telediagnosis was carried out in 18 patients, 8 are awaiting elective operations, and 4 died before surgical correction. The Very Small Aperture Terminal enabled a higher bandwidth that allowed clear images with no significant diagnostic errors. This study demonstrates that pediatric telecardiology effectively delivers cardiac care in rural centers in developing countries with stretched medical resources, where the specialists are urban centered and the majority of patients are rural based.
Assuntos
Cardiologia/métodos , Atenção à Saúde , Cardiopatias/diagnóstico por imagem , Pediatria/métodos , Consulta Remota , Serviços de Saúde Rural , Adolescente , Procedimentos Cirúrgicos Cardíacos , Criança , Pré-Escolar , Estudos de Viabilidade , Cardiopatias/mortalidade , Cardiopatias/cirurgia , Humanos , Índia , Lactente , Recém-Nascido , Seleção de Pacientes , Valor Preditivo dos Testes , Comunicações Via Satélite , Fatores de Tempo , Ultrassonografia , Comunicação por VideoconferênciaRESUMO
Permanent pacemaker implantation in pediatric patients poses challenges in finding a suitable pocket for generator implantation. We present our experience with 6 patients in whom the pacemaker was placed in an extrapleural intrathoracic location. We find that an extrapleural intrathoracic pocket is a useful site for generator placement in the neonatal and pediatric age group. It is safe, reproducible, and both the lead and generator can be placed through a single incision. We briefly discuss the advantages and disadvantages of other techniques that require a single incision for both lead and generator placement.
