RESUMEN
Hemoglobin SC (HbSC) disease is a hemoglobinopathy that may produce sickling under conditions of hypoxemia, dehydration, and acidosis. We present a case of HbSC disease and tricuspid atresia, type IB. We describe management by cardiopulmonary bypass CPB using exchange transfusion at initiation of bypass and fractionation of collected blood, allowing platelet and plasma apheresis, as an option for patients unable to undergo this procedure off pump.
Asunto(s)
Puente Cardiopulmonar/métodos , Enfermedad de la Hemoglobina SC/complicaciones , Atresia Tricúspide/cirugía , Anticoagulantes/administración & dosificación , Transfusión de Sangre Autóloga , Preescolar , Cianosis , Recambio Total de Sangre , Femenino , Procedimiento de Fontan , Paro Cardíaco Inducido , Heparina/administración & dosificación , Humanos , Hipotermia Inducida , Cuidados Paliativos , Plasmaféresis , Plaquetoferesis , Cuidados Preoperatorios , Atresia Tricúspide/complicacionesRESUMEN
Owing to increased life expectancy, patients with grown-up congenital heart disease nowadays present various types of arrhythmias. We report treatment of a 27-year-old patient with tricuspid and pulmonary atresia who was referred to our department with symptomatic tachycardia. During electrophysiologic study, a diagnosis of typical AV-nodal re-entrant tachycardia was made, and he was successfully treated despite the described anatomic malformation.
Asunto(s)
Nodo Atrioventricular/fisiopatología , Ablación por Catéter/métodos , Sistema de Conducción Cardíaco/cirugía , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Atresia Tricúspide/complicaciones , Adulto , Electrocardiografía , Técnicas Electrofisiológicas Cardíacas , Estudios de Seguimiento , Sistema de Conducción Cardíaco/fisiopatología , Humanos , Masculino , Taquicardia por Reentrada en el Nodo Atrioventricular/etiología , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Atresia Tricúspide/fisiopatología , Atresia Tricúspide/cirugíaRESUMEN
OBJECTIVES: There are reports associating an increased incidence of Wolff-Parkinson-White syndrome with tricuspid atresia. Here we report on electrophysiologic studies in patients with tricuspid atresia and Wolff-Parkinson-White syndrome after the Fontan operation. In these patients the atrial arrhythmia often seen in patients undergoing the Fontan operation triggered atrioventricular re-entrant tachycardia or caused life-threatening arrhythmias. METHODS: Five patients with tricuspid atresia after palliation with a modified Fontan operation (atrioinfundibular connections) and Wolff-Parkinson-White syndrome are presented. RESULTS: Four of these patients had symptomatic paroxysmal orthodromic atrioventricular re-entrant tachycardia and a history of syncope; one of them additionally had atrial flutter with 2:1 conduction to the ventricle. A fifth patient presented with a life-threatening broad-complex tachycardia. In electrophysiologic studies an accessory pathway was localized in the right septal area in 3 patients. In 2 patients the accessory atrioventricular pathways were created by means of surgical intervention, connecting the right atrial appendage to the right ventricular outflow tract. All patients could be managed successfully by means of catheter ablation. CONCLUSIONS: In patients with tricuspid atresia, there are congenital and surgically acquired accessory pathways responsible for the increased rate of Wolff-Parkinson-White syndrome. Both types of accessory pathways can and should be treated by means of catheter ablation because atrial arrhythmia often seen in patients undergoing the Fontan operation can trigger atrioventricular re-entrant tachycardia or cause life-threatening tachycardia. Congenital accessory pathways should be excluded carefully before surgical intervention for total cavopulmonary anastomosis in patients with tricuspid atresia.