ABSTRACT
Children with suspected pulmonary hypertension must undergo extensive and invasive evaluations to establish a definitive diagnosis. A previously healthy 4-year old girl, newly diagnosed with suprasystemic pulmonary hypertension required multiple lung biopsies. Each procedure was associated with significant bleeding. The challenging anesthetic management of lung biopsy in the presence of suprasystemic pulmonary hypertension is described.
Subject(s)
Anesthetics/administration & dosage , Biopsy/methods , Hemorrhage/etiology , Hypertension, Pulmonary/diagnosis , Biopsy/adverse effects , Child, Preschool , Female , Humans , Lung Diseases/diagnosisABSTRACT
Although early treatment with intravenous immunoglobulin reduces the risk of coronary artery aneurysms, in refractory cases of Kawasaki disease, myocardial infarction can result from thrombosis of coronary artery aneurysms. Early recognition of myocardial infarction from Kawasaki disease myocarditis can reduce morbidity and mortality. This report describes successful treatment of myocardial infarction from coronary thrombosis in an infant with Kawasaki disease using intravenous tissue plasminogen activator and abciximab.
Subject(s)
Coronary Thrombosis/complications , Mucocutaneous Lymph Node Syndrome/complications , Myocardial Infarction/drug therapy , Abciximab , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal/therapeutic use , Coronary Thrombosis/drug therapy , Coronary Thrombosis/etiology , Fibrinolytic Agents/administration & dosage , Fibrinolytic Agents/therapeutic use , Humans , Immunoglobulin Fab Fragments/administration & dosage , Immunoglobulin Fab Fragments/therapeutic use , Infant , Male , Myocardial Infarction/etiology , Platelet Aggregation Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/therapeutic use , Tissue Plasminogen Activator/administration & dosage , Tissue Plasminogen Activator/therapeutic use , Treatment OutcomeABSTRACT
Plastic bronchitis is potentially a life-threatening complication of long-standing surgically palliated single ventricle congenital heart disease. Patients can present with hypoxia requiring urgent bronchoscopy for removal of bronchial casts. Perioperative care for these patients is challenging and anesthesia is associated with significant cardiac risk. As more surgically corrected single ventricle patients survive to adulthood, these patients are expected to present more frequently. This report details the perioperative management of 2 Fontan patients with hypoxia and significant plastic bronchitis disease burden.