RESUMEN
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.
Asunto(s)
Conducto Arterioso Permeable/clasificación , Aorta Torácica/anomalías , Aorta Torácica/cirugía , Puente Cardiopulmonar , Constricción , Corazón Triatrial/cirugía , Vasos Coronarios/cirugía , Conducto Arterioso Permeable/patología , Conducto Arterioso Permeable/cirugía , Resultado Fatal , Defectos del Tabique Interatrial/cirugía , Humanos , Hipertensión Pulmonar/cirugía , Lactante , Masculino , Pericardio/patología , Pericardio/cirugía , Arteria Pulmonar/anomalías , Arteria Pulmonar/cirugía , Vena Cava Superior/anomalías , Vena Cava Superior/cirugíaRESUMEN
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.
Asunto(s)
Anomalías de los Vasos Coronarios/complicaciones , Síndrome Mucocutáneo Linfonodular/complicaciones , Preescolar , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico , Ecocardiografía , Ecocardiografía Doppler , Femenino , Estudios de Seguimiento , Hemodinámica/fisiología , Humanos , Lactante , Masculino , Síndrome Mucocutáneo Linfonodular/diagnósticoRESUMEN
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.
Asunto(s)
Gasto Cardíaco Bajo/terapia , Cateterismo , Oxigenación por Membrana Extracorpórea , Función Ventricular Izquierda , Gasto Cardíaco Bajo/diagnóstico por imagen , Gasto Cardíaco Bajo/etiología , Gasto Cardíaco Bajo/fisiopatología , Preescolar , Ecocardiografía , Humanos , Recién Nacido , Miocarditis/complicacionesRESUMEN
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.