RESUMEN
Though respiratory complications after cardiac surgery for congenital heart disease are common, and malformations of the diaphragm can be expected in these patients, the presence of an occult diaphragmatic defect unrecognisible preoperatively and complicating the post operative course is very rare and need a high index of suspicion for diagnosis in the setting of post operative respiratory failure. We present here a case of post operative respiratory failure from a delayed presenting diaphragmatic hernia in a 2-month-old boy who underwent corrective surgery for Taussig bing anomaly and hypoplastic aortic arch. Surgical repair of the diaphragmatic defect and reduction of the bowel loops to the abdomen resulted in rapid weaning from ventilation and recovery with subsequent discharge from hospital.
Asunto(s)
Cardiopatías Congénitas/cirugía , Hernias Diafragmáticas Congénitas/complicaciones , Hernias Diafragmáticas Congénitas/fisiopatología , Complicaciones Posoperatorias/fisiopatología , Insuficiencia Respiratoria/etiología , Diagnóstico Diferencial , Hernias Diafragmáticas Congénitas/cirugía , Humanos , Lactante , Masculino , Complicaciones Posoperatorias/cirugíaAsunto(s)
Aorta Torácica/fisiopatología , Aneurisma de la Aorta Abdominal/complicaciones , Disección Aórtica/complicaciones , Tronco Braquiocefálico/fisiopatología , Electrocardiografía , Frecuencia Cardíaca/fisiología , Enfermedad Aguda , Anciano , Disección Aórtica/diagnóstico , Disección Aórtica/cirugía , Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/cirugía , Tronco Braquiocefálico/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Diástole , Ecocardiografía Transesofágica , Procedimientos Endovasculares/métodos , Humanos , MasculinoRESUMEN
We describe a 23-year-old man with no history of any other illness contacting H1N1 infection during convalescence from dengue fever. The patient had bilateral pneumonia with renal and hepatic dysfunction. The patient was treated successfully with osaltamivir and noninvasive ventilation along with other supportive measures. Despite multiorgan involvement and severe pulmonary involvement, he had a rapid improvement and did not require invasive ventilation. The possibility of the preceding or concomitant dengue viral infection reducing the severity of H1N1 infection was considered. It may be possible for two viruses to infect the same cell and as such, there may be interaction of the pathologic pathways of the two viruses, leading to change of virulence or altered host response. Such an interaction between the two viruses may be clinically important in the setting of the current H1N1 pandemic and the increased geographic distribution of the dengue virus.
RESUMEN
Patients with genetic disorders associated with multiple congenital anomalies present unique challenges to the anesthesiologist. We report the successful perioperative management of a child with biliary atresia, situs inversus totalis, and Kartegener syndrome scheduled for corrective biliary surgery. We recommend that patients with multiple congenital anomalies need to be thoroughly and cautiously evaluated. The perioperative management should be individualized based on associated anomalies along with appropriate monitoring.