Inadvertent irreversible closure of arterial duct following therapeutic use of transplacental indomethacin in a fetus with severe Ebstein's anomaly and circular shunt.

We report on a fetal case of Ebstein's anomaly with severe tricuspid regurgitation, functional pulmonary atresia and progressive circular shunting (CS) across a widely patent ductus arteriosus (DA) and regurgitant pulmonary valve, contributing to significant systemic hypoperfusion. To mitigate the extent of CS and allow the pregnancy to continue, maternal non-steroidal anti-inflammatory drug (NSAID) therapy with indomethacin was started at 33 + 5 weeks to induce DA constriction. Rather than achieving the desired narrowing of the DA, the treatment led to its complete closure and only minimal antegrade flow across the pulmonary valve. While closure of the DA resulted in the anticipated improvement in fetal hemodynamics, at birth, the child was at risk of severe hypoxemia and its consequences due to the lack of adequate pulmonary perfusion. Reduction and eventual discontinuation of the NSAID treatment did not result in DA reopening. Our experience illustrates the risk of unintended irreversible DA closure when NSAIDs are used to treat CS. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Simple testicular cyst in infants: a case report and review of the literature.

We report a 5-month-old boy with testicular cyst. He presented with a right inguinal hernia and a scrotal mass. Ultrasonography showed a cystic mass in the right testicular parenchyma, suggesting a testicular cyst. He underwent right herniotomy and unroofing of the cyst. Simple testicular cyst is extremely rare with only 48 cases reported in the literature. Of these cases, 8 patients were less than two years old. The diagnosis of simple testicular cyst can be made preoperatively with ultrasonography. Testis-preserving excision or unroofing the cyst is the treatment of choice.

[Combined operation for ischemic heart diseases and valvular heart diseases].

We performed combined operation for patients who have both ischemic heart disease and valvular heart disease in 21 cases from January 1991 to October 1999. This operation was 3.1% of 682 cases of coronary artery bypass grafting and 5.0% of 416 cases of operation for valvular heart disease during that period. The mean age of these patients was 67.9 +/- 9.1 years. The average number of grafts in the coronary artery bypass grafting was 1.5 +/- 0.6. Aortic valve replacement was performed in 6 cases, mitral valve replacement in 10 cases and mitral valve plasty in 5 cases. Together with this combined operation, ascending aorta and aortic arch replacement was done in 1 case and abdominal aortic replacement in 2 cases. Three patients died due to postoperative aortic rupture, cerebral infarction or excessive surgical intervention in ascending aorta and aortic arch replacement. Combined operation for ischemic heart diseases and valvular heart diseases can safely performed, but it appears necessary to pay attention to arteriosclerotic lesions.

[Double valve replacement without blood transfusion in a case complicated with liver cirrhosis and pancytopenia].

A 63-year-old woman complicated with liver cirrhosis and pancytopenia was admitted for aortic and mitral valve replacement. As laboratory findings at time of admission showed pancytopenia with Hb of 7.3 g/dl, WBC of 2,200/mm3, and platelet of 6.2 x 10(4)/mm3, splenectomy was first conducted and the blood cells and platelet increased in number. At 27 days after splenectomy, double vale replacement was performed without blood transfusion and her postoperative course was unevenfull. It is considered that preoperative splenectomy is useful in management of patients complicated with hypersplenism and pancytopenia.