RESUMO
A 55 year old male patient with a diagnosis of hypertrophic cardiomyopathy was admitted with features of sepsis related to cholangitis. Initial management with intravenous (i.v.) fluids and antibiotics did not cause any change in his general condition mandating an emergency endoscopic retrograde cholangio-pancreatography (ERCP). After successful retrieval of CBD stone on ERCP, patient had massive upper gastrointestinal bleed leading to hypotension and shock. Addition of inotropes had led to further deterioration in his clinical status with a mean arterial BP falling to 44 mm of Hg. His echocardiography showed a resting left ventricular outflow tract (LVOT) gradient of 90 mm of Hg and thus was taken up for emergency alcohol septal ablation (ASA). Immediately after ASA, patient had significant decrease in LVOT obstruction and rise of systemic arterial pressures. After 10 days of antibiotic therapy patient was discharged with a residual LVOT obstruction of 28 mm of Hg.
Assuntos
Técnicas de Ablação/métodos , Cardiomiopatia Hipertrófica/tratamento farmacológico , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangite/complicações , Etanol/uso terapêutico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Insuficiência de Múltiplos Órgãos/etiologia , Sepse/etiologia , Obstrução do Fluxo Ventricular Externo/tratamento farmacológico , Obstrução do Fluxo Ventricular Externo/etiologia , Antibacterianos/uso terapêutico , Colangite/cirurgia , Ecocardiografia , Septos Cardíacos/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The bidirectional Glenn surgery is a life-saving palliative surgery in patients with univentricular cardiac anatomy and physiology. This procedure can be performed either under cardiopulmonary bypass (CPB) or off CPB. In this article, we will present a new innovative technique, which was performed on 6 individuals of age ranging from 2 to 18 years and followed up over a few months, which is effective, less morbid, as well as simple, safe, economically more viable, and is easily reproducible.
Assuntos
Ponte Cardiopulmonar/métodos , Técnica de Fontan/métodos , Cardiopatias Congênitas/cirurgia , Anastomose Cirúrgica/métodos , Pré-Escolar , HumanosRESUMO
Aortopulmonary collaterals (APCs) are occluded either preoperatively or at the time of cardiac surgery in patients with pulmonary atresia and ventricular septal defect (PAVSD). If left untreated, APCs are an important cause of deterioration in the early postoperative period. We present here an unusual case with a large residual APC causing refractory low-output state in the early postoperative period. Usual arterial approach failed due to extensive angulation with ostial narrowing. The large residual APC was successfully closed with an Amplatzer duct occluder (ADO) device delivered through the transvenous route.