Successful surgical repair of pulmonary dominant common arterial trunk without aortic arch obstruction in a neonate.

The pulmonary dominant variant of the common arterial trunk has always been reported to be associated with aortic coarctation, or interruption of the aortic arch, along with a duct-dependent systemic circulation. This mandates a complex surgical repair with attendant high surgical mortality. We report a 23-day-old baby with a pulmonary dominant trunk with mild aortic hypoplasia but with an arch free of coarctation or interruption, who underwent successful surgical repair.

Concordant Ventriculoarterial Connections With Abnormally Related Arterial Trunks (Anatomically Corrected Malposition) Associated With Right Ventricular Outflow Tract Obstruction by Accessory Valvar Tissue.

Anatomically corrected malposition of the great arteries is a rare conotruncal anomaly that is often confused with congenitally corrected transposition of the great arteries. This case report describes the successful surgical management of an adolescent with severe right ventricular outflow obstruction caused by accessory tricuspid valve tissue in the presence of situs inversus with atrioventricular and ventriculoarterial concordance with malposed great arteries (anatomically corrected malposition) {I,L,D}.

Mechanical cause for acute left lung atelectasis after neonatal aortic arch repair with arterial switch operation: Conservative management.

Respiratory complications due to mechanical obstruction of the airways can occur following pediatric cardiac surgery. Clinically significant intrathoracic vascular compression of the airway can occur when extensive dissection and mobilization of arch and neck vessels is involved as in repair of interrupted aortic arch. This case report describes a neonate who underwent interrupted aortic arch repair along with an arterial switch operation and developed a left lung collapse immediately after tracheal extubation.

Transient Electromechanical Dissociation Caused by a Transesophageal Echocardiography Probe.

Intraoperative transesophageal echocardiography is an established modality for confirming the preoperative diagnosis, assess adequacy of surgical repair, identify residual problems, and help improve the outcome after operation. Despite the multitude of advantages, intraoperative transesophageal echocardiography can affect the hemodynamic parameters in small neonates and children. A severe transient electromechanical dissociation caused by the anteflexion of a transesophageal echocardiography probe during a total anomalous pulmonary venous connection repair in an infant is reported.

Induced Pectus Carinatum.

During the surgical repair of a truncus arteriosus with aortic arch interruption and pulmonary artery origin stenosis, a Contegra conduit was implanted as part of reconstruction of the pulmonary artery in a small infant. There was a mismatch between the conduit size and the patient that resulted in protrusion of the conduit between the sternal edges. To accommodate the conduit inside the thoracic cavity, traction was applied to the sternum that was gradually released over a period of time guided by transesophageal echocardiography-derived cardiac output data, as well as continuous hemodynamic parameters.

Right ventricular free wall intramyocardial hematoma after coronary bypass.

Intramyocardial dissecting hematoma is a rare form of incomplete cardiac rupture usually reported with reference to the left ventricle or interventricular septum. Here we report the case of a 64-year-old man with an isolated right ventricular dissecting intramyocardial hematoma following coronary artery bypass surgery.

Dynamic left ventricular outflow tract obstruction complicating aortic valve replacement: A hidden malefactor revisited.

It is known that a dynamic left ventricular outflow tract (LVOT) obstruction exists in patients, following aortic valve replacement (AVR) and is usually considered to be benign. We present a patient with dynamic LVOT obstruction following AVR, who developed refractory cardiogenic shock and expired inspite of various treatment strategies. This phenomenon must be diagnosed early and should be considered as a serious and potentially fatal complication following AVR.

Arterial switch operation: troponin T does not predict ventilation requirements.

The aim of this study was to assess whether postoperative cardiac troponin T levels could predict ventilation requirements in infants undergoing the arterial switch operation. Cardiac troponin T was measured 6 hours after aortic cross clamping and prior to tracheal extubation in 20 consecutive patients; 10 had simple and 10 had complex (with ventricular septal defect) transposition of the great arteries. The mean plasma troponin T level prior to extubation did not differ significantly in patients who were re-intubated and those who were successfully extubated.

Selection of monitoring site and outcome after neonatal coarctation repair.

To assess whether simultaneous invasive arterial pressure monitoring of right upper and lower limbs in neonatal aortic coarctation with or without arch hypoplasia has an impact on surgical decision-making and outcome, data of 140 newborns who underwent emergency surgical repair over 15 years were analyzed retrospectively. The 36 who had simultaneous right arm and lower limb arterial pressure monitored intraoperatively were assigned to group 1. The other 104 who had blood pressure monitored invasively at a single site (either upper or lower limb) were allocated to group 2.

Wandering permanent pacemaker generators in children: a case series.

Introduction: Epicardial permanent pacemaker generators are implanted some times in the abdominal wall in pediatric age groups.

Case Presentation: Three permanent epicardial pacemakers that migrated in an unusual manner producing intraabdominal complications are reported.

Conclusion: The different clinical presentations of pacemaker migration in the pediatric age groups are highlighted and a few suggestions are made for avoiding such a complication.

Management of sickle cell disease during CABG surgery--a case report.

Elective Coronary Artery Bypass Graft (CABG) surgery using cardiopulmonary bypass techniques following preoperative transfusions to increase the hemoglobin A levels to above 60%, in a male patient with sickle cell disease [SCD] is described. Avoidance of hypoxia and acidosis lead to an uneventful perioperative period. Our institutional protocol for preoperative transfusions is highlighted.

A novel technique for off pump bidirectional Glenn shunt--safety issues--a case report.

A new technique to decompress the superior vena cava (SVC) during off pump bi-directional Glenn [BDG] shunts is described. Cerebral protection maneuvers and the safety concerns of the technique are addressed.

A mysterious journey of a cardiac pacemaker.

A permanent bipolar cardiac pacemaker was inserted in the abdomen of a child with Down's syndrome, due to complete heart block following repair of atrioventricular septal defect. This report describes an unusual and unreported complication of the pacemaker getting extruded through the rectum without dysfunction. Implications for early diagnosis and appropriate management and steps to prevent such episodes in future are discussed.

Myocardial protection during neonatal cardiac surgery.

Myocardial protection is of major concern in neonatal cardiac surgery where coronary ostial transfer is required as part of the surgical procedure. Retrograde coronary sinus perfusion (RCSP) of cold cardioplegic solution was evaluated in infants undergoing arterial switch operations. Hemodynamic measurements and postoperative cardiac troponin I (cTnI) levels were estimated in addition to transthoracic echocardiography to assess the extent of myocardial injury.

Diastolic dysfunction complicating anesthetic management.

Coronary artery disease combined with constrictive pericarditis results in diastolic dysfunction with a well-preserved systolic function. A case of constrictive pericarditis with a restrictive filling pattern and a well-established preoperative diastolic dysfunction, that had an elective pericardiectomy and an off pump coronary artery by pass graft, is discussed. Once revascularization was performed, introduction of Inj.

Off-pump bidirectional Glenn shunt by active decompression of the superior vena cava.

We report 2 cases of infants in whom off-pump bidirectional Glenn shunts were performed. A technique of decompressing the superior vena cava by active manual aspiration has been described. The challenges of maintaning the hemodynamic status, and cerebral protection maneuvers in association with mild hypothermia and a high transcranial pressure have been highlighted.