Troubleshooting During Temporary Epicardial Lead Implantation in a Child with an Erosive Twiddler's Syndrome and Multiple Sternotomies: A case report.

Temporary epicardial cardiac pacing in patients with bradyarrhythmias may be used as a bridge to implantation of a permanent pacemaker. The temporary epicardial lead placement may sometimes necessitate a sternotomy that may pose a challenge in patients who have had multiple earlier sternotomies. The difficulty in accessing the epicardium for urgent implantation of temporary epicardial pacing leads depends on the extent of adhesions in such patients.

Co-axial Endotracheal Tube Technique for Achieving One Lung Ventilation in a Toddler With a Space Occupying Malignant Tumor of the Right Lung.

Achieving one-lung ventilation in pediatrics is often challenging. In caring for these patients, the anesthesiologist must consider the child's age and size, underlying tracheobronchial anatomy, equipment availability, urgency of procedure, and as well as the experience level of the anesthesiologist. This report describes a "tube-inside-tube" technique that was adopted for providing one-lung ventilation in a toddler.

Surgical repair of interrupted right-sided cervical aortic arch with hypoplasia of the descending thoracic aorta in a child with PHACE syndrome.

Obstruction of a right cervical aortic arch in association with hypoplasia of the descending aorta is a rare congenital cardiac malformation. We report the case of a 6-month-old boy with posterior fossa anomalies, hemangioma, arterial anomalies, cardiac anomalies and eye anomalies (PHACE) syndrome and interruption of a right-sided cervical aortic arch. The descending thoracic aorta in the child had a long hypoplastic segment and the patient also had small ventricular septal defect and pulmonary valve stenosis.

Aortic root abscess and anomalous aortic origin of right coronary artery in a 5-year-old child.

Background: Aortic root abscess is a rare complication of infective endocarditis in children.

Case Report: A 5-year-old boy with infective endocarditis of aortic valve and an anterior aortic root abscess was found to have anomalous aortic origin of right coronary artery from the left coronary sinus on computed tomography scan with contrast.

Result: He was managed surgically by "patch and prosthesis" approach and required aortic root enlargement.

Large aortopulmonary collateral artery exclusively supplying the lower lobe of left lung in an infant with common arterial trunk with aortic dominance with confluent pulmonary arteries.

Introduction: Common arterial trunk with aortic dominance has well-developed bilateral pulmonary arterial arborization without any essential major aortopulmonary collateral arteries (MAPCAs), whereas "solitary" arterial trunk is characterized by collateral arterial supply to all bronchopulmonary segments and absent pulmonary arteries.

Case Report: We report a term female neonate with common arterial trunk with aortic dominance with confluent pulmonary arteries with a large MAPCA as the sole blood supply to the lower lobe of the left lung.

Results: Initial diagnostic workup missed this MAPCA from the descending thoracic aorta.

Double outlet right atrium-A "bridge" across the bridging leaflets.

Introduction: Mal-alignment between the inter-atrial septum (IAS) and the inter-ventricular septum (IVS) during cardiac embryogenesis results in abnormal atrioventricular (AV) connections ranging from doubleoulet left atrium (DOLA) to double outlet right atrium (DORA)1.

Case Report: We report DORA resulting from partial override of the interatrial septum (IAS) across the cleft between the bridging leaflets of the left atrioventricular (AV) valve.

Results: Successful surgical management with preservation of the orifice is described, leading to an unusual type of double orifice left AV valve.

Real-time confirmation of tracheal decompression.

Aims: The primary objective was to highlight the role of intraoperative bronchoscopic guidance during the management of central airway obstruction.

Materials & Methods: A 6-month-old child presented with recurrent chest infections due to innominate artery compression of distal trachea. Aortopexy was performed under real-time bronchoscopic guidance.

Group A Streptococcal Pericarditis in a Four-Month-Old Infant: Case report.

Purulent pericarditis is uncommon among paediatric patients and cases caused by group A (GAS) are even rarer. We report a four-month-old female infant who was referred to the Royal Hospital, Muscat, Oman, in 2015 with pericardial effusion and cardiac tamponade. She had initially presented to a secondary hospital with a two-week history of fever, a runny nose and shortness of breath.

Coarctation of the aorta, known yet can be missed.

The clinical presentation of coarctation of aorta (CoA) is well known; however, it is the most common congenital heart disease in the newborn period to be missed, with significant mortality and morbidity associated with missing the diagnosis. We report a 20-day-old newborn boy who presented with congestive heart failure and weak femoral pulses. Chest X-ray (CXR) showed cardiomegaly and pulmonary edema and electrocardiography (ECG) showed extreme right axis deviation and absent left ventricular forces in the left precordial leads.

Novel anaesthetic approach for surgical access and haemodynamic management during off-pump coronary artery bypass through a left thoracotomy.

For myocardial revascularization on a beating heart through a thoracotomy, a properly deployed endobronchial blocker (EBB) provides ideal conditions for surgical access. In addition, adequate volume replacement to achieve optimal cardiac performance is a primary goal of haemodynamic management in patients undergoing off-pump coronary artery bypass grafting. To achieve both these ends, this case report describes the combined use of a left-sided EBB along with a volumetric pulmonary artery catheter in a patient who underwent a successful off-pump coronary artery bypass surgery through an anterolateral thoracotomy.

Preoperative exchange transfusion for sickle cell disease patients undergoing open-heart surgery: an exception to the rule.

Preoperative exchange transfusion is a routine practice in patients with sickle cell disease having elevated sickle cell hemoglobin levels (>40%) undergoing open-heart surgery on cardiopulmonary bypass. A new approach toward acceptance and management of sickle cell disease patients with high sickle cell hemoglobin levels for open-heart surgery without preoperative exchange transfusion of blood is presented.

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.

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.