- A nine-month-old girl (weight: 7.92 kg; height: 70 cm) was taken to the operating room for the creation of a bilateral bidirectional Glenn shunt and atrial septectomy. Patent ductus arteriosus stenting had been done when the child was four days old. Transthoracic echocardiography showed heterotaxy (left atrial isomerism) with situs inversus, discordant atrioventricular and concordant ventriculoarterial connections (ventricular ‘noninversion’), a large ventricular septal defect, membranous pulmonary atresia with a hypoplastic main pulmonary artery, confluent branch pulmonary arteries, aorta anterior and to the right of the pulmonary artery, and bilateral superior vena cava with no bridging vein.
- A 5-YEAR-OLD female (weight 14 kg, height 110 cm) presented with persistent arterial hypoxemia after undergoing a Fontan completion. In the neonatal period, the child was diagnosed with situs inversus dextrocardia, congenitally corrected transposition of the great arteries, and pulmonary atresia, with a large ventricular septal defect. An urgent left modified Blalock-Taussig shunt was created when the patient was nine days old because she had profound hypoxemia despite prostaglandin E1. The arterial oxygen saturation was 80% at the time of discharge.
- A 33-YEAR-OLD man (weight 93 kg, height 177.5 cm, body mass index 29.5 kg/m2) presented to the authors’ institution for evaluation of dyspnea. The patient had a remote history of congenital heart surgery as a young boy, but no other details about the surgery were known. A chest radiograph showed right basal consolidation, with vertical densities over the right and left hemithorax (Fig 1, white arrows). Electrocardiography showed a right axis deviation with an incomplete right bundle- branch block.
- The role of intraoperative saline contrast echocardiography in the detection of a residual right-to-left shunt after a complex intracardiac surgical repair was described previously.1 We report an additional benefit of contrast echocardiography in an infant that helped confirm the location of an apical ventricular septal defect during a complex cardiac surgical procedure.
- A 35-YEAR-OLD man (weight 67 kg, height 169.9 cm), with a history of cough, dyspnea on exertion, and hemoptysis of 90 days’ duration, presented to the authors’ institution for further evaluation. Eight months before his presentation, he underwent radiofrequency catheter ablation for paroxysmal atrial fibrillation. About 5 months after the procedure, he was admitted to the hospital in respiratory distress with dyspnea and hemoptysis. Thoracic computed tomography showed left upper lobe consolidation (Fig 1).
- The primary objective was to compare the frequency of first-attempt successful axillary vein cannulation by the Seldinger technique using out-of-plane ultrasound guidance versus in-plane imaging. Between the two ultrasound imaging planes, this study also compared the number of attempts that were necessary for the cannulation of the left axillary vein along with the number of needle redirections that had to be done for final cannulation of the vein. Incidence of complications and the number of times the procedure was abandoned also were compared between the two imaging planes.
- MALIGNANT VENTRICULAR ARRHYTHMIAS are usually the cause for sudden death in young patients.1 The underlying cause for such malignant ventricular arrhythmias may be a primary cardiomyopathy such as hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, dilated cardiomyopathy, or an inherited condition such as long- or short-QT syndrome, Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia. Coronary artery anomalies also have been known to cause sudden cardiac arrest.