The Warden procedure for partial anomalous pulmonary venous connection in children: 10 years experience in 65 cases

2020 ◽  
Vol 30 (10) ◽  
pp. 1486-1489
Author(s):  
Hesham Alkady ◽  
Ahmed Elnaggar ◽  
Mahmoud Eldegwy ◽  
Abdallah Nosair
Keyword(s):  
Sinus Node ◽  
Pulmonary Veins ◽  
Sinus Node Dysfunction ◽  
Long Term Results ◽  
Age Group ◽  
Caval Vein ◽  
Superior Caval Vein ◽  
Paediatric Age ◽  
The Mean ◽  
Low Incidence

AbstractIntroduction:In this study, we share our experience in the Warden procedure for the repair of partial anomalous pulmonary venous connections (PAPVCs) draining high in the superior caval vein in 65 cases of the paediatric age group over a period of 10 years.Patients and methods:In total, 65 patients receiving the Warden procedure for the repair of high PAPVCs (draining above the cavoatrial junction) over a period of 10 years starting from January, 2010 to January, 2020 were included in this study.Results:In total, 34 were males (52.3%) and 31 were females (47.7%). The mean age was 3.47 ± 1.4 years, while the mean weight was 17.3 ± 5.3 kilograms. The mean bypass time was 84.2 ± 13.9 minutes and the mean cross clamp time was 54.8 ± 12.9 minutes. The mean intensive care unit stay was 2.14 ± 0.89 days, while the mean hospital stay was 5.9 ± 1.4 days. There was no in-hospital mortality or persistent sinus node dysfunction necessitating permanent pacemaker. In total, 62 patients (95%) could be followed up for a mean period of 7.8 ± 1.2 years after discharge. During the follow-up period, no stenosis was detected in the Warden anastomosis or the rerouted pulmonary veins and only one case of late mortality (1.6%) occurred due to a non-cardiac cause.Conclusion:The Warden procedure is a safe approach for the repair of high PAPVCs (above the cavoatrial junction) in the paediatric age group with good long-term results and low incidence of complications like sinus node dysfunction as well as pulmonary vein and superior caval vein obstruction.

Endocarditis of a congenital coronary fistula in a child

2017 ◽  
Vol 28 (2) ◽  
pp. 334-337 ◽  
Author(s):  
Thomas Krasemann ◽  
Ingrid M. van Beynum ◽  
Ingrid M. E. Frohn-Mulder ◽  
Michiel Dalinghaus
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Right Atrium ◽  
Age Group ◽  
Coronary Fistula ◽  
Vascular Plug ◽  
Caval Vein ◽  
Superior Caval Vein ◽  
Paediatric Age ◽  
The Right

AbstractEndocarditis of congenital coronary fistulas in the cardiac chambers is rare, especially in the paediatric age group. We describe the case of a 9-year-old boy with a fistula from the dilated right coronary artery to the junction of the superior caval vein to the right atrium, complicated by endocarditis. Treatment consisted of 6 weeks of antibiotics and interventional closure of the fistula 3 months later with an Amplatzer vascular plug.

Clarifying the anatomy of the superior sinus venosus defect

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319334
Author(s):  
Jay Relan ◽  
Saurabh Kumar Gupta ◽  
Rengarajan Rajagopal ◽  
Sivasubramanian Ramakrishnan ◽  
Gurpreet Singh Gulati ◽  
...  
Keyword(s):  
Left Atrium ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Interatrial Septum ◽  
Sinus Venosus ◽  
Caval Vein ◽  
Therapeutic Implications ◽  
Superior Caval Vein ◽  
Inferior Pulmonary Vein ◽  
The Right

ObjectivesWe sought to clarify the variations in the anatomy of the superior cavoatrial junction and anomalously connected pulmonary veins in patients with superior sinus venosus defects using computed tomographic (CT) angiography.MethodsCT angiograms of 96 consecutive patients known to have superior sinus venosus defects were analysed.ResultsThe median age of the patients was 34.5 years. In seven (7%) patients, the defect showed significant caudal extension, having a supero-inferior dimension greater than 25 mm. All patients had anomalous connection of the right superior pulmonary vein. The right middle and right inferior pulmonary vein were also connected anomalously in 88 (92%) and 17 (18%) patients, respectively. Anomalous connection of the right inferior pulmonary vein was more common in those with significant caudal extension of the defect (57% vs 15%, p=0.005). Among anomalously connected pulmonary veins, the right superior, middle, and inferior pulmonary veins were committed to the left atrium in 6, 17, and 11 patients, respectively. The superior caval vein over-rode the interatrial septum in 67 (70%) patients, with greater than 50% over-ride in 3 patients.ConclusionAnomalous connection of the right-sided pulmonary veins is universal, but is not limited to the right upper lobe. Not all individuals have over-riding of superior caval vein. In a minority of patients, the defect has significant caudal extension, and anomalously connected pulmonary veins are committed to the left atrium. These findings have significant clinical and therapeutic implications.

Partially Anomalous Pulmonary Venous Connection to Solitary and Persistent Left Superior Caval Vein in Usual Visceroatrial Arrangement

2017 ◽  
Vol 11 (4) ◽  
pp. NP88-NP90
Author(s):  
Anoop Ayyappan ◽  
Arun Gopalakrishnan ◽  
Kapilamoorthy Tirur Raman
Keyword(s):  
Pulmonary Veins ◽  
Caval Vein ◽  
Superior Caval Vein ◽  
The Right ◽  
Anomalous Pulmonary Venous Connection

Although the occurrence of bilateral superior caval veins (SCVs) is not unusual, persistence of the left SCV with atretic right SCV is extremely uncommon in the setting of normal visceroatrial arrangement. We report such a case that was also associated with anomalous pulmonary venous connection of the right pulmonary veins to the solitary left SCV.

The Warden procedure for partially anomalous pulmonary venous connection to the superior caval vein

2004 ◽  
Vol 14 (1) ◽  
pp. 64-67 ◽  
Author(s):  
Daniel J. DiBardino ◽  
E. Dean McKenzie ◽  
Jeffrey S. Heinle ◽  
Jason T. Su ◽  
Charles D. Fraser
Keyword(s):  
Normal Sinus Rhythm ◽  
Sinus Bradycardia ◽  
Sinus Node ◽  
Heart Association ◽  
First Grade ◽  
Atrial Pacing ◽  
Caval Vein ◽  
Superior Caval Vein ◽  
Number Of Patients ◽  
Anomalous Pulmonary Venous Connection

Purpose:When there is partially anomalous pulmonary venous connection to the superior caval vein, intracardiac repair alone can result in obstruction. Although the Warden procedure involving translocation of the superior caval vein is commonly performed as an alternative to atriocavoplasty, follow-up of a larger number of patients in the modern era is lacking. We report and discuss the experience of a single institution with the Warden procedure for correction of partially anomalous pulmonary venous connection to the superior caval vein.Methods:Since 1995, all 16 patients presenting with partially anomalous pulmonary venous connection to the superior caval vein underwent the Warden procedure at a mean age of 7.1 ± 4.2 years, with a range from 0.2 to 14.3 years, and a mean weight of 24.7 ± 14.0 kg, with a range from 4.1 to 52.9 kg. There were 9 males and 7 females. In 8 patients, we performed 10 concomitant procedures, including closure of an atrial or ventricular septal defect in 7, and advancement of the aortic arch in the other.Results:There were no deaths, and only one episode of postoperative sinus bradycardia with intermittent junctional rhythm, which resolved spontaneously during temporary atrial pacing. All patients were discharged home in normal sinus rhythm at an average of 4.1 ± 2.2 days after the procedure, with a range from 2 to 10 days. All are currently in the first grade of the New York Heart Association up to 5.6 years postoperatively. There is currently no evidence of sinus nodal dysfunction, nor obstruction of the superior caval vein, in any patient.Conclusion:The Warden procedure for partially anomalous pulmonary venous connection to the superior caval vein produces excellent results, preserves the function of the sinus node, and should be routinely considered for the repair of this lesion.

SPLENECTOMY IN PAEDIATRIC AGE GROUP

2021 ◽  
Vol 5 (9) ◽  
Author(s):  
Mayur Maheshwari ◽  
Pritanshi Singh
Keyword(s):  
Open Surgery ◽  
Operative Management ◽  
Age Group ◽  
Medical College ◽  
Age At Surgery ◽  
Paediatric Age ◽  
The Mean ◽  
Study Completion ◽  
Haematological Disorders ◽  
Clinical Problems

Background: In view of splenectomy in dealing with certain clinical problems in paediatric age group. Objective: To describe the profile, indications, post-operative management and outcomes of children undergoing splenectomy. Methods: All children undergoing splenectomy from June’2019 till August’2021 at INDEX MEDICAL COLLEGE, INDORE, M.P. Results: The mean age at surgery was 9.9 years (range 3-16). Most splenectomies were per-formed for haematological disorders and were open .The mean post-operative length of stay (LOS) in patients who underwent open surgery was 4 days. No cases of overwhelming post splenectomy infec-tion (OPSI) were noted. At study completion, haematological disorders were the most common indication for splenectomy in children. Conclusion: Indications for paediatric splenectomy mirror those found in international litera-ture. We haven't performed splenectomy, laparoscopically. Within this short span of time, no mortal-ity was recorded. We did not have any case of OPSI. Key words: splenectomy        

scholarly journals Emery-Dreifuss muscular dystrophy presenting as a heart rhythm disorders in children

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T S Kovalchuk ◽  
E V Yakovleva ◽  
S G Fetisova ◽  
T L Vershinina ◽  
T M Pervunina ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Skeletal Muscle ◽  
Muscular Dystrophy ◽  
Atrial Flutter ◽  
Sinus Node ◽  
Heart Rhythm ◽  
Sinus Node Dysfunction ◽  
Supraventricular Arrhythmias ◽  
Heart Rhythm Disorders ◽  
The Mean

Abstract Introduction Emery-Dreifuss muscular dystrophy (EDMD) is an inherited muscle dystrophy often accompanied by cardiac abnormalities in the form of supraventricular arrhythmias, conduction defects, sinus node dysfunction. Cardiac phenotype typically arises years after skeletal muscle presentations, though, can be severe and life-threatening. The disease usually manifests during the third decade of life with elbow joint contractions and progressive muscle weakness and atrophy. Objective To present our clinical experience of diagnosis and treatment of arrhythmias in children with Emery-Dreifuss muscular dystrophy Materials and methods We enrolled 5 patients with different forms of EDMD (X-linked and autosomal dominant) linked to the mutations in EMD and LMNA genes, presented with early onset of cardiac abnormalities and no leading skeletal muscle phenotype. The predominant forms of cardiac pathology were atrial flutter, atrial fibrillation and conduction disturbances that progress over time. Clinical examination included physical examination, 12-lead electrocardiography, Holter ECG monitoring (HM), transthoracic echocardiography, neurological examination and biochemical and hormone tests. Also we performed CMR, electrophysiological study (EPS), treadmill test of some patients. One patient underwent an endomyocardial biopsy to exclude inflammatory heart disease. Target sequencing was performed using a panel of 108 or 172 genes Results We observed five patients with EDMD and cardiac debut during first-second decades of life: 3 with 1st subtype (variants in EMD gene) and 2 with 2nd subtype (variants in LMNA gene). All patients were males. The mean age of cardiac manifestation was 13,2±3,11 (from 9 to 16 y.o.). The mean follow-up period was 7,4±2,6 years. All patients presented with sinus node dysfunction and four out of five with AV conduction abnormalities. The leading arrhythmic phenotypes included various types of supraventricular arrhythmias: multifocal atrial tachycardia (AT) (n=4), premature atrial captures (PACs) (n=4), atrial flutter, (AF) (n=3), atrial fibrillation (AFib) (n=3) and AV nodal recurrent tachycardia (AVRNT). Heart rhythm disorders were the first manifestation in all three patients with 1st EDMD subtype. Radiofrequency ablation was performed in 2 patients, one of them received permanent pacemaker implantation. Conclusions In conclusion, while being the rare cases, heart rhythm disorders can represent the first and for a long time, the only clinical symptom of EDMD even in the pediatric group of patients. Therefore, thorough laboratory and neurological screening along with genetic studies, are of importance in each pediatric patient presenting with complex heart rhythm disorders of primary supraventricular origin to exclude EDMD or other neuromuscular disorders. FUNDunding Acknowledgement Type of funding sources: None.

Acute recoil of stents used for the relief of stenotic great vessels in the setting of congenital cardiac disease

2003 ◽  
Vol 13 (6) ◽  
pp. 519-525 ◽  
Author(s):  
Hideshi Tomita ◽  
Satoshi Yazaki ◽  
Kohji Kimura ◽  
Ken Watanabe ◽  
Kinya Hatakeyama ◽  
...  
Keyword(s):  
Pulmonary Veins ◽  
Pulmonary Arteries ◽  
Caval Vein ◽  
Superior Caval Vein ◽  
Congenital Cardiac Disease ◽  
Significant Difference ◽  
Great Vessels ◽  
Palmaz Stents ◽  
Stenotic Vessel ◽  
Minimal Diameter

We implanted either large or medium Palmaz stents, or a Palmaz Corinthian stent, in various stenotic vessels, such as the pulmonary arteries, pulmonary veins, aorta, or superior caval vein. Using angiograms, we measured the diameter of the stenotic vessel before or after the implantation, the minimal diameter of the lumen, the minimal diameter of the largest fully expanded balloon used to expand the stent, and the diameter immediately after withdrawal of the balloon.The minimal diameter of the fully expanded balloon, and the minimal diameter of the lumen subsequent to expansion, were 8.2 ± 2.4, and 7.7 ± 2.3 mm, giving an absolute recoil of 0.5 ± 0.4 mm, and a proportional recoil of 7 ± 4%. There was no significant difference in either the absolute or proportional recoil for any of the stents, or for any of the different stenotic vessels. The proportional recoil correlated linearly with the minimal diameter of the lumen prior to the procedure, and with the ratio of the stenosis to the balloon, while the diameter of the stenotic vessels, the minimal diameter of the largest fully expanded balloon, the proportional stenosis prior to the procedure, and the ratio of the balloon to the diameter of the stenotic vessel, had no significant correlation with proportional recoil. The proportional recoil exceeded more than one-tenth when the minimal diameter of the lumen prior to the dilation was less than 3 mm, or the ratio of the balloon to the stenosis was greater than 3.0.An absolute recoil of around 1 mm is common when a large or medium Palmaz, or a Palmaz Corinthian stent, is implanted in great vessels. Balloons with a diameter of approximately one-tenth greater than that of the adjacent vessel may be needed if the minimal diameter of the lumen is small prior to the procedure.

Absence of the right superior caval vein associated with disease of the sinus node

1992 ◽  
Vol 36 (1) ◽  
pp. 115-117 ◽  
Author(s):  
Catina Bernardis ◽  
Andrew Chatzis ◽  
Tom Treasure
Keyword(s):  
Sinus Node ◽  
Caval Vein ◽  
Superior Caval Vein ◽  
The Right

scholarly journals Comparative evaluation of caudal tramadol and fentanyl when mixed with bupivacaine in paediatric age group

2020 ◽  
Vol 8 (4) ◽  
pp. 1445
Author(s):  
Abhinav Tewari ◽  
Ajit Kumar Singh
Keyword(s):  
Postoperative Analgesia ◽  
Comparative Evaluation ◽  
Pediatric Patients ◽  
Analgesic Efficacy ◽  
Age Group ◽  
Caudal Block ◽  
Pain Scores ◽  
Haemodynamic Changes ◽  
Paediatric Age ◽  
The Mean

Background: A caudal block is commonly performed block for postoperative analgesia pediatric surgeries. Duration can be enhanced by addition drugs like fentanyl, tramadol, clonidine midazolam etc to local anesthetics helps in decreasing the requirement of postoperative analgesics. This study was conducted to assess the analgesic efficacy of tramadol or fentanyl when mixed with bupivacaine in pediatric patients for surgeries below the umbilicus.Methods: Fifty children of ASA I and ASA status, between 2 to 12 years of age, of both sexes underwent elective surgeries below umbilicus were selected and randomly divided into groups of 25 each. One Group, T (n = 25) received 0.75 ml/kg of 0.25% bupivacaine with tramadol 1mg/ kg and other Group F (n = 25) received 0.75 ml/kg of 0.25% bupivacaine with Inj fentanyl 1μg/kg. Assessment of analgesia and any side effects after caudal injection to the first administration of analgesia were recorded for both the groups in next 24 hours following objective pain scores. Duration of analgesia and requirement of additional rescue analgesics was noted.Results: The Mean duration of analgesia recorded longer in Group T (18.26±6.1 hours) as compared to Group F (10.0+/- 2.68 hrs.) and no significant haemodynamic changes or adverse effect noted between 2 groups.Conclusions: Addition of tramadol, 1mg/kg to bupivacaine 0.25% for caudal anesthesia in children undergoing surgeries below umbilicus, enhances and prolongs postoperative analgesia compared to caudal fentanyl 1μg/kg and bupivacaine 0.25% alone.

scholarly journals Microbiological profile of common bacterial isolates from acute tonsillitis in pediatric age group patients

2020 ◽  
Vol 6 (10) ◽  
pp. 1818
Author(s):  
Ashish Sharma ◽  
Naga Babu Pyadala
Keyword(s):  
Histopathological Examination ◽  
Age Group ◽  
Bacterial Isolates ◽  
Acute Tonsillitis ◽  
Follicular Hyperplasia ◽  
Microbiological Profile ◽  
Pediatric Age Group ◽  
Paediatric Age ◽  
Group A ◽  
The Mean

<p class="abstract"><strong>Background:</strong> The paediatric age group are more prone to tonsillitis. The management of tonsillitis mainly based on understanding of microbiological and pathological features. This study aimed to discuss the microbiological profile of acute tonsillitis in children.</p><p class="abstract"><strong>Methods:</strong> Children fewer than 16 years age group was included in this study and the children underwent tonsillectomy or in antibiotics for at least one month were excluded from study. The throat swabs were taken for microbiological diagnosis.</p><p class="abstract"><strong>Results:</strong> A total of 150 children were diagnosed as acute tonsillitis during the period of 1 year from January 2019 to December 2019. The mean age group of children were 9.6 years. There were total 70 males and 80 females. The most common isolates were <em>Streptococcus viridians</em> group, Group A β-hemolytic <em>Streptococci</em>. There were only 3 cases with polymicrobial growth. The histopathological examination reported acute tonsillitis with follicular hyperplasia in all children.</p><p class="abstract"><strong>Conclusions:</strong> The understanding of microbiological profile could help in management of acute tonsillitis. The pathological profile can help us to identify the organisms which are difficult to culture.</p>

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