scholarly journals An Unusual Coronary Artery Complication after Surgery for a Complex Congenital Heart Disease: A Case Report

2021 ◽  
Vol 6 (12) ◽  
pp. 919-923
Author(s):  
Zaher Faisal Zaher, MD
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Coronary Artery ◽  
Ventricular Septal Defect ◽  
Congenital Heart ◽  
Septal Defect ◽  
Arterial Switch Operation ◽  
Complex Congenital Heart Disease ◽  
Switch Operation

Background: Unexpected events in cardiac surgery may increase morbidity and mortality, which may be more complicated and difficult to manage especially in redo complex congenital heart surgery in children. This report presents a case of unusual coronary artery complication after redo surgery for a complex congenital heart disease. Case Presentation:  A female baby with ventricular septal defect, transposition of great arteries and coarctation of the aorta, underwent coarctation repair and pulmonary banding in neonatal period then at one year old, she underwent arterial switch operation and ventricular septal defect repair. In the pediatric cardiac intensive care unit, she required high doses of vasoactive inotropic drugs and echocardiography revealed sever right ventricular dysfunction without significant gradients or shunts. Accordingly, a diagnostic cardiac catheterization was performed and the aortic angiography revealed that the right coronary artery was not inadvertently transferred into the neo -aortic root during the step of arterial switch operation. The surgeon declared that he came upon confounding factors during the intraoperative assessment, which led him to identify a single coronary artery. Immediate reoperation performed to translocate the non-transferred right coronary artery into the neo aortic root and postoperatively the case required extracorporeal membrane oxygenation till she stabilized, and she was discharged in an acceptable condition.  Conclusion:  Early diagnosis and management of any complications related to coronary artery during pediatric cardiac surgery could lower risk and achieve favorable outcome.

Ventricular septal defect with anomalous origin of the left descending coronary artery from the right sinus of Valsava and an intraseptal course

2021 ◽  
pp. 021849232110470
Author(s):  
Guillaume Carles ◽  
Marianne Peyre ◽  
Alexia Dabadie ◽  
Loïc Macé ◽  
Marien Lenoir
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Coronary Artery ◽  
Ventricular Septal Defect ◽  
Congenital Heart ◽  
Septal Defect ◽  
The Right ◽  
Coronary Compression ◽  
Anatomic Result

Patients with anomalous aortic origin of the left anterior descending coronary artery (AAOCA) from the right sinus of Valsava, and associated with a trans-septal course, are recommended for surgery only when symptoms of ischemia are present. The transconal unroofing method is straightforward and provides good anatomic result. In absence of significant coronary compression, surgical management of the trans-septal coronary course is proposed if the patient is a candidate to cardiac surgery for another reason, such as congenital heart disease. We describe a transconal approach in a patient with a trans-septal coronary artery and a ventricular septal defect.

scholarly journals Stenting of modified Blalock–Taussig shunt in adult with palliated pulmonary atresia and ventricular septal defect: a case report

2019 ◽  
Vol 3 (4) ◽  
pp. 1-4
Author(s):  
Julia Illner ◽  
Holger Reinecke ◽  
Helmut Baumgartner ◽  
Gerrit Kaleschke
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Congenital Heart ◽  
Septal Defect ◽  
Pulmonary Atresia ◽  
Complex Congenital Heart Disease ◽  
Bare Metal

Abstract Background Adults with complex congenital heart disease palliated with systemic-to-pulmonary artery shunts have become rare and represent a particularly challenging patient group for the cardiologist. One of the complications and causes of severe clinical deterioration during long-term follow-up are progressive obstruction or total occlusion of the shunt. The risk for surgical intervention is frequently high and catheter intervention may be complicated by complex anatomy and shunt calcification. Case summary We report the case of a 47-year-old man with uncorrected (palliated) pulmonary atresia and ventricular septal defect who presented with progressive cyanosis (oxygen saturation 69%) and decreasing exercise capacity. Computed tomography revealed a totally occluded modified left Blalock–Taussig (BT) shunt and a severely stenosed central shunt (Waterston–Cooley) in a patient with confluent but hypoplastic pulmonary arteries and multiple major aortic pulmonary collaterals. Due to a high operative risk, an interventional, percutaneous approach was preferred to re-do surgery. From a radial access the calcified BT shunt could be crossed with a hydrophilic guidewire. Then, a rotational thrombectomy, balloon dilatation, and bare-metal stenting at the proximal and distal anastomoses were performed. Post-interventionally, peripheral oxygen saturation increased from 69% to 82%. Clopidogrel was administered for 1 month after bare-metal stenting. At 1-year follow-up, the BT shunt was still patent on echocardiography and exercise tolerance markedly improved. Discussion This case highlights the benefit of percutaneous rotational thrombectomy followed by stenting of chronically occluded systemic-to-pulmonary artery shunts for further palliation in adult patients with complex congenital heart disease not suitable for surgical repair.

Pre-operative coagulopathy management of a neonate with complex congenital heart disease: a case study

Perfusion ◽  
2000 ◽  
Vol 15 (2) ◽  
pp. 161-168 ◽  
Author(s):  
Alfred H Stammers ◽  
Eric D Rauch ◽  
Lynne D Willett ◽  
Jamie W Newberry ◽  
Kim F Duncan
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Septal Defect ◽  
Fresh Frozen Plasma ◽  
Complex Congenital Heart Disease ◽  
At Iii ◽  
Fresh Frozen ◽  
Frozen Plasma

Severe coagulation defects often develop in neonates undergoing cardiac surgery, both as a result of the surgical intervention, and as pre-existing defects in the hemostatic mechanisms. The following case report describes a newborn patient with complex congenital heart disease and respiratory failure whose pre-operative coagulopathy was aggressively managed prior to surgical correction. A 5-day-old, 2.5 kg child presented with interrupted aortic arch, ventricular septal defect, atrial septal defect, and patent ductus arteriosus. On admission, he was in respiratory arrest suffering from profound acidemia. In addition, the child was hypothermic (30.1°C), septic ( Streptococcus viridans), and coagulopathic (disseminated intravascular coagulation - DIC). The patient was immediately intubated and initial coagulation assessment revealed the following: prothrombin time (PT) 48.9 s (international normalized ratio (INR) 15.7), activated partial thromboplastin time (aPTT) •106 s, platelet count 30 000 mm3, fibrinogen 15 mg dL-1 and antithrombin III (AT-III) 10%. Before cardiac surgery could be performed, the patient’s DIC was corrected with the administration of cryoprecipitate (15 ml), fresh frozen plasma (300 ml), and platelets (195 ml). In spite of the large transfusion of fresh frozen plasma, the AT-III activity, measured as a percentage, remained depressed at 33. Initial thromboelastographic (TEG) determination revealed an index of +2.02, and following 100 IU administration of an AT-III concentrate, declined to -2.32. Sequential TEG profiles were performed over several days, with the results used to guide both transfusion and medical therapy. The congenital heart defect correction was subsequently performed with satisfactory initial results, but the patient developed a fungal infection and expired on the 16th post-operative day. The present case describes techniques of coagulation management for a newborn with both a severe hemostatic defect and congenital heart disease.

Angiographic classification of a single ventricle of the heart

1982 ◽  
Vol 63 (6) ◽  
pp. 44-46
Author(s):  
B. E. Shakhov
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Single Ventricle ◽  
Complex Congenital Heart Disease ◽  
Heart Ventricle ◽  
New Classification ◽  
Angiographic Examination

Based on the data of angiographic examination of 25 patients with a single heart ventricle, a new classification of complex congenital heart disease is proposed. It indicates the type of defect without taking into account the morphology of the single ventricular chamber, which is angiographically difficult or impossible to determine in some cases. This classification simplifies the interpretation of angiographic images, reflects the anatomical variants of the defect and meets the modern requirements of cardiac surgery.

scholarly journals Acute ischaemic stroke in secondary polycythaemia due to complex congenital cyanotic heart disease

2019 ◽  
Vol 12 (10) ◽  
pp. e231261
Author(s):  
Jeyaraj Durai Pandian ◽  
Ivy Anne Sebastian ◽  
Ashlee Sidhu
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Ischaemic Stroke ◽  
Congenital Heart ◽  
Septal Defect ◽  
Brain Mri ◽  
Neurological Deficits ◽  
Complex Congenital Heart Disease ◽  
Haematocrit Level ◽  
Polycythaemia Vera

A 65-year-old woman presented to the emergency department with an acute onset of left-sided hemiparesis and slurred speech for 6 hours. Physical examination was notable for clubbing and peripheral cyanosis. Brain MRI showed an acute infarct involving the right gangliocapsular region. Investigations showed an elevated haemoglobin level, a haematocrit level of >65% and thrombocytopaenia. Transthoracic echocardiography revealed tricuspid atresia, ventricular septal defect and atrial septal defect. A diagnosis of cyanotic congenital heart disease was made. Studies have indicated an association between raised haematocrit and vascular occlusive episodes in patients with polycythaemia vera. However, a relationship between raised haematocrit due to polycythaemia secondary to complex congenital heart disease and vascular thrombosis has not been reported. The improvement of neurological deficits in our patient coincided with a decline in haematocrit. The objective of this report was to highlight an association between elevated haematocrit and ischaemic stroke in patients with secondary polycythaemia due to complex congenital heart disease.

Coronary anatomy in children with bicuspid aortic valves and associated congenital heart disease

Heart ◽  
2017 ◽  
Vol 104 (5) ◽  
pp. 385-393 ◽  
Author(s):  
Wilke M C Koenraadt ◽  
Margot M Bartelings ◽  
Regina Bökenkamp ◽  
Adriana C Gittenberger-de Groot ◽  
Marco C DeRuiter ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Congenital Heart ◽  
Outflow Tract ◽  
Complex Congenital Heart Disease ◽  
Coronary Anatomy ◽  
Perimembranous Ventricular Septal Defect ◽  
Clinical Awareness

ObjectiveIn patients with bicuspid aortic valve (BAV), coronary anatomy is variable. High take-off coronary arteries have been described, but data are scarce, especially when associated with complex congenital heart disease (CHD). The purpose of this study was to describe coronary patterns in these patients.MethodsIn 84 postmortem heart specimens with BAV and associated CHD, position and height of the coronary ostia were studied and related to BAV morphology.ResultsHigh take-off right (RCA) and left coronary arteries (LCA) were observed in 23% and 37% of hearts, respectively, most frequently in hearts with hypoplastic left ventricle (HLV) and outflow tract anomalies. In HLV, high take-off was observed in 18/40 (45%) more frequently of LCA (n=14) than RCA (n=6). In hearts with aortic hypoplasia, 8/13 (62%) had high take-off LCA and 6/13 (46%) high take-off RCA. High take-off was seen 19 times in 22 specimens with perimembranous ventricular septal defect (RCA 8, LCA 11). High take-off was associated with type 1A BAV (raphe between right and left coronary leaflets), more outspoken for the RCA. Separate ostia of left anterior descending coronary artery and left circumflex coronary artery were seen in four hearts (5%), not related to specific BAV morphology.ConclusionHigh take-off coronary arteries, especially the LCA, occur more frequently in BAV with associated CHD than reported in normal hearts and isolated BAV. Outflow tract defects and HLV are associated with type 1A BAV and high take-off coronary arteries. Although it is unclear whether these findings in infants with detrimental outcome can be related to surviving adults, clinical awareness of variations in coronary anatomy is warranted.

scholarly journals On non-healing of the interventricular septum of the heart (Roger's disease)

1935 ◽  
Vol 31 (1) ◽  
pp. 27-35
Author(s):  
F. F. Piaid
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Congenital Heart ◽  
Septal Defect ◽  
Interventricular Septum ◽  
Artery Stenosis ◽  
Pulmonary Artery Stenosis

Simple uncomplicated forms of congenital heart disease in adults - pulmonary artery stenosis, non-healing of the Botall's duct - although they are a rarity, still studied more or less enough, and their lifelong recognition is not particularly difficult. Unfortunately, this cannot be said of another heart anomaly, a ventricular septal defect.

Coronary artery disease screening in adults with congenital heart disease prior to cardiac surgery

2019 ◽  
Vol 14 (6) ◽  
pp. 895-900 ◽  
Author(s):  
Bradley Johnson ◽  
Matthew Buelow ◽  
Michael Earing ◽  
Scott Cohen ◽  
Peter Bartz ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Coronary Artery ◽  
Congenital Heart ◽  
Disease Screening ◽  
Artery Disease
Sign in / Sign up

Export Citation Format

Share Document