scholarly journals Image to Fit the Clinical Picture: Point-of-care Ultrasound Assessment of Ebstein’s Anomaly in Peru

2020 ◽  
Vol 4 (2) ◽  
pp. 222-224
Author(s):  
Ashley Rider ◽  
Andrea Dreyfuss ◽  
Roberto Inga
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart Defect ◽  
Congenital Heart ◽  
Point Of Care ◽  
Ebstein’S Anomaly ◽  
Point Of Care Ultrasound ◽  
Ebstein's Anomaly ◽  
Ultrasound Findings ◽  
Ultrasound Assessment

Ebstein’s anomaly is a congenital heart defect that when left untreated can lead to unique physical exam and ultrasound findings. This case describes a patient who presented with dyspnea and was found to have cyanosis, clubbing, and dilation of right-sided chambers on point-of-care ultrasound. The series of images highlights findings in late-stage Ebstein’s anomaly and serves as a springboard for the discussion of the pathophysiology, diagnosis, and treatment of this rare congenital heart disease.

scholarly journals Anorexia Nervosa in a Postoperative Patient With Ebstein Anomaly

2021 ◽  
Author(s):  
Sato Kengo ◽  
Watanabe Ryosuke ◽  
Okada Tsuyoshi ◽  
Nishiyori Yasushi ◽  
Kobayashi Toshiyuki ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Congenital Heart Disease ◽  
Anorexia Nervosa ◽  
Heart Disease ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Ebstein’S Anomaly ◽  
Ebstein Anomaly ◽  
Ebstein's Anomaly ◽  
Fontan Surgery

Abstract Background: Along with the improved life prognosis of patients with congenital heart disease, their diverse complications have come under scrutiny. Due to the various medical restrictions attendant on their upbringing, patients with congenital heart disease often have coexisting mental disorders. However, reports of patients with congenital heart disease and coexisting eating disorders are very rare. In this paper the authors report the case of a patient who developed anorexia nervosa following surgery for Ebstein’s anomaly.Case Presentation: A 21-year-old female with Ebstein’s anomaly who underwent a Fontan surgery was transferred to our institution with suspected anorexia nervosa after a more than 2-year intermittent stay in a medical hospital for decreased appetite. Initially, she did not express a desire to lose weight or a fear of obesity, and we suspected that she was suffering from appetite loss due to a physical condition associated with the Fontan circulation. But gradually the pathology of the eating disorder became apparent.Conclusions: Patients with congenital heart disease are more likely to have a psychological background as well as physical problems that might contribute to eating disorders. Indeed, it is unclear why there are not more cases of eating disorders in association with congenital heart diseases.

scholarly journals P843 A rare cause of chest pain: paradoxical embolism in Ebstein"s anomaly

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H S A Abdelgawad ◽  
N Hisham ◽  
M Shehata ◽  
M A Abdelhay
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Right Ventricle ◽  
Patent Foramen Ovale ◽  
Congenital Heart ◽  
Paradoxical Embolism ◽  
Ebstein’S Anomaly ◽  
Foramen Ovale ◽  
Ebstein's Anomaly ◽  
The Right

Abstract Introduction Ebstein’s anomaly is characterized by displacement of the proximal attachments of the tricuspid valve from the atrioventricular ring into the right ventricle. This structural abnormality divides the right ventricle into an ‘atrialized’ portion and a distal ‘ventricularized’ portion. The severity is variable and accounts for the broad clinical spectrum, from severe disease causing fetal or neonatal death to mild disease compatible with natural survival as late as the eighth decade of life. Ebstein’s anomaly is an uncommon defect occurring in less than 1% of patients with congenital heart disease, but it is disproportionately represented in the adult congenital heart disease population because of its favourable natural history Case report A 55 year old man with no previous cardiac history .He presented to our medical facility complaining of acute retrosternal squeezing retrosternal chest pain few hours before admission. On clinical examination, he had a pansystolic murmur over the tricuspid area .ECG showed right bundle branch block. Laboratory results were unremarkable except elevated cardiac enzymes. 2D Transthoracic Echocardiography revealed a small well-functioning right ventricle, 15 mm/m2 apical displacement of the tricuspid septal leaflet with severe tricuspid regurgitation . 2D and 3D transesophageal echocardiography with intravenous agitated saline injection revealed patent foramen ovale with right to left shunt with immediate crossing of bubbles.Coronary angiography revealed normal coronaries. The patient refused intervention and he was maintained on warfarin treatment . Conclusion The clinical presentation of Ebstein’s anomaly is highly variable—depending on anatomic severity, haemodynamics ,and degree of interatrial shunting. The majority of patients have shunting through a secundum ASD or patent-foramen ovale. Paradoxical embolism maybe an indication for PFO/ ASD closure Abstract P843 Figure.

scholarly journals Point-of-Care Ultrasound-Guided Protocol to Confirm Central Venous Catheter Placement in Pediatric Patients Undergoing Cardiothoracic Surgery: A Prospective Feasibility Study

2021 ◽  
Vol 10 (24) ◽  
pp. 5971
Author(s):  
Torsten Baehner ◽  
Marc Rohner ◽  
Ingo Heinze ◽  
Ehrenfried Schindler ◽  
Maria Wittmann ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Radiation Exposure ◽  
Congenital Heart ◽  
Pediatric Patients ◽  
Point Of Care ◽  
Cardiothoracic Surgery ◽  
Diagnostic Methods ◽  
Point Of Care Ultrasound ◽  
Central Venous

Background: Central venous catheters (CVC) are commonly required for pediatric congenital cardiac surgeries. The current standard for verification of CVC positioning following perioperative insertion is postsurgical radiography. However, incorrect positioning may induce serious complications, including pleural and pericardial effusion, arrhythmias, valvular damage, or incorrect drug release, and point of care diagnostic may prevent these serious consequences. Furthermore, pediatric patients with congenital heart disease receive various radiological procedures. Although relatively low, radiation exposure accumulates over the lifetime, potentially reaching high carcinogenic values in pediatric patients with chronic disease, and therefore needs to be limited. We hypothesized that correct CVC positioning in pediatric patients can be performed quickly and safely by point-of-care ultrasound diagnostic. Methods: We evaluated a point-of-care ultrasound protocol, consistent with the combination of parasternal craniocaudal, parasternal transversal, suprasternal notch, and subcostal probe positions, to verify tip positioning in any of the evaluated views at initial CVC placement in pediatric patients undergoing cardiothoracic surgery for congenital heart disease. Results: Using the combination of the four views, the CVC tip could be identified and positioned in 25 of 27 examinations (92.6%). Correct positioning was confirmed via chest X-ray after the surgery in all cases. Conclusions: In pediatric cardiac patients, point-of-care ultrasound diagnostic may be effective to confirm CVC positioning following initial placement and to reduce radiation exposure.

scholarly journals Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease

2021 ◽  
Vol 9 ◽  
Author(s):  
Jessica N. Persson ◽  
Jacqueline Holstein ◽  
Lori Silveira ◽  
Aimee Irons ◽  
Taufiek Konrad Rajab ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Fluid Overload ◽  
Subcutaneous Tissue ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Extravascular Fluid ◽  
Skin Ultrasound

Purpose: Fluid overload is a common post-operative issue in children following cardiac surgery and is associated with increased morbidity and mortality. There is currently no gold standard for evaluating fluid status. We sought to validate the use of point-of-care ultrasound to measure skin edema in infants and assess the intra- and inter-user variability.Methods: Prospective cohort study of neonates (≤30 d/o) and infants (31 d/o to 12 m/o) undergoing cardiac surgery and neonatal controls. Skin ultrasound was performed on four body sites at baseline and daily post-operatively through post-operative day (POD) 3. Subcutaneous tissue depth was manually measured. Intra- and inter-user variability was assessed using intraclass correlation coefficient (ICC).Results: Fifty control and 22 surgical subjects underwent skin ultrasound. There was no difference between baseline surgical and control neonates. Subcutaneous tissue increased in neonates starting POD 1 with minimal improvement by POD 3. In infants, this pattern was less pronounced with near resolution by POD 3. Intra-user variability was excellent (ICC 0.95). Inter-user variability was very good (ICC 0.82).Conclusion: Point-of-care skin ultrasound is a reproducible and reliable method to measure subcutaneous tissue in infants with and without congenital heart disease. Acute increases in subcutaneous tissue suggests development of skin edema, consistent with extravascular fluid overload. There is evidence of skin edema starting POD 1 in all subjects with no substantial improvement by POD 3 in neonates. Point-of-care ultrasound could be an objective way to measure extravascular fluid overload in infants. Further research is needed to determine how extravascular fluid overload correlates to clinical outcomes.

P263 Paradoxical embolus causing myocardial infarction in a young adult with congenital heart disease

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Veerappan ◽  
S Moharem-Elgamal ◽  
J Luszczak ◽  
N Manghat ◽  
S Lyen ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Tricuspid Regurgitation ◽  
Congenital Heart ◽  
Multimodality Imaging ◽  
Left Ventricular ◽  
Ebstein’S Anomaly ◽  
Gadolinium Enhancement ◽  
Ebstein's Anomaly ◽  
Paradoxical Embolus

Abstract Case Report A 17 year old girl presented to her local hospital 24 hours after the onset of severe central chest pain that lasted for 30 minutes and spontaneously resolved. Her congenital heart disease background was of Ebstein’s anomaly of the tricuspid valve, coarctation of the aorta and ventricular septal defect (VSD). She underwent surgical repair of the coarctation and PA band at two months of age, followed by VSD closure when she was a year old.. An atrial communication was deliberately left open at the time of this operation and she had a known residual VSD and mild tricuspid regurgitation. Her resting saturations were 97% in air . On admission, she had a significantly raised Troponin T of 24,000ng/L with no significant ST segment elevation. An echocardiogram demonstrated new left ventricular (LV) systolic impairment with an ejection fraction of 33%. She underwent a ‘triple rule out’ cardiac CT scan and subsequently a cardiac MRI. On retrospective review, the CT demonstrated a sizeable atrial communication with left to right shunt, focal tight mid left anterior descending (LAD) artery stenosis aftersecond diagonal branch with mid to apical anterior and anteroseptal hypoperfusion. The MRI demonstrated extensive full thickness late gadolinium enhancement in mid to apical septum extending to the apical cap and apical inferior segment with microvascular obstruction (MVO) in the mid septum with possible VSD patch breakdown. No thrombi was notes on the gadolinium enhancement images. She was transferred to our hospital and underwent an invasive coronary angiogram that demonstrated recanalization of her coronary artery. She remained haemodynamically well throughout the admission. Anticoagulation with a direct acting oral anticoagulant (DOAC) was started alongside ACE-I and Beta blocker therapy. Discharge transthoracic echocardiogram showed flow across the atrial septum, a small residual VSD and mild LV dysfunction with akinesia of mid-to-distal LAD territory and very good function of remaining LV segments. She was discharged home with a plan for elective outpatient admission for a closure of her interatrial communication in a few months once she has recovered. Figure 1 summarises the key aspects of the multimodality imaging in this patient. Discussion Coronary embolus is the underlying cause of 3% of acute coronary syndromes with a small proportion being from a paradoxical embolus from the venous circulation through a right to left shunt across an atrial communication. Ebstein’s anomaly is a rare disorder, accounting for <1% of all congenital heart defects. Right-to-left shunt across the atrial communication is common in this condition due to RA dilatation and increased RA pressures secondary to tricuspid regurgitation. Our case illustrates the importance of having a high index of suspicion in patients with congenital heart disease for this rare complication of paradoxical coronary embolus, especially given the significant morbidity. Abstract P263 Figure 1

Point-of-care hemostasis in children with congenital heart disease, the POCHEMO study

2019 ◽  
Vol 30 (5) ◽  
pp. 199-204
Author(s):  
David Longchamp ◽  
Marie-Hélène Perez ◽  
Julia Natterer ◽  
Vivianne Amiet ◽  
Thomas Ferry ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Point Of Care

Status and Challenges of Care in Africa for Adults With Congenital Heart Defects

2017 ◽  
Vol 8 (4) ◽  
pp. 495-501 ◽  
Author(s):  
Frank Edwin ◽  
Liesl Zühlke ◽  
Heba Farouk ◽  
Ana Olga Mocumbi ◽  
Kow Entsua-Mensah ◽  
...  
Keyword(s):  
Health Care ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart Defect ◽  
Congenital Heart ◽  
Heart Defects ◽  
Health Care Systems ◽  
Birth Prevalence ◽  
Care Systems ◽  
Courageous Action

The 54 countries in Africa have an estimated total annual congenital heart defect (CHD) birth prevalence of 300,486 cases. More than half (51.4%) of the continental birth prevalence occurs in only seven countries. Congenital heart disease remains primarily a pediatric health issue in Africa because of the deficient health-care systems: the adults with CHD made up just 10% of patients with CHD in Ghana, and 13.7% of patients with CHD presenting for surgery in Mozambique. With Africa’s population projected to double in the next 35 years, the already deficient health systems for CHD care will suffer unbearable strain unless determined and courageous action is undertaken by the African leaders.

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