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Published byApril McBride Modified over 9 years ago
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Erle H. Austin, MD Kosair Children’s Hospital Louisville, Kentucky
A Few Examples Erle H. Austin, MD Kosair Children’s Hospital Louisville, Kentucky No Disclosures
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Patient # 1 Newborn female 37 wks; 2.8 kg; Apgars 7/8
Heart murmur; pink with “blue spells” Echo: PA, VSD, right aortic arch, atypical PDA Cardiac cath at 4 days of age Discharged age 13 days
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4 Days Old - Cath
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4 Days Old - Cath
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7 Months Old - Cath
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7 Months Old - Cath
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10 Months Old - Surgery Median sternotomy
Unifocalization of central PAs and MAPCAs Small native LPA ( & tiny native RPA) Dissected off CPB L and R inferior MAPCAs; R superior MAPCA Dissected on CPB small fragile vessels; all probed at completion VSD closure 12mm RV-PA conduit (pulmonary homograft) Atrial septal fenestration
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10 Months Old - Surgery cont.
Separated from CPB with good sats/BP TEE good function, no residual VSD RV pressure !!! % LV pressure !!! VSD patch fenestration Discharged POD#11
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2 Years Old Qp/Qs = 0.52
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7 Years Old
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Patient # 2 Newborn male Full term; 4.4 kg; Apgars 9/9
Heart murmur; 93% sats with desat episodes Echo: PA, VSD, right aortic arch, probable MAPCAs Cardiac cath at 4 days of age
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4 Days Old - Cath
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5 Days Old - Surgery Median sternotomy 4mm central shunt
Ascending aorta to native central PA Brizard et al. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 12:
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Still on the ventilator !!!
13 Days Old Still on the ventilator !!!
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14 Days Old - Cath Qp/Qs = 8/1
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14 Days Old - Surgery Left Thoracotomy
Banding of large branch right MAPCA Banding of large branch left MAPCA
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Patient #2 Extubated 2 days later Discharged at 2 months of age
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10 Months Old - Cath Qp/Qs = 1.3/1
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12 Months Old - Surgery Redo left thoracotomy Redo median sternotomy
Identify left-sided MAPCAs Ligation origin MAPCA from left subclavian Redo median sternotomy Unifocalization of left-sided MAPCAs Patch angioplasty of native right PA Placement of 8mm RV-PA Gore-Tex conduit Discharged POD#8
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21 Months Old - Cath
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Patient # 3 Newborn male 37 wk; 3.6 kg; Apgars 8/8 Fetal dx: TOF/PA
II/VI systolic murmur; Sats low 90s Echo: TOF/PA, typical PDA, confluent 4.2mm PAs; ?MAPCAs? PGE1 Cardiac cath at 2 days of age
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2 Days Old - Cath
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3 Days Old - Surgery Median sternotomy
Right modified BT shunt (3.5 mm) ?Ductus? Not ligated 22q11 deletion Discharged POD#23
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5 Months Old - Cath
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