China
Africa
Explore chapters and articles related to this topic
Cardiology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
In simple transposition, two parallel circulations exist with deoxygenated blood circulating from the right atrium to the right ventricle into the aorta and around the body returning via the vena cava to the right sided system; oxygenated blood returns from the lungs into the left atrium, left ventricle and exits via the transposed pulmonary artery back to the lungs. The vascular arrangement of TGA is not compatible with life ex utero and survival depends on the presence of other lesions and the patency of fetal structure that permits mixing of oxygenated and deoxygenated blood. Mixing of blood from these two parallel circulations is usually via the foramen ovale and little mixing occurs at ductal level; however, maintaining ductal patency may increase left atrial pressure and therefore shunting across the foramen. A secundum ASD may allow oxygen saturation to be reasonable after delivery and a significant VSD may mean that the baby is only mildly cyanosed. However, for most babies, there is only a foramen ovale and they are very cyanosed at birth. An emergency balloon septostomy is required with a balloon catheter from the femoral vein or umbilicus tearing the atrial septum.
Congenital heart disease
Published in Swati Gupta, Alexandra Marsh, David Dunleavy, Kevin Channer, Cardiology and the Cardiovascular System on the move, 2015
Swati Gupta, Alexandra Marsh, David Dunleavy, Kevin Channer
TreatmentBalloon septostomy after echocardiographical diagnosis: A tear is produced in the atrial septum.Allows mixing of blood from the two circulations and so does not cure cyanosis.Ultimate management is surgical: Previously atrial switch operations (Senning or Mustard procedures).Current arterial switch procedures allow anatomical and physiological correction of flow.
Congenital heart disease in the neonatal period
Published in Janet M Rennie, Giles S Kendall, A Manual of Neonatal Intensive Care, 2013
Janet M Rennie, Giles S Kendall
Cross-sectional echocardiography shows the posterior great artery arising from the LV to be the pulmonary trunk. The aorta arises in parallel with it anteriorly from the RV. During the first few days of life, the ductus arteriosus closes and the baby becomes lethargic, mottled and tachypnoeic, with severe hypoxia and acidosis, rapid deterioration and death. The severity of hypoxia depends upon the potential for mixing across the foramen ovale and the presence and size of any VSD. When the diagnosis is suspected, a prostaglandin infusion should be commenced and the baby must be referred to a specialist centre. Nowadays, most centres undertake an arterial switch operation within a few days of diagnosis. Balloon septostomy enlarges the foramen ovale and helps to stabilize the situation by mixing the circulations and is still likely to be needed if there is a poor response to prostaglandins or if early surgery cannot be done.
Femoral venous haemostasis in children and young adults using the ‘figure‐of‐eight’ suture technique
Published in Acta Cardiologica, 2022
Yasemin N. Dönmez, Hayrettin Hakan Aykan, Kutay Sel, İlker Ertuğrul, Derya Duman, Ebru Aypar, Dursun Alehan, Tevfik Karagöz
After removing the sheaths for the diagnostic and/or interventional cardiac procedures in 90 patients (48 males, 42 females), the ‘figure-of-eight’ suture was performed to provide haemostasis. The patients’ mean weight was 38,7 ± 23,7 kg, median age was 12,5 years (minimum 3 days, maximum 22 years) and a total of 100 sutures were performed. Table 1 shows the characteristics of the patients and the procedures (diagnostic angiography, n = 6; radiofrequency and/or cryoablation, n = 7; interventional procedures, n = 87). In 23 procedures, a sheath was inserted into the femoral artery for hemodynamic monitoring. We generally preferred the opposite femoral artery for arterial access. We provided hemostasis with manual compression for femoral artery hemostasis. Otherwise, we kept the sutured area as far from the arterial region as possible in our patients on the same side of femoral access (approximately 5 patients). Three infants with haemodynamically unstable coagulation parameters were sutured with the ‘figure-of-eight’ suture. Especially in newborns with congenital heart disease, patients referred to our hospital may deteriorate during transport and when we need to take them to the emergency angiography unit, we may have to perform the procedure with abnormal coagulation parameters. For example, two of our newborns underwent immediately the balloon septostomy procedure with impaired coagulation, deep acidosis, and cardiovascular compromise. Five patients were neonates, three patients had two sheaths and four patients had three sheaths. The median size of the sheaths was 8.5 French (minimum 5 French, maximum 18 French) and ten patients weighed less than 10 kg. None of the patients developed pseudoaneurysm, large haematoma or arteriovenous fistula, and there was no major bleeding or necessity for blood transfusion. A minor bleeding complication was observed in a patient where the suture was a little loose, but bleeding was controlled by tightening the suture. One patient developed a bullous lesion on the skin due to tension of the suture. The ‘figure-of-eight’ suture failed in one severely malnourished patient because there was not enough subcutaneous tissue. The sheaths were replaced with a central catheter via the Seldinger technique in eight patients, with the ‘figure-of-eight’ suture being used for stabilisation of the central catheter and haemostasis. We left the suture as long as the central catheter sheath remained since the central catheter is smaller in diameter than previously inserted sheath, we might see leakage. We did not encounter and discomfort in that because the central catheter’s tip would also create pressure, and it did not require a very tight and much tissue piece.