Assuming that undiscovered anatomic and/or hemodynamic issues would have had a strong negative influence on survival, we may conclude that the risk-benefit ratio was positive and favorable. Catheter studies during ECLS are safe and should be performed expeditiously when diagnostic questions cannot be resolved by noninvasive means.
A 14-year old boy was admitted with an anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva, with an interarterial course of the narrow proximal segment. He underwent coronary ostial augmentation and main pulmonary artery translocation to the left pulmonary artery. In the post-cardiopulmonary bypass (CPB) period, he developed thrombotic occlusion of the RCA resulting in arrhythmia and ventricular dysfunction, requiring extracorporeal life support (ECLS) in the form of extracorporeal membrane oxygenation rather than CPB. After confirming this complication by cardiac catheterization, the right coronary artery territory was revascularized with a pedicled right internal thoracic artery graft. The entire procedure was performed on a beating heart using a stabilizer during ECLS. This strategy may be useful in situations with unstable haemodynamics and a low risk of blood loss.
A nine-year-old boy with incomplete atrioventricular septal defect (AVSD) and Ebstein's anomaly had undergone a closure of primum atrial septal defect and repair of right and left AV valves at four years of age. He presented with severe regurgitation of the right AV valve. He underwent further surgery, and a cone reconstruction of the right AV valve was performed. The association of Ebstein's anomaly with AVSD has been reported only rarely. We present a case of this association treated with the previously unreported application of the cone reconstruction (da Silva repair) as a secondary strategy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.