Fetal cardiac intervention is in a rapid state of progress now. Attempts are being made to prevent fetal hydrops due to congenital heart defects, to recruit hypoplastic ventricles, to create a two-ventricle circulation after birth, and to remodel the fetal pulmonary vascular bed whose outlet is obstructed. Open heart surgery in the fetus has yet to be done successfully, but interventions for improved cardiac outcomes are now being tested. Their outcomes will depend, in large part, on their successful physiological effects. How to measure these and quantitate the effects of our interventions will require further advances in the understanding of these diseases-both their natural and unnatural courses. New ultrasound techniques and assessment tools to assess fetal cardiac wellness could enhance the limited progress in fetal intervention in the heart so far.
Kawasaki disease (KD) is an uncommon multisystem inflammatory disease of children in which the cardiovascular system is involved with a nonspecific vasculitis of the major branches of the aorta including the coronary arteries. Coronary artery aneurysms (CAAs) occur in 20% of untreated patients and may result in acute thrombosis or progressive stenosis of the coronary artery. 1 We describe a case of ruptured giant CAA of the left main coronary artery (LMCA) treated by emergency coronary artery bypass grafting, postoperative extracorporeal membrane oxygenation, and subsequent orthotopic cardiac transplantation.Case report. A 3-year-old white boy was transferred to the Children's Hospital of Philadelphia after 2 weeks of fever, malaise, and poor oral intake. His physical examination showed conjunctivitis, an erythematous oropharynx, and cervical lymph node enlargement. Laboratory findings included a white blood cell count of 20,000 cells//xl, hematocrit of 27%, a platelet count of 835,000 cells/txl, and an erythrocyte sedimentation rate of 75 mm/hr. The electrocardiogram was normal, and the chest radiograph demonstrated small pleural effusions. A twodimensional echocardiogram revealed a 5 mm aneurysm of the right coronary artery and a "giant" (2.5 cm long and 1.5 cm in diameter) aneurysm of the LMCA. Left ventricular function was normal, and there was no mitral regurgitation. Treatment for KD was begun with aspirin and a 2 gm/kg dose of intravenous gammaglobulin (IgG).On hospital day 2, the patient had a cardiac arrest. Electrocardiography revealed electromechanical dissociation; cardiopulmonary resuscitation was initiated, ice was placed on the patient's head, and endotracheal intubation was performed. A stable blood pressure was obtained, and an echocardiogram demonstrated a tense hemopericardium. He was transferred to the operating room, where, after median sternotomy and decompression of the hemo-From the
Cardiac catheterisation continues to play an important role in the long-term management of patients with common arterial trunk and transposition of the great arteries. Although non-invasive imaging has largely eliminated the need for diagnostic catheterisation in newborns with these congenital cardiac lesions, cardiac catheterisation is an important tool for the diagnosis of a variety of problems encountered after surgical intervention, and allows interventions to be performed when feasible. We review the indications for cardiac catheterisation and describe the specifics for various interventional procedures for these patients in this manuscript.
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.