Aortopulmonary window combined with double outlet right ventricle (DORV) is a very rare congenital cardiac anomaly. We managed a 5-month-old child weighing 4.5 kg diagnosed as a case of aortopulmoary window (APW) combined with DORV with ostium secundum atrial septal defect (ASD), and bilateral confluent and adequate pulmonary arteries. The surgical correction was planned under general anesthesia. Transesophageal echocardiography (TEE; Philips pediatric S7-3t) in the upper esophageal position with slight anticlockwise rotation detected a communication between ascending aorta and main pulmonary artery [ Figure 1]. The TEE images of APW with DORV are shown in Figures 1 and 2. Aortopulmonary window was arising approximately 1.0 cm above the aortic valve annulus and its diameter measured approximately 10 mm [ Figure 3]. The approximate size of the pulmonary artery and aorta was 13.5 and 12 mm. Under cardiopulmonary bypass, the APW was dissected and transected. Both the openings on ascending aorta and pulmonary artery were closed by continuous suture. The DORV and ASD were corrected. Post cardiopulmonary bypass TEE examination revealed no residual ventricular septal defect (VSD), APW and left/right ventricular outflow tract obstruction [ Figures 4 and 5]. The trachea was extubated after 12 h of mechanical ventilation. The subsequent course was uneventful.Aortopulmonary window is an uncommon anomaly, occurring in 1% of all patients with congenital heart disease. [1] Aortopulmonary
Left atrial myxomas are usually attached to the interatrial septum. This case highlights the unusual site of attachment of left atrial myxoma. The site of attachment was via a broad stalk at the junction of mitral valve annulus close to anterior mitral leaflet and adjacent left atrial wall. Transesophageal echocardiography helped in the detection of site of attachment as well as in postoperative evaluation.
How to cite this article
Makhija N, Irpachi K, Chowdhury UK, Kiran U. Unusual Attachment of Left Atrial Myxoma: Role of Transesophageal Echocardiography. J Perioper Echocardiogr 2016;4(1):30-33.
4 month old female child diagnosed a case of long QT syndrome with recurrent polymorphic ventricular tachycardia (VT) storm with moderate left ventricular (LV) dysfunction with status epilepticus presented with recurrent seizures in an emergency. Patient was intubated and put on mechanical ventilation. Recurrent seizures subsided with intravenous midazolam and anticonvulsants. In view of unstable rhythm, recurrent polymorphic VT storm and unstable haemodynamic, patient required antiarrhythmic agents such as flecainide and multiple inotropic supports. There was frequent pause dependent VT hence it was decided to put on permanent pacemaker. A repeated pacing attempt failed and on table plan for cardiac sympathectomy was made. However, the parents refused for the later. The patient left back with her own rhythm and parents are prognosticated.
Infective endocarditis (IE) accounts for 0.5 to 1 of every 1,000 hospital admissions. This case describes a left atrial mass of fungal etiology mimicking an atrial myxoma. At times, the diagnosis of mass in left atrium can be a challenge, which is discussed in this report.
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