Background: Fast-track recovery protocols in cardiac surgery is gaining worldwide popularity and have contributed to significant reductions in the postoperative hospital stay and cost without any increase in postoperative mortality and morbidity. The aim of this study was to find out the feasibility of fast track paediatric cardiac surgery in Bangladeshi setting. Method: It was a prospective study conducted in National Institute of Cardio-vascular Diseases, Dhaka, from July 2009 to June 2010. All patients, between 3 to 18 years, underwent surgical closure of atrial or ventricular septal defect under cardio-pulmonary bypass. 20 patients from our unit served as fast track group and 30 patients from other units of the same hospital served as conventional group. Fast track patients were extubated in less than 6 hours after surgery, shifted from ICU in less than 24 hours and geared up to discharge home within 3 days of surgery. Result: 18 (90%) of the 20 patient of the fast track group were discharged within 3 days of surgery, 2 patients cannot be discharged within this time frame. Mean post operative hospital stay for study group was 3.1 days, whereas the mean hospital stay in the control group was 7.5 days. Follow-up was 100% complete at 30 days. There was no major in-hospital or out-of-hospital complications in either group. No patient was readmitted at our centre or elsewhere for any complication arising from this process. Conclusion: Fast tracking is feasible and safe in low-risk paediatric open-heart surgery in Bangladeshi scenario. A multidisciplinary approach with a set protocol is required to achieve this goal in a safe and reproducible manner. Keywords: Cardiac surgery; Congenital heart disease; Fast track; Hospital discharge. DOI: 10.3329/cardio.v3i1.6427Cardiovasc. j. 2010; 3(1): 50-54
Left atrial myxomas are benign, slow-growing primary cardiac tumors. They present with gradual onset of one or more of a triad of obstructive, embolic, or constitutional symptoms. Echocardiography aids in the detailed preoperative and intraoperative evaluation of the myxoma for surgical strategy planning. We describe a case of interstitial hemorrhage in a left atrial myxoma leading to rapid expansion of the tumor with features of acute, mitral valve obstruction. Echocardiography showed a cystic area in the left atrial tumor that corresponded to an area of recent hemorrhage confirmed on surgical removal. A 42 yrs old housewife presented with severe dyspnoea, cough and chest pain for 7 days, after detail evaluation she was diagnosed as a case of left atrial myxoma with heart failure. Subsequently she underwent emergency open heart surgery under cardiopulmonary bypass; removal of a huge LA myxoma was done, and recovered uneventfully.Cardiovasc. j. 2016; 8(2): 155-157
Closure of patent ductus arteriosus (PDA) with device or coil is presently the first line of therapy.but it has got different acute and late complications. A 3 years old male child presented with history of percutaneous closure of the PDA Amplatzer device 18 months back. Now he presented with dislodgement of the device to descending thoracic aorta and reappearance of a large PDA. The child underwent surgical closure of PDA and removal of the device from descending thoracic aorta. We are presenting this case as one of the uncommon late complications of device closure of PDA.Cardiovasc. j. 2016; 8(2): 158-160
TAPVC is characterized by the failed union of the pulmonary veins with the developing left atrium in combination with a persistent embryologic connection between the pulmonary and systemic venous system. 1 The impact of the pulmonary circulation depends on the degree to which the pulmonary venous derainage is obstructed and the magnitude of the left to right shunt. 1 TAPVC is a rare congenital anomaly, corresponding to approaximately 2% of all congenital heart defects. A recognized classification divides TAPVC into four groups according to the site of connection. With type I, having a supracardiac connection (50%), the common pulmonary trunk joins the left vertical vein, the innominate vein or the superior vena cava. With type II, having a cardiac connection (30%), the anomalous pulmonary venous drainage enters the coronary sinus and flows directly into the right atrium. With type III, the site being infracardiac (15%), connection occurs to the portal vein, venous duct, or inferior vena cava below the diaphragm. With type IV, a mixed site variety (5%), the anomalous venous return occurs at several levels. Pathophysiologically, these four types are subclassified according to whether the pulmonary venous return is obstructed or nonobstructed. 2 Case Report: A two and half years aged female baby was admitted to our department because of respiratory distress and cyanosis and severe pulmonary artery hypertension. She weighs 12 Kg and her general condition was poor. A systolic murmur was noted. Chest radiography showed pulmonary venous congestion with interstitial and alveolar edema. Echocardiography revealed that the right atrium, right ventricle and left atrium could not be identified, coronary sinus was found to be narrow in size. There was 15mm defect in interatrial septum and right to left shunt was seen through the defect. There was supracardiac TAPVC and there was a PDA with left to right shunt. Pulmonary artery systolic pressure was observed 95mm Hg.Catheter angiographic examination was undertaken and the diagnosis was confirmed, it was supracardiac TAPVC with ASD secundum with obstruction at the level of vertical vein in between the LPA and left principal bronchus with severe PAH. But in case of pulmonary hypertension due to pulmonary venous obstruction it carries an increased risk.
The association of Down syndrome (DS) with congenital cardiovascular malformation is well established. Complete atrioventricular septal defects have been associated most commonly with DS. There are also reports of VSD, ASD, TOF and PDA with DS. We here reported two patients of Down syndrome with ventricular septal defect (VSD), underwent repair of VSD, diagnosis was suggested by echocardiography and confirmed by surgery and chromosomal study. Both the patient discharged from hospital with good result. Survival and quality of life have been improving in patient with Down syndrome after repairing VSD. Key words: Down syndrome; Ventricular septal defect. DOI: 10.3329/cardio.v3i1.6438Cardiovasc. j. 2010; 3(1): 107-109
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