A 3 1/2-year-old female child presented with massive hemoptysis 5 months after a modified Blalock-Taussig (BT) shunt for double-outlet right ventricle with pulmonary stenosis. Computerized tomographic scan and angiography showed a false aneurysm of the subclavian artery at the insertion of the shunt. Successful surgical management is discussed.
This study emphasizes the importance of the baseline PAP in MS to which was proportionate the functional disability and the cardiac chamber alterations (except LA). Their postoperative improvement accompanying the PAP regression differed in degree and time frame relative to PAP. The higher pressure group showed greater regression, but greater prevalence of residual abnormalities, suggesting that the pathologic changes in them might take longer to resolve, necessitating further evaluation.
Infants with atrial septal defects are seldom symptomatic and usually require elective surgery between 2 and 4 years of age. However a small minority is symptomatic and management at this age has been controversial. This study evaluated surgical closure of atrial septal defect below 2 years of age. Eighteen infants with a mean age of 13.4 +/- 5.7 months were operated on for secundum atrial septal defect from 1994 to 2001. Fourteen patients were symptomatic with failure to thrive in 7 and recurrent respiratory infections in 7, one had increasing cardiomegaly, and 3 were operated on early for social reasons. The defect was isolated in 11 patients (61%) and the other 7 (39%) had minor associated lesions requiring additional procedures such as ductal ligation, direct closure of a tiny ventricular septal defect, and inspection of the mitral valve. There were no early or late deaths. The postoperative course was complicated by pulmonary problems in 4 cases. Of the 16 patients available for follow-up, 14 were asymptomatic and 2 were symptomatically improved. Most showed a dramatic improvement in growth and development. These gratifying results indicate that consideration should be given to early surgical closure of atrial septal defect in symptomatic infants.
A 2-year-old male child presented with fever, complete heart block, and congestive cardiac failure. Echocardiography showed a dumbbell-shaped mass in the right ventricle and right atrium. He was operated on with a provisional diagnosis of rhabdomyoma. Histopathology and immunohistochemistry of the resected tumor revealed a malignant germ cell tumor with predominant yolk sac differentiation.
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