Atypical presentation of extralobar sequestration with absence of pericardium in an adult

Abstract

failure, size of VSD, posterior/inferior locations, and residual VSD. 3 Management consists of VSD closure, coronary artery bypass grafting as needed, and aggressive postcardiotomy and end-organ support. Residual shunts are found in up to 40% of patients. Operative repair is associated with mortality greater than 60%, 4 which has prompted interest in percutaneous closure, but the role of these procedures is still undefined. 5 In our case, the implantation of a biVAD served as a bridge to recovery. By minimizing associated postoperative end-organ damage with cardiac support, we allowed for physiologic recovery so the residual VSD could be successfully closed and the impact of the massive myocardial infarction and associated heart failure could be minimized. Limitations include the need for multiple procedures (ie, device weaning/explant), aggressive anticoagulation in a high-risk patient, and meticulous follow-up.Right ventricular support is critical after the acute volume and pressure overload of a PI-VSD. Recovery may be unpredictable and prolonged, necessitating long-term biventricular support. Short-term univentricular options, such as intraaortic balloon pumps, extracorporeal membrane oxygenation, or left ventricular assist devices, are limited in right ventricle failure and residual shunting. A total artificial heart precludes native cardiac recovery and obligates transplantation; nevertheless, this may be an option with the appropriate resources and experience. ConclusionBiventricular mechanical support, as demonstrated in this complex case, should be considered a useful tool as a bridge to recovery in patients with PI-VSDs.

Rare localized extralobar sequestration with congenital cystic adenomatoid malformation: a case report

“…In patients with ELS, massive intraoperative bleeding due to injured aberrant vessels has been reported [9]. It is therefore very important to identify aberrant vessels to prevent an uncontrolled hemorrhage.…”