Surgical correction of a ventricular septal defect in a child with spinal muscular atrophy type 2 treated with nusinersen sodium: a case report

Abstract

Introduction Spinal muscular atrophy (SMA) is a severe, inherited neuromuscular disorder characterized by progressive muscle weakness and atrophy. Cardiac pathology co-existence is reported more frequently in the severely affected patient groups. Structural heart anomalies, mainly septal, and outflow tract defects are commonly observed pathologies. Case presentation We herein report the case of a 23 days-old female patient with the diagnosis of spinal muscular atrophy type 2 complicated with structural heart defects. Successful pulmonary banding, and at the age of 17 months, subsequent surgical atrial and ventricular septal defect closure were performed on our patient who was under treatment of Nusinersen Sodium. Post-operative recovery was uncomplicated. Cardiac assessments were normal, and the patient was neurologically improving in her recent follow-up. Conclusion In the literature, there are no reported cases of successful surgical repair of heart defects in spinal muscular atrophy patients. These patients can be perceived as risky surgical candidates with suboptimal postoperative recovery given the unfavorable disease prognosis of SMA in untreated patients. We report our promising experience with a SMA type 2 patient undergoing a disease-modifying medical treatment. The SMA patients under treatment may be potential candidates for successful surgical cardiac correction given their overall improved prognosis.

Motor Neuron Disease and Delicate Anesthesia Choices – Anesthesia for Motor Neuron Disease Patients

“…Likewise, there are two cases of general anesthesia for surgical correction of heart defects in SMA type II patients [38]. A 23-day-old SMA type 2 patient successfully underwent pulmonary banding and patent ductus arteriosus ligation with 4 mg thiopental, 4 mg fentanyl, and 1.5 mg rocuronium being used for anesthesia induction and maintenance [38].…”

“…Likewise, there are two cases of general anesthesia for surgical correction of heart defects in SMA type II patients [38]. A 23-day-old SMA type 2 patient successfully underwent pulmonary banding and patent ductus arteriosus ligation with 4 mg thiopental, 4 mg fentanyl, and 1.5 mg rocuronium being used for anesthesia induction and maintenance [38]. Atrial and ventricular septal defect closure and pulmonary artery reconstruction were performed on a 17-month-old patient using rocuronium, pentothal, dormicum, and fentanyl, with maintenance via 0.1 mg/kg/h precedex and 0.6-0.7 minimum alveolar concentration (MAC) of sevoflurane [38].…”

“…Atrial and ventricular septal defect closure and pulmonary artery reconstruction were performed on a 17-month-old patient using rocuronium, pentothal, dormicum, and fentanyl, with maintenance via 0.1 mg/kg/h precedex and 0.6-0.7 minimum alveolar concentration (MAC) of sevoflurane [38]. Both patients were extubated and recovered uneventfully [38].…”