Mustard surgery three months after a covid-19 infection: a case report

Introduction: This past year, on a global scale, since 2019, public health warnings have gone off because of the recent epidemiological crisis set of the Covid-19 pandemic. This pandemic holds responsibility for millions of infections, manifesting broadly in its clinical presentation, which ranges from asymptomatic carriers to respiratory failure, myocardial pathology and death; increasing the rates of hospitalization. Pediatric patients are at high risk of contracting the disease including those with congenital cardiomyopathy that are in need of surgical intervention in order to survive. Objective: Show that there exists an opportunity for elective surgical treatment and short term and medium term recovery in these patients in spite of respiratory and cardiovascular sequelae. Case presentation of an eleven-month infant diagnosed with Transposition of the Great Vessels, who after three months of idleness for having tested positive for Covid-19, received definitive surgical care for the initial diagnosis. Results: The perioperative strategy was based in the probable sequelae due to the infection. There are not respiratory complications like consequence for the previous lung injury. The auriculoventricular dysfunctional immediate post-operative was related with the surgical technique. Conclusion: A period no less than three months could be offer security for surgery using extracorporeal circulation in pediatric patients who suffered covid-19. Patient with favorable post-op prognosis resulting from the work of a multi-disciplinary team that met all challenges of the complications inherent in the post-operative period following a complex cardiovascular surgery along with those of a potentially fatal virus.

Diagnosis and Outcome of Cardiac Paragangliomas: A Retrospective Observational Cohort Study in China

Background: Cardiac paragangliomas (CPGLs) are rare neuroendocrine tumors that are easily overlooked and difficult to diagnose. Detailed comprehensive data regarding CPGL diagnosis and outcome are lacking.Methods: We retrospectively analyzed a cohort of 27 CPGL patients. This cohort represents the largest such cohort reported to date.Results: The prevalence of trilogy symptoms (concurrent palpitations, hyperhidrosis, and headache) was frequent (9/27, 33.3%). Sensitivity of echocardiography and contrast-enhanced computed tomography for localization of CPGL were 81.8% and 87%, respectively. Octreotide scintigraphy showed 100% sensitivity for detecting GPCLs, while sensitivity of I131-metaiodoben-zylguanidine scintigraphy was only 32.9%. Multiple tumors were found in 29.6% of patients. Most CPGLs originated from the epicardium or root of the great vessels (92.9%) and were mostly supplied by the coronary arteries and their branches (95.7%). Twenty-four patients underwent surgical treatment. Although local invasion was present in 40.0% of patients, it did not affect long-term outcome. Mean follow-up was 6.9 ± 3.6 years. Biochemical remission was achieved in 85% of patients. The recurrence rate was 15%.Conclusions: Manifestations of CPGLs are non-specific and they can be difficult to detect on imaging examinations. Octreotide scintigraphy should be performed in patients with suspected paragangliomas to screen for multiple lesions. Surgical resection of CPGLs can achieve symptom relief and biochemical remission.

Mustard Surgery Three Months after A Covid-19 Infection. A Case Report

Introduction: This past year, on a global scale, since 2019, public health warnings have gone off because of the recent epidemiological crisis set of the Covid-19 pandemic. This pandemic holds responsibility for millions of infections, manifesting broadly in its clinical presentation, which ranges from asymptomatic carriers to respiratory failure, myocardial pathology and death; increasing the rates of hospitalization. Pediatric patients are at high risk of contracting the disease including those with congenital cardiomyopathy that are in need of surgical intervention in order to survive. Objective: Show that there exists an opportunity for elective surgical treatment and short term and medium term recovery in these patients in spite of respiratory and cardiovascular sequelae. Case presentation of an eleven-month infant diagnosed with Transposition of the Great Vessels, who after three months of idleness for having tested positive for Covid-19, received definitive surgical care for the initial diagnosis. Results: The perioperative strategy was based in the probable sequelae due to the infection. There are not respiratory complications like consequence for the previous lung injury. The auriculoventricular dysfunctional immediate post-operative was related with the surgical technique. Conclusion: A period no less than three months could be offer security for surgery using extracorporeal circulation in pediatric patients who suffered covid-19. Patient with favorable post-op prognosis resulting from the work of a multi-disciplinary team that met all challenges of the complications inherent in the post-operative period following a complex cardiovascular surgery along with those of a potentially fatal virus.

Is combined MDCT and echocardiography needed to guarantee accuracy in diagnosis and surgical planning of DORV and associated anomalies?

Background The term of Double-outlet right ventricle (DORV) is used to describe a spectrum of complex congenital cardiac malformations where anomalies of the ventriculo-arterial alignment are noted where both great arteries (pulmonary artery and aorta) originate completely or predominantly from the right ventricle. The purpose of this study is to evaluate the diagnostic accuracy of electrocardiography (ECG) gated multidetector computed tomography (MDCT) in preoperative assessment of DORV and its associated malformations, providing key anatomic parameters that affect surgical planning. Results A total of 50 patients diagnosed by echocardiography with DORV referred from our institute between September 2018 and August 2020 were enrolled. The location of the ventricular septal defect (VSD) to the great vessels and the alignment of the great vessels to each other as well as other associated malformations that affect the surgical planning were assessed by MDCT. The patients were retrospectively classified into subgroups according to the relative positions of the great arteries, the relationship between the great arteries and the VSD, and the presence of associated malformations according to the classification of Society of Thoracic Surgeons database. The diagnostic value of MDCT and transthoracic echocardiography (TTE) in evaluation of associated cardiac malformations apart from double outlet right ventricle was compared in 20 patients, whom surgeries were performed and surgical results were obtained. Fallot type of DORV was the most common clinical type which represented 48% of the patients in which the VSD is committed to the aorta. The second most common clinical type was Taussig–Bing anomaly which represented 30% of the patients and the VSD was seen committed to the pulmonary artery. The atrio-ventricular septal defect (AVSD)/uni-ventricular type represented 16% of the patients in the current study, with pulmonary and systemic venous anomalies, heterotaxy syndrome and situs anomalies were commonly associated. A total of 53 malformations apart from DORV were found in 20 patients whom performed surgical interventions. MDCT detected different vascular and situs anomalies in those patients with 100% sensitivity and 100% positive predictive value compared to 71.4% and 94% respectively in TTE. On the other hand, in our study TTE was superior to MDCT for detection of intracardiac anomalies with 100% sensitivity and 100% accuracy compared to 87.5% and 95% respectively in MDCT. Conclusions Our study suggested that ECG gated MDCT serves as a rapid, noninvasive imaging modality with good spatial resolution and provides excellent diagnostic image quality and has satisfactory diagnostic accuracy in the preoperative assessment of DORV. It is superior to echocardiography in providing a comprehensive mapping of the anatomy of complex anomalies especially that of extra-cardiac structures such as aorta, systemic veins, pulmonary veins, and pulmonary arteries. However, it can miss tiny intracardiac malformations. So combining the results of MDCT and echocardiography would be beneficial to guarantee the accuracy of diagnosis of DORV.

Acute Cardiac Tamponade Secondary to Cardiac Vascular-Type Pleomorphic Leiomyosarcoma: Case Report

Soft tissue sarcomas represent <1% of all neoplasms. Leiomyosarcomas comprise only 5–7% of cases, and only 2% of these are vascular. Vascular leiomyosarcomas are extremely rare and represent only 0.001% of all neoplasms, the venous type being up to 5 times more frequent. Arterial leiomyosarcomas most frequently affect the great vessels, being fatal in most cases. In the reported cases of arterial leiomyosarcomas, the most frequently affected site is the pulmonary artery. We present the clinical case of 2 patients (a 42-year-old woman and a 36-year-old man) with a diagnosis of arterial pleomorphic leiomyosarcoma that conditioned cardiac tamponade as the initial manifestation. As it is an exceptionally rare neoplasm and with few cases reported in the literature, it is important to identify and describe this pathology which, due to the impossibility of offering surgical treatment, represents a therapeutic challenge.

The Value of Transthoracic Echocardiography in the Detection of Extra-Cardiac Lesions

Objective: Transthoracic echocardiography (TTE) is generally recognized as the top choice for detecting myocardial and cardiac cavity lesions. Sonographers mostly focus on myocardial, cardiac cavity and cardiac hemodynamics, whereas the abnormal extra-cardiac lesions are always unrecognized. The aim of this study was to investigate the ultrasonic image features in abnormal extra-cardiac lesions and the value of TTE in the detection of extra-cardiac lesions.Methods: 49 cases of abnormal extra-cardiac lesion detected by TTE from January 2014 to December 2019 were collected, which were confirmed by pathology. The two-dimensional ultrasonic characteristics and the relationships with the cardiac and great vessels were summarized on the basis of multi-view by TTE. All patients were also performed by computed tomography (CT). Results: In 49 patients with abnormal extra-cardiac lesions, 37 malignant cases and 12 benign cases were included. There were 41 cases (41/49,86.67%) of mediastinal lesions and 8 cases (8/49,16.33% ) of lung lesions. The maximum diameter ranged from 3.2cm to 13.66cm, and the median diameter was about 7.4cm, among which 29 cases (29/49,59.18%) were larger than 5cm. 4 cases (4/49, 4.08%) of cystic anechoic lesions were pericardial cyst. 2 cases (2/49, 4.08%) of cystic-solid echogenic lesions were teratoma. The remaining 45 cases (45/49, 91.84%) presented as solid hypoechoic or heterogeneous masses. 6 cases compressed the heart and 21 cases encroached on the heart and vessels. Diagnosis coincidence rates of TTE and CT were respectively 77.55% and 93.88%, with a statistical difference (p =0.012).Conclusion: Although the diagnostic coincidence rate of TTE is slightly lower than that of CT, TTE has certain diagnostic value for extra-cardiac lesions.

Stiff “Left Atrial” syndrome post-mustard procedure

Objectives: We describe the clinical course and management of two patients with post-capillary pulmonary hypertension due to diffuse pulmonary venous baffle calcification decades post-Mustard procedure. Background: From the late 1950s to the early 1990s, the definitive surgical repair for children with D-transposition of the great vessels (D-TGA) was an atrial switch procedure (either Senning or Mustard operation) which utilizes atrial-level baffles to shunt pulmonary venous blood to the morphologic right (systemic) ventricle and caval blood to the morphologic left (sub-pulmonary) ventricle. From a hemodynamic standpoint, baffle leaks and stenoses as well as precapillary pulmonary hypertension have all been described as both early and late complications [1]. Recently, delayed post-capillary pulmonary hypertension (in the absence of discrete baffle obstruction) decades post-atrial switch has also been described [2]. The underlying pathophysiology for this postcapillary pulmonary hypertension is unclear but is theorized to involve impaired diastology referable to the pulmonary venous baffle. Methods/Results: Using hemodynamic and imaging data, we describe two patients with extensive pulmonary venous baffle calcification and resultant pulmonary hypertension from the so-called “stiff left atrial (LA) syndrome.” This problem can be difficult to treat medically and is not amenable to catheter-based interventions. We hypothesize that this is an underlying mechanism for pulmonary hypertension in at least some post-Mustard and Senning patients. Conclusion: We describe the treatments and clinical course for each of these patients, and in particular describe how the surgical revision of the pulmonary venous baffle in one case led to the complete resolution of symptoms.

Chylooperitoneum in the cardiovascular possurgical. Presentation of a case

Introduction: Chyloperitoneum is defined as the presence of lymph of thoracic or intestinal origin in the abdominal cavity. It is reported infrequently and is a rare manifestation of multiple deseases. Most of the cases are secondary and are associated with direct trauma to the peritoneal dialysis. Renal replacement therapy is necessary in up to 10% of children who undergo cardiac surgery with extracorporeal circulation, indicated in cases of water overload, acute renal dysfunction or ionic alterations. Objective: To report the case of a 15-day-old newborn, operated on for Transposition of the Great Vessels, who presented as a postoperative complication, dicharge of chylous content through the Tenckhoff, after a peritoneal dialysis regimen due to acute renal failure and fluid overload. Results: Despite the therapeutic measures taken, the patient maintains centuries-old losses of lymph, which lead to nutritional and immunological deterioration with the consequent multiple organ dysfunction and death. Conclusions: The perpetuation of lymph losses in the postoperative period of cardiovascular surgery produces a nutritional and immunological deterioration of the patient, with a high risk of mortality due to sepsis.