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PEDIATRIC HEART SURGERY
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PEDIATRIC HEART SURGERY

Posted By  CCF Cardio MD-SGM on October 14, 1997 at 15:36:06:

In Reply to: PEDIATRIC HEART SURGERY posted by SRICHAND D SABNANI on October 12, 1997 at 11:42:37:

:
  MY SON MASTER ANKIT SABNANI  AGE 8 YEARS MALE IS HAVING
  CONGENITAL HEART DISEASE
  .
  ECHO REPORT IS AS FOLLOWS.
  ===========================
  M-Mode & 2D Examination revealed presence of normal situs with normal veno-atrial connections. Retro aortic innominate view.
  Two atrioventricular valves are placed normally between respective atria & ventricles. Ventriculoarterial connections concordant. Small PFO with L_R flow. Large anterior malalignment conoventricular VSD with aortic override. Blind RVOT.
  Left ventricle is normal in size, and shows normal contractility. Global LVEF is normal . Both leaflets of mitral valves show normal motion during diastole No Sam or mitral valve prolapse is seen. Mitral valve opening is normal . Aortic valve has three cusps which are not thickened and closure line is central. Aortic valve opening is not restricted. Tricuspid value leaflets shows normal motion. Pulmonary valve is normal. No intracardia mass or thrombus is seen. No pericardial pathology is observed . Right aortic arch. Large collateral arises from descending aorta and supplies both PAS. Confluent PAS. RPA 7mm, LPA 7mm,
  DOPPLER:
  -----------------
  Continuous flows in both PAS
  L-R flow across PFO
  COLOUR FLOW.
  --------------------------
  Colour Flow imaging revealed :-
  1, Bidirectional flow across VSD.
  FINAL DIAGNOSIS.
  M mode 2-D and colour Doppler echo cardiography.
  of Mast . Ankit Shrichand Sabnani revealed.:-
  1. TOF, Pulmonary atresia.
  2. Large aortic pulmonary collateral with filling of both PAS
  3. Confluent but small pulmonary arteries.
  
  ANGIOGRAPHY REPORT  dated 13/069/97
  =================
  DIAGNOSIS
  Normal atrial arangement
  Tetralogy of Fallot with pulmonary atresia
  PREVIOUS SURGERIES & INTERVENTIONS
  ======================================
          None
  PRESSURES AND SATURATION
  ============================
   SITE                 BASAL
  -------------------------------------------------------
                 S/a      D/v      M       SAT     PO2    O2C
  -----------------------------------------------------------------------------------
    
  LPA        100       56       80  
  ------------------------------------------------------------------------------------
  RPA        100      60        80
  -------------------------------------------------------------------------------------
  LV           100        8
  -------------------------------------------------------------------------------------
  AAO        100      60        80       91         -        17.33
  ------------------------------------------------------------------------------------------    
  CONTRAST Agent :   Urograffin.
  ===========================
  LV   (  0  )  RV    (  0  )   LA  (  0  )  RA  (  0  )       SVC  (  0  )   IVC  (  0  )
  PV  (  0  )  PVW (  0  )  PA   (  0  )  AO  ( 28 )   MAPCA ( 60  ) SHUNT ( 0  )
  TOTAL  ( 88  )  

  ANGIOGRAM
  ---------------------
  Aortogram- Two large MAPCAS from the descentding aorta filling the native  right and left pulmonary artery which are confluent. These MAPCAS do not  show any stenosis throghout its course.
  
  FINAL DIAGNOSIS.
  ------------------------------
  Situs solitus. AV concordance. Tetralogy of Fallot with pulmonary atresia Large nonobstructed  MAPCAS. Severe bilateral pulmonary hypertension.
  PROCEDURE
  -----------------------
  Diagnostic Study.
  
  COMPLICATIONS
  -----------------------------
          Nil.
  
  COMMENTS
  ---------------------
  Selective entry into the right and left pulmonary artery via the MAPCAS revealed systemic pressures.
  PLAN
  ---------
  Medical follow up ?  MAPCA ligation
  KINDLY INFORM IF SURGERY IS RECOMMENDED AT THIS STAGE .
  WHETHER SURGERY WILL BE OF ANY HELP TO THE CHILD.
  KINDLY RECOMMEND US THE BEST HOSPITAL/ SURGEON IN USA.
  SPECIALIZED IN ABOVE FIELD
  KINDLY E_MAIL US IF ANY BODY CAN HELP US REGARDING THIS MATTER.  
  THANKING YOU IN ADVANCE.
  E-mail  :  ***@****
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-
Dear Mr. Sabnani,
Your description of your son's condition represents a very specific problem in the field of congenital heart disease.   Surgical correction would ideally have been performed at a younger age.  The concern correction at this time is fixed pulmonary hypertension, which
would make surgery less likely to be successful, and more complex.  
I recommend that your cardiologist contact Dr. Roger Mee, a preeminent pediatric cardiac surgeon at the Cleveland Clinic Foundation.  Upon reviewing the films, xrays, and echocardiographic data, Dr. Mee could make an expert recommendation regarding therapy at this time.  Your cardiologist can reach him through the Cleveland Clinic at (USA prefix)  1-800-CCF-CARE  (1-800-223-2273).




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