Correction of cor triatriatum sinistrum in a Jehovah's Witness infant

Area of Science:

• Pediatric Cardiology
• Cardiac Surgery
• Cardiovascular Physiology

Background:

• Cor triatriatum sinistrum is a rare congenital heart defect requiring surgical intervention.
• Management of pediatric cardiac surgery in patients with religious objections to blood transfusion presents unique challenges.
• Erythropoietin therapy can be utilized to optimize hemoglobin levels preoperatively.

Observation:

• A 14-week-old infant diagnosed with cor triatriatum sinistrum required surgical correction.
• The infant belonged to a Jehovah's Witness family, necessitating a bloodless surgical approach.
• Preoperative erythropoietin treatment was administered to achieve a target hemoglobin level of 14 g/dl.

Findings:

• Surgical correction was successfully performed using cardiopulmonary bypass without blood product transfusion.
• Postoperative modified ultrafiltration maintained adequate hemoglobin levels (11.5 g/dl).
• The infant demonstrated rapid recovery, extubation on the same day, and discharge on postoperative day 8.

Implications:

• This case highlights the feasibility of successful surgical management of cor triatriatum sinistrum in infants without blood transfusions.
• It underscores the importance of multidisciplinary planning and patient-centered care in managing complex pediatric cardiac conditions within specific ethical frameworks.
• Long-term follow-up confirmed good recovery, with the child in sinus rhythm and developing well two years post-surgery.