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Unexpected ST segment changes in children--a case report
Andrej Alfirevic1, Emad Mossad, Julie Niezgoda
1Division of Anesthesiology and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Insights
Myocardial ischemic changes are rare in healthy children during anesthesia. A case report highlights pulmonary arteriovenous fistula as a potential cause of hypoxemia and paradoxical embolism.
Area of Science:
- Pediatric Anesthesiology
- Cardiology
- Pulmonology
Background:
- Myocardial ischemic changes during anesthesia are uncommon in children without pre-existing conditions.
- This case involves a healthy child undergoing adenoidectomy and bilateral tympanostomy.
Observation:
- The patient exhibited significant ST changes and experienced intraoperative and postoperative hypoxemia.
- Echocardiography suggested intrapulmonary right to left shunting.
Findings:
- Pulmonary arteriovenous fistula is suspected as the primary cause of hypoxemia and paradoxical air embolism during positive pressure ventilation.
- Anomalous coronary artery origin is also considered as a potential cause for ST segment changes.
Implications:
- Further diagnostic work-up is crucial to rule out underlying pathologies, even if initially inconclusive.
- Long-term follow-up is essential for understanding these potentially fatal, often subclinical conditions.
Abstract:
In children, myocardial ischemic changes during anesthesia are a rare event unless there is underlying pathology. The patient in this case report was an apparently healthy child scheduled for adenoidectomy and bilateral tympanostomy. Occurrence of significant ST changes as well as intraoperative and postoperative hypoxemia required further diagnostic work-up. Postoperative echocardiographic findings were suspicious of intrapulmonary right to left shunting. The pulmonary arteriovenous fistula is probably the major pathophysiological factor for the development of hypoxemia and paradoxical air embolism especially during positive pressure ventilation in our patient. Unexpected ST segment changes might also occur in patients with anomalous origin of coronary arteries. Although diagnostic work-up was inconclusive, it is necessary to rule out any underlying pathological process. Further follow-up is also important in order to learn more about these disease states that often have subclinical, but potentially fatal presentation.