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[Deep hypothermia for the correction of a congenital cardiac defect complete with atrioventricular block]
Insights
Deep hypothermia effectively corrects complex congenital heart defects, even with pre-existing heart rhythm issues. This technique ensures stable physiological parameters during surgery for conditions like isomerism and atrioventricular block.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Medical Technology
Background:
- Congenital cardiac defects require complex surgical interventions.
- Deep hypothermia is a known technique for cardiac defect correction.
- Pre-existing rhythm abnormalities can complicate surgical management.
Observation:
- A neonate presented with left atrial isomerism, dextrocardia, and complete atrioventricular block.
- The patient experienced heart failure and required temporary pacing.
- Surgical correction involved a Mustard operation under surface deep hypothermia with total circulatory arrest.
Findings:
- The surgical procedure was successful despite the complex congenital cardiac malformation and complete atrioventricular block.
- Physiological parameters remained stable throughout the deep hypothermia procedure, even with a very low heart rate.
- A permanent pacemaker was implanted, and the patient recovered well postoperatively.
Implications:
- Surface deep hypothermia is a viable and safe technique for complex congenital heart defect repair in neonates, even with complete atrioventricular block.
- This approach allows for stable intraoperative conditions, facilitating successful surgical outcomes.
- The case highlights the successful management of a rare and complex cardiac anomaly using established and advanced surgical techniques.
Abstract:
The techniques of deep hypothermia for correction of congenital cardiac defects are well known in many cardiac centers and many cases can be treated even if there are pre-existing rhythm troubles. Our patient had the following diagnosis: left atrial isomerism, dextrocardia; left sided azygos continuation of inferior vena cava; left and right superior venae cavae, hepatic veins, pulmonary veins, all draining into a common atrium; d-loop with normally related ventricles; ventriculo-arterial concordance, small VSD. In addition complete a-v block was present. The patient, 40 days old and 3.4 kg., in heart failure, was paced with a temporary transvenous catheter at 130/min and, afterwards, catheterized. Surgery was undertaken three days post-catheterization using surface deep hypothermia. A Mustard operation, including enlargement of the new left atrium with PTFE (Goretex), was performed during total circulatory arrest. At the end, a permanent pacemaker was positioned in the abdomen and epicardial wires were left on the right ventricle. The postoperative period was uneventful and the patient is doing well 3 months latter. The interest of the case is that even in a complex congenital cardiac malformation with complete a-v block, the technique of surface deep hypothermia can be used because all the physiological parameters remain stable during the procedure in spite of the very low heart rate.