Erle H. Austin, MD Kosair Childrens Hospital Louisville,
Kentucky
A Few Examples Erle H. Austin, MD Kosair Childrens Hospital
Louisville, Kentucky No Disclosures Patient # 1 Newborn female 37
wks; 2.8 kg; Apgars 7/8
Heart murmur; pink with blue spells Echo: PA, VSD, right aortic
arch, atypical PDA Cardiac cath at 4 days of age Discharged age 13
days 4 Days Old-Cath 4 Days Old-Cath 7 Months Old- Cath 7 Months
Old- Cath 10 Months Old - Surgery Median sternotomy
Unifocalization of central PAs and MAPCAs Small native LPA ( &
tiny native RPA) Dissected off CPB L and R inferior MAPCAs; R
superior MAPCA Dissected on CPB small fragile vessels; all probed
at completion VSD closure 12mm RV-PA conduit (pulmonary homograft)
Atrial septal fenestration 10 Months Old - Surgery cont.
Separated from CPB with good sats/BP TEE good function, no residual
VSD RV pressure !!! % LV pressure !!! VSD patch fenestration
Discharged POD#11 2 Years Old Qp/Qs = 0.52 7 Years Old Patient # 2
Newborn male Full term; 4.4 kg; Apgars 9/9
Heart murmur; 93% sats with desat episodes Echo: PA, VSD, right
aortic arch, probable MAPCAs Cardiac cath at 4 days of age 4 Days
Old- Cath 5 Days Old - Surgery Median sternotomy 4mm central
shunt
Ascending aorta to native central PA Brizard et al. Semin Thorac
Cardiovasc Surg Pediatr Card Surg Ann 12: Still on the ventilator
!!!
13 Days Old Still on the ventilator !!! 14 Days Old-Cath Qp/Qs =
8/1 14 Days Old - Surgery Left Thoracotomy
Banding of large branch right MAPCA Banding of large branch left
MAPCA Patient #2 Extubated 2days later Discharged at 2 months of
age 10 Months Old-Cath Qp/Qs = 1.3/1 12 Months Old - Surgery Redo
left thoracotomy Redo median sternotomy
Identify left-sided MAPCAs Ligation origin MAPCA from left
subclavian Redo median sternotomy Unifocalization of left-sided
MAPCAs Patch angioplasty of native right PA Placement of 8mm RV-PA
Gore-Tex conduit Discharged POD#8 21 Months Old-Cath Patient # 3
Newborn male 37 wk; 3.6 kg; Apgars 8/8 Fetal dx: TOF/PA
II/VI systolic murmur;Sats low 90s Echo: TOF/PA, typical PDA,
confluent 4.2mm PAs; ?MAPCAs? PGE1 Cardiac cath at 2 days of age 2
Days Old-Cath 3 Days Old - Surgery Median sternotomy
Right modified BT shunt (3.5 mm) ?Ductus? Not ligated 22q11
deletion Discharged POD#23 5 Months Old-Cath