Cases reported "Ductus Arteriosus, Patent"

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1/13. Successful use of high frequency oscillatory ventilation for pneumomediastinum.

    An infant with pneumomediastinum due to mechanical ventilation was successfully treated using high frequency oscillatory ventilation (HFOV). The 3-month-old male had undergone ligation of a patent ductus arteriosus and suffered from barotraumatic pneumomediastinum in the postoperative period. Computed tomography of the chest confirmed the diagnosis. While using conventional mechanical ventilation the respiratory failure worsened. HFOV was instituted and the patient improved. A lower airway pressure by this mode of ventilation provided significant advantages in the patient with an air leak. He was subsequently extubated and discharged home.
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2/13. Bronchoplasty for bronchial stenosis in a neonate: a case report.

    Bronchial stenosis is an uncommon problem in children. Management can be difficult because of the small luminal diameter and proximity of the lung parenchyma to the bronchial lesion. Bronchoplasty procedures have obvious advantages in children because of their long life expectancy. Long-term functional results are superior compared with pneumonectomy because of preserved lung tissue. A premature neonate weighing only 779 g at birth was born with severe respiratory distress syndrome complicated with hyperbillirubinemia and bronchopulmonary dysplasia. The child underwent bronchoplasty using a costal cartilage graft for a right main bronchus stenosis after 2 failed attempts at bronchoscopic dilatations. In spite of all complications, the child improved sufficiently to be discharged without any oxygen dependency. Our case highlights the successful application of bronchoplasty in a very small baby. Preoperative and intraoperative bronchoscopy was helpful in localization of the endobronchial lesion. Understanding the principle, precise attention to technical detail and meticulous postoperative care contribute toward long-term benefit for pulmonary conservation.
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3/13. Successful surgical ligation under intraoperative portal vein pressure monitoring of a large portosystemic shunt presenting as an intrapulmonary shunt: report of a case.

    We report a rare case of patent ductus venosus (PDV) with collapsed intrahepatic portal branches and an intrapulmonary shunt. Excellent improvement of the intrahepatic portal vein flow was achieved by ligating the large ductus venosus under intraoperative portal vein pressure (PVP) monitoring. A 3-year-old boy being followed up for hypergalactosemia at a local hospital was found to have mild lip cyanosis, exertional dyspnea, clubbed fingers, and mild liver dysfunction with high levels of transaminase and ammonia. cardiac catheterization indicated an intrapulmonary shunt with a ratio of 33%. Abdominal ultrasonography and computed tomography showed remarkable communication between the portal vein and the inferior vena cava. We performed laparotomy and successfully ligated the PDV under PVP monitoring. The PVP did not increase until the catheter was removed 7 days postoperatively. The patient's liver function test results returned to normal within 2 weeks. His serum galactose level was 0 mg/dl after drinking milk, and his SpO2 in room air and exertional dyspnea also improved. He was discharged 18 days after his operation, without any complications. We propose that ligation of a PDV under PVP monitoring could be a treatment of choice, bearing in mind that PDV is associated with collapsed intrahepatic portal branches.
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4/13. adult patent ductus arteriosus: successful surgical therapy in a rare presentation of a missed finding.

    Delayed clinical presentation of patent ductus arteriosus (PDA) in adults is very rare. The clinical presentation in adults consists of either aortic or pulmonary valve endocarditis. We report the case of 34-year-old patient with a known history of rheumatic heart disease in childhood and chronic heart failure for 5 years who presented with acute heart failure and no evidence of PDA at prior echocardiography. blood cultures grew staphylococcus epidermidis, and echocardiography showed infective endocarditis of both aortic and pulmonary valves in the context of a large and severely inflamed PDA. cardiopulmonary bypass and deep hypothermic circulatory arrest were used to interrupt the PDA from within the pulmonary artery because of inability to ligate the severely inflamed and calcified PDA prior to bypass. Combined pulmonary and aortic valve replacement and high-dose inotropic support were used. dialysis was used for renal failure. The patient recovered and was discharged 10 days postoperatively. Six months later the patient was asymptomatic, and renal failure had resolved. The history and surgical management are discussed with an updated review of the literature.
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5/13. Patent ductus arteriosus with a left to right shunt in a 64-year-old asymptomatic male.

    We report here the unusual case of a 64 year old male, who was incidentally found to have a patent ductus arteriosus (PDA). The patient was asymptomatic. echocardiography revealed a moderate sized PDA with normal left ventricular function and mild pulmonary hypertension. As the patient was asymptomatic and was not willing for any form of intervention, he was discharged and is currently under close follow-up. To the best of our knowledge this is the oldest reported case of a PDA in Indian literature.
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6/13. Hansenula anomala fungemia in an infant with gastric and cardiac complications with a review of the literature.

    A 6-month-old female infant, with a birth weight of 2.74 kilograms, was born with multiple congenital abnormalities, including gastric and gastrointestinal defects. She was admitted to the hospital with hematemesis. The patient could not be fed orally, and parenteral nutrition was initiated through a central venous catheter. Following pyloroplasty, she developed superior vena cava syndrome, renal disfunction and episodes of sepsis. Stool and respiratory specimens were negative for fungi, but four blood cultures yielded Hansenula anomala var. anomala. Cultures for fungi from intravenous catheter tips were negative. The baby was treated with amphotericin b (am B) and 5-fluorocytosine (5-FC), (amB; 0.1 mg/kg body weight and 5-FC, 100 mg, q.i.d.). The minimal inhibitory concentrations of am B, 5-FC, am B 5-FC (1:1, w:w) and fluconazole to H. anomala were 1.56, less than 0.195, 1.56, and 1.56 micrograms, respectively. Following antifungal therapy and removal of the catheter, the patient tolerated oral feeding and, at the time of discharge, her weight had increased to 4.91 kg. This report records H. anomala as an opportunistic yeast pathogen for the first time in alberta, canada. Previously published cases of H. anomala infections are reviewed.
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7/13. Single lung transplantation and closure of patent ductus arteriosus for Eisenmenger's syndrome. Toronto Lung Transplant Group.

    A case report of the first single lung transplantation and closure of a patent ductus arteriosus for Eisenmenger's syndrome is presented. The operation was performed on Sept. 28, 1988. The patient was extubated on postoperative day 8, discharged from the intensive care unit on postoperative day 13, and discharged from the hospital on postoperative day 43, free of symptoms and without supplementary oxygen. Subsequent symptoms of dyspnea, presyncope, and fatigue recurred in association with subvalvular right ventricular outflow tract obstruction. Symptomatic improvement occurred gradually in association with reduction of the outflow tract obstruction. The patient is in new york Heart association class I-II 12 months after the operation. The rationale, methods, and management of this patient are discussed, as well as the potential for application of this operation in similar settings.
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8/13. heart transplantation in repaired transposition of the great arteries.

    Cardiac transplantation was carried out in a 40-year-old man with the diagnosis of repaired transposition of the great arteries and right-sided aortic arch who had end-stage cardiac failure due to myopathy of the ventricles. Because of several previous surgical repairs and the orientation of the great vessels, the operation presented some technical problems. Therefore, modifications of operative procedures were used, including recipient hypothermia, circulatory arrest, and changes in the donor heart implantation. The removal of the donor heart was modified in such a way that the graft included the aortic arch and both pulmonary arteries. With the extra length of ascending aorta and transverse arch, the innominate, left carotid, and left subclavian vessels were excised as a button, thereby leaving the distal orifice of the aorta in the superior portion of the transverse arch. For the recipient, the operation was performed using hypothermic total circulatory arrest to dissect free the huge pulmonary artery and the short right-sided aortic arch to place the clamp. Implantation of the donor heart was modified accordingly. The technical results were confirmed one and a half months later on a control digital angiogram. Thirty-five days postoperatively the patient was discharged. Six months after operation, the patient is doing better than ever before in his life. Our findings suggest that a complicated conotruncal development does not preclude cardiac transplantation.
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9/13. Transcatheter closure of a calcified patent ductus arteriosus in an elderly man.

    Successful transcatheter closure of a calcified patent ductus arteriosus was performed in a symptomatic 78 year old man. cardiac catheterization revealed a left to right shunt across the patent ductus arteriosus with a pulmonary to systemic flow ratio of 2.8:1. Calcification of the ductus and severe lung disease increased the risk of surgical patent ductus arteriosus closure. A 17 mm Rashkind double umbrella was positioned in the ductus percutaneously by way of the femoral vein. After closure of the ductus there was marked hemodynamic improvement and the patient was discharged with improved exercise tolerance. Transcatheter closure of patent ductus arteriosus may be a viable option for the elderly patient too sick to withstand cardiovascular surgery.
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10/13. Surgical treatment for hypoplastic left heart syndrome: case reports.

    A 58-day-old girl with hypoplastic left heart syndrome underwent bypass grafting from the pulmonary artery to the descending aorta, ligation of the ductus arteriosus, and banding of the main pulmonary artery distal to the graft. Anastomoses of the graft were performed by partial clamping of the arteries under moderate surface hypothermia. The patient tolerated the procedure well and was discharged from the intensive care unit on the eleventh postoperative day, but she died on the twentieth day of metabolic derangement. Our total experience with this anomaly includes three other infants, and a summary of these patients and applied surgical procedures are presented. Surgical and diagnostic considerations for this anomaly based on our experiences are discussed.
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