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No abstract

Severe pulmonary hypertension (PH) was reported in 22.4% of ventricular septal defect (VSD) and it was mainly seen on a large VSD. Atrial septostomy (AS) could improve the hemodynamic condition and long-term survival of PH patients. Here, three VSD and PH cases in children who underwent AS surgery as their early treatment, concomitant with PH-specific pharmacological treatment were reported. Patient’s hemodynamic and general condition improved with no further complications during the follow-up period. Atrial septostomy was usually conducted after all PH-specific pharmacological interventions failed. However, a study found that the survival benefit of AS was significantly increased if it was conducted before PH-specific pharmacotherapies. Most of the patients in this case received immediate hemodynamic and functional improvement. In this case series, it was reported that the AS procedure could lower the pulmonary arterial pressure and be safely conducted without further complications or death >24 hr post-surgery. Considering the clinical benefit, safety procedure, and improved pulmonary arterial pressure, performing AS procedure concomitant with PH-specific pharmacotherapy as an early treatment for PH patients is recommended.

Infective endocarditis (IE) is one of the congenital heart disease complications which is frequently seen in ventricular septal defects (VSD). The Duke criteria are the diagnostic criteria for IE. One of the major criteria is evidence of vegetation. In VSD complicated with IE, vegetation is frequently found on the opening of the defect, on the right ventricular side of the opening, on the tricuspid valve, and less frequently it is found on the pulmonary valve. Vegetation found in the lumen of pulmonary artery is rarely reported. In this article, we reported a rare case of pulmonary artery vegetation in a boy with moderate VSD and treated with combination of parenteral antibiotic followed by successful surgical vegetation evacuation and VSD closure. A 6 years old boy was consulted with congenital heart disease. His chief complaint was shortness of breath. He came with unspecific signs and symptoms with a history of frequent hospitalization due to pneumonia and paleness. Chest X-ray showed enlargement of heart chambers. Transthoracic echocardiography (TTE) revealed moderate size VSD and multiple vegetation on right ventricle outflow tract, pulmonary artery valve, and inside the lumen of main pulmonary artery and right pulmonary artery. The blood culture showed a positive result for Streptococcus viridans. He was treated with parenteral antibiotic and operated on later. We successfully performed evacuation of the vegetation and VSD closure.

An man in his early 40s suffered from end-stage renal disease and underwent living donor renal transplantation. Doppler ultrasonography before surgery showed a normal iliac artery and vein without any thrombus. There was clear evidence of urine production intraoperatively. On the 5th postoperative day, there was no improvement in his renal function, and painless right leg oedema was noted. The clinical workup revealed pitting oedema without loss of arterial pulsation, discolouration or focal tenderness in the right leg. Serial Doppler ultrasonography examination showed thrombus progression from the right popliteal vein to the right external iliac vein around renal vein anastomosis despite anticoagulant administration with a downtrend of diuresis and worsening renal function. This condition led the patient to undergo surgical exploration on the 10th day post-transplantation. We decided to perform a thrombectomy and bypass the right external iliac vein to the inferior vena cava.