Preterm infants showed stable LS on both sides of the VS, the RV free wall, and the LV despite significant hemodynamic changes during the first 72 h of life. These results suggest that the right and left sides of the VS respond differently to the complex cardiopulmonary transitions from fetal to neonatal life in preterm infants.
A 3-year-old girl presented with muscle weakness of her limbs and trunk 6 days after developing symptoms of common cold. Two days later, she experienced respiratory arrest with a Glasgow Coma Scale score of 3, necessitating endotracheal intubation. Therefore, she was transferred to our hospital with suspected acute encephalopathy. Although no abnormalities were observed on brain and spinal magnetic resonance imaging and electroencephalography, peripheral nerve conduction velocity tests failed to evoke motor and sensory nerve action potentials. Thus, we gave a diagnosis of fulminant Guillain-Barré syndrome and initiated immunoglobulin therapy. On day 3 of admission, she developed sinus tachycardia that induced circulatory failure and oliguria, which was successfully treated with landiolol. Subsequently, we performed plasmapheresis followed by immunoglobulin and steroid pulse therapies. She was weaned off the mechanical ventilator by day 20 of admission, was ambulatory by day 44, and had completely recovered without any adverse sequelae by day 55. In conclusion, landiolol was effective for treating acute sinus tachycardia-induced circulatory failure and played a key role in saving the life of this patient.
Background: In small children, conduits for right ventricular out ow tract reconstruction are limited because of patient size and conduit resources, particularly in Japan. Methods: Since 2007, we have performed the Rastelli-type procedure using 16-mm handmade trilea et expanded polytetra uoroethylene (ePTFE) conduits in nine approximately 1-year-old children. e median age and body weight at surgery was 17.3 months (range: 10 22 months) and 8.9 kg (range: 6.8 11 kg), respectively. e patient diagnoses were double-outlet right ventricle (DORV) with pulmonary stenosis (PS) in four, pulmonary atresia with ventricular septal defect (PA/VSD) and major aortopulmonary collateral arteries (MAPCA) in four, and PA/VSD in one patient. All patients had undergone previous surgical procedures, including modi ed Blalock shunt in ve and unifocalization of MAPCA and modi ed Blalock shunt in four patients. Conduit function, re-intervention, and right ventricular function were retrospectively investigated. Results: ere was no early or late mortality. During the median follow-up of 45 months (range: 18 79 months), balloon dilation for conduit stenosis was performed in two patients at 47 and 51 months post surgery, respectively. One of these patients required conduit replacement 27 months a er balloon dilation. Excluding this patient, the most recent echocardiographic pressure gradients of the conduits were 0 20 mmHg in four, 21 40 mmHg in four, and no patient had conduit stenosis with the pressure gradients over 41 mmHg. Conduit regurgitation was trivial in four, mild in two, and moderate in two patients. Conclusion: e Rastelli-type procedure using 16-mm handmade trilea et ePTFE conduits in approximately 1-year-old infants showed acceptable mid-term results. Conduit stenosis gradually developed over 5 6 years. Balloon dilation for conduit stenosis has the potential to delay conduit replacement without increasing conduit regurgitation.
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