Dipankar Gupta

Left Atrial Appendage Aneurysm Characterized by Multimodal Imaging

We present a four-year-old female with an incidental finding of a congenital left atrial appendage aneurysm who underwent surgical resection with excellent results. This case highlights the importance of multimodal imaging in the diagnosis and characterization of this rare condition.

Heart Transplant in Patient With Isolated Left Superior Vena Cava by Atrial Appendage Rotation

Orthotopic heart transplantation in patients with an isolated persistent left superior vena cava is extremely rare, and the anastomotic connection between a right-sided donor superior vena cava and left-sided recipient superior vena cava can be challenging to perform. We present a novel technique used in an infant female, using the left atrial appendage to extend the superior vena cava anastomosis.

Effect of prenatal diagnosis on hospital costs in complete transposition of the great arteries

Prenatal diagnosis of congenital heart disease (CHD) is associated with improved clinical outcomes, yet its impact on the cost of hospitalization is not well described. We hypothesized that prenatal diagnosis of complete transposition of the great arteries (d‐TGA) results in lower total hospital costs compared with postnatal diagnosis.

Left Ventricular Metastasis in Neuroblastoma: A Case Report.

Neuroblastoma is the most common extracranial solid tumor in children. Most common sites of metastases from neuroblastoma are bone marrow, bone and lymph nodes, however cardiac metastasis is rarely seen. Metastatic cardiac tumors are 20 to 40 times more common than primary cardiac tumors. Mechanism of cardiac metastasis can be hematogenous, lymphatogenous, and direct extension/infiltration of tumor cells. Usually right heart metastasis is seen. Left ventricular metastatic tumor has never been reported with neuroblastoma.

Coronary Cardiac Fistula Evaluation by Cardiac CTA for Management

We present the case of a 5-year-old otherwise healthy female referred to our clinic for evaluation of a continuous cardiac murmur heard at the left upper sternal border. A differential diagnosis of patent ductus arteriosus versus coronary cardiac fistula versus arteriovenous fistula was considered based on the physical examination. Initial transthoracic echocardiogram demonstrated a large right coronary artery (RCA) to right ventricle (RV) fistula with a very dilated (7 mm) proximal RCA (Supplementary Video S1). There was associated moderate right heart dilation. On further discussion with our pediatric cardiothoracic surgeon and interventional cardiologist, initial consensus was to first obtain a prospectively gated pediatric cardiac computed tomographic angiography (CTA) to better delineate morphology of the coronary cardiac fistula especially with respect to elucidating the proximity of the distal communication of the coronary cardiac fistula to the posterior descending artery prior to establishing surgical versus interventional candidacy. The CTA confirmed the anatomy of the RCA to RV fistula and demonstrated diffuse ectasia of the RCA (7.2 mm; z score of 14.5). Maximum intensity projection with vessel tracking software clearly delineated the fistulous connection at the base of RV (Figure 1A). Three-dimensional reformation from the CTA demonstrated the dilated RCA and its fistulous connection to the RV (Figure 1B, Supplementary Video S2). The RCA was massively dilated secondary to the increased flow from the fistula (Figure 1C, Supplementary Video S3). The CTA findings were determined to be conducive for device closure of the coronary cardiac fistula and the patient successfully underwent percutaneous catheter-directed coil occlusion of the fistula (Figure 1D, Supplementary Videos S4-S6). She remains asymptomatic on anticoagulation for ongoing dilation of her RCA. Our case highlights the utility of cardiac CTA in delineating aberrant pediatric coronary anatomy, allowing for assessment of operative candidacy and treatment planning (surgical vs interventional) especially as it pertains to delineating the baseline morphology but also minimizing the risk of potential device-related complications such as compression of adjacent structures or embolization. Cardiac CTA clearly delineated the anatomy of the coronary cardiac fistula while complementing the functional assessment provided by echocardiogram.