Douglas W. Teske

Diphenhydramine hydrochloride intoxication.

DIPHENHYDRAMINE HYDROCHLORIDE (Benadryl; Parke, Davis & Co) is widely prescribed and therapeutically important as an effective antihistamine and mild sedative. At Columbus Childrens Hospital in 1975, there were 363 out-patient prescriptions for diphenhydramine hydrochloride. The toxicity of this compound is no longer appreciated. Twenty to fifty percent of individuals who take antihistamines experience some side effects including drowsiness, dryness of the mouth, urniary frequency, dizziness, anorexia, constipation, and nervousness. 1 Younger children may experience an excitation phase with hallucinations, incoordination, muscular twitchings, fever, convulsions, and even cardiorespiratory collapse and death. The following is a case of near fatal poisoning from an accidental ingestion of diphenhydramine hydrochloride. An ensuing complication was an unusual cardiac arrhythmia.

Coronary artery fistula in the pediatric age group: A 19-year institutional experience

Ten patients with coronary artery fistulae were identified from records at Columbus Childrens Hospital between 1974 and 1993. Clinical presentations of patients were quite variable, from 1 day to 20 years of age. Symptoms ranged from none to severe cardiorespiratory failure requiring extracorporeal membrane oxygenation. Long term follow-up revealed one sudden death and one spontaneous closure of the fistula. This lesion should be ruled out in patients who present as extracorporeal membrane oxygenation candidates. Patients with mild forms of this lesion may be followed up medically if the left to right shunt is inconsequential, because spontaneous closure is a possibility. Because of the risk of sudden death, close long-term follow-up is mandatory even for operated patients, and antiplatelet therapy should be considered for these patients.

Reopening After Successful Coil Occlusion for Patent Ductus Arteriosus

OBJECTIVES This study was performed to determine the frequency of patent ductus arteriosus (PDA) reopening and the factors that may predict reopening after successful coil occlusion. BACKGROUND Transcatheter coil occlusion is a widely used and accepted method to close a PDA. After documented successful coil occlusion, we found PDAs that reopened. We hypothesized that specific factors are involved in those that reopened. METHODS All patients who underwent percutaneous transarterial PDA coil occlusion were studied. Successful coil occlusion was documented. PDA reopening was determined when Doppler-echocardiography (DE) performed after the procedure was negative for PDA flow but at follow-up demonstrated PDA shunting. Patients with a reopened PDA were compared with all other patients in evaluating independent variables. RESULTS Coil occlusion for PDA was attempted in 22 patients. Clinical success was achieved in 20 patients (91%), and DE was negative for PDA shunting in 19 patients (90%). At follow-up, five patients demonstrated reopening. The PDA minimal diameter was 1.4 +/- 0.5 mm (mean +/- SD) for the reopened group and 1.2 +/- 0.7 mm for the other patients. The PDA length was 2.9 +/- 1.9 mm for the reopened group and 7.1 +/- 3.2 mm for all other patients. All those with type B PDA were in the reopened group. When independent variables were compared between groups, only PDA length and type B PDA predicted reopening (p < 0.05). CONCLUSIONS PDA reopening may occur after successful coil occlusion. Short PDA length and type B PDA are associated with reopening. The data suggest that in such anatomy, alternative strategies to the current coil occlusion technique should be considered.

Air Gun Pellet Injury of the Heart with Popliteal Embolus

An air gun pellet cardiac injury, in which there was penetration through the right ventricle, interventricular septum, and anterior papillary muscle and ejection from the left ventricle, is described. The pellet embolus was removed from the left popliteal artery with restoration of flow. The particular implications of pellet embolization are discussed and contrasted with those of bullet embolism.

Palliative arterial repair for transposition, ventricular septal defect, and pulmonary vascular disease

Failure to repair transposition of the great arteries and ventricular septal defect in the young infant results in the early development of pulmonary vascular occlusive disease. Complete repair, preferably by an arterial switch procedure and ventricular septal defect closure, may then not be possible. We report a palliative arterial switch procedure in a 5 1/2-year-old patient with transposition, ventricular septal defect, and severe pulmonary vascular obstructive disease in whom progressive hypoxemia and exercise intolerance developed. An arterial repair without ventricular septal defect closure was performed. After the operation, the childs systemic arterial oxygen saturation and exercise tolerance have substantially improved. Although the progression of pulmonary vascular disease may not be altered, arterial repair can provide effective palliation in this subset of patients.

Cavopulmonary anastomotic aneurysm: A complication in pulsatile pulmonary arteries

An aneurysm of a left superior vena cava developed after anastomosis to the left pulmonary artery during repair of an atrioventricular septal defect with a persistent left superior vena cava entering directly into the left atrium. We believe this implies caution should be used in accepting the recent suggestion of using a bidirectional cavopulmonary connection to a pulsatile pulmonary arterial circuit as a way of allowing anatomic correction of atrioventricular septal defect with a small right ventricle.

Anomalous course of the left main coronary artery in tetralogy of fallot

An extremely rare coronary artery anomaly where the left main coronary artery arose anteriorly from the right coronary sinus and coursed in front of the right ventricular outflow tract was present in a patient with tetralogy of Fallot. Preoperative angiocardiography was interpreted as normal. Operative recognition was prevented by dense adhesions and a partial intramural course. Division of the vessel at repair resulted in death of the patient. The angiographic pattern associated with this anomaly is very unusual, and in many views looks deceptively normal. Details are presented.

Pedunculated Left Ventricular Rhabdomyoma

A patient with an unusual left ventricular outflow tract obstruction caused by a solitary pedunculated left ventricular rhabdomyoma is described. Diagnosis was based on two-dimensional echocardiographic findings alone. The obstructive portion of the tumor was successfully removed from the interventricular septum by an aortic root approach.

Echocardiographic Evaluation of the Postoperative Cardiac Patient

The postpericardiotomy syndrome is a febrile illness occurring with evidence of pleural and pericardial reactions after the first postoperative week. The syndrome is a frequent postoperative finding in cardiac surgery patients who have had an opened pericardium. Previously, the syndrome has been diagnosed by the clinical findings of fever, chest pain, a pleural and/or pericardial friction rub, plus cardiomegaly due to the effusion, and ST-T wave changes of pericarditis on the electrocardiogram. Bacterial infections as a cause of the fever have to be excluded. Because of patient discomfort and prolonged morbidity, rapid diagnosis of a pericardial effusion in the postpericardiotomy syndrome becomes essential.