Ishwarappa Balekundri Vijayalakshmi

Purulent Pericarditis with Quadruple Valve Endocarditis

Patient: Male, 7 Final Diagnosis: Purulent pericarditis with quadruple valve endocarditis Symptoms: — Medication: (4S,4aS,5aR,12aS)-9-[2-(tert-butylamino)acetamido]-4,7 bis(dimethylamino)-1,4,4a,5,5a,6,11,12aoctahydro-3,10,12,12a-tetrahydroxy-1,11-dioxo-2 naphthacenecarboxamide Clinical Procedure: Pericardiocentisis Specialty: Cardiology Objective: Rare disease Background: Infective endocarditis (IE) is a disease with a highly varied clinical picture. Spread of the infection to the pericardium from the infective endocardium is uncommon and IE involving all 4 cardiac valves is also a very rare occurrence, being more common in intravenous drug users (IVDU). Case Report: A 7-year-old boy had purulent pericarditis with infective endocarditis (IE) on all 4 cardiac valves and vegetation in the left ventricular and right atrial cavity. Culture of the pericardial fluid grew methicillin-resistant staphylococcus aureus (MRSA) sensitive to tigecycline. The child made a dramatic improvement with tigecycline treatment. Conclusions: Aggressive management with pericardiocentesis and appropriate antibiotics can show remarkable clinical improvement. Tigecycline can be used safely and effectively as a life-saving drug in children.

A rare anomaly: ‘hemitruncus’

A 7-year-old boy with a history of frequent respiratory tract infections in infancy, presented with easy fatigability and exertional dyspnoea. On examination, he had mild cyanosis, clubbing, left parasternal heave and a loud pulmonary component of the second heart sound with no murmurs. An electrocardiogram showed right ventricular hypertrophy with …

Percutaneous Device Closure of Patent Ductus Arteriosus with Pulmonary Artery Hypertension: Long-Term Results

UNLABELLED Device closure of patent ductus arteriosus (PDA) is treatment of choice. But device closure in presence of pulmonary artery hypertension (PAH) remains a challenge. Data on patient selection, technical considerations, and complications are limited. AIM To know the challenges and efficacy of device closure of PDA with PAH. MATERIALS AND RESULTS Out of 1,325 cases of device closure of PDA, 246 (18.6%) with PAH formed the study material. To test the feasibility, chosen device is used to occlude PDA for ten minutes without oxygen inhalation. The device is released only if PAH reduced. PAH decreased in all except in 1 patient after closure with muscular ventricular septal occluder (MVSDO), pulmonary artery pressure (PAP) transiently increased (became supra-systemic), without significant reduction in aortic pressure. Device embolized in 8 patients (3.3%). Percutaneous retrieval was done in 4 (by snare in 2 and by fixing the cable to device in 2) and replaced with bigger devices. The surgical removal of the embolized MVSDO and ligation was done in 4 cases. All patients were on oral sildenafil and bosentan until PAP regressed to normal. Follow up was from 6 months to 9 years. No residual shunt in any patient on follow-up. The PAP regressed to normal in all except 5 cases (2.03%) of Downs syndrome with systemic PAP. CONCLUSIONS Device closure of PDA with PAH is feasible, safe in all age groups. Temporary PDA occlusion with device is effective and time saving for evaluating pulmonary vascular reactivity. Device embolization in aorta is higher with severe PAH. Novel method of retrieval is effective.

Holt-oram syndrome associated with double outlet right ventricle: A rare association

Holt-Oram syndrome is a rare inherited disorder that causes abnormalities of the hands, arms, and the heart. Most commonly, there are defects in the carpal bones of the wrist and in the bones of the thumb along with cardiac defects such as atrial or ventricular septal defects. We report a case of Holt-Oram syndrome with a rare association of double outlet right ventricle.

Percutaneous closure of pseudoaneurysm of common iliac artery with amplatzer duct occluder II

Seven-year-old boy presented with pain in right lower limb and abdomen after a fall from a bullock cart. He was referred for management of pseudoaneurysm of the right common iliac artery. After CT angiogram, the vascular surgeon opined that child was not suitable for surgical patch or graft or endovascular stenting as there was no landing zone for the stent. Hence the child was treated with transcatheter closure with two Amplatzer duct occluder II (ADO II). On follow-up the symptoms and bruit disappeared. To the best of our knowledge this is the first case of pseudoaneurysm, treated with ADO II.

The retrieval of the diagnostic catheter which broke and embolised twice

We are presenting a nightmare case of successful retrieval of the broken distal tip of a multipurpose catheter which embolised into the left pulmonary artery (LPA) during atrial septal defect device closure. During the course of snaring it initially slipped once in the LPA and subsequently while snaring it into the delivery sheath it slipped again in the inferior vena cava and yet again embolised into the LPA!! Subsequent attempt was successful but the distal fragment itself broke into two parts while being pulled inside the delivery sheath. Luckily the fragments did not embolise again as they were stuck at the tip of the sheath. The distal fragments were pulled out en masse along with the delivery sheath maintaining negative pressure at the side port of the delivery sheath using a 20 mL syringe. The final outcome was successful and the patient was unharmed by this potentially grave complication.