Michael J. Tyrrell

Neurological complications of balloon angioplasty in children

SummaryWe report on the occurrence of cerebrovascular accidents as a possible complication of balloon angioplasty in children. The first patient underwent balloon angioplasty for aortic stenosis and subsequently developed a right temporoparietal infarct in the vascular territory of the right middle cerebral artery. The second patient developed a right temporoparietal infarct also in the vascular territory of the right middle cerebral artery following balloon angioplasty of native coarctation of the aorta. This experience suggests that, in addition to the previously reported complications of balloon angioplasty, the occurrence of a potential cerebrovascular accident must be considered in the risk-benefit analysis of this procedure.

Fibromuscular dysplasia of the aorta presenting as multiple recurrent thoracic aneurysms

A 17-year-old boy, who had undergone resection of aortic coarctation with a large saccular aneurysm 10 years previously, developed recurrent aneurysms above and below the site of a Gore-Tex interposition graft. These were resected using femoral-femoral bypass, and the upper thoracic aorta was replaced with a Hemashield Dacron tube. Histology of the aorta showed fibromuscular dysplasia. In addition to aortic dissection and aortic rupture, such patients may be at risk of forming further aneurysms.

Mitral valve replacement in the neonate: A report of two cases

SummaryMitral valve replacement was performed in two critically ill neonates with severe mitral stenosis and regurgitation. Both patients had coexisting severe aortic stenosis previously treated by transventricular aortic valve dilatation.Preoperative echocardiography showed a mitral annulus measuring between 11 and 12 mm in diameter—too small for any of the commercially available free-standing valve prostheses. Accordingly, the porcine valve from a commercially available 12-mm external-valved conduit was removed and sutured into position. The function of the valve was satisfactory in both cases and cardiopulmonary bypass was discontinued easily with a good cardiac output established in both.Both patients died—one at 20 h and one 36 h after surgery. In each case, the immediate cause of death was acute bleeding secondary to preexisting hepatic failure and depletion of coagulation factors.At autopsy, both prostheses had been correctly placed and were competent. Left ventricular outflow tract obstruction secondary to strut imposition was not evident.Both patients were very ill preoperatively. Although neither patient survived mitral valve replacement, we were encouraged by the relative hemodynamic improvement in the immediate postoperative period. We believe that prosthetic valve replacement could become a viable therapy for the neonate with severe mitral valve abnormalities.

Complex transposition with interrupted right aortic arch and partial Di George syndrome: Successful palliation with combined medical and surgical therapy

SummaryA five-day-old infant with transposition of the great arteries, ventricular septal defect, and an interrupted right aortic arch underwent successful balloon septostomy, pulmonary artery banding, and aortic arch repair. The infant also had abnormal facies with severe refractory hypocalcemia and depressed T-lymphocyte number and function believed to represent a partial Di George syndrome. The hypocalcemia resolved following treatment with a vitamin-D analogue, T-cell number increased, and T-cell function improved, but both remained subnormal.

Saccular aortic aneurysm in an asymptomatic child

SummaryAn asymptomatic boy was found to have coarctation of the thoracic aorta. Despite no history of endocarditis or trauma, a large saccular aneurysm involving the coarctation site was identified angiographically, confirmed, resected surgically, and examined histologically.

Left ventricular transvenous electrode dislodgement after Mustard repair for transposition of the great arteries.

An 11‐year‐old girl who underwent Mustards operation for complete transposition of the great arteries in infancy, developed Mobitz type II second‐degree AV block 81/2 years later. A transvenous, active fixation left ventricular lead was inserted and connected to a rate responsive pacemaker. Two years later the lead dislodged due to the childs growth. A new active fixation electrode was positioned in the left ventricle below the pulmonary valve, leaving an electrode loop in the ventricle. Such an approach may prevent lead dislodgement due to growth after intraatrial repair for transposition of the great arteries, but regular radiological or echocardiographic follow‐up of lead position is recommended in these patients.

Isolated connection of the right superior caval vein to the left atrium: non-invasive neonatal diagnosis

Isolated anomalous drainage of the right superior caval vein to the left atrium is a very rare cause of cyanosis in the newborn. Herein, the cross-sectional echocardiography and colour Doppler findings of this malformation are described.