Secundum Atrial Septal Defect Research Articles

Intensive Management of Postoperative Septic Shock in Patient with Secundum Atrial Septal Defect: A Case Report

Background: Sepsis is a life-threatening organ dysfunction caused by an abnormal inflammatory response to infection. This study aimed to describe the intensive management of postoperative septic shock in secundum atrial septal defect patients.
 Case presentation: A 28-year-old woman complaining of pus discharge and reddish swelling in the scar after a cesarean section operation. The patient has a history of pulmonary hypertension and secundum ASD. While in the ICU, examination of vital signs found the patient was weak, compost mentis conscious, blood pressure 80/55 mmHG (MAP 63), Respiration 28 times per minute, pulse 114 times per minute, temperature 38.6°C with 98% oxygen saturation with NRM 10 L/ and laboratory examinations obtained hemoglobin 8.6, leukocytes 14.870, platelets 236.000, hematocrit 24, albumin 2.4 and procalcitonin > 100.
 Conclusion: This study reported that septic shock is a life-threatening condition, especially in patients with congenital heart disease. Appropriate, rapid, and comprehensive treatment and addressing the source of infection are essential in managing sepsis shock.

Transcatheter closure of atrial septal defect in the elderly: a systematic review and meta-analysis

ObjectiveDespite the establishment of transcatheter closure as the treatment of choice in adults with secundum atrial septal defects (ASDs), the effectiveness of this approach in the elderly is disputed. This...

Utility of Screening Fetal Echocardiograms at aSingle Institution Following Normal Obstetric Ultrasound in Fetuses with Down Syndrome.

Fetal echocardiograms (F-echo) are recommended in all pregnancies when the fetus has Down syndrome (DS) even if there was a prior obstetric scan (OB-scan) that was normal. The utility of a screening F-echo in this high-risk population when an OB-scan is normal is unknown. Goal of this study was to evaluate if any diagnosis of a critical congenital heart disease (CHD) was missed in a fetus with DS who had a normal OB-scan. Secondary goal was to determine if any CHD was missed postnatally when an OB-scan was read as normal. Retrospective chart review of all fetuses that had a F-echo whose indication was DS between 1/1/2010 to 6/30/2022 was performed. Fetuses were included if they had an OB-scan that was read as normal and had a F-echo. Postnatal transthoracic echocardiogram (pTTE) was reviewed when available. Critical CHD was defined as CHD requiring catheterization or surgical intervention < 1month of age. One hundred twenty-two F-echo on fetuses with DS were evaluated, of which 48 met inclusion criteria. OB-scan was performed at 20.4 ± 4.5weeks gestational age and F-echo was performed at 24.0 ± 4.6weeks gestational age. No patient with a normal OB-scan had a diagnosis of a critical CHD by F-echo (n = 48, negative predictive value = 100%). Evaluating those patients that had an OB-scan and a pTTE (n = 38), 14 patients were diagnosed with CHD (muscular ventricular septal defect (VSD) n = 5, perimembraneous VSD n = 3, secundum atrial septal defect (ASD) n = 2, primum ASD n = 1, transitional atrioventricular septal defect (AVSD) n = 2, and aortic valve abnormality n = 1; negative predictive value = 63.2%). F-echo correctly diagnosed 4 of the 14 missed OB-scan CHD (perimembraneous VSD n = 2, muscular VSD n = 1, and transitional AVSD n = 1). Critical CHD was not missed with a normal OB-scan in this high-risk population. F-echo also missed the majority of CHD when an OB-scan was read as normal. The cost/benefit of screening F-echo in fetuses with DS should be evaluated if a normal OB-scan has been performed, considering all these patients would have a pTTE performed per guidelines.

Comparison of Short-Term Outcomes of Transcatheter versus Surgical Closure of Atrial Septum Defect at a Tertiary Cardiac Care Facility

Objective: To compare the short-term outcomes of transcatheter versus surgical closure of atrial septal defect (ASD) at a tertiary cardiac care facility in South Punjab, Pakistan.&#x0D; Study Design: Prospective comparative study.&#x0D; Place and Duration of the Study: Department of Paediatric Cardiology and Paediatric Cardiac Surgery, Chaudhary Pervez Elahi Institute of Cardiology, Multan Pakistan, from Jul 2019 to Jun 2021.&#x0D; Methodology: A total of 110 patients with moderate to large isolated secundum ASDs without severe pulmonary hypertension and planned to undergo closure of secundum ASD by either surgical approach or device closure were included. All surgical and transcatheter procedures were performed adopting standard techniques. Intra-procedural or post-procedural outcomes were noted.&#x0D; Results: In a total of 110 patients, 59(53.6%) underwent transcatheter closure of ASD, while surgical closure was done in the remaining 51(46.4%) patients. Post-procedural complications were significantly more in the Surgical Closure Group in comparison to the Transcatheter Closure Group, [14(27.5%) vs 5(8.5%) (p=0.026)]. None of the cases in the Transcatheter Closure Group required inotropes in the post-procedure period in comparison to 24(47.1%) cases (p&lt;0.001). The total cost of treatment was significantly higher in transcatheter closure patients compared to surgical closure patients (1504±60.4 US$ versus 1448±75.4 US$, p&lt;0.001). Overall, successful closure was noted in 108(98.2%) cases. No mortality was recorded.&#x0D; Conclusion: Overall, short-term outcomes of transcatheter ASD closure were comparable to the surgical approach, but patients with transcatheter ASD closure had significantly less duration of hospitalization and low rates of post-procedural complications.Keywords: Atrial septum defect, Mortality, Surgical closure, Transcatheter closure.

Relationship Between Transthoracic Echocardiography and Transesophageal Echocardiography in the Anatomic and Hemodynamic Assessment of Secundum Atrial Septal Defects in Children and Adults

Objective: To determine the relationship between transthoracic and transesophageal echocardiography in the anatomic and hemodynamic assessment of secundum atrial septal defects in children and adults.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Paediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi Pakistan, from Jul 2020 to Jun 2021.&#x0D; Methodology: Seventy-seven patients above three years of age with secundum atrial septal defects were included. Linear regression was used to determine any statistically significant difference between transthoracic and transesophageal echocardiography approaches.&#x0D; Results: Of 77 patients, there were 37(48.1%) male and 40(51.9%) female. No significant difference was noted in terms of any of the clinical parameters during transthoracic echocardiography and transesophageal echocardiography. As per transthoracic echocardiography, 35(45.5%) were noted to be deviceable, while in transesophageal echocardiography, 36(46.8%) patients were found to be deviceable (p=0.872). No emergency exploration or deaths occurred. Linear regression showed no statistically significant difference between transthoracic echocardiogram and transesophageal echocardiography findings in terms of atrial septal defects size (p=0.226), total septal length (p=0.930), RV systolic pressure (p=0.440), RV functions and TAPSE (0.748) except LV ejection fraction function findings (p&lt;0.001).&#x0D; Conclusion: Anatomic and hemodynamic assessment of secundum atrial septal defects in children and adults correlated well with transthoracic and transesophageal echocardiography.

Reverse Platypnea–Orthodeoxia with Atrial Septal Defect and Diffuse Pulmonary Arteriovenous Fistulae in Hepatopulmonary Syndrome

A 69-year-old male with a long-standing diagnosis of interstitial lung disease and on domiciliary oxygen therapy was evaluated by echocardiography. His supine oxygen saturation ranged between 77% and 86% and upright oxygen saturation was 93%–94%. Two-dimensional transthoracic echocardiography showed a secundum atrial septal defect of 15 mm diameter with left-to-right shunting but without dilatation of right-sided chambers. Air bubble contrast echocardiography showed no air bubbles crossing the atrial septum but bubbles appeared in left-sided chambers through pulmonary veins after five cardiac cycles indicating intra-pulmonary shunting. Computed tomography of the chest demonstrated a mosaic pattern of the lung parenchyma, characterized by the presence of alternating geographic areas of low attenuation with regions of relatively increased attenuation typical of diffuse pulmonary arteriovenous fistulae. This is a rare case of reverse platypnea-orthodexia with possible contribution of two different pathophysiologic mechanisms but precise mechanism remains elusive.

The Prevalence of and Predisposing Factors for Late Atrial Arrhythmias after Transcatheter Closure of Secundum Atrial Septal Defects in Children.

A 24 h Holter study in children after transcatheter secundum ASD (ASD II) closure was conducted to detect the prevalence of defects and/or device-related late atrial arrhythmias (LAAs). ASD II closure with an Amplatzer septal occluder (ASO) is an established procedure. Little is known about LAAs after device implantation. The eligible participants were children who had undergone ASO implantation, with a follow-up of ≥5 years, as well as one pre- and at least one post-procedural Holter ECG. In total, 161 patients (mean age: 6.2 ± 4.3 years), with a mean follow-up of 12.9 ± 3.1 years (range 5-19), were included. A median of four Holter ECGs per patient were available. LAAs occurred before intervention in four patients (2.5%), and it was peri-interventional in four patients (2.5%), sustained in three patients (1.9%), and developed in three patients (1.9%). In patients with pre- and peri-interventional LAAs, the Qp/Qs ratio was higher (6.4 ± 3.9 vs. non-AA: 2.0 ± 1.1 (p = 0.002)) and the IAS/ASO ratio was lower (1.18 ± 0.27 vs. non-AA: 1.7 ± 0.4 (p < 0.001)). The patients with LAAs differed from those without LAAs in their Qp/Qs (6.8 ± 3.5 vs. 2.0 ± 1.3; p < 0.0001) and IAS/ASO ratios (1.14 ± 0.19 vs. 1.73 ± 0.45; p < 0.001). The patients with LAAs had a Qp/Qs ratio ≥2.94:1, and those who developed LAAs had an IAS/ASO ratio <1.15. LAAs occurred in 1.9% of patients and were sustained in another 1.9% of patients but persisted in those with large shunt defects and large occluders in relation to the atrial septal length. The predisposing factors for LAAs after ASD closure were a high Qp/Qs ratio, pre-existing atrial arrhythmias, and a low IAS/ASO ratio.

The promising role of different imaging diagnostic modalities for percutaneous transcatheter device closure of secundum atrial septal defect in pediatrics in sohag university hospital

The promising role of different imaging diagnostic modalities for percutaneous transcatheter device closure of secundum atrial septal defect in pediatrics in sohag university hospital

Cardiac Hypertrophy in Neonates Born to Diabetic Mothers at Farhat Hached of Sousse University Hospital

<i>Introduction:</i> The association between cardiac hypertrophy and hyperinsulinism is mainly observed in the newborn, although the onset in older infants has also been described. The aim of our study is to research a cardiac hypertrophy in newborns of diabetic mothers. <i>Methodology</i>: This was a cross-sectional study, involving one hundred and twenty (120) newborns of diabetic mothers from August 1^stto November 30, 2020. These newborns of diabetic mothers had received an echocardiographic examination at the laboratory of the FARHAT HACHED University Hospital in Sousse (Tunisia) regardless of the associated cardiac or extracardiac pathology, during the study period, to detect cardiac hypertrophy. <i>Results:</i> The sex ratio was in favor of the female gender at 0.90. The average weight was 3554.04 g, with extremes ranging from 1,600 g to 5,200 g. Twelve (12) newborns had a weight greater than or equal to 4,000 g (10.00% of macrosomes). Among mothers, there were 03 types of diabetes: type 1 diabetes (2.65%), type 2 diabetes (0.88%) and gestational diabetes (96.46%). Echocardiography was normal in 91 neonates (75.83%) and abnormal in 29 neonates (24.17%). The prevalence of cardiac hypertrophy was 09.17% and that of other associated cardiac abnormalities was 21.66%. There were 11 cases of patent foramen ovale, 11 cases of patent ductus arteriosus, 02 cases of ostium secundum atrial septal defect, 01 case of interrupted aortic arch, 01 case of pulmonary stenosis. These abnormalities were associated on the one hand with the septal hypertrophy and on the other hand, associated with each other in the same newborn. Left ventricular ejection function was normal in all neonates with an average of 66% and extremes between 59% and 76%. <i>Conclusion:</i> Cardiac hypertrophy described in the newborn of diabetic mother is characterized by hypertrophy of the ventricular walls more often predominating over the septum. Transthoracic echocardiography is the reference (non-invasive) technique for diagnosing and monitoring these hypertrophies.

Atrial fibrillation in adult congenital heart disease and the general population

Atrial fibrillation (AF) in adult patients with congenital heart disease (ACHD) may appear early, depending on individual characteristics. The goals of this study were to investigate the epidemiological spectrum of AF in the entire cohort of ACHD and compare it with that in the general population. A retrospective study was performed in the nationwide cohort 2000-2014 with AF onset during 2003-2014. In the cohort of ACHD, 2350 patients had AF; the incidence increased with age, plateauing around age 70. In patients aged 25-29, 45-49, 65-69, 75-79, and ≥80 years, the annual incidence was 1.3, 7.9, 20.6, 23.7, and 21.4/1000 per year, respectively. In the general population without CHD, 347,979 patients had AF; the annual incidence was <1/1000 per year in those aged <55 years but increased steadily with age (3.6, 8.6, and 14.2/1000 per year in aged 65-69, 75-79, and ≥80 years, respectively). Compared with individuals without ACHD, ACHD patients aged <50 years and those aged both 50-54 and 55-59 years exhibited a 20-fold and 10-fold higher incidence of AF, respectively. Patients with complex congenital heart disease and Ebstein's anomaly had the highest risk of AF (cumulative risk >10% by age 50 and >20% by age 60), followed by those with tetralogy of Fallot, tricuspid atresia, endocardial cushion defect, and secundum atrial septal defect (cumulative risk >5% by age 50 and >10% by age60). Compared with individuals without ACHD, AF in patients with ACHD likely appeared 30 years earlier, with a 10- to 20-fold higher incidence plateauing around age 70. Yet, incidence in individuals without ACHD continued to increase. AF burden in patients with ACHD is not expected to increase in a never-ending way.

A tale of two ASDs-Compliance matters.

Key Points Patients with secundum atrial septal defects (ASDs) who have pulmonary atresia with intact ventricular septum or critical pulmonary stenosis, exhibit different ASD physiology compared to patients with isolated secundum ASDs. The indication and timing of secundum ASD closure in these patients should be made on a case‐by‐case basis. Long‐term assessment of the physiological consequences of secundum ASD closure in this group of patients should be kept in mind, as these patients have right ventricles that represent a spectrum ranging from significantly restrictive right ventricles, to right ventricles with normal compliance.

Echocardiographic right ventricular remodeling after percutaneous atrial septal defect closure

BackgroundIn order to prevent right ventricular (RV) dysfunction, closure of secundum type atrial septal defects (ASD) is often indicated and percutaneous closure is the preferred treatment modality to do so. The magnitude and time course of RV remodeling is still incompletely understood. MethodsThis retrospective cohort study included consecutive patients who underwent percutaneous secundum ASD closure in two tertiary referral centers in The Netherlands. Main study parameters were RV and right atrial dimensions measured with transthoracic echocardiography before and after percutaneous ASD closure. Secondary outcome was change in New York Heart Association (NYHA) functional class at follow-up. ResultsFrom the 454 patients who underwent secundum ASD closure, 88 patients (median age 46 [range 17–84]) were included. The majority of RV and right atrial dimensional improvement occurred within 24 h. After a median follow-up of 569 days (IQR: 280–772) a further decrease in dimensions was observed. Comparing baseline and latest follow-up, end-diastolic RV basal diameter decreased from 4.5 SEM 0.1 to 3.9 SEM 0.1 cm (p < 0.001) and end-systolic right atrial area from 22.9 SEM 1.0 to 17.9 SEM 0.7 cm2 (p < 0.001). No significant changes in RV function were observed. NYHA functional class improved from 1.5 at baseline (IQR: 1.0–2.0) to 1.0 (IQR: 1.0–1.5) at latest follow-up (p < 0.001). ConclusionRemodeling of the RV heart dimensions commences within 24 h after percutaneous secundum ASD closure for the majority of patients, followed by a further gradual recovery. A concurrent improvement of NYHA functional class was observed during follow-up.

Effect of percutaneous closure on atrium and appendage functions in patients with secundum atrial septal defects.

The study aimed to assess the impact of percutaneous transcatheter atrial septal defect (ASD) closure on atrium and atrial appandage functions among patients with ostium secundum ASDs. A total of 101 patients (34,7% male, 65,3% female, 37,6 ± 12) with the diagnosis of ostium secundum type ASD underwent transthorasic (TTE) and transesophageal echocardiography (TEE) before and six months after percutaneous transcatheter ASD closure. Pulmonary venous flow and atrial appendage flow velocities were obtained from the TEE recordings. The offline evaluation of the global and segmental atrial appendage strains were evaluated with speckle tracking echocardiography (STE) via EchoPac 6,3 (GE Vingmed, Horten, Norway). Mean values of pulmonary artery pressure, right ventricular, left atrium, left ventricular end-diastolic and end-systolic diameters were significantly decreased 6 months after ASD closure. Statistically significant changes were documented in pulmonary venous and left atrial appendage flow velocities after ASD closure. Both left and right atrial appendage flow velocities and global strains of atrial appandages were improved after ASD closure. The mean left atrial appendage global strain value was - 11.45 ± 4.13% before the procedure, this value was - 16.82 ± 3.78% sixth months after the procedure (P < 0.001).The mean right atrial appendage global strain was - 13.31 ± 4.84% before the procedure and - 18.53 ± 4.69% sixth months after the procedure (P < 0.001). Left and right atrial appendage flow velocities and global strains of left and right atrial appandage can be improved after transcatheter ASD closure. Percutaneous transcatheter closure of ASDs not only improves atrial and left ventricular dimensions but also have a positive impact on left and right atrial appandage functions.

Case report of coexisting transposition of the great arteries with supracardiac total anomalous pulmonary venous connection: focus on computed tomography features

BackgroundThe coexisting of transposition of the great arteries (TGA) with total anomalous pulmonary venous connection (TAPVC) is one of the rare anomalies. The incidence of coexisting TAPVC and TGA is unknown with very few cases ever reported.Case presentationWe reported a case of a 13-month-old female toddler with history of cyanosis. Echocardiography revealed atrioventricular ambiguity with pulmonary atresia, all PVs drain into the innominate vein via vertical vein (VV), ostium secundum atrial septal defect (ASD) and ventricular septal defect (VSD) were observed. The CT scan confirmed co-occurrence of TGA and TAPVC. All four confluence PVs behind the small left atrium (LA), drains into an ascending lateral large VV, coursing to innominate vein without any PV access into LA. The superior vena cava, right atrium and right ventricle (RV) were dilated. The RV is the origin of the aortic root. The aorta continues on the right side, with an arterial connection to the right pulmonary aberrant artery at the level of the aortic arch. Main pulmonary artery originates from LV and appears atretic with only connection to the left pulmonary artery. Large ASD and VSD were identified.ConclusionsTGA and TAPVC are a rare combination and should be suspected in mild-cyanotic cases with levocardia with situs solitus. CT angiography is one of the modalities of choice to characterize the vasculature anomalies.

Maternal cyclobenzaprine exposure and risk of birth defects in the National Birth Defects Prevention Study (1997-2011) and Birth Defects Study to Evaluate Pregnancy exposureS (2014-2018).

Cyclobenzaprine is a muscle relaxant indicated for acute pain. Little is known about cyclobenzaprine's safety during pregnancy. We explored the association between maternal cyclobenzaprine exposure and risk of birth defects among offspring. We combined data from two large, multi-site, population-based case-control studies in the United States. Cases were identified from birth defects registries across 10 states; controls were liveborn infants without birth defects randomly selected from the same catchment areas. Participants reported cyclobenzaprine use during the month before conception through the third month of pregnancy ("periconception") via computer-assisted telephone interview. We used logistic regression to assess associations between periconceptional cyclobenzaprine exposure and selected structural birth defects. We calculated crude odds ratios (OR) with corresponding 95% confidence intervals (CI). Our study included 33 615 cases and 13 110 controls. Overall, 51 case (0.15%) and 9 control (0.07%) participants reported periconceptional cyclobenzaprine use. We observed increased risk for all seven defects with ≥3 exposed cases: cleft palate (OR = 4.79, 95% CI 1.71-13.44), cleft lip (OR = 2.50, 95% CI 0.89-7.02), anorectal atresia/stenosis (OR = 6.91, 95% CI 1.67, 28.65), d-transposition of the great arteries (OR = 6.97, 95% CI 2.17-22.36), coarctation of the aorta (OR = 5.58, 95% CI 1.88-16.58), pulmonary valve stenosis (OR = 4.55, 95% CI 1.10-18.87), and secundum atrial septal defect (OR = 3.08, 95% CI 0.83-11.45). Even in our large sample, cyclobenzaprine use was rare. Our estimates are unadjusted and imprecise so should be interpreted cautiously. These hypothesis-generating results warrant confirmation and further research to explore possible mechanisms.

Endovascular Closure of Secundum Atrial Septal Defects with Complex Anatomy

According to European guidelines, endovascular closure is the method of choice for defects with favorable anatomy. However, there are no clear criteria for determining favorable anatomy and this issue requires additional investigation. According to literature data, only 24.2% of secundum atrial septal defects (ASDII) have a central location, others have complicated anatomy.&#x0D; The aim. To analyze the experience of endovascular closure of ASDII with complex anatomy. Materials. In the period from 2003 to 2021, 1732 transesophageal echocardiographies and intracardiac echocardiographieswereperformedinpatientswithASDIIinitiallydiagnosedaccordingtotransthoracicechocardiography, and only 1408 (91.8%) were selected for endovascular closure. Mean age was 19.9±18 years, mean weight was 45±26.68 kg.&#x0D; Methods. The standard closure technique was primarily used in 100% of cases, and only when it was ineffective, we used modified techniques.&#x0D; Results. Modified techniques were used in 478 (33.9%) of 1408 patients and were effective in 460 (96.2%) patients with the complex anatomy. Based on previous statement, 460 (32.6%) of 1408 patients (one third of all) had modified techniques utilized and avoided open surgery. In 18 (1.3%) cases, it was impossible to close the defect. The overall technical success of transcatheter closure was 98.7% (1390 patients). Nineteen (1.3%) patients with poor visualization of inferior rim on transesophageal echocardiography had intracardiac echocardiography; in two of them inferior rim was present, others had open surgery. The rate of complications in immediate periprocedural period was 1.9% (27 patients). One death was recorded in the period of introduction of percutaneous interventions in our institution. Mean follow-up period was 5.41±3.28 years. In the follow-up period two complications were observed: 1 case of erosion, 17 (1.9%) cases of new-onset atrial fibrillation.&#x0D; Conclusion. The majority (90.6%) of ASDII can be closed percutaneously. Modified techniques improve the efficacy of the procedure enabling to close 32.6% of the defects. Safe procedure for the defects with complex anatomy is possible only with surgical and arrhythmological services back-up.

Percutaneous Treatment of Pulmonary Valvular Stenosis and Secundum Type Atrial Septal Defect in a Young Adult

Pulmonary valve stenosis (PS) and secundum type atrial septal defect (ASD) are common forms of congenital heart disease. While traditional treatment for PS and ASD is open surgery, percutaneous treatment of both diseases are widely used with high rates of success and lower complication. However, the combination of PS with ASD in the same patient is relatively rare, and the optimal strategy is debated. We performed consecutive percutaneous balloon pulmonary valvuloplasty and ASD occlusion in a young adult patient with severe congenital PS associated with a secundum ASD.

Anaesthesia Perioperative Management in Laparotomy Procedure in Neonates with Tetralogy of Fallot (ToF): A Case Study

Tetralogy of Fallot (TOF) is a congenital heart condition characterized by right ventricular hypertrophy, pulmonary stenosis, aortic overriding, and ventricular septal defect. Its presence raises mortality and perioperative risk. Noncardiac abnormalities associated with this condition include neurological, musculoskeletal, and ophthalmological defects, all of which were present in the index case. The complexity of the heart lesion, coupled with individuals' potential to compensate, the urgency of the operation, and numerous concurrent conditions all present challenges for anesthesiologists when dealing with patients with cyanotic congenital heart disease (CHD) who require extracardiac surgery. The objectives of anaesthesia in patients with ToF are to minimize pulmonary vascular resistance (PVR), maintain or raise systemic vascular resistance (SVR), and prevent intraoperative hypercyanotic episodes. To investigate a case report in neonates with tetralogy of Fallot and discuss further anaesthesia perioperative management in laparotomy procedure in neonates with tetralogy of Fallot (ToF). A 20-days female neonate, weighing 1,9 kg, was referred to our hospital with the diagnosis of high-level bowel obstruction et causa suspect atresia duodenum dd duodenal stenosis, tetralogy of Fallot (ToF), and a Secundum Atrial Septal Defect (ASD) with ASA IV. The patient was planned to undergo general anaesthesia for explorative laparotomy surgery. There were hemodynamic changes during surgery, but they can be appropriately managed. Anaesthesia and surgery were successful, and the patient improved. Preoperative, Durante-operative, and postoperative management was shown. Tetralogy of Fallot (TOF) Children generally have congenital heart defects. Preoperative planning, managing anaesthesia during surgery, and typical postoperative problems in the critical care unit are all perioperative considerations. The procedure will be completed successfully with the help of careful planning and a solid understanding of physiological and pharmacological principles.

Laparoscopic Repair of Morgagni Hernia in Children

PurposeThis study aimed to evaluate our patients who underwent laparoscopic-assisted transabdominal repair for Morgagni hernia (MH). MethodsWe retrospectively reviewed patients who underwent laparoscopy-assisted transabdominal repair using loop sutures for MH between March 2010 and April 2021. Demographic data, symptoms, operative findings, operation methods, and postoperative complications of the patients were reviewed. ResultsA total of 22 patients with MH were treated with laparoscopy-assisted transabdominal repair using loop suture. There were 6 girls (27.2%) and 16 boys (72.7%). Two patients had Down syndrome, and two patients had cardiac defects (secundum atrial septal defect, patent foramen ovale). One patient had a V–P shunt due to hydrocephalus. One patient had cerebral palsy. The mean operation time was 45 min (30–86 min). The hernia sac was not removed, and a patch was not used in any of the patients. The mean hospitalization time was 1.7 days (1–5 days). One patient's defect was very large, and another patient's liver was densely attached to the liver sac, causing bleeding during dissection. In total, two patients were converted to open surgery. There was no recurrence during the follow-up. ConclusionLaparoscopy-assisted transabdominal repair is an efficient and safe choice for the repair of MH. Leaving the hernia sac does not increase the recurrence, so there is no need to dissect the sac.

Anaesthetic management of type II abernethy malformation posted for endovascular device closure

Abernethy malformation is a rare congenital vascular malformation in which anomalous communication is seen between portal and systemic circulation. While treating the main goal is to prevent shunting of portal blood into the systemic circulation and preserving hepatic blood flow. This can be achieved surgically or non-surgical method. We report anaesthetic management of non-surgical closure of type II Abernethy malformation of 10 year old female child who had undergone ostium secundum ASD (atrial septal defect) patch closure.