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Focused Cardiac Ultrasound Diagnosis of Cor Triatriatum Sinistrum in Pediatric Cardiac Arrest.

Kehrl T, Dagen CT, Becker BA - West J Emerg Med (2015)

Bottom Line: Cardiac arrest in the adolescent population secondary to congenital heart disease (CHD) is rare.Focused cardiac ultrasound (FoCUS) in the emergency department (ED) can yield important clinical information, aid in resuscitative efforts during cardiac arrest and is commonly integrated into the evaluation of patients with pulseless electrical activity (PEA).We report a case of pediatric cardiac arrest in which FoCUS was used to diagnose a critical CHD known as cor triatriatum sinistrum as the likely cause for PEA cardiac arrest and help direct ED resuscitation.

View Article: PubMed Central - PubMed

Affiliation: WellSpan York Hospital, Department of Emergency Medicine, York, Pennsylvania.

ABSTRACT
Cardiac arrest in the adolescent population secondary to congenital heart disease (CHD) is rare. Focused cardiac ultrasound (FoCUS) in the emergency department (ED) can yield important clinical information, aid in resuscitative efforts during cardiac arrest and is commonly integrated into the evaluation of patients with pulseless electrical activity (PEA). We report a case of pediatric cardiac arrest in which FoCUS was used to diagnose a critical CHD known as cor triatriatum sinistrum as the likely cause for PEA cardiac arrest and help direct ED resuscitation.

No MeSH data available.


Related in: MedlinePlus

Apical four chamber view, slightly off axis, with a large ventricular septal defect (arrow).RV, right ventricle; LV, left ventricle; RA, right atrium; LA, left atrium
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f1-wjem-16-753: Apical four chamber view, slightly off axis, with a large ventricular septal defect (arrow).RV, right ventricle; LV, left ventricle; RA, right atrium; LA, left atrium

Mentions: The treating emergency physicians then performed a FoCUS using a phased-array probe (Phillips, Andover, MA). Images obtained in the parasternal and apical windows demonstrated a globally hypokinetic left ventricle with significant spontaneous echo contrast in all four chambers of the heart. The apical view demonstrated spontaneous echo contrast passing freely between the left and right ventricles through a large VSD (Figure 1). On the parasternal long axis view, the VSD was confirmed and a septation in the left atrium was noted (Figure 2, Video). FoCUS allowed for the emergency physicians to recognize the patient’s congenital heart defect as the probable cause of the cardiac arrest. Approximately two minutes after ROSC, the patient’s end-tidal CO2 dropped precipitously and pulses were lost despite ongoing electrical activity on the monitor. ROSC was regained briefly after three additional rounds of CPR and IV epinephrine, but was subsequently lost again. Cardiothoracic surgery was consulted emergently as it was felt that initiation of extracorporeal membrane oxygenation (ECMO) would potentially stabilize the patient and allow bridge to definitive operative repair. Attempts were made at both percutaneous cannulation and cut-down of the femoral vessels to allow for placement of ECMO cannulae but were ultimately unsuccessful and resuscitative efforts were halted. Post-mortem autopsy was requested by the family and revealed a large VSD, CTS and evidence of biventricular heart failure.


Focused Cardiac Ultrasound Diagnosis of Cor Triatriatum Sinistrum in Pediatric Cardiac Arrest.

Kehrl T, Dagen CT, Becker BA - West J Emerg Med (2015)

Apical four chamber view, slightly off axis, with a large ventricular septal defect (arrow).RV, right ventricle; LV, left ventricle; RA, right atrium; LA, left atrium
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644046&req=5

f1-wjem-16-753: Apical four chamber view, slightly off axis, with a large ventricular septal defect (arrow).RV, right ventricle; LV, left ventricle; RA, right atrium; LA, left atrium
Mentions: The treating emergency physicians then performed a FoCUS using a phased-array probe (Phillips, Andover, MA). Images obtained in the parasternal and apical windows demonstrated a globally hypokinetic left ventricle with significant spontaneous echo contrast in all four chambers of the heart. The apical view demonstrated spontaneous echo contrast passing freely between the left and right ventricles through a large VSD (Figure 1). On the parasternal long axis view, the VSD was confirmed and a septation in the left atrium was noted (Figure 2, Video). FoCUS allowed for the emergency physicians to recognize the patient’s congenital heart defect as the probable cause of the cardiac arrest. Approximately two minutes after ROSC, the patient’s end-tidal CO2 dropped precipitously and pulses were lost despite ongoing electrical activity on the monitor. ROSC was regained briefly after three additional rounds of CPR and IV epinephrine, but was subsequently lost again. Cardiothoracic surgery was consulted emergently as it was felt that initiation of extracorporeal membrane oxygenation (ECMO) would potentially stabilize the patient and allow bridge to definitive operative repair. Attempts were made at both percutaneous cannulation and cut-down of the femoral vessels to allow for placement of ECMO cannulae but were ultimately unsuccessful and resuscitative efforts were halted. Post-mortem autopsy was requested by the family and revealed a large VSD, CTS and evidence of biventricular heart failure.

Bottom Line: Cardiac arrest in the adolescent population secondary to congenital heart disease (CHD) is rare.Focused cardiac ultrasound (FoCUS) in the emergency department (ED) can yield important clinical information, aid in resuscitative efforts during cardiac arrest and is commonly integrated into the evaluation of patients with pulseless electrical activity (PEA).We report a case of pediatric cardiac arrest in which FoCUS was used to diagnose a critical CHD known as cor triatriatum sinistrum as the likely cause for PEA cardiac arrest and help direct ED resuscitation.

View Article: PubMed Central - PubMed

Affiliation: WellSpan York Hospital, Department of Emergency Medicine, York, Pennsylvania.

ABSTRACT
Cardiac arrest in the adolescent population secondary to congenital heart disease (CHD) is rare. Focused cardiac ultrasound (FoCUS) in the emergency department (ED) can yield important clinical information, aid in resuscitative efforts during cardiac arrest and is commonly integrated into the evaluation of patients with pulseless electrical activity (PEA). We report a case of pediatric cardiac arrest in which FoCUS was used to diagnose a critical CHD known as cor triatriatum sinistrum as the likely cause for PEA cardiac arrest and help direct ED resuscitation.

No MeSH data available.


Related in: MedlinePlus