Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania U.S.
Undersea Hyperb Med. 2020 Third Quarter;47(3):431-434.
A 30-year-old female with a history of seizure disorder and hypoplastic left heart syndrome treated with a Norwood procedure in 1986 followed by a modified non-fenestrated Fontan (Left SVC to IVC to pulmonary arteries) with a known baffle leak presented to the emergency department. On day of presentation, the patient became unresponsive, with perioral cyanosis, rightward gaze and a left facial droop near the end of a platelet transfusion. An emergent non-contrast head CT revealed intracranial air in the right MCA distribution. She was taken to the hyperbaric chamber and was treated with a U.S. Navy Table 6 in a multiplace chamber with no extensions. Ten minutes into the treatment patient became more alert and spontaneously asked questions. The following day she was treated with a U.S. Navy Table 5. Patient had repeat CT of the head, which showed resolution of intracerebral gas and small areas of ischemia in right frontal lobe and right caudate. On hospital day five neurologic exam was normal, with 5/5 strength and no residual deficits. Treating the patient was a concern because patient has a single ventricle, in which the pulmonary artery is connected directly to the vena cava. There is very little data regarding the effects of hyperbaric oxygen (HBO2)therapy on single-ventricle physiology. Only two case reports of three pediatric patients treated with HBO2 for CAGE in a similar setting are known. In these cases the patients had improvements in their symptoms following HBO2. These cases and ours indicate HBO2 is feasible and indicated for CAGE in patients with cyanotic congenital heart disease.
一位 30 岁的女性，患有癫痫病史和左心发育不全综合征，1986 年接受了 Norwood 手术，随后进行了改良的非开窗 Fontan（左上腔静脉至下腔静脉至肺动脉）手术，但存在已知的分流器漏。患者因分流器漏就诊于急诊科。就诊当天，患者在血小板输注即将结束时出现意识丧失、口唇周围发绀、向右凝视和左侧面瘫。紧急非对比头部 CT 显示右侧 MCA 分布区颅内积气。她被送往高压氧舱，并在无扩展的多人高压氧舱中接受了美国海军 6 号表治疗。治疗 10 分钟后，患者变得更加警觉，并自发地提出问题。第二天，她接受了美国海军 5 号表治疗。患者重复头部 CT 显示颅内气体吸收，右侧额叶和右侧尾状核有小面积缺血。住院第五天，神经检查正常，肌力为 5/5，无残留缺陷。由于患者为单心室，肺动脉直接与腔静脉相连，因此治疗患者是一个问题。关于高压氧（HBO2）治疗对单心室生理学的影响的数据非常有限。仅已知有两例类似情况下接受 HBO2 治疗 CAGE 的儿科患者的病例报告。在这些情况下，患者在接受 HBO2 治疗后症状有所改善。这些病例和我们的病例表明，HBO2 对发绀性先天性心脏病患者的 CAGE 是可行且有指征的。
