KK Women's and Children's Hospital, Singapore.
KK Women's and Children's Hospital, Singapore
BMJ Case Rep. 2021 Sep 3;14(9):e244023. doi: 10.1136/bcr-2021-244023.
We present a rare case of premature low birthweight neonate with right diaphragmatic hernia and transposition of great vessels requiring balloon atrial septostomy. Congenital diaphragmatic hernia poses a unique challenge to umbilical venous catheterisation. Based on the radiographic position of umbilical vein catheter, umbilical venous cannulation was attempted; however, the catheter could not be navigated to the right atrium. Saline contrast echocardiography was used to delineate the abnormal umbilical and ductus venosus drainage. Eventually, the procedure was successfully completed via the femoral venous approach. We emphasise the importance of defining ductus venosus anatomy and umbilical venous drainage using a simple tool like saline contrast echocardiography before performing catheterisation using the umbilical venous access in such cases.
我们报告了一例罕见的早产低体重儿，患有右膈疝和大血管转位，需要进行球囊房间隔造口术。先天性膈疝对脐静脉置管提出了独特的挑战。根据脐静脉导管的影像学位置，尝试进行脐静脉置管; 然而，导管无法进入右心房。使用盐水对比超声心动图来描绘异常的脐静脉和静脉导管引流。最终，通过股静脉途径成功完成了该操作。我们强调，在使用脐静脉通路进行置管之前，使用盐水对比超声心动图等简单工具来明确静脉导管解剖结构和脐静脉引流的重要性。
