Dey Chandan K, Anand Varun, Agha Mussavvir, Karim Habib Md R, N Pharanitharan, Panda Chinmaya K, Kesavankutty Manu P
Trauma and Emergency, All India Institute of Medical Sciences, Raipur, Raipur, IND.
Anaesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND.
Cureus. 2023 Jun 23;15(6):e40840. doi: 10.7759/cureus.40840. eCollection 2023 Jun.
While congenital heart disease is not uncommon, cyanotic congenital heart disease (CCHD) accounts for a minor fraction of them. However, when cyanosis is present, it usually indicates a severe or critical illness. Tetralogy of Fallot (TOF) is one of the common CCHDs, representing 7-10% of all congenital cardiac malformations. Double-outlet right ventricle (DORV) is another CCHD similar to the TOF and associated with decreased pulmonary flow, ventricular septal defect (VSD), and aorta receiving blood from both ventricles. Reduced oxygen arterial saturation and increased viscosity by polycythemia induce focal cerebral ischemia, often in the area supplied by the middle cerebral artery leading to brain abscess. Brain abscesses require craniotomy, which is a major surgery. These patients also often show features of sepsis and increased intracranial pressure. The presence of CCHD further complicates the situation, making perioperative management even more challenging. There are studies in the literature on the management of similar cases, and they report successful management in most of them. However, not all such cases need intensive postoperative management. We present four pediatric cases who had either TOF or DORV and had to undergo craniotomy for brain abscess or ventriculoperitoneal shunt placement. We describe case management and highlight the critical features and cases that require prolonged postoperative critical care management.
虽然先天性心脏病并不罕见，但青紫型先天性心脏病（CCHD）仅占其中的一小部分。然而，一旦出现青紫，通常表明病情严重或危急。法洛四联症（TOF）是常见的CCHD之一，占所有先天性心脏畸形的7%-10%。右心室双出口（DORV）是另一种与TOF相似的CCHD，与肺血流量减少、室间隔缺损（VSD）以及主动脉接受来自两个心室的血液有关。动脉血氧饱和度降低和红细胞增多症导致的血液黏稠度增加会引发局灶性脑缺血，通常发生在大脑中动脉供血区域，进而导致脑脓肿。脑脓肿需要开颅手术，这是一项大型手术。这些患者还常常表现出败血症和颅内压升高的特征。CCHD的存在使情况更加复杂，使得围手术期管理更具挑战性。文献中有关于类似病例管理的研究，并且他们报告大多数病例都成功进行了管理。然而，并非所有此类病例都需要术后强化管理。我们介绍了4例患有TOF或DORV且因脑脓肿或脑室腹腔分流术而不得不接受开颅手术的儿科病例。我们描述了病例管理，并强调了需要延长术后重症监护管理的关键特征和病例。
