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Washington University Experience | VASCULAR | Infarct, watershed | 3A0 Case 3 History
Case 3 History ---- The patient was a 5 week old male who was born at 37 4/7 weeks to a 22 year old woman. Prenatal testing showed a normal AFP and no 22 q11.2 deletion. Antenatal course was significant for intrauterine growth retardation and complex congenital heart disease. By imaging the patient was noted to have a large primum secundum ASD, pulmonary atresia, significant aortopulmonary collateral on right, single ventricle, unbalanced AV canal, abnormal pulmonary venous return, dextrocardia, asplenia, and bilateral IVCs draining into single atria. Also noted was bilateral isomerism with bilateral right-handedness, heterotaxy, right sided stomach, reverse orientation of superior mesenteric vein and artery, and imperforate anus. On day 2 after birth, the patient underwent surgery for colostomy creation for his imperforate anus. On 12/3 he had an aortopulmonary shunt placed. The patent ductus arteriosus which was kept patent with prostaglandin therapy as the circulation was ductal dependent. On 12/5, the patient coded and required ECMO, and on 12/9 he was taken off ECMO. The patient developed significant hemodynamic instability on 12/14 and was taken for emergent catheterization where practically all vessels supplying the lungs were found to be clotted. A stent was placed in one of the collaterals, but the patient coded and no further stenting could be performed at that time. On 12/20, the patient was extubated after which he seemed to do well. The patient was quite stable on nasal CPAP, when on the morning of 1/6, he suddenly became bradycardic and coded. Despite extensive support, the patient continued in asystole. The decision was made by the parents to limit further intervention and the patient expired.
