Cath: Angiogram of AVSD, Inlet VSD

Images from Radiology of Congenital Heart Disease by Kurt Amplatz & James H. Moller. Mosby Year Book, St. Louis, MO. 1993.
p.386-87.
Appearance & Location of inlet VSD in LAO view angiogram.
Notice the distance from aortic valve to crest of ventricular septum (black arrow)

CXR: Obstructed Supracardiac TAPVR

"Snow storm in a cage"

History: The Azygos Factor

British Journal of Surgery 1953;40(164):616-21.
A.T.Andreasen & F.Watson

This paper and the one before this paper, from the same group showed that the dogs survived when both SVC and IVC were clamped with only azygos flow allowed to go into right atrium. After the experiment, all surviving dogs behaved "normally".

Later, Lillehei's group in Minnesota showed that the amount of flow via Azygos vein was 10% of the venous return. This formed the basis for cross-circulation surgeries performed using another human being as the cardiopulmonary support - prior to availability of cardio-pulmonary bypass machine.

Donor is cannulated in the groin. The blood from the donor goes through a pump that is set to pump a calculated volume (equivalent to the azygos factor) to the recipient. Open heart surgery was performed with this set up in 1953-54.

Enoxaparin (Lovenox) - Subcutaneous injection

From Lexi-Comp:

Neonates (<>
Prophylactic use: 0.75 mg/kg q12hrs
Therapeutic use: 1.5 mg/kg q12hrs

Infants (> 2 mo):
Prophylactic use: 0.5 mg/kg q12hrs
Therapeutic use: 1 mg/kg q12hrs

Then, check Antifactor Xa level and adjust to set maintenance dose:
< 0.35 U/ml → Increase by 20% - Check dose 4 hr after next dose
0.35-0.49 U/ml → Increase by 10% - Check dose 4 hr after next dose
0.5 - 1.0 U/ml → No change - Check level next day, 1 week later and monthly
1.1 - 1.5 U/ml → Decrease by 20% - Check level before next dose
1.6 - 2.0 U/ml → Hold dose for 3 hrs and Decrease by 30% - Check level before next dose and 4 hr after
? 2.0 U/ml → Hold doses until level is 0.5 U/ml, Resume with decreased dose by 40% - Check every 12 hrs until level < 0.5 U/ml. Then, before next dose.

CXR: Figure of 3

Courtesy Dr. Thapar.
Child with Coarctation of aorta.

CXR: Newborn, Egg on side

Courtesy Dr. Thapar.
Baby with d-transposition of great arteries.

Anticoagulation: Warfarin

From Lexi-Comp
To maintain INR 2-3:
Loading:
Day 1: 0.2 mg/kg/day (0.1 mg/kg/day if liver dysfunction is present)
Day 2-4: Depends on daily INR
1.1 - 1.3 → Repeat same dose
1.4 - 3.0 → 50% of loading dose
3.1 - 3.5 → 25% of loading dose
> 3.5 → Hold until INR < 3.5. Then, start 50% of loading dose.

Maintenance (Day 5 & beyond): Depends on INR
1.1 -1.4 → Increase 20%
1.5 - 1.9 → Increase 10%
2-3 → No change
3.1 - 3.5 → Decrease 10%
> 3.5 → Hold until INR < 3.5. Then, start 20% lower than prior dose

Marfans Syndrome: Aortic Root Normal Values

Roman MJ et al. AJC 1989;64:507-512
(Also see newer nomogram from Parisian Children - AJC 2010;105:888-94)

ICU: Cardiopulmonary interaction, s/p Glenn operation

JTCVS 2003;126:1033-39
Scott Bradley et al.
Hypoventilation strategy to improve oxygenation after Glenn operation:
Protocol in Table 1, Response in other figures:

EKG - Interpret this

13 year old, girl.