(From Esophagography in anomalies of the aortic arch system by A.C. Klinkhamer. 1969. Williams & Wilkins Company, Baltimore, MD)
See related posting
12/04/2011
Anatomy: Left Aortic Arch with Right Descending Aorta
Left Aortic Arch with Right Descending Aorta: Possible type
(From Esophagography in anomalies of the aortic arch system by A.C. Klinkhamer. 1969. Williams & Wilkins Company, Baltimore, MD)
See related posting
(From Esophagography in anomalies of the aortic arch system by A.C. Klinkhamer. 1969. Williams & Wilkins Company, Baltimore, MD)
See related posting
12/02/2011
Vascular Ring - General Rules
From Moss & Adams(Vol. 1) 7th ed. 2008.
Chapter: Aortic Arch Anomalies by Dr. Paul Weinberg.
1) Arch sidedness: Retroesophageal or Isolated vessel always is the vessel on opposite side from the arch.
2) Vascular Ring: Easier to recognize the existence of vascular ring if all components of the ring are patent. The following rule is helpful when the ring is completed by an atretic ligament on one side i.e. Presence of one of the 3 Ds on the opposite side from the aortic arch indicates presence of a vascular ring. (3Ds are Diverticulum, Dimple or Descending aorta).
Chapter: Aortic Arch Anomalies by Dr. Paul Weinberg.
1) Arch sidedness: Retroesophageal or Isolated vessel always is the vessel on opposite side from the arch.
2) Vascular Ring: Easier to recognize the existence of vascular ring if all components of the ring are patent. The following rule is helpful when the ring is completed by an atretic ligament on one side i.e. Presence of one of the 3 Ds on the opposite side from the aortic arch indicates presence of a vascular ring. (3Ds are Diverticulum, Dimple or Descending aorta).
12/01/2011
11/30/2011
ICU: What's wrong with this picture...
6-mo old. s/p Complete AVSD repair. Immediate postop. Just arrived from operating room.
Hint: The anomaly is the relationship between LA pressure and PA pressure.
Panel 1 - Has a problem/mistake. (Pardon the shaken image)
Panel 2 - The problem/mistake has been rectified.
Hint: The anomaly is the relationship between LA pressure and PA pressure.
Panel 1 - Has a problem/mistake. (Pardon the shaken image)
Panel 2 - The problem/mistake has been rectified.
11/29/2011
ICU: Pulsus Alternans
What is the significance of Pulsus Alternans?
6 mo old baby girl, s/p VSD closure, Repair of Cleft mitral valve. Postop. ICU stay. Residual VSD with Pulmonary hypertension. Pulsus alternans is noted in the PA line pressure traces.
Panel 1 - DDD pacing
Panel 2 - Pacing Off
Panel 3 - AAI pacing
Panel 4 - VVI pacing
6 mo old baby girl, s/p VSD closure, Repair of Cleft mitral valve. Postop. ICU stay. Residual VSD with Pulmonary hypertension. Pulsus alternans is noted in the PA line pressure traces.
Panel 1 - DDD pacing
Panel 2 - Pacing Off
Panel 3 - AAI pacing
Panel 4 - VVI pacing
ICU: Arterial Pressure Trace Distortion
(From Cardiovascular Dynamics by Robert F. Rushmer. 3rd Ed. 1970. W.B. Saunders Company)
11/19/2011
Quiz, EKG: What is the rhythm? Junctional vs. Low Atrial rhythm?
11 yr old boy. s/p Repair of Sinus venosus ASD. Started with AAI pacing at 80 bpm in the operating room. You set out to determine the underlying rhythm. The following strips are availabe for analysis. Second-from-the-last panel has atrial lead electrogram in V1. (Click on the images to enlarge).
Last panel image is from Principles of Clinical Electrocardiography by Mervin J. Goldman. Lange Medical Publications. 11th ed. 1982.
11/09/2011
ICU: Pericardial Tamponade
Beware of the importance of looking "all-around" when you are doing a "quick" echo when a baby is unstable, in the immediate postoperative period. (Poor image quality is part of the deal!)
The first two panels show no significant effusion. However, in the lower-most panel - angled more posteriorly - there is a localized collection of clot compressing right atrium and part of right ventricle. This was not recognized due to poor images. Chest was opened to cannulate for ECMO! Clot was noted in the pericardial space, compressing right atrium (Lower-most panel). Hemodynamic status improved when the clot was removed. ECMO was not necessary.
Newborn, s/p Arterial switch operation. 3 hrs postop.
The first two panels show no significant effusion. However, in the lower-most panel - angled more posteriorly - there is a localized collection of clot compressing right atrium and part of right ventricle. This was not recognized due to poor images. Chest was opened to cannulate for ECMO! Clot was noted in the pericardial space, compressing right atrium (Lower-most panel). Hemodynamic status improved when the clot was removed. ECMO was not necessary.
Newborn, s/p Arterial switch operation. 3 hrs postop.
11/06/2011
EKG: Nomogram / Table: Cycle Length to Heart Rate Table
L = Cycle length (seconds)
R = Heart rate
In pediatrics, it is useful remember the cycle length range of 200-300 ms (0.2 to 0.3 seconds) where most of pediatric arrhythmias occur.
R = Heart rate
In pediatrics, it is useful remember the cycle length range of 200-300 ms (0.2 to 0.3 seconds) where most of pediatric arrhythmias occur.
Subscribe to:
Posts (Atom)