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Transvenous pacing through the pulmonary valve in a patient with cyanotic congenital heart disease after Glenn shunt - A case report.

ABSTRACT: Bradyarrhythmia requiring pacing is infrequently encountered in patients with complex cyanotic congenital heart disease. Even though epicardial pacing is the preferred mode, rarely, a need for endocardial lead implantation arises. Patients with cavopulmonary shunts limit access to the venous atria and ventricles, necessitating alternate methods of pacemaker implantation. We report transvenous endocardial lead implantation by an unconventional method in a patient with congenitally corrected transposition of great arteries after a bidirectional Glenn shunt.

SUBMITTER: Bhyravavajhala S

PROVIDER: S-EPMC7952776 | biostudies-literature | 2021 Mar-Apr

REPOSITORIES: biostudies-literature

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Transvenous pacing through the pulmonary valve in a patient with cyanotic congenital heart disease after Glenn shunt - A case report.

Bhyravavajhala Srinivas S Vanaparty Bharathi B Yerram Sreekanth S

Indian pacing and electrophysiology journal 20210109 2

Bradyarrhythmia requiring pacing is infrequently encountered in patients with complex cyanotic congenital heart disease. Even though epicardial pacing is the preferred mode, rarely, a need for endocardial lead implantation arises. Patients with cavopulmonary shunts limit access to the venous atria and ventricles, necessitating alternate methods of pacemaker implantation. We report transvenous endocardial lead implantation by an unconventional method in a patient with congenitally corrected trans ...[more]

PMID: 33429048

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Project description:BackgroundSince oxygen saturation from pulse oximetry (SpO2) and partial pressure of arterial oxygen (PaO2) are observed to improve immediately after surgical correction of cyanotic congenital heart disease (CHD), we postulate that cerebral (CrO2) and somatic (SrO2) oximetry also improves immediately post-correction. We aim to prospectively examine CrO2 and SrO2, before, during, and after surgical correction as well as on hospital discharge in children with cyanotic CHD to determine if and when these variables increase.MethodsThis is a prospective observational trial. Eligibility criteria included children below 18 years of age with cyanotic CHD who required any cardiac surgical procedure. CrO2 and SrO2 measurements were summarized at six time-points for comparison: (1) pre-cardiopulmonary bypass (CPB); (2) during CPB; (3) post-CPB; (4) Day 1 in the pediatric intensive care unit (PICU); (5) Day 2 PICU; and (6) discharge. Categorical and continuous variables are presented as counts (percentages) and median (interquartile range), respectively.ResultsTwenty-one patients were analyzed. 15 (71.4%) and 6 (28.6%) patients underwent corrective and palliative surgeries, respectively. In the corrective surgery group, SpO2 increased immediately post-CPB compared to pre-CPB [99 (98, 100) vs. 86% (79, 90); p < 0.001] and remained in the normal range through to hospital discharge. Post-CPB CrO2 did not change from pre-CPB [72.8 (58.8, 79.0) vs. 72.1% (63.0, 78.3); p = 0.761] and even decreased on hospital discharge [60.5 (53.6, 62.9) vs. 72.1% (63.0, 78.3); p = 0.005]. Post-CPB SrO2 increased compared to pre-CPB [87.3 (77.2, 89.5) vs. 72.7% (65.6, 77.3); p = 0.001] but progressively decreased during PICU stay to a value lower than baseline at hospital discharge [66.9 (57.3, 76.9) vs. 72.7% (65.6, 77.3); p = 0.048].ConclusionCrO2 and SrO2 did not increase after corrective surgery of cyanotic CHD even up to hospital discharge. Future larger studies are required to validate these findings. (This study is registered with ClinicalTrials.gov ID: NCT02417259.).

Dataset Information

Transvenous pacing through the pulmonary valve in a patient with cyanotic congenital heart disease after Glenn shunt - A case report.

Publications

Transvenous pacing through the pulmonary valve in a patient with cyanotic congenital heart disease after Glenn shunt - A case report.

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