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CASE REPORT
Year : 2010  |  Volume : 54  |  Issue : 3  |  Page : 242-245

Anaesthetic management of a child with "cor-triatriatum" and multiple ventricular septal defects - A rare congenital anomaly


1 Consultant Cardiac Anaesthesiologist, J. N. Medical College, Nehru Nagar, Belgaum - 590 010, Karnataka; Department of Anaesthesiology, J. N. Medical College, Nehru Nagar, Belgaum - 590 010, Karnataka, India
2 Consultant Cardiac Anaesthesiologist, J. N. Medical College, Nehru Nagar, Belgaum - 590 010, Karnataka, India
3 Director, KLES Heart Foundation, J. N. Medical College, Nehru Nagar, Belgaum - 590 010, Karnataka; Professor, Department of CVTS, J. N. Medical College, Nehru Nagar, Belgaum - 590 010, Karnataka, India
4 Professor, Department of CVTS, J. N. Medical College, Nehru Nagar, Belgaum - 590 010, Karnataka, India

Correspondence Address:
Sriram Sabade
Cardiac Anesthesia and Critical Care, Department of Anesthesiology, J.N. Medical College, Nehru Nagar, Belgaum - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.65375

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Cor-triatriatum is a rare congenital cardiac anomaly. It accounts for 0.1% of congenital heart diseases. Its association with multiple ventricular septal defects (VSD) is even rarer. A five-month-old baby was admitted with respiratory distress and failure to thrive. Clinical examination revealed diastolic murmur over mitral area. Chest X-ray showed cardiomegaly. Haematological and biochemical investigations were within normal limits. Electrocardiogram showed left atrial enlargement. 2D echo showed double-chambered left atrium (cor-triatriatum), atrial septal defect (ASD) and muscular VSD with moderate pulmonary arterial hypertension. The child was treated with 100% oxygen, diuretics and digoxin and was stabilized medically. We used balanced anaesthetic technique using oxygen, air, isoflurane, fentanyl, midazolam and vecuronium. Patient was operated under cardiopulmonary bypass (CPB) with moderate hypothermia. Through right atriotomy abnormal membrane in the left atrium was excised to make one chamber. VSD were closed with Dacron patches and ASD was closed with autologous pericardial patch. Patient tolerated the whole procedure well and was ventilated electively for 12h in the intensive care unit. He was discharged on the 10 th postoperative day.


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