1/3. Successful transcutaneous arterial embolization of a giant hemangioma associated with high-output cardiac failure and kasabach-merritt syndrome in a neonate: a case report.We describe the case of a patient with a neonatal giant cutaneous hemangioma with high-output cardiac failure and kasabach-merritt syndrome and successfully treated with transcutaneous arterial embolization aimed at controlling severe congestive heart failure and consumption coagulopathy. A patient was admitted to the neonatal care unit on the first day of age because of a large hemangioma on his right lateral chest wall and respiratory distress, associated with cardiac failure resulting from arteriovenous shunting. On the second day of age the platelet count decreased to 5.7 x 10(4)/microliter and fibrinogen level was 85 mg/dl. The values of prothrombin time and activated partial thromboplastin time were prolonged. Intravenous predonisone therapy was started immediately, but bleeding tendency was getting worse and the evidence of congestive heart failure persisted. On the third day the patient then underwent embolization of feeding arteries with microcoils. The cardiac failure and thrombocytopenic coagulopathy had improved significantly without complications. We conclude that transcutaneous arterial embolization is an effective and safe treatment in this neonate and should be considered for the treatment of control high-output cardiac failure and coagulopathy in infants with hemangioma and kasabach-merritt syndrome.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/3. Remission of high-output heart failure after surgical repair of 30-month arteriovenous femoral fistula: case report.We present a 15-year-old male patient who was admitted to our hospital because of breathlessness and palpitations at minimal physical effort (new york Heart association class II). The patient had a history of an abdominal and left thigh firearm wound that was surgically treated 30 months earlier. auscultation over the left femoral groin region revealed a systolodiastolic murmur. X-ray examination of the chest demonstrated significant cardiomegaly. Transthoracic echocardiography revealed an enlargement of 4 cardiac chambers, as well as significant mitral and tricuspid regurgitation. Vascular ultrasound of the femoral artery and vein confirmed the diagnosis of a traumatic arteriovenous fistula. The patient underwent surgical correction of the fistula, after which the symptoms subsided rapidly. Follow-up echocardiography performed 2 months after surgical repair showed a substantial reduction of cardiac size and a nearly complete absence of valvular regurgitations. This case highlights the importance of the recognition of arteriovenous fistulas as a cause of unexpected heart failure and demonstrates that the condition may improve substantially and rapidly after fistula correction.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
3/3. High-output heart failure caused by arteriovenous fistula long after nephrectomy.A 70-year-old Japanese woman was admitted to our hospital because of anasarca. At 32 years of age, she had undergone nephrectomy for renal tuberculosis. A continuous abdominal bruit was heard. The chest X-ray showed cardiomegaly and dilatation of the pulmonary artery. Abdominal three-dimensional computed tomography scanning clearly revealed an arteriovenous fistula. cardiac catheterization disclosed cardiac output of 9.2 l/min and a step-up of oxygen saturation at the renal vein level of the inferior vena cava. Surgical closure of the fistula promptly decreased her cardiac output and improved the heart failure. This is a rare case of an arteriovenous fistula developing long after nephrectomy and causing high-output heart failure.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |