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Management of high-risk reentry sternotomy in an infant for repair of a giant pseudoaneurysm of the right ventricular outflow tract


1 Department of Anesthesia, The Stanford University School of Medicine, Stanford, CA, USA
2 Department of Anesthesia, Lucile Packard Children's Hospital, and The Stanford University School of Medicine, Stanford, CA, USA

Correspondence Address:
Bryan G Maxwell
Department of Anesthesiology, Stanford University Medical Center, 300 Pasteur Drive H3586, Stanford, CA
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.124145

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Year : 2014  |  Volume : 17  |  Issue : 1  |  Page : 59-61

 

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Improved survival from congenital heart disease has led to an increasing need for complex reoperation by reentrant sternotomy. Peripheral cannulation and initiation of cardiopulmonary bypass prior to sternotomy to avoid the risk of cardiac injury and massive hemorrhage is an option in adults and larger children, but femoral vessel size precludes this strategy in infants. We describe the management of a high-risk reentry sternotomy in an infant for repair of a giant pseudoaneurysm after prior homograft repair of tetralogy of Fallot, using surgical dissection for suprasternal cannulation of the innominate artery and subxyphoid cannulation of the inferior vena cava.






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1 Department of Anesthesia, The Stanford University School of Medicine, Stanford, CA, USA
2 Department of Anesthesia, Lucile Packard Children's Hospital, and The Stanford University School of Medicine, Stanford, CA, USA

Correspondence Address:
Bryan G Maxwell
Department of Anesthesiology, Stanford University Medical Center, 300 Pasteur Drive H3586, Stanford, CA
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.124145

Rights and Permissions

Improved survival from congenital heart disease has led to an increasing need for complex reoperation by reentrant sternotomy. Peripheral cannulation and initiation of cardiopulmonary bypass prior to sternotomy to avoid the risk of cardiac injury and massive hemorrhage is an option in adults and larger children, but femoral vessel size precludes this strategy in infants. We describe the management of a high-risk reentry sternotomy in an infant for repair of a giant pseudoaneurysm after prior homograft repair of tetralogy of Fallot, using surgical dissection for suprasternal cannulation of the innominate artery and subxyphoid cannulation of the inferior vena cava.






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