#great vessel transposition

[jcsmicasereports]

Successful Jatene procedure for great arteries transposition correction in newborn with SARSCoV-2 infection by Guillermo Careaga-Reyna MD in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Pandemic of COVID-19 represents a challenge for treatment of patients with congenital herat disease. We present a newborn with great vessels transposition and positive SARS-CoV-2 PCR test. The patient was submitted to a successful surgical treatment with corrective Jatene procedure, requiring opened chest wall during 72 h of postoperative period and 43 days of total in-hospital lenght of stay.

KEY-WORDS: COVID-19, SARS-CoV-2, great vessel transposition, Jatene procedure, congenital heart disease.

Introduction

Coronaviruses are single stranded ribonucleic acid viruses with a diameter of 60–140 nm and a high rate of genetic mutations and recombinations, rendering them capable of escaping from the immune system and causing novel infections (1). In less than six months, the coronavirus disease 2019 (COVID-19) pandemic has swiftly spread from one city in China to over 190 countries worldwide (2-4). Neonatal infections with SARS-CoV-2 have been described although robust data on vertical transmission are lacking. In most instances where neonatal infection has been reported, close contact with infected mother or caregiver is postulated to have occurred (4).

In newborns, the case is regarded as positive for infection if any of the following conditions occurs, (1): positive PCR for SARS-CoV-2 in respiratory tract or blood samples, high homology of viral gene sequences of the samples from the respiratory tract or blood to the COVID-19 sequence.

We present a case of a newborn with great vessel transposition and SARS-CoV-2 infection.

Case Report

We present a new born with great arteries transposition associated to aquired SARS-COV-2 infection.

The patient was refrerred to our hospital, with a positive SARS-CoV-2 test, with mechanical ventilatory support in order to confirm a complex congenital heart disease.

The diagnosis was established via echocardiographic evaluation which showed normal venous return, concordance atrio-ventricular and ventriculo-arterial discordance. It was concluded: great arteries transposition, patent ductus arteriosus and permeability of foramen oval.

The patient was recovered from a septic shock with no evidence of systemic inflammatory response requires inotropic support and after stabilization in neonatal intensive care unit, at 10 day in-hospital stay,  was submitted to an open heart surgery consisted in anatomic correction with Jatene procedure. The aortic cross-clamping time was 119 min, with cardiopulmonary bypass (CPB) of 181 min. It was decided to maintain in postoperative period opened chest wall, and after 72 the chest wall closure was succesfully realized with favorable posoperative evolution. After 32 days of postoperative, the patient was discharged from hospital. Actually, two years after surgery, the patient is doing well, only with mild pulmonary stenosis without hemodinamic or clinical repercusion.

Discussion

For infants born to COVID positive mothers should be reasonable to separate him from the mother if will need cardiac surgery to try avoid post-natal infection.

In fact, there is minimal evidence of placental vertical transmisión. In this case, the patient has a positive test for SARS-CoV-2 infection and evolved with septic shock in the preoperative period.

It may also be reasonable to do serial testing on the infant, but there is no consensus on the correct timing surgery should be scheduled with advice from a multidisciplinary team of experts including cardiac medical, cardiac surgical, and infectious diseases as indicated. After evaluation of the clinical conditions for a heart team in our hospital, it was decided to realize the surgical procedure in order to avoid progression of heart damage and irreversible heart failure.

However we must remember that, if prudent, surgery should be delayed until the patient’s symptoms have improved and/or testing has been repeated (often after 14 days) and is negative (5).

On the other side, in older patients the inflammatory response due to SARS-CoV-2 infection has been a frequent complication.

In our patient, probably due to the age, it was no presented even with the septic shock o posteriorly associated to the use of CPB during the surgical procedure

It was concluded taht COVID-19 may affect all age patients. However with cautious evaluation and treatment of associated disease as in our case, the patient improves survival, despite severity of viral illness, and during this pandemic period, patients with active COVID-19, at neonatal period we have no treated any other.

[jcrmhscasereports]

Successful Jatene procedure for great arteries transposition correction in newborn with SARSCoV-2 infection by Guillermo Careaga-Reyna MD in Journal of Clinical Case Reports Medical Images and Health Sciences

ABSTRACT

Pandemic of COVID-19 represents a challenge for treatment of patients with congenital herat disease. We present a newborn with great vessels transposition and positive SARS-CoV-2 PCR test. The patient was submitted to a successful surgical treatment with corrective Jatene procedure, requiring opened chest wall during 72 h of postoperative period and 43 days of total in-hospital lenght of stay.

KEY-WORDS: COVID-19, SARS-CoV-2, great vessel transposition, Jatene procedure, congenital heart disease.

INTRODUCTION

Coronaviruses are single stranded ribonucleic acid viruses with a diameter of 60–140 nm and a high rate of genetic mutations and recombinations, rendering them capable of escaping from the immune system and causing novel infections (1). In less than six months, the coronavirus disease 2019 (COVID-19) pandemic has swiftly spread from one city in China to over 190 countries worldwide (2-4). Neonatal infections with SARS-CoV-2 have been described although robust data on vertical transmission are lacking. In most instances where neonatal infection has been reported, close contact with infected mother or caregiver is postulated to have occurred (4).

In newborns, the case is regarded as positive for infection if any of the following conditions occurs, (1): positive PCR for SARS-CoV-2 in respiratory tract or blood samples, high homology of viral gene sequences of the samples from the respiratory tract or blood to the COVID-19 sequence.

We present a case of a newborn with great vessel transposition and SARS-CoV-2 infection.

CASE REPORT

We present a new born with great arteries transposition associated to aquired SARS-COV-2 infection.

The patient was refrerred to our hospital, with a positive SARS-CoV-2 test, with mechanical ventilatory support in order to confirm a complex congenital heart disease.

The diagnosis was established via echocardiographic evaluation which showed normal venous return, concordance atrio-ventricular and ventriculo-arterial discordance. It was concluded: great arteries transposition, patent ductus arteriosus and permeability of foramen oval.

The patient was recovered from a septic shock with no evidence of systemic inflammatory response requires inotropic support and after stabilization in neonatal intensive care unit, at 10 day in-hospital stay,  was submitted to an open heart surgery consisted in anatomic correction with Jatene procedure. The aortic cross-clamping time was 119 min, with cardiopulmonary bypass (CPB) of 181 min. It was decided to maintain in postoperative period opened chest wall, and after 72 the chest wall closure was succesfully realized with favorable posoperative evolution. After 32 days of postoperative, the patient was discharged from hospital. Actually, two years after surgery, the patient is doing well, only with mild pulmonary stenosis without hemodinamic or clinical repercusion.

DISCUSSION

For infants born to COVID positive mothers should be reasonable to separate him from the mother if will need cardiac surgery to try avoid post-natal infection.

In fact, there is minimal evidence of placental vertical transmisión. In this case, the patient has a positive test for SARS-CoV-2 infection and evolved with septic shock in the preoperative period.

It may also be reasonable to do serial testing on the infant, but there is no consensus on the correct timing surgery should be scheduled with advice from a multidisciplinary team of experts including cardiac medical, cardiac surgical, and infectious diseases as indicated. After evaluation of the clinical conditions for a heart team in our hospital, it was decided to realize the surgical procedure in order to avoid progression of heart damage and irreversible heart failure.

However we must remember that, if prudent, surgery should be delayed until the patient’s symptoms have improved and/or testing has been repeated (often after 14 days) and is negative (5).

On the other side, in older patients the inflammatory response due to SARS-CoV-2 infection has been a frequent complication.

In our patient, probably due to the age, it was no presented even with the septic shock o posteriorly associated to the use of CPB during the surgical procedure

It was concluded taht COVID-19 may affect all age patients. However with cautious evaluation and treatment of associated disease as in our case, the patient improves survival, despite severity of viral illness, and during this pandemic period, patients with active COVID-19, at neonatal period we have no treated any other.

FINANCIAL SUPPORT: None.

CONFLICTS OF INTEREST: The authors declares there is no conflict of interests.

For more information: https://jmedcasereportsimages.org/about-us/

For more submission : https://jmedcasereportsimages.org/

[dragontatoes]

nobody ever gets how funny it is to have transposition of the great vessels and also be transgender. it's so funny. no listen after I explain what my heart defect is you'll think it's so funny

[elvensworld]

Okay…. I don’t usually do these types of things, but for once I am… I seriously need some help with everything going on.

As some of you know, my son was born March 28th and was not breathing. He was immediately rushed to NICU where he was put on a cpap and given medications to keep a ductal development open to save his life. We knew that he had a heart condition before he was born which allowed doctors to act quickly.

To explain what is wrong with his heart…. He has dextrocardia, congenitally corrected transposition of the great arteries, pulmonary atresia, and VSD. To break all that down. His heart is on the right side of his chest, his heart is mirrored, he is missing the part of his pulmonary artery that connects to his heart (there was a ductal development that kept blood flow from the pulmonary to the aorta which was connected to the heart right at the VSD) and a hole between the bottom two chambers of his heart (VSD). Ductal developments are normal in babies. It is a small vessel that connects the pulmonary artery to the aorta while in the womb which provides blood flow to the lungs. Within 48 hours of birth, this ductal development will shrink till it no longer exists.

At 3 days old, we transferred from the birth hospital to Children’s Healthcare of Atlanta, where he went to cardiac ICU. Doctors were pretty sure they could place a stint in the ductal development to keep it open and get him home pretty quickly. At less than a week old, he went in for the stint where they discovered that the tissue of the ductal development was also in his pulmonary artery. This meant that he had to have open heart surgery to repair the pulmonary artery and place a shunt to allow blood flow into his lungs. His surgery was April 5th when he was only 8 days old and went well.

The recovery from surgery was going to tell us everything we needed to know about his future surgery and what to expect. Thankfully this wasn’t as bad as it could be. He did recover a lot slower than we expected. Because of that, we have not moved to acute care yet and are still in the cardiac ICU. I have spent most days here with Erik while my husband is at home with our toddler. The reason for this is we can’t afford for me to drive back and forth. It’s 100 miles round trip which is rough, especially with gas prices being $3.49 or higher. On top of that, I am having to get food 3x a day, plus pay for parking and breastmilk bags because I am not allowed to breast feed him yet. I am having to pick up new clothes for him because he is so small he is wearing preemie clothing. I am staying at the Ronald McDonald House and they ask for $20 a day if we can and covering one meal a day. My toddler had to start daycare so my husband can work. We really are in need of some help. Every little bit helps and if you can’t, can you please at least share this to help get the word out. Maybe someone can help us in some way.

Other ways to help are:

Cashapp: $Cosmichairdesigns

Venmo: @cosmichairdesigns

Paypal: kalis.iacon00@gmail.com

To everyone who can share or help, thank you so much. You are appreciated more than I can express in words.

[aditi-jagtap-pune]

Early Intervention for Heart Disease in Babies: Aditi Jagtap Pune

The birth of a baby is a moment of joy and celebration for families. However, when a child is born with a heart defect, it can be a devastating and challenging experience. Congenital heart disease (CHD) is the most common birth defect, affecting approximately 1 in every 100 newborns worldwide. The good news is that with early intervention and advancements in medical technology, many babies born with heart disease can lead healthy and fulfilling lives. In this blog, we will explore the importance of early intervention for heart disease in babies, the types of heart defects they may face, and the cutting-edge treatments available to give them a fighting chance at a normal life.

Understanding Congenital Heart Disease

As per Aditi Jagtap pune, Congenital heart disease refers to a range of structural heart defects that occur before birth. These defects can affect the heart’s walls, valves, or blood vessels, leading to improper blood flow. While some defects are minor and may not require treatment, others can be life-threatening if left untreated. Understanding the different types of congenital heart defects is crucial for early diagnosis and intervention.

Ventricular Septal Defect (VSD): VSD is the most common type of congenital heart defect. It involves a hole in the wall (septum) that separates the heart’s lower chambers (ventricles). This hole can disrupt normal blood flow, causing the heart to work harder and potentially leading to heart failure.

Atrial Septal Defect (ASD): ASD is another common defect, where there is a hole in the septum that separates the heart’s upper chambers (atria). This condition can cause oxygen-rich and oxygen-poor blood to mix, leading to oxygen deficiency in the body.

Tetralogy of Fallot (TOF): TOF is a complex heart defect involving four abnormalities: a ventricular septal defect, a narrowed pulmonary valve, an enlarged right ventricle, and an aorta that overrides the ventricular septal defect. Children with TOF may experience severe cyanosis (bluish skin due to low oxygen) and require immediate intervention.

Transposition of the Great Arteries (TGA): In TGA, the two main arteries that carry blood out of the heart are reversed, leading to oxygen-rich blood returning to the lungs and oxygen-poor blood circulating throughout the body. This defect often necessitates surgery shortly after birth.

Early Diagnosis is Key

Early diagnosis of congenital heart disease is critical for effective intervention. While some heart defects can be detected during routine prenatal ultrasounds, others may not become apparent until after birth. Newborns are screened for CHD using pulse oximetry, a non-invasive test that measures the oxygen levels in the blood. Abnormal readings can be an indicator of a heart problem, prompting further evaluation.

In some cases, symptoms of congenital heart disease may not manifest until a baby is a few weeks or months old. These symptoms can include:

Rapid breathing

Difficulty feeding and poor weight gain

Bluish skin or lips (cyanosis)

Fatigue or excessive sweating during feeds

Persistent cough or wheezing

Swelling in the legs, abdomen, or around the eyes

Parents and caregivers should be vigilant for these signs and seek medical attention promptly if they notice any concerning symptoms in their infant, says Dr. Ranjit Jagtap Daughter.

Early Intervention and Treatment Options

Once a congenital heart defect is diagnosed, early intervention becomes paramount. Treatment options depend on the type and severity of the defect but may include:

Medications: Some infants with heart defects may require medications to help the heart work more efficiently, reduce fluid retention, or control blood pressure.

Catheter-Based Procedures: Many congenital heart defects can be treated using minimally invasive catheter-based procedures. Cardiac catheterization involves threading a thin tube (catheter) through blood vessels to the heart, where the defect can be repaired or closed.

Open-Heart Surgery: In more complex cases, open-heart surgery may be necessary to correct the defect. Surgeons can repair or replace heart valves, close holes in the heart, or reconstruct malformed blood vessels.

Heart Transplant: In rare cases where the heart defect is severe and cannot be effectively treated through other means, a heart transplant may be considered.

The specific treatment plan will be determined by pediatric cardiologists and cardiac surgeons, taking into account the baby’s age, overall health, and the complexity of the heart defect.

Advancements in Pediatric Cardiology

Over the years, remarkable advancements in pediatric cardiology have significantly improved the outcomes for babies born with heart defects. Some of these innovations include:

3D Printing: Cardiologists can create 3D-printed models of a baby’s heart from imaging scans, allowing for better preoperative planning and simulation of surgical procedures.

Hybrid Procedures: Combining catheter-based interventions with traditional surgery has led to innovative hybrid procedures that are less invasive and often result in quicker recoveries.

Fetal Interventions: In some cases, heart defects can be treated while the baby is still in the womb through fetal interventions, reducing the severity of the defect before birth.

Pediatric Cardiac Imaging: Advanced imaging techniques, such as magnetic resonance imaging (MRI) and computed tomography (CT) scans, provide detailed insights into heart anatomy and function, aiding in diagnosis and treatment planning.

Support for Families

Caring for a baby with congenital heart disease can be emotionally and physically taxing for families. It’s essential to seek support from healthcare providers, social workers, and support groups. Many organizations and foundations also provide resources, information, and financial assistance to families facing the challenges of managing heart disease in their infants.

Conclusion

Early intervention for heart disease in babies is a life-saving approach that can significantly improve outcomes and quality of life. Thanks to Dr. Ranjit Jagtap Daughter, many infants born with congenital heart defects can go on to lead healthy, fulfilling lives. As parents, caregivers, and healthcare professionals work together, we can continue to advance our understanding and treatment of congenital heart disease, offering hope and a brighter future for these young patients.

[drdineshchandra]

heart surgery in Delhi

Heart Failure Surgery Heart and Lung Transplant Organ transplantation is the replacement of diseased organ with a healthy organ obtained from patient-donor. In heart and lung transplantation both the diseased heart and lungs will be replaced simultaneously with a healthy heart and lungs obtained from a human donor. Heart and lung transplantation requires suitable donors and potential donors are patients who are declared brain-dead but on life-support, having no heart or lung diseases.

It is recommended as a treatment in patients with following conditions:

End-stage heart and lung disease. Complex congenital heart disease. Eisenmenger syndrome (atrioventricular canal defect, transposition of the great vessels, and truncus arteriosus). Irreversible right-sided heart failure resulting from pulmonary hypertension. Heart and lung transplantation is not suitable for patients having impaired kidney and liver function, insulin dependent diabetes mellitus and other serious disorders. Patients who require heart and lung transplantation should undergo stringent screening procedures that assess the overall physical and psychological health. A thorough medical history which includes history of previous cardiopulmonary disease, infectious disease and family history is taken.

Surgical Procedure Donor operative procedure The patient is given general anesthesia and made comfortable throughout the procedure. The surgeon makes an incision through the centre of the breast bone for initial inspection of the heart and lungs. The heart and lungs are then mobilised without harming the lung tissues. The heart is flushed using cold cardioplegia solution and at the same time the lungs are flushed with cold, modified Collins solution. Then, the heart-lung block is removed and placed in a sterile, cold electrolyte solution for storage. Trachea should be closed during storage and transport.

Recipient Operative Procedure The surgical procedure in the recipient is performed under heart-lung bypass machine which maintains the blood circulation and oxygen levels of the body. The diseased heart and lungs are removed. The phrenic nerve and bronchial artery circulation is preserved so that post-operative complications are avoided. Then, the donor heart and lungs are inserted followed by fusing of the trachea, right atrium and aorta. After the completion of this procedure the heart-lung bypass support will be disconnected.

Risks And Complications Some of the potential risks and complications involved with heart and lung transplantation procedure include:

Transplanted Organ Failure. Rejection Of The Transplant. Infection Because Of Anti-rejection Medications (reduce Body’s Ability To Fight Infections). Blood Clots. Stroke. Recovery Recovery from an organ transplant takes a long span of about 6 months. Anti-rejection medications should be taken as prescribed to prevent rejection of the transplant. Frequent follow-up visits and routine blood tests will be necessary. https://drdineshchandra.com/ https://goo.gl/maps/eE4F7qzJsioCufp97

[mghospital]

Best Heart Specialist in Narasaraopet | Mahathma Gandhi Hospital

Cardiologists at Mahathma Gandhi Hospital diagnose and treat a wide range of heart conditions including coronary heart disease, Atherosclerosis, Aortic Stenosis, acquired and inherited arrhythmias, acquired and inherited cardiomyopathy, high blood cholesterol and triglycerides, heart attacks, chest pain, angina, valvular heart disease, pulmonary hypertension, pericarditis, peripheral vascular disease, heart failure, restrictive and hypertrophic cardiomyopathy, supraventricular tachycardia, ventricular tachycardia and congenital heart disease.

The department of cardiology has the best cardiologists, technology, facilities and support staff who are committed to providing care encompassing all aspects of cardiac care – preventive, diagnostic and therapeutic. Our cardiology department caters to all the subspecialties of cardiology including diagnostic, interventional, non-invasive, and surgical.

The skilled healthcare personnel at Mahathma Gandhi Hospital provide the below-listed services for patients.

Open heart surgery

Heart transplant

Heart bypass surgery

Angioplasty surgery

Heart stent surgery

CABG surgery

Sclerotic aortic valve

Transcatheter aortic valve replacement

TAVR surgery

TAVI surgery

Cardiothoracic and vascular surgery

Cardiothoracic Surgery

The department of cardiothoracic surgery at Mahathma Gandhi Hospital has the most advanced setup with top-notch facilities. The team comprises cardiothoracic and vascular surgeons and paediatric cardiothoracic surgeons who perform adult cardiac surgery, general thoracic surgery, congenital cardiac surgery and heart transplant surgery. Our senior consultant cardiothoracic surgeons, trained cardiologists, nurses and cardiac rehabilitation specialists provide support to patients during their pre-operative and post-operative needs.

Paediatric Cardiothoracic Surgery

Paediatric cardiothoracic surgeons perform congenital heart defect corrective surgeries to treat or fix the defect. To ensure the long-term health or well-being of the child, corrective surgery is needed. Our paediatric cardiothoracic surgeons perform Atrial septal defect (ASD), Ventricular septal defect (VSD), coarctation of the aorta repair, patent ductus arteriosus (PDA) ligation, hypoplastic left heart repair, Total anomalous pulmonary venous return (TAPVR) correction, tricuspid atresia repair, truncus arteriosus repair, transposition of the great vessels repair and tetralogy of Fallot repair.

For Appointment:

Call: 08647-230 007, 230008

Visit: https://mahathmagandhihospitals.com/service/cardiology/

[punksarahreese]

This would be at least four chapters if I decide to stick with the fic format because I would split it by procedure? I think

Prenatal

Norwood procedure (~2 days)

Glenn shunt (6 months)

Complete fontan (18 months-2 years)

Might write Ava and Connor doing a three step single ventricle repair over two years with a CHD patient with an end result fontan circulation,,, as a treat <3

[teachingrounds]

Let's review the 6 cyanotic conditions. You can count them up on your fingers and hand:

(1) Truncus arteriosus is first because the aorta and pulmonary artery don't separate embryologically, creating one big vessel leaving the heart.

(2) Transposition of the Great Arteries (TGA) is second because the two big arteries (aorta and pulmonary artery) are connected to the wrong chambers of the heart: aorta to right ventricle and pulmonary artery to left ventricle.

(3) Tricuspid Atresia is third because of the TRI-cuspid valve leading from the right atrium to the right ventricle.

(4) Tetralogy of Fallot (TOF) is fourth because the four characteristics of TOF are pulmonary stenosis, an over-riding aorta (to pull from the right ventricle too), a ventriculoseptal defect (VSD), and right ventricular hypertrophy.

(5) Total Anomalous Pulmonary Venous Return (TAPVR) is fifth because the name has five words. It means that the pulmonary veins return oxygenated blood from the lungs to the heart via the right atrium rather than the left atrium.

(6) Hypoplastic Left Heart Syndrome (HLHS) goes in the palm, which looks like a chamber of the heart if you fold your thumb toward your fingers.

Image Source: DrawItToKnowIt

[fauvester]

I know that Transposition of the great vessels is a really serious medical emergency and people who survive need lifelong care. but something about the concept of it is still so fucking funny to me. they really did just hook it up wrong

[mcatmemoranda]

Neonatal hypoglycemia is a common complication of diabetic pregnancy, occurring in 9% of patients with gestational diabetes, 29% of women with DM type 1, and 24% of women with DM type 2. Maternal hyperglycemia in poorly controlled diabetic mothers leads to fetal hyperglycemia. Excess glucose levels stimulate the fetal pancreas, causing hyperplasia of the islets of Langerhans and increased insulin production. After birth, hyperinsulinemia persists despite the drastic decrease in glucose levels, resulting in fasting neonatal hypoglycemia. Approximately 15-25% of neonates delivered from women with diabetes during gestation develop hypoglycemia during the immediate newborn period. Signs and symptoms include poor feeding, jitteriness, hypotonia, lethargy, and hypothermia. Unrecognized neonatal hypoglycemia can progress to seizure, coma, and permanent brain damage. Therefore, it is important that neonatal hypoglycemia be recognized and treated early. First-line treatment is a 5% or 10% dextrose drip for several days until hyperinsulinemia resolves. Strictly controlling maternal diabetes during pregnancy and preventing hyperglycemia during labor and delivery can prevent neonatal hypoglycemia.

Administration of glucagon in neonates with hypoglycemia is rare and reserved for those non-responsive to glucose and glucocorticoid administration. A failure to respond to glucagon raises the possibility of a glycogen storage disorder or defect in glycogen synthesis.

Bottom Line: Neonatal hypoglycemia is a common complication of diabetic pregnancy and usually manifests 1 to 2 hours after birth or 12 to 24 hours after poor enteral intake. Signs and symptoms include hypotonia, jitteriness, lethargy, poor feeding, and seizures. Treatment requires prompt glucose replacement with either oral or IV dextrose.

Clavicle fracture results in an absent Moro reflex on the affected side, along with spasm of the sternocleidomastoid muscle. The child is usually unable to move the ipsilateral arm, and crepitus or bony irregularities are present. Treatment is generally immobilization, although it is not always indicated.

Gestational diabetes occurs in 3-5% of all pregnancies and is commonly seen after 20 weeks’ gestation. All women are screened at 24-28 weeks with a 1-hour 50-g glucose challenge test. Abnormal results are confirmed by a 3-hour 100-g glucose tolerance test. The effects of diabetes on the fetus depend on the severity of the diabetic state. Poorly controlled maternal diabetes leads to maternal and fetal hyperglycemia, which stimulates the fetal pancreas causing hyperplasia and excess insulin production. Fetal hyperinsulinemia results in increased fat and protein production causing fetal macrosomia. Infants of diabetic women are at increased risk for injury during birth due to difficult vaginal delivery and shoulder dystocia. Common birth injuries include clavicle fracture, brachial plexus injury, facial nerve injury, and cephalohematoma. All infants should be evaluated for other complications of gestational diabetes including congenital anomalies (lumbosacral dysgenesis), congenital heart defects (VSD, ASD, transposition of the great vessels), unconjugated hyperbilirubinemia, hypocalcemia, neural tube defect, polycythemia, renal disorders (double ureter, renal agenesis), respiratory distress syndrome, and transient tachypnea of the newborn.

[coreapologetics]

Why Is God Silent?

Dialogue with a doubter by Ron Davis

The following is a response to one of the many people God has privileged us with helping in the area of religious doubt. There is great anonymity in this process, and this blog does not violate this in any way. This person asked, “Why doesn’t God interact with me in an existentially substantive way?” This blog is a response to this question. I am sure there are many who can benefit from this response, so we have decided to make it available you in this format. If you need help in this area, or any other area of religious doubt, please feel free to contact us. We would love to help!

Why doesn’t God interact with me in an existentially substantive way? Many followers of Christ desire to have a real existential relationship with God that is consistent. You most certainly are one of these people and find yourself expressing, “I want to love you, but where are you?” I do not think this is unreasonable, nor do I think it is impossible to answer. I want to address this from a few areas. This is a very complex issue, and I want to try and cover it in a substantive way in this response but also, at the same time, begin a conversation that will continue.

This issue seems to be affected by the metaphysical concepts of reality and how “knowing” is even possible. I say this because you are struggling with accepting a reality where God exists but is silent, and the best we can hope for is agnosticism. The alternative explanation also troubles you because Christian theism is absurd without a personal relationship with God  — a concept that seems to elude you at this moment. In other words, a correspondence with reality (as defined by Christian theism) and a plausible correlation to the world you experience seem to be in opposition (or at least disjunctive). Thus, the question has to be asked: can we really know with precise certainty that true existence, and knowing/comprehending it, is something to be grasped? Within this framework/discussion, certainty is as much existential as it is intellectual. For instance: you are 100% certain that you have anxiety/confusion over why God does not existentially relate to you on a more regular basis. This certainty is as much an existential concept for you as it is an intellectual one. 

Consciousness demands an interaction and explanation of reality that requires confidence in our senses, cognitive abilities, etc., but it also requires our senses and cognitive abilities to be connected to an objective referent. Since we do not have one outside of our senses and cognition, the idea of exhaustive, 100% certainty is more of a straw man than an actual pillar of cognitive and/or faith related concepts of reality. I have come to embrace the idea that I can be certain that I exist and Christ, the resurrected Lord, is my Savior. This certainty is existential, i.e., peace of God, forgiveness of sins, joy, etc.; and it is also intellectual, i.e., the rationality of Christian theism, claims of Scripture, evidence (scientific, historical, anthropomorphic), etc. When I engage both of these, the most reasonable response is: yes, I truly exist and Christ is the impetus of this admission and the Truth by which I correspond to reality and correlate to the world (physical, emotional, spiritual). So, for me, 100% certainty is exhaustive inside of the proper faith framework. Outside of these parameters, what certainty can anyone have? Thus the beauty of the gospel: the brokenness of the world that brings about your anxiety over these issues has found its remedy in the person of Jesus Christ who came for one purpose: to redeem mankind and the world. From our discussion, you seem have experienced this redemption and have hope in Christ and the potential perspective that you, to a 100% certainty, not only exist but have value in God through Christ.

If the former is accurate, it requires admission of the value of humanity, even a single human, to be part of the redemptive expression of biblical concepts, i.e., God cares for mankind because of the redemptive work of Christ. The problem lies inside of the expectations you have for a relationship with a God who “loves,” has made himself “known” through natural and divine revelation, but seems to be hiding himself from the very ones that he claims to love and be reconciled to through Christ. So…let me make a connection to the previous discussion about “knowing” to the concepts of what is known by engaging the parameters of transposition. I would describe transposition as a way of life by which knowledge comes downward to us through sensory experience, i.e., we gather information from an existential and intellectual process providing lower level knowledge that connects to higher level experiences and/or concepts. For instance, you are reading this email because your eyes see organized funny-shaped objects that your brain has assembled into meaning. These objects were introduced to you as lower level knowledge that transposes into higher level understanding. Thus, all communication/learning takes place within this process, i.e., “knowing” is a fluid reality and not a static one. It seems reasonable to conclude that the the experience of knowing through sensory perception is a reflection of a principle that operates in the spiritual realm. Modernity did more than bifurcate these two realms (natural/supernatural), it also produced the desire within humanity to do so. (Maybe this is evidenced throughout history, but it seems to be more prevalent in post-enlightenment epistemology.) God does not share this desire, and it is evidenced by the Incarnation. Jesus brought both worlds together in a way that had not been realized since Eden (pre-Fall). Agreeing with Jürgen Moltmann, “Embodiment is the end of all God’s works” (God in Creation, 244). This Word-become flesh expression of reality enabled the redemption of man as the seen and unseen worlds merge into the beautiful expression of divine humanity — a God-man who redeemed a fallen world and forever merged two worlds together. No wonder Paul exclaims that we are “in Christ” all throughout his writings. Thus, the miraculous advent of Christ in the Incarnation gives the fullest expression of transposition: humanity can become vessels filled with the Spirit of God allowing the acts of redeemed men/women to become nothing less than works of the Divine.

What does this have to do with the silence of God (divine hiddenness)? Everything. The coming of Christ, as the transpositional act of God for man, produced the vehicle by which the world can know the good news of the gospel. Is God silent? Is he hidden? I would like to answer this with another question: are we silent? This broken world that we find ourselves in required a redemptive act — an act that could only be carried out by the One who could unite both the seen and the unseen. The transpositional nature of the Incarnation is evidence of the “beyond knowing” concepts of the Divine, and we, as his followers and mouthpiece, will sometimes have a hard time connecting our lower level learning with the higher level knowledge of the redemption of man, the love of God, and, most importantly, the existential nature of our relationship with him. Why is this so hard for us to grasp in our post-enlightenment world? We have a tendency to let reductionism run rampant without recognizing it for what it truly is: a way of perception and, not necessarily, a way of revealing, i.e., is it not a method by which cognitive realities can be clearly defined but a informative process that engages a part of the equation but not the whole. I think it is impossible to grasp what our existential relationship with God should/could be by comparing it, reductionistically, to relationships we have with friends, family, etc. It seems more prudent to construct a concept of the hiddenness of God based upon the transpositional elements of our relationship with him. Maybe the silence of God is more about the epistemic failure of man than an existential failure of God. Agreeing with Alvin Plantiga, the epistemic environment of mankind is not functioning inside of the original design of God, i.e., we live in a fallen world. This provides a framework by which epistemic blindness can be a reality (of course we have sinful structures, noetic failure/blindness, human freedom that brings epistemic harm, etc.). 

Maybe the silence of God is better described as the blindness of man, i.e., we have not positioned ourselves well to experience the existential presence of God. Is this because God is elusive and the road to experience with the Divine is a shadowy trail on the epistemic journey of existence? I would have to say, no. It seems better to conclude that we have, from a transpositional perspective, failed to connect the beauty and grandeur of God because we do not perceive the true benevolence of God inside of our own lack of being truly benevolent. Of course there could be a myriad of transpositional short-comings, and this is to be expected. After all, we live in a fallen world with a broken epistemic environment that will one day be redeemed, and the new heaven and the new earth will bring about what is so longed for — a return to an Edenic relationship with God. And this is all made possible by the redemptive work of Christ bringing hope to the world and the beautiful existential encounters with the Divine — even if they are remote, sporadic and seemingly fickle.

[choithram-hospital]

Heart Diseases

Best Heart Treatment in Indore

Congenital heart diseases are found since birth but may remain undetected up to childhood or even up to adulthood. In general language, it is said like a hole in heart, narrow valve, valve leakage or anomalous connection of vessels. These are different from coronary heart diseases which are predominantly found in the adult population and related to lifestyle.

If any symptom of CHD persists, proper and timely treatment will help the patient live a healthy life. In the previous era, open-heart surgery used to be considered as the only option for the treatment of CHDs (Congenital heart diseases).  However, it had drawbacks like a surgical scar on the chest, long hospital stay, and associated morbidities as longer rest, secondary infection and reduced immunity.

Nowadays with advancements in technology and medical sciences, many of the heart diseases can be treated by cardiac intervention by a venous or arterial route that will have no surgical scar, reduced hospital stay, and infection. The patient can resume full activity on the very next day, and no special precaution or diet is required for it.

There are multiple varieties of procedures which are done by cardiac intervention; few of them are mentioned here-

Holes in the heart such as Atrial septal defect (ASD), Ventricular septal defect (VSD), Aortopulmonary window (AP Window), and RSOV fistula can be closed with the specially designed device.

Abnormal venous or arterial connection as patent ductus arteriosus (PDA), coronary cameral fistula can be occluded with the device.

Narrowing of valve such as pulmonary stenosis, aortic stenosis, mitral or tricuspid stenosis can be dilated with balloon dilatation.

Narrowing of arteries as coarctation of aorta can be treated by balloon dilatation or stenting.

In complex heart diseases like Transposition of great arteries, balloon atrial septostomy (BAS) is done to stabilize the newborn baby till surgery.

Post myocardial infarction VSD device closure.

Temporary or permanent pacemaker implantation done in heart rate and rhythm abnormality.

All these procedures are done on affordable rates in highly advanced Cath lab equipped with all modern technology in Choithram hospital and research centre, INDORE. In central India, Choithram hospital is the only hospital which has dedicated Paediatric Cardiologist, pediatric cardiac anaesthetist, state of art level III NICU and PICU, management of heartbeat problems and heart blocks in newborn babies and children like pacemaker implantation, arrhythmia clinic, hypertension clinic, heart failure clinic so that all types of cardiac problems can be evaluated and treated.

We have dedicated Pediatric Cardiologist and adult

Structural cardiac disease interventionist Dr. Prashant Agrawal, who has huge experience in congenital heart disease management and intervention in all age groups from newborns to adults. He has a special interest and expertise in Fetal Echo and fetal cardiac management dilated cardiomyopathy and heart failure, systemic and pulmonary hypertension, and arrhythmias management.

[irispublisherscardiovascular]

Permanent Pacemaker Implantation Through Persistent Left Superior Vena Cava

Authored by Muhammad Sarim Ansari*

Abstract

The left superior vena cava is a persistent embryo-genetic variant, occurring in 0.3 to 0.5% of individuals in which the venous blood of the upper half of the body is drained through a left vena cava into the coronary sinus and/or through the atrio-ventricular groove in the right atrium. We present a case of incidental finding of persistent left superior vena cava (PLSVC) in a 70 years female who was being implanted with a single chamber pacemaker for complete heart block.

Keywords:Permanent Pacemaker; Persistent Left Superior Vena Cava; Complete Heart Block

Case Presentation

70 year old female patient known to have hypertension for last 15 year compliant to medication came to emergency room with complains of shortness of breath and dizziness for last 15 days. Electrocardiogram (ECG) showed complete heart block for which she was placed on temporary intravenous pacing through right subcalvian venous approach. Work up was done for which no reversible cause was noted. Impression of senile deterioration of conducting tissue was made. Single chamber pacemaker implantation was planned. Lead was placed through the left subclavian vein. Access was performed via direct puncture; the guide-wire was advanced through left subclavian vein to persistent left superior vena cava and coronary sinus to right atrium. This was incidental finding which was confirmed during the procedure through venogram from left upper limb. Lead (Medtronic CapSureFix MRI active fixation 58 cm lead, Minneapolis, USA) was actively fixed in right ventricle apex with alpha loop configuration (Figure 1 & 2).The patient tolerated the procedure well and there were no complications. A chest X-ray obtained after procedure showed satisfactory lead positioning and no pneumothorax. At followup, she was noted to be in good health and her pacemaker was functioning normally.

Discussion

Persistent left superior vena cava (PLSVC) is a congenital vascular anomaly, occurring in 0.3 to 0.5% of individuals in the general population [1]. During embryogenesis, the sinus venosus consists of the right and left horns. Each receives blood from the common cardinal, vitelline and umbilical veins. During gestation, the left horn, after obliteration of the above veins, evolves into the coronary sinus and oblique vein of the left atrium, while the right becomes incorporated into the right atrium. The right common cardinal vein and the proximal part of the right anterior cardinal vein build the right superior vena cava. The left anterior cardinal vein changes into the internal jugular vein. The presence of the left anterior cardinal vein and obliteration of the left common cardinal vein leads to the formation of the left superior vena cava, which drains into the right atrium through the coronary sinus [2,3]. PLSVC is responsible for approximately 20% of the total venous blood return from the left arm, left half of the head and neck. In 80-90 % cases it drains into right atrium generally through CS resulting in CS dilation which can compress AV node or His bundle causing arrhythmias. PLSVC is associated with variety of congenital cardiac anomalies, such as anomalous connections of the pulmonary veins, aortic coarctation, tetralogy of Fallot, transposition of the great vessels as well as dextroversion [4-6]. Transvenous permanent pacemaker implantation in patients with PLSVC is challenging because of the complex anatomy. The coronary sinus (CS) may be dilated, which render pacing leads positioning from the left subclavian region difficult, especially the ventricular lead.

The use of active fixation leads with special curved stylet may help in overcoming this technical difficulty [7]. PLSVC is usually asymptomatic and is detected when cardiovascular imaging is performed for unrelated reasons. On chest X-ray, PLSVC can be seen as a widened shadow of the aorta with a visible venous halfmoon shadow from the left side of the aortic arch to the middle of the left clavicle. Basic diagnostic methods include transesophageal and transthoracic echocardiography. However, in our case report, PLSVC was diagnosed incidentally during pacemaker implantation which was confirmed through venogram during the procedure and as this finding was missed on pre- procedure transthoracic echocardiography. Right ventricular lead was successfully implanted with alpha loop configuration.

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[punksarahreese]

would you like to share some of your thoughts for restart? 👀👀👀

Restart my beloved <3

Sarah didn’t show up for rounds one day and Ava was mildly concerned

Because this was only about a week after her avoidant moment and Ava knew she hadn’t been in the best mindset

She went to ask Goodwin about it because it was customary when a student didn’t show to double check and apparently Sarah had called in

Ava really tried to leave it alone

Maybe Sarah was just sick

So she went about her day and let surgeries be a distraction 

Until the next day Sarah wasn’t there still

Ava was completely preoccupied her whole shift

Connor was surprisingly the first to pick up on it

Mostly because he found Ava in the locker room before a pre op typing away on her phone

He was of course annoyed with her and was like “Ava you��re not seriously stalling a pre op meeting for whoever you’re texting”

Ava just shook her head because she wasn’t in the mood to argue

So she didn’t push him away when Connor peaked over her shoulder

A long winded email thread boasted Sarah’s name at the top

“You seriously don’t have her number?”

“That’s not very professional, Connor. She’s my student.”

“So why are you blowing off work to message her?”

So Ava conceded and told him her worries

And it was really that moment where Connor realized Sarah meant a lot of Ava

Not just in the way him and Sam teased her about

Like Ava clearly cared about the med student a lot to check in on her like this

And in a way he got it

Ava was still surprised when he didn’t press it anymore

Just elbowed her gently and said “she’ll come back when she’s ready. Just come do the pre-op, Avey.”

Connor calling her Avey has been on my mind all week

So she did eventually go back to her work

And Sarah responded eventually

“Sorry, Ava. Family trouble, I had to go see my mom.”

Ava didn’t really believe her

Maybe she did go back to Connecticut

But it didn’t sit right that she hadn’t told Ava and she wasn’t responding to her

It just wasn’t like her

And maybe Ava was super anxious until she saw Sarah again <3

The backstory to this tsf which I may actually write as a oneshot

Ava had been called to the NICU

A baby was born premature with hypoplastic left heart syndrome

He also had transposition of the great vessels (aorta and pulmonary artery are switched)

She was called to consult but the second she saw his heart on the echo she knew there wasn’t anything she could do

The neonatologist knew that but needed the confirmation

The mother was in surgery, complications during her emergency c-section

And the father refused to leave the surgical waiting area

Ava broke the news to him up there

“Your son has a critical heart defect. Given his weight and the state of the organ I cannot ethically recommend surgery.”

“What are you saying?”

“Unfortunately his body is not receiving enough oxygen and we can only make him comfortable. His organs will begin to shut down, we’ve already seen indications of liver failure.”

The father was silent

He stared at Ava for a while but then turned away, returning to his pacing of the hallway

She was taken aback but couldn’t help but explain again

“Sir, I’m afraid your son does not have long. If you would like to hold him…”

“No,” he said firmly, “Cassie should be the one to hold him first.”

“I don’t think-”

“I’m not leaving until she’s okay.”

So Ava went back to the NICU

She couldn’t stop herself even though she had other things to do

She knew medically this baby would not survive until his mother was out of surgery and stable enough to see him

And Ava knew far too much about grieving fathers to know she shouldn’t push him to see his son

She couldn’t bear the idea of this baby dying alone in that incubator

They had given the child painkillers, though he did not have the energy to show any indication of his pain

He wasn’t on the vent because they knew it would do nothing, his heart was not connected properly to sustain a proper rhythm or oxygenate him at all

Ava tried so hard to be careful as she picked him up from the bed, the infant fitting almost in one hand alone

He was cyanotic and cold, even as she wrapped a blanket around him and held him close she knew his body couldn’t hold any heat

And so she stood, holding the baby close because no one deserved to die without knowing a little comfort

Ava had never been one to do this, it felt like a boundary a surgeon shouldn’t cross in most moments

But this was different

He was so little and she knew every single thing that was going wrong in that moment

The clock on the wall said half an hour had passed, the infant’s breathing hoarse and barely there

He was mouth breathing and each inhale shook him

Ava knew it was time

All she could do was press a kiss to his tiny head and watch helplessly as the monitor flatlined

And Ava was shaking when she reached out to silence the tone

A nurse came in then, she had been hovering outside because she didn’t want to disturb the doctor

But Ava knew she couldn’t stay and risk bursting into tears

So she let the nurse take the baby and she left the NICU

Beelining for the elevator to the roof because she couldn’t stand being in the building

Ava found herself standing by the guard rail of the roof

And she let the tears starts

Even though she hated how helpless it made her feel

This is why she wasn’t in paediatrics

[pius2017]

Transposition of the great vessels (TGV) is rare but typically results in the pulmonary trunk and aorta developing in transposed positions. In other words, the aorta drains the right ventricle and the pulmonary trunk drains the left ventricle. If everything else is normal about the heart, what problem(s) would be associated with the transposition of the aorta and pulmonary trunk? Select all that apply

Transposition of the great vessels (TGV) is rare but typically results in the pulmonary trunk and aorta developing in transposed positions. In other words, the aorta drains the right ventricle and the pulmonary trunk drains the left ventricle. If everything else is normal about the heart, what problem(s) would be associated with the transposition of the aorta and pulmonary trunk? Select all that apply

Transposition of the great vessels (TGV) is rare but typically results in the pulmonary trunk and aorta developing in transposed positions. In other words, the aorta drains the right ventricle and the pulmonary trunk drains the left ventricle. If everything else is normal about the heart, what problem(s) would be associated with the transposition of the aorta and pulmonary trunk? Select all that…