digoxin and Transposition-of-Great-Vessels

Topics: Age Factors; Arrhythmias, Cardiac; Child; Child, Preschool; Chlorothiazide; Diet, Sodium-Restricted; Digitalis Glycosides; Digoxin; Diuretics; Ethacrynic Acid; Furosemide; Heart Block; Heart Defects, Congenital; Heart Failure; Heart Septal Defects, Ventricular; Humans; Infant; Infant, Newborn; Organomercury Compounds; Pacemaker, Artificial; Phenytoin; Procainamide; Propranolol; Quinidine; Tetralogy of Fallot; Transposition of Great Vessels

Transposition of great arteries (TGA) is one of the mixing lesions between right and left side with a prevelance of 0.21 per 1,000 live births. A 25 years old lady from KSA, Gravida 3, Para 1 + 1, at 34 weeks gestational age was admitted to KAUH with symptoms suggestive of heart failure (NYHA Class IV). She was born with congenitally corrected TGA and coarctation of the aorta for which she under went several operations, the last one of which was tricuspid valve replacement, she being on chronic anti-coagulation. On hospital admission, she was treated with anti-failure measures with stoppage of the oral anti-coagulant intake and shift to I.V. heparin. Cesarean section was performed under subarachnoid block using 2 ml of hyperbaric bupivacaine 0.5% with several precautions to avoid abrupt decrease in the systemic vascular resistance. Baby was delivered with APGAR score 10 after 5 minutes. Postoperatively, the patient was admitted to the ICU for monitoring of the vital signs, and subcutaneous heparin was resumed immediately.

Topics: Adult; Anesthesia, Obstetrical; Anesthesia, Spinal; Anesthetics, Local; Anti-Arrhythmia Agents; Anticoagulants; Bupivacaine; Cesarean Section; Digoxin; Diuretics; Female; Furosemide; Heparin, Low-Molecular-Weight; Humans; Monitoring, Intraoperative; Pregnancy; Preoperative Care; Transposition of Great Vessels

Digoxin-immune antibody fragments (Fab) for treatment of digitalis intoxication was introduced in 1976. Many reports have been published concerning this therapy for children, but few have focused on its immediate reversal of cardiac as well as extracardiac life-threatening manifestations of digoxin toxicity. We present a case of life-threatening digitalis intoxication in a child with postoperative renal insufficiency, after a Sennings procedure for transposition of the great arteries. Digoxin administration according to the nationally recommended dosage and intervals unexpectedly resulted in serum levels in the toxic range. Severe cardiac arrhythmias, haemodynamic instability and a rapid-increasing serum potassium level resulted. This report demonstrates how administration of Fab according to the manufacturer's dosage recommendation reversed the tachyarrhythmia immediately and re-established a normal level of serum potassium within minutes.

Topics: Antibodies, Blocking; Antibody Specificity; Cardiac Surgical Procedures; Cardiotonic Agents; Digoxin; Electrocardiography; Female; Humans; Hyperkalemia; Immunoglobulin Fab Fragments; Infant; Postoperative Complications; Potassium; Transposition of Great Vessels

Topics: Adult; Amiodarone; Anti-Arrhythmia Agents; Child; Cranial Nerve Neoplasms; Digoxin; Down Syndrome; Ductus Arteriosus, Patent; Facial Nerve; Facial Paralysis; Female; Heart Defects, Congenital; Heart Septal Defects, Atrial; Humans; Hypothyroidism; Infant, Newborn; Male; Neurilemmoma; Transposition of Great Vessels

To screen for sinoatrial node dysfunction following the Mustard procedure for transposition of the great arteries, we studied the chronotropic response to graded maximal treadmill exercise in 29 patients at mean 6.7 years after operation. Although 93% of patients had normal resting heart rate (HR), 83% demonstrated significant depression of maximum HR and/or recovery HR after termination of exercise. These findings were similarly present among a subset of 13 patients with normal exercise tolerance. Resting and exercise-induced HR in 10 patients receiving chronic digoxin therapy were no different than in the 19 patients without medication. Sixteen patients with abnormal chronotropic responses to exercise had intracardiac electrophysiologic evaluation which confirmed sinoatrial node dysfunction in nine. Abnormal HR responses did not correlate with clinical symptoms, cardiac arrhythmias, or postoperative hemodynamics. Maximal exercise testing may be a sensitive noninvasive method to identify sinoatrial node dysfunction in postoperative children.

Topics: Adolescent; Adult; Atrial Flutter; Cardiac Catheterization; Child; Child, Preschool; Digoxin; Electrocardiography; Exercise Test; Female; Follow-Up Studies; Heart Block; Heart Rate; Humans; Male; Sinoatrial Node; Transposition of Great Vessels

Topics: Animals; Arrhythmias, Cardiac; Blood Pressure; Bradycardia; Cardiovascular Diseases; Digoxin; Emergencies; Epinephrine; Female; Fetal Diseases; Fetal Heart; Haplorhini; Heart Failure; Heart Rate; Humans; Hypoxia; Infant; Infant, Newborn; Infant, Newborn, Diseases; Isoproterenol; Lidocaine; Pregnancy; Radiography; Resuscitation; Transposition of Great Vessels

Topics: Arrhythmias, Cardiac; Child, Preschool; Digoxin; Female; Follow-Up Studies; Heart Arrest; Heart Block; Hemorrhage; Humans; Hypotension; Infant; Male; Methods; Postoperative Complications; Propranolol; Transposition of Great Vessels

Topics: Aortic Coarctation; Aortic Valve Stenosis; Child, Preschool; Digoxin; Diuretics; Heart Defects, Congenital; Heart Failure; Heart Septal Defects, Ventricular; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Pulmonary Valve Stenosis; Transposition of Great Vessels

Topics: Adult; Aortic Valve Insufficiency; Bundle-Branch Block; Carotid Arteries; Diagnosis, Differential; Digoxin; Electrocardiography; Female; Heart Block; Humans; Male; Massage; Middle Aged; Pacemaker, Artificial; Postoperative Complications; Prognosis; Transposition of Great Vessels

Topics: Anti-Bacterial Agents; Anticoagulants; Aortic Coarctation; Bradycardia; Chlorothiazide; Diet, Sodium-Restricted; Digitalis Glycosides; Digitoxin; Digoxin; Drug Tolerance; Electrocardiography; Endocardial Fibroelastosis; Furosemide; Heart Block; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Lanatosides; Myocarditis; Organomercury Compounds; Oxygen Inhalation Therapy; Potassium Chloride; Pulmonary Edema; Tachycardia; Tachycardia, Paroxysmal; Transposition of Great Vessels

Topics: Angiocardiography; Blood Gas Analysis; Digoxin; Electrocardiography; Female; Heart Atria; Hemodynamics; Humans; Infant, Newborn; Transposition of Great Vessels

In 28 infants and children with complete transposition of the great vessels, atrial septal defects were created utilizing an open technique with inflow caval occlusion and moderate hypothermia. Of the 12 infants for whom operation was necessary during the first two weeks of life only two survived, suggesting that this technique is not adequate for infants at this age. Only four of the 16 children operated on between the ages of two weeks and three years failed to survive. Two of these died because of pre-existing non-cardiac conditions. Seven children with associated systemic-to-pulmonary shunts survived; the open technique may be preferable in this particular group. Despite the initial improvement afforded by this procedure, three sudden late deaths occurred. For this reason, and because of the danger of early development of pulmonary vascular disease, total operative correction of the malformation should be performed early.

Topics: Angiocardiography; Cardiac Surgical Procedures; Child; Digoxin; Diuretics; Ductus Arteriosus; Ductus Arteriosus, Patent; Heart Septal Defects; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Humans; Hypothermia; Hypothermia, Induced; Infant; Infant, Newborn; Organomercury Compounds; Thoracic Surgery; Transposition of Great Vessels