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   Table of Contents - Current issue
Coverpage
May-August 2017
Volume 11 | Issue 2
Page Nos. 21-30

Online since Tuesday, December 12, 2017

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ORIGINAL ARTICLE  

Ultrasound-guided internal jugular catheterisation in paediatric cardiac surgical patients: a prospective observational study p. 21
Santosh S Parajuli, Apurb Sharma
DOI:10.4103/ejca.ejca_10_17  
Background Obtaining central venous access in paediatric patients is challenging and failure rates range from 5 to 19%. Ultrasound guidance has been newly introduced to our resource-limited set-up, and our aim was to evaluate the success rate during internal jugular catheterization in paediatric cardiac surgical patients. Patients and methods Over a period of 6 months, 106 consecutive paediatric patients scheduled for cardiac surgery requiring cannulation of the right internal jugular vein were enrolled in the study. The outcome measure was to find out the correlating factors for the number of attempts required and the rate of complications along with the success rate and time taken for successful cannulation. Results The overall success rate was 100% with a rate of successful catheterization in the first attempt being 76.41% [95% confidence interval (95% CI): 68.33–84.49]; second attempt was required in 16.98% (95% CI: 9.83–24.13) and the third attempt in 5.66% (95% CI: 1.26–10.06). The mean number of attempts for successful cannulation was 1.29±0.59. The mean time from skin prick to blood aspiration after successful cannulation was 134.06±81.59 s. The overall complication was 10.4% (95% CI: 4.59–16.21) among which arterial puncture and haematoma formation was seen in all 11 cases; pneumothorax and haemothorax were seen in one (0.9%) of those patients The number of attempts required showed weak negative correlation with age, height, body weight, body surface area and cross-sectional area. Conclusion Ultrasound guidance for central venous cannulation in paediatric patients has acceptable success rates. Arterial puncture with haematoma formation is the most common complication. The overall complication rate is directly related to the number of pricks.
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CASE REPORTS Top

Repair of ascending aortic aneurysm following resection of subaortic membrane in a 4-year-old child p. 25
Mai A Madkour
DOI:10.4103/ejca.ejca_12_17  
Clinical findings of infective endocarditis in children may be nonspecific in the form of prolonged low-grade fever, weakness, and weight loss, all of which require careful investigations for infective endocarditis. Transoesphageal echocardiography was helpful in management of intraoperative repair of ascending aortic aneurysm as a complication of infective endocarditis in this child.
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Transesophageal echocardiography for surgically corrected pulmonary venous baffle obstruction after Senning repair p. 28
Ira Dhawan, Neeti Makhija, Suruchi Ladha, Deepanwita Das
DOI:10.4103/ejca.ejca_13_17  
We present a case of D-transposition of great arteries with a ventricular septal defect for which the child required balloon atrial septostomy at 1 month of age and was later taken up for Senning’s procedure at 2 years of age. The patient remained asymptomatic up to 7 years after surgery. At 9 years of age, this child presented to us with a history of recurrent episodes of cough with expectoration and hemoptysis for 1 year. Transthoracic echocardiography confirmed pulmonary venous baffle stenosis with a peak gradient of 17 mmHg and a mean of 5 mmHg. Intraoperative transesophageal echocardiography indicated a peak gradient of 25 mmHg. The stenotic area was excised and augmentation was performed using homologous pericardium. Intraoperative transesophageal echocardiography confirmed adequate correction.
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