Case reports
Inadvertent interruption of descending thoracic aorta on cardiopulmonary bypass during repair of a ventricular septal defect and interruption of a patent ductus arteriosus: Its recognition, consequences, and prevention

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Case report

The patient, a 2-year-old female child weighing 6.8 kg presented with the history of recurrent chest infection and failure to thrive. The patient was tachypnic at rest. On cardiovascular examination, a pansystolic murmur was heard all over the precordium. Chest x-ray of the patient showed a cardiothoracic ratio of 65% and plethoric lung fields. Transthoracic echocardiography of the patient showed a 6-mm PDA and a 10-mm nonrestrictive subaortic VSD, with a large left-to-right shunt. Laboratory

Discussion

During the midsternotomy approach for a VSD repair and PDA interruption, Kirklin et al4 recommend that the ductus should only be dissected after establishing CPB. During the dissection of the ductus, the perfusate temperature should be maintained at 34°C and the tapes around the vena cavae left open so that the heart does not fibrillate and distend.4 If the heart fibrillates, the CPB flow should be reduced immediately to complete the dissection of the ductus.4 The undersurface of the aorta and

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