- Baby V is an 11-year-old female with tricuspid atresia, restrictive VSD, and PS who underwent a right-sided BDG at 10 months of age for cyanosis. She now presents with exertional dyspnea and increasing cyanosis. - Examination found cyanosis, clubbing, and oxygen saturation of 50%. Echo showed patent glenn shunt and small restrictive VSD with moderate ASD, no forward flow across PA, and good ventricular function. - Cardiac cath was performed to assess PA pressures, collaterals, and suitability for Fontan. It found elevated PA pressures but improved Qp/Qs ratio, making her a candidate for Font

1. CATH MEET: Pre Fontan Cath
07/09/2019
Murtaza Kamal
murtaza.vmmc@gmail.com
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2. Patient’s details
• Baby V 11y/ F: Diagnosed CHD ante- natal period
• Tricuspid atresia, restrictive VSD, PS in neonatal period: Cyanosis: Told
for 2 stage surgeries 2nd after some years
• Underwent rt. sided BDG at 10 months of age: I hospital (2010)
• Cyanosis decreased
• Irregular follow up
• Exertional dyspnea since last 6 months- Class 2 symptoms, No
othopnea/ PND, Not gaining weight properly, Increasing cyanosis
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3. Examination
• Conscious, oriented, thin built
• PR: 92/ min, RR: 18/min, BP: 100/70 mm hg, Afebrile
• BMI: 15kg/m2
• Cyanosis with grade 3 pandigital clubbing (spo2: 50%)
• JVP: Not raised
• LV apex- 5th ICS at MCL, midline scar +nt, silent chest, S1: Normal, S2:
Single, No S3, S4, No murmur or additional sounds
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4. CXR
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5. ECHO
• SS, levocardia, levoposition
• S/P Rt BDG for Tricuspid atresia Type 1b
• Patent glenn shunt, Unobstructed flow in glenn shunt
• Small restrictive VSD with moderate sized OS ASD
• No forward flow across PA
• No AVVR
• Good ventricular function
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6. Cardiac cath
• Indication: Assessment of PA pressures and anatomy, collaterals
(arterio- venous and veno venous), and suitability for Fontan
completion
• Access: 5F RFA, 6F RFV, 5F RIJV
• 100U/kg heparin iv, seldinger technique for access
• Hardware: 5F MPA endhole, 5F Pigtail angiographic catheter, regular
and terumo wires
• Vitals:HR: 92/ min, RR: 18/ min,BP: 110/74mm hg, Temp:, spo2:
• Wt: 20 kg, O2 consumption: 144ml/min /m2
• Hb: 11.9g/dl
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7. GLENN
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8. FA
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9. LV AND GLENN
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10. LV-EDP
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11. Oxymetry
Chamber Po2 Spo2
Aorta 35.2 53.6
SVC/ Glenn 34.7 53.8
IVC 29.7 38.4
Lt PV 233 100
Rt PV 44.6 44.6
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12. Calculations
Parameters Values-01 Values-02
Qp 1.92 4.75
Qs 6.02 6.02
Qp/Qs 0.31 0.78
PVR 1.56 0.63
PVRi 1.23 0.49
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13. Angios
• RPA: -2.01
• LPA: -1.99
• DA at diaphragm: -1.63
• Mc Goon’s ratio: 1.7
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14. Thank you
• Images on 04/09/2019
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