虽然先天性心脏病并不少见,紫红色先天性心脏病(CCHD)占其中的一小部分。然而,当出现紫癜时,它通常表示严重或危重的疾病。法洛四联症(TOF)是常见的CCHD之一,占所有先天性心脏畸形的7-10%。右心室双出口(DORV)是另一种类似于TOF的CCHD,与肺血流减少有关。室间隔缺损(VSD),和从两个心室接受血液的主动脉。红细胞增多症引起的氧动脉饱和度降低和粘度增加引起局灶性脑缺血,通常在大脑中动脉供应的区域,导致脑脓肿。脑脓肿需要开颅手术,这是一个大手术。这些患者还经常表现出败血症和颅内压升高的特征。CCHD的存在使情况进一步复杂化,使围手术期管理更具挑战性。文献中有关于处理类似病例的研究,他们报告说,他们中的大多数人都有成功的管理。然而,并非所有此类病例都需要强化术后管理。我们介绍了4例患有TOF或DORV的儿科病例,他们必须接受开颅手术治疗脑脓肿或脑室腹膜分流术。我们描述了病例管理,并强调了需要长期术后重症监护管理的关键特征和病例。
While congenital heart disease is not uncommon, cyanotic congenital heart disease (CCHD) accounts for a minor fraction of them. However, when cyanosis is present, it usually indicates a severe or critical illness. Tetralogy of Fallot (TOF) is one of the common CCHDs, representing 7-10% of all congenital cardiac malformations. Double-outlet right ventricle (DORV) is another CCHD similar to the TOF and associated with decreased pulmonary flow, ventricular septal defect (VSD), and aorta receiving blood from both ventricles. Reduced oxygen arterial saturation and increased viscosity by polycythemia induce focal cerebral ischemia, often in the area supplied by the middle cerebral artery leading to brain abscess. Brain abscesses require craniotomy, which is a major surgery. These patients also often show features of sepsis and increased intracranial pressure. The presence of CCHD further complicates the situation, making perioperative management even more challenging. There are studies in the literature on the management of similar cases, and they report successful management in most of them. However, not all such cases need intensive postoperative management. We present four pediatric cases who had either TOF or DORV and had to undergo craniotomy for brain abscess or ventriculoperitoneal shunt placement. We describe
case management and highlight the critical features and cases that require prolonged postoperative critical care management.