Browsing by Author "Karmustaji, Fatema"

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Systematic approach to obtain axillary arterial access for pediatric heart catheterizations
(2024-01) Karmustaji, Fatema; Al Soufi, Mahmoud; Kasem, Mohamed
Abstract: Background: Axillary arterial access (AAA) in pediatric heart catheterizations is undervalued. Methods: We retrospectively reviewed children with congenital heart diseases (CHDs) who received trans-axillary arterial catheterizations between January 2019 and February 2023. We aimed ultrasound-guided punctures in the proximal two-thirds of axillary arteries with diameters ≥2 mm to insert 7 cm/4 Fr short introducers. We administrated intra-arterial verapamil (1.25 mg) and heparin (100 UI/kg). We infiltrated per-operatively 2% lignocaine (10 mg) for arterial spasms, long sheaths use (≥5 Fr), and ≥60 min procedures in <3 kg patients. Results: We identified 30 patients (66.7% males) with a median age of 1.1 months (IQR, 0.3-5.4), and a median weight of 3.1 kg (IQR, 2.7-3.7). 5/30 patients had six redo interventions after a median of 3.9 months (IQR, 1.7-5.1). Overall, 27/36 procedures were interventional, including 6 aortic valvuloplasties, 6 balloon angioplasties, and 15 stenting procedures. The median arterial axillary angiographic diameter was 2.6 mm (IQR, 2.4-3). Access was right-sided in 23/36 (63.9%) procedures and obtained using 21G/2.5 cm bevel needles in 25/36 (69.4%) procedures. No hemodynamical change occurred after introducing spasmolytic drugs. The median fluoroscopy time was 26.1 min (IQR, 19.2-34.8). There were two self-resolving arterial dissections, one sub-occlusive arterial thrombosis (resolved with 6 weeks of enoxaparin), and one occlusive arterial thrombosis (resolved with alteplase thrombolysis and 6 weeks of enoxaparin). Median follow-up was 11.7 months (IQR, 8-17.5). Four patients with complex univentricular hearts died from non-procedural causes at a median of 40 days (IQR, 31-161) postoperative. Conclusion: Systematic approach for AAA is the key to success and unlocks the many potentials of trans-axillary pediatric cardiology interventions.
Transomental Hernia: Rare Presentation in a Virgin Abdomen
(Springer Science and Business Media LLC, 2024-12-21) Shafi, Asiyah; Karmustaji, Fatema
Internal hernias are characterized by the protrusion of abdominal viscera through congenital or acquired apertures within the abdominal cavity and are a recognized etiology of intestinal obstruction. Internal hernias can cause symptoms ranging from mild abdominal discomfort to complete intestinal obstruction. Transomental hernias are often associated with postoperative anatomical changes and are rare in patients without prior abdominal surgeries. This report details one case of a 31-year-old otherwise healthy female with no history of prior surgery, highlighting the clinical variability associated with internal hernias. The patient presented with severe epigastric pain and nausea, with initial ultrasound findings unremarkable. Hours later, she returned with left iliac fossa pain and vomiting. A CT scan of the abdomen with contrast showed free fluid and dilated bowel loops, suggestive of small bowel obstruction. Emergency laparoscopy revealed small bowel herniation through a congenital omental band and ischemia, which resolved after the band was released. The patient recovered uneventfully and was discharged on day three. Transomental herniation exhibits nonspecific clinical symptoms of bowel obstruction. Radiographic presentations are generally nonspecific; however, a conclusive diagnosis is typically reached during surgery, where the detection of gangrenous bowel tissue is common, especially during exploratory laparoscopy. The postoperative mortality is largely attributed to bowel necrosis and delays in initiating treatment. This emphasizes the significant risk posed by undiagnosed cases and the critical importance of timely and effective intervention.