Coxsackie B2 Virus Infection Causing Multiorgan Failure and Cardiogenic Shock in a 42-Year-Old Man

Infections from coxsackie B2 viruses often cause viral myocarditis and, only rarely, multisystem organ impairment. We present the unusual case of a 42-year-old man in whom coxsackie B2 virus infection caused multiorgan infection, necessitating distal pancreatectomy, splenectomy, renal dialysis, and venoarterial extracorporeal membrane oxygenation with mechanical ventilation. In addition, the patient had a rapid-eye-movement sleep-related conduction abnormality that caused frequent sinus pauses of longer than 10 s, presumably due to myocarditis from the coxsackievirus infection. He recovered after permanent pacemaker placement and was discharged from the hospital. We discuss our aggressive supportive care and the few other reports of multiorgan impairment from coxsackieviruses

Coxsackie B2 Virus Infection Causing Multiorgan Failure and Cardiogenic Shock in a 42-Year-Old Man

Infections from coxsackie B2 viruses often cause viral myocarditis and, only rarely, multisystem organ impairment. We present the unusual case of a 42-year-old man in whom coxsackie B2 virus infection caused multiorgan infection, necessitating distal pancreatectomy, splenectomy, renal dialysis, and venoarterial extracorporeal membrane oxygenation with mechanical ventilation. In addition, the patient had a rapid-eye-movement sleep-related conduction abnormality that caused frequent sinus pauses of longer than 10 s, presumably due to myocarditis from the coxsackievirus infection. He recovered after permanent pacemaker placement and was discharged from the hospital. We discuss our aggressive supportive care and the few other reports of multiorgan impairment from coxsackieviruses

Converting Fontan-Björk to 1.5- or 2-ventricle circulation

Patients with tricuspid atresia and ventricular septal defect have in the past occasionally undergone a Fontan with “Björk” modification to create a connection between the right atrium and the right ventricular outflow tract. While rarely performed now, patients with this physiology often face severe complications requiring re-intervention. We hypothesize that surgical conversion to a 2-ventricle or 1.5-ventricle circulation can improve hemodynamics, clinical status, and thus increase time to transplant. We present two successful cases to illustrate this idea

When Adolescent and Parents Disagree on Medical Plan, Who Gets to Decide?

Duchenne muscular dystrophy (DMD) is an X-linked autosomal recessive disease affecting 16 to 20 per 100 000 live births.1,2 It is characterized by progressive muscle weakness due to a defect in the dystrophin gene. It typically leads to loss of ambulation by age 8 to 14 years,1 followed by cardiomyopathy and respiratory failure. Historically, adolescents with DMD have died at ∼20 years of age.1–3 As respiratory compromise occurs, patients are supported with noninvasive ventilation (eg, nasal bilevel positive airway pressure).3–6 When this becomes unsuccessful, patients may be candidates for tracheostomy; this often happens in the second or third decade of life.7 The decision of whether to proceed with tracheostomy is complicated and is most often left to the patient and family. Family members do not always agree. We present a case in which acute illness forced a minor and his family to face this decision earlier than is typical. The adolescent desired a tracheostomy to extend his life. The parents did not believe that a tracheostomy was in his best interest and felt that comfort care was the most appropriate approach. Experts comment on the ethical issues raised by medical decision-making in cases involving adolescents and life-and-death decisions

Successful TPV Implantation in a Pregnant Patient With Right Ventricle to Pulmonary Artery Conduit Obstruction

A patient with repaired double outlet right ventricle presented during early gestation with heart failure symptoms due to severe right ventricle–pulmonary artery conduit stenosis and insufficiency. In the first trimester, she underwent transcatheter therapy with Melody pulmonary valve implantation with excellent hemodynamic results and completed pregnancy without significant maternal complications. (Level of Difficulty: Advanced.

Management of Severe Coarctation of the Aorta During Pregnancy

An 18-year-old primigravida woman underwent emergent percutaneous balloon stent repair of a severe coarctation of the aorta, allowing her to undergo an uneventful remaining pregnancy and the delivery of a healthy baby. Her case also demonstrates the association between maternal coarctation and fetal Shone complex. (Level of Difficulty: Beginner.

Warden Procedure in a 77-year-old Man

Partial anomalous pulmonary venous return (PAPVR) is a rare congenital heart defect characterized by one or more but not all of the pulmonary veins draining somewhere other than the left atrium thereby creating a left-to-right shunt. Over time, patients may develop right-sided volume overload and its subsequent complications. We present a case of isolated PAPVR in an older patient who underwent a Warden procedure at age 77 years with rapid improvement in right ventricular size and function