VCOM Louisiana Research Day Program Book 2024

Case Studies

Erika Lytle, OMS-III 1 ; Lynne F. Holladay, MD 2 1 VCOM-Louisiana; 2 Pediatric Healthcare Associates, Willis-Knighton Health System 47 ATYPICAL PRESENTATION OF COMPLEX CONGENITAL CARDIAC ANOMALIES IN A NEWBORN PEDIATRIC PATIENT: A CASE REPORT

Background: While completing my clinical rotation at a pediatrics clinic in Shreveport, Louisiana, I saw a milieu of interesting and complex pathologies presenting in children. Among the unique diagnoses of Marfan syndrome and growth hormone deficiency, we were also presented with the case of a neonate diagnosed with congenital tricuspid atresia following fetal imaging studies. Our patient had a myriad of other complex cardiac anomalies, including a large muscular ventricular septal defect, a thickened pulmonary valve, a small atrial septal defect, a small patent ductus arteriosus, etc. However, I found it most intriguing how this patient’s case followed a stepwise, holistic approach in the management of these diagnosed congenital heart defects. I chose to dissect this rare presentation of complex congenital anomalies, while also providing insight into the multidisciplinary team-based approach utilized for this patient, including frequent cardiology and pediatric consults, access to occupational therapy, home health care, a nutritionist team, and thorough family education of this challenging diagnosis. Objective: Tricuspid atresia, a critical congenital heart defect, accounts for approximately one percent of all cases of congenital heart defects. However, when tricuspid atresia is coupled with numerous other unexpected congenital cardiac

anomalies, a patient’s condition becomes more serious and more complex. We present a case that demonstrates the stepwise approach to the holistic treatment of congenital tricuspid atresia in the presence of normally related great vessels, a large ventricular septal defect, atrial septal defect, and trivial patent ductus arteriosus. While expanding upon the implementation of chest X-ray imaging, serial transthoracic echocardiogram imaging, and the balloon atrial septostomy procedure, we also provide insight into the multidisciplinary team-based approach utilized for this patient’s case. In illustrating the multidisciplinary management and treatment of a rare critical congenital heart defect coupled with other, more common congenital cardiac anomalies, it is possible the mortality rates associated with this diagnosis could decline. Methods: Our patient presented with a myriad of complex congenital cardiac anomalies and required immediate postnatal imaging studies and medical intervention. With fetal imaging demonstrating congenital tricuspid atresia, normally related great vessels, and a VSD, her medical team determined she would require a chest X-ray and TTE soon after birth. With these imaging modalities, it was made apparent the patient had numerous other unexpected cardiac anomalies that necessitated further evaluation and management. This patient’s case was

followed and reported, following the steps in her medical treatment and familial education regarding her care. With this assistance of this patient’s cardiac care team, it was quickly determined that this patient required an echocardiography-assisted balloon atrial septostomy. In creating this shunt, blood could now pass from the right side of the heart to the left side and bypass the lungs, alleviating pressure on the right ventricle of her heart. The BAS was only a temporary repair, however, and her healthcare team determined the next best approach would be a bi-directional Glenn procedure at 4 to 6 months of age. Lastly, this patient’s healthcare team practiced interdisciplinary management through utilization of caretaker involvement and education, home health care, nutrition, occupational therapy, and social work applications. Results: Our patient’s presentation is particularly rare, as tricuspid atresia accounts for approximately 1% of all cases of CHD. Moreover, the numerous other CHDs diagnosed in correspondence made the understanding of this case and patient’s expectant management more complex. The patient’s mother followed normal prenatal care and the patient’s history was not significant for any known risk factors, making this case even more unique. This clinical case highlights the necessity of interdisciplinary

67 2024 Via Research Recognition Day