Background:Ketamine is applied widely for sedation during cardiac catheterization in spontaneously breathing children with congenital heart disease(CHD).However,a rare and unreported respiratory complication,transient and reversible atelectasis of lungs(TRAL),was identifi ed.Purpose:The study was performed to investigate retrospectively the prevalence and clinical characteristics of TRAL after ketamine sedation in pediatric cardiac catheterization.Methods:Four thousand four hundred and seventy-four sick children were sedated with ketamine,and pediatric cardiac catheterization was carried out under spontaneous breathing.TRAL was detected in 33 children(17 M/16 F,age was 2.1±1.7 years)by retrospective analysis.The clinical and radiographic characteristics were recorded before,during and after TRAL.Results:In pediatric cardiac catheterization,the prevalence of TRAL was 0.74%after ketamine sedation.TRAL occurred in 23 children with cyanotic CHD,and 10 with acyanotic CHD.All TRALs had common clinical and radiographic features:the diffuse opacity of bilateral lungs developed rapidly(identifi ed under X-ray fl uoroscopy),associated with decrease in lung volume,and then the decrease in SpO2(94.2±9.2%vs.59.4±2.2%,P<0.05),and heart rates(143.5±14.3 bpm vs.58.3±9.7 bpm,P<0.05)followed quickly.TRAL was relieved by supportive oxygen in 32 children(23 with face mask,and 9 with endotracheal intubation),and the duration of TRAL was 1.6±0.5 minutes.However,TRAL caused the death of one child.Conclusions:TRAL is a rare and urgent respiratory complication after ketamine sedation,and the mechanism is unclear.Rapid and diffuse opacity of bilateral lungs is the earliest sign of TRAL in pediatric cardiac catheterization,and the immediate supportive oxygen is crucial.
致心律失常性右室心肌病(arrhythmogenic right ventricular cardiomyopathy,ARVC)是青年猝死的常见原因,自19世纪70年代末至今,人们对该病的认识不断加深、更新,本文通过对ARVC疾病的定义、在心肌病分类中的发展以及诊断标准等的梳理,重点综述了近年ARVC心血管磁共振评价的最新进展。
