![](\"images\/ijn_header.jpg\")
<\/center>DISCHARGE SUMMARY<\/strong><\/span><\/p>\nName : <\/strong>Ahmad Naqib Naqiuddin Bin Ahmad Kamil Principal Operation(s) and or Procedure(s) :<\/strong><\/p>\n 1). Right Blalock-Taussig Shunt and pulmonary artery banding for left ventricular retraining were done on 3rd December 2004 by Mr. Hamdan’s team. Findings: Left ventricle involuted.<\/p>\n 2). Arterial switch operation and pulmonary artery debanding were done on 17th December 2004 by Mr. Hamdan’s team. 3). Delayed sternal closure was done on 18th December 2004 by Mr. Hamdan’s team. Brief Hospital Course:<\/strong><\/p>\n A). Post pulmonary artery banding and Blalock-Taussig Shunt. – So heparin infusion lOunits\/kg\/hour was commenced immediately. 2). Pneumonia. 3). Ventilator dependent. B). Post arterial switch operation:<\/p>\n 1). Pulmonary hypertension. 2). Renal impairment. 3). Wound infection. 4). Presumed sepsis. 5). Chronic lung disease. —————————————————————————<\/strong><\/p>\n Condition of Patient upon Discharge :<\/p>\n Pink with oxygen saturation > 95% on air. —————————————————————————<\/strong><\/p>\n Medications : —————————————————————————<\/strong><\/p>\n Follow up care (Clinic Visit) : —————————————————————————<\/strong><\/p>\n Referring Doctor : —————————————————————————<\/strong><\/p>\n Senior Registrar \/ Medical Officer : Dr. Rozaina Hj Md Said, Senior Medical Officer Alhamdulillah. Terima Kasih atas doa semua. Naqiuddin kini dah kembali ke rumah di Pandan indah setelah 1 bulan 10 hari di IJN. Siapa yang faham … “Naqiuddin dah Ada kat rumah”<\/span><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-65","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/kamilz.my\/index.php?rest_route=\/wp\/v2\/posts\/65","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kamilz.my\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kamilz.my\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kamilz.my\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kamilz.my\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=65"}],"version-history":[{"count":1,"href":"https:\/\/kamilz.my\/index.php?rest_route=\/wp\/v2\/posts\/65\/revisions"}],"predecessor-version":[{"id":1266,"href":"https:\/\/kamilz.my\/index.php?rest_route=\/wp\/v2\/posts\/65\/revisions\/1266"}],"wp:attachment":[{"href":"https:\/\/kamilz.my\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=65"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kamilz.my\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=65"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kamilz.my\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=65"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\nMRN : <\/strong>16XXXX
\nIC :<\/strong> 0409XXXXXXXX
\nDate of Birth : <\/strong>22\/09\/2004
\nAdmission Date :<\/strong> 28\/11\/2004
\nDischarge Date: <\/strong>07\/01\/2005
\nConsultant : <\/strong>Dr. Haifa Abdul Latif \/ Mr. Hamdan Leman
\n—————————————————————————
\nPrincipal Diagnosis : <\/strong>Simple transposition of great arteries with involuted right ventricle. Status post balloon atrial septostomy (23\/9\/2004).
\n—————————————————————————
\nSecondary Diagnosis: <\/strong>Pre-existing conditions or complications that arose which required treatment during this hospitalisation:
\n—————————————————————————<\/p>\n\n
\nFindings:<\/p>\n\n
\n—————————————————————————<\/p>\n
\n1). Blocked shunt.
\n– About 2 hours postop, he was noted to desaturated to 40%.
\n– Urgent echocardiography revealed :<\/p>\n\n
\n– Following that oxygen saturation gradually improved.
\n– About 7 hours later shunt murmur could be heard and his oxygen saturation maintain > 75%.
\n– Repeat echocardiography reveal Blalock-Taussig Shunt flow seen but minimal.<\/p>\n
\n– Serial CXR done since post operative day 4 showed pneumonic changes.
\n– Initially he was treated with IV Rocephine and IV Amikacin.
\n– However as he still having low grade fever after 6 days of these antibiotics, he was started on IV Imipenam.
\n– All cultures were negative.<\/p>\n
\n– On post operative day 5, he persistently had lowish oxygen saturation despite on high ventilator settings.
\n– So nitric oxide ventilation was commenced immediately.
\n– Following that his oxygen saturation improved.
\n– So his nitric oxide ventilation was gradually wean down and managed to off after 6 days.
\n– However he required quite high ventilator settings and had difficulty in weaning down his setting.
\n– Discussion was done in the cardiothoracic – paediatric cardiology meeting and decided
\nto proceed with arterial switch and pulmonary artery debanding.<\/p>\n
\n– Immediately postop, he was noted to have high pulmonary artery pressure that is about 1\/2 systemic.
\n– So nitric oxide ventilation and primacor infusion were commenced immediately.
\n– Following that his pulmonary artery pressure gradually decreased to 1\/3 systemic.
\n– So his nitric oxide ventilation and primacor infusion were gradually wean down and was off by post operative day 3 and post operative day 6 respectively.<\/p>\n
\n– Few hours postop, he was noted to have decreased urine output and his body became oedematous.
\n– So peritoneal dialysis was inserted and lasix infusion were commenced immediately.
\n– Following that he had good urine output.
\n– His peritoneal dialysis and lasix infusion were discontinued by post operative day 3.<\/p>\n
\n– On post operative day 6, his wound was noted to be infected.
\n– Wound swab C&S : no growth.
\n– Treated with IV Vancomycin and IV Amikacin for 10 days.<\/p>\n
\n– On post operative day 12 he was noted to have thrombocytosis and leucocytosis.
\n– Treated with IV Imipenam for 1 week.
\n– Blood C&S : no growth.<\/p>\n
\n– His serial CXR since post operative day 6 shows chronic lung changes.
\n– Had failed trial of extubation twice.
\n– Finally managed to extubate him by post operative day 10.
\n– He was given IV Dexamethasone according to BPD regime and was put on Budesonide MDI and combivent MDI.<\/p>\n
\nMildly tachypnoeic.
\nAfebrile.
\nLungs : clear.
\nCardiovascular system: Ejection systolic murmur at left sternal edge 3\/6.
\nEcho:
\n– No pericardial effusion \/ pleural effusion.
\n– Both diaphragm moving well.
\n– Normal chambers size.
\n– Good left ventricular function ejection fraction 70%.
\n– No mitral regurgitation \/ tricuspid regurgitation.
\n– Mild pulmonary regurgitation pressure gradient 11mm Hg ( normal pulmonary artery pressure ).
\n– Proximal right pulmonary artery \/ left pulmonary artery well seen and no obstruction.
\n– Small patent foramen ovale with left to right shunt.
\n* Pleural and pericardia! effusion are common complications following cardiac surgery. They should be suspected if the patient presents with cardio-respiratory symptoms.<\/p>\n
\nSyr. Lasix – 5mg tds
\nSyr. Captopril – 3mg bd
\nSyr. Aldactone – 6.25mg bd
\nSyr. Viagra – 2mg 6 hourly
\nBudesonide MDI – 400mcg bd
\nCombivent MDI – 200mcg 6 hourly<\/p>\n
\nTo come again 6 weeks for review ( 22\/2\/2005 @ 11.00am) – Cardiothoracic doctor .
\nTo come again 3 months for review (13\/4\/2005 @ 10.00am) – Paediatric cardiology doctor.<\/p>\n
\nProf. Madya Dr. Bilkis Abd. Aziz
\nPakar Perunding Kardiologi Kanak-Kanak Address :
\nHospital Universiti Kebangsaan Malaysia
\nJalan Yaacob Latif
\nBandar Tun Razak
\n56000 Cheras
\nKuala Lumpur.<\/p>\n
\nMBBS (UM)
\nDepartment of Pedriatic Cardiology,
\nInstitut Jantung Negara Sdn Bhd,
\nKuala Luimpur.
\nDate : <\/strong>7th January 2005<\/p>\n","protected":false},"excerpt":{"rendered":"