Out of the frying pan into the fire--the never forgiving complex congenital heart: a case of liquefied splenic infarct post-electrophysiology ablation

A 36-year-old man born with pulmonary atresia intact ventricular septum, atrial septal defect and Ebstein anomaly with hypoplastic right heart (figure 1 and online supplementary video). Waterson shunt had been performed in childhood, but over a period of time it had occluded with pulmonary circulation being dependent on bronchopulmonary collaterals. He is on targeted therapy for pulmonary hypertension. He was symptomatic with intermittent focal atrial tachycardia, despite amiodarone therapy. Coumarin therapy was avoided due to risk of massive haemoptysis. At electrophysiology, he had an atrial flutter circuit, which was resolved by cavotricuspid isthmus ablation. Postablation, he developed pleuritic left-sided chest and shoulder tip pain treated as lower respiratory tract infection. He continued to have significant pain with symptoms of sepsis. CT scan demonstrated number of splenic infarcts and a large splenic liquefied haematoma. Aspiration of the splenic haematoma showed altered blood. Diagnosis was of splenic infarcts secondary...
Source: Heart Asia - Category: Cardiology Authors: Tags: Images in cardiovascular medicine Source Type: research