, Volume 21, Issue 2, pp 127-128
Date: 15 Jan 2005

Inappropriate sinus node tachycardia following gastric transposition surgery in children

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Dear Sir,

Gastric transposition for esophageal replacement in children seems to produce favorable results [1]. We wish to highlight a problem that we have been facing following gastric pull-up surgery for esophageal substitution in children (both for caustic esophageal stricture and pure esophageal atresia).

Transient tachycardia was frequently observed postoperatively, which resolved over the course of time with no adverse sequelae. However, two of our patients, aged 3 years, developed marked tachycardia as soon as the stomach was pulled into the chest. The heart rate rose above 180 beats/min and remained there despite adequate volume (fluid and blood) replacement, analgesia, and maintenance of normothermia. Preoperative echocardiography had shown no congenital cardiac anomaly. We put these patients on elective mechanical ventilation postoperatively with continuous morphine analgesia. The tachycardia was narrow-complex, sinus and was persistent and nonresponsive, with little variation i ...