GRADE IV VESICOURETERAL REFLUX ON SINGLE FUNCTIONING KIDNEY OR PENTALOGY OF FALLOT: WHICH CONDITION HAS TO BE CORRECTED FIRST? A CASE REPORT

摘要

Tetralogy of Fallot is a congenital heart disorder which comprises right ventricular outflowtract obstruction, ventricular septal defect, aorta dextroposition and right ventricle hypertrophy.Complicated with an atrial septal defect or patent ductus arteriosus, it is called pentalogy of Fallot.Vesicoureteral reflux (VUR) is characterized by retrograde flow of urine from the bladder to the kidneys,and may be associated with urinary tract infection, hydronephrosis and abnormal kidney development(renal dysplasia). Both conditions above have a poor influence on renal function. The order and themethod of the treatment represent a challenge when they affect the same patient. Case report: A 14month-old male, born in a territorial hospital in Romania, was sent to our service for clinical evaluationand possible surgical correction. By the age of 5 months, pentalogy of Fallot and VUR grade IV on thesingle functioning kidney was diagnosed. After proper preoperative investigations, rightnephroureterectomy and Cohen transvesical left ureteal reimplantation were made in our service.Postoperatively, after 25 hours, the patient died in the intensive care unit, the determined cause of deathwas sudden cardiac arrest. Conclusions: Surgical correction sequence is problematic, as each conditionhas serious influences on the other. An important question emerges: which defect has to be correctedfirst: VUR grade IV on single functioning kidney or pentalogy of Fallot?