Case Report: A comprehensive rehabilitation protocol in a post-operative case of ASD closure along with PAPVC

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This can happen directly into the right atrium or via draining into systemic veins. A 10 year old female patient had chief complaints of difficulty in breathing and frequent fever hence she visited rural hospital where 2D echo was done which reviled PAPVC associated with 16 mm ASD (Atrial Septal Defect). She underwent ASD closure along with pulmonary valvotomy as a part of surgical management after which a well-planned cardiac rehabilitation has been ingrained through several breathing methods such as breathing exercises, respiratory muscle strength and home exercise program, helping the patient to carry out her activities of daily living. The Visual Analog Scale (VAS), Respiratory Muscle Strength using MicroRPM device, 6 Minute Walk Distance (MWD), Borg Scale and Fatigue Severity Scale (FSS). In this present instance, carefully thought-out physical therapy rehabilitation has been shown to be successful in enhancing functional capacity, respiratory muscle strength, optimizing functional capacity, and lowering fatigue." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-433/v1", "name": "Case Report: A comprehensive rehabilitation protocol in a post-operative..." } } ] } Home Browse Case Report: A comprehensive rehabilitation protocol in a post-operative... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Vardhan V and Choubisa C. Case Report: A comprehensive rehabilitation protocol in a post-operative case of ASD closure along with PAPVC [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :433 ( https://doi.org/10.12688/f1000research.143983.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: A comprehensive rehabilitation protocol in a post-operative case of ASD closure along with PAPVC [version 1; peer review: 1 approved with reservations, 1 not approved] Vishnu Vardhan 1 , Chitrakshi Choubisa https://orcid.org/0000-0003-4122-6850 1 Vishnu Vardhan 1 , Chitrakshi Choubisa https://orcid.org/0000-0003-4122-6850 1 PUBLISHED 01 May 2024 Author details Author details 1 Department of Cardio-respiratory Physiotherapy, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India Vishnu Vardhan Roles: Conceptualization, Investigation, Resources, Supervision, Validation, Visualization Chitrakshi Choubisa Roles: Conceptualization, Formal Analysis, Investigation, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Datta Meghe Institute of Higher Education and Research collection. Abstract An array of congenital cardiac disorders known as partial anomalous pulmonary venous connections (PAPVC) occur when pulmonary veins, abnormally drain into the right atrium. This can happen directly into the right atrium or via draining into systemic veins. A 10 year old female patient had chief complaints of difficulty in breathing and frequent fever hence she visited rural hospital where 2D echo was done which reviled PAPVC associated with 16 mm ASD (Atrial Septal Defect). She underwent ASD closure along with pulmonary valvotomy as a part of surgical management after which a well-planned cardiac rehabilitation has been ingrained through several breathing methods such as breathing exercises, respiratory muscle strength and home exercise program, helping the patient to carry out her activities of daily living. The Visual Analog Scale (VAS), Respiratory Muscle Strength using MicroRPM device, 6 Minute Walk Distance (MWD), Borg Scale and Fatigue Severity Scale (FSS). In this present instance, carefully thought-out physical therapy rehabilitation has been shown to be successful in enhancing functional capacity, respiratory muscle strength, optimizing functional capacity, and lowering fatigue. READ ALL READ LESS Keywords PAPVC, congenital heart diseases, open heart surgery, physiotherapy management, cardiac rehabilitation, case report Corresponding Author(s) Chitrakshi Choubisa ( [email protected] ) Close Corresponding author: Chitrakshi Choubisa Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Vardhan V and Choubisa C. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Vardhan V and Choubisa C. Case Report: A comprehensive rehabilitation protocol in a post-operative case of ASD closure along with PAPVC [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :433 ( https://doi.org/10.12688/f1000research.143983.1 ) First published: 01 May 2024, 13 :433 ( https://doi.org/10.12688/f1000research.143983.1 ) Latest published: 01 May 2024, 13 :433 ( https://doi.org/10.12688/f1000research.143983.1 ) Introduction The atypical drainage of pulmonary veins into the right atrium leads to a variety of congenital cardiac conditions known as partial anomalous pulmonary venous connections (PAPVC). This can occur by draining directly into the right atrium or through systemic veins. 1 PAPVCs, which frequently coexist with atrial septal defect (ASD) and manifest as a left-to-right shunt, have negative consequences on cardio-pulmonary physiology. 2 In 0.4-0.7% of autopsies, PAPVC are discovered. Most frequently, the right pulmonary veins that drain into the right atrium or superior vena cava (SVC) are involved in the aberrant venous connection. Less commonly, abnormal pulmonary veins flow into the coronary sinus, innominate vein, or inferior vena cava. 2 , 3 Various transcathater or surgical approaches have been proven to improve the competency of the patient’s having anomalous venous connections, which includes balloon angioplasty and surgical repair of associated anomalies. 4 To facilitate flow of blood from pulmonary veins to left atrium, the wall between the coronary sinus and left atrium is excised. The coronary sinus opening is then sealed off. ASD is also closed, if it is present. 2 An anastomosis between the left atrium and the pulmonary venous confluence is made in infracardiac and supracardiac PAPVC. Unless there is severe pulmonary hypertension, the vertical vein is mostly ligated in the same surgical setting. In complicated and mixed type PAPVC, a number of other procedures, such as intra-atrial rerouting, have also been employed. 2 , 5 Following heart surgery, there are a number of issues that call for specialised treatment, particularly in the respiratory system. These issues can extend a patient’s stay in the hospital, raising hospital expenses and playing a significant role in morbidity and death. Recent research has demonstrated that early mobilisation, such as getting out of bed and walking, improves the patient’s functional state and shortens the period of hospitalisation. Patients should receive physical treatment regularly to ensure their rehabilitation of their motor skills. 6 These studies show that inspiratory muscle re-training (IMRT) is possibly beneficial in improving breathing mechanics and decreasing exercise-induced dyspnea. It is also likely useful in enhancing respiratory muscle strength and lowering airway closure (i.e., greater FVC). These mechanistic alterations reflect our developing understanding of the function of IMRT in paediatric patients and can be used to explain improvements in symptomology and clinical outcomes. 7 Case report Patient information A 10-year-old female patient presented to our hospital with a complaint of insidiously developing and increasingly worsening breathlessness which increases while walking uphill along with frequent episodes of fever. Following assessment she was admitted to the hospital. 2D Echo was done which reviled PAPVC along with 16 mm ASD. She underwent ASD closure along with pulmonary valvotomy. Clinical presentation Prior to the examination, the patient’s caretaker provided informed permission, and the patient was then placed in a supine posture. The patient was conscious and following instructions. The patient’s BMI was 16.1 kg/m 2 , making her ectomorphic. Prior to surgery, the patient had gradual, insidious dyspnea that worsened as she walked uphill and subsided with rest. The patient is currently having discomfort at the suture site ( Figure 1 ), which she rates 5/10 on a VAS (visual analogue scale). The pain was abrupt in start and dull aching in character. The pain aggravates on coughing and while inhaling deeply and she rated it 7/10 on VAS. Foley’s catheter, central line and drain were present in situ. Figure 1. Illustrating the suture line. An examination of the cardiovascular and respiratory systems revealed a normal pericardium that was bilaterally symmetrical, had an apex beat at the level of the fifth intercostal space, and had sutures on the midsternal area. The heartbeat was regular and rhythmic at 89 beats per minute, and all of the peripheral pulsations were present. The middle and lower zones of the chest expanded less than usual, and the respiratory rate was 18 beats per minute. Timeline : Table 1 included a timeline of the occurrences. It depicts series of incidence from the patient’s hospital admission until the commencement of the physiotherapy treatment. Table 1. Timeline of the events. Sr. No Dates Events 1. 30 August 23 Patient came to rural hospital with the complaints of breathlessness while walking uphill 2. 1 September 23 2D ECHO was done reviling ASD along with PAPVC 3. 4 September 23 Patient underwent ASD closure surgery 4. 5 September 23 Physiotherapy session was started Diagnostic assessment: 2D ECHO revealing 14×16 mm of Atrial septal defect along with PAPVC along with grade 1 pulmonary arterial hypertension with interstitial edema. Therapeutic intervention : Table 2 represents a comprehensive rehabilitation protocol post cardiac surgeries in paediatric population. The protocol includes education of the patient’s care taker and family members about the condition and post-operative care. Pain control: using chest binder to support suture line and decrease pain. Promote bronchial hygiene: nebulization and initiating with active cycle of breathing technique for effective expectoration. Improving inspiratory hold and vital capacity by giving incentive spirometer ( Figure 2 ) and diaphragmatic breathing exercises. Facilitation of normal chest movements by asking the patient to perform thoracic expansion exercises. Improving inspiratory muscle strength: making use of Powerbreathe medic plus device ( Figure 3 ) which is exclusively used for re-training of inspiratory muscles. Hallway ambulation to improve functional capacity ( Figure 4 ). Incorporating home exercise programme to promote functional independence and improving level of activities of daily living. Table 2. A table representing a well-planned rehabilitation protocol for patients undergoing cardiac surgery. Sr. No. Goals Intervention Rationale 1. To inform the patient and her family of the procedure for physical treatment and its advantages Education and counselling for the patient's family To promote the patient's active involvement, hence boosting the treatment's effectiveness 2. To keep the bronchial system clean Nebulization with Budecort and huffing technique with chest binding for five repetitions, twice daily Helps in preserving patency of airways thereby enhancing essential capacity 3. To increase vital capacity and respiratory function • Thoracic expansion exercises and diaphragmatic breathing (2 sets of 10 repetitions twice a day) • Incentive Spirometer with 3-5 second holds that are increased to 10 second holds twice day in sets of 10. Keeping lungs expanding properly, and refrain from using your auxiliary muscles 4. To increase the respiratory muscles' strength Exercising the muscles of inspiration using the PowerBreathe medic plus device (Twice a day, two sets of ten repetitions) To avoid cardiac and pulmonary problems after surgery 5. To improve strength of bilateral upper and lower limb • Strengthening of upper and lower extremities with half kilogram weight cuff progressing to 1 kilogram weight cuff (2 sets of 10 reps twice a day) • Bed mobility training Reduce fatigue and improve exercise outcome 6. To improve Quality of Life Home exercise programme To maintain the gained progress and promote further improvement Figure 2. The use of incentive spirometry to improve inspiratory holds. Figure 3. Inspiratory muscle training by using powerbreathe medic plus device. Figure 4. Hallway Ambulation training to improve functional capacity. Follow-up and outcome measures: Preoperatively and on the first day of physical therapy rehabilitation, the outcome measures were evaluated. A follow-up was done after one week and two weeks of the physiotherapy intervention. The outcomes were listed in Table 3 . Table 3. Outcome measures. Outcome measure Pre operatively POD - 1 After 1 week After 2 weeks PIMax 37.5 cmH 2 O 19.1 cmH 2 O 29.1 cmH 2 O 35 cmH 2 O RPE (Borg scale) 9 9 9 7 6 MWD 530 m 210 m 470 m 500 m Fatigue severity scale 5.4 5.10 4.2 3.9 Discussion André Luiz Lisboa Cordeiro et al. in their studies have stated that Surgery for a coronary artery bypass graft (CABG) is linked to longer hospital stays, pulmonary problems, and reduced functional ability. Patients who are at a high risk for post-operative (PO) pulmonary problems prior to CABG experience these adverse effects to a greater degree. The healing phase for CABG patients has been demonstrated to be aided by inspiratory muscle training (IMT). However, there is insufficient evidence to support the use of IMT post-operatively to promote speedier recovery in high-risk patients. 6 According to Tamires Daros Dos Santos et al. Patients undergoing CABG experienced additional advantages from short-term moderate-to-high intensity IMT combined with aerobic and resistance training in terms of exercise capacity, inspiratory muscle strength, QoL, and antioxidant profile. 8 Studies conducted by Balbino Rivail Ventura Nepomuceno Jr et al. suggest that early implementation of inspiratory muscle training on hospitalised patients without established respiratory deficits may prevent adverse outcomes that are either directly or indirectly related to the loss of respiratory muscle mass inherent to a prolonged hospital stay. Training the respiratory muscles can prevent endotracheal intubation, muscular wasting, and death. 9 According to Rhoia Neidenbach et al. Respiratory training is known to improve exercise capacity and cardiopulmonary function showing significant improvement in oxygen saturation and maximum workload capacity. 10 In this current case we have found significant improvement in PIMax and functional capacity. Consent An informed written consent was taken from patients parents before assessment and implementing rehabilitation protocol. Written informed consent was taken from the patient and her parents for sharing clinical details and images for the publication. References 1. Mounir R, Nya F, Mohammed B, et al. : Adults forms of scimitar syndrome. J. Card. Surg. 2020 Jul; 35 (7): 1697–1699. PubMed Abstract | Publisher Full Text 2. Sahay S, Krasuski RA, Tonelli AR: Partial Anomalous Pulmonary Venous Connection and Pulmonary Arterial Hypertension. Respirol. Carlton Vic. 2012 Aug; 17 (6): 957–963. PubMed Abstract | Publisher Full Text | Free Full Text 3. Wang H, Kalfa D, Rosenbaum MS, et al. : Scimitar Syndrome in Children and Adults: Natural History, Outcomes, and Risk Analysis. Ann. Thorac. Surg. 2018 Feb; 105 (2): 592–598. PubMed Abstract | Publisher Full Text 4. Gao YA, Burrows PE, Benson LN, et al. : Scimitar syndrome in infancy. J. Am. Coll. Cardiol. 1993 Sep; 22 (3): 873–882. Publisher Full Text 5. Early Outcomes for In Situ Pericardial Roll Repair for Distant Anomalous Pulmonary Venous Return - PubMed.[cited 2023 Jul 17]. Reference Source 6. Cordeiro ALL, Carvalho BSCD, Silva EGD, et al. : Inspiratory muscle training and functional capacity following coronary artery bypass grafting in high-risk patients: A pilot randomized and controlled trial. J. Clin. Transl. Res. 2022 Jun 17; 8 (4): 266–271. PubMed Abstract 7. Bhammar DM, Jones HN, Lang JE: Inspiratory Muscle Rehabilitation Training in Pediatrics: What Is the Evidence? Can. Respir. J. 2022 Aug 18; 2022 : 1–18. Publisher Full Text 8. Dos Santos TD, Pereira SN, Portela LOC, et al. : Moderate-to-high intensity inspiratory muscle training improves the effects of combined training on exercise capacity in patients after coronary artery bypass graft surgery: A randomized clinical trial. Int. J. Cardiol. 2019 Mar 15; 279 : 40–46. PubMed Abstract | Publisher Full Text 9. Nepomuceno BRV, Barreto MS, Almeida NC, et al. : Safety and efficacy of inspiratory muscle training for preventing adverse outcomes in patients at risk of prolonged hospitalisation. Trials. 2017 Dec 28; 18 (1): 626. PubMed Abstract | Publisher Full Text | Free Full Text 10. Neidenbach R, Freilinger S, Stöcker F, et al. : Clinical aspects and targeted inspiratory muscle training in children and adolescents with Fontan circulation: a randomized controlled trial. Cardiovasc. Diagn. Ther. 2023 Feb 28; 13 (1): 11–24. PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 01 May 2024 ADD YOUR COMMENT Comment Author details Author details 1 Department of Cardio-respiratory Physiotherapy, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India Vishnu Vardhan Roles: Conceptualization, Investigation, Resources, Supervision, Validation, Visualization Chitrakshi Choubisa Roles: Conceptualization, Formal Analysis, Investigation, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 01 May 2024, 13:433 https://doi.org/10.12688/f1000research.143983.1 Copyright © 2024 Vardhan V and Choubisa C. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Vardhan V and Choubisa C. Case Report: A comprehensive rehabilitation protocol in a post-operative case of ASD closure along with PAPVC [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :433 ( https://doi.org/10.12688/f1000research.143983.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 01 May 2024 Views 0 Cite How to cite this report: Awosika A. Reviewer Report For: Case Report: A comprehensive rehabilitation protocol in a post-operative case of ASD closure along with PAPVC [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :433 ( https://doi.org/10.5256/f1000research.157716.r334941 ) The direct URL for this report is: https://f1000research.com/articles/13-433/v1#referee-response-334941 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 08 Nov 2024 Ayoola Awosika , University of Illinois Chicago, Chicago, Illinois, USA Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.157716.r334941 Author should consider the following: - Add the full meaning of PAPVC in the topic - In line 3 of your abstract you can reword it as: "A 10-year-old female presents with concerns of difficulty in breathing and ... Continue reading READ ALL Author should consider the following: - Add the full meaning of PAPVC in the topic - In line 3 of your abstract you can reword it as: "A 10-year-old female presents with concerns of difficulty in breathing and frequent fever hence she visited rural hospital where 2D echo was done which revealed PAPVC. Consider rewriting the clinical presentation section to be better articulated. This will ensure readers of the article can follow the thought process from admission to discharge of the patient. - You can start with Patient chief concern, followed by 3 - 4 line details about the history of present illness. Followed by other pertinent past medical history (is this the first time seeing the patient or has this been an ongoing concern with the patient). Followed by patient physical examination findings (especially Cardiovascular and Respiratory systems). Followed by patient vital signs at presentation/admission and laboratory testing. Followed by the hospital course of events, treatment, and intervention. Under the Clinical presentation; this statement seems to be incorrect. Physical examination cannot reveal what the pericardium looks like. "An examination of the cardiovascular and respiratory systems revealed a normal pericardium that was bilaterally symmetrical" The discussion section is very scanty, consider discussing your Cardiopulmonary rehab data points here. How did it help the patient? What was the initial workload used and how did that progress? With the incentive spirometry, how did you increase this over time, etc and other interventions done as well. Overall, this is an interesting case and it adds to the body of scholarly knowledge. All claims and conclusions made are consistent with existing literature. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Cardiology, Clinical Exercise physiology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Awosika A. Reviewer Report For: Case Report: A comprehensive rehabilitation protocol in a post-operative case of ASD closure along with PAPVC [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :433 ( https://doi.org/10.5256/f1000research.157716.r334941 ) The direct URL for this report is: https://f1000research.com/articles/13-433/v1#referee-response-334941 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Hasan B. Reviewer Report For: Case Report: A comprehensive rehabilitation protocol in a post-operative case of ASD closure along with PAPVC [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :433 ( https://doi.org/10.5256/f1000research.157716.r330526 ) The direct URL for this report is: https://f1000research.com/articles/13-433/v1#referee-response-330526 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 24 Oct 2024 Babar Hasan , Sindh Institute of Urology and Transplantation, Karachi, Pakistan Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.157716.r330526 The introduction should be short and crisp and should mention - What is known about the topic - What are the gaps in knowledge - Which gap is this case report addressing. ... Continue reading READ ALL The introduction should be short and crisp and should mention - What is known about the topic - What are the gaps in knowledge - Which gap is this case report addressing. The uniqueness of this case report is not coming through. What the authors are describing is quite standard of care and routinely done as part of post CHD cardiac rehab. Going into details of surgery in the introduction is distracting and doesn't help define which knowledge gap this case report strives to address. Table 1 and the figures are not adding much to the the case discussion. Crux is in table 2 where they define their rehab protocol. The effectiveness of this protocol cannot be judged by just one case report and for a post-op simple cardiac lesion. Publishing the utility of their protocol in a systematic manner on more patients may be a worthy contribution to the literature. Discussion is around CABG patients which is a totally different population than the patient in the case study. It is important to mention previously published work which addresses a similar patient population. Is the background of the case’s history and progression described in sufficient detail? No Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? No Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? No Is the case presented with sufficient detail to be useful for other practitioners? No Competing Interests: No competing interests were disclosed. Reviewer Expertise: Pediatric Cardiology I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Hasan B. Reviewer Report For: Case Report: A comprehensive rehabilitation protocol in a post-operative case of ASD closure along with PAPVC [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :433 ( https://doi.org/10.5256/f1000research.157716.r330526 ) The direct URL for this report is: https://f1000research.com/articles/13-433/v1#referee-response-330526 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 01 May 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 1 01 May 24 read read Babar Hasan , Sindh Institute of Urology and Transplantation, Karachi, Pakistan Ayoola Awosika , University of Illinois Chicago, Chicago, USA Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Awosika A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 08 Nov 2024 | for Version 1 Ayoola Awosika , University of Illinois Chicago, Chicago, Illinois, USA 0 Views copyright © 2024 Awosika A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Author should consider the following: - Add the full meaning of PAPVC in the topic - In line 3 of your abstract you can reword it as: "A 10-year-old female presents with concerns of difficulty in breathing and frequent fever hence she visited rural hospital where 2D echo was done which revealed PAPVC. Consider rewriting the clinical presentation section to be better articulated. This will ensure readers of the article can follow the thought process from admission to discharge of the patient. - You can start with Patient chief concern, followed by 3 - 4 line details about the history of present illness. Followed by other pertinent past medical history (is this the first time seeing the patient or has this been an ongoing concern with the patient). Followed by patient physical examination findings (especially Cardiovascular and Respiratory systems). Followed by patient vital signs at presentation/admission and laboratory testing. Followed by the hospital course of events, treatment, and intervention. Under the Clinical presentation; this statement seems to be incorrect. Physical examination cannot reveal what the pericardium looks like. "An examination of the cardiovascular and respiratory systems revealed a normal pericardium that was bilaterally symmetrical" The discussion section is very scanty, consider discussing your Cardiopulmonary rehab data points here. How did it help the patient? What was the initial workload used and how did that progress? With the incentive spirometry, how did you increase this over time, etc and other interventions done as well. Overall, this is an interesting case and it adds to the body of scholarly knowledge. All claims and conclusions made are consistent with existing literature. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Cardiology, Clinical Exercise physiology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Awosika A. Peer Review Report For: Case Report: A comprehensive rehabilitation protocol in a post-operative case of ASD closure along with PAPVC [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :433 ( https://doi.org/10.5256/f1000research.157716.r334941) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-433/v1#referee-response-334941 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Hasan B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 24 Oct 2024 | for Version 1 Babar Hasan , Sindh Institute of Urology and Transplantation, Karachi, Pakistan 0 Views copyright © 2024 Hasan B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The introduction should be short and crisp and should mention - What is known about the topic - What are the gaps in knowledge - Which gap is this case report addressing. The uniqueness of this case report is not coming through. What the authors are describing is quite standard of care and routinely done as part of post CHD cardiac rehab. Going into details of surgery in the introduction is distracting and doesn't help define which knowledge gap this case report strives to address. Table 1 and the figures are not adding much to the the case discussion. Crux is in table 2 where they define their rehab protocol. The effectiveness of this protocol cannot be judged by just one case report and for a post-op simple cardiac lesion. Publishing the utility of their protocol in a systematic manner on more patients may be a worthy contribution to the literature. Discussion is around CABG patients which is a totally different population than the patient in the case study. It is important to mention previously published work which addresses a similar patient population. Is the background of the case’s history and progression described in sufficient detail? No Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? No Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? No Is the case presented with sufficient detail to be useful for other practitioners? No Competing Interests No competing interests were disclosed. Reviewer Expertise Pediatric Cardiology I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Hasan B. Peer Review Report For: Case Report: A comprehensive rehabilitation protocol in a post-operative case of ASD closure along with PAPVC [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :433 ( https://doi.org/10.5256/f1000research.157716.r330526) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-433/v1#referee-response-330526 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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