Cardiac diseases as a risk factor for stroke in Saudi children

To ascertain the role of cardiac diseases as a risk factor for stroke in a cohort of Saudi children who were evaluated in a retrospective and prospective study. Children with cardiac diseases were identified from within a cohort of 104 Saudi children who presented with stroke. They were seen as inpatients in the Pediatric Wards or evaluated at the Outpatient Clinics of the Division of Pediatric Neurology [DPN], and the Division of Pediatric Cardiology at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia during the periods July 1992 to February 2001 [retrospective study] and February 2001 to March 2003 [prospective study]. A comprehensive form for clinical, neuroimaging, neurophysiological and laboratory data retrieval was designed and completed for each patient. Cardiac evaluation included 12-lead ECG and serial echocardiograms. Cardiac catheterization and 24-hour ambulatory ECG [Holter] were conducted on clinical discretion. Cardiac diseases were the underlying risk factor for stroke in 6 [5.8%] of the 104 children [aged one month to 12 years]. The patients [4 males and 2 females] were evaluated at the DPN at a mean age of 5.3 years [range = 1 - 8 years; median 6.5 years]. Onset of stroke was at a mean age of 34 months [range = 4 months - 8 years; median = 30 months]. Five patients had stroke in association with congenital heart disease [CHD], whereas the sixth had restrictive cardiomyopathy. The identified CHD consisted of membranous ventricular septal defect in a 5-year-old boy who had moyamoya syndrome and sickle cell beta - thalassemia, asymptomatic patent ductus arteriosus [PDA] in a 17-month-old girl, atrioventricular canal defect and PDA in an 8-year-old boy who also had Down syndrome, partial anomalous pulmonary venous drainage in a one-year-old boy, and Tetralogy of Fallot in an 8-year-old boy. The latter patient developed hemiparesis secondary to a septic embolus, which evolved into brain abscess involving the right fronto-parietal region. This was successfully managed surgically. The sixth patient was an 8 1/2 -year-old girl who had hemiparesis and complex partial seizure in association with restrictive cardiomyopathy. Serial echocardiograms depicted resolution of the cardiac abnormalities within 5 years and subsequent normal findings. Cardiac diseases, as a group, constitute a significant risk factor for stroke in Saudi children. Early diagnosis of these diseases is important to prevent further recurrences of stroke, and because some of them are potentially curable.

Endocarditis prophylaxis in children with congenital heart disease. A parent's awarenes

The aim of this study is to determine the parental knowledge of bacterial endocarditis prophylaxis [BEP]. Parents of 205 patients attending the Pediatric Cardiology Clinics at King Khalid University Hospital, Riyadh, King Fahad University Hospital, Al-Khobar and Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia from July 1999 to June 2000, were interviewed by a standard questionnaire pertaining to their knowledge of their child's cardiac disease, medications, and BEP. The patients' cardiac lesions and current medications were verified by a review of medical records. Each patient's need for BEP was determined according to American Heart Association recommendations. All parents answered the interview questions. The patients' mean age was 5 years and 8 months with a range of one month to 15 years. One hundred and two [50%] parents were high school graduates. Fifty-two [25%] parents correctly defined endocarditis. Two hundred and one [98%] parents knew the correct name of their child's cardiac condition, and 46/50 [92%] of those on medication knew the names of their child's current medications. Only 113/176 [64%] parents with at risk children were aware of measures to prevent endocarditis. While most parents know the name of their child's heart lesion and current medications, parental knowledge of endocarditis and BEP was limited. Intensified education and awareness programs are needed in order to prevent potential major morbidity and mortality for pediatric patients with congenital heart disease

Congenital central hypoventilation syndrome: diagnosis and the challenge of management

Congenital central hypoventilation syndrome is a rare disease characterized by a lack of automatic, but with intact, voluntary control of breathing. Patients with this disease need assisted ventilation mostly during sleep. To the best of our knowledge our patient is the first case reported among Saudi and Arab children. Since these patients need special respiratory care with difficulties in family adaptation, reappraisal is needed of the available therapeutic option in the kingdom, including the availability of adequate support for home ventilation at different regions

Low Dose Prostaglandin [E1] for Duct Dependent Congential Heart Disease

To assess the efficacy of prostaglandin E[1][PGE[1]] on duct dependent congenital heart diseases at our center, a hospital-based retrospective study of neonates with congenital heart disease, cyanotic and acyanotic, who were treated by intravenous prostaglandin at King Khalid University Hospital, Riyadh, Saudi Arabia, over five years period. A total of28 neonates, 16 males and 12 females, divided into three groups; Group I were given PGE[1], to increase pulmonary blood flow, Group II to improve mixing of blood and Group III to increase systemic blood flow. The drug was successful in all cases, with one episode of apnea; a common drug side effect. PGE [1]helped many cyanotic babies to reach safely to the well-equipped centers where accurate cardiac diagnosis and cardiac surgery could be done. When used in the suggested low dose for a reasonable period of time, only few babies will experience the expected side effects

Radiofrequency perforation of pulmonary atresia with intact ventricular septum: and initial experience

Pulmonary atresia with intact ventricular septum is a category of cyanotic congenital heart disease which constitutes an emergency in critically-ill newborns. These patients are ductus dependent requiring prostaglandin E[1] infusions until a systemic-to-pulmonary artery shunt is created or they undergo pulmonary valvotomy, either alone or combined with the shunt. Non-surgical [transcatheter] intervention using radiofrequency perforation techniques for the atretic pulmonary valve is now available as an alternative to surgery. We report successful applications of this technique in 3 patients who tolerated the procedure well and had encouraging follow-up results. We conclude that radiofrequency opening of atretic pulmonary valve will have a role in the treatment of pulmonary valve atresia with intact ventricular septum and will be a valuable alternative to surgical pulmonary valvotomy