[Comparison of sedative and adverse effects of hydroxyzine hydrochloride and chloral hydrate in children witch undergo echocardiography]

Background: To overcome of infants and children anxiety confronting with diagnostic and therapeutic procedures, different drugs have been used in this study efficacy and side effects of hydroxyzine and chloral hydrate assessed during echocardiography

Methods: The study was performed on 107 patients in two groups of hydroxyzine [52 people] and chloral- hydrate [55 people].for the first group one milligram of hydroxyzine syrup and for the second group 50 gram of chloral hydrate syrup per kilogram of patient body weight was used

Results: The patients of two groups were similar about sex, age, weight and effectiveness of drugs. The volume and price of the chloral hydrate significantly was more than hydroxyzine. The time needed to begin of drug effect was similar but the duration of drug effect was significantly long about chloral hydrate. Vomiting and irritability were seen more significantly in chloral hydrate group

Conclusion: It seems that the hydroxyzine is a suitable and acceptable substitute for chloral hydrate with little side effect during non-invasive procedures such as echocardiography

Perventricular muscular ventricular septal defect [VSD] closure under epicardial echocardiography guidance: a case report

Ventricular septal defects [VSDs] are among the most common congenital cardiac lesions. Large defects at apicomuscular regions, especially in young patients, are far from accessible to surgeons for conventional surgery. Moreover, the transcatheter closure of VSDs in these patients is difficult and carries a high risk of complications because of the large sheath size relative to the patient's size. The periventricular approach simplifies VSD closure and, thus, eliminates the potential complications of cardiac catheterization and fluoroscopy as it is performed under echocardiographic guidance. A 3-year-old girl with a body weight of 11 kg [failure to thrive] was referred to us. She had multiple adjacent apicomuscular VSDs, the largest one being about 19 mm in diameter, and subsystemic pulmonary artery pressure [PAP]. The patient underwent periventricular apicomuscular VSD closure with a Lifetech muscular VSD occluder [size 22 mm] under epicardial echocardiography guidance without cardiopulmonary bypass. Post procedure, the PAP was decreased to mild level. The residual shunt was mild across the adjacent small defects. She was discharged after 7 days without complications. At 2 years' follow-up, the patient was hemodynamically stable and had a normal PAP [PAP = about 16 mmHg] by transthoracic echocardiographic assessment

effect of cyanosis on active clotting time during diagnostic catheterization

Cardiac catheterization is a common procedure which needs a careful coagulation monitoring. In our study, we aimed to find factors influencing active clotting time [ACT] following heparin therapy. ACT of 71 patients who were scheduled to undergo transcutaneous diagnostic catheterization and angiography were measured at baseline, 2 and 60 minutes after 50 IU/kg heparin loading. ACT in two groups of patients [cyanotic and non-cyanotic] was compared. All data were analyzed with Wilcoxon, Mann-Whitney test and Pearson in SPSS 16, P value less than 0.05 was considered significant. ACT following heparin at 2nd and 60th minutes was not significantly different in cyanotic and non-cyanotic groups. At 60th minute following heparin administration, ACT decreased more dramatically in older children. Cyanosis does not affect ACT measures following heparin treatment. Moreover, after 60 minutes, heparin efficacy [ACT values] decreased more with increase in patients' age.

Complications of aortic stenting in patients below 20 years old: immediate and intermediate follow-up

Optimal timing and mode of treatment for patients with coarctation of the aorta [COA] remain controversial, particularly in children. Surgery, balloon dilatation, and stent implantation have all proven effective in the treatment of moderate or severe obstruction. The aim of this study was to investigate the complications of COA stenting angioplasty in pediatric patients. This retrospective, descriptive study was conducted on patients less than 20 years of age who underwent aortic stenting angioplasty because of congenital COA in the pediatric catheterization laboratory of Rajaie cardiovascular, medical and research Center, Tehran between 2005 and 2010. A total of 26 patients [18 [65.4%] males and 9 [34.6%] females] with congenital COA who had undergone aortic stenting angioplasty were recruited. Nineteen [73.1%] of these patients had native COA and 7 [26.9%] had recurrent COA. Most of the early complications were minor and temporary; only one patient developed early major complications. During the follow-up, whereas none of the native group patients developed late complications, in the re-COA group 28.57% of the patients had re-stenosis and 14.28% had chronic systemic hypertension, requiring drug therapy. Our investigation into post-stenting complications in patients with native COA and re-COA showed that endovascular stenting could be an effective and safe method, even in young patients with native COA

Validity of sildenafil test in patients with pulmonary arterial hypertension associated with congenital heart disease according to clinical and ecardiographic parameters

Pulmonary arterial hypertension is a complication of most congenital heart diseases. We sought to assess the effect of sildenafil on patients suffering from pulmonary arterial hypertension in association with congenital heart disease on the basis of clinical and echocardiographic parameters and compare the catheterization and treatment results so as to evaluate the predictive value of sildenafil on the operability of patients.After primary echocardiography, 21 patients were selected for the final study with a diagnosis of moderate-to-large ventricular septal defect and pulmonary artery hypertension. They were divided into 3 age groups: younger than one year, 1 to 2 years, and older than 2 years. Before and one hour after the consumption of sildenafil, the patients had their oxygen saturation and blood pressure measured. Additionally, the patients underwent echocardiography and cardiac catheterization. The patients' operability was determined on the basis of their clinical condition and their response to oxygen inhalation in the catheterization room. Finally, the results of the drug response and final treatment were analyzed statistically. The 21 patients, who had ventricular septal defect and pulmonary arterial hypertension, were comprised of 8 [38%] boys and 13 [62%] girls. The patients aged from 2.5 to 204 months [mean 30 months]. It was clear that the younger patients had a more positive response to the drug. All the patients who had a positive response to the drug were considered operable after catheterization and all of them had a positive response to treatment. There was no significant correlation between operable/inoperable conditions and response to treatment [P value=0.262], while there was a very significant correlation between response to treatment and response to drug [P value=0.005]. According to the results of this study and given the low cost and availability of sildenafil and its oral consumability on the one hand and the availability and non-invasiveness of echocardiography on the other, it seems that sildenafil is useful in determining the pulmonary vascular bed reactivity via echocardiographic parameters and facilitating the decision-making process for surgery in patients with pulmonary arterial hypertension and congenital heart diseases