Results of senning operation modified with wide-based pericardial graft [an echocardiographic evaluation]

Despite the fact that the arterial switch operation is the treatment of choice for complete transposition of the great arteries, patients with unbalanced ventricles still needs the Senning operation. Known surgical complications like baffle obstruction may result in early deterioration of ventricular function and impaired exercise performance. It is not clear wether these complications are inevitable or predisposing factors at surgery or during follow up may identify patients at high risk Baffle obstruction after Senning operation may result in early deterioration of RV function and impaired exercise performance. The Objective was to assess the effect of surgical modification in avoiding surgical complications with its deleterious effects on early as well as late follow up. Echocardiography was used to assess postoperative outcome. This prospective study included 30 cases who were candidates for Senning operation for simple transposition of great arteries in the cardiothoracic department of Aboul-Reesh Pediatic hospital Cairo University where an in-situ wide-based pericardial patch was used for the outer baffle, modified right atriotomy and suture lines were modified in all patients. Left atrial appendage augmentation was used in 8, Eustachian valve in 6 cases. Postoperatively patients were subjected to clinical evaluation using Ross scoring for heart failure, ECG and echocardio graphic evaluation to assess RV size, degree of TR, baffle patency, LVOT dynamic obstruction, and global RV systolic and diastolic functions using the myocardial performance index [MPI]. We had early 2 mortalities [6.66%] out of low cardiac output, accelerated nodal rhythm was experienced in other 2 patients [6.66%], internal baffle pressure was 6.1 +/- 2.64cc H20. Data higher than 12cc H[2]O was found in 3 patients [10%], none of them had augmentation with the left appendage. Outer baffle pressure was 9.2+ 1.08 cc H20. No baffle leakage was detected. Clinical examination postoperatively revealed that only one patient had four points on Ross score of HF and the rest of patients had a zero score. Nodal arrhythmias were found in three patients, marked RV dilatation was found in one case and the other 27 cases had mild dilatation, moderate TR was present in 4% of cases, mild TR in 72% of cases. There was no baffle obstruction or LVOT obstruction in our patients. Patients who had Senning operation after the first year of life [40%] had RV MPI more than 0.4 while those under the first year [60%] had MPI less than 0.4. Baffle Augmentation with the wide based pericardial patch offered less chance for baffle obstruction, Left atrial appendage could be used in addition to offer an additional tool to avoid higher internal baffle pressures. Patients subjected to Senning operation earlier in the first year of life and patients have higher oxygen saturation at the time of the operation have better global RV functions

Myocardial performance in hydroxyurea versus transfusion treated sickle cell disease pediatric cases

Sickle cell disease [SCD] is associated with many cardiac abnormalities including increase cardiac output, pulmonary hypertension [PH] and myocardial perfusion abnormalities. Hydroxyurea [HU] is considered to be the most successful drug therapy for severe sickle cell disease. The objective is to study the echocardiographic cardiac abnormalities in patients with SCD on HU therapy comparing them with those on isolated blood transfusion regimen. Descriptive cross sectional case study was conducted on 29 cases of SCD on transfusion regimen [16 cases] and on HU therapy [13 cases]. Doppler echocardiographic assessment of left ventricular systolic and diastolic function, calculation of myocardial performance index [MPI] and left ventricular mass were done to all patients. Right ventricular MPI was higher in HU treated group with difference approaching significance [p = 0.06]. No significant correlation between HU dose and duration and left ventricular systolic or diastolic function, right ventricular diastolic function, or pulmonary artery pressure [PAP]. PH was present in 55% of SCD. No significant difference in PAP between HU and transfusion treated groups. Negative significant correlation between left ventricular deceleration time and estimated systolic pulmonary artery pressure [r=-0.37 p =0.04]. No deleterious echocardiographically detected cardiac effects were observed in HU treated SCD patients. HU had no effect on PH

Selenium and thyroid hormone status pre and post open heart surgery in children with congenital heart disease

Transient myocardial ischemia that occurs during cardiac surgery leads to oxidative stress and production of free radicals. Selenium [Se] status has important implications for cardiovascular morbidity and mortality as selenium is an integral component of the enzymes glutathione peroxidase and 5-iodothyronine deiodinase. Thyroid hormones have important effect on the heart and peripheral vascular system. Cardiopulmonary bypass [CPB] results in low triiodothyronine [T3] state, due to central depression of the hypothalamic pituitary axis together with impaired conversion of T4 to T3 secondary to reduced activity of iodothyronine deiodinase. This work aimed to study the effect of cardiopulmonary bypass on selenium and thyroid hormone status in infants and children with congenital heart disease [CHD]. Also it aimed to study the possible effect of selenium and thyroid hormone status on the hemodynamic condition of these infants and children after open heart surgery. Twenty five children were subjected to open heart surgery in the Cardio Thoracic Unit, Pediatric Hospital, Cairo University. The patients were subjected to full history taking, general and local cardiac examination, M mode, 2D and Doppler Echocardiography. Serum samples were collected, at the induction of anesthesia and 48 h after cardiopulmonary bypass for assessment of selenium, free T3[FT3]and free T4[FT4] levels. Assessment of serum selenium takes place at [NRC] using graphite furnace atomic absorption spectrometry [GFAAS]. Assessment of FT3 and FT4 takes place at Radioactive Isotope Department using RIA technique. Significantly lower postoperative selenium, FT3 and FT4 serum levels, compared to those at the induction of anesthesia, were found [p< 0.005, 0.025, and 0.025 respectively]. Longer CPB time was associated with lower FT3 and FT4 levels [r =0.49 and 0.63 respectively]. On the other hand higher FT3 and FT4 levels were associated with less time needed for inotropic support [r =0.48 and 0.60 respectively]. There is significant decrease of selenium, free T3 and freeT4 levels after cardiopulmonary bypass. The degree of decrease of thyroid hormones is affected by CPB time. Thyroid hormone levels have an evident impact on the myocardial functions and hemodynamic condition after open heart surgery

Role of chest ultrasound in determining the nature of pleural effusion in children

Because of its ready availability and ability for bed side imaging, sonography has become a major imaging modality not only in determining the presence of pleural fluid and its nature, but also as a guide to aspiration. The pleura is a relatively superficial structure and therefore, it is accessible to sonography. The aim of our work was to investigate the usefulness of sonographic findings, including the internal echegenicity and associated changes in the pleura and lung parenchyma, in determining the nature of pleural effusion, and to compare the results with the CT findings, and those of pleural aspirate. This study was conducted on 50 children suffering from pleural effusion ranging in age between 2 months and 13 years. They were subjected to full history taking, clinical examination, laboratory investigations, laboratory analysis of pleural aspirate, chest Xray, CT chest [if needed] and chest ultrasound. The results of our study revealed that pleural fluid appearance in chest ultrasonography was classified into four main categories: anechoic in 50%; complex non septated in 16.7%; complex septated in 8.3%; and homogeneously echogenic in 25% of cases. We regarded transudates [45.8%] as usually anechoic. Exudates [28.2%] were considered when the pleural effusion was complex septated and non septated. Empyema [20.8%] was considered in our study in cases with homogeneously echogenic pleural effusion. Chest ultrasonography detected 91% of transudates, 80% of empyema, and all cases with inflammatory exudates

Conclusion : We concluded that chest ultrasonography is a valuable method in assessing the nature of pleural effusion and it seems to give additional information over chest x-ray and CT chest