Peripheral venous pressure as a predictor of central venous pressure in continuous monitoring in children

Measurement of central venous pressure [CVP] is a reliable method for evaluating intravascular volume status and cardiac function; however it is an invasive and expensive method that may result in some complications such as arterial puncture, pneumothorax and development of infections. This study was performed to compare CVP measurements between central and peripheral catheters in infant and children with congenital heart disease. The CVP and peripheral venous pressure [PVP] were measured simultaneously in 30 patients within 10 consecutive hours. The mean difference between CVP and PVP was 1.48 +/- 0.98 mmHg. The linear regression equation showed that CVP was 0.374+0.774 PVP [r[2] = 0.725]. PVP measured from a peripheral intravenous catheter in infants and children with congenital heart disease is an accurate estimation of CVP and its changes has good concordance with CVP over a long period of time

Coronary artery origin anomalies with especial emphasis on delayed diagnosis of anomalous origin of the left coronary artery from pulmonary artery, a report from south of Iran

The aim of this study was to determine the clinical course and outcome of coronary artery anomalies including anomalous origin of the left coronary artery from the pulmonary artery [ALCAPA] diagnosed by coronary artery angiography [CAA] at our institution. The term coronary artery anomaly refers to a wide range of congenital abnormalities, involving the origin, course and the structure of epicardial coronary arteries. Anomalous origin of the left coronary artery from the pulmonary artery [ALCAPA] is an extremely rare, but potentially fatal congenital coronary anomaly. The review included 21280 patients undergoing CAA at Medical Centers of Shiraz University between years 1997 -2006. The hospital records of all patients with diagnosis of ALCAPA reviewed for analysis. Data were expressed as percentages. There were 149 [0.7%] cases of coronary anomalies, including 9 [6.04%] proven cases of ALCAPA. In ALCAPA group, five patients presented with congestive heart failure [CHF] and a non-specific systolic murmur on examination. Isolated mitral valve regurgitation [MR], cerebrovascular accident due to embolization of a mural thrombus, and chest pain were the main presentations in three patients. Two of the patients were under follow up with presumptive diagnosis of coronary artery fistula. The patients aged between 4 months and 35 years. Surgical correction done for all the patients with ALCAPA by direct reimplantation in 8 patients and Takeuchi technique in one. We had one early hospital mortality in our group. ALCAPA should be considered in differential diagnosis of any patient presenting with dilated cardiomyopathy, CHF, MR or chest pain syndrome. Awareness of such pathology can prevent or decrease the morbidity and mortality of a potentially fatal congenital heart disease

Vital signs changes in post-operative corrective surgery for cyanotic and noncyanotic congenital heart diseases

Post open cardiac surgery is associated with rises in fever, blood pressure and heart rate. The objective of the present study was to determine the changes in temperature, blood pressure and heart rate in first week after open cardiac surgery of non-complicated cyanotic and noncyanotic congenital heart diseases. Temperature, blood pressure and heart rate were obtained from 100 patients with different congenital heart disease after open cardiac surgery. The patients divided in two groups, 40 cyanotic CHD and 60 noncyanotic CHD. Half of patients had fever in first day after surgery. Cyanotic patients became afebrile earlier than noncyanotic group. Cyanotic patients had higher heart rate and lower blood pressure than noncyanotic group. The study suggests that post open heart surgery body temperature, blood pressure and heart rate are different in patients with cyanotic and non cyanotic congenital heart diseases

Parental knowledge of bacterial endocarditis prophylaxis: a report from southern Iran

We determined the knowledge of parents of 200 pediatric patients for bacterial endocarditis prophylaxis [BEP], using an eight question survey pertaining to their knowledge of their child's cardiac disease, medications, and BEP. The patient's cardiac lesion and current medications were verified at the time of admission for diagnostic or interventional cardiac catheterization. Each patient's need for BEP was determined according to American Heart Association [AHA] recommendations. Eighty-one respondents [40-5%] were high school graduates. Only 12 parents [6%] correctly defined endocarditis. One-hundred and fifty-eight parents [77%] knew the name or condition of their child's cardiac problem, one-hundred [50%] of the families had knowledge of BEP, and only 46 parents [23%] knew that antibiotics are needed for prophylaxis at the time of dental procedures. It is concluded that while most parents know the name of their child's heart lesion and current medications, their knowledge of endocarditis and BEP is limited, and for prevention of such a major complication for pediatric patients with heart diseases, intensified education and awareness programs are needed

Doppler echocardiography in subclinical rheumatic valvular regurgitation: a long term study

Doppler echocardiography [DE] is known to be a valuable tool for detecting subclinical forms of valvular regurgitation [VR] in the acute phase of rheumatic fever [RF]. Previous studies have mostly dealt with the acute phase problem with only short-term follow-up. In this study, 24 children between 4-15 years of age [mean age 11.8 +/- 2.7 years] with RF without clinically diagnosed carditis [most with arthritis] who had two or more DE studies in the course of follow-up [more than 12 months] were assessed utilizing DE. Twenty-one patients had positive DE findings in one or more valve[s] [87.5%]. VR disappeared within 1-8 months[mean4.4 +/- 2.3mo.]in 9[42.8%] and persisted in 12 [57.2%] patients during 12-60 months follow-up, whereas DE in children with normal heart structure was rarely associated with left-sided VR [P<0.001]. Therefore DE can be a more valuable tool for detection of acute and late phase disease, and follow-up and prevention of RF, and since endocarditis may be the only significant finding of organic cardiac involvement, it may be accepted as a major diagnostic criterion

Rheumatic valvulitis without auscultatory findings: doppler echocardiography study

In order to evaluate the value of pulsed Doppler echocardiography in acute rheumatic fever valvulitis with negative auscultatory findings, we studied 25 patients prospectively in a 2 year period. Eighteen patients [72%] had significant Doppler findings at a single or more valves. In a period of one to three months, 50% of the patients had no more significant flow by Doppler studies and no change in findings on the third follow-up performed 18 months after second evaluation in 24% of the patients. It is concluded that valvular regurgitation as detected by Doppler in patients with ART and negative auscultatory findings can be used as evidence of valvulitis during the acute phase of the disease. It may also help to monitor the treatment and follow-up of such cases