[Balloon atrial septostomy under echocardiographic guide: case series]

Balloon atrial septostomy is an emergent procedure in pediatric cardiology. Nowadays, most patients in need of the procedure have acceptable outcomes after surgical repair. Thus, it is important to perform this procedure as safe as possible. By performing early arterial switch operation and prostaglandin infusion, the rate of balloon atrial septostomy has markedly decreased. However, not all centers performing early arterial switch repairs have abandoned atrial septostomy, even in patients who respond favorably to prostaglandin infusion. In total, eight 1- to 15-day old term neonates admitted in Shahid Rajaee Heart Center in Tehran, Iran from October 2009 to February 2011, with congenital heart diseases were scheduled for balloon atrial septostomy. In six cases the procedure was done exclusively under echocardiographic guidance and in two cases with the help of fluoroscopy. Success was defined as the creation of an atrial septal defect with a diameter equal to or more than 5 mm and ample mobility of its margins. Male sex was predominant [87%] and the mean age of the neonates was six days. The diagnosis in all cases was simple transposition of great arteries. The procedure was successful in all patients with any cardiovascular complication. Balloon atrial septostomy is an emergent procedure that can be done safely and effectively under echocardiographic guidance. According to the feasibility of this technique it could be performed fast, safe and effective at bedside, avoiding patient transportation to hemodynamic laboratory or referral center.

Segmented coronary artery aneurysms and kawasaki disease

Kawasaki disease [KD] is an acute vasculitis syndrome of unknown etiology. It occurs in infants and young children, affecting mainly small and medium-sized arteries, particularly the coronary arteries. Generalized microvasculitis occurs in the first 10 days, and the inflammation persists in the walls of medium and small arteries, especially the coronary arteries, and changes to coronary artery aneurysms. We report the case of a 10-month-old girl referred to our center three months after the onset of disease due to the aneurysms of the coronary arteries. During the acute phase of her illness, she received 2 gr/kg intravenous gamma globulin; and after her referral to us, the patient was treated by antiaggregant doses of acetylsalicylic acid [ASA] [5 mg/kg] and Warfarin [1 mg/daily]. At three months' follow-up, the aneurysms still persisted in the echocardiogram

[ evaluation of late outcome of balloon pulmonary valvuloplasty in children]

Isolated pulmonary valve stenosis represents 8-10% of congenital cardiac anomalies. This study was performed to evaluate the late outcomes of Balloon Pulmonary Valvuloplasty [BPV] in children with residual infundibular stenosis. Seventy-eight patients underwent BPV in Rajaee Heart Center in Tehran Iran, from 2008-2010. The patients were divided into two groups: with and without infundibular stenosis. The group with infundibular stenosis was subdivided into two groups: with and without propranolol administration. Gradient measurement follow-ups by Doppler echocardiography were done on the first day and 1, 3, 6 and 12 months afterwards. Thirty five [44.9%] patients were male and 43 [55.1%] were female. The mean age of participants was 4.29 +/- 3.5 years and the mean weight 16.18 +/- 8.8 kg 33 patients [43%] did not show residual infundibular stenosis but 45 [57%] did so in the evaluations. There were no significant differences between the two groups regarding age, weight, sex, kind of balloon valvuplasty, balloon to body surface area ratio and pulmonary regurgitation [PR]. Propranolol was administered to 27 [60%] patients with residual stenosis for six months but 18 [40%] did not receive the medication. In both groups, the gradient significantly decreased immediately after BPV [P<0.0001]. In the propranolol group a constant decrease in residual gradient was seen. There was a significant relationship between balloon to body surface area ratio [387 +/- 94mm2/m[2]] with moderate to severe PR [P<0.015]. BPV is a safe and effective procedure to treat PS. Residual infundibular gradient after BPV decreases over time and propranolol helps decrease the gradient

Evaluation of exercise-induced hypertension post endovascular stenting of coarctation of aorta

Coarctation of the aorta [COA] is a defect that accounts for 5-8% of all congenital heart diseases. Balloon angioplasty as a treatment for COA is increasingly performed, with endovascular stents having been proposed as a means of improving the efficacy and safety of the procedure. The aim of this study was to evaluate the systolic blood pressure gradient at rest and during maximal exercise at follow-up in patients post endovascular stenting of COA. Thirteen patients [4 native and 9 re-coarctation cases of COA after surgery or balloon angioplasty] with a mean age of 11.1 +/- 4.7 years underwent endovascular stenting between November 2007 and December 2009 via standard techniques for native COA as an alternative to surgical repair. Doppler echocardiography was performed pre and post stenting. Resting and exercise assessment of blood pressure was performed at follow-up. Post stent implantation, no angiographic major complications were evident. Systolic blood pressure gradient decreased from 42 +/- 8.8 mm Hg before stent placement to 7 +/- 10 mm Hg at follow-up [p value < 0.001]. Peak Doppler pressure gradient decreased from 30 +/- 14 mm Hg to 14 +/- 10 mm Hg at follow-up [p value < 0.007]. One case of exercise-induced hypertension was seen in patients. Endovascular stenting for native COA in older children and post-surgical COA repair in patients with residual COA and re-coarctation is a reasonable alternative to surgical correction. During early follow-up, stenting effectively alleviates the aortic arch obstruction with normalization of the systemic blood pressure both at rest and during maximal exercise