Pediatric heart diseases in Madina, Saudi Arabia. Current status and future expectations

To demonstrate the magnitude of pediatric heart disease problem in Madina, current situation of heart service, obstacles and future expectations. We conducted this cross sectional study in Madina Maternity and Children Hospital, Madina, Kingdom of Saudi Arabia from January 2007 to June 2008. The study was approved by the Ethical Committee. A computer based program was established to register the data of all children attended the pediatric cardiology unit. A total of 4348 children were seen in the study period; 2301 were follow up cases while 2047 were new cases. Of the new cases, 794 [38.8%] were found to have heart diseases. Of this, 705 have CHD [cardiomyopathies 34, rheumatic heart disease 26, mitral valve prolapse 15, Kawasaki disease 9, and arrhythmia 5]. Ventricular septal defect was the most common CHD [34.5%], and followed by atrial septal defect [8.9%]. Other CHDs were as follows pulmonary stenosis [7.9%], patent ductus arteriosus [6%], atrioventricular septal defect [3.8%], aortic stenosis [3.5%], dextro-transposition of great arteries [3.5%], tetralogy of fallot [3%], coarctation of aorta [2.8%], and others [26%]. Three hundred and ten patients required referral to the cardiac centers in Riyadh for catheterization or surgical intervention. Urgent referral was required in 128 patients. All patients were transferred via medical evacuation service. Pediatric heart disease constitutes a major health problem in Madina. The majority of patients have CHD. The need for cardiac centre in Madina was emphasized to avoid problems of transportations

Splenectomized versus non-splenectomized patients with thalassemia major. Echocardiographic comparison

To study the effect of splenectomy in patients with thalassemia major on the cardiovascular system through echocardiographic study. A prospective, cross sectional study was carried out from December 2006 to December 2007. Patients from the Thalassemia Center in the Maternity and Children's Hospital, Madina, Kingdom of Saudi Arabia, were screened by means of history, physical examination, laboratory studies, and echocardiography. Fifty-seven patients were studied: 36 were non-splenectomized, while 21 were surgically splenectomized. The 2 study groups were well matched for age, gender, height, and weight. The total amount of blood given during the previous year [6577.1 +/- 206.9 ml versus 5390.5 +/- 220.2 ml, p=0.0005], and the annual transfusion index [200.9 +/- 11.3 versus 134.1 +/- 7.3, p=0.0001] were significantly lower in the splenectomized group. There was no significant difference between the 2 groups regarding laboratory studies. Left ventricular systolic function shows no difference regarding fraction shortening between the 2 groups. The mitral valve E/A ratio was significantly higher in the splenectomized group [1.6 +/- 0.2 versus 1.4 +/- 0.2, p=0.02]. The pulmonary artery pressure was higher in the splenectomized group [34.2 +/- 9.1 versus 20.8 +/- 9.2 mm Hg, p=0.0001]. There was a significantly higher number of patients with pulmonary hypertension in the splenectomized group [14 [66.7%] versus 6 [16.7%], p=0.0004]. Splenectomized patients with thalassemia major are at high risk of having impaired diastolic left ventricular function and pulmonary hypertension