Mid-term results of the lateral tunnel operation at Queen Alia heart institute

To determine midterm results of univentricular repair using intra-atrial lateral tunnel at Queen Alia Heart Institute. Between January 1999 and January 2005, 159 patients [99 males, 60 females] underwent either a fenestrated or non-fenestrated lateral tunnel [Fontan procedure], for a wide range of complex congenital heart disease with a functional single ventricle at Queen Alia Heart Institute. Median age at operation time was 3.8 years [range 1.5-17 years]. Multiple factors were analyzed including: anatomical variations, mean right atrial pressure, pulmonary artery pressure, ventricular end diastolic pressure, aortic saturation, cardiopulmonary bypass time and ischemic time, presence of arrhythmias, pacemaker insertion, thromboembolic complications, early and late mortality. The major anatomic diagnosis was double inlet left ventricle in 72 patients [45.3%] and the least was unbalanced complete atrioventricular septal defect among 8 patients [5%]. Dextrocardia was found in 17 patients. The mean right atrial pressure was 8 +/- 3 mmHg, pulmonary artery pressure 13 +/- 2.6 mmHg, PVR 1.9 +/- 2 Woodunits.m2, ventricular end diastolic pressure 14 +/- 2.2 mmHg, aortic saturation 83 +/- 4%, cardiopulmonary bypass time 121 +/- 9 minutes, ischemic time 47 +/- 3 minutes. Early postoperative supraventricular tachyarrhythmia [SVT] occurred among 10 cases [6.3%] of patients, in whom four needed antiarrhythmic drugs before discharge. Early bradyarrhythmia needing pacemaker in 2 patients [1.26%], whereas 6 patients needed pacemaker at mid term follow-up. There were 10 [6.3%] early deaths and no late deaths occurred after 6 years of follow-up. Seven [4.7%] patients developed protein loosing enteropathy as a late complication and 7 more patients [4.7%] developed neurological complications. Proper selection of patients for the lateral tunnel Fontan procedure results in excellent early and mid-term survival and functional outcome with low incidence of complications

Transcatheter closure of patent ductus arteriosus using the amplatzer duct occluder at Queen Alia Heart Institute: Medium-term follow-up

Transcatheter closure of patent ductus arteriosus is a well-established procedure. The aim of this study was to assess the medium term results of patent ductus arteriosus closure using the Amplatzer Duct Occluder. From January 1998 to January 2005, 204 cases [77 males and 127 females] underwent an attempt of transcatheter closure of their patent ductus arteriosus at Queen Alia Heart Institute using the Amplatzer Duct Occluder[Tm] device. Their median age was 3.5 years [range 0.8-13 years], their median weight 14kg [range 6-32kg], their mean Qp/Qs was 2.3 +/- 0.6, their mean systolic pulmonary artery pressure was 38.44 +/- 7mmHg. The mean narrowest diameter of the pulmonary end of the patent ductus arteriosus angiographically was 4.2 +/- 0.8mm [range 3-8mm]. The devices used were [6-4, 8-6, 10-8 and 12-10mm] delivered antegrade via 5-7 French sheaths. All patients had chest X-ray and color flow echocardiographic follow-up at 24 hours, one, three, six months and yearly thereafter. There was immediate and complete closure of the ductus in 180 [88.24%] of cases. The remaining 24 [11.76%] patients had a trivial residual shunt through the device mesh. Follow-up color flow Doppler echocardiography revealed complete closure of patent ductus arteriosus in 96% of cases at 24 hours, and complete closure at one month follow-up in 100% of cases. One patient developed aortic obstruction where the duct joined the aorta at a more acute angle, which was retrieved surgically. Otherwise no other complications were reported. Neither thromboembolization nor hemolysis or recanalization of the ductus was reported. Furthermore, chest radiographs and Doppler echocardiography follow up revealed no evidence of wire fracture or device disruption or any episodes of infective endocarditis. Since the initial clinical experience in 1998, the transcatheter closure of patent ductus arteriosus using the Amplatzer Duct Occluder has proven to be an easy procedure that could be mastered quickly but with caution and at the same time it is an effective procedure that has almost replaced surgery in our center. Longer follow up will be needed to precisely define the safety and indications of this device

Transcatheter closure of post-fontan communication between the hepatic vein and left atrium by amplatzer duct occluder: a case report

A 14-year-old boy underwent palliative total cavopulmonary connection [modified Fontan operation] for a single ventricle and pulmonary atresia. At postoperative outpatient clinic follow-up visits progressive cyanosis was noticed. Cardiac catheterization and angiography revealed a hepatic vein draining to the left atrium accounting for the arterial desaturation. The communication was successfully closed by transcatheter method using the Amplatzer duct occluder

Clinical outcome of small ventricular septal defects [VSDs] in children

To assess the clinical outcome of patients with isolated ventricular septal defects small enough not to require surgical closure. Between January 2001 and May 2003 a total of 118 patients who were recently or previously diagnosed to have isolated ventricular septal defects small enough not to require surgical closure were included in this study. Inclusion criteria for the study were single ventricular septal defect with a size less than 5 mm in diameter on a 2-D echo, normal or borderline left ventricular end diastolic diameter [20-44 mm], normal left ventricular fractional shortening [0.30-0.40], normal or slightly raised pulmonary artery pressure [less than 30/15 mmHg, with a mean less than 19 +/- 7 mmHg] and absent ventricular septal defect-related clinical symptoms. Exclusion criteria were symptomatic small ventricular septal defect patients and those who had an additional hemodynamically relevant heart defects. Follow up period was recorded. Mean age of the study population at presentation was 13.3 +/- 1.4 months [range, one week-10 years] and at last follow-up visit 6.0 +/- 0.7 years [range 2.5-12.5 years]. Follow-up was performed for 111 patients [94 percent]. The mean follow up period was 5.5 +/- 0.6 years [pre- and post enrollment]. Spontaneous closure was observed in 12 of perimembranous, and 10 of muscular ventricular septal defects [overall rate of spontaneous closure 19.8 percent], by the end of the study. None of the patients died nor required medical or surgical treatment. Two patients developed mild aortic insufficiency and two patients had infective endocarditis during the follow-up period. None of the patients had definite increasing dimensions or functional deterioration of the left ventricle. Twenty-five patients underwent exercise treadmill testing; 84 percent of those achieved a target heart rate more than 80 percent of age-predicated maximum heart rate. None had a target less than 70 percent of predicated maximum heart rate or any exercise-induced significant arrhythmias. On the other hand 21 percent showed non-significant rhythm abnormalities either at resting electrocardiogram or 24-hour Holter monitoring. The overall clinical outcome of asymptomatic children with small isolated ventricular septal defect is excellent. Spontaneous closure may occur and these children may be allowed to participate freely in physical exercise and engage in competitive sports. Clinical and 2-D echo follow-up are indicated

Ectopic spleen: a rare cause of abdominal pain

We report a five-year-old female, who presented to the pediatric clinic with chronic intermittent abdominal pain, and on physical examination, a large abdominal mass was felt in the right lower abdomen. Ectopic spleen was confirmed using abdominal ultrasonography, CT scan and isotope scanning. The patient underwent successful splenoplexy at King Hussein Medical Center