Mid-term follow-up of the transcatheter closure of Perimembranous Ventricular Septal defects in children using the amplatzer

Background: The ventricular septal defect [VSD] is the most common form of congenital heart defects. The purpose of this study was to evaluate the results of the early complications and mid-term follow-up of the transcatheter closure of the VSD using the Amplatzer VSD Occluder

Methods: Between April 2012 and October 2013, 110 patients underwent the percutaneous closure of the perimembranous VSD. During the procedure, the size and type of the VSD were obtained via ventriculography. A device at least 2 mm larger than the VSD diameter measured via ventriculography was deployed. The size of the VSD, size of the Amplatzer, and devicesize to VSD-size ratio were calculated. After the confirmation of the suitable position of the device via echocardiography and left ventriculography, the device was released. Follow-up evaluations were done at discharge as well as at 1, 6, and 12 months and yearly thereafter for the VSD occlusion and complete heart block

Results: The study population comprised 62 females and 48 males. The mean age and weight of the patients at procedure were 4.3 +/- 5.6 years [range: 2 to 14] and 14.9 +/- 10.8 kg [range: 10 to 43]. The average device size was 7.0 +/- 2.5 mm [range: 4 to 14]. The VSD occlusion rate was 72.8% at the completion of the procedure and rose up to 99.0% during the follow-up. The most serious significant complication was complete atrioventricular block, which was seen in 2 patients. The mean follow-up duration was 10.9 +/- 3.6 months

Conclusion: The transcatheter closure of the perimembranous VSD was a safe and effective treatment with excellent closure rates in our study population. This procedure had neither mortality nor serious complications

Lipid and glucose serum levels in children with congenital heart disease

Coronary artery disease is one of the most common causes of morbidity and mortality in developed countries. Atherosclerosis begins in early childhood and progresses through life. With advances in pediatric cardiology, the prevalence of congenital heart disease in adults has increased in relation to children. A great deal of research has been conducted on serum glucose and lipid concentrations in patients with congenital heart disease, but comparison has yet to be made between congenital patients and the general population, especially in pediatric groups. The aim of this study was to compare the serum concentrations of glucose and lipids between pediatric congenital heart disease patients and a healthy age and sex-matched control group. We measured and compared the total cholesterol, low-density lipoprotein [LDL] cholesterol, high-density lipoprotein [HDL] cholesterol, triglyceride [TG], and plasma glucose concentrations of 100 pediatric congenital heart disease patients [cases] and 100 individuals matched for age and sex [controls] during a period of 7 months between November 2011 and June 2012. Total cholesterol, triglyceride, HDL cholesterol, and LDL cholesterol concentrations were significantly higher in the patients than in the control group [p value < 0.05]. Blood sugar levels in both groups had no significant difference [p value = 0.25]. In the case group, the cholesterol level was higher in the males than in the females [p value = 0.30]; moreover, the TG and HDL cholesterol levels were lower in the males than in the females and the LDL cholesterol and blood sugar levels had no statistically significant difference. In the control group, there was no difference between the males and females in terms of the cholesterol, HDL cholesterol, LDL cholesterol, TG, and blood sugar levels. The results of this study showed that our pediatric congenital heart disease patients had significantly higher levels of serum lipids than did their age and sex-matched controls. In light of these results, we recommend that the lipid profile be screened in children with congenital heart disease so as to reduce the risk of atherosclerosis

Pulmonary regurgitation after balloon valvuloplasty in children with pulmonary stenosis

Pulmonary valve stenosis [PS] is one of the most common congenital heart disease in children. Isolated pulmonary stenosis is the most common form of pulmonary stenosis. Isolated Pulmonary stenosis is responsible for 8 to 10 percent of congenital heart disease. Balloon valvuloplasty is the choice of treatment for this cardiac disease. One of the most important complications of this disease is pulmonary regurgitation in follow-up. The purpose of this study was to characterize the status of pulmonary regurgitation on follow-up after pulmonary valvuloplasty by balloon. We studied pulmonary regurgitation after balloon valvuloplasty retrospectively in children less than 14 years old age and isolated pulmonary stenosis. These patients had not complex congenital heart disease and admitted for balloon valvuloplasty during period of September 2001 to September 2011 in Shahid Rajaee Cardiovascular Research Center. The mean time of follow-up was 7+/-2.5 years. Four hundred and fifty-eight patients with mean age of 10.3+/-8.6 months were studied. Two hundred and fifty-five patients were male and 230 were female. Right ventricular pressure was decreased from 82.3+/-42.2 mmHg before procedure to 45.2+/-22.4 mmHg after procedure [P= 0.043]. Pressure gradient between right ventricle and pulmonary artery was decreased from 75.4+/-18.2 mmHg to 25.7+/-15.13 mmHg during procedure [P= 0.032]. The day after procedure, 180 [37.1%] patients had no pulmonary regurgitation echocardiographic evaluation, 175 [36.08%] had mild, and 118 [24.3%] had moderate pulmonary regurgitation. In patients with moderate pulmonary regurgitation, 7 [0.14%] of those improve to severe pulmonary regurgitation. In echocardiographic exam, 12 [2.4%] patients had severe regurgitation the day after balloon valvuloplasty. During long-term follow-up [7+/-2.5 years] for 3 patient pulmonary valve replacement were performed. In our study, balloon to annulus ratio in three groups of pulmonary regurgitation [mild, moderate and sever] had significant correlation [P=0.012]. Pulmonary regurgitation was seen after balloon valvuloplasty in some patients.In most patients it had no symptoms and long-term follow-up is necessary

Prepregnancy maternal weight and body mass index of children with and without congenital heart disease

Congenital heart diseases are among the most frequent major congenital anomalies. One of the suspected reasons for congenital heart defects is overweight and obesity of mother during prepregnancy and pregnancy. We studied the relationship between maternal overweight and obesity and the risk of congenital anomaly. All of children with congenital heart defect [164 infants with major nonsyndromic heart disease] referred to our pediatric cardiology clinic or admitted to our ward during 2011-2012 were included in this study. Controls were 158 live-born infants without any major malformations and their mothers. Mothers of these infants were studied for weight, height and body mass index [BMI]. The most frequent congenital heart disease was ventricular septal defect [39%], patent ductus arteriosus [11%], complete atrioventricular septal defect [10%], pulmonary stenosis [9.1%], and atrial septal defect [8.5%]. There was no significant difference between maternal age [P=0.1], weight [P=0.8] and height [P=0.3] in the two groups. The mothers had not significantly higher BMI than that of the control mothers. Compared with underweight [BMI <18.5] and normal weight women [OR: 1.24, 95%CI: 0.40-3.89], overweight [OR: 0.98, 95%CI: 0.31-3.10] and obese women [OR: 1.16, 95%CI: 0.34-4.00] were not more likely to have an infant with a congenital heart defect. This study suggests that there may not be a relation between maternal BMI and having a child with congenital heart defect

When can we release the Amplatzer Ductal Occluder [ADO] safely?

The ductus arteriosus connects the main pulmonary trunk to the descending aorta. The incidence of isolated patent ductus arteriosus [PDA] in full-term infants is about 1 in 2000. The Amplatzer Ductal Occluder [ADO] is recommended for PDAs with sizes larger than 2 mm. In this procedure, we must confirm the ADO position in PDA by aortogram from the arterial line. The purpose of this study was to determine the optimal release time of the ADO in the PDA closure procedure, especially in the absence of an arterial line for post-PDA aortography. This study recruited all patients scheduled to undergo PDA transcatheter closure with the ADO between September 2009 and September 2012 in our center. Age, weight, PDA diameter, systolic and diastolic pulmonic pressures, fluoroscopy time, and total angiographic time were studied. Major complications such as mortality and vascular complications were considered. We studied 237 patients in our investigation. We had 130 female and 107 male patients at a mean age of 34.3 +/- 40.6 months and mean weight of 14.2 +/- 7.8 kg. PDA sizes ranged from 2.1 to 6.2 mm and its mean was 3.7 +/- 1.8 mm. Mean of fluoroscopy time was 11.4 +/- 9.7 min and mean of total angiographic time was 42.0 +/- 12.3 min. There were no significant complications. We herein describe a new sign, which proved extremely helpful during our PDA closure procedures with the ADO. By considering the angle between the ADO and the cable during the procedure, the operator can release the ADO safely

Tissue doppler echocardiographic findings of left ventricle in children with sickle-cell anemia

Sickle-cell disease [SCD] is an inherited hemoglobin childhood disorder, frequently complicated by pulmonary hypertension and cardiac involvement. Cardiovascular events and complications are the leading cause of mortality and morbidity in patients with SCD. Tissue Doppler imaging and the myocardial performance index [Tei index], are simple indices for the assessment of the cardiac function. The purpose of this study was to assess the left ventricular function in children with SCD. Sixty-four patients with SCD [mean age = 11.7 +/- 5.5 years] were compared with 50 age matched healthy controls [mean age = 11.2 +/- 5.20 years]. Myocardial wall motion velocities at the lateral mitral annulus and the junction between the medial mitral annulus and the interventricular septum were assessed during systole [Sa], early diastole [Ea], and late diastole [Aa] through a four-chamber view using pulsed Doppler echocardiography. The ejection fraction and shortening fraction were estimated. The Tei index was estimated via tissue Doppler echocardiography. The results showed that Ea and Aa velocity in the mitral annulus and interventricular septum had no difference between the patients and controls [p value > 0.05], and nor was there any difference between the two groups as regards the Tei index, Ea/Aa, ejection fraction, and shortening fraction [p value > 0.05]. Sam wave velocity, however, had a significant difference between the two groups [p value < 0.038]. The Tei index is a sensitive indicator for the cardiac function in chronic diseases and the right ventricular function in some disorders such as SCD

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 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

Correlation of post-operative hypoalbuminemia with outcome of pediatric cardiac surgery

Hypoalbuminemia may be caused by liver disease, nephrotic syndrome, burns, protein-losing entropathy, malnutrition, and metabolic stress. Alterations in albumin in metabolic stress such as cardiac surgery have been previously investigated. We studied serum albumin concentration in children with congenital heart disease and also the association of hypoalbuminemia with mortality and morbidity after pediatric cardiac surgery. We measured serum albumin concentration prospectively in 300 children with congenital heart disease who underwent surgery between July and September 2008 in Shaheed Rajaee hospital. Serum albumin concentration was measured before and 48 hours after cardiac surgery and was subsequently compared between 2 groups: cyanotic and acyanotic and also with normal values. Serum albumin concentration decreased on the second post-operative day in 70 [23.3%] patients. There was a positive correlation between the post-surgical hypoalbuminemia and cyanotic heart disease. The cyanotic children had lower serum albumin concentration Thant the acyanotic ones [P value < 0.001]. There was a significant association between post-operative serum albumin concentration and acute renal failure [P value < 0.001] and death [P value < 0.001]. Drop in serum albumin concentration was more prominent in the males than in the females [P value= 0.038] and in the cyanotic patients than in the acyanotic ones [P value < 0.001] as well as in those with acute renal failure [P value < 0.001], pericardial effusion [P value= 0.050], seizure [P value < 0.001], and death [P value < 0.001]. Hypoalbuminemia was not associated with longer hospital [P value = 0.142] or intensive care unit stay [P value = 0.199]. Post-operative serum albumin concentration was lower in the cyanotic children and male patients in our study. In addition, the post-operative decrease in albumin was associated with an increased risk of pericardial effusion, renal failure, seizure, and death.