Radiofrequency ablation of accessory pathways in children with complex congenital cardiac lesions: a report of three cases

Catheter ablation is an accepted, highly effective modality of treatment for cardiac arrhythmias in children. The success rate depends on the operator's experience, especially in cases involving complex anatomies. We hereby report our recent experience of successful ablation of accessory pathways in three children with complex congenital heart diseases. The first case was a 7-year-old girl with tricuspid atresia and a previous Glenn shunt, in whom a sub-epicardial overt accessory pathway was successfully ablated via the coronary sinus. The second case, a 9-year-old girl, received accessory pathway ablation via the fenestration of an extracardiac Fontan pathway. The third case was a 14-year-old boy with dextrocardia, common atrium, common ventricle, and a previous extracardiac Fontan operation, in whom ablation of a concealed accessory pathway was carried out retrogradely from the aorta. All the ablations were done in Rajaie Cardiovascular, Medical and Research Center, Tehran, and all the patients were discharged from the hospital without any complication

Pericardial effusion after pediatric cardiac surgeries: a single center observation

Development of fibrinous pericarditis after pericardiotomy is a well-recognized reaction. Within a few post-operative days, the inflammated surface of pericardium begins to fuse to the overlying sternum. Our aim was to assess the prevalence, risk factors, time course and therapy response of pericardial effusion [PE] after cardiac surgeries in children. PE occurrence was assessed prospectively in 486 children who underwent cardiac surgery for congenital heart diseases by serial echocardiography. Clinical manifestations were observed and response to different therapies was analyzed. The prevalence of PE was about 10% for all cardiac surgeries. Symptoms were exclusively seen in patients who had moderate to large effusions. The mean onset of pericardial effusion was 11 [ +/- 8] days after surgery procedure, with 87% [42 of 48] of cases being diagnosed on or before day 13 after operation. The prevalence of effusion after Fontan-type procedures and AVSD repair [29%, 5 of 17 for both] was significantly higher than other types of cardiac surgeries. Aspirin administration was effective in 77% and prednisone in 90% of the cases. PE may be developed as late as weeks after cardiac surgeries. PE after palliative cardiac surgeries is not uncommon. Low doses of aspirin and corticosteroids are usually effective for treating this complication

Interventional electrophysiology in children: a single-center experience

Ablation techniques in children arrhythmia have significantly progressed in the past decade; however, the number of pediatric ablations is still significantly lower than that in adults. Accordingly, there is less information regarding the success rate and complications in this age group. All pediatric ablations conducted Between March 2005 and February 2011 at Rajaie Heart center were studied. Abolishing the arrhythmia source by the end of procedure was considered as success. Recurrences before hospital discharge and those thereafter were named early recurrence and late recurrence, respectively. A total of 125 catheter ablations were performed for 112 patients. Of them 118 [94.4%] procedures were successful. The success rate was significantly higher in the patients with atrioventricular nodal reentry tachycardia [AVNRT]. Of 105 patients who continued followed up program, 7 [6.7%] cases experienced recurrence; the recurrence rate was inversely dependent on the patients' body size [p value<0.05]. There was no mortality. Five cases were complicated during or early after the procedures, all the complications were cured completely. Therapeutic electrophysiology in children is as an effective and relatively low-risk method. The recurrence and complication rates are similar to those reported in adults. Considering our results and the previous reports, pediatric patients with serious arrhythmia should not be deprived from ablation and should not be exposed to long-term toxic drugs

Growth status of Iranian children with hemodynamically important congenital heart disease

The relationship between congenital heart disease [CHD] and growth retardation is well documented. We investigated the growth condition of Iranian children with several types of congenital heart disease [CHD] and compared it with worldwide researches. Growth condition was investigated in 469 patients with important CHD aged from 1 month to 18 years. The patients were divided into two groups; infants [aged 12 months or less], and children [1-18 yrs of age]. Children with hemodynamically unimportant small VSDs or small ASDs were not studied. Other exclusion criteria were prematurity, known genetic disorders and neurologic disease affecting growth. All patients' cardiac diagnoses were made on the basis of clinical and laboratory examinations; including electrocardiography, echocardiography, cardiac catheterization, and angiography. Body weight and height of all patients were measured using conventional methods and compared with standard growth charts. In all patients body weights and heights were significantly lower than normal population. This difference was greater in the weight of female children. Other risk factors for growth failure were large left-to-right intracardiac shunts, pulmonary hypertension and cyanosis. Iranian children with CHD have growth failure somewhat different from other countries. Lower body weights of cyanotic patients and female children indicated that these patients need more nutritional and psychosocial attention

Congenital left ventricular diverticulum associated with ASD, VSD, and epigastric hernia

Congenital left ventricular diverticulum is a rare cardiac malformation. Two categories of congenital ventricular diverticulum have been identified with regard to their localization: apical and non-apical. Apical diverticula are always associated with midline thoraco-abdominal defects and other heart malformations. Non-apical diverticula are always isolated defects. Diagnosis is established by imaging studies such as echocardiography, magnetic resonance imaging, or left ventricular angiography. Mode of treatment has to be individually tailored and depends on clinical presentation, accompanying abnormalities, and possible complications. We report a 10-month-old girl with left ventricular apical diverticulum, large atrial septal defect, two small muscular ventricular septal defects, and pulmonary hypertension, associated with epigastric hernia. This patient underwent total surgical repair for intra-cardiac defects as well as diverticular resection

Efficacy of adenosine for acute treatment of supraventricular tachycardia in infants and children

This study was done to assess the efficacy and adverse effects of the different doses of adenosine in the pediatric age group with respect to multiple patient variables. Over a period of 1 year, 86 occasions of supraventricular tachycardia [SVT] were treated with adenosine in 81 infants and children aged between 18 days and 12 years [median of 1.3 years, SD=3]. Adenosine efficacy was evaluated in terms of the patients' demographics, SVT rate, electrocardiogram characteristics, and route of drug administration. The dose of 50microg/kg was effective only in 24% of the SVT cases, and the additional doses of 100microg/kg, 150microg/kg, and 200microg/kg were effective in another 29% of the cases. The drug efficacy was higher in the infants than that in the older children. There were no predictors other than age for the estimation of the efficacy of the drug. Our findings showed that the current recommended doses of adenosine are ineffective in the vast majority of children and infants with SVT. No patient-related factor other than age seems to affect the efficacy of the drug