[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.

Prognostic value of serum B-Type natriuretic peptide in early mortality and morbidity of children with congenital heart disease after open heart surgery

Brain type natriuretic peptide [BNP] is a cardiac hormone that is secreted mainly by the ventricles in response to volume expansion and pressure load. It can predict post-operative complications after heart surgery in adults. We sought to investigate the prognostic value of BNP in children after heart surgery. We measured the BNP serum levels in 96 children with congenital heart diseases before, immediately after, and 12 hours after open heart surgery. We studied the ability of the post-operative BNP serum level variations to predict mortality and morbidity in children. In total, 96 patients, comprising 40 [41.7%] females and 56 [58.3%] males with a mean age of 4.1 years [range: 1 month to 17 years], with various congenital heart diseases were studied. The rise in the serum BNP level 12 hours post surgery was directly related to mortality before discharge from hospital [P value=0.004], congestive heart failure after surgery [P value<0.001], patients' cyanosis [P value=0.045], duration of ICU stay [r=0.342, P value=0.004], and post-operative need for inotropic drugs [P value<0.001]. The rise in the BNP serum level 12 hours after heart surgery is a good marker for predicting mortality, morbidity, and early diagnosis of heart failure in children

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.