Aorto-left ventricular tunnel arising from the left coronary sinus of valsalva

Aortico-left ventricular tunnel is a rare congenital cardiac defect that bypasses the aortic valve via a para-valvular connection from the left ventricle to aorta. In most cases, the tunnel arises from the right aortic sinus. In this case report, we present a case of Aortico-left ventricular tunnel, in which the aortic orifice arose from the left aortic sinus, requiring special attention to avoid injuring the left coronary artery at the time of surgical repair.

Initial experience of atrial septal defect closure with occlutech figulla occluder device at queen alia heart institute

To evaluate the effectiveness of the Occlutech Figulla occluder device in the treatment of ostium secundum atrial septal defect. This is a retrospective review which was conducted between June 2008-June 2011 involving 54 cases with ostium secundum atrial septal defect who underwent transcatheter closure using the Occlutech Figulla device at Queen Alia Heart Institute. All procedures were performed under general anaesthesia with continuous Transesophageal Echocardiographic monitoring. Clinical and echocardiographic assessments were performed after 24 hours and then after one, three and six months respectively. The results are presented as means, standard deviations and percentages. From the 54 cases, 33 patients [61%] were females. Their mean age and weight were 16.47 +/- 11.8 year, 38.4 +/- 20.7kg respectively. The mean atrial septal defect diameter by Transesophageal Echocardiogram was 13.2 +/- 4.2mm, and the mean atrial septal defect size of the implanted device was 15.97 +/- 4.5mm, ranging from 10.5 to 27mm. Two cases were sent for surgery due to inadequate postero-inferior rim. The procedure success rate was 96.3%. In five cases [9.6%] there was trivial residual shunt after 24 hours of the procedure which had disappeared at follow-up. The Occlutech Figulla occluder device is a safe and effective for transcatheter closure of secundum atrial septal defect. Longer term follow-up studies to evaluate the safety of the device are needed

Anomalous left coronary artery arising from the pulmonary artery diagnosed with cardiac CT angiography and reconstruction: a case report

Anomalous origin of coronary artery from the pulmonary artery [ALCAPA] is a rare congenital cardiac malformation with a mortality rate of 90% within the first year of life without surgical intervention. We report a 10 month old girl presenting as a case of ALCAPA with the left main coronary artery arising from the left posterior pulmonary sinus. Diagnosis was made using cardiac CT angiography with 3D- reconstruction and the patient underwent successful surgical repair

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

Jervell and Lange-Nielsen syndrome in four Jordanian families

To report the importance of the cardiologic aspect in the evaluation of syncope in children with congenital deafness. A total of 16 deaf-mute siblings in four Jordanian families were studied. Each family had at least one sibling with congenital deafness and syncopal attacks. Audiogram confirmed the profound sensorineural hearing loss in all the siblings. Electrocardiogram was done in all symptomatic siblings and corrected QT interval was calculated. Screening for corrected QT interval prolongation was performed in the asymptomatic siblings and parents. Eight siblings had abnormal prolongation of corrected QT interval and were diagnosed as Jervel-Lange-Nielsen syndrome [congenital sensorineural deafness and abnormal prolongation of corrected QT interval]. The syncope in all symptomatic siblings was controlled with the use of propranolol while the asymptomatic siblings were given propranolol for prophylaxis. Electrocardiogram is an important diagnostic test in congenitally deaf children, especially those with syncopal episodes

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 patent ductus arteriosus using Gianturco coil: Jordanian experience

To assess the immediate and mid-term results of transcatheter closure of patent ductus arteriosus [PDA] less than 4 mm in diameter using single or multiple Gianturco coils. Settings: Queen Alia Heart Institute, a tertiary center for cardiac patients, Amman, Jordan. Patients And From December 1977 to January 2002, 32 patients [21 female, 11 male] underwent a transcatheter closure of a small PDA less than 4 mm in diameter in our institution as an alternative to standard surgical ligation. The patient's mean age was 8.4 years [range 1-27 years]; their mean weight was 26.5 kg [range 8-81 kg]. All patients were asymptomatic. Gianturco stainless steel coils [Cook] with thrombogenic strands attached to them were used for closure. The mean followup period was 2.1 years [range 0.5-4]. The mean narrowest PDAdiameter was 2.8 mm range [1.4-4], the mean pulmonary/systemic flow ratio was 1.57 range [1.22-2.5]. A single coil was used in 24 patients [75%], four patients [12.5%] needed two coils, four patients [12.5%] needed three coils to achieve complete closure of the PDA. The patients who had two or three coils, had larger shunts with PDA's narrowest diameter more than 3.5 mm. There were two incidents of coil migration to the left pulmonary artery, which were retrieved with a gooseneck snare. There was immediate and complete closure in 28 patients out of 32 [87.5%] as confirmed by post-closure descending aortogram. Four patients had residual shunt, which disappeared after 24 hours. All patients were discharged home one day after the procedure. Coil occlusion of PDA less than 4 mm was safe and effective. Immediate success rate was high. Residual shunts were commonly observed immediately following coil occlusion, but spontaneous closure occurs in all patients. The risk of coil embolization was less in PDA less than 4 mm in diameter. No complications have been encountered during the first four years of follow up

Transcatheter closure of residual ductus arteriosus with gianturco coils after implantation of rashkind occluder device

Nonsurgical closure of patent ductus arteriosus [PDA] can be performed using different devices. This study was undertaken to evaluate the use of Gianturco coil to close a leaking Rashkind PDA device. Queen Alia Heart Institute [QAHI], a tertiary cardiac center, Jordan. Out of 53 cases of Rashkind PDA closure performed at QAHI, four patients had a residual leak, which was closed with Gianturco coils. Their ages ranged from 1.8-17 years. The leak was diagnosed by 2D- colour Doppler echocardiography. All patients underwent an attempt to reclose the PDA leak using Gianturco coils of different sizes. Follow ups 3 months later showed an absence of any residual leak across the ductus arteriosus. The use of Gianturco coils for closing residual Rashkind PDA leaks can be performed successfully and safely, with a lower potential for left pulmonary artery stenosis and aortic isthmic narrowing, and it is cost effective