ABSTRACT
@#Congenital heart disease (CHD) is one of the most common birth defects, with an incidence of nine out of every 1,000 live births. Critical CHD (CCHD) is defined as cardiac lesions that require surgery or cardiac catheterization within the first month (or within the first year by different definitions) of life to prevent death or severe end-organ damage. An early diagnosis and timely intervention can significantly reduce the likelihood of an adverse outcome. However, studies from the United States and other developed countries have shown that as many as 30%–50% of infants with CCHD are discharged after birth without being identified. Pulse oximetry is a tool to measure oxygen saturation, and based on the presence of hypoxemia, many cardiac lesions are detected. Due to its ease of application to the patient, providing results in a timely manner and without the need for calibrating the sensor probe, pulse oximetry offers many advantages as a screening tool. Pulse oximetry was recommended as a screening tool to detect critical CHD in 2011 by the American Academy of Pediatrics and the American Heart Association. Pulse oxymetry screening (POS) for early detection of CCHD is a simple, noninvasive, and inexpensive test, which meets the necessary criteria for inclusion to universal newborn screening panel. Wider acceptance and adoption can significantly decrease morbidity and mortality in infants with CCHD.
ABSTRACT
Background@#Congenital heart disease (CHD) is the most common congenital disorders in the newborn and about 25% of them are complex heart diseases which needs early intervention or open heart surgery in neonate period. The incidence of CHD is varies from 8-10 in 1000 live births and half of them are major heart diseases. Abnormal ductusvenosus blood flow at 110-136 weeks has also been described in association with fetal aneuploidy, cardiac defects and adverse perinatal outcome. In the last few years the clinicians are using the nuchal translucency, ductus-venosus regurgitation in fetus as a biomarker of congenital heart disease.@*Objective@#To assess the method of combining fetal nuchal translucency and ductusvenosus blood flow measurements in the detection of major cardiac defects in the first-trimester scan.@*Methods@#Prospective cohort study data was derived from first-trimester screening of pregnant women at National Center for Maternal and Child Health between March 2014 and May 2017. </br> A total of 318 patients at 110 to 136 weeks of gestation enrolled in the study. An ultrasonography scan was performed trans abdominally (using 3 to 7.5 MHz curvilinear transducers),first, to determine gestational age from the measurement of the fetal crown-rump length; second, to measure fetal nuchal translucency thickness; and third, to assess blood flow across in the ductus-venosus.@*Results@#During the study period, we carried out an ultrasonographic examination at 110-136 weeks in 318 singleton pregnancies with a live fetus and crown-rump length of 45-84 mm. The median age of women was 34 (range, 19-46 years). In our study 9(2,8%) of all singleton pregnancies were diagnosed with major heart defects and increased NT, ductus-venosus regurgitation was shown to be strongly associated with the CHD. The sensitivity of nuchal translucency to CHD was 83% (p-0.0001), dustus-venosus regurgitation was 75% (p-0.007), ductus-venosus PI was 80% (p-0.001). @*Conclusions@#First trimester biomarkers for fetal CHD screening can detect major heart defects. Increased NT, abnormal DV flow can be important indicators for echocardiography, which is favorablefor early prenatal diagnosis of CHD.
ABSTRACT
Congenital heart disease is the most common group of congenital disorder with a reported prevalence that rates from 8/1000 live births. Also, CHD accounts for nearly one-third of all major congenital anomalies. In recent years, the country’s congenital heart disorders diagnosis has improved significantly, but has been of late diagnosis of cases.Once the diagnosis of congenital heart disorders later case, the resultant complications occurred because the majority is unable to similarly cardiac surgical treatment. Therefore, early diagnosis of congenital heart defects, and thus treatment is necessary to solve the problem early.A retrospective, descriptive study was conducted from January 1st8 2012 and January 1st8 2013 there were 263 deliveries at the Urgoo maternal hospital and child health research center of Mongolia. We reviewed the medical records of all neonatal in 2012-2013 who were born in the Urgoo maternity hospital of Ulaanbaatar and NICU and NCU of National Center of Maternal and Child Health. A total of 263 infants with congenital heart disease.The number of neonatal intensive care unit and neonatal unit with Congenital heart defect was 99 (37.7%) in 2012 were as there 164 (62.3%) in 2013 increasing 1.4 times respectively. A total of 263 infants met the inclusion criteria, of whom 130 (55.1%) were males. The reasons for the higher incidence of congenital heart defect observed in infants remain unclear.The most frequently occurring conditions were patent ductus arteriosus /21.7%/, arterial septal defect with patent foramen ovale /41.2%/, other majority defect-31.9%, Dextracaria-5,2%. This raises question regarding the clinical significance of some of lesions, such as small VSDs, which are widely considered to be congenital heart defects. When all clinical presentations of heart disease were analyzed together, atrial septal defect (ASD), Ventricular septal defect (VSD), and Patent ductus arteriosus (PDA) accounted for 62.9% of all defects identified. From diagnosed CHD with percent less than was critical congenital heart defect, which required urgent surgical treatment in neonate period.CHD is expected to increase in the coming years. Thus, when the fetus is affected by a malignant diagnosis.According to the survey findings to diagnose congenital heart defects in the first weeks of the prognosis and treatment options, and shows that it is important to prevent complications. Obstetric and regional diagnostic centers in rural pediatric cardiologist and ultrasound machines shows that it is important for diagnosis and treatment.
ABSTRACT
The Jones criteria is a clinical guideline for the diagnosis of rheumatic fever(RF) and carditis. The clinical features were divided into major and minor categories. Major manifestations include carditis, joint symptoms, subcutaneous nodules, erythema marginatum and chorea. The minor manifestations comprised clinical fi ndings(fever, artralgia, cardialgia,abdominal pain, nose bleeding ) and laboratory markers(Leukocytosis, elevated erythrocyte sedimentation rate and C-reactive protein, prolonged PR on ECG). It was proposed that the presence of two major, or one major and two minor manifestations offered reasonable clinical evidence of rheumatic activity.Carditis is the single most important prognostic factor in RF; only valvulitis leads to permanent damage and its presence determines the prophylactic strategy. The clinical diagnosis of carditis in an index attack of RF is based on the presence of signifi cant murmurs (suggestive of mitral and aortic regurgitation), pericardial rub, or unexplained cardiomegaly with congestive heart failure.Myocarditis(alone) in the absence of valvulitis is unlikely to be of rheumatic origin and by itself should not be used as a basis for such a diagnosis. Two dimentional echo-Doppler and colour fl ow Doppler echocardiography are most sensitive for detecting structural abnormality, abnormal blood fl ow and valvular regurgitation. This method can detect all audible valvular regurgitations to be dThe use of 2D echo-Doppler and colour fl ow Doppler echocardiography may prevent the overdaignosis of a functional murmur as a valvular heart disease. Similarly, the overinterpretation of physiological or trivial valvular regurgitation may result in misdiagnosis of iatrogenic valvular disease. Accurate interpretation of the echocardiographic signals is therefore important.