Percutaneous closure of patent ductus arteriosus under echocardiographic guidance

Percutaneous closure of patent ductus arteriosus [PDA] is done in the cardiac catheterization laboratory, usually under fluoroscopic and angiographic guidance. The aortogram is used for assessing PDA size and shape the pre-device implantation. Additionally, post-device aortograms are applied for the assessment of device position, profile and residual shunt. Angiograms expose patient to radiation and possible untoward effects of contrast media. Recently, transthoracic echocardiography has been utilized to guide in PDA closure to avoid radiation exposure as well as contrast material. On two occasions, we were obligated by special circumstances to close the PDA under echocardiography guidance. First case was a 6-month baby girl with mild signs of heart failure having moderate size PDA. She underwent device closure under transthoracic echocardiogram as the angiographic system had stopped working during the procedure. Second case was a 6-year girl, weighting 16-kg with chronic renal failure. She had moderate size PDA closed by device under transthoracic echocardiographic, guidance avoiding the use of contrast agent due to chronic renal failure

Pulmonary atresia with hypoplastic right ventricle and large subaortic ventricular septal defect

A neonate is presented with a very rare association consisting of pulmonary atresia with large ventricular septal defect but additionally, combined with a hypoplastic right ventricle and well developed pulmonary arteries. The management strategy is described

Doppler echocardiographic signs to differentiate between chronic lung disease and right ventricular dysfunction in a child with calcified pericardium

A 7 year-old girl was admitted with history of low-grade fever, weight loss and occasional cough for the last 6 months. Tuberculosis was suspected, for which antituberculous treatment was initiated. Chest X-ray demonstrated calcification of the pericardium with chest miliary shadowing. CT chest was done showing very fine sharply defined miliary nodularity throughout both lungs without mediastinal lymphadenopathy. The patient was referred to paediatric cardiology service to rule out constrictive pericarditis. Clinical cardiac examination as well as the electrocardiogram was normal. Echocardiography and Doppler were done showing normal cardiac anatomy and function apart from the detected pericardial calcification. Doppler tracing in the hepatic vein as well as in the superior vena cava could clearly exclude any negative effect on diastolic cardiac function, which could occur in the setup of pericardial calcification. Doppler, instead helped to identify the chronic pulmonary disease by showing increased inflow velocity throughout inspiration