Neurologic complications of cyanotic congenital heart disease

Children with cyanotic congenital heart disease are at risk for neurologic complications including cerebrovascular accidents, and cerebral abscesses. During a period from 1989 to 1999, eight children with cyanotic heart disease who suffered from a neurologic complication were admitted at our pediatrics ward. They were 6 girls and 2 boys. The age on hospitalization ranged from 6 months to 15 years. Five patients had tetralogy of Fallot and 3 had transposition of great arteries. There were three cases of brain abscesses. Five patients had cerebrovascular accidents, in two of them; the sequelae were secondary to cardiac catheterization. Prolonged uncorrected chronic hypoxemia, and polycythemmia in addition to increased blood viscosity were the most common risk factors in the patients

Cardiomopathy in childhood: a 10 - year retrospective study

The clinical profile and course of 44 children [mean age 5.5 years, range from 3 months to 13 years] with cardiomyopathy during a period of 10 years [1987 to 1997] were evaluated. The frequency of different types of cardiomyopathies were as follows; idiopathic dilated 42 [95.5%] and hypertrophic 2[4.5%]. There was no case of restrictive cardiomyopathy. All cases presented with congestive heart failure. Cardiogenic shock and pulmonary edema were the two other frequent signs. In patients with dilated cardiomyopathy absence of heart murmur on physical examination [71.4%], low voltage QRS complex in electrocardiography [33.3%], decreased ejection fraction and shortening fraction in echocardiography [100%] were frequent findings. Ten patients with dilated cardiomyopathy and 2 with hypertrophic type died. The overall mortality rate was 27%. This study confirms that the outcome of children with cardiomyopathy still remains poor

Infective endocarditis in children

A total of 14 cases of infective endocarditis [IE] in children aged 6 months to 10 years were seen from December 1987 to December 1992 at the pediatric unit of Ayatollah Taleghani Medical Center. The majority of patients [12 of 14] were between 5 and 10 years of age. Acyanotic congenital heart disease was known to preexist in 78.6% and rheumatic valvular heart disease in 21.4% of cases. Organisms were identified by blood culture in 50%, the majority being Streptococcus viridans [36% of cases]. Vegetations were detected by echocardiography in 64%. The overall death rate was 21.4%. Two patients with aortic stenosis developed IE after cardiac surgery for repair of stenotic valves and both of them died. One patient with rheumatic aortic and mitral valve insufficiency underwent valve replacement due to intractable heart failure. In conclusion, the frequent presence of underlying heart disease, the rarity of IE in infancy, and the ominous prognosis of postoperative endocarditis and aortic valve involvement are emphasized

Rheumatic fever in Iranian children: clinical and preventive aspects

A total of 70 children aged 6 to 15 years with rheumatic fever and completed in-hospital data were reviewed from 1988 to 1993. In 58.6% of patients this was the first attack of disease, while in 41.4% the episode represented a recurrence. Noncompliance of antimicrobial prophylaxis was noted in all of the subjects with recurrences. 61.4% of cases gave a previous history of sore throat, and inappropriate or inadequate antibiotics had been prescribed for all of them. Carditis had occurred. In 76% of patients and 51% of them had developed heart failure. Congestive heart failure was three times more prevalent in recurrences than in initial attacks. The study showed an urgent requirement for a national training program for all health personnel [including doctors], along with the education of healthy children, patients, and their families in order to establish effective primary and secondary prophylaxis in this area

Congestive heart failure in children: a survey of 114 patients

During a period of four years between June, 15, 1988 to one, 15, 1992 one hundred and fourteen patients with congestive heart failure [CHF] were admitted to the pediatric department of Taleghani General Hospital. During the above period, 192 patients with heart disease were hospitalized at this department and CHF was the cause of admission in 59.4% of them. Congenital heart disease [CHD] was the most common cause [65 cases, 57%] of heart failure in this group, followed by rheumatic heart disease [RHD] [26 cases, 23%] and cardiomyopathy [CM] [23 cases, 20%]. Sixty-five patients [57%] were male and forty-nine [43%] were female [M/F = I.3/ 1]. The youngest patient was 2 days old while the oldest one had 13 years. The mean age of the patients was 4.5 years. Forty-nine [43%] were under one year of age and the majority [44/49, 90%] suffered from CHD. All the children with RHD were between 6 to 13 years of age. 14 patients [12%] died. CHD was the most common cause of death. The variations in the pattern of heart failure according to different age groups in this study are compatible with those in other developing countries