Transcatheter coil occlusion of patent ductus arteriosus.

Between May 1995 and October 1997, 17 cases of small patent ductus arteriosus (PDA) underwent percutaneous coil occlusion at the Department of Pediatrics, Chulalongkorn Hospital. The mean age was 5.3 +/- 3.6 years (range, 1 year 4 months to 12.0 years); mean weight was 18.9 +/- 11.7 kg (range, 9 to 48 kg). The mean minimum diameter of the PDA was 2.8 +/- 0.6 mm (range, 1.7 to 4.0 mm). PDA occlusion was achieved with one coil in 9 patients and two coils in 8 patients. One patient required the second coil occlusion procedure to occlude the residual PDA leakage. Of the 17 patients, coils were successfully implanted in 15 patients: complete closure of PDA was obtained in 14 patients, confirmed by aortography or by color flow echo imaging or both. In the two unsuccessful coil implantation cases, coils migrated to the distal left pulmonary artery (1 case) and the distal right pulmonary artery (1 case). They could not be retrieved. Both patients had surgical closure of PDA on the following day after the failed procedure. No clinical and chest X-ray showed any evidence of pulmonary complication from the migrated coils up to 1-year follow-up. PDA coil occlusion provides an alternative to surgical closure. The procedure is safe and has a good result.

Ventricular functions in children with human immunodeficiency virus infection after ACE-inhibitors.

Nine pediatric symptomatic patients infected with human immunodeficiency virus with elevated pulmonary arterial pressure (MPA pressure) and ejection fraction (EF); and with fractional shortening, (FS) mean velocity of circumferential fiber shortening (MVCfc) and left ventricular peak systolic wall stress (PS) were prospectively evaluated using 2-dimensional and M-mode serial echocardiography and Doppler cardiography after administration of an ACE inhibitor (Inhibace 0.025 mg/kg/D orally) for 12 weeks. The MPA pressure was not decreased, however the MVCfc and PS improved significantly (p < 0.05). Further, long term evaluation is required to determine its effect in preventing dilated cardiomyopathy and elevated mean pulmonary pressure.

Cardiovascular manifestations and left ventricular functions in human immunodeficiency virus infection in infants and children in Thailand.

During January through December 1993, twelve symptomatic infants and children (6 females, 6 males) with human immunodeficiency virus infection were prospectively evaluated for their cardiovascular clinical manifestations and ventricular functions, using two-dimensional, M-mode and Doppler echocardiographic examination. From auscultation, the pulmonic component of the second heart sound was accentuated in 8 cases and the murmur of atrioventricula valve regurgitation and pericardial friction rub were audible in 7 and 6 patients, respectively. Cardiomegaly and venous congestion were present on chest roentgenogram in 6 cases and electrocardiogram was abnormal in 5. The echocardiogram demonstrated elevated pulmonary arterial pressure in 9 patients. There were 5 cases of non-tamponade pericardial effusion. Five patients had mitral and pulmonary insufficiency while six had tricuspid insufficiency. The ejection fraction and shortening fraction were increased in all. The incidence of pulmonary hypertension was more frequent than previously reported.

Cardiac dysfunction in beta-thalassemic children.

The biventricular systolic function was evaluated by M mode and Doppler echocardiography in 16 patients with homozygous beta-thalassemia and beta-thalassemia Hb E disease, aged 5-14 yrs (9.9 +/- 2.4 yr). The left ventricular end-diastolic dimension and left ventricular mass were increased in 88 per cent of the patients. Left ventricular fractional shortening and cardiac index were normal in all but one patient. Fifteen patients had evidence of pulmonary artery hypertension manifested by abnormality in the ratio of right ventricular acceleration time to ejection time (AT/ET). There was good correlation between platelets count and AT/ET (r = -0.70, P = 0.002). Thrombocytosis was noted in 4 patients. Our findings indicated that in beta-thalassemic children, right ventricular dysfunction was detected earlier than left ventricular dysfunction and platelets may play a role in the pathogenesis of pulmonary artery hypertension.

Doppler echocardiographic predictions of pulmonary artery pressure in children with congenital heart disease.

Continuous wave Doppler echocardiography was used to examine the accuracy of predictions of pulmonary artery pressure by means of main pulmonary artery flow velocity in children with congenital heart disease, without pulmonary stenosis. The ratio of acceleration time to ejection time (AT/ET) was correlated to catheterized mean pulmonary artery pressure. The result was: mean pulmonary pressure equal to 120-2.4 (AT/ET x 100), r = 0.92, SEE = 7.9 mmHg, P value less than 10(-6). We then used this equation prospectively to predict mean pulmonary artery pressure in 20 children. The result was: catheterized mean pulmonary artery pressure equal to 0.9 predicted pressure minus 0.3, r = 0.94, SEE = 4.8 mmHg, 95 per cent confidence limit interval of X coefficient was 0.8 to 1.2. This result suggested that continuous wave Doppler predictions of pulmonary artery pressure correlate significantly with values subsequently obtained at catheterization.

Limitation of 2 dimensional color Doppler echocardiography in the diagnosis of congenital heart disease.

To assess the limitations of 2 Dimensional Color Doppler Echocardiography in the evaluation of cardiac anatomy in children with congenital heart disease. 2DCDE were performed in 140 infants and children before cardiac catheterization and/or operation or autopsy. The segmental echocardiographic analysis included determination of intracardiac, great artery, systemic venous and pulmonary venous anatomy. Among 140 patients there were 270 separate cardiovascular abnormalities of which 215 (80%) were identified by 2D echo. There were 55 (20%) false negative diagnosis by 2DE. Small VSD, unusual location of PDA, stenosis of pulmonary arterial and venous system, intra pulmonary arterio-venous fistula and pseudotruncus were the lesions most likely to be misdiagnosed by 2DE. Color Doppler was useful to detect abnormal flow of valvular regurgitation or left to right shunt. Doppler is useful to detect abnormal flow from obstruction or regurgitation or left to right shunt and may be used to predict the pressure in the chambers of the heart and great artery. General limitation of 2DCDE to diagnose CHD include; obesity and emphysematous child, some inherent limitation in each instrument and also inexperienced echocardiographer.

Ceftriaxone prophylaxis in cardiovascular surgery in children.

Fifty patients undergoing closed and open heart surgery were prospectively studied for the effectiveness of peri-operative prophylaxis with Ceftriaxone. Twenty-four patients (Gr I) that underwent closed heart surgery received 50 mg/kg single dose of Ceftriaxone given intravenously at the start of anesthesia. Twenty-six patients (Gr II) that underwent open heart surgery received 50 mg/kg. Ceftriaxone given intravenously at the start of anesthesia followed by another 50 mg/kg 24 hours later. The mean duration of surgery in Gr I was 1.7 hours and Gr II was 4.2 hours. The duration of post-operative fever in Gr I ranged from 0-4 days (mean 2.4) and Gr II ranged from 1-13 days (mean 6). The duration of post-operative hospitalization in Gr I ranged from 5-18 days (mean 9) and Gr II ranged from 7-71 days (mean 19). Early and late infectious complications were not found in Gr I. Late infectious complications were not found in Gr I. Late infectious complications in Gr II consisted of 2 cases of pneumonitis, 5 pleural effusions and 1 staphylococcus aureus would infection (36.8%). We concluded that a single dose of Ceftriaxone should provide adequate prophylaxis for closed heart surgery. An additional 2-3 days of daily dose Ceftriaxone may be needed when associated with tissue hypoxia, longer duration of intravenous lines and drainage tubes in open heart surgery.