A STUDY ON PATTERN AND CLINICAL PROFILES OF CONGENITAL HEART DISEASES IN TERTIARY CARE CENTRE, KAKINADA.

BACKGROUND: Congenital heart disease is an abnormality of anatomical structure of the heart that is of paramount importance. The incidence is approximately 8 per 1000 live births. CHD not only contributes to signi?cant mortality and morbidity but also causes tremendous psychological stress and economical burden to whole family. OBJECTIVE: To study the pattern and clinical pro?le of congenital heart diseases in a tertiary care hospital and to aid for early stdetection and quick referral of children with congenital heart disease In this study, done between January 1 2020 to RESULTS: june 31st 2021, 54 children with con?rmed congenital heart disease were observed. ACHD was the most common type of CHD and of them, VSD was the most common type, followed by ASD. Based on sex distribution, 31 were male (55.5%) and 23 were female (44.5%), with a male: female ratio of 1.25:1. Most children belonged in the age group 6m – 1year (46.2%) followed by (42.5%) in 30days – 6months age. The common clinical presentation observed in this study was breathlessness. The common complication observed in the current study was heart failure followed by malnourishment and recurrent LRTI.

Clinical profile and outcome of congenital cyanotic heart disease in neonatal period: a retrospective study

Background: Congenital Cyanotic Heart Disease (CCHD) is under reported during neonatal period and mortality rate is high in India. Aims and objectives of the study determine clinical presentation, maternal and neonatal risk factors and outcome of CCHD during neonatal period.Methods: A retrospective study conducted over 15-month period during March 2017 to June 2018 in a tertiary out born NICU. Neonates with echocardiographically confirmed case of structurally abnormal heart disease were analyzed.Results: Among 106 CCHD neonates, 60% neonates were asymptomatic, 22% had persistent cyanosis and 19% had tachypneic at birth. Cyanosis (35%) and tachypnea (30%) were common initial presentation in postnatal period. 22% neonates were readmitted with initial clinical symptom after discharge from birthing centre. CCHD were more common in male and term neonate, 34% were small for age, median age at admission and discharge were 5days (2-12) and 5 days (2.7-9.2) days respectively. Nineteen percent neonates had fetal distress and 6% neonates required aggressive resuscitation at birth. First trimester abortion (16%), maternal diabetes (10%) and hypothyroidism (7%) were common maternal risk factor. Nearly 20% neonates were diagnosed at referring hospital and 4.7% were transported with PGE1 during transport. TGA (17%) was most common lesion noted followed by pulmonary atresia (10%). Fourteen percent neonates died during the neonatal period. Disease specific death rate was highest for Single ventricle (42%) followed by TGA with IVS (37.5%) and aortic arch anomaly (28.5%) in this study.Conclusions: Early diagnosis and management may improve the survival in CCHD neonates.

A retrospective cross sectional study on neurological profile of children with congenital heart disease

Background: Children with Congenital Heart Disease have associated structural neurological    abnormalities and those surviving infancy are even subjected to various environmental factors   which might contribute to neurological abnormalities. Hence the objective is to study the neurological abnormalities of children with Congenital Heart Disease.Methods: A retrospective cross-sectional observation study was conducted over the period of 3 years (June 2016-May 2019). Data were collected from medical records department of 121 children of 2-12 years of age diagnosed with congenital heart disease. Neurological examination findings and neuro imaging and EEG findings where relevant    were noted. To assess the association of adverse neurological outcome and congenital heart disease, data analysis was        performed using Fisher's exact test.Results: 38% children of 2-12 years of age with congenital heart disease had adverse neurological profile. Neurological abnormalities were significantly associated with cyanotic heart disease (p value 0.0001). Statistically significant association were found between congenital cyanotic heart disease and seizure (p value=0.04), hemi paresis (p value=0.039), brain abscess (p value=0.012) and coma (p=0.01).Conclusions: Congenital cyanotic heart disease has significant associations with neurological abnormalities in children. These results demand attention for the   neurological health of the largely uncorrected cardiac disease in Indian children

Bilateral Spontaneous Urinoma in a Cyanotic Child

Background: Urinoma is an encapsulated collection of extravasated urine, secondary totrauma or obstructive uropathy. Spontaneous bilateral urinoma is rare. Casecharacteristics: 7-year-old boy with cyanotic heart disease and fever of unknown origin.Obeservation: The ultrasound abdomen and CT abdomen revealed bilateral spontaneousurinoma which was aspirated and was found to be infected. Following intravenous atibioticsthe child became afebrile, with subsequent renal scans showing no recurrence. Message:Hypoxia and consequent polycythemia may be responsible for perinephric leaks leading toNon-traumatic spontaneous urinoma.

Implantación de stent en neonatos y lactantes menores con cardiopatía congénita cianosante ductus dependiente / Stent implantation in neonates and young infants with ductus-dependent cyanotic congenital heart disease

Introducción: Los pacientes con cardiopatía congénita cianosante ductus dependiente, requieren de su permeabilidad para garantizar el flujo al sistema pulmonar o al sistémico. En casos de permeabilidad del ductus arterioso, la implantación de un stent ductal mejora la sobrevida del paciente y acarrea complicaciones mínimas. Objetivos: General: caracterizar neonatos y lactantes menores con cardiopatía congénita cianosante ductus dependiente tratados con la implantación de stent ductal. Específicos: determinar la morbilidad y mortalidad en neonatos y lactantes menores con cardiopatía congénita cianosante ductus dependiente, tratados con implantación de stent ductal. Materiales y métodos: Se incluyeron 37 pacientes recién nacidos con cardiopatía congénita cianosante ductus dependiente tratados con implantación de stent ductal, entre el 1.º de enero de 2008 al 31 de diciembre de 2012 (5 años), en Cali, Colombia. Resultados: La implantación del stent ductal fue exitosa en 26 pacientes; uno falleció inmediatamente después del procedimiento. No hubo complicaciones mayores durante el procedimiento de implantación del stent. Diez pacientes fueron sometidos a cirugía de Blalock-Taussig modificada después de la implantación fallida del stent ductal. Conclusiones: La implantación del stent ductal se convierte en una herramienta importante en el paciente con cardiopatía congénita cianosante ductus dependiente ya que ofrece menor tasa de morbilidad y mortalidad.

Introduction: Patients with ductus-dependent cyanotic congenital heart disease require its permeability to ensure the flow to the pulmonary or systemic system. In cases of ductus arteriosus patency, the implantation of a ductal stent improves patient survival and carries minimal complications. Objectives: General: characterize neonates and young infants with ductus-dependent cyanotic congenital heart disease treated with ductal stent implantation. Specific: To determine the morbidity and mortality in neonates and young infants with ductus-dependent cyanotic congenital heart disease treated with ductal stent implantation. Materials and Methods: 37 newborn patients with ductus-dependent congenital cyanotic heart disease treated with ductal stent implantation, from January 1, 2008 to December 31, 2012 (5 years) in Cali, Colombia, were included. Results: Ductal stent implantation was successful in 26 patients; one died immediately after the procedure. There were no major complications during stenting procedure. Ten patients underwent modified Blalock -Taussig surgery after failed ductal stent implantation. Conclusions: Ductal stent implantation becomes an important tool in patients with ductus-dependent cyanotic congenital heart disease as it offers lower morbidity and mortality rate.

Comparison of the Effects of Propofol and Midazolam on Inflammation and Oxidase Stress in Children with Congenital Heart Disease Undergoing Cardiac Surgery

PURPOSE: To investigate and compare the effects of propofol and midazolam on inflammation and oxidase stress in children with congenital heart disease undergoing cardiac surgery. MATERIALS AND METHODS: Thirty-two ASA class I-II children with congenital heart disease undergoing cardiac surgery were randomly divided into two groups: propofol combined with low dose fentanyl (PF group, n = 16) and midazolam combined with low dose fentanyl (MF group, n = 16). Tracheal extubation time and length of Intensive Care Unit (ICU) stay were recorded. Blood samples were taken before operation (T0), at 2 h after release of the aorta cross-clamp (T3) and at 24 h after operation (T4) to measure interleukin 6 (IL-6), IL-8, superoxide dismutase (SOD) and malondialdehyde (MDA) levels. Myocardium samples were collected at 10-20 min after aorta cross-clamp (T1) and at 10-20 min after the release of the aorta cross-clamp (T2) to detect heme oxygenase-1 (HO-1) expression. RESULTS: Tracheal extubation time and length of ICU stay in PF group were significantly shorter than those of the MF group (p < 0.05, respectively). After cardiopulmonary bypass, IL-6, IL-8 and MDA levels were significantly increased, and the SOD level was significantly reduced in both two groups, but PF group exhibited lower IL-6, IL-8 and MDA levels and higher SOD levels than the MF group (p < 0.05, respectively). The HO-1 expression in the PF group was significantly higher than that in MF group at the corresponding time points (p < 0.05, respectively). CONCLUSION: Propofol is superior to midazolam in reducing inflammation and oxidase stress and in improving post-operation recovery in children with congenital heart disease undergoing cardiac surgery.

Abscesso cerebral associado à cardiopatia congênita cianótica / Cerebral abscess in congenital heart disease

Abscesso cerebral associado a cardiopatia congênita cianótica não tem sido uma patologia comum na prática clínica. Foi feita extensa revisão bibliográfica sobre o tema e a casuística própria é apresentada. No período entre janeiro de 1992 e julho de 2000 foram internados 17 casos de abscesso cerebral associado à cardiopatia congênita cianótica no Serviço de Neurocirurgia do Hospital João Alves Filho e da Fundação Beneficente Hospital de Cirurgia (Aracaju, SE). Foram analisados quanto a sexo, idade, patologia cardíaca, microrganismos encontrados, localização do abscesso, quadro clínico, exames complementares, tratamento e prognóstico.Não houve predominância do sexo e a média etária foi de 6,5 anos. A cardiopatia congênita mais comum foi tetralogia de Fallot (76,5%), seguida da atresia tricúspide (11,7%), trilogia de Fallot (5,9%) e persistência do ducto arteriosus (5,9%). As sintomatologias predominantes foram febre(70,6%), cefaléia (53%), hemiparesia (47%), crise convulsiva (47%), náuseas e vômitos (35,3%) e papiledema (35,3%). A localização do abscesso predominou no lobo parietal (47,1%), seguido do lobo frontal (23,6%), frontoparietal (11,7%), temporoparietal (11,7%); abscessos múltiplos foram observados em um caso (5,9%). O tratamento cirúrgico foi realizado em 14 pacientes e o conservador, em três. Óbito ocorreu em quatro casos (23,5%.): em três devido a sepse e, em um, ao edema cerebral.

Brain abscess associated to congenital cyanotic heart disease has not been a common pathology in the clinical practice. During the period from January, 1992 to July, 2000, seventeen cases of brain abscess associated to congenital cyanotic heart disease were admitted in the Neurosurgery Service of the Hospital João Alves Filho and Fundação Beneficente Hospital de Cirurgia (Aracaju, Sergipe, Brazil). The following items were analyzed: sex, age, heart pathology, microbiological study, location of the abscess, clinical picture, suitable therapeuties and prognosis. No sex prevalence was observed and the mean age was 6.5 years. The most common congenital heart disease was tetralogy of Fallot (76.5%), followed by tricuspid atresia (11.7%), trilogy of Fallot (5.9%) and persistence ducto arteriosus (5.9%). Presenting symptons included: fever (70.6%), headache (53%), hemiparesis (47%), seizures (47%), nausea and vomiting (35.3%) and papilledema (35.3%). The predominant location of the abscess was the parietal lobe (47.1%) followed by the frontal lobe (23.6%), fronto-parietal (11.7%), temporo-parietal (11.7%); multiple abscesses were present in one case (5.9%). Surgical treatment was indicated in fourteen cases and conservative in three. The overall mortality rate was of 23.5%. There were four deaths: three due to sepsis andone due to intracranial hypertension. Two patients did not have the correction of the congenital heart disease due to the precariousness of their general condition.