Coronary artery origin anomalies with especial emphasis on delayed diagnosis of anomalous origin of the left coronary artery from pulmonary artery, a report from south of Iran

The aim of this study was to determine the clinical course and outcome of coronary artery anomalies including anomalous origin of the left coronary artery from the pulmonary artery [ALCAPA] diagnosed by coronary artery angiography [CAA] at our institution. The term coronary artery anomaly refers to a wide range of congenital abnormalities, involving the origin, course and the structure of epicardial coronary arteries. Anomalous origin of the left coronary artery from the pulmonary artery [ALCAPA] is an extremely rare, but potentially fatal congenital coronary anomaly. The review included 21280 patients undergoing CAA at Medical Centers of Shiraz University between years 1997 -2006. The hospital records of all patients with diagnosis of ALCAPA reviewed for analysis. Data were expressed as percentages. There were 149 [0.7%] cases of coronary anomalies, including 9 [6.04%] proven cases of ALCAPA. In ALCAPA group, five patients presented with congestive heart failure [CHF] and a non-specific systolic murmur on examination. Isolated mitral valve regurgitation [MR], cerebrovascular accident due to embolization of a mural thrombus, and chest pain were the main presentations in three patients. Two of the patients were under follow up with presumptive diagnosis of coronary artery fistula. The patients aged between 4 months and 35 years. Surgical correction done for all the patients with ALCAPA by direct reimplantation in 8 patients and Takeuchi technique in one. We had one early hospital mortality in our group. ALCAPA should be considered in differential diagnosis of any patient presenting with dilated cardiomyopathy, CHF, MR or chest pain syndrome. Awareness of such pathology can prevent or decrease the morbidity and mortality of a potentially fatal congenital heart disease

Distribution and characteristics of the heart disease in pediatric age group in southern Iran

The spectrum of heart diseases among pediatric age group may be different between communities and, in this connection there is no documented report from Iran. We studied cardiac problems among Iranian pediatric age group referred to the pediatric cardiology and cardiac surgery out-patient clinic, in a tertiary center for possibility of heart disease. Of 2341 patients, aged from 1 day to 16 years referred, during 2001 and 2003, to the above center, 1817 [77.6%] patients had cardiac diseases. The most common reason for referrals was abnormal heart sounds on routine physical examination [49%]. Congenital heart diseases [CHD] were the most frequent cardiac problems [76.1%], followed by mitral valve prolaps [8.3%] and rheumatic cardiac involvement including sub-clinical findings [7.9%]. Other significant disturbances were associated chromosomal abnormalities, genetic disorders, and electrical and conduction problems. Although rheumatic carditis has very low incidence compared with congenital heart diseases [nearly 1/10], it is still a significant problem in this region and a planning for its better prevention is essential

Is prophylaxis against bacerial endocarditis warranted in circumcision?

The occurrence of bacteremia during oro-dental manipulation and surgical procedures with subsequent development of endocarditis after bacteremia is well established. However, the prevalence of bacteremia and thus the necessity of endocarditis prophylaxis after circumcision is not yet settled. To further clarify this issue, blood cultures in one hundred normal 2-5 year-old boys who underwent circumcision were examined pre-operatively, immediately and/or 15 minutes after surgery. A positive blood culture for Staphylococcus aureus was found in only two children, neither of whom developed signs or symptoms of bacteremia or sepsis. In a retrospective chart review over a ten-year period of 85 male patients with endocarditis and 51 male cases of septicemia, circumcision was not found to be a predisposing factor for bacterial endocarditis and sepsis. We believe that in patients with structural heart disease, endocarditis prophylaxis for circumcision, is not warranted