Pulmonary regurgitation after balloon valvuloplasty in children with pulmonary stenosis

Pulmonary valve stenosis [PS] is one of the most common congenital heart disease in children. Isolated pulmonary stenosis is the most common form of pulmonary stenosis. Isolated Pulmonary stenosis is responsible for 8 to 10 percent of congenital heart disease. Balloon valvuloplasty is the choice of treatment for this cardiac disease. One of the most important complications of this disease is pulmonary regurgitation in follow-up. The purpose of this study was to characterize the status of pulmonary regurgitation on follow-up after pulmonary valvuloplasty by balloon. We studied pulmonary regurgitation after balloon valvuloplasty retrospectively in children less than 14 years old age and isolated pulmonary stenosis. These patients had not complex congenital heart disease and admitted for balloon valvuloplasty during period of September 2001 to September 2011 in Shahid Rajaee Cardiovascular Research Center. The mean time of follow-up was 7+/-2.5 years. Four hundred and fifty-eight patients with mean age of 10.3+/-8.6 months were studied. Two hundred and fifty-five patients were male and 230 were female. Right ventricular pressure was decreased from 82.3+/-42.2 mmHg before procedure to 45.2+/-22.4 mmHg after procedure [P= 0.043]. Pressure gradient between right ventricle and pulmonary artery was decreased from 75.4+/-18.2 mmHg to 25.7+/-15.13 mmHg during procedure [P= 0.032]. The day after procedure, 180 [37.1%] patients had no pulmonary regurgitation echocardiographic evaluation, 175 [36.08%] had mild, and 118 [24.3%] had moderate pulmonary regurgitation. In patients with moderate pulmonary regurgitation, 7 [0.14%] of those improve to severe pulmonary regurgitation. In echocardiographic exam, 12 [2.4%] patients had severe regurgitation the day after balloon valvuloplasty. During long-term follow-up [7+/-2.5 years] for 3 patient pulmonary valve replacement were performed. In our study, balloon to annulus ratio in three groups of pulmonary regurgitation [mild, moderate and sever] had significant correlation [P=0.012]. Pulmonary regurgitation was seen after balloon valvuloplasty in some patients.In most patients it had no symptoms and long-term follow-up is necessary

[Balloon atrial septostomy under echocardiographic guide: case series]

Balloon atrial septostomy is an emergent procedure in pediatric cardiology. Nowadays, most patients in need of the procedure have acceptable outcomes after surgical repair. Thus, it is important to perform this procedure as safe as possible. By performing early arterial switch operation and prostaglandin infusion, the rate of balloon atrial septostomy has markedly decreased. However, not all centers performing early arterial switch repairs have abandoned atrial septostomy, even in patients who respond favorably to prostaglandin infusion. In total, eight 1- to 15-day old term neonates admitted in Shahid Rajaee Heart Center in Tehran, Iran from October 2009 to February 2011, with congenital heart diseases were scheduled for balloon atrial septostomy. In six cases the procedure was done exclusively under echocardiographic guidance and in two cases with the help of fluoroscopy. Success was defined as the creation of an atrial septal defect with a diameter equal to or more than 5 mm and ample mobility of its margins. Male sex was predominant [87%] and the mean age of the neonates was six days. The diagnosis in all cases was simple transposition of great arteries. The procedure was successful in all patients with any cardiovascular complication. Balloon atrial septostomy is an emergent procedure that can be done safely and effectively under echocardiographic guidance. According to the feasibility of this technique it could be performed fast, safe and effective at bedside, avoiding patient transportation to hemodynamic laboratory or referral center.

Growth status of Iranian children with hemodynamically important congenital heart disease

The relationship between congenital heart disease [CHD] and growth retardation is well documented. We investigated the growth condition of Iranian children with several types of congenital heart disease [CHD] and compared it with worldwide researches. Growth condition was investigated in 469 patients with important CHD aged from 1 month to 18 years. The patients were divided into two groups; infants [aged 12 months or less], and children [1-18 yrs of age]. Children with hemodynamically unimportant small VSDs or small ASDs were not studied. Other exclusion criteria were prematurity, known genetic disorders and neurologic disease affecting growth. All patients' cardiac diagnoses were made on the basis of clinical and laboratory examinations; including electrocardiography, echocardiography, cardiac catheterization, and angiography. Body weight and height of all patients were measured using conventional methods and compared with standard growth charts. In all patients body weights and heights were significantly lower than normal population. This difference was greater in the weight of female children. Other risk factors for growth failure were large left-to-right intracardiac shunts, pulmonary hypertension and cyanosis. Iranian children with CHD have growth failure somewhat different from other countries. Lower body weights of cyanotic patients and female children indicated that these patients need more nutritional and psychosocial attention

Validity of sildenafil test in patients with pulmonary arterial hypertension associated with congenital heart disease according to clinical and ecardiographic parameters

Pulmonary arterial hypertension is a complication of most congenital heart diseases. We sought to assess the effect of sildenafil on patients suffering from pulmonary arterial hypertension in association with congenital heart disease on the basis of clinical and echocardiographic parameters and compare the catheterization and treatment results so as to evaluate the predictive value of sildenafil on the operability of patients.After primary echocardiography, 21 patients were selected for the final study with a diagnosis of moderate-to-large ventricular septal defect and pulmonary artery hypertension. They were divided into 3 age groups: younger than one year, 1 to 2 years, and older than 2 years. Before and one hour after the consumption of sildenafil, the patients had their oxygen saturation and blood pressure measured. Additionally, the patients underwent echocardiography and cardiac catheterization. The patients' operability was determined on the basis of their clinical condition and their response to oxygen inhalation in the catheterization room. Finally, the results of the drug response and final treatment were analyzed statistically. The 21 patients, who had ventricular septal defect and pulmonary arterial hypertension, were comprised of 8 [38%] boys and 13 [62%] girls. The patients aged from 2.5 to 204 months [mean 30 months]. It was clear that the younger patients had a more positive response to the drug. All the patients who had a positive response to the drug were considered operable after catheterization and all of them had a positive response to treatment. There was no significant correlation between operable/inoperable conditions and response to treatment [P value=0.262], while there was a very significant correlation between response to treatment and response to drug [P value=0.005]. According to the results of this study and given the low cost and availability of sildenafil and its oral consumability on the one hand and the availability and non-invasiveness of echocardiography on the other, it seems that sildenafil is useful in determining the pulmonary vascular bed reactivity via echocardiographic parameters and facilitating the decision-making process for surgery in patients with pulmonary arterial hypertension and congenital heart diseases