Screening of School Children for Operable Congenital Heart Diseases in Dhaka city.

Backgrond: As there is no basic epidemiological study of congenital heart disease in Bangladesh, so this work was designed by the study group and was supported by Bangladesh Medical Research Council. Methods: Cross-sectional study of school going children , age ranging from 6-16 of Dhaka City were physically examined in addition to history and when required special investigation such as echocardiography was done. Results: A random sample of 5900 school-going children in the age group of 6-16 years from public and private schools of Dhaka city were screened for the prevalence of operable congenital heart diseases (CHD) during a period of 1 year. Congenital heart diseases were diagnosed, preliminary on the basis of clinical history and/or clinical examination, then confirmed by supportive investigations, such as echocardiography. Out of examined sample, 112 were found suffering from CHD, giving an overall prevalence of 19.0/1000 (16.2/1000 in boys and 22.2/1000 in girls), far greater than that of the figures recorded in available literatures for other countries. The prevalence rate was higher in girls than that of boys in the present study, which may indicate a negligence of caring towards female children in the family. In consistent, children from lower income group had a higher prevalence rate compared to their middle income group counterparts (Low income group vs middle income group: 24.5/1000 vs 13.0/1000).Poor income group had less antenatal checkup which could detect congenital heart disease earlier. Fifty three children were found to be suffering from definite operable CHD giving a prevalence of 8.98 per thousand, where, again, girls were the main victims (girls vs boys: 12.0/1000 vs 6.4/1000). Atrial septal defect was the commonest lesion 7.6%) with a prevalence of 76 per thousand followed by ventricular septal defect (4.7 %) with a prevalence of 47 per thousand. Five (9.4%) cases had a family history of CHD. History of rheumatic fever and/or rheumatic heart disease were found to have a significant prevalence among cases with CHD (11.9%) as compared to children without CHD (0.9%). Conclusion: The findings of the present survey suggest the need of more frequent antenatal checkup especially in low income group large scale screening of apparently healthy children for CHD, and family members of those suffering from CHD, and that special attention be paid to the occurrence of rheumatic fever/rheumatic heart disease in cases of CHD.

Cardiac malignant lymphoma in severe combine immunodeficient mice.

Extranodal malignant lymphomas are known to occur with increased frequency in patients with human immunodeficiency virus infection. Although cardiac malignant lymphomas are rare, recently an increasing number of patients with acquired immune deficiency syndrome (AIDS) and cardiac lymphoma have been reported. To clarify the relationship between AIDS and cardiac lymphomas, we used 60 severe combine immunodeficient (SCID) mice as animal models in whom five different types of human lymphoma cell lines were injected. Primary lymphomas at the site of cell line injection developed within 14-30 days in 58 mice. Cardiac malignant lymphoma was detected in 10 cases (17%), among which tumour was macroscopically evident in 2. Tumour was present on the pericardial aspects of the heart extending into the myocardium in most cases, but no intracavitary lesion was observed. In one case, obstructive features were marked near the root of the great vessels by direct pressure of the growth. This study indicates that lymphomas have a predilection to invade the heart in immunocompromised conditions.

Ruptured aneurysm of the sinus of Valsalva.

The objective of the present study was to assess the value of imaging techniques in the diagnosis of ruptured aneurysm of sinus of Valsalva (RASV). 38 patients were included in the study. 30 were male and 8 female. Their age ranged from 7 to 55 years (mean 25.8 years). Echocardiographic and doppler studies were done in all cases and 20 patients underwent catheterization and angiography. Two patients were asymptomatic, 20 (53%) had acute onset of symptoms and in the remaining 16 (42%) patients symptoms developed gradually. Twenty two (58%) patients were in NYHA functional class III or IV when first seen. Predominant symptoms were dyspnea (79%), palpitation (55%) and chest pain (52%). A continuous machinery murmur was detected in all the patients with associated thrill in 34 patients. Right coronary sinus (RCS) was the most common sinus involved (89%) followed by the noncoronary sinus (NCS) which was involved in 11% of patients. None of the patients in our series had aneurysm of the left coronary sinus. Twenty eight of the 34 RCS aneurysms ruptured into the right ventricular outflow tract (RVOT), 4 into right ventricular cavity (RVC), one into right atrium (RA) and one dissected into the ventricular septum and subsequently ruptured into the left ventricle. Of the 4 NCS aneurysms, 2 ruptured into RVC, one into RA and one into both the RA and RVC. Associated ventricular septal defect (VSD) was found in 10 (26%) patients and all of these patients had RCS aneurysm that ruptured into the RVOT. Aortic regurgitation (AR) was detected in 16 (42%) cases. Discrete subaortic stenosis was detected in one patient who also had associated VSD and AR. Vegetation of the aortic valve was detected in one patient who had RCS aneurysm. Twelve patients (11 male and one female) underwent surgical correction, 10 with and 2 without prior catheterization. Localization of the involved sinus, site of rupture and associated cardiac lesions by echocardiography and doppler study were found accurate at surgery and/or angiography in 22 cases of our series. Imaging techniques, thus appeared to be reliable tools for the diagnosis of RASV.

Acute myocardial infarction: A complication of left atrial myxoma.

A 58-year-old female patient, immediately after an acute myocardial infarction underwent an echocardiographic examination and emergency coronary arteriography which led to the discovery of left atrial infarction. Successful emergency coronary arterial by-pass graft (CABG) and excision of the myxoma was done within 24 h of the onset.