Pericardial effusion after pediatric cardiac surgeries: a single center observation

Development of fibrinous pericarditis after pericardiotomy is a well-recognized reaction. Within a few post-operative days, the inflammated surface of pericardium begins to fuse to the overlying sternum. Our aim was to assess the prevalence, risk factors, time course and therapy response of pericardial effusion [PE] after cardiac surgeries in children. PE occurrence was assessed prospectively in 486 children who underwent cardiac surgery for congenital heart diseases by serial echocardiography. Clinical manifestations were observed and response to different therapies was analyzed. The prevalence of PE was about 10% for all cardiac surgeries. Symptoms were exclusively seen in patients who had moderate to large effusions. The mean onset of pericardial effusion was 11 [ +/- 8] days after surgery procedure, with 87% [42 of 48] of cases being diagnosed on or before day 13 after operation. The prevalence of effusion after Fontan-type procedures and AVSD repair [29%, 5 of 17 for both] was significantly higher than other types of cardiac surgeries. Aspirin administration was effective in 77% and prednisone in 90% of the cases. PE may be developed as late as weeks after cardiac surgeries. PE after palliative cardiac surgeries is not uncommon. Low doses of aspirin and corticosteroids are usually effective for treating this complication

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

Transcatheter closure of fenestration after modified fontan operation in children

Fenestration in the modified Fontan operation allows right-to-left shunting, which reduces the Fontan pathway pressure and improves cardiac output. However, on account of the fact that persistent right-to-left shunting results in cyanosis and paradoxical emboli, fenestration closure is recommended after recovery from the Fontan operation. This study recruited 3 patients who underwent the transcatheter closure of the Fontan fenestration with the ASD-Amplatzer because of severe cyanosis and significant intracardiac shunts. Fenestration closure was performed at a mean age of 8 yr [6-12 yr] and average of 15 months after the Fontan operation. Aortic O[2] saturation increased by an average of 17.6% [9-26%]. During more than a two-year period of follow-up [mean: 27 months], two patients had complete occlusion on echocardiography and the other one had a small residual shunt. One of these patients had atrial flutter during the follow-up. The transcatheter closure of the Fontan fenestration is a safe and feasible technique that is effective in elevating systemic O[2] saturation and well-being and confers acceptable growth and development in children