Profile of Cardiac Involvement in Children After Exposure to COVID-19

Objective: To evaluate the incidence and pattern of cardiac involvement in children postCOVID (coronavirus disease) infection in a tertiary care referral hospital in India. Methods: A prospective observational study was conducted including all consecutive children with suspected MIS-C referred to the cardiology services. Results: Of the 111 children with mean (SD) age 3.5 (3.6) years, 95.4% had cardiac involvement. Abnormalities detected were coronary vasculopathy, pericardial effusion, valvular regurgitation, ventricular dysfunction, diastolic flow reversal in aorta, pulmonary hypertension, bradycardia and intracardiac thrombus. The survival rate post treatment was 99%. Early and short-term follow-up data was available in 95% and 70%, respectively. Cardiac parameters improved in the majority. Conclusion: Cardiac involvement post COVID-19 is often a silent entity and may be missed unless specifically evaluated for. Early echocardiography aids in prompt diagnosis, triaging, and treatment, and may help in favorable outcomes.

Indian Guidelines for Indications and Timing of Intervention for Common Congenital Heart Diseases: Revised and Updated Consensus Statement of the Working Group on Management of Congenital Heart Diseases. Abridged Secondary Publication

ustification: A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However,these guidelines are for patients living in high income countries. Separate guidelines, applicable to Indian children, are required whenrecommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and mayhave co-existing morbidities and malnutrition. Process: Guidelines emerged following expert deliberations at the National ConsensusMeeting on Management of Congenital Heart Diseases in India, held on 10th and 11th of August 2018 at the All India Institute of MedicalSciences, New Delhi. The meeting was supported by Children’s HeartLink, a non-governmental organization based in Minnesota, USA.Objectives: To frame evidence based guidelines for (i) indications and optimal timing of intervention in common congenital heartdiseases; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases.Recommendations: Evidence based recommendations are provided for indications and timing of intervention in common congenitalheart diseases, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductusarteriosus and others), obstructive lesions (pulmonary stenosis, aortic stenosis and coarctation of aorta) and cyanotic congenital heartdiseases (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebsteinanomaly and others). In addition, protocols for follow-up of post surgical patients are also described, disease wise.

Is it Really PPHN? Think Before Starting Sildenafil!.

The use of sildenafil has become a common practice in neonatal intensive care unit on clinical ground, because opinion by Pediatric Cardiologist is usually not available especially in peripheral centers. We consider it essential to share our experience that severe pulmonary arterial hypertension can be due to some unusual hemodynamics or extremely rare structural causes which do not require pulmonary vasodilator therapy.

Myocardial Dysfunction Due to Hypocalcemia.

Hypocalcemia is a curable cause of myocardial dysfunction and clinical congestive cardiac failure, with only stray reports available in literature. We describe 15 infants presenting with severe left ventricular dysfunction, who were found to have hypocalcemia with or without hypomagnesemia. Vitamin D deficiency was identified as the main cause of hypocalcemia. These children improved on supplementation of vitamin D and calcium.

Giant congenital diverticulum of the right atrium.

Congenital diverticulum of heart is a rare entity, which may arise from the atria, atrial appendages, coronary sinus or the ventricles. A 3-year-old child presented with history of early fatigability for 6 months and recent upper respiratory tract infection. Chest X-ray and echocardiogram revealed marked right atrial enlargement. At surgery, a right atrial diverticulum was excised under cardiopulmonary bypass. Pathology revealed thickened endocardium with edema and myocardial fiber hypertrophy. Our experience with this rare congenital disease is presented along with a review of the literature.

Rare variants of total anomalous pulmonary venous connection to coronary sinus-echocardiographic recognition and surgical correction.

Total anomalous pulmonary venous connection (TAPVC) to the coronary sinus is a well-known entity but variations in connection sites are known to occur, the commonest among them is mixed connection. Here we describe two rare variants of TAPVC to coronary sinus. Group I (3 cases) in which there were dual sites of connection and group II (2 cases), TAPVC to coronary sinus was associated with a persistent left superior vena cava (LSVC). This was seen in total number of 45 cases of isolated TAPVC and 8 cases of TAPVC to coronary sinus between 2000 and December 2005 in our institute. All patients underwent surgical correction. In both of these groups, surgical correction may pose a challenge, which is discussed.

Comparison between transcatheter closure and minimally invasive surgery for fossa ovalis atrial septal defect: a single institutional experience.

BACKGROUND: Although, conventional surgical closure of atrial septal defect (ASD) provides excellent results with very low mortality and morbidity, it leaves the scar of incision and postoperative pain. Newer treatment modalities like minimal invasive surgery and percutaneous closure are being increasingly used nowadays where available. AIM: To compare the patient population, success, safety, and efficacy of transcatheter closure of ASD (Group A) with that of minimally invasive surgery (Port Access) (Group B). METHODS: In this retrospective non-randomized study, a record of a total of 640 patients with diagnosis of ASD secundum between May 1997 and October 2006 were reviewed. A total of 470 out of 640 patients were selected for transcatheter closure (Group A) while 170 patients were taken for surgical closure by minimally invasive port access surgery (Group B). The safety and efficacy of two groups was evaluated on the basis of morbidity and mortality, duration of intensive care unit (ICU) stay, total duration of hospital stay, post-procedural complications, residual sequel at time of discharge, and residual flow across the ASD. RESULTS: Success rate in two groups was 97.1% and 99.4%, respectively and had no statistically significant difference. Similarly major complication rate also had no difference in statistical significance (1.8% and 2.9% for Group A and B, respectively). Group B patients had longer hospital stay. A small but significant number of patients were not found suitable for device closure. This number is likely to decrease as experience with technique increases. Port access surgery is currently not possible in small children (femoral artery diameter 35 mm) due to difficulty in cannulation. CONCLUSION: Percutaneous device closure of ASD can be offered as a treatment option in suitable patients. Port access is minimally invasive and an equally safe and effective alternative choice in ASDs with deficient rim in patient with appropriate age and weight.

Transcatheter closure of fossa ovalis atrial septal defect: a single institutional experience.

Transcatheter closure of the fossa ovalis atrial septal defect with adequate rims has become the procedure of choice in recent times. We report our experience with 439 patients who were selected for percutaneous device closure and 430 of whom underwent transcatheter closure of fossa ovalis atrial septal defects from May 1997 to May 2006. Device closure was not attempted in the remaining nine patients after initial evaluation due to high right atrial pressure following balloon occlusion (n=1 not parallel, high pulmonary vascular resistance (n=1), significant coronary artery disease (n=1), or the fact that the atrial septal defect was unsuitable for device closure (n=6). The anatomical size of the atrial septal defects ranged from 7-40 mm. Six patients underwent a combined procedure at the time of the atrial septal defect device closure (balloon pulmonary valvotomy in 4 cases, balloon pulmonary valvotomy and patent ductus arteriosus device closure in 1, and pulmonary ductus arteriosus coil closure in 1). The patients were in the age group of 2-77 years, the mean age being 20 years. Major complications occurred in seven cases. In 4 patients, there was device embolization immediately after deployment; there was left atrial appendage perforation, in one patient leading to cardiac tamponade during deployment of the device, and development of pulmonary edema in two patients. The cases in which device embolization took place underwent conventional surgery for atrial septal defect patch closure, while the patient with left atrial appendage perforation underwent emergency surgery (suturing of the left atrial appendage). Both patients with pulmonary edema were managed conservatively. The immediate success rate of device closure was 96.9%. All but one patient with multiple defects had no residual shunt at follow-up. On three months' to nine years' follow-up, the device remained stable, with no significant residual shunt and no history of thrombus formation on transthoracic echocardiography.

Aortico-left ventricular tunnel: echocardiographic recognition.

Aortico-left ventricular tunnel (ALVT) is a rare congenital malformation characterized by an abnormal communication between aorta and left ventricular cavity and the child presents with features of congestive heart failure in early infancy. We report the case of a 7-day-old baby who was diagnosed as a case of ALVT by echocardiography. The child was operated successfully and echocardiographic findings were confirmed.

Total anomalous pulmonary venous connection to azygos vein: echocardiographic recognition of a rare variant.

Total anomalous pulmonary venous connection to the azygos vein is a rare congenital malformation in which all the pulmonary veins drain anomalously to the azygous vein. Among 55 consecutive patients diagnosed as isolated total anomalous pulmonary venous connection by echocardiography at our institute between 1995 and January 2005, this anomaly was diagnosed in two patients. The malformation was diagnosed correctly in both the patients by echocardiography and the findings were confirmed on surgery. The importance of differentiating this condition from total anomalous pulmonary venous connection to superior vena cava by echocardiography and the differential diagnosis are discussed here.