Pattern of congenital heart disease among Egyptian children: a 3-year retrospective study.

BACKGROUND: Congenital heart disease (CHD) is a multifactorial birth defect which has variable demographic characteristics among children in different geographical areas. This study aimed to detect the distribution of demographic data, perinatal risk factors, types, age, and mode of presentation of CHD among Egyptian children. RESULTS: The medical records of 1005 patients were included. They were 545 males (54%) and 462 females (46%) with a ratio of 1.2:1. Acyanotic CHD was encountered in 79.2%. Isolated ventricular septal defect and tetralogy of Fallot were the most common acyanotic and cyanotic lesions, respectively. The majority was diagnosed within the first year of life (86.7%) and was born to young mothers (91.3%). The accidental discovery of a murmur was the most frequent presentation (35%). Heart failure was detected in 44%, audible murmurs in 74.4%, maternal illnesses in 54%, consanguinity in 44.6%, prematurity in 19.3%, assisted reproduction in 11.7%, family history of CHD in 9.2%, abortions in 7.1%, and extracardiac anomalies in 3.6% of the studied population. Down syndrome (DS) was the most commonly occurring chromosomal anomaly, and the atrioventricular septal defect was the most characteristic cardiac lesion found among them. CONCLUSIONS: There is no sex predilection among Egyptian children with CHD. Most of the cases are diagnosed in early infancy. Accidental discovery of a murmur is the most common mode of presentation. A variety of predisposing risk factors are abundant in the Egyptian population. DS is the most common chromosomal anomaly linked to CHD. Establishment of a national medical birth registry containing all information about all births in Egypt is needed for adequate surveillance and monitoring of perinatal health problems and congenital birth defects so that preventive measures can be early implemented. Proper and detailed data collection should be fulfilled in the medical records of every single patient.

A Pilot Study to Predict Future Cardiovascular Events by Novel Four-dimensional Echocardiography Global Area Strain in ST-Elevation Myocardial Infarction Patients Managed by Primary Percutaneous Coronary Intervention.

CONTEXT: Four-dimensional speckle-tracking echocardiography (4D-STE) is ideal to accurately assess myocardial deformation. The novel 4D global area strain (GAS) uses global longitudinal and global circumferential strains (GCSs) to detect subtle changes in myocardium. AIMS: The aim of this study was to determine the predictive value of 4D strain echocardiography for major adverse cardiovascular events (MACEs) in ST-elevation acute myocardial infarction (STEMI) patients after successful reperfusion by primary percutaneous coronary intervention (PCI). SETTINGS AND DESIGN: This was a longitudinal study at a single center. PATIENTS AND METHODS: We enrolled 170 patients who underwent successful primary PCI. Each patient was evaluated with 2D echocardiography and 4D echocardiography with 4D strain parameters and followed up over a year for the occurrence of MACE. STATISTICAL ANALYSIS USED: Chi-square test, independent t-tests, and multivariate logistic regression analysis were used. RESULTS: Over 1 year of follow-up, 32 MACE were recorded. Patients with MACE were more likely to have had percutaneous transluminal coronary angioplasty done during the index primary PCI intervention, multivessel coronary artery disease, higher left ventricular end-diastolic and end-systolic dimensions (left ventricle end diastolic dimension (LVEDD) and left ventricle end systolic dimension (LVESD), respectively), lower 2D left ventricular ejection fraction (LVEF), higher wall motion score index, higher baseline heart rate, higher end-diastolic and end-systolic volumes, lower 3D-LVEF, higher 4D global longitudinal strain, 4D-GCS, 4D-GAS, and lower 4D global radial strain (4D-GRS) (P < 0.005 for all parameters). The most powerful predictor for MACE among our study population is 4D-GAS, with the best cutoff value of 4D-GAS >-17 (P = 0.008; odds ratio = 20.668; confidence interval = 2.227-191.827). CONCLUSIONS: The novel 4D-GAS echocardiography predicts adverse clinical events in STEMI patients managed by successful primary PCI.

Assessment of left ventricular systolic function after VSD transcatheter device closure using speckle tracking echocardiography.

BACKGROUND: This is a case-control study conducted on 30 children, 15 with VSD who performed VSD transcatheter device closure (group A) and 15 controls of matching age and gender (group B), in the period between September 2015 and February 2018. We aimed to assess the global left ventricular (LV) systolic function by 2D speckle tracking before and after ventricular septal defect (VSD) transcatheter closure, in comparison to normal controls. All patients were subjected to full history taking; general and cardiac examination; ECG; CXR; full transthoracic echocardiographic examination, including VSD number, size, and site; LV dimensions and volumes; estimated pulmonary artery pressure; right ventricular size and function; left ventricular circumferential; and radial strain imaging by 2D speckle tracking. Patients who had ventricular septal defect closed were reassessed by transthoracic echocardiography after 3 months. RESULTS: The study included 15 children with VSD: 3 males and 12 females; their age ranged from 2 to 13 years; all had subaortic VSD except for 1 who had apical muscular VSD: VSD size ranged from 3 to 8 mm; PFM coil was used to close defect in all patients except for 2 patients who had an Amplatzer duct occlude I (ADOI) device, and 1 patient needed an additional vascular plug after significant hemolysis. Pre-procedurally, group A had a significantly higher LVEDD, LVESD, and LVEDV than group B. Mean circumferential strain was significantly higher (more negative) in group A than that in group B either pre- or post-procedure. Post-procedurally, there was a significant decrease in circumferential strain (less negative) and a significant increase in radial strain (more positive). CONCLUSION: Following transcatheter VSD closure, there is a significant decrease in LV circumferential strain and a significant increase in LV radial strain, which conclude a decrease in LV volume overload with the improvement of its contractility.

A novel three-dimensional echocardiographic method for device size selection in patients undergoing ASD trans-catheter closure.

BACKGROUND: Proper device size selection is a crucial step for successful ASD device closure. The current gold standard for device size selection is balloon sizing. Balloon sizing can be tedious, time consuming and increase fluoroscopy and procedure times as well as risk of complications. We aimed to establish a simple and accurate method for device size selection using three-dimensional echocardiographic interrogation of the ASD.This is a prospective observational study conducted over a period of 12 months. All patients underwent 2D TTE, three-dimensional echocardiographic assessment of the IAS and transesophageal echocardiogram. Comparison between echocardiographic variables was done using independent sample t test. Linear correlation was established between three dimensional echocardiographic variables and respective variables of device size and 2D TTE and TEE measurements. RESULTS: The study included 50 patients who underwent successful ASD device closure with properly sized device. There was no significant difference between 3D ASD maximum diameter and all diameters measured by TTE and TEE. There was a strong positive correlation between device size used for closure and both 3D measured ASD area (r = 0.907, P<0.0001) and 3D measured ASD circumference (r = 0.917, P<0.0001). Two regression equations were generated to determine proper device size where Device size = 10.8 + [3.95 x 3D ASD area] and Device size = [3.85 x 3D ASD circumference] -1.02 CONCLUSION: Three-dimensional echocardiogram can provide a simple and accurate method for device size selection in patients undergoing ASD device closure using either 3D derived ASD area or ASD circumference.

Subclinical LV Dysfunction Detection Using Speckle Tracking Echocardiography in Hypertensive Patients with Preserved LV Ejection Fraction.

BACKGROUND: Early detection of subclinical left ventricular (LV) systolic dysfunction in hypertensive patients is important for the prevention of progression of hypertensive heart disease. METHODS: We studied 60 hypertensive patients (age ranged from 21 to 49 years, the duration of hypertension ranged from 1 to 18 years) and 30 healthy controls, all had preserved left ventricular ejection fraction (LVEF), detected by two-dimensional speckle tracking echocardiography (2D-STE). RESULTS: There was no significant difference between the two groups regarding ejection fraction (EF) by Simpson's method. Systolic velocity was significantly higher in the control group, and global longitudinal strain was significantly higher in the control group compared with the hypertensive group. In the hypertensive group, 23 of 60 patients had less negative global longitudinal strain than -19.1, defined as reduced systolic function, which is detected by 2D-STE (subclinical systolic dysfunction), when compared with 3 of 30 control subjects. CONCLUSION: 2D-STE detected substantial impairment of LV systolic function in hypertensive patients with preserved LVEF, which identifies higher risk subgroups for earlier medical intervention.