An update work of pulse oximetry screening for detecting critical congenital heart disease in the newborn.

BACKGROUND: Congenital Heart Disease (CHD) is the commonest group of congenital malformations and affects 7-8 per 1000 live born newborns. Nevertheless, it is estimated that more than 50% of babies with undiagnosed CHD are not detected by routine neonatal cardiac examination. AIM: To find the incidence of CHD in newborns and to determine the accuracy of pulse oximetry for detecting clinically unrecognized critical congenital heart disease (CCHD) in the newborns. METHODS: Pulse oximetry was performed on clinically normal newborns within 4 hours of first day of life. Inclusion criteria: All newborns who were admitted in postnatal ward & Neonatal Intensive care unit (NICU). Exclusion criteria: babies and neonates with a prenatal diagnosis of duct dependent circulation. If oxygen saturation (SpO2) was below 90%, then echocardiography was performed. RESULTS: During the study period, 4926 live born neonates were examined. Nine out of 12 neonates with SpO2<90% had CCHD. Four neonates had tetralogy of Fallot (TOF), two had tricuspid atresia, two had transposition of great arteries (TGA) and one had truncus arteriosus. The incidence of CHD was 33.49 per 1000 live births and CCHD was 1.82 per 1000.  A pulse oximetry cut-off value of below 90% for detecting CCHD showed 90% sensitivity, 99.94% specificity, 75% positive predictive value (PPV) and 99.98% negative predictive value (NPV). CONCLUSION: Pulse oximetry is safe, feasible and noninvasive and also used to screen for CCHD. It is the nice method to detect the CHD along with the physical examination of neonates by medical personal.

Predominant RV endomyocardial fibrosis masking rheumatic mitral stenosis.

We report a 30 year female with rheumatic mitral stenosis, presenting with progressive right heart failure without overt leftheart symptoms. Rapid progression to severe right heart failure with moderate pericardial effusion prompted the diagnosis of associated restrictive cardiomyopathy. A MRI scan of the heart revealed diffuse subendocardial scarring of LV and RV explaining patient's rapid downhill course.

Echocardiographic recognition of a criss-cross heart with double outlet right ventricle.

Crisscross heart (CCH) is a rare cardiac malformation characterized by crossing of the inflow streams of the two ventricles due to an apparent twisting of the heart about its long axis. The developmental mechanisms and causes of CCH are remaining unknown. Neonates mainly presents with cyanosis and a systolic murmur. We herein present a case of CCH with concordant atrioventriculo connections with double outlet right ventricle (DORV) which was diagnosed by echocardiography.

Accuracy of pulse oximetry screening for detecting critical congenital heart disease in the newborns in rural hospital of Central India.

BACKGROUND: Congenital cardiovascular malformations are the most common category of birth defects and responsible for mortality in the first twelve months of life. Critical congenital heart disease (CCHD) will be present in approximately one quarter of these children, which requires catheter or surgery intervention in the first year of life. AIM: To determine the accuracy of pulse oximetry for detecting clinically unrecognized CCHD in the newborns. METHODS: Pulse oximetry was performed on clinically normal newborns within first 4 hours of life. If screening oxygen saturation (SpO2) was below 90%, echocardiography was then performed. INCLUSION CRITERIA: All newborns who were admitted in postnatal ward & NICU. EXCLUSION CRITERIA: Out born babies and babies with a prenatal diagnosis of duct dependent circulation. RESULTS: Pulse-oximetric screening was performed on 2110 clinically normal newborns. Low SpO2 (<90%) was found in eight babies seven of them had CCHD, including three neonates with TGA, two with tricuspid atresia, one with tetralogy of fallot and one with transposition of great vessels. A pulse oximetry cut-off value of below 90% for detecting CCHD showed 100% sensitivity, 99.95% specificity, 87.50% positive predictive value, 100% negative predictive value. CONCLUSIONS: Pulse oximetry is safe, feasible and noninvasive, can be used as screening tool for detecting CCHD in clinically normal newborn. If SpO2 is below 90% in clinically normal newborns within 4 hours of birth, urgent echocardiography is suggested to rule out CCHD.

Familial hypercholesterolaemia IIA with bicuspid aortic valve.

A young male presented with multiple xanthomas and xanthelesmas, progressive breathlessness and angina on exertion. Investigations confirmed diagnosis of familial hypercholesterolaemia, bicuspid aortic valve with severe aortic stenosis and significant obstructive coronary artery disease.

Cor triatriatum sinister with situs inversus totalis in an infant.

Cor triatriatum sinister is a rare congenital cardiac malformation characterized by a membrane in the left atrium which separates the left atrium into the proximal and distal chambers. Association of cor triatriatum is extremely rare with situs inversus totalis. Here we report a rare case of cor triatriatum sinister with situs inversus totalis in a 5 month old female infant.

Double orifice mitral valve associated with Ventricular Septal Defect in an infant: Case Report.

Double orifice mitral valve (DOMV) is an uncommon anomaly characterized by a mitral valve with a single fibrous annulus with two orifices opening into the left ventricle. Here we present a rare case of DOMV with ventricular septal defect (VSD) which was detected by 2-D echocardiography.

Diagnosis of aortic origin of a pulmonary artery by echocardiography.

The aortic origin of right or left branch pulmonary artery is a rare cardiac anomaly in which the right pulmonary artery usually arises from the ascending aorta just above the aortic sinuses, whereas the main pulmonary artery and the other pulmonary branch arise in their normal position. We report a rare case of isolated origin of right pulmonary artery from the ascending aorta.

Infantile blount disease: a case report.

Blount disease is an acquired growth disorder of the medial aspect of the proximal tibial physis, epiphysis and metaphysis. Infantile Blount disease present with bowing and length discrepancy in the lower limbs. The deformed medial tibial metaphysis represent as nontender bony protuberance can be palpated along the medial aspect of the proximal tibia. Here, we present an 18-month-old boy presented with the complaints of bilateral bowing of lower limb with normal biochemical investigation and radiological survey revealed Blount disease.

Predictor of low birth weight babies by anthropometry.

OBJECTIVE: The present study was undertaken to find out the best simple anthropometric parameter for identifying low birth weight (LBW) babies. STUDY DESIGN: Hospital-based cross-sectional study. PARTICIPANTS: Newborn babies born in KHS hospital, Sevagram. RESULTS: In the present study, out of 868 newborn babies studied, 52.2% were male. Total 12.6% of them were birth weight < 2000 g and 44.6% were birth weight < 2500 g. Birth weight was significantly correlated (p < 0.001) with thigh circumference (TC), mid-arm circumference (MAC), calf circumference (CFC) and head circumference (HC). All anthropometric indicators had a statistically significant sensitivity, specificity and predictive value (p < 0.001) for identifying < or =2500 g birth weight babies. Receiver operating curve (ROC) analysis was done to identify the optimal cut-off points of these anthropometric measures separately for LBW babies and <2000 g birth weight babies. CONCLUSION: HC and TC appears to be better indicators for picking up LBW babies and MAC and CFC appears to be better in picking up very LBW babies.