Three Dimensional (3D) Echocardiography as a Tool of Left Ventricular Assessment in Children with Dilated Cardiomyopathy: Comparison to Cardiac MRI.

BACKGROUND: Left ventricular (LV) volumes and ejection fraction (EF) is Strong prognostic indicators for DCM. Cardiac MRI (CMRI) is a preferred technique for LV volumes and EF assessment due to high spatial resolution and complete volumetric datasets. Three-dimensional echocardiography is a promising new technique under investigations. AIM: Evaluate 3D echocardiography as a tool in LV assessment in DCM children about CMRI. PATIENTS AND METHODS: A group of 20 DCM children (LVdiastolic diameter < 2 Z score, LVEF < 35%) at Children s Hospital, Ain-Shams University (gp1) (mean age 6.6 years) were compared to 20 age and sex-matched children as controls (gp2). Patients were subjected to: clinical examination, conventional echocardiography, automated 3D LV quantification, 3D speckle tracking echocardiography (3D-STE) (VIVID E9 Vingmed, Norway) and CMRI (Philips Achieva Nova, 1.5 Tesla scanner) for LV end systolic volume (LVESV), LVend diastolic volume (LVEDV) that were indexed to body surface area, EF% and wall motion abnormalities assessment. RESUTS: No statistically significant difference was found between automated 3D LV quantification echocardiography, 3D-STE, and CMRI in ESV/BSA and EDV/BSA assessment (p = 1, 0.99 respectively), between automated LV quantification echocardiography and CMRI in EF% assessment (p = 0.99) and between CMRI and 3D-STE in LV Global hypokinesia detection (P = 0.255). As for segmental hypokinesia CMRI was more sensitive [45% of patients vs. 40%, (P = 0,036), basal septal hypokinesia 85% vs. 75%, (p = 0.045), mid septal hypokinesia 80% vs. 65%, (p = 0.012) and lateral wall hypokinesia 75% vs. 65%, (p = 0.028)]. CONCLUSION: Automated 3D LV quantification echocardiography and 3D-STE are reliable tools in LV volumetric and systolic function assessment about CMRIas a standard method. 3D speckle echocardiography is comparable to CMRI in global wall hypokinesia detection but less sensitive in segmental wall hypokinesia which mandates further studies.

Cardiac parameters and interleukin-6 differences between adolescents with hepatitis B infection versus those complicated with hepatocelluar carcinoma

Background and study aim: Hepatitis B virus (HBV) is a major risk factor of hepatocellular carcinoma (HCC) in all age groups. There is a need to differentiate between them in the adolescence age by laboratory and physical examination for assessment of different outcomes of both diseases.Subjects and Methods: Cross sectional study that included Session [UserIDID] adolescents with HBV, another Session [UserIDID] with HCC with age ranging from 12 and up to 17 years. They were selected from those admitted to Tropical Medicine Department, Menofia University and Tropical Medicine Department, Zagazig University. All patient underwent laboratory assessment of interleukin6 (IL6) and were further examined at the Cardiology Unit in Pediatric department of Ain Shams University hospitals for complete echo-cardiographic and anthropometric evaluation.Results: Twenty four patients have HCC were examined with mean age (14.15± 3.01) years and another Session [UserIDID] are having HBV (14.64±3.13) years. Differences were found between both groups as regards IL6 as mean values were (13.29 pg/ml) in HBV and (77.63 pg/ml) in HCC group while no differences were detected as regards cardiac and anthropometric evaluations.Conclusion: IL6 seems to be a useful marker to compare between HBV and HCC in adolescent patients instead of depending on clinical cardiac evaluation or growth parameters that showed no differences

The Prevalence and Risk Factors of Early Arrhythmias Following Pediatric Open Heart Surgery in Egyptian Children.

AIM: This study aimed to assess the prevalence of early postoperative arrhythmias after cardiac operation in the pediatric population, and to analyse possible risk factors. MATERIAL AND METHODS: Cross-sectional study included 30 postoperative patients, with age range four up to 144 months. They were selected from those admitted to the Cardiology Unit in the Pediatric department of Ain Shams University hospitals, after undergoing cardiopulmonary bypass (CPB) surgery for correction of congenital cardiac defects. All patients had preoperative sinus rhythm and normal preoperative electrolytes levels. All patients' records about age, weight, type of surgery, intraoperative arrhythmias, cardiopulmonary bypass time, ischemic time and use of inotropic drugs were taken before they were admitted to the specialised pediatric post-surgery intensive care unit (ICU). RESULTS: Arrhythmia was documented in 15 out of 30 patients (50%). Statistically significant difference between the arrhythmic and non-arrhythmic group were recorded in relation to the age of operation (23 vs 33 months), weight (12 vs. 17 kg), ischemic time (74.5 vs. 54 min), cardiopulmonary bypass time (125.5 vs. 93.5min), inotrope use (1.6 vs. 1.16) and postoperative ICU stay (5.8 vs. 2.7 days), P<0.05. CONCLUSION: Early postoperative arrhythmias following surgery for congenital heart disease are relatively frequent in children (50%). Younger age, lower body weight, longer ischemic time and bypass time, and more inotrope use are all risk factors for postoperative arrhythmias and lead to increase the hospital stay.

Early Cardiac Involvement and Risk Factors for the Development of Arrhythmia in Patients With ß-Thalassemia Major.

BACKGROUND: Cardiac iron overload is the most serious complication in thalassemia; even patients treated with intensive chelation suffer at a certain point from cardiomyopathy and arrhythmia. AIM: The aim of the study was to identify indicators of cardiac dysfunction in thalassemia as well as risk factors associated with the development of arrhythmia. PATIENTS AND METHODS: A total of 45 patients with ß-thalassemia major were enrolled in this cross-sectional study. Patients were divided into 2 groups according to the absence (group A) or the presence of arrhythmia (group B). Cardiac parameters in thalassemic groups were evaluated using 24-Holter recording, Stress electrocardiogram, and M-mode echocardiography. Serum ferritin and Cardiac T2* were used to assess the iron status. RESULTS: Group B showed significantly higher values of cardiac T2* and serum ferritin (P<0.05). Group B patients had significantly higher maximum heart rate with significant attacks of bradycardia and ST segment changes. In addition, they achieved a lower percentage of maximum age predicted heart rate and lower values of maximum metabolic equivalents (P<0.05). Significantly higher values of the left atrial diameter, the interventricular septum diameter, and the left-ventricle posterior wall diameter (P<0.05) were identified in group B. CONCLUSIONS: The increase in left atrial diameter, interventricular septum diameter, and left-ventricle posterior wall diameter seems to be related to the development of arrhythmia in patients with thalassemia, especially supraventricular arrhythmias.