Review Articles
Post-catheterisation arterial thrombosis in children – pathophysiology, prevention, and treatment
- João Silva Marques, Cristina Gonçalves
-
- Published online by Cambridge University Press:
- 27 February 2014, pp. 767-773
-
- Article
- Export citation
-
Lower limb ischaemia is the most frequent complication of cardiac catheterisation in children. It is often overlooked, but it can cause significant disability and may limit arterial access sites to repeat diagnostic or interventional catheterisations. A narrative review of the literature on arterial access site thrombosis in children was carried out with a special focus on current evidence that supports preventive and treatment strategies. Anticoagulation, thrombolysis, and thrombectomy have been used successfully to treat arterial access site thrombosis. However, it is not completely established which is the role of each treatment modality and what is the most appropriate timing to deliver it. Therefore, diagnostic and therapeutic strategies have to be prospectively investigated, particularly for clarifying the role of new pharmacologic interventions and of percutaneous and surgical thrombectomy in the current era.
Abnormal origins of the coronary arteries from the aortic root
- Julien I.E. Hoffman
-
- Published online by Cambridge University Press:
- 23 April 2014, pp. 774-791
-
- Article
- Export citation
-
Anomalous origin of a coronary artery from the aorta is a potentially serious anomaly that occurs in about 0.1–0.2% of the population. This percentage is small; however, it translates into about 4000 annual births with these anomalies. The clinical presentation of these anomalies is rare, and hence most are and will remain asymptomatic. The various anatomic anomalies are described, with anomalous origin of the left coronary artery that then passes between the aorta and pulmonary artery being the most serious of these anomalies. The pathophysiology resulting from these anomalies is described, as are methods for identifying those who require treatment; however, we still do not know the best methods of determining which patients need treatment.
Assessment of therapeutic biomarkers in the treatment of children with postural tachycardia syndrome and vasovagal syncope
- Jing Lin, Hongfang Jin, Junbao Du
-
- Published online by Cambridge University Press:
- 28 April 2014, pp. 792-796
-
- Article
- Export citation
-
Background: Postural tachycardia syndrome and vasovagal syncope are common causes of orthostatic intolerance in children. The supplementation with water, or salt, or midodrine, or β-blocker was applied to children with postural tachycardia syndrome or vasovagal syncope. However, the efficacy of such medication varied and was not satisfied. This review aimed to summarise the current biomarkers in the treatment of the diseases. Data sources: Studies were collected from online electronic databases, including OVID Medline, PubMed, ISI Web of Science, and associated references. The main areas assessed in the included studies were clinical improvement, the cure rate, and the individualised treatment for postural tachycardia syndrome and vasovagal syncope in children. Results: Haemodynamic change during head-up tilt test, and detection of 24-hour urinary sodium excretion, flow-mediated vasodilation, erythrocytic H2S, and plasma pro-adrenomedullin as biological markers were the new ways that were inexpensive, non-invasive, and easy to test for finding those who would be suitable for a specific drug and treatment. Conclusion: With the help of biomarkers, the therapeutic efficacy was greatly increased for children with postural tachycardia syndrome and vasovagal syncope.
Percutaneous management of coronary sinus atrial septal defect: two cases representing the spectrum for device closure and a review of the literature
- Nefthi Sandeep, Michael C. Slack
-
- Published online by Cambridge University Press:
- 25 March 2014, pp. 797-806
-
- Article
- Export citation
-
Coronary sinus atrial septal defects are the rarest defects of the atrial septum comprising <1% of the five different types of atrial septal defects. Despite the widespread adoption of percutaneous device closure of secundum atrial septal defects, the published experience with percutaneous device closure of coronary sinus atrial septal defects is limited to only a few isolated case reports because of uncertainty regarding safety and efficacy. Open-heart surgical repair remains the treatment of choice for coronary sinus atrial septal defects, although this may not be the only treatment option in selected cases. Herein we describe our own experience with two patients with different clinical presentations and our method of successful percutaneous coronary sinus atrial septal defect closure in each. We then present a review of the anatomic spectrum of coronary sinus atrial septal defects along with a review of contemporary surgical and percutaneous device treatment.
Original Articles
The use of dornase alpha for post-operative pulmonary atelectasis after congenital heart surgery
- Erkut Ozturk, Ibrahim C. Tanidir, Sertac Haydin, Ismihan S. Onan, Ender Odemis, Ihsan Bakir
-
- Published online by Cambridge University Press:
- 06 August 2013, pp. 807-812
-
- Article
- Export citation
-
Objective: To investigate the efficacy of dornase alpha, a mucolytic agent, in children who developed pulmonary atelectasis after congenital heart surgery. Design: Retrospective case–control study. Setting: Paediatric cardiac intensive care unit at a tertiary care hospital. Patients: Between July, 2011 and July, 2012, 41 patients who underwent congenital cardiac operations and developed post-operative pulmonary atelectasis that was resistant to conventional treatment and chest physiotherapy. Interventions: In all, 26 patients received dornase alpha treatment. As a control group, 15 patients were treated with conventional medications and chest physiotherapy. Main results: The median age of patients was 25.5 (3–480) days in the study group and 50.0 (3–480) days in the control group. A total of 15 (57.6%) patients in the study group and 8 (53.3%) patients in the control group were male. The median weight was 4.2 (2.9–14.2) kg and 4.0 (3.5–13.6) kg in the study and control group, respectively. In the study group, pulmonary atelectasis was diagnosed at a median period of 5 (2–18) days after operations, whereas in the control group atelectasis was diagnosed at a median period of post-operative 6 (3–19) days. In the study group, the median atelectasis score decreased from 3.4 (1–6) to 0.8 (0–3) (p = 0.001). The median pO2 level increased from 69 (17–142) mmHg to 89 (30–168) mmHg (p = 0.04). In addition, heart rate and respiratory rate per minute were significantly decreased (p < 0.05). There were no significant changes in these parameters in the control group. Conclusions: The use of dornase alpha can be effective for the management of pulmonary atelectasis that develops following congenital heart surgery.
Atrioventricular valve regurgitation at diagnosis in single-ventricle patients: does it affect longitudinal outcomes?
- Jason M. Garnreiter, Lloyd Y. Tani, Hsin-Yi Weng, Xiaoming Sheng, Nelangi M. Pinto
-
- Published online by Cambridge University Press:
- 19 September 2013, pp. 813-821
-
- Article
- Export citation
-
Introduction
Significant atrioventricular valve regurgitation at diagnosis in single-ventricle patients has been associated with mortality and morbidity. However, longitudinal data on the effect of valve regurgitation at diagnosis on outcomes in the era of surgical valve interventions are scarce.
Materials and methodsThis is a retrospective review of single-ventricle patients admitted to a regional centre from 2005 to 2008. Data were reviewed from birth to 18 months, and association of atrioventricular valve regurgitation at diagnosis with mortality and morbidity was evaluated.
ResultsA total of 118 patients were studied, 73% with a single right ventricle. At diagnosis, 37 patients (31%) had mild, 5 (4%) had mild to moderate, and 4 (3%) had ≥ moderate atrioventricular valve regurgitation. Moderate or greater valve regurgitation was associated with mortality (HR 5.51, 95% CI 1.24–24.61, p = 0.025), and all four patients with ≥ moderate valve regurgitation died. However, valve regurgitation was not associated with mortality for left ventricle patients. In all, 12 patients (10%) had surgical atrioventricular valve interventions. There were no independent predictors of valve intervention, and no patient having an intervention had > mild valve regurgitation at diagnosis. There was no association between valve regurgitation and days of hospitalisation or chest tube drainage.
ConclusionSignificant atrioventricular valve regurgitation at diagnosis remains a risk factor for mortality in single-ventricle patients, although it may be less important for single left ventricle patients. However, it is not associated with increased morbidity or surgical atrioventricular valve intervention in survivors. Reliably predicting surgical atrioventricular valve intervention remains a challenge in single-ventricle patients.
The value of stress perfusion cardiovascular magnetic resonance imaging for patients referred from the adult congenital heart disease clinic: 5-year experience at the Toronto General Hospital
- Djeven P. Deva, Felipe S. Torres, Rachel M. Wald, S. Lucy Roche, Laura Jimenez-Juan, Erwin N. Oechslin, Andrew M. Crean
-
- Published online by Cambridge University Press:
- 18 September 2013, pp. 822-830
-
- Article
- Export citation
-
Background: Vasodilator stress perfusion cardiovascular magnetic resonance imaging is a clinically useful tool for detection of clinically significant myocardial ischaemia in adults. We report our 5-year retrospective experience with perfusion cardiovascular magnetic resonance in a large, quarternary adult congenital heart disease centre. Methods: We reviewed all cases of perfusion cardiovascular magnetic resonance in patients referred from the adult congenital heart disease service. Dipyridamole stress perfusion cardiovascular magnetic resonance was undertaken on commercially available 1.5 and 3 T cardiovascular magnetic resonance scanners. Late gadolinium enhancement imaging was performed 8–10 minutes after completion of the rest perfusion sequence. Navigator whole-heart coronary magnetic resonance angiography was also performed where feasible. Results of stress cardiovascular magnetic resonance were correlated with complementary imaging studies, surgery, and clinical outcomes. Results: Over 5 years, we performed 34 stress perfusion cardiovascular magnetic resonance examinations (11 positive). In all, 84% of patients had further investigations for ischaemia in addition to cardiovascular magnetic resonance. Within a subgroup of 19 patients who had definitive alternative assessment of their coronary arteries, stress perfusion cardiovascular magnetic resonance demonstrated a sensitivity of 82% and specificity of 100%. Of the 34 studies, two were false negatives, in which the aetiology of ischaemia was extrinsic arterial compression rather than intrinsic coronary luminal narrowing. Coronary abnormalities were identified in 71% of cases who had coronary magnetic resonance angiography. Conclusion: Stress perfusion cardiovascular magnetic resonance is a useful and accurate tool for investigation of myocardial ischaemia in an adult congenital heart disease population with suspected non-atherosclerotic coronary abnormalities.
Pre-operative renal volume predicts peak creatinine after congenital heart surgery in neonates
- J. Bryan Carmody, Michael D. Seckeler, Cortney R. Ballengee, Mark Conaway, K. Anitha Jayakumar, Jennifer R. Charlton
-
- Published online by Cambridge University Press:
- 08 November 2013, pp. 831-839
-
- Article
- Export citation
-
Objective: Acute kidney injury is common in neonates following surgery for congenital heart disease. We conducted a retrospective analysis to determine whether neonates with smaller pre-operative renal volume were more likely to develop post-operative acute kidney injury. Design/Setting: We conducted a retrospective review of 72 neonates who underwent congenital heart surgery for any lesion other than patent ductus arteriosus at our institution from January 2007 to December 2011. Renal volume was calculated by ultrasound using the prolate ellipsoid formula. The presence and severity of post-operative acute kidney injury was determined both by measuring the peak serum creatinine in the first 7 days post-operatively and by using the Acute Kidney Injury Network scoring system. Results: Using a linear change point model, a threshold renal volume of 17 cm3 was identified. Below this threshold, there was an inverse linear relationship between renal volume and peak post-operative creatinine for all patients (p = 0.036) and the subgroup with a single morphologic right ventricle (p = 0.046). There was a non-significant trend towards more acute kidney injury using Acute Kidney Injury Network criteria in all neonates with renal volume ≤17 cm3 (p = 0.11) and in the subgroup with a single morphologic right ventricle (p = 0.17). Conclusions: Pre-operative renal volume ≤17 cm3 is associated with a higher peak post-operative creatinine and potentially greater risk for post-operative acute kidney injury for neonates undergoing congenital heart surgery. Neonates with a single right ventricle may be at higher risk.
Thrombotic events in critically ill children with myocarditis
- Kimberly Y. Lin, Basavaraj Kerur, Char M. Witmer, Lauren A. Beslow, Daniel J. Licht, Rebecca N. Ichord, Beth D. Kaufman
-
- Published online by Cambridge University Press:
- 09 September 2013, pp. 840-847
-
- Article
- Export citation
-
Background: Children with myocarditis have multiple risk factors for thrombotic events, yet the role of antithrombotic therapy is unclear in this population. We hypothesised that thrombotic events in critically ill children with myocarditis are common and that children with myocarditis are at higher risk for thrombotic events than children with non-inflammatory dilated cardiomyopathy. Methods: This is a retrospective chart review of all children presenting to a single centre cardiac intensive care unit with myocarditis from 1995 to 2008. A comparison group of children with dilated cardiomyopathy was also examined. Antithrombotic regimens were recorded. The primary outcome of thrombotic events included intracardiac clots and any thromboembolic events. Results: Out of 45 cases with myocarditis, 40% were biopsy-proven, 24% viral polymerase chain reaction-supported, and 36% diagnosed based on high clinical suspicion. There were two (4.4%) thrombotic events in the myocarditis group and three (6.7%) in the dilated cardiomyopathy group (p = 1.0). Neither the use of any antiplatelet or anticoagulation therapy, use of intravenous immune globulin, presence of any arrhythmia, nor need for mechanical circulatory support were predictive of thrombotic events in the myocarditis, dilated cardiomyopathy, or combined groups. Conclusions: Thrombotic events in critically ill children with myocarditis and dilated cardiomyopathy occurred in 6% of the combined cohort. There was no difference in thrombotic events between inflammatory and non-inflammatory cardiomyopathy groups, suggesting that the decision to use antithrombotic prophylaxis should be based on factors other than the underlying aetiology of a child's acute decompensated heart failure.
Are the children and adolescents with congenital heart disease living in Southwestern Ontario really overweight and obese?
- Eva Welisch, Ralf Rauch, Jamie A. Seabrook, MA Guido Filler, Kambiz Norozi
-
- Published online by Cambridge University Press:
- 25 September 2013, pp. 848-853
-
- Article
- Export citation
-
Objective
To assess the prevalence of overweight and obesity in children with congenital heart disease and compare them with age-matched healthy children in Southwestern Ontario, Canada.
MethodsWe compared the Center of Disease Control weight and body mass index z-scores of 1080 children, aged 2 to 18 years, who presented to our paediatric cardiology outpatient clinic from 2008 to 2010 for congenital heart disease with 1083 healthy controls.
ResultsIn all, 18.2% of the children with congenital heart disease and 20.8% of healthy children were identified to be either overweight or obese. Overall, the weight category distribution had been similar between the congenital heart disease and healthy control groups, as well as between the congenital heart disease subgroups. There was no difference in normal weight and overweight/obese categories between children with congenital heart disease and healthy children. The underweight category, however, showed a significantly higher prevalence in congenital heart disease compared with healthy children (6.8 and 4.5%, respectively, p = 0.03).
ConclusionThe prevalence of overweight/obesity did not differ in children with congenital heart disease compared with age-matched healthy children; however, it is still high (18.2%). Obesity may represent an additional risk factor for the long-term cardiovascular health of congenital heart disease patients aside from the underlying heart defect.
Left ventricular strain and strain rates are decreased in children with normal fractional shortening after exposure to anthracycline chemotherapy
- Thomas J. Moon, Shelley D. Miyamoto, Adel K. Younoszai, Bruce F. Landeck
-
- Published online by Cambridge University Press:
- 18 September 2013, pp. 854-865
-
- Article
- Export citation
-
Background
Anthracycline chemotherapeutic agents carry the well-recognised risk of cardiotoxicity. Previous methods to evaluate cardiac function are useful, but have significant limitations. We sought to determine the left ventricular strain and strain rate of paediatric cancer patients with normal fractional shortening treated with anthracyclines using the latest ultrasound feature-tracking technology.
Patients and methodsEchocardiograms on cancer patients before anthracycline exposure and following completion of treatment were retrospectively analysed using Velocity Vector Imaging software in the circumferential and longitudinal planes. The same analysis was performed on matched controls. Only patients with a fractional shortening ≥28% were included.
ResultsIn all, 71 patients were identified with an age at diagnosis of 10.5 ± 4.7 years. The time from diagnosis to follow-up was 3.9 ± 4.0 years and the cumulative anthracycline dose was 356 ± 106 mg/m2. Following anthracycline exposure, paediatric cancer patients had a higher heart rate and a lower longitudinal strain, longitudinal diastolic strain rate, circumferential strain, and circumferential systolic and diastolic strain rate when compared with controls. Diastolic strain rate showed the greatest percent difference following anthracycline exposure versus controls.
ConclusionDespite having a normal fractional shortening, children exposed to anthracyclines have subclinical derangement of their left ventricular deformation as measured by decreases in strain and strain rate in both the circumferential and longitudinal axis. In particular, there was a profound decrease in diastolic strain rate following anthracycline exposure compared with controls. Whether the decline of strain or strain rate can predict future risk of developing cardiomyopathy requires further investigation.
Congenital heart disease in 37,294 births in Tunisia: birth prevalence and mortality rate
- Dorra Abid, Anis Elloumi, Leila Abid, Souad Mallek, Hajer Aloulou, Imen Chabchoub, Amira Bouraoui, Afef Thabet, Lamia Gargouri, Malek Zribi, Sourour Yaich, Mongia Hachicha, Abdellatif Gargouri, Abdelmajid Mahfoudh, Samir Maatoug, Jamel Dammak, Samir Kammoun
-
- Published online by Cambridge University Press:
- 08 October 2013, pp. 866-871
-
- Article
- Export citation
-
Aim: To investigate the previously unknown birth incidence, treatment, and mortality of children with congenital heart disease in Tunisia. Methods: We undertook a retrospective review of medical records of all patients who were born in 2010 and 2011, and were diagnosed in Sfax (Tunisia) with congenital heart defect. Results: Among 37,294 births, 255 children were detected to have congenital heart disease, yielding a birth incidence of 6.8 per 1000. The most frequently occurring conditions were ventricular septal defects (31%), ostium secundum atrial septal defects (12.9%), and pulmonary valve abnormalities (12%). Coarctation of the aorta, tetralogy of Fallot, univentricular physiology, pulmonary atresia with ventricular septal defect, and transposition of the great arteries were found in 4.3%, 6.2%, 3.4%, 2.7%, and 2.7%, respectively. During the follow-up of 1 year, 23% of the children died. About three-quarters of those deaths happened before surgery. Conclusion: The present study is in line with the general estimates in the world. It has revealed a high case of mortality among the patients awaiting corrective surgery. These children need more facilities.
An evaluation of heart rate variability and its modifying factors in children with type 1 diabetes
- Senem Özgür, Özben Ceylan, Filiz Şenocak, Utku A. Örün, Vehbi Doğan, Osman Yılmaz, Mahmut Keskin, Zehra Aycan, Sercan Okutucu, Selmin Karademir
-
- Published online by Cambridge University Press:
- 09 September 2013, pp. 872-879
-
- Article
- Export citation
-
Objective: To evaluate heart rate variability by Holter monitoring in type 1 diabetic children compared with a healthy control group and determine the factors modifying heart rate variability. Methods: This was designed as a prospective study comparing 28 patients, diagnosed with type 1 diabetes and under follow-up, with 27 healthy control group subjects. Results: The patients were aged 9.9 ± 4.2 years in the diabetic group, including 13 (46.5%) girls and 15 (53.5%) boys. The healthy control group comprised 20 (74%) girls and seven boys (26%) with an average age of 8.6 ± 3.7 years. The search for factors modifying heart rate variability yielded the following correlations: for the time-dependent variables, negative between age and both average and maximal heart rate (r = −0.263 and −0.460, respectively), negative between haemoglobin A1c and percentage of differences between adjacent RR intervals >50 ms, positive between diabetes duration and square root of the mean of the sum of squares of differences between adjacent NN intervals. The average heart rate and percentage of differences between adjacent RR intervals >50 ms was significantly higher in the girls than the boys in all groups. With regard to the frequency-dependent factors affecting heart rate variability, correlations were found between haemoglobin A1c level and both total power and very low frequency (r = −0.751 and −0.644) and between very low frequency and diabetes duration. Conclusion: A reduction in heart rate variability parameters was observed in type 1 diabetes mellitus patients who had a long disease duration or were poorly controlled, as compared with healthy controls.
Sedation for paediatric transcatheter atrial septal defect closure: comparison of two sedation protocols
- Ayşe Ülgey, Adnan Bayram, Işın Güneş, Recep Aksu, Cihangir Bicer, Aynur Akin, Ali Baykan, Nazmi Narin, Adem Boyaci
-
- Published online by Cambridge University Press:
- 09 September 2013, pp. 880-885
-
- Article
- Export citation
-
Aim: This study aimed to compare the effects of dexmedetomidine–propofol and ketamine–propofol sedation on haemodynamic stability, immobility, and recovery time in children who underwent transcatheter closure of atrial septal defects. Methods: In all, 46 children scheduled for transcatheter closure of atrial septal defects (n = 46) were included. The dexmedetomidine–propofol group (n = 23) received dexmedetomidine (1 μg/kg) and propofol (1 mg/kg) for induction, followed by dexmedetomidine (0.5 μg/kg/hour) and propofol (100 μg/kg/minute) for maintenance. The ketamine–propofol group (n = 23) received ketamine (1 mg/kg) and propofol (1 mg/kg) for induction, followed by ketamine (1 mg/kg) and propofol (100 μg/kg/minute) for maintenance. Results: In all, 11 patients in the dexmedetomidine group (47.8%) and one patient (4.3%) in the ketamine group demonstrated a decrease ≥20% from the baseline in mean arterial pressure (p = 0.01). Heart rates decreased ≥20% from the baseline value in 10 patients (43.4%) in the dexmedetomidine group and three patients (13%) in the ketamine group (p = 0.047). Heart rate values were observed to be lower in the dexmedetomidine group throughout the procedure after the first 10 minutes. The number of patients requiring additional propofol was higher in the dexmedetomidine group (p = 0.01). The recovery times were similar in the two groups – 15.86 ± 6.50 minutes in the dexmedetomidine group and 19.65 ± 8.19 minutes in the ketamine group; p = 0.09. Conclusion: The ketamine–propofol combination was less likely to induce haemodynamic instability, with no significant change in recovery times, compared with the dexmedetomidine–propofol combination. The ketamine–propofol combination provided good conditions for the intervention.
Catheter ablation of idiopathic ventricular tachycardia in children using the EnSite NavX system with/without fluoroscopy
- Isa Ozyilmaz, Yakup Ergul, Celal Akdeniz, Erkut Ozturk, Ibrahim C. Tanidir, Volkan Tuzcu
-
- Published online by Cambridge University Press:
- 10 September 2013, pp. 886-892
-
- Article
- Export citation
-
Objectives
Curative therapy of idiopathic ventricular tachycardia remains a challenge in interventional electrophysiology. The aim of this study was to demonstrate the utility of an EnSite NavX system in the catheter ablation of idiopathic ventricular tachycardia in children.
Patients and methodsIn all, 17 children with idiopathic ventricular tachycardia underwent electrophysiological studies using the EnSite NavX system guidance.
ResultsThe mean patient age was 13 ± 2.4 years (range: 7.8–17.9) and the mean patient weight was 52.3 ± 11.9 kg (range: 32–75). The origin of ventricular tachycardia was in the right ventricular outflow tract in nine patients, in the left ventricle in six, near the bundle of His/right bundle branch in one, and in the left aortic cusp in one. The mean procedure and fluoroscopy times were 169.3 ± 43.2 minutes and 8 ± 10.8 minutes, respectively. No fluoroscopy was used in six patients. The mean radiation exposure was 33.1 ± 56.4 mGy. Acute success was achieved in 14 patients (82%). The focus of ventricular tachycardia was epicardial in two failed procedures. During a mean follow-up of 8.5 ± 7.6 months, ventricular tachycardia recurred in three patients, two of whom underwent a second procedure. Except for one patient who developed transient right bundle branch block, no complications were seen.
ConclusionCatheter ablation of idiopathic ventricular tachycardia in children can be performed safely and effectively with low fluoroscopy exposure using the EnSite NavX system.
Chronic pain in children after cardiac surgery via sternotomy
- Mette H. Lauridsen, Anders D. Kristensen, Vibeke E. Hjortdal, Troels S. Jensen, Lone Nikolajsen
-
- Published online by Cambridge University Press:
- 18 September 2013, pp. 893-899
-
- Article
- Export citation
-
Introduction
Chronic pain is common after sternotomy in adults with reported prevalence rates of 20–50%. So far, no studies have examined whether children develop chronic pain after sternotomy.
Material and methodsPostal questionnaires were sent to 171 children 10–60 months after undergoing cardiac surgery via sternotomy at the age of 0–12 years. The children were asked to recall the intensity and duration of their post-operative pain, if necessary with the help from their parents, and to describe the intensity and character of any present pain. Another group of 13 children underwent quantitative sensory testing of the scar area 3 months after sternotomy.
ResultsA total of 121 children, median (range) age 7.7 (4.2–16.9) years, answered the questionnaire. Their age at the time of surgery was median (range) 3.8 (0–12.9) years, and the follow-up period was median (range) 4 (0.8–5.1) years. In all, 26 children (21%) reported present pain and/or pain within the last week located in the scar area; in 12 (46%) out of the 26 children, the intensity was ≥4 on a numeric rating scale (0–10). Quantitative sensory testing of the scar area revealed sensory abnormalities – pinprick hyperalgesia and brush and cold allodynia – in 10 out of 13 children.
ConclusionChronic pain after cardiac surgery via sternotomy in children is a problem that should not be neglected. The pain is likely to have a neuropathic component as suggested by the sensory abnormalities demonstrated by quantitative sensory testing.
Initial use of endothelial progenitor cells capturing stents in paediatric congenital heart disease
- Nuno Cabanelas, José D. F. Martins, Fátima Pinto
-
- Published online by Cambridge University Press:
- 18 September 2013, pp. 900-904
-
- Article
- Export citation
-
Introduction
Stenosis, mediated by neointimal hyperplasia and thrombosis, is a major limiting factor in successful stent implantation. The introduction of a stent, coated in its endoluminal surface by antihuman CD34 antibodies with endothelial progenitor cell-capturing properties, opens the possibility of promoting a rapid and normal functioning coverage by endothelium and thus avoids both an excessive cell proliferation within stent and the need for long-term dual antiplatelet therapy. These stents, developed for adult coronary artery disease, have not yet been implanted in children or in those with congenital heart disease.
Objective and methodsIn this paper, we describe the implantation of Genous® stents in three children with cyanotic congenital heart disease and obstructed systemic-to-pulmonary shunts. We describe the use of this stent and address its potential feasibility in paediatric congenital heart disease.
ResultsTo maintain the patency of two modified Blalock–Taussig shunts and one ductus arteriosus, four Genous® stents were implanted in three infants with cyanotic heart disease. All procedures were immediately successful, with resolution of stenosis and improvement in transcutaneous oxygen saturation from 66% ± 3.6% to 92% ± 2.6%. In the follow-up, one stent had no occlusion; however, the remaining two had partial occlusion after 5 and 5.5 months, which were successfully managed with balloon dilatation preceding elective definitive surgical correction.
ConclusionIn our preliminary experience, we demonstrated that Genous® stent implantation was feasible in infants with complex congenital heart disease. Additional studies with larger samples and longer follow-up are required to confirm the potential benefits of this technology in this clinical setting.
Prevalence of congenital heart disease among Palestinian children born in the Gaza Strip
- Mahmoud Zaqout, Emad Said Aslem, Forijat Sadeldin Oweida, Daniel De Wolf
-
- Published online by Cambridge University Press:
- 19 September 2013, pp. 905-909
-
- Article
- Export citation
-
Objective
This study was designed to estimate the birth prevalence of children with congenital heart disease born in the Gaza Strip during 2010 and to compare these with estimates from elsewhere.
MethodsWe reviewed the medical records of all children born in 2010 who were diagnosed, treated, and/or followed up in the four paediatric cardiology clinics in the Gaza Strip. Data were also obtained from El Makassed Hospital in East Jerusalem and from the Schneider Hospital, Wolfson Medical Center, and Tel HaShomer Hospital in Israel, where we had referred some of our patients for percutaneous or surgical treatment.
ResultsA total of 598 children with congenital heart disease were detected among the 59,757 children born alive in the Gaza Strip during 2010, yielding a birth incidence of 10 per 1000 live births. The most frequently occurring conditions were ventricular septal defects (28%), ostium secundum atrial septal defects (17%), patent ductus arteriosus (8.5%), and pulmonary valve abnormalities (8%). In this study, 7% of the children died. The actuarial survival at 6 months and 1 year of age was 94% and 93%, respectively, and remained stable over 18 months of follow-up.
ConclusionThe birth incidence of congenital heart disease in the Gaza Strip in 2010 (10 per 1000) is higher than most estimates in Western Europe (8.2 per 1000 live births) and North America (6.9 per 1000 live births) but is similar to estimates from other parts of Asia (9.3 per 1000 live births).
Behavioural and emotional outcomes in school-aged children after surgery or transcatheter closure treatment for ventricular septal defect
- Guotao Guan, Haiyan Liu, Yulin Wang, Bo Han, Youpeng Jin
-
- Published online by Cambridge University Press:
- 24 September 2013, pp. 910-917
-
- Article
- Export citation
-
Objection
We aimed to assess and compare the behavioural and emotional outcomes of school-aged children after surgery or transcatheter closure for ventricular septal defect and investigate the risk factors for developing abnormal behavioural problems with the condition.
MethodsIn this study, we included 29 children, including 20 boys, with ventricular septal defect who underwent surgery and 35 children, including 21 boys, who underwent transcatheter closure (6–13 years old) and their age- and sex-matched best friends (n = 56) and their parents. The Child Behavior Checklist was used to obtain standardised parents’ reports of behavioural and emotional problems in children. The 28-item version of the General Health Questionnaire was used to assess parents’ psychological distress. Pearson correlation and logistic regression were used to analyse risk factors for developing behaviour problems.
ResultsBehavioural problems were greater for boys and girls undergoing surgery or transcatheter closure than controls. The behavioural problems were mainly depression, somatic complaints, and social withdrawal for boys and thought problems, depression, somatic complaints, and social withdrawal for girls. Depression and somatic complaints were greater for boys undergoing surgery than for boys undergoing transcatheter closure. Behavioural problems did not differ between treatment groups for girls. Risk factors for developing behavioural problems were age at the time of ventricular septal defect repair (p = 0.03; odds ratio = 2.35), skin scar (p = 0.04; odds ratio = 3.12), post-operative atrioventricular block (p = 0.03; odds ratio = 2.81), and maternal anxiety (p < 0.01; odds ratio = 4.5).
ConclusionSchool-aged children who underwent repair of ventricular septal defect regardless of the type of treatment (surgery or transcatheter closure) exhibit internalising behavioural problems. Risk factors for developing problems are young age, scarring, post-operative atrioventricular block, and maternal anxiety. In particular, maternal anxiety is the most important risk factor.
Assessment of P-wave dispersion in children with atrial septal aneurysm
- Derya Arslan, Derya Cimen, Osman Guvenc, Bulent Oran, Fatma Hilal Yilmaz
-
- Published online by Cambridge University Press:
- 25 September 2013, pp. 918-922
-
- Article
- Export citation
-
Background
This was a prospective controlled study to determine the P-wave duration and P-wave dispersion in patients with atrial septal aneurysm.
MethodsA total of 41 children with atrial septal aneurysm, including 21 boys and 20 girls (mean age 11.85 ± 3.8 years), and 32 controls, including 17 boys and 15 girls (mean age 12.3 ± 2.9 years), were included. P-wave dispersion was calculated from the 12-lead electrocardiogram. Cardiac functions, morphology of the aneurysm, and left atrial diameter were measured using conventional echocardiography. The diagnosis of atrial septal aneurysm was made when the base of the aneurysms with an excursion ratio ≥25% was found on echocardiography.
ResultsThere was no significant difference between the patient and control groups in demographic, clinical findings, and M-mode echocardiographic parameters. The P-wave dispersion in patients with atrial septal aneurysm was significantly longer compared with the control group (64.4 ± 13.4 ms; p < 0.0001). Similarly, the the maximum duration of the P wave in the patient group was significantly longer compared with the control group (106.1 ± 13.3 ms; p < 0.001). The P-wave duration and dispersion were not correlated with age, gender, systolic and diastolic blood pressure, or m-mode echocardiographic parameters.
ConclusionsThis study shows that P-wave dispersion is delayed in atrial septal aneurysm patients. Prolonged P-wave dispersion was determined to indicate electrical disturbance, and therefore it has an increased electrocardiographic risk of atrial arrhythmia in children with atrial septal aneurysm.