Annals of Pediatric Cardiology最新文献

{"title":"Transcatheter closure of large ostium secundum atrial septal defects in symptomatic small children: A single-center retrospective study.","authors":"Jahangir Ahmed Naseem, Mirza Shohiab Ur Riyaz, Shobhit Priyanshu Joseph, Jesu Krupa, Mayank Agarwal, Pratheesh George Mathen, Oommen K George, Paul V George, John Jose, Viji Samuel Thomson","doi":"10.4103/apc.apc_163_23","DOIUrl":"10.4103/apc.apc_163_23","url":null,"abstract":"<p><strong>Background: </strong>In general, the risks associated with transcatheter atrial septal defect (ASD) device closure are reported to be relatively low, but the evidence stems from trials involving adults and older children. Current guidelines do not recommend ASD device closure in children with defect sizes >20 mm due to limited data available in this group of patients. This retrospective study sought to determine the clinical and procedural characteristics of successful transcatheter ASD device closure in small children with large defects and assess the complication rates and reasons for unsuccessful device closure.</p><p><strong>Methods: </strong>We retrospectively reviewed the data of all patients who underwent elective transcatheter closure of ostium secundum ASD in our department between September 2013 and February 2022. All children weighing <20 kg, requiring a device of size 20 mm or greater, were included. Major and minor complications were predefined and indications for referral were evaluated. Echocardiogram reports were reviewed from the time of referral, postcatheterization day 1, and at 1-year follow-up.</p><p><strong>Results: </strong>We identified 40 patients meeting inclusion criteria with a median (interquartile range [IQR]) procedural age of 5 (4-7) years and median (IQR) weight of 14 (12-18) kg. Successful device closure was achieved in 39 patients with a success rate of 97.5%. The total complication rate was 2.5% (95% confidence interval: 0.44%- I2.8%) with only 1 major complication. All children had right heart enlargement and exertional dyspnea, 30% of patients had recurrent lower respiratory tract infections, and 10% had failure to thrive. At 1-year follow-up, a transthoracic echocardiogram showed a well-endothelialized device in a stable position in all the patients, and none of the patients had a residual shunt.</p><p><strong>Conclusion: </strong>In experienced centers, percutaneous ASD closure of large defects in symptomatic small children can be done effectively and safely with a great degree of predictability and a low complication rate.</p>","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11135894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141178537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between alveolar functional fraction and clinical outcomes in children during postoperative care after surgery for single-ventricular heart.","authors":"Dana Barry, Ellen A Spurrier, Jigar C Chauhan","doi":"10.4103/apc.apc_111_23","DOIUrl":"10.4103/apc.apc_111_23","url":null,"abstract":"<p><strong>Background: </strong>Optimization of pulmonary to systemic blood flow (Qp: Qs) is the key to postoperative care of children with a single-ventricular heart. The ratio of end-tidal CO2 to partial pressure of CO2 called alveolar functional fraction (AFF) has shown a strong relationship with Qp: Qs in the catheterization lab in this population (with Qp: Qs of 1 correlating with AFF of 0.7). As there are no studies to understand the relationship between AFF and clinical outcomes in the postoperative care of these children, this study was carried out.</p><p><strong>Methodology and results: </strong>This retrospective cohort study included 29 postoperative periods of children who underwent surgery for a single-ventricular heart. The average AFF was calculated for each early postoperative period. The primary clinical outcome was time in hours to normalize lactate. Other clinical outcomes included duration of mechanical ventilation, duration of milrinone infusion; presence of acute kidney injury (AKI), seizures and necrotizing enterocolitis (NEC); need for tracheostomy, need for extra-corporeal support, and mortality in the first 60 days postoperatively. The study population was divided into Group 1 with AFF ≤0.7 and Group 2 with AFF >0.7, to compare the outcome differences between the groups. Time to normalize the lactate had a modest negative correlation with the AFF, with Pearson's <i>r</i> = -0.49 (<i>P</i> = 0.007) for the entire cohort. The clinical outcomes were not statistically different for groups with AFF ≤0.7 and with AFF >0.7, although the group with AFF ≤0.7 had a higher incidence of NEC and higher mortality, whereas the group with AFF >0.7 had a higher incidence of AKI.</p><p><strong>Conclusions: </strong>In this small study, the AFF showed a modest negative correlation with the time to normalize lactate in postoperative care after surgery for a single-ventricle heart. There were the trends with some other important clinical outcomes but not statistically significant. A larger, multi-center study is needed to delineate these relationships further.</p>","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11135889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141178602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anomalous origin of branch pulmonary artery from the aorta: Current challenges in the management.","authors":"Jeeva Vijayan, Manjunath Venkataswamy, Anand Subramanian, Nischal Rajendra Pandya, Honnakere Venkataiya Jayanth Kumar","doi":"10.4103/apc.apc_166_23","DOIUrl":"10.4103/apc.apc_166_23","url":null,"abstract":"<p><p>Anomalous origin of a branch pulmonary artery from the aorta is a rare congenital anomaly that requires early surgery to prevent pulmonary vascular disease. The rate of reintervention after surgery remains high. Many aspects of the management could be improved such as assessment of operability in late presenters, selection of suitable surgical technique in each case, and prevention of anastomotic complications. We report the series of 10 patients who were operated for this anomaly. We aim to focus on the current challenges in the management of this condition.</p>","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11135887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141178286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echocardiographic assessment of cardiac function abnormalities and related risk factors in Thai overweight and obese children.","authors":"Darunwan Nimpum, Worawan Jittham","doi":"10.4103/apc.apc_134_23","DOIUrl":"10.4103/apc.apc_134_23","url":null,"abstract":"<p><strong>Background: </strong>Childhood obesity has become a global concern, with its prevalence steadily increasing over the past decade. This condition negatively impacts the cardiovascular system, increasing the risk of morbidity and mortality in adulthood. This study aimed to identify cardiac function abnormalities and related risk factors among overweight and obese Thai children.</p><p><strong>Materials and methods: </strong>A cross-sectional observational study of 70 children with body mass index (BMI) >1 standard deviation above the mean for Thai children was conducted at Naresuan University Hospital. Body fat percentage (%Fat) was measured, and standard transthoracic echocardiography was performed. Metabolic profiles were collected from medical records.</p><p><strong>Results: </strong>The thickness and diameter of the Left ventricle (LV) wall, including the LV posterior wall, LV internal diameter, and interventricular septum (IVS), were significantly increased in both systolic and diastolic phases in obese children. LV concentric hypertrophy and an abnormal E/E' ratio were found in 27% and 34.3% of participants, respectively. Right ventricular systolic dysfunction indicated by abnormal tricuspid annular plane systolic excursion values was found in 55.7% of all participants. In addition, 27.1% of all obese children had pulmonary hypertension. Significant differences in BMI and %Fat were detected between children with abnormal and normal IVS diastolic (IVSd) (<i>P</i> = 0.016). Our univariate and multivariate correlation analyses revealed a significant positive association between abnormal IVSd and %Fat, with an odd ratio (OR) of 1.13 (95% confidence interval [CI]: 1.01-1.27; <i>P</i> = 0.047) and an adjusted OR of 1.17 (95% CI: 1.01-1.36; <i>P</i> = 0.04).</p><p><strong>Conclusions: </strong>Cardiac function abnormalities in childhood obesity exhibit a significant positive correlation with BMI and various cardiac dimensions, including ventricular wall thickness. One important related risk factor for increased IVS thickness is %Fat. Therefore, multidisciplinary management of obesity should be initiated as early as possible to prevent future cardiovascular morbidity and mortality.</p>","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11135886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141178243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent mitral regurgitation and left atrial aneurysm in a pediatric patent: A complex case of infective endocarditis.","authors":"Muhammad Kamran Younis Memon, Prabhat Khakural, Sivakumar Sivalingam","doi":"10.4103/apc.apc_192_23","DOIUrl":"10.4103/apc.apc_192_23","url":null,"abstract":"<p><p>A 6-year-old boy with a history of infective endocarditis (IE) presented with recurrent disease manifesting as left hip arthritis and severe mitral regurgitation. He developed a rare complication - a left atrial pseudoaneurysm. Despite the absence of classic fever and systemic symptoms, imaging revealed the recurrence and guided surgical repair. This case highlights the complexities of recurrent IE in children and underscores the importance of high clinical suspicion and imaging modalities like echocardiography for diagnosis and management.</p>","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11135891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141178593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why pediatric cardiology in India?","authors":"Ankur Handa","doi":"10.4103/apc.apc_52_24","DOIUrl":"10.4103/apc.apc_52_24","url":null,"abstract":"","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11135884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141178615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulsating abdominal mass in a newborn - Pentalogy of Cantrell with left ventricular diverticulum.","authors":"Nabeel Faisal, Praveen Jeyakumar, Niraj Nirmal Pandey, Shiv Kumar Choudhary, Pradeep Ramakrishna Reddy, Sivasubramanian Ramakrishnan","doi":"10.4103/apc.apc_188_23","DOIUrl":"10.4103/apc.apc_188_23","url":null,"abstract":"<p><p>Pentalogy of Cantrell is a rare congenital anomaly involving the anterior diaphragm, pericardium, sternum, peritoneum, and associated intracardiac defects. In this report, we describe a neonate with pentalogy of Cantrell evaluated with multimodality imaging and successfully managed by a multidisciplinary team.</p>","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11135885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141178437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Being a Pediatric Cardiologist in India - A clarion call.","authors":"Sivasubramanian Ramakrishnan, Sunita Maheshwari","doi":"10.4103/apc.apc_62_24","DOIUrl":"10.4103/apc.apc_62_24","url":null,"abstract":"","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11135880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141178240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anomalous right coronary artery from the pulmonary artery in an infant with tetralogy of Fallot.","authors":"Swati Garekar, Ronak Sheth, Sachin Patil, Bharat Soni, Dhananjay P Malankar","doi":"10.4103/apc.apc_169_23","DOIUrl":"10.4103/apc.apc_169_23","url":null,"abstract":"<p><p>An anomalous right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital anomaly that does not have the typical presentation of the more common anomalous left coronary artery. We present an infant with tetralogy of Fallot with atypical findings on the preoperative echocardiogram. A cardiac computerized tomographic (CT) scan showed ARCAPA. This was confirmed intraoperatively and repaired successfully. Close attention to coronaries on echocardiography and a low threshold for additional imaging can successfully diagnose ARCAPA in the presence of additional congenital heart defects.</p>","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11135895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141178294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of on-table extubation on resource utilization and maternal anxiety in children undergoing congenital heart surgery in a low-resource environment.","authors":"Kaushik Jothinath, Vijayakumar Raju, Michael E Nemergut, Grace M Arteaga, Pavithra Ramanath, Thirumalaisamy Vijayalakshmi","doi":"10.4103/apc.apc_162_23","DOIUrl":"10.4103/apc.apc_162_23","url":null,"abstract":"<p><strong>Objective: </strong>To study the applicability of on-table extubation (OTE) protocol following congenital cardiac surgery in a low-resource setting and its impact on the length of intensive care unit (ICU) stay, hospital stay, hospitalization cost, parental anxiety, and nurse anxiety.</p><p><strong>Materials and methods: </strong>In this prospective, nonrandomized, observational single-center study, we included all children above 1 year of age undergoing congenital cardiac surgery. We evaluated them for the feasibility of OTE using a prespecified protocol following separation from cardiopulmonary bypass. The data were prospectively collected on 60 children more than 1 year of age, belonging to the Risk Adjustment for Congenital Heart Surgery 1, 2, 3, and 4 groups and divided into two groups: those who underwent successful OTE and those who were ventilated for any duration postoperatively (30 children in each group). Duration of hospital stay, ICU stay, and total hospital cost were collected. Anxiety levels of the primary caregiver (nurse) in the ICU and the mother were assessed immediately after the arrival of the child in the ICU using the State Trait Anxiety Inventory (STAI).</p><p><strong>Results: </strong>Children who were extubated immediately following congenital cardiac surgery had significantly shorter ICU stay (median 20 [19, 22] h vs. 22 [20, 43] h [<i>P</i> < 0.05]). Patients extubated on table had a significant reduction in hospital cost {median Rs. 161,000 (138,330; 211,900), approximately USD 1970 (<i>P</i> < 0.05)} when compared to children who were ventilated postoperatively {median Rs. 201,422 (151,211; 211,900) , approximately USD 2464}. The anxiety level in mothers was significantly less when their child was extubated in the operating room (STAI 36.5 ± 5.4 vs. 47.4 ± 7.4, <i>P</i> < 0.001). However, for the same subset of patients, anxiety level was significantly higher in the ICU nurse (STAI 46.0 ± 5.6 vs. 37.8 ± 4.1, <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>OTE following congenital cardiac surgery is associated with a shorter duration of ICU stay and hospital stay. It also reduces the total hospital cost and the anxiety level in mothers of children undergoing congenital heart surgery. However, the primary bedside caregiver during the child's ICU stay had increased anxiety managing patients with OTE.</p>","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11135879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141178312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}