Cardiology in the Young最新文献

Coronary artery fistulas are rare cardiac anomalies, often asymptomatic and frequently discovered incidentally during routine cardiac imaging. Transcatheter closure with coil embolisation is increasingly recognised as a preferable alternative to surgical intervention due to its lower complication rates. In this report, we present three paediatric cases in which coronary artery fistulas were successfully embolised using the Azur® CX Peripheral Coil System. This system demonstrates low-profile suitability for occluding highly tortuous vessels in children, enabling controlled coil delivery via a microcatheter. Its hydrogel-coated coils allow for expansion between gaps, making it highly effective as a minimally invasive treatment.

Sinus tachycardia due to hyperthyroidism is generally treated with beta-blockers. But some patients do not respond to beta-blockers or may have non-tolerable side effects or have contraindications. We presented a case with persistent sinus tachycardia secondary to hyperthyroidism refractory to maximal doses of propranolol. After ivabradine treatment, her heart rate was < 100 bpm within 24 hours. There were no electrocardiogram changes or side effects. The use of ivabradine is promising and can be considered in cases where tachycardia cannot be controlled in children with hyperthyroidism.

We present the case of a 9-year-old girl with a distal aortopulmonary window (APW) with anomalous origin of right coronary artery from the main pulmonary artery and an isolated left subclavian artery arising from the main pulmonary artery. This report highlights the unusual combination of the three anomalies and late presentation of APW.

Kawasaki disease is an idiopathic vasculitis that involves the participation of various physiological systems and the inflammation of small-to medium-sized arteries, resulting in the formation of aneurysms. It most commonly affects children under 5 years. The development of coronary artery aneurysms is a significant concern in the context of Kawasaki disease, rendering it the prevailing acquired cardiac condition among children. It has been observed that 1-30% of Kawasaki illness patients experience neurological complications. However, facial nerve palsy is uncommon, with a prevalence of only 0.9%. Infants with Kawasaki disease and facial nerve palsy tend to be under 6 months of age and had a higher chance to develop coronary artery aneurysms compared to those without facial nerve palsy whose condition was never treated.

Approximately 90% of primary paediatric cardiac tumours are benign lesions. Depending on their location and size, benign cardiac tumours may cause inflow and outflow obstructions, cyanosis, valvular insufficiencies, myocardial ischaemia, associated dysfunction, systemic embolisation, arrhythmias, and even sudden death. Decision-making and timing for surgery can be challenging in children. Herein, we present an asymptomatic 11-year-old girl with papillary fibroelastoma in the mitral, tricuspid, and pulmonary valves, discussing the decision-making process and successful surgical management.

Kawasaki disease is a childhood vasculitic disorder that has a special predilection for coronary arteries. Kawasaki disease has been reported from all regions of the world, with an increasing incidence in several countries. Kawasaki disease is now the most common cause of acquired heart disease in children all over the world. However, it is concerning that the estimated vast majority of Kawasaki disease cases in low- and middle-income countries are not getting diagnosed and treated. The World Health Organization acknowledges cardiovascular disease in their priority of actions. The World Health Organization is invited to acknowledge the reality of Kawasaki disease in its list of cardiovascular diseases and take steps to facilitate the diagnosis and treatment of Kawasaki disease, especially in low- and middle-income countries. It is a disease of public health importance and needs urgent prioritisation by the World Health Organization.

Objectives: Primary pulmonary vein stenosis is a rare congenital heart condition and carries a poor prognosis. Various surgical techniques have been introduced to treat primary pulmonary vein stenosis. However, there is no consensus on the optimal approach. This study aimed to evaluate the outcomes of surgical treatment of primary pulmonary vein stenosis, identify the risk factors for pulmonary vein restenosis and reintervention, and determine the optimal strategy for primary pulmonary vein stenosis repair.

Methods: From December 2008 to December 2023, 64 patients with primary pulmonary vein stenosis undergoing surgical repair in our institution were included [non-sutureless group, n = 42; sutureless group, n = 22]. The Cox proportional hazard model was used to identify risk factors for pulmonary vein restenosis and pulmonary vein restenosis-related reintervention.

Results: There were three in-hospital deaths and one late death. The survival rates at 1, 5, and 15 years were 91.9%, 84.2%, and 69.8%, respectively, in the whole cohort. Compared with the non-sutureless group, the sutureless group did not significantly improve the long-term survival of primary pulmonary vein stenosis patients (P = 0.484). Pulmonary vein restenosis occurred in 15 patients. Multivariable analysis showed that Involvement of the left inferior pulmonary vein (P < 0.001) was the only independent risk factor for pulmonary vein restenosis, while sutureless repair (P = 0.037) was a protective factor. Pulmonary vein restenosis-related reintervention occurred in 12 patients. On multivariate analysis, three or four pulmonary veins involvement (P = 0.001) and preoperative severity score exceeding 5 (P = 0.050) were found to be independent risk factors associated with pulmonary vein restenosis-related reintervention; however, sutureless repair (P = 0.021) was a protective factor.

Conclusions: Management of infants with primary pulmonary vein stenosis is challenging. Surgical repair of primary pulmonary vein stenosis can be safely achieved using different techniques, with similar long-term mortality. Compared with non-sutureless repair, sutureless repair was significantly associated with decreased pulmonary vein restenosis and decreased pulmonary vein restenosis-related reintervention, respectively. Preoperative severity score exceeding 5, 3, or 4 pulmonary veins involvement, and left inferior pulmonary vein involvement are independent risk factors for adverse outcomes.

Background: Congenital heart Disease (CHD) is a significant cause of morbidity and mortality. Pulse-oximetry is a good non-invasive simple tool for critical CHD screening. Implications of this tool may be possible in certain areas and non-practical in others. We aim to report on the preliminary results of a recent ongoing protocol concerning the use of pulse-oximetry in detecting critical CHD in newborn in Egypt.

Patients & methods: All neonates born in or transferred to 10 university hospitals during the period between February and November 2023 and fulfilled the criteria of inclusion were screened for critical CHD by pulse-oximetry using Granelli protocol in the first 24-72 hours after birth.

Results: During a 10-month pilot period, a total of 2392 neonates were screened. A total of 549 neonates (23%) tested positive (failed) screening. Among the positive cases, 213 neonates (42%) died during their hospital stay, while the remaining were discharged or scheduled for intervention. The positive cases underwent echocardiography that revealed CHD in the majority of cases (80.3%). Only 40 cases of those cases had cardiac defects that are classified as critical CHD with a prevalence of 16.7 per 1000 live births, while the rest of the cases have either simple (non-critical CHD) or persistent pulmonary hypertension. About 19.7% of positive cases have completely free echocardiograms without cardiac defects.

Conclusion: The prevalence of critical CHD in Egypt is higher than the mean worldwide prevalence. The introduction of pulse-oximetry as a mass screening tool for critical CHD is possible and effective in low-income countries.

We report simultaneous transcatheter closure of a secundum atrial septal defect, a perimembranous ventricular septal defect, and a patent ductus arteriosus in a 3-year-old female wıth symptoms of heart failure. As it was not possible to determine the impact of each defect on the patient's symptoms, all of them were closed with good results, for a tiny residual venrricular septal defect.

For many patients with right ventricular outflow tract (RVOT) dysfunction, percutaneous pulmonary valve implantation (PPVI) offers a less-invasive alternative treatment option to surgery with a similar long-term result. However, the implantation of the valves recently available on the European market was only possible in patients with a limited maximal RVOT diameter. In patients with large RVOT, surgical treatment has remained the only possible treatment modality until recently. The self-expandable Harmony transcatheter pulmonary valve is a valve dedicated for patients with severe pulmonary regurgitation in the native and surgically repaired wide RVOT. The initial experience worldwide with this valve is very promising. However, it has not been implanted in Europe until recently. We report on four young adult patients with severe pulmonary valve regurgitation who underwent a successful PPVI with Harmony valve implantation. There were no serious complications in our small study group. In conclusion, the Harmony valve may offer a less-invasive and safe treatment alternative to surgery for patients in whom the available balloon-expandable valves offer only limited applicability. This valve has only recently become accessible on the European market.