golnar mortaz hejri

The Arterial Switch Operation (ASO) has been the preferred surgical method for Transposition of great arteries (TGA) since its introduction over 40 years ago. Although initial survival rates have improved significantly, long-term complications often require reoperation. In this retrospective cohort study, medical records of 302 patients with TGA, who underwent ASO between 2004 and 2022, were reviewed. Data on demographic and morphological characteristics, surgical reports, and follow-up interventions were collected. Reoperation data, including surgical and catheter-based interventions, were analyzed. Thirty-seven reoperations were performed on 31 patients, with a reoperation rate of 10.26%. Open surgical interventions included Right Ventricle Outflow Tract Obstruction (RVOTO) relief (3.31%), neo-aortic root and valve surgery (0.66%), ascending aorta replacement (0.33%), VSD closure (0.33%), and pacemaker implantation (2.31%). Catheter-based interventions included balloon angioplasty (1.65%) and stent implantation (1.65%) for RVOTO, with additional procedures for aortic arch stenosis (0.66%) and coronary artery stenosis (0.33%). Residual shunts were treated in 0.99% of cases. ASO has revolutionized the management of TGA, providing infants a chance at a normal, healthy life. As our understanding of congenital heart defects grows, ASO remains pivotal in enhancing patient outcomes. Despite the average time to reoperation being 4 years, regular follow-up is essential. Gradual complication development necessitates periodic monitoring to prevent escalation requiring surgical intervention.

Kawasaki disease (KD) is an acute, self-limiting vasculitis that predominantly affects children under five years of age. It is recognized as the leading cause of acquired coronary artery disease in this age group.

This manuscript presents two cases of KD complicated by significant coronary artery abnormalities, which ultimately necessitated heart transplantation.

Emphasizing the importance of early diagnosis and treatment, this study underscores the critical need for continued research to improve outcomes for affected patients.

There is a concern regarding the relationship between biodemographic parameters at different ages and the size of inferior vena cava (IVC) and the collapsibility index (CI). Due to the lack of normative data on these parameters in children, we aimed to use ultrasound to determine the mean sizes of IVC in healthy children and calculate the CI.

In this analytical cross-sectional study, we measured the IVC diameter in euvolemic children aged four weeks to 12 years. The maximum IVC diameter was recorded during the exhalation phase of the respiratory cycle, while the minimum diameter was recorded during the inhalation phase using M-mode. Additionally, we calculated the CI by dividing the difference between the maximum and minimum IVC diameters by the maximum diameter.

In this study, 534 euvolemic healthy children with a mean age of 6.77±3.22 years were assessed. The mean diameter of the maximum IVC during exhalation was 5.26±4.70 and the mean diameter of the minimum IVC during inspiration was 2.96±2.89 mm. The mean CI in the present study was 0.5±0.13. Ultrasound measurements of IVC diameter during exhalation, unlike IVC diameter during inhalation, were positively correlated with age, weight, and height. The mean IVC and CI had a direct and significant correlation with biodemographic parameters, such as age, height, weight, and body mass index.

Evaluating intravascular volume status holds significant clinical relevance, particularly in pediatric patients. Utilizing ultrasound to assess the IVC allows for swift and noninvasive analysis of an individual’s hemodynamics, impacting clinical decision-making positively. Establishing normative IVC measurements in healthy and euvolemic children can serve as valuable reference data for clinicians and help them accurately assess fluid status in unwell pediatric patients.

Heart transplantation is the last therapeutic choice in patients with severe heart failure who are symptomatic despite medical treatments and are estimated to have less than a year to live. Given the dearth of information on the initial years and outcomes of heart transplantation, we conducted the present study to determine the results of this procedure at Rajaie Cardiovascular Medical and Research Center, Tehran, Iran, since the first transplantation. 

The current observational study, performed as a retrospective cohort, recruited 50 consecutive children who underwent heart transplantation between March 2014 and April 2017 in a census manner and determined their outcomes. 

Renal failure before transplantation was reported in 3 patients (6%), of whom 2 patients (4%) required dialysis. After transplantation, 11 subjects required dialysis. Eight patients (16%) developed hepatic failure before transplantation. Infectious complications were seen in 14 patients (28%) after transplantation. Nine patients (18%) had 1 rejection time. The mortality rate was 6%. 

It seems that despite similar indications for heart transplantation in different centers, our study revealed better results than previous studies. However, the technical and skill differences between physicians in various settings should be considered possible explanations.