mostafa behjati ardakani

Congenital coronary-cameral fistula is an abnormal connection between coronary arteries and a cardiac chamber. Although trans-catheter closure appears to be a safe alternative to surgical treatment but there is an imprecision about modality of choice. We describe a huge left coronary artery fistula to the right ventricle, found in an 8-year-old girl with dyspnea on exertion and chest pain. She was treated with an Amplatzer duct occluder. After procedure, echocardiography revealed, complete closure of fistula orifice and the girl remained completely asymptomatic during 48 months follow-up period. This study demonstrated that Amplatzer duct occluder might be a useful and safe armamentarium for coronary-cameral fistula treatment. Nevertheless, further experience and long-term follow-up studies are required to guarantee our results.

Congenital heart disease is the most common congenital anomaly. About 50% of Neonates with congenital heart disease are asymptomatic in the first few days of life and are not diagnosed on initial examination. Pulse oximetry is a non-invasive method that can show the percentage of oxygen saturation in the blood and congenital heart disease.

This was a descriptive cross-sectional study and the sampling method was census. Echocardiography was performed for all neonates with spo2 less than 95% and also neonates who were diagnosed with a problem by a cardiologist. After collecting the samples, the results obtained from pulse oximetry, physical examination and echocardiography were analyzed using SPSS software version 16 and statistical tests of Kolmogorov-Smirnov normality and Spearman correlation. Was investigated.

In pulse oximetry evaluation, 1.9% of neonates had spo2 (arterial oxygen saturation) less than 95%. 1.7% of neonates had heart problems in physical examination and 2.12% of neonates had heart problems in echocardiography. The highest correlation between pulse oximetry and echocardiography was 0.917.

Considering the diagnostic importance of congenital heart diseases and their impact on a personchr('39')s life, it is recommended that pulse oximetry be added to physical examinations at birth as a screening method for heart disease.

In this study, a sensitive and accurate aptasensor was designed for early detection of myocardial infarction through the determination of troponin T (TnT). The successful immobilization of a specific aptamer sequence on the surface of gold that had a high affinity toward TnT was accomplished. TnT was electrochemically quantified. The results indicated that the aptasensor detected TnT in a range of 0.05-5 ng mL and with a detection limit of 0.01 ng/mL. The performance of the aptasensor was investigated by analyzing 99 human serum samples. Both diagnostic specificity and sensitivity of the aptasensor were found to be 95%. The use of the designed aptamer-based biosensor could be an essential achievement in health policy, preventing deaths caused by myocardial infarction, and reducing patients with heart failure. The extensive use of this aptamer-based biosensor can also reduce costs, enhance speed, and improve accuracy in the diagnosis of TnT as an important myocardial infarction biomarker.

Congenital heart disease (CHD) is a major health problem and its prevalence is different around the world. The aim of study was determination of the epidemiological aspects of CHD in central and southern district of Iran.

In this descriptive and analytical study, 3714 medical records were evaluated from March 21, 2001 to December 18, 2011. Medical records of inpatients from angiography and outpatients in the Heart Clinic of Afshar hospital (a referral hospital in center and south of Iran) were the source of information. Types of CHD and demographic data including age, sex and residential location are collected. The data were analyzed by SPSS (version 17) software. Chi-square and Fisher's exact tests were used to compare variables between groups.

At the study, the mean age of the patients at diagnosis time was 8.8 ± 11.6 year (at the range of one day to 76 years with median of 4 years). The percentage of females and males was 54.2 (n: 2014) and 43.8 (n: 1627), respectively. The chi-square test showed that there was significant difference in frequency of CHDs between females and males (P value < 0.0001). Ventricular septal defect (VSD) was found to be the most frequent of CHDs (27%). Patent ductus arteriosus (PDA) (16.8%), atrial septal defect (ASD) (15.8%), pulmonary stenosis (PS) (11%) and Tetralogy of Fallot (TOF) (8.9%) were more prevalent in CHDs after VSD.

The frequency of CHDs in female was more than male and VSD, PDA, ASD, PS, and TOF were most common in CHDs, respectively.
 

Transluminal balloon valvuloplasty is an alternative to surgical valvotomy for congenital pulmonary valve stenosis. The aim of this study was to evaluate the long term results (to 13.5 years) of balloon pulmonary valvuloplasty. From June 1998 to January 2012, percutaneous balloon pulmonary valvuloplasty for congenital pulmonary valve stenosis was performed in 98 patients (50 males, 48 females, with a median age of 6.75 years) underwent balloon valvuloplasty of pulmonary valve stenosis. Follow-up was performed based on the Doppler echocardiographic data and clinical findings. Forty three of ninety eight patients were 10 years of age or older. The mean peak to peak pressure gradient across pulmonary valve before and immediately after balloon pulmonary valvuloplasty (BPV) was 88.7±36.4 mmHg and 21.8±15.9 mmHg (P<0.001) respectively. Doppler pressure gradient across pulmonary valve before BPV, at 3 month (short term), at 1 year (intermediate term) and long–term follow–up were 93.2±41.3 mmHg, 18.7±15.8 mmHg (P<0.001), 15.8±13.1 mmHg (P<0.001) and 13.6±7.4 mmHg (P<0.017) respectively. Mild pulmonary regurgitation (PR) was observed in 55 (57%) patients immediately after BPV and 30 (31%) patients at late follow up. Rupture of the right ventricular outflow tract was the major complication in two patients with fatal event. Short, intermediate and long-term results of BPV for typical valvular pulmonary stenosis are excellent. Therefore, it can be considered as treatment of choice for patients with typical valvular pulmonary stenosis.

Critical pulmonary valve stenosis (CPVS) and atrial septal defect (ASD) is an uncommon form of congenital heart disease. Concurrent transcatheter pulmonary valvuplasty and closure of secundum atrial septal defect appears to be an interesting alternative to surgical correction. We present the simultaneous balloon valvuloplasty of critical pulmonary stenosis (PS) with supra systemic right ventricular pressure and medium sized secundum ASD with right to left shunt.

transcatheter balloon valvuloplasty has been the accepted first line treatment for congenital pulmonic stenosis (PS) in children. Transcatheter closure of perimembranous ventricular septal defect (VSD) with Amplatzer VSD occluder is an alternative to surgical repair. A 12 year old boy presented with history of exertional dyspnea and atypical chest pain. Physical finding were suggestive of severe pulmonic stenosis. Transthoracic echocardiography, right and left ventricular angiography showed medium to large sized perimembranous VSD and severe valvular pulmonary stenosis. Transcatheter closure of VSD was done first so as to avoid large left to right shunt across VSD after Balloon pulmonary valvuplasty. we demonstrated the feasibility and success in treating combined ventricular septal defect and severe pulmonary valve stenosis with transcatheter interventional procedure in the same session.

Background and The purpose of the study was to asses the natural and clinical course of isolated ventricular defect in children. Patients and From 1997 to 2011 we prospectively studied a total of 218 infants and children diagnosed as isolated ventricular septal defects. The Çhi-squar or Fisher exact Test and ÂNÔVÂ were used to compare the differences where appropriate. Â valve less than 0.05 was considered statistically significant. The patients who had an additional hemodynamic significant heart defect were excluded. Â total of 218 patients, 125 females VS 93 males (57% VS 43%) were followed up for the mean time of 55.7 months (Range 12-170 mo)The distribution of perimembranous, muscular, subarterial and inlet type VSD were 65.1%, 32.1%, 1.4% and 1.4% respectively.Regardless of type of VSD, spontaneous closure was observed in 86 (39.5%) cases. Forty four (31%) perimembranous VSD and forty two (57.2%) muscular defect closed spontaneously. Ïnlet or subarterial defects were not closed spontaneously. Regardless of type VSDS, 71 (52.6%) of small and 15 (25%) of moderate size defect closed spontaneously.Fifty (24.3%) cases needed surgical Treatment. Âortic regurgitation developed in 11 (5%) patient.Ïnfective endocarditis was observed in 3 (1.7%) in patients. Ôther complications were pulmonary hypertension in 39 (17.9%), congestive heart failure in 12 (5.5%), sub pulmonic stenosis in 16 (7.3%) mitral regurgitation in 6 (2.8%) and sub aortic ridge in 7 (3.2%) patients.Çonclusion: Ït is concluded that patients with VSD should be followed closely through life because the complications such as pulmonary hypertension, Ëisenmenger syndrome, infective endocarditic sub pulmonic stenosis, aortic ridge and aortic regurgitation may develop, although spontaneous closure of the defect is to be expected in many cases (39.51%), a significant percentage of defects may need surgical treatment (24.3%).

Lutembacher syndrome refers to the rare combination of a congenital atrial septal defect and acquired mitral stenosis. Traditionally, Lutembacher syndrome has been corrected by surgical treatment. We describe two patients treated percutaneouly with a combined Inoue balloon valvuloplasty and septal defect closure using the Amplatzer septal occlusion device.

Giant coronary artery aneurysms caused by Kawasaki disease are rare; however, they are one of the most serious complications and can be lethal. We report a 3.5-month-old boy referred to us because of high fever for fifteen days, generalized maculopapular rash, irritability and cough. Transthoracic echocardiography showed dilatation of right coronary (RCA) and left main coronary (LCA) arteries. Serial echocardiography revealed rapidly progressive dilatation of coronary artery aneurysms of RCA and LCA. We performed invasive cardiac catheterization with selective coronary angiography when the boy was 16 months old. Selective right and left coronary arteriography showed a super giant fusiform aneurysm of RCA and a diffuse giant aneurysm of the proximal LCA. Regression of coronary artery aneurysms was not observed during 6 years of follow up. Pediatricians should be alert for possibility of incomplete Kawasaki disease in young infants with atypical presentation. They are at higher risk of coronary aneurysm formation. The diagnosis often was late with higher complication rate of coronary aneurysm. Echocardiography is an important tool for diagnosis of incomplete Kawasaki disease. Selective coronary angiography is the gold standard for diagnosis, and estimation of shape and size of aneurysms.

The transcatheter closure of patent ductus arteriosus has advanced rapidly with improvements in device designs. The aim of this study was to analyze the safety, efficacy, and early and intermediate follow-up results of the percutaneous closure of persistent ductus arteriosus (PDA) with the Amplatzer ductal occluder (ADO) in children. Between May 2004 and March 2007, fifty patients between 7 months and 20 years of age underwent the transcatheter closure of PDA, using the ADO. The mean PDA diameter at its narrowest segment (pulmonary end) was 7.35±2.57 mm (range: 4 to 16mm). Follow-up evaluations were performed via echocardiography at 24 hours, and 1, 3, 6, and 12 months and then yearly after implantation. Successful immediate occlusion of PDA was achieved in 42 (84%) of the 50 cases. In 5 cases, there were trivial intraprosthetic residual shunts. In addition, there was a small residual shunt in one case, left pulmonary artery narrowing in one case, and embolization of the device immediately after the procedure in one case. At 24 hours, color Doppler flow mapping revealed complete closure in all except one case with a small shunt. At 3 months’ follow-up, occlusion was complete in all the patients. At a median follow-up of 17 months (range: 3 months to 32 months), all the patients had complete closure. We conclude that although the transcatheter closure of PDA using the ADO is a highly effective and safe treatment for most patients, several complications including embolization and left pulmonary artery narrowing may occur in certain cases.