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Objective To investigate the incidence, timing indications and outcome of tracheotomy in children who underwent cardiac surgeries. Methods All pediatric cardiac patients (under 14years of age) who underwent cardiac surgeries and required tracheotomy from November 2000 to November 2010 were reviewed. The data were collected and reviewed retrospectively. Results Sixteen children underwent tracheotomy after cardiac surgery. Fifteen of these cases had surgery for congenital heart disease, and one had surgery for an acquired rheumatic mitral valve disease. The mean±SEMs of the durations of ventilation before and after tracheotomy were 60.4±9.8 and 14.5±4.79days respectively ( P value 0.0002). The means±SEM of the lengths of ICU stay before and after tracheotomy were 63.31±10.15 and 22±5.4days respectively ( P value 0.0012). After the tracheotomy 12/16 patients (75%) were weaned from their ventilators and 10/16 were discharged from the PCICU. Six patients were discharged from the hospital and 3 were successfully decannulated. The overall survival rate was 9/16 (56%). Conclusion Tracheostomy shortens the duration of mechanical ventilation and facilitates discharge from the ICU. The mortality of tracheotomy patients is still significant but is mainly related to the primary cardiac disease.

Persistent fifth aortic arch is a rare congenital anomaly that can be discovered incidentally or at postmortem exam. It can be associated with major congenital heart malformations involving the systemic or the pulmonary circuits. It usually has no clinical significance but can be either, beneficial as in systemic outflow tract obstructions or cause hemodynamic compromise when associated with a significant left to right shunt. We report an infant with persistent fifth aortic arch associated with Shone’s complex diagnosed accurately by transthoracic echocardiography and confirmed by cardiac catheterization and computed tomography.

The arterial switch operation is the procedure of choice for patients with isolated transposition of the great arteries or those with associated atrial and/or ventricular septal defects. After the development of pulmonary arterial hypertension, the surgical options for patients with a late presentation include either retraining the left ventricle by pulmonary artery banding followed by an arterial switch operation or palliative atrial or arterial switch, with or without medical management of pulmonary hypertension. We present a case with D-transposition of the great arteries with ventricular septal defects and irreversible pulmonary arterial hypertension who improved after a palliative atrial switch operation.

Chest pain is a common paediatric complaint. Chest pain due to a cardiac condition is rare in children and adolescents, with a prevalence of less than 6%. History and physical exam may be sufficient for identifying the majority of significant aetiologies. Objectives To review the different causes of chest pain of patients referred to PSCC-Q Method Rertrospective analysis of our database. Follow up of patients was done with telephone call of all patients family to ask about the child and the chest pain status. Results During the period from January 2011 till December 2012, 28 patients were referred because of chest pain to the cardiac clinic. 18 (64%) were females and 10 (36%) were males. Palpitations were present in 7 of them (25%). Four patients were having noncardiac symptoms in the form of arthralgia in two and recurrent tonsillitis in two. Tow patients were having a positive family history of cardiac problems in the form of mitral valve prolapse in one and dilated cardiomyopathy in the other. General examination and Vital signs were normal in all of them. The mean ± SD of the heart rate, blood pressure and saturation were 99 ± 15 bpm, 102/63 ± 11/9 mm Hg, and 97 ± 1% respectively. The mean ± SD of the weight and height were 30 ± 16 kg and 131 ± 10 cm, respectively. Cardiovascular examination was normal in all of them. Innocent systolic murmur was present in 5 of them (18%). ECG was also normal in all of them. One patient had mild prolongation of the PR interval. Those with history of palpitations had Holter monitoring for 24 h which were normal in all of them. Chest pain was recurrent in 6 patients (22%) and was related to exertion in only one. On Followup all patients were alive and asymptomatic. Conclusion Chest pain in children usually is benign. History and physical exam usually are sufficient. Laboratory testing should be guided by History and physical exam.

Background Echocardiography is the main diagnostic modality of coarctation of the aorta especially in infants less than 3 months. Sometimes it is difficult to diagnose coarctation of the aorta either because of poor echo window or because of the presence of a large PDA. Failure or delay in the diagnosis of coarctation will lead to morbidity as well as mortality. Objectives The objectives of our study were to look for echocardiographic predictors of coarctation of the aorta. Methods During the period from September 2010 to July 2011 echocardiographic measurements were performed for 67 normal infants referred for echocardiography. This was compared with 37 patients with proved coarctation either by surgery or cath. Echocardiographic measurements performed in both groups include aortic annulus, ascending aorta diameter, proximal transverse arch diameter, distal transverse arch diameter, aortic isthmus diameter, distance between aortic arch branches. Aortic valve anatomy , associated findings as well as surgical and cath diagnosis were reviewed. The ratio between the transverse arch and ascending aorta as well as between transverse arch and the distance between aortic arch branches were calculated. We compared both groups using SPSS statistical software. Measurements were done online as well as offline. Results During the study period 67 normal infants and 37 infants with coarctation were reviewed. The age group were from one day to one year and the mean weight were 4.48 ± 1.67 and 3.8 ± 2.19 kg for the normal and abnormal groups, respectively. There were no statistical difference between the two groups regarding the age weight as well as the gender. There were statistical difference in the echocardiographic measurements between the two groups regarding the transverse arch diameter with a smaller diameter in the CoA group (3.89 ± 1.17 vs 5.8 ± 1.05 mm, P value 0.0001). The ratio between the transverse arch and the ascending aorta was smaller in patients with CoA (0.55 ± 0.16 vs 0.73 ± 0.16, P value 0.0001). The distance between the left common carotid and the left subclavian arteries was longer in patients with CoA compared to those with normal arch (4.76 ± 2.37 mm vs 2.85 ± 1.59 mm, P value 0.0012). The ratio between the distance between the left common carotid and the left subclavian arteries to that of the transverse aortic arch diameter was higher in patients with Co (1.3311 ± 0.71 vs 0.54 ± 0.29, P value 0.0001). Bicuspid aortic valve was found in 57% of patients with CoA compared to only 6.5% of patients without coarctation (P value 0.0001). Conclusions Echocardiographic predictors of coarctation of the aorta include the presence of bicuspid aortic valve, hypoplasia of the transverse arch, smaller ratio between the transverse arch and the ascending aorta and high ratio between the distance between aortic arch branches and transverse aortic arch.

Introduction Chronic illness may result in a variety of stressful outcomes, families of children with congenital heart disease are not exception. In Saudi Arabia, many public supporting groups for families with chronically ill children like diabetics or cancer patients are active and giving a great deal of help but unfortunately, non are available for families of children with severe congenital heart disease. Our study is an effort to put this issue in focus. Objective To evaluate the social impact on families of patients with of congenital heart disease. Design Cross sectional survey. Setting Pediatric cardiology outpatient department at Prince Sultan Cardiac Center – Qassim. Patients Parents of 71 randomly selected children with CHD of different severity. Main outcome measures The social impact on family score. Methods The impact on family questionnaire of Stein and Riessman was instituted. This questionnaire, which determines the effects of a chronic illness on parents and families, has been used to assess the impact of CHD. It is based on four subscales assessing perceived (1) financial burden; (2) familial/social impact; (3) personal strain; and (4) mastery. The first subscale contains four statements. The second subscale contains nine statements assessing social effects of CHD. The third subscale has six statements relating to the personal stress imposed by CHD on the parent. The third subscale has six statements relating to the personal stress imposed by CHD on the parent. The final subscale contains positively phrased statements to assess the positive effects of the child’s CHD on the parent’s feelings of control in his or her life. The parent’s response is given as a number from 1 to 4, where 1 represents strong agreement, 2 predominant agreement, 3 weak partial agreement, and 4 strong disagreement. The fourth subscale is reverse coded, so that it is compatible with the other subscales to calculate a final score where a low score corresponds to a high impact. This score is then inverted so that a high score is equivalent to a high impact. The questionnaire was administered by a two Researchers. Patients were divided into three groups according to the severity of the CHD they do have (Mild, Moderate and Sever). Mild CHD was defined as any CHD with no need for medical or surgical management. Moderate CHD was defined as a CHD which required surgical or cath intervention. Severe CHD was defined as CHD with single ventricle physiology who underwent Glenn or Fontan procedure, as well as patients with dilated CMP taking more than two cardiovascular medications. The mean impact on family scores was compared among the different groups by two sample t test analysis. Results Families of 71 children with severe CHD were interrogated. The main age was 3.76 ± 3 years. 23 were males (32.4%) and 48 (67.6%) were females. Mild CHD constitute 36.6%, moderate 29.6% and severe 33.8%. Families of children with severe CHD had a significantly higher impact on family score (mean of 62) than families with mild and moderate CHD (mean of 48) P value > .005. Conclusion Families of patients with severe CHD have significant social impact because of their child illness. Supporting public groups in Saudi Arabia should be initiated and encouraged.