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Background: Pacemaker implantation is an effective life-long treatment in patients with atrioventricular block to generate a reliable heartbeat. Choosing between epicardial and endocardial (trans-venous) techniques in children is based on the cardiac center experience and each technique has some benefits and risks. Methods: In this observational cross-sectional study, we reviewed file-records of 186 under 18- year-old patients who underwent cardiac pacemaker implantation due to atrioventricular block. All of endocardial implantations had been performed by experienced pediatric cardiologists and all epicardial pacemakers by experienced cardiac surgeon from 2006 to 2018 in Namazi and Faghihi hospitals in Shiraz, Iran. Results: One hundred and five patients had epicardial pacemaker and 81 patients had endocardial pacemaker. One hundred and seventy-eight patients had postoperative complete heart block after correction of congenital cardiac abnormality due to the destruction of conductive pathway. Eight patients were born with complete heart block. Four (2.15%) patients in the endocardial group developed pacemaker related infection. Two (1%) patients had sudden cardiac death after pacemaker insertion in the follow-up; Medtronic single chamber pacemaker was inserted for one patient who had complete heart block after surgical ventricular septal defect closure. However, a month later she expired due to sudden cardiac arrest during exercise and one patient after correction of complete atrio-ventricular septal defect had pacemaker insertion and sudden death, 3 months after pace insertion (1.12%); none of them had history of palpitation, syncope, arrhythmia in their post-operation electrocardiography, or tachycardia in their pacemaker analysis. Conclusion: In Conclusion, epicardial pacemaker has a noticeable battery longevity in comparison to endocardial pacemakers and fewer valvular complications and endocarditis cases. Also, it appears that increasing size and vessel stiffness followed by aging can prime better vascular access and less lead malfunction in older pediatrics in endocardial approach; however, the site of ventricular pacing is still a puzzle because of the effect of pacing site on left ventricle synchrony and ejection fraction.

Abstract Background Transcatheter closure of intracardiac defects might be complicated by intravascular hemolysis. We evaluated hemolysis and its outcome after transcatheter closure of these defects. Methods and patients All patients who underwent transcatheter closure of patent ductus arteriosus, ventricular septal defect and atrial septal defect were included in this prospective study. Clinical data were obtained before and after the catheterization. Results One hundred and thirty-eight patients were enrolled; and four (3%) patients developed intravascular hemolysis; while two cases had residual shunt and two other cases had not residual flow. Although residual shunt occurred in ten patients, only 2 of these cases developed hemolysis. Patent ductus arteriosus closure was done for one of these cases and the other one, underwent perimembranous ventricular septal defect closure. Moreover, hemolysis occurred after device closure of patent ductus arteriosus in 2 of the other patients with no residual shunt. In this study the hemolysis was eliminated by conservative management within 2 weeks although residual shunt continued in this time. We observed a decline in lactate dehydrogenase value after catheterization in comparison with precatheterization, which was mainly among ventricular septal defect patients that might be due to mild chronic hemolysis in these patients. Conclusion Incidence of hemolysis after device closure was low, and occurred with and without residual flow and was eliminated by conservative management in 2 weeks, without the need for surgery, although the residual shunt was continued.

Objective : Anthracycline administration in children is associated with cardiac dysfunction. Speckle-tracking echocardiography (STE) can detect subclinical cardiac damage that may go undetected by conventional two-dimensional (2D) echocardiography. This study aims to investigate medium-term anthracycline cardiotoxicity using STE and determine a safer administrable level of anthracyclines (ACs). Methods : This observational case-control study enrolled 37 healthy controls and 78 pediatric cancer survivors who received chemotherapy. The patients were divided into two groups: cardiotoxic received (CR) and cardiotoxic free (CF). Data on segmental longitudinal strain (LS), global LS (GLS), and 2D echocardiographic parameters were collected after a drug-free period of at least one year. Results : A total of 115 children with a mean age of 108 ± 55 months, of whom 66% were males, were included in the study. Both the groups of cancer survivors exhibited significantly reduced GLS compared to healthy controls (CR vs. controls, P = 0.001; CF vs. controls, P = 0.013), but no significant difference in left ventricular ejection fraction (LVEF) was observed (P = 0.75). Overall, cancer survivors treated with ACs demonstrated a significant reduction in strain in 10 left ventricular segments, particularly in the basal segments (P < 0.05). Among CR patients, those with impaired GLS (n = 43, GLS worse than -21.9) had significantly higher mean age and cumulative anthracycline dose compared to CR patients with normal GLS (age, P = 0.024; anthracycline dosage, P = 0.036). Using an anthracycline cutoff of 223 mg/m² resulted in a higher detection rate (49% vs. 25%) and fewer missed cases (51% vs. 74%) compared to the 360 mg/m² anthracycline cutoff. Conclusion : Childhood cancer survivors demonstrate significantly reduced GLS while preserving a normal LVEF, which does not differ significantly from reference values of healthy children. The reduction in strain appears to be associated with higher anthracycline doses and older age. Lowering the anthracycline threshold to 223 mg/m² may improve the predictability of a decline in cardiac function using strain imaging at medium-term follow-up. [ABSTRACT FROM AUTHOR]

Background: Benefits of stem cell therapy on remodelling and cardiac function have been described in adults with dilated cardiomyopathy and acute myocardial infarction. Objectives: We investigated the effect of this treatment modality amongst children with severe dilated cardiomyopathy. Methods: Intracoronary injection of autologous bone marrow mononuclear stem cells was performed in our centers for 8 severely ill children during 2015 - 2016. Themeanage of the patients was 10.1 years (5 girls, 3 boys). They were followed by longitudinal speckle tracking echocardiography (STE) and conventional echocardiography for 6 months. Results: Heart functional class improved in 62% of patients. M-mode echocardiography showed significant improvement in ejection fraction (mean 24.8±8.3 vs. 37.4±10.5) and in STE, the mean global longitudinal strain improved (GLS: -2.8±1.9 vs. -5.2±3.9). None of the patients had serious complications. Conclusions: Intracoronary injection of autologous mononuclear stem cells might improve the ventricular function and cardiac remodelling in pediatric patients with dilated cardiomyopathy and could be considered in critically ill patients. [ABSTRACT FROM AUTHOR]

Isolated major aortopulmonary collaterals are rare in healthy term neonates or infants without congenital heart disease; only a few cases have been reported with heart failure or recurrent lower respiratory tract infection in an otherwise structurally normal heart and there is no consensus about their treatment. We report a case with repeated pneumonia, failure to thrive, pulmonary hypertension, and shift of heart to right which is successfully managed by stage coil closure of collaterals. [ABSTRACT FROM AUTHOR]

Introduction: Changes in cardiac structure and function are common among patients with end-stage renal disease. The aim of this study was to evaluate the effect of hemodialysis on global and segmental cardiac function in children with end-stage renal disease.Materials and Methods: Fifty-two children with ESRD who were on long-term hemodialysis at Nemazee Hospital, Shiraz, were enrolled. They underwent echocardiography (M-mode, 2-dimensional, Doppler, and speckle echocardiography) 30 minutes prior to and after hemodialysis, and the values were compared.Results: The mean age of the patients was 13.00 ± 3.53 years. There was a significant reduction in left ventricular systolic and diastolic dimensions and volume (P < .001) and the E:A ratio after dialysis (P = .03). Global and longitudinal strain and strain rate showed no significant changes before and after hemodialysis.Conclusions: Hemodialysis with volume reduction decreases left ventricular volume but not regional strain and strain rate significantly in children. This study showed preload independency of speckle echocardiography in children. [ABSTRACT FROM AUTHOR]

Background: Transcatheter closure of intracardiac defects might be complicated by intravascular hemolysis. We evaluated hemolysis and its outcome after transcatheter closure of these defects. Methods and patients: All patients who underwent transcatheter closure of patent ductus arteriosus, ventricular septal defect and atrial septal defect were included in this prospective study. Clinical data were obtained before and after the catheterization. Results: One hundred and thirty-eight patients were enrolled; and four (3%) patients developed intravascular hemolysis; while two cases had residual shunt and two other cases had not residual flow. Although residual shunt occurred in ten patients, only 2 of these cases developed hemolysis. Patent ductus arteriosus closure was done for one of these cases and the other one, underwent perimembranous ventricular septal defect closure. Moreover, hemolysis occurred after device closure of patent ductus arteriosus in 2 of the other patients with no residual shunt. In this study the hemolysis was eliminated by conservative management within 2 weeks although residual shunt continued in this time. We observed a decline in lactate dehydrogenase value after catheterization in comparison with precatheterization, which was mainly among ventricular septal defect patients that might be due to mild chronic hemolysis in these patients. Conclusion: Incidence of hemolysis after device closure was low, and occurred with and without residual flow and was eliminated by conservative management in 2 weeks, without the need for surgery, although the residual shunt was continued. [ABSTRACT FROM AUTHOR]

Background: Coronary sinus dimension is an important factor for diagnosing some types of cyanosis as well as congenital heart diseases and insertion of some devices into the coronary sinus if required. This study was designed to access the diameter and Z-score of the coronary sinus among children under 18 years of age. Methods: In this cross-sectional study on 95 individuals, the coronary sinus diameter was measured by transthoracic echocardiography in the four-chamber view at the connection to the right atrium, middle part, and distal end. The linear regression equation was utilized to determine age-adjust reference values, Z-scores, and the relationship between the individuals' coronary sinus diameter age, height, and body surface area. The study was conducted from March to July 2020 in Namazi hospital clinic of Shiraz University of Medical Sciences, Shiraz, Iran. Results: The mean age of the persons who entered this study was 5.87 ± 4.25 years. The mean coronary sinus diameter was 4.91 ± 1.29 mm at the site of connection to the right atrium, 4.50 ± 1.44 mm at the middle part, and 3.74 ± 1.32 mm at the distal end. Coronary sinus diameter correlates positively with the participants' age, weight, height, and body surface area (P < 0.001). Conclusion: Coronary sinus diameter significantly correlates with the age, height, and body surface area of the cases. These features are useful in diagnosing some congenital heart diseases and insertion of suitable devices through it. [ABSTRACT FROM AUTHOR]