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Balloon atrial sept ostomy is usually necessary for survival beyond infancy in patients with transposition of the great arteries and insufficient intracardiac mixing. Since the umbilical vein and ductus venosus are often patent in the newborn infants, this route can be considered as an alternative to a femoral venous route in a critically ill infant. A 7 day-old newborn with D-transposition with intact ventricular septum and small patent foramen ovate was successfully managed by creating atrial septal defect through transumbilical balloon arterial septostomy. The procedure was carried out in the neonatal intensive care unit, guided by 2D-echocardiography. The arterial oxygen saturation increased dramatically upon the completion of the procedure, and a large atrial septal defect could be demonstrated echocardiographically. Unfortunately the infant died before further definitive surgery was performed.

We report a case o fhereditary long Q-T syndrome without congenital deafness (Romano-Ward syndrome). In four members of a family, a father and his daughters, the Q-T intervals on the EKG were found to be prolonged. There were no other accompanying familial anomalies such as deafness or a tendency to extracellular hypokalemia The youngest daughter which had the longest. Q-T interval had several Adams-Stokes attacks, and died in the last attack at the age of 23 months. Her two older siblings died at the age of 15 and 10 months with the same typical clinical histories. The eldest daughter, a 12-year old girl, has no clinical symptoms at all, while the fourth child, 5-yeltr old girl has several occasions of near fainting attacks. The EKG of the father showed several runs of supraventricular premature contractions that ceased spontaneously, besides evidence of the prolongation of Q-T interval. The beta-adrenergic blocking drug (propranalol) given in a relatively small maintenance dose, proved to be effective in preventing attacks of the father and the fourth child, despite the unchanged prolongation of the Q-T interval.

We evaluated the implementation of diagnostic criteria on 547 ambulatory patients with rheumatic fever (RF) and rheumatic heart disease (RHD) between January 1, 1983 and December 31, 1992. The diagnosis of RF and reactive RHD was established by either revised Jones criteria, modified Jones criteria, or clinical judgment The patient's age ranged from 4-18 years, 255 (46.6%) of them were boys. The clinical manifestations found were fever (58.1 %), arthritis (41.9%), chorea (8.6%), subcutaneous nodule (1.3%), erythema marginatum (1.1%), holosystolic murmur (56.9%), mid-diastolic murmur (25.4%), and early diastolic murmur (29.5%). The laboratory changes were hemoglobin 20 mm/h (56.30/o), ASTO >200 U (29.6%), PR interval> 0.16 sec (13.3%), and erR> 0.55 (27.6%). Revised Jones criteria were met in 162 cases (29%), modified criteria in 474 cases (86,6%), and clinical judgment in 521 cases (95.2%).

We compared the diagnostic accuracy of electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in 119 randomly selected from 400 patients with thalassemia major treated at the Department of Child Health, Medical School, University of Indonesia, Jakarta. Echocardiographically derived left ventricular hypertrophy (EchoLVH), both for body surface area (BSA)-indexed and height-indexed, served as the gold standard. There were 57 girls and 62 boys available, ranging in age from 5 to 27 years. ECG criteria for LVH was detected in 23 outof119 patients, while echo-LVH was detected in 47 patients if BSA-indexed LVH was used, or 22 patients if height-indexed LVH was used. The sensitivity and specificity of ECG-LVH were 25.5 and 84.7% respectively if BSA indexed LVH was used as gold standard, or 36.4% and 84.5%, respectively, when height indexed echo-LVH was used. It is concluded that ECG criteria for LVH has a low sensitivity and hjgh specificity in detecting increased left ventricular mass in children with thalassemia major.

Twenty patients with secundum atrial septal defect, who had undergone open heart surgery were studied retrospectively. Girls were more affected than boys; the sex ratio was 1.5 : I. Associated cardiac defects were diagnosed in two patients, one with moderate valvular pulmonic stenosis and the other one with small ventricular septal defect. Typical clinical findings consisted of loud first heart sound, widely fixed split second heart sound and soft ejection systolic murmur at the upper left sternal border were heard in all cases. Mid diastolic murmur due to relative tricuspid stenosis was detected in most cases (75%). Electrocardiographic findings included right axis deviation, prolonged PR-interval and right atrial enlargement were found in 50%, 15% and 60% of cases, respectively. Incomplete right bundle branch block and right ventricular enlargement were found in all cases, as was cardiomegaly with increased vascular markings were found in all cases. Paradoxical ventricular septal motion and visualization of the atrial septal defect were seen in 95% and 75% of cases, respectively. Cardiac catheterization was performed in 19 patients (95%). The pulmonary-systemic flow ratio (Qp/Qs) ranged from 1.7 to 6.3 (mean 2.9 ± 0.67), and was correlated to the presence of mid diastolic tricuspid flow murmur and paradoxical ventricular septal motion. Simple closure of the defect was the procedure of choice, but in one patient (5%) pericardial patch was used to close the very large defect. The mortality rate was 10 percent. Physical retardation was found in all boys and 50% of girls, before surgery. Body weight percentile increased in most cases (61.1 %), while body height percentile increased in only 5.6% of cases, postoperatively. Ejection systolic murmur at the upper left sternal border was still detected in one patient (5.6%). lncomplele right bundle branch block persisted in all cases, while cardiomegaly was still found in 5. 6% of cases followed up six months to five years after surgery. There was no residual left ventricular dysfunction in all cases.

Background Respiratory problems, such as aspiration pneumonia, are major causes of morbidity and mortality in children with cerebral palsy (CP) and greatly affect the quality of life of these children. Nevertheless, there is limited data on the incidence and risk factors of aspiration pneumonia in children with CP in Indonesia. Objective To determine the incidence and risk factors of aspiration pneumonia in children with cerebral palsy . Methods In children with CP aged 1-18 years, incidence of pneumonia was studied prospectively for 6 months and the prevalence of the risk factors was studied cross-sectionally. At baseline, we evaluated subjects’ by history-taking, physical examination, risk factors, and chest X-ray to assess the incidence of silent aspiration. Subjects were followed-up for six months to determine the incidence of overt or silent aspiration pneumonia. Results Eight out of 36 subjects had one or more episodes of aspiration, consisting of silent aspiration (2/36) and clinically diagnosed aspiration pneumonia (7/36). Subjects with more severe gross motor dysfunction experienced more episodes aspiration pneumonia, although it was not statistically significant (p = 0.06), while dysphagia (P=0.2) and nutritional status (P=0.11) were not associated with pneumonia or silent aspiration. Conclusion Twenty-five percent of children with CP experienced aspiration pneumonia during the 6-month study period, with gross motor dysfunction as a possible risk factor.

Background: Evaluating outcome and identifying predictors of major complications among children undergoing cardiac surgery are essential to improve care. We evaluated short-term outcomes of postcardiac surgery and predictors of major complications in a national referral hospital in Indonesia. Methods: A prospective cohort study was conducted from April 2014 to March 2015 on all children undergoing cardiac surgery. Participants were followed up from the time of surgery until hospital discharge and 30-day mortality. We performed univariate and multivariate logistic regression using STATA 12-1 to identify predictors of postsurgical major complications. Results: A total of 257 patients (median age: 36 months) were recruited; 217 (84.1%) had complications, including low cardiac output syndrome (19.8%), arrhythmia (18.6%), sepsis (17.4%), and pleural effusion (14.8%). Forty-nine (19%) patients had major complications, including cardiac arrest (5%), need for emergency chest opening (3.9%), and multiple organ failure (7.4%). 12.8% died during hospital stay, and 30-day mortality was 13.6%. Predictors of major complications were cyanotic congenital heart disease (odds ratio [OR]: 4.6, 95% confidence interval [CI]: 1.5–14.2), longer duration of cardiopulmonary bypass (CPB, OR: 4.4, 95% CI: 1.5–13.4), high inotropes (OR: 13.1, 95% CI: 3.2–54.2), and increase in lactate >0.75 mmol/L/h or more in the first 24 h (OR: 37.1, 95% CI: 10.1–136.3). Conclusion: One-fifth of children undergoing cardiac surgery experienced major complications with around 13% mortality. Cyanotic congenital heart disease, longer duration of CPB, high inotropes on leaving operating theater, and increase in blood lactate are associated with major complications in children after cardiac surgery.

Background The technical aspects of ductal stenting have been reported, but little is known about the fate of the duct after stent implantation. Objectives To determine the effects of PDA stenting on the degree of cyanosis, blood oxygen saturation, long-term patency of PDA, and the growth of pulmonary artery and its branches, in patients with duct-dependent pulmonary circulation. Methods This was a case series study conducted at the Department of Pediatric Cardiology, Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia from November 1996 to September 2001 on patients with duct-dependent pulmonary circulation who underwent stent implantation. All patients were followed-up until occlusion or block occurred or until the end of follow-up time. The evaluation consisted of clinical manifestations, electrocardiography, chest x-ray, echocardiography, and cardiac catheterization. Results Stent was successfully implanted in 60 patients (84%), failed in 7 patients (10%) and contra indicated in 4 patients (6%). There was significant improvement on the degree of cyanosis after stent implantation (p

Background Patent ductus arterious (PDA) is one of the most common congenital heart diseases encountered in preterm infants. The lower the birth weight and gestational age are, the higher the incidence of PDA is. Objectives To investigate the incidence of PDA in premature infants hospitalized in the neonatal wards of Cipto Mangunkusumo Hospital using echocardiography. Methods Preterm infants born between August and October 2003 were included in this study. Clinical features were retrieved from medical charts. The first echocardiography was conducted on all of the preterm infants at the chronological age of 3 days. If PDA was detected, echocardiography was repeated at the chronological age of 6 days. Results During the 3-month period, sixty-five preterm infants participated in this study and underwent echocardiography. In the first echocardiogram, the incidence rate of PDA was 32%. At gestational age of less than 28 weeks, 1 of 2 infants had PDA. Of 3 infants with birth weight of more than 1000 grams, 2 had PDA. On the second echocardiography, the incidence rate of PDA was 14% and mostly found in infants at gestational age of less than 28 weeks (8/9) and in those with birth weight of less than 1000 grams (7/9). All infants with RDS whose PDA was identified in the first echocardiography proved to maintain their PDA in the second echocardiography. Conclusion The incidence rate of PDA in preterm infants was 14%. The lower the birth weight, the higher the incidence rate of PDA. The presence of RDS is related to the delay in the closing of the arterial duct [Paediatr Indones 2004;44:223-227].

Background Hemodynamic instability in sepsis, especially in the neonatal population, is one of the leading causes of death in hospitalized infants. The major contribution for heart dysfunction in neonatal sepsis is the myocardial dysfunction that leads to decreasing of ventricular function. The combination of echocardiography and laboratory findings help us to understand the ventricular condition in preterm infants with sepsis.Objective To assess for a correlation between ventricular function and serum high-sensitivity cardiac troponin T (hs-cTnT) level in preterm infants with neonatal sepsis.Methods We prospectively studied 30 preterm infants with neonatal sepsis who were admitted to the neonatal intensive care unit (NICU) of Cipto Mangunkusumo Hospital from June 1 – August 31, 2013. The ventricular functions were measured using 2-dimensional echocardiography. The parameters of right ventricular (RV) function assessment were tricuspid annular plane systolic excursion (TAPSE) and RV myocardial performance index (MPI). For left ventricular (LV) performance, we assessed ejection fraction (EF), fractional shortening (FS), and LV-MPI. Serum hs-cTnT was measured and considered to be a marker of myocardial injury.Results Subjects had a mean gestational age of 31.5 (SD 2.18) weeks and mean birth weight of 1,525 (SD 437.5) g. The mean LV function measured by MPI was 0.281 (SD 0.075); mean EF was 72.5 (SD 5.09)%; and mean FS was 38.3 (SD 4.29)%. The RV function measured by TAPSE was mean 6.85 (SD 0.94) and that measured by MPI was median 0.255 (range 0.17-0.59). Serum hs-cTnT level was significantly higher in non-survivors than in survivors [282.08 (SD 77.81) pg/mL vs. 97.75 (24.2-142.2) pg/mL, respectively P =0.023]. There were moderate correlations between LV-MPI and hs-cTnT concentration (r=0.577; P=0.001), as well as between RV-MPI and hs-cTnT concentration (r=0.502; P=0.005). The positive correlation between LV and RV-MPI in neonatal sepsis was strong (r=0.77; P

Transcatheter closure of patent ductus arteriosus (PDA) has been suggested to be the standard treatment of PDA. Although, in general, the procedure shows a high successful rate, outcomes may vary among pediatric cardiology centers. To evaluate the effectiveness of transcatheter closure of PDA in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, this was a retrospective study on patients who underwent transcatheter closure of PDA in Cipto Mangunkusumo Hospital during the period of 2002–2013. Hospital registry was reviewed and data about patients’ characteristics, PDA severity, procedure, and outcomes were retrieved. There were 298 patients, of whom 90 were males, who underwent transcatheter closure of PDA during the study period. Median age was 3.4 years (1 months–18 years), and median body weight was 12 (3.6–59) kg. The diameter of PDA ranged from 1.1 to 15.4 mm with a median of 3.7 mm. Device could be deployed in all patients, in which most were the Amplatzer ductal occluder (69.8 %) and the remainders were coils. Median fluoroscopy time was 15.4 (1.5–87) min, and procedure time was 76 (30–200) min. Complete closure was achieved in most patients (97.3 %), whereas device migration occurred in a minority (0.3 %) of patients. No major complication occurred during or after the procedure. Transient anemia and bradycardia were found in 3.7 and 1.3 % patients, respectively. Most patients were discharged from the hospital at 1 day after the procedure. Transcatheter closure method is a safe and effective procedure to close PDA.

Background Thalassemia is a major public health problem in Indonesia. Cardiac diseases remain as the main cause of death in these patients due to iron overload. Although the T2* magnetic resonance imaging has been considered as the gold standard for assessing cardiac iron overload but it has limited availability. The tissue doppler imaging (TDI) echocardiography, a fairly new and easy method that is suggested, can detect early abnormal myocardial iron overload. Objective To assess myocardial systolic and diastolic function of thalassemic patients using TDI and examine their correlation with serum ferritin level. Methods A cross􀁌sectional study was conducted from January to March 2011 at the Harapan Kita Women and Children Hospital. We performed clinical examination, serum ferritin level, as well as conventional and tissue doppler echocardiography on all subjects. Results We included 34 regularly􀁌tranfused patients, of which 17 were boys. The mean age of the subjects was 11.6 (SD 4.7 years, range 2.6 􀁌 20 years). Mean pulse rate and blood pressure were within normal range. Hemoglobin level at inclusion ranged from 5.8 to 6 g/dL. Almost all patients did not receive regular chelation therapy. Median serum ferritin level was 6275 ng/mL (range 2151 - 17,646 ng/mL). Conventional echocardiography showed normal systolic function, but some diastolic dysfunctions were found including E wave abnormalites in 4 patients, A wave abnormalites in 3, and E/A ratio abnormalites found in 3. The TDI showed decreased systolic function (Sa wave abnormality) in 9 patients and diastolic dysfunctions (Ea wave abnormality in 11 patients and Aa wave abnormaly in 2). No abnormality was found in Ea/Aa and ElEa ratios. There was a weak negative correlation between ferritin level and Sa wave and Ea wave respectively and a moderately negative correlation between ferritin level and Ea/ Aa ratio. There was no correlation between serum ferritin and Aa wave or ElEa ratio. Conclusion TDI identifies a greater number of patients Mth systolic and diastolic myocardial dysfunction than was revealed by conventional echocardiography. There was a weak negative correlation between serum ferritin to Sa wave and Ea wave, and a moderately negative correlation between ferritin and Ea/Aa ratio. There was no correlation between serum ferritin and Aa wave or ElEa ratio. [paediatr Indones. 2012;52:187,93].

Background Cancer in children can adversely affect their developments and growth. The assessment of health-related quality of life (HRQL) will justifY its physical and psychological effects. Methods Seventy-seven subjects who underwent therapy were assessed using the PedsQL™, which consisted of parent-proxy reports and or child-self reports. PedsQL™ is assessments of physical, social, emotional and role functions. The control group was students with the same number and age as the sample group. Results Children with cancer had lower HRQL than normal healthy children (odds ratio 3. 7). Children with cancer who came from low socio-economic families had lower social functions and girls had tendencies to have lower quality oflife. Fathers' education had strong influence in children's quality of life. Leukemic patients had better quality of life than those of lymphoma and solid organ tumor. Group with age of diagnosis at 6-9 year old had lower HRQL compared with younger or older groups. The longer period of illness was, the more emotional function would improved. Despite of a good accordance between parents' and child's reports, parents usually had reports about having lower quality of life. Conclusions Children's HRQL is influenced by clinical characteristics and social-demographic variables differently. Assessment of the children's HRQL is better done with parents and or child as the source of information.

Background: Transcatheter closure of atrial septal defects (ASD) has been accepted world-wide as an alternative to surgical closure with excellent results. This interventional, non-surgical technique plays an important role in the treatment of ASD mostly in the developing world where resources are limited. Objectives: To report the outcomes and short term follow-up of transcatheter closure of ASD over a 12-year period at our institution with limited resources. Patients and Methods: This retrospective study included all patients with the diagnosis of secundum ASD and significant shunting (Qp/Qs > 1.5:1) as well as dilated right atrium and right ventricle who had transcatheter closure at Integrated Cardiovascular Center (PJT), Dr. Cipto Mangunkusumo Hospital between October 2002 and October 2014. One hundred fifty-two patients enrolled in this study were candidates for device closure. Right and left heart cardiac catheterization was performed before the procedure. All patients underwent physical examination, ECG, chest X-ray and transthoracal echocardiography (TTE) prior to device implantation. Results: A total of 152 patients with significant ASD underwent device implantation. Subjects’ age ranged from 0.63 to 69.6 years, with median 9.36 years and mean 16.30 years. They consisted of 33 (21.7%) males and 119 (78.3%) females, with mean body weight of 29.9 kg (range 8 to 75; SD 18.2). The device was successfully implanted in 150 patients where the majority of cases received the Amplatzer septal occluder (147/150; 98%) and the others received the Heart Lifetech ASD occluder (3/150, 2%), whereas two other cases were not suitable for device closure and we decided for surgical closure. The mean ASD size was 19.75 (range 14 - 25) mm. During the procedure, 5 (4.9%) patients had bradycardia and 3 (2.9%) patients had supraventricular tachycardia (SVT), all of which resolved. Conclusions: In our center with limited facilities and manpower, transcatheter closure of atrial septal defect was effective and safe as an alternative treatment to surgery. The outcome and short-term follow-up revealed excellent results, but long-term follow-up is needed.

Background Indomethacin and ibuprofen are the drugs of choice for closure of patent ductus arteriosus (PDA) in preterm infants. However, intravenous preparations are of limited availability in Indonesia. Circumstantial evidence has shown that intravenous paracetamol may be an alternative therapy for PDA closure in premature infants.Objective To evaluate the effect of intravenous paracetamol on PDA closure in preterm infants.Methods A before-and-after study was conducted between May and August 2014 in Cipto Mangunkusumo General Hospital, Jakarta in preterm infants with hemodynamically significant PDAs, as established by echocardiography using the following criteria: duct diameter >1.4 mm/kg, left atrium to aorta ratio >1.4, and mean velocity in the left pulmonary artery >0.42 m/s or mean diastolic velocity in the left pulmonary artery >0.2 m/s. Subjects, aged 2 and 7 days, received intravenous paracetamol (15 mg/kg every six hours) for 3 days. Paired T-test was used to compare pre-intervention PDA diameter to those assessed at 24 hours after the intervention and at 14 days of life.Results Twenty-nine subjects had a mean gestational age of 30.8 weeks and mean birth weight of 1,347 grams. Nineteen (65.5%) patients had closed PDAs at the day 14 evaluation, 1 experienced PDA reopening, and 9 had failed PDA closure. No liver toxicity was identified. Mean duct diameters before, 24 hours after the intervention, and at 14 days of life were 3.0, 0.9, and 0.6 mm, respectively (P

Background Thalassemia major (TM) is a transfusion-depen- dent disease. Multiple transfusions cause an accumulation of iron in the body. On the heart, iron can induce cardiomyopathy, the leading cause of death in TM. Objective To evaluate left ventricular functions and mass among adolescents and young adults with TM. Methods A cross-sectional study was conducted on 58 patients with TM in Cipto Mangunkusumo Hospital, Jakarta. Hematological data was collected from medical record. Left ventricular systolic func- tions (EF, FS), diastolic functions (A, E, E/A ratio, IVRT), and mass (LVDDi, LVDSi, LVMi) were detected using an echocardiography Sonos 4500. T test, linier regression, and multiple regression analy- sis were performed. Results Out of 32 TM patients, 30 were enrolled to study. Left ventricular systolic and diastolic functions of TM patients were lower than those of the control and statistically significant [EF 66.1% (SD 4.9) and 71.6% (SD 5.6); P

Background Injection ofbenzatine penicillin G (BPG) every 28 days is still the drug of choice for secondary prevention of rheu- matic heart disease (RHD). BPG sometimes poses problems due to pain at the injection site, possible anaphylaxis, and is not always available. Some centers choose oral penicillin over BPG. Objectives To compare minimal inhibitory capacity (MIC) and minimal bactericidal capacity (MBC) of oral penicillin V serum with those of BPG among SGA infected RHD. Methods This was a clinical trial with crossover design study to compare MIC of penicillin V and BPG. Outcome measures were MIC and MBC. Statistical analysis was performed using paired t-test and wilcoxon test. Result There were 32 subjects consisted of 17 males and 15 females. The mean value of MIC and MBC serum of penicillin V were 0.031 and 0.125. The mean value of MIC and MBC serum of BPG3 were 0.094 and 0.031. Respectively the MIC of penicillin V was similar to that of BPGy The mean value of MIC and MBC of BPG4 were 0.125 and 0.250. Respectively the MIC of penicillin V was significantly higher than that of BPG 4. The MBC of penicillin V was significantly higher than that of BPG 4. The MIC ofBPG 3 was similar to that ofBPG 4• The MBC of BPG 3 was similar to that of BPG 4. Conclusions The MIC of penicillin V was similar to that ofBPG 3, the MBC of oral penicillin V was higher than that ofBPG 3• The MIC and MBC of penicillin V was higher than those of BPG 4.

Background Cardiovascular diseases remain the leading cause of death worldwide. Atherosclerotic process increases rapidly during adolescence. Physical activity is considered important in this period to modify cardiovascular risk factors, thus preventing disease in the future.Objective To determine whether different physical activity status in adolescence can influence body mass index (BMBMI), waist-to-hip ratio, blood pressure (BP), and blood lipid profile.Methods This was a cross-sectional descriptive study, conducted from December 2009 to January 2010. Adolescents who fulfilled the study criteria were classified into high and low physical activity category. Further examination including body mass index, waist-to-hip ratio, blood pressure, and blood lipid profile were performed.Results Adolescents with high physical activity had higher, but statistically insignificant, BMBMI compared to adolescents in the P=0.493] and significantly lower waist-to-hip ratio [0.80 (range 0.73-0.9) vs.. 0.82 (range 0.7-0.9), P=0.019]. Difference in BP was not statistically significant between both groups [diastolic BP (70 (range 60-90) mmHg vs. 70 (range 60-90) mmHg, P=0.148; systolic BP 100 (range 90-130) mmHg vs. 100 (range 90-140) mmHg, P=0.228)]. Blood lipid examination in the high activity group showed significantly higher HDL cholesterol and lower triglyceride compared to the low activity group [HDL 59.8 (SD 11.8) mg/dL vs. 54.7 (SD 8.9) mg/dL; p=0.044; triglyceride: 60 (range 32-203) mmHg vs. 82 (range 37-198) mmHg, P=0.014]. Total and LDL cholesterol [total cholesterol 169.8 (SD 28.6) mmHg vs. 181.2 (SD 30.8) mmHg, P=0.107; LDL 103.6 (SD 26.8) mmHg vs. 114.1 (SD 27.3) mmHg, P=0.100] were lower in the high activity group but not statistically different in both groups.Conclusions Adolescents with high physical activity show less cardiovascular risk factors compared to those in the low physical activity group.

Background Neonatal asphyxia is a disorder in neonates dueto decreased oxygenation (hypoxia) and decreased perfusion toorgans (ischemia). Duration of asphyxia and early managementinfluence the severity of organ dysfunction, including the heart.Objectives To obtain patterns of cardiac abnormality inneonatal asphyxia in Cipto Mangunkusumo Hospital withechocardiography. Design A cross-sectional study was performed on 22 asphyxiated neonates and 22 other non-asphyxiated neonates from March to October 2008. Inclusion criteria were term neonates, Apgar score :S 6 in the first minute for asphyxiated neonates and ?. 7 for normal/non-asphyxiated neonate. Echocardiographic examination was performed before the age of 48 hours.Results There were 7/22 asphyxiated neonates and 1/22 nonaxphyxiated neonate with heart disease (P

Twenty five patients with patent ductus arteriosus, who had undergone surgical closure were studied retrospectively. Girls were more affected than boys; the sex ratio was 4 : I. Associated cardiac lesions were diagnosed in 3 patients, two with ventricular septal defect and one with congenital mitral stenosis. Congestive heart failure was diagnosed in 5 patients before surgery. Typical continuous murmur was heard in most cases (76%), while in the rest only systolic murmur was detected. Electrocardiographic left atrial enlargement, left ventricular hypertrophy and right ventricular hypertrophy were found in 8%, 48% and 40%, respectively.Cardiomegaly with increased pulmonary vascular markings was found in 60% of cases, while ratio of left atrial to aortic root diameter greater than 1.2 was detected in 60% of patients. The PDA could be directly visualized by echocardiography in 15 cases.Cardiac catheterization was performed in 17 cases, 47% with hyperkinetic pulmonary hypertension, 41% with high pulmonary flow without pulmonary hypertension and 12% with mild increased pulmonary flow. The pulmonary-systemic flow ratio (Qp/Qs) was more correlated to pulmonary vascular markings rather than to cardio-thoracic ratio. Division of the ductus was the procedure of choice, but in 16% of cases ductal ligation was performed because of technical reasons. Postoperative catch-up in both weight and height was observed more clearly in children operated at earlier age. Ejection systolic murmur was still detected in 2 patients, in whom hyperkinetic pulmonary hypertension existed prior to surgery. No cardiomegaly was found in patients followedup I year or more after surgery. The mortality was nil.

We report clinical and laboralory findings of 15 children with bacterial endocarditis, admitted ro the Department of Child Health, University of Indonesia/Cipto Mangunkusumo Hospital from February, 198710 June, 1989.There were 8 boys and 7 girls with bacterial endocarditis, ranging in age from 10 weeks 10 16 years. The diagnosis was suspected because of prolonged fever, with or without other manifestations, i.e. congestive heart failure, refractory anemia, or paroxysmal atrial tachycardia. The underlying heart disease was congenital in 12 cases and rheumatic heart disease in 3 cases.The clinical, electrocardiographic, and radiologic manifestations were generally predominated by the pre-existing heart disease. No characteristic findings of bacterial endocarditis, i.e. Osler's nodes, Janeway lesions or splinter haemorrhages were detected.Positive bacterial culture was obtained in 12 cases; the most frequent bacteria isolated was Pseudomonas aeruginosa (4 cases), Streptococcus viridans was isolated in 2 cases only.Vegetation was visualized echocardiographically in 12 cases; 9 with clear cut evidence of large vegetation, and the other 3 the vegetation was equivocal. On follow-up they disappeared gradually with clinical improvemenl. Large vegetation might need 2 full months 10 disappear echocardiographically.