Search

Objective: To determine post procedural immediate and short-term outcomes of transcatheter Ventricular Septal Defect (VSD) device closure. Study Design: Longitudinal Cross-sectional study. Place and Duration of Study: Pediatric Cardiology Unit at Tertiary Cardiac Care Centre, Rawalpindi, Pakistan, from Feb to Oct 2022. Methodology: Total of 62 patients fulfilling inclusion and exclusion criteria who underwent transcatheter VSD device closure were retrospectively identified from our institutional database by non-probability consecutive sampling technique. Preprocedural evaluation [Transthoracic Echocardiography (TTE) & Electrocardiography(ECG)], procedural details and immediate post procedure outcomes were documented. Follow-up evaluations were done at 6 and 12 months. It included clinical examination, TTE and 12 lead ECG. New onset and status of old complications were documented in each visit. SPSS version 24.00 was used to analyze data. Chi-square test was used to find association between study variables. p-

Objective: To measure the frequency of dyspnea in pregnant patients and to evaluate the clinical and echocardiographic findings of pregnant women had dyspnea. Study Design: Analytical descriptive cross-sectional. Place and duration of study: Gynae and Obstetric Department of Tertiary Care Facility from Feb 2022 to Apr 2022. Methodology: It was an analytical cross sectional study conducted during three months. Consecutive pregnant females through non-probability consecutive sampling were included in the study. Patients who had diagnosed history of cardiac disease, respiratory illness, anemic and had covid-19 infection history of 3 months were excluded. The calculated sample size was 323. The pregnant females were assessed for dyspnea (shortness of breath) during pregnancy. Those patients who had dyspnea were referred to cardiac facility for 2D-ECHO (Echocardiography) to determine the cause of dyspnea. Frequency & percentage and mean ± SD were calculated for qualitative and quantitative data respectively. Chi square test was applied to find association between categorical variables. Student t-test was applied for continuous data. Results:A total of 323 pregnant females of age more than 18 years were included in the study. Out of 87(26.9%) pregnant females who had dyspnea during their pregnancy, 2(2.1%) females were from 1st trimester, 26(23.2%) of 2nd trimester and 59(50.8%) of 3rd trimester. ECHO showed that mean left ventricle end-diastolic diameter (LVEDd) was 46±8mm, LVEF 58.8±7%, sPAP 25.40±3.5mmHg and LVESd 29.33±8.8mm. As compared to the normal range sPAP, LVESd were in lower range, while LVEDd value was higher than the normal range (27.2 mm). Study population who had dyspnea and hypertension (HTN) were (n=13)15.4% (p=1.000) and (n=7)7.7% were had Diabetes (DM) (p=1.000). Cardiac disease was found to be higher in females who had dyspnea i.e.(n=67) 76.9% (p=

Objective: To assess the immediate and short-term efficacy and safety of transcatheter closure of cardiac defects with Lifetech™ Konar-MFO in a Tertiary Cardiac Care Center. Study Design: Descriptive cross-sectional study. Setting and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Mar 2019 to Dec 2021 Methodology: Patients of all ages and both gender undergone transcatheter closure of a cardiac defect with Konar-MFO from Jan 2021 to Dec 2021 were included in the study through non-probability consecutive sampling and approval by the institutional ethical review committee was taken prior to data collection. Data of patients undergone transcatheter closure with Konar-MFO from Mar 2019 to Dec 2020 was extracted retrospectively to assess the immediate and short-term efficacy and safety of the occluder. SPSS version-23 was used for data entry and analysis. Results: A total of 138 patients had transcatheter closure of a cardiac defect with Lifetech™ Konar-MFO during the study period. Case of VSD were 124(89.9%), PDA 9(6.5%), post-operative cases were 4(2.9%) along with 1(0.7%) case of coronary artery fistula (CAF) to the right ventricle. Out of 138 patients, 73(52.9%) were females while 65(47.1%) were males. The mean age was 9.3 ±8.1 years with a range of 6 months to 36 years. Mean fluoroscopy time was 13.68±9.74 min. The procedure was successful in 137(99.27%) cases. The device embolized in 2(1.45%) cases. Conclusion: In selected cases of VSD, PDA and in some post-operative cases the occlusion with Lifetech™ Konar-MFO is safe and efficacious with the added benefits of softness and versatility of the approach.

In congenital cardiac surgery, intracardiac repair procedures like ventricular septal defect (VSD), atrioventricular septal defect and tetralogy of fallot (TOF) are associated with conduction system injury. Fewer cases are reported describing life threatening complication of late post-operative complete heart block. We are reporting 2 patients who presented with late complete heart block after ventricular septal defect repair and managed by permanent pacemaker placement in AFIC Cath lab.

Objective: To determine the spectrum of Grown up Congenital Heart (GUCH) at Armed Forces Institute of Cardiology/National Institute of Heart Dieases. Study Design: Descriptive cross sectional study. Place and Duration of Study: Paediatric Cardiac Surgery and Obstetric department of Armed Force Institute of Cardiology/National Institute of Heart Diease, Rawalpindi Pakistan, from 2011 to 2021. Methodology: It was a descriptive cross sectional study conducted at Paediatric Cardiology, Paediatric Cardiac Surgery and Obstetric department of AFIC/NIHD. After taking informed consent, a total of 1344 patients fulfilling inclusion and exclusion criteria with non probability consecutive sampling were enrolled in study from 2011 to 2021. Diagnosis, transthoracic echocardiography findings, procedural details (cardiac catheterization/cardiac surgery/obstetrical intervention) and outcome of all patients were noted. Results: Out of 1344 patients, 700 patients had cardiac catheterization. Among patients who underwent cardiac cath, 304(43%)were males and 396(56.6%) were females. 279(39%) diagnostic and 421(61%) cardiac interventional procedures were done.Most common procedure done was ASD device closure in 227(32%) patients. Complications were seen in 29(4%) patients and mortality in 3(0.4%) patients. There were a total of 188 patients who underwent congenital cardiac surgery. Out of patients who underwent congenital cardiac surgery procedures, 96(51%) were male and 92(49%) were female patients. Major complications were observed in 51(25%) patients and the mortality was 11(5%).There were total of 456 patients in obstetrics department. Out of 456 patients, 54(11%) were with congenital cardiac lesions .The most common defect was VSD 27(6%)patients and dilated cardiomyopathy (DCM) 27(6%) patients followed by ASD and TOF. The maternal and fetal mortality was12(2.7%) and 22(5.5%) respectively. Conclusion:With immense advancement in diagnosis and management of congenital cardiac diseases, a significant number of patients remain undiagnosed and untreated till the time they present as GUCH. Most common presentation is ASD which is mostly manageable by transcatheter intervention, however late presentation carries a risk of complications like pulmonary hypertension.

Recent increase in deployment of trans-catheter devices such as septal or ductal occluding coils and devices has been a possible risk factor for infective endocarditis, predominantly in the initial post deployment period before endothelialization has ensued. Though a long-term study of trans-catheter Atrial Septal Defect (ASD) closure revealed no cases of Infective Endocarditis, some case reports of endocarditis in trans-catheter device closure of ASD, VSD and Patent ductus arteriosus(PDA) advocate that residual defect after device occlusion may be a factor in the risk for Infective Endocarditis. We herein describe the case of a 9-month-old female patient who underwent device closure for peri-membranous ventricular septal defect (VSD) and developed fungal infective endocarditis in early post occlusion period which was confirmed on blood culture. Despite treatment with appropriate antifungal as per sensitivity, clinical condition of the patient deteriorated and it was decided to manage her with surgical explanation of device and closure of defect.

Objective: To determine the frequency of congenital cardiac lesions in pregnant women reporting for fetal echocardiogram and correlate with obstetrical risk factors. Study Design: Descriptive cross-sectional study. Place and Duration of Study: To be conducted at pediatric cardiology and obstetrical unit of AFIC/NIHD and CMH Rawalpindi, from Jan 2009 to Jan 2020. Methodology: Pregnant women referred for fetal echocardiogram from 19-49 years of age were enrolled. Echo was done between 20 to 36 weeks gestation. Primary outcome was the nature of cardiac lesion and gestation at diagnosis. Neonatal scan was done at follow up to confirm cardiac diagnosis. Secondary outcome was obstetrical risk factors which were the reason for referral. This included age consanguinity, family history, previous history of intrauterine death or early neonatal death, maternal and paternal diseases. Data was collected and analyzed n frequencies and percentage. Chi-square was applied for association between variable and p-valve 0.05 was considered significant. Results: A total of n=967 pregnant women referred to outpatient department for fetal echocardiogram. Congenital cardiac lesion were detected in n=83 patients. Majority of patients had CAVSD (1.2%) CCAVB (1.2%) followed by ASD (1.1%) VSD (0.9%) Abnormal heart rate (0.8%) Single ventricle (0.3%). Most significant maternal age group was between 21 to 30 and 30-40 years (43.7 and 46.2%). Only 3% below 20 years and 6.7% above 40 years of age. Most important maternal risk factor was previous off spring 0.5% past family history 0.3% and abnormal obstetrical ultrasound 0.3% Followed by maternal diabetes 0.1% and maternal hypertension 0.1%. The yield of detection of congenital cardiac lesions was 8.3%. Conclusions: Congenital cardiac diseases are the second most common congenital anomaly and huge burden n pediatric population. Timely diagnosis and referral can be lifesaving.

Objective: To compare trans-atrial/Trans-pulmonary and trans-annular/trans-ventricular techniques of surgical correction of tetralogy of fallot. Study Design: Descriptive cross sectional study. Place and Duration of Study: AFIC-NIHD Rawalpindi, from Jan 2005 to Jan 2020. Methodology: Pre-op variables included age, gender, weight, SaO2 and any previous operation (like Modified Blalock Taussig Shunt.) Operative variables were any previous Blalock Taussig Shunts and if present, then their takedown, Cardiopulmonary Bypass Time, Aortic Clamp Time, any Right Ventricle - Pulmonary Artery conduit, Main Pulmonary Artery patch-plasty, Left Pulmonary Artery/ Right Pulmonary Artery patch-plasty, dosage of inotropes and pacing started during weaning off CPB. Post-op variables were mechanical ventilation time (hrs), ventilation time >72 hrs, dosage and duration of inotropes, pacing >24 hrs, renal complications, neurological complications, sepsis, low cardiac output, re-ventilation, tachyarrythmias, any re-opening surgery, mean intensive care unit stay (hrs), overall hospital stay (days) and overall all-cause mortality. Results: A total of 1271 TOF patients were operated. In (38.6%) cases Trans-atrial / Trans-pulmonary approach was used while in 780 (61.3%) correction was done by TAP/TV technique. In both techniques, male patients were 365 (66.4%) vs. 73 (64.1%) females. Mean age was 5 ± 2.3 vs. 4 ± 2.5 years, MPA patch-plasty was 190 ± 5 (38.6%) vs. 780 ± 8 (100%) (p-0.058), RPA/LPA Patch Plasty was 25 ± 6 (5%) vs. 180 ± 10 (23%) (p- 0.025), In ICU, Ventilation hours was 25 ± 8 and 30 ± 12, Ventilation >72 Hrs was 15 (3%) vs. 65 (8.3%) (p-0.015), Inotrope duration >72 Hours was 90 (18.3%) vs. 400 (51.2%) (p-0.338), pacing >24 hours was 30 (6.1%) vs. 150 (19.2%) (p-0.0001), renal complications were 10 (2.3%) vs. 35 (4.4%) (p- 0.285), Neurological complications were 7 (1.4%) vs. 15 (1.9%) (p0.553), Sepsis was 11 (2.2%) vs. 47 (6%) (p-0.33), Low cardiac output was 15 (3%) vs. 66 (8.4%) (p- 1.000), re-ventilation was 10 (2%) vs. 110 (14%) (p- 0.41), Tachy-arrhythmia was 25 (5%) vs. 150 (19.2%) (p- 0.11), re-openings were 19 (3.8%) vs. 65 (8.3%) (p- 0.0003), ICU stay (Hours) was 87 ± 8 vs. 108 ± 10, Mortality was 35 (7.1%) vs. 75 (9.6%) (p-0.094), Mean hospital stay (Days) was 12.2 ± 2.5 vs. 15.8 ± 4.9. Conclusion: Fifteen years’ experience of Tetralogy of fallot corrections at AFIC-NIHD indicates that Trans-atrial / Trans-pulmonary approach is more beneficial to patients due to high survival rate, less morbidity, less hospital stay and an early discharge. This ultimately translates into less financial burden on the patients, hospital, society and the country at large.

After total correction for tetrolgy of fallot (TOF), right ventricle behaves in an unpredictable manner depending on type of right ventricular outflow tract (RVOT) reconstruction and surgical expertise of infundibular muscle resection. We are reporting a 23 years old girl who underwent total correction at two years of age. RVOT was reconstructed with native pericardial patch. Gradually she developed breathlessness and occasional chest pain. Echocardiograghy revealed hugely dilated right ventricle (RV) with gross pulmonary regurgitation and RV dysfunction. Cardiac MRI also calculated right ventricular end systolic volume (RVESV) 57 ml/m2 and right ventricular end diatolic volume (RVEDV) 157ml/m2. We decided to implant transcatheter venus p-valve at pulmonary position. The procedure went successful having competent pulmonary valve and improved RV function. Total fluoro time was 36.4 minutes and total procedural time was two hours. This procedure was done first time in Pakistan with optimal results.

Objective: The aim of study was to evaluate the results and complications of percutaneous balloon aortic valvuloplasty (BAV) in children with congenital aortic valve stenosis (AVS) at our setup. Study Design: Quasi experimental study. Place and Duration of Study: Pediatric cardiology department of Armed forces institute of cardiology / National institute of heart diseases (AFIC/NIHD) from 1st August 2010 to 31st July 2012. Patients and Methods: We included 27 consecutive children including 21 (78%) male, who underwent BAV and procedural success was defined as if peak to peak pressure gradient (PG) across aortic valve was reduced to less than 50% of pre-procedural value with no more than grade II aortic regurgitation. Balloon to annulus ratio was kept under 0.9 and strictly followed in all cases. Results: The mean age of study population was 7.7 ± 4.6 years and procedure was successful in 25 (92.6%) cases and in these cases mean pre-procedural PG was reduced from 80.1 ± 34 mmHg to 26.1 ± 16.9 mmHg. Procedure was considered unsuccessful in two children including one case, where PG reduced to 60% of pre-procedural value. In another patient, procedure was abandoned as aortic valve could not be crossed after multiple attempts and transseptal puncture was not feasible. Local vascular complications occurred in 07 (26%) children. There were no deaths, non fatal cardiac arrest, cardiac tamponade or requirement of emergency cardiac surgery in our study population. Conclusion: BAV is an effective procedure with low complication rate in children. [ABSTRACT FROM AUTHOR]