Evaluation of Regional Myocardial Function by Strain and Strain Rate before and after Surgical Repair of Congenital Heart Anomalies.

Background: Tissue Doppler imaging yields useful information about regional myocardial function. The purpose of this study was to investigate myocardial function by strain and strain rate in a group of patients with congenital heart disease (CHD) before and after cardiac surgery. Methods: Three consecutive tissue Doppler echocardiographic examinations were performed on 25 patients with CHD, who underwent open-heart surgery. The study was conducted from April 2013 to April 2014 in a university hospital, and the assessments were done 1 day before and 1 week and 1 month after surgery. The effects of demographic variables, types of anomalies, and cardiopulmonary bypass factors on strain were evaluated. Results: The study population comprised 13 female and 12 male patients at a mean age of 9.4 ± 9.8 years. Compared to the preoperative data, repeated measurements of strain in 9 segments of the ventricles showed a significant reduction 1 week after surgery, followed by a significant augmentation 1 month postoperatively (p value = 0.001 for all 9 segments). The reduction in strain at the middle segment of the left ventricular free wall was significant in the cyanotic patients (p value = 0.037). The increase in strain at the middle segment of the septum and the right ventricular basal and middle segments was significant (p value = 0.021, p value = 0.015, and p value = 0.021, respectively) in the patients with a shorter pump time. Conclusion: Our patients experienced an early decline in myocardial function after cardiac surgery, but their myocardium recovered its contractility gradually.

Optimal method for early detection of cardiac disorders in thalassemia major patients: magnetic resonance imaging or echocardiography?

BACKGROUND: Heart failure resulting from myocardial iron deposition is the most important cause of death in ß-thalassemia major (TM) patients. Cardiac T2*magnetic resonance imaging (MRI), echocardiography, and serum ferritin level serve as diagnostic methods for detecting myocardial iron overload. In this study, we aimed to evaluate the relationship between the above-mentioned methods. METHODS: T2*MRI and echocardiographic measurement of left ventricular (LV) systolic and diastolic function were performed in 63 patients. Serum ferritin level was measured. The relationships between all assessments were evaluated. RESULTS: There were 40 women and 23 men with a mean age of 23.7±5.1 years (range, 15-35 years). There was no statistically significant correlation between serum ferritin level and LV systolic and diastolic function (P=0.994 and P=0.475, respectively). T2*MRI results had a significant correlation with ferritin level; 63.6% of patients with serum ferritin level >2,000 ng/mL had abnormal cardiac MRI, while none of the patients with ferritin level <1,000 ng/mL had abnormal cardiac MRI (P=0.001). There was no significant correlation between MRI findings and LV systolic function (P=1.00). However, we detected a significant difference between LV diastolic function and cardiac siderosis (P=0.03). CONCLUSION: MRI findings are a good predictor of future cardiac dysfunction, even in asymptomatic TM patients; however, diastolic dysfunction may happen prior to cardiac siderosis in some patients, and echocardiography is able to diagnose this diastolic dysfunction while T2*MRI shows normal findings.

A prospective observational study of paediatric cardiac surgery outcomes in a postoperative intensive care unit in Iran.

OBJECTIVE: To evaluate the incidence of complications, morbidity and mortality, and the associated risk factors with mortality at a Paediatric Cardiology Intensiv Care Unit of a developing country. METHODS: The prospective observational study was conducted at Shahid Modarres Hospital, Tehran, Iran, from August 2009 to July 2010. A total of 202 patients were monitored from the time they entered the Paediatric Cardiology Intensive Care Unit till their final discharge. SPSS 16 was used for statistical analysis and p < or = 0.05 was considered statistically significant. RESULTS: Of the total, 107 (53%) were male and 95 (47%) were female. The mean age of the patients was 4.5 +/- 4.9 years (range: 2 days to 18 years). Among the patients 59 (29.2%) had complications and 25 (12.37%) of them died. A total of 177 (87.6%) survived and were discharged. Infants (p = 0.012), cyanotic congenital heart disease (p = 0.002), longer duration of cardiopulmonary bypass (p = 0.027), longer aortic cross-clamp time (p = 0.038), longer mechanical ventilation time (p < 0.006), and early post-operative period (p = 0.05) were associated factors for mortality. According to regression analysis, cyanotic congenital heart disease, longer intubation time, and early post-operative period were major factors for mortality (p = 0.01, p < 0.001, and p = 0.001) respectively. CONCLUSION: Critically ill cyanotic young infants in the first 24 hours after operation experienced high mortality. Prolonged mechanical ventilation was also associated with high mortality.

The Relationship between Coronary Artery Aneurysm and QT Interval Dispersion in Acute Phase of Kawasaki Disease.

OBJECTIVE: QT dispersion (QTd) has been proposed as a marker of ventricular repolarization inhomogeneity and several investigations have proved the relationship between it and cardiac ischemia, ventricular arrhythmia and sudden cardiac death. The aim of this study was to assess the relation between coronary artery involvement and QTd, and QTc dispersion (QTcd) in the acute phase of Kawasaki disease (KD). METHODS: We studied 65 patients with acute KD. Patients were divided into 3 groups. Group one consisted of 48 patients without coronary artery involvement. Group two comprised 13 patients with small to medium size aneurysm. In Group three there were 4 patients with giant aneurysm or multiple small to medium size aneurysms or thrombosis in coronary arteries. For each patient 12 lead electrocardiography was obtained, and QT, QTc, QTd, QTcd, and RR interval were calculated. FINDINGS: There were 40 males and 25 females with a mean age of 41.4±31.1 months. There was no significant difference in QT, QTc, RR measurements between 3 groups. QTd was greater in group 3 versus group 1 and 2, but the difference was not statistically significant (P=0.06). QTcd was significantly greater in group 3 than in groups 1 and 2 (75.02±11.53 ms versus 46.82±15.39 ms and 48.88±10. 55 ms respectively (P = 0.04). The sensitivity of QTcd ≥60 ms to detect the patients with severe coronary arteries involvement was 100%, the specificity was 93.4%, positive predictive value was 50%, negative predictive value was 100%, and accuracy was 93.8%. CONCLUSION: QTcd can be used as a predictive factor for diagnosis of severe coronary arteries involvement in the acute phase of KD.

Discharge of children from hospital against medical advice.

BACKGROUND: Discharge against medical advice (DAMA) from hospital may have negative effects on the well-being of the patients. In pediatric patients the decision for DAMA is made by the parent(s). The present study aimed to evaluate the prevalence of DAMA and examine the reasons for DAMA provided by the parents. METHODS: A cross-sectional descriptive study on DAMA was conducted from March 2005 to February 2007 in the pediatric ward of Taleghani hospital in Tehran, Iran. RESULTS: The prevalence of DAMA was 5.3%, comprising 97 of 1842 children discharged. The age of the 97 children ranged from 1 day to 8 years, with a mean hospitalization duration of 4 ± 3.3 days. Seventy-seven (79.4%) of the 97 children were <12 months. Thirty-four (35.1%) children were discharged within 48 hours of admission. The most commonly diagnosed diseases in these children were neonatal jaundice (37.1%), sepsis (21.6%), and gastroenteritis (16.4%). The reasons for DAMA were as follows: parent's assumption of improvement (32.9%), dissatisfactory treatment and care (29.9%), inconvenience for child hospitalization (18.5%), and financial constraints (15.5%). CONCLUSIONS: The prevalence of DAMA in the present study was within the range of other DAMA studies in children. The majority of DAMA cases could have been prevented by more satisfactory facilities and effective communication between medical staff and the parents.

Late cardiotoxic effects of anthracycline chemotherapy in childhood malignancies.

OBJECTIVE: To determine the frequency of changes in left ventricular function in patients, at least 5 years after completion of anthracycline-therapy for childhood malignancy. METHODS: Echocardiographic examination was performed on 58 patients (36 males and 22 females) with mean age of 17.5+/-4.6 years (range 9-29 years, median 17.5 years). The control group was 58 healthy age and sex matched children. RESULTS: The age at the time of diagnosis and start of treatment ranged from 2 to 14 years with a median of 6 years. The time of follow-up was between 5 to 22 years with a median of 9 years. The cumulative dose of anthracycline was 30 to 557 mg/m2, median 128.5 mg/m2. All the patients were asymptomatic. Abnormal systolic and/or diastolic functions were found in 29 (50%) patients. We found a strong correlation between systolic and diastolic cardiac dysfunction and longer time of follow-up (P = 0.02 and p = 0.04), respectively, but not a relation to the cumulative dose, sex, and age at diagnosis. CONCLUSION: The data showed a relatively high incidence of subclinical cardiotoxicity in long-term survivors. The significance of this subclinical cardiotoxicity on the morbidity and mortality of patients should be followed in the future.

Risk factors in congenital heart disease.

A case-control study was conducted to investigate the risk factors of congenital heart disease (CHD). The cases were 346 children with CHD who were admitted to a university hospital in Tehran from 1995 to 2000 and controls (n=346) were randomly selected from children without CHD who were admitted during the same period. The medical records of both cases and controls were reviewed. Ten risk factors were studied and found to be more prevalent among cases (47%) than controls (35%, p < 0.005). Extracardiac malformations (OR, 31.1; CI95, 15.9-60.9; p < 0.001) and chromosomal abnormalities (OR, 34.05; CI95, 23.3-49.8; p < 0.001) were significant risk factors for CHD. Dysmorphic syndromes (p < 0.05) and CHD in siblings (p < 0.001) were also significant risk factors. Maternal illness and drug use in the first trimester of pregnancy, maternal history of previous abortions and stillbirths, parental consanguinity, and parental cardiac lesions were not significant risk factors for CHD in offspring. Results suggest that genetic factors more than environmental or reproductive factors can increase the occurrence of cardiac defects.