COVID-19: A New Horizon in Congenital Heart Diseases.

Objective: Previous studies have demonstrated that both children and adult patients with a history of congenital heart disease (CHD) are at high risk for coronavirus disease 2019 (COVID-19) infection. This study investigates the status of COVID-19 infection among children undergoing surgical repair within the past 2 years. Methods: All alive patients operated on in a tertiary referral center between March 2018 and March 2020 were recruited in the present study. Detailed demographics, past medical and surgical history, and physical examination were reviewed for each patient. During the COVID-19 pandemic, data regarding the patient's status were collected by telephone survey from April 15 to April 30, 2020. Results: A total number of 210 patients are analyzed in this study. Participants' median age was 21.59 months [interquartile range (IQR) = 12-54.67], and 125 (59.5%) were female. The median interval between surgery and COVID-19 assessment was 305 days (IQR = 215-400). In addition, 67 (32%) patients used angiotensin receptor blocker (ARB)/angiotensin-converting enzyme (ACE) inhibitor (spironolactone and/or captopril). Sixteen patients (7.6%) were symptomatic and had positive chest CT results and/or RT-PCR compared to the previously reported prevalence of COVID-19 among the pediatric population (2.4% of children with <18 years of age); the prevalence of COVID-19 among the patients operated on due to CHD in the present study was significantly higher (p = 0.00012). Two patients were admitted to the intensive care unit (ICU); one patient was discharged 2 weeks later with acceptable status, and one patient died 2 days after ICU admission due to cardiac and respiratory arrest and myocarditis. The complexity of the underlying cardiac disorders was not different between patients with low risk (p = 0.522), suspicious patients (p = 0.920), and patients positive for COVID-19 (p = 0.234). The ARB/ACE inhibitor consumption was not associated with the COVID-19 infection [p = 0.527, crude odds ratio (OR) = 1.407, 95% CI = 0.489-4.052]. Conclusion: Children with a history of previous CHD surgery are more susceptible to infections, especially those infections with pulmonary involvements, as the lung involvement could cause worsening of the patient's condition by aggravating pulmonary hypertension. The results of the current study indicate that these patients are more prone to COVID-19 infection compared to the healthy children population.

Effect of RaCe, ProTaper, and V-Taper rotary systems on dentinal crack formation during endodontic treatment: An in vitro study.

Background. Prevention of dentinal crack formation is of utmost importance in endodontic treatment. This study aimed to evaluate the effect of RaCe, ProTaper, and V-Taper rotary systems on dentinal crack formation in three root regions during endodontic treatment. Methods. Seventy human mandibular first molars were selected randomly, and their distal roots were used. Ten samples were assigned to the control group, and sixty samples were assigned to three groups (n=20). Each group was prepared with RaCe, ProTaper, or V-Taper rotary files according to the manufacturers' instructions. A stereomicroscope was used to view cracks at ×40 magnification. Friedman's, chi-squared, and Kruskal-Wallis tests were used for statistical analysis of data (P < 0.05). Results. A comparison of the three rotary systems did not reveal any significant differences in the number of cracks between the three root thirds evaluated (P > 0.05). A comparison of the number of cracks in the coronal, middle, and apical thirds in each rotary system showed that the number of cracks in the middle third was fewer than that in the two other thirds only in the V-Taper group (P < 0.05), with no significant differences in the ProTaper and RaCe groups between the different root regions (P > 0.05). Conclusion. The application of RaCe, ProTaper, and V-Taper rotary files resulted in a similar rate of crack formation in endodontic treatment. V-Taper files created the minimum number of cracks in the middle third.

Non diagnosed PAPVC induce large reverse venovenous shunt after modified Fontan surgery: A case report of a rare anomaly and embolization therapy.

Fontan operation is a reliable palliative surgery for patients with single ventricle physiology. Still, the development of complication is common; one of these complications that need to interventional approach is veno-venous collaterals between systemic and pulmonary veins. A 16-yearoldgirl with a history of modified Fontan operation at 9 years ago was referred with progressive cyanosis and dyspnea on exertion. In contrast trans-thoracic echocardiography (TTE), no fenestration was seen in Fontan circulation. Cardiac magnetic resonance revealed partial anomalous pulmonary vein connection (PAPVC) from left upper pulmonary vein to vertical vein and then into the in nominate vein and SVC with the reverse flow from superior vena cava (SVC) to left upper pulmonary vein(LUPV). This anomalous vein became severe engorged and tortuous. Possibly, LUPV and the verticalvein was dilated gradually as a result of increased pressure in the Fontan circuit. Finally, she underwent successful coil embolization in the midpart of the vertical vein. The oxygen saturation increased from80% to 93%.

Lessons learnt from COVID-19 in adult congenital heart patient in Tehran: a survey-based study of prevention, exposure, susceptibility, and outcomes.

BACKGROUND: COVD-19 pandemic has overwhelmed many healthcare systems worldwide. Underlying cardiovascular disease predisposes to greater disease susceptibility and more complications including mortality. Such data is unverified in adults with congenital heart disease (ACHD). The aim of the study is to report the Tehran experience with respect to preventative self-care measures, disease exposure, susceptibility, and outcomes after COVD-19 infection in ACHD patients. METHODS: A telephone-based survey was conducted in ACHD patients, focusing on new-onset symptoms that might indicate COVID-19 infection, prevention measures, confirmed infection rates, and outcomes. RESULTS: Three-hundred and nine ACHD patients, with a mean age of 29.13 years (range from 14 to 72 years, SD = 10.64), and 170 (55%) women were assessed. The majority (86.7%) had moderate or complex ACHD. Two-thirds (67.3%) of the patients practiced high-level preventative self-care measures. After community exposure, 33.3% developed COVID-19, and after household exposure, 43.7% developed COVID-19. There was only one mortality in a post-operative patient. Thirty-seven patients (12%) reported new symptoms including cough (10%), fatigue (8%), fever (7%), and new dyspnoea (6.5%). Amongst 18 (6%) with confirmed COVID-19, there was only 1 mortality in a post-operative patient. Age (adjusted OR = 1.19, 95% CI: 1.07-1.31, p = 0.001), contact with confirmed COVID-19 cases (adjusted OR = 59.34, 95% CI: 3.68-955.10, p = 0.004) were independently associated with COVID-19 infection. CONCLUSIONS: Mortality risk associated with COVID-19 infection in ACHD patients with moderate or severe disease appears to be relatively low, similar to the general population. Such risk appears to act through conventional risk factors, and in this cohort, we demonstrated age as a significant risk factor in addition to exposure to the development of COVID-19 infection. Preventative self-care measures are a potentially significant and impactful intervention target for intervention and for improving outcomes.

Fibrinolytic therapy for mechanical pulmonary valve thrombosis.

Treatment of prosthetic heart valve thrombosis using intravenous thrombolytics, although an acceptable alternative to surgery, is not complication free, and the literature has a dearth of data on the subject. This study analyzed the results of fibrinolytic treatment (FT) among a single-center group of patients with mechanical pulmonary valve thrombosis. Between 2000 and 2013, 23 consecutive patients with 25 episodes of pulmonary valve thrombosis received FT. The diagnosis of mechanical pulmonary valve thrombosis was established by fluoroscopy and echocardiography. Streptokinase (SK) was used in 24 cases and alteplase in 1 case. The FT was continued a second day for 14 patients (58.3%), a third day for 1 patient, and a fourth day for 1 patient. Echocardiography and fluoroscopy were performed every day until improvement of malfunction was achieved. Of the 23 patients, 19 had complete resolution of hemodynamic abnormalities after FT, 1 had partial resolution, and 2 showed no change. No patient had major complications. Five minor complications were detected, namely, fever, nausea, thrombophlebitis, epistaxi, and pain. Seven patients (30%) experienced recurrence of thrombosis, whereas four patients had surgery (biological pulmonary valve replacement) without re-thrombolytic therapy, one patient was treated with Alteplase, one patient received SK, and one patient received intense anticoagulation using heparin and warfarin. Overall, FT had a success rate of 84%. The results indicate that regardless of the time to pulmonary valve replacement and echocardiographic and fluoroscopic findings, FT was effective in most cases of mechanical pulmonary valve thrombosis. The efficacy increased with second-day thrombolytic therapy. Major complications were not common after lytic therapy for mechanical pulmonary valve thrombosis.

Predictors of syncope in patients with hypertrophic cardiomyopathy.

BACKGROUND: Approximately 30% of patients with hypertrophic cardiomyopathy (HCM) suffer syncope and syncope was the only symptom associated with sudden death. However, no systematic studies in large cohorts looking at predictors of syncope are available in the literature. Therefore, we sought to determine predictors of syncope in patients with HCM. METHODS: One hundred and seventy-three consecutive patients with HCM and a mean age of 42 +/- 18 years (range 10-78) underwent extensive clinical, electrocardiographic, and echocardiographic testing to identify predictors of syncope. RESULTS: During the mean follow-up duration of 50 months, syncope occurred in 28% of the HCM patients. Univariate analysis showed male gender, age <40 years, family history of sudden death, PR interval, QRS width, >or=2 bursts of nonsustained ventricular tachycardia (NSVT), >or=3 bursts of nonsustained supraventricular tachycardia (NSSVT), maximum left ventricular wall thickness >or=30 mm, and abnormal blood pressure response, out of 24 demographic, clinical, hemodynamic, electrocardiographic, and echocardiographic features, to be significantly associated with syncope. Of these nine variables, the only independent predictors of syncope at multivariate analysis were age <40 years (odds ratio [OR]: 4.4, 95% confidence interval [CI]: 2.2-16, P = 0.003), >or=2 bursts of NSVT (OR: 9.9, 95% CI: 2.0-46, P = 0.0001), and >or=3 bursts of NSSVT (OR: 2.7, 95% CI: 0.38-8.25, P = 0.001). The concomitant occurrence of all three variables had a sensitivity of 87% and specificity of 73% in identifying the patients with syncopal events. CONCLUSIONS: The results of this study showed that age <40 years, bursts of NSVT, and NSSVT were independently associated with the risk of syncope in patients with HCM. Demographic data and ambulatory ECG findings could help in risk stratification of patients with HCM.

ST-segment depression as a risk factor in hypertrophic cardiomyopathy.

AIMS: From the spectrum of electrocardiogram (ECG) changes that may occur in hypertrophic cardiomyopathy (HCM), there is no criterion reported to be useful for risk stratification. We sought to determine whether there was a relationship between the resting ECG findings and prognosis in patients with HCM. METHODS AND RESULTS: We retrospectively analysed data on 173 consecutive patients admitted to our centre with a diagnosis of HCM. The 12-lead ECGs were assessed for underlying rhythm, PR interval, QRS voltages, QRS width, corrected QT interval, ST-segment deviation, T-wave inversion, and left atrial enlargement (LAE). During a mean follow-up of 50 months, 6.4% of patients had a combined endpoint [sudden death or appropriate implantable cardioverter-defibrillator (ICD) therapy]. The frequency of the combined endpoint was greater in patients with syncope, non-sustained ventricular tachycardia, maximal left ventricular (LV) wall thickness >or=30 mm, and ST-segment depression in the high lateral leads (all P < 0.05). Other ECG findings (LV hypertrophy, LAE, abnormal Q wave, abnormal ST-T changes, and underlying rhythm), family history of sudden death, and LV outflow obstruction were not related to the combined endpoint. The results of our multivariate analysis demonstrated that ST-segment depression in the high lateral leads (OR: 20.0, 95% CI: 12.7-27.5; P = 0.0001) and syncope (OR: 19.0, 95% CI: 11.7-26.9; P = 0.0001) were the predictors of sudden death or appropriate ICD therapy in patients with HCM. CONCLUSION: The results of this study indicated that, in addition to generally accepted risk factors, ST-segment depression in the high lateral leads could be of prognostic significance in HCM patients.