Annals of Pediatric Cardiology
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   2010| January-June  | Volume 3 | Issue 1  
    Online since June 12, 2010

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Oral anticoagulants in pediatric cardiac practice: A systematic review of the literature
Shreepal Jain, Balu Vaidyanathan
January-June 2010, 3(1):31-34
DOI:10.4103/0974-2069.64371  PMID:20814473
Recent advances in the pediatric heart surgery, especially the Fontan procedure, has necessitated an increased use of oral anticoagulants in pediatric cardiac patients. Warfarin is the standard agent used for most pediatric indications, though there are very few randomized control studies in children regarding its use. This review summarizes the current indications and evidence base regarding the use of oral anticoagulants in the pediatric age group.
  7,334 1,039 2
Diaphragmatic palsy after cardiac surgical procedures in patients with congenital heart
Sachin Talwar, Sandeep Agarwala, Chander Mohan Mittal, Shiv Kumar Choudhary, Balram Airan
January-June 2010, 3(1):50-57
DOI:10.4103/0974-2069.64370  PMID:20814476
Paralysis of diaphragm on one or, exceptionally, both sides is a common cause of delayed recovery and excessive morbidity following pediatric cardiac surgery. The consequences of this complication after all forms of congenital heart surgery in newborns and young infants can be potentially serious. The impact of diaphragmatic palsy on the physiology after single ventricle palliations is particularly significant. It is necessary for all professionals taking care of children with heart disease to be familiar with the etiology, diagnosis, and management of this condition. Early recognition and prompt management of diaphragmatic palsy can potentially reduce the duration of mechanical ventilation and intensive care in those who develop this complication. This review summarizes the anatomy of the phrenic nerves, reasons behind the occurrence of diaphragmatic palsy, and suggests practical guidelines for management.
  7,256 707 10
Establishing a pediatric cardiac intensive care unit - Special considerations in a limited resources environment
Rakhi Balachandran, Suresh G Nair, R Krishna Kumar
January-June 2010, 3(1):40-49
DOI:10.4103/0974-2069.64374  PMID:20814475
Pediatric cardiac intensive care has evolved as a distinct discipline in well-established pediatric cardiac programs in developed nations. With increasing demand for pediatric heart surgery in emerging economies, a number of new programs are being established. The development of robust pediatric cardiac intensive care units (PCICU) is critical to the success of these programs. Because of substantial resource limitations existing models of PCICU care cannot be applied in their existing forms and structure. A number of challenges need to be addressed to deliver pediatric cardiac intensive care in the developing world. Limitations in infrastructure, human, and material resources call for a number of innovations and adaptations. Additionally, a variety of strategies are required to minimize costs of care to the individual patient. This review provides a framework for the establishment of a new PCICU program in face of resource limitations typically encountered in the developing world and emerging economies.
  6,900 700 9
Pleural effusions in children undergoing cardiac surgery
Sachin Talwar, Sandeep Agarwala, Chander Mohan Mittal, Shiv Kumar Choudhary, Balram Airan
January-June 2010, 3(1):58-64
DOI:10.4103/0974-2069.64368  PMID:20814477
Persistent pleural effusions are a source of significant morbidity and mortality following surgery in congenital heart disease. In this review, we discuss the etiology, pathophysiology, and management of this common complication.
  6,915 674 12
Electrocardiogram interpretation skills in pediatric residents
Michael Crocetti, Reid Thompson
January-June 2010, 3(1):3-7
DOI:10.4103/0974-2069.64356  PMID:20814469
Objective : The primary objective of this study was to evaluate pediatric residents' ability to correctly identify electrocardiogram (ECG) findings and pair them to a corresponding cardiac diagnosis. Methods: Forty-six pediatric residents from the Johns Hopkins Children's Center were surveyed to evaluate their ability to interpret ECGs and factors affecting that ability. Included in the survey was a packet of 10 patient vignettes each accompanied by a 12-lead ECG. The primary outcome variable was the resident's score of correctly paired ECG findings with the appropriate cardiac diagnosis. One point was given for each pair correctly identified for a maximum of 10 points. Simple and multiple linear regression was used to estimate the magnitude and significance of any association between score of correct responses and resident year, completion of a pediatric cardiology rotation, self-rated ability to read ECGs, and training received in reading ECGs. Results : The mean number of correct ECG findings and cardiac diagnosis pairings out of 10 for the PGY 1 group was 4.1 ± 3, PGY 2 group 4.9 ± 2.9, PGY 3 group 6.6 ± 2, and the PGY 4 group 6.8 ± 1.7. In the unadjusted linear regression model, the PGY 3 group correctly identified 2.4 more pairings compared to the PGY 1 group (P =0.02). Those who completed a pediatric cardiology rotation correctly identified 2.5 more pairings compared to those who did not complete a rotation (P=0.001). Conclusions: ECG interpretation significantly improved from PGY 1 to PGY 3. Educational programs involving ECG interpretation should target those diagnoses with high clinical severity and average to poor resident knowledge.
  6,618 850 9
Hybrid management of a large atrial septal defect and a patent ductus arteriosus in an infant with chronic lung disease
Simone F Pedra, Marcelo Jatene, Carlos A.C Pedra
January-June 2010, 3(1):68-73
DOI:10.4103/0974-2069.64358  PMID:20814479
We report a case wherein a dysmorphic four-month-old infant (weighing 4.5 kgs) with an 8 mm atrial septal defect (ASD), a 1.5 mm patent ductus arteriosus (PDA), a 2 mm mid-muscular ventricular septal defect (VSD) associated with chronic lung disease, and severe pulmonary hypertension, was successfully managed using a hybrid approach, without the use of cardiopulmonary bypass (CPB). Through a median sternotomy, the PDA was ligated and the ASD was closed with a 9 mm Amplatzer septal occluder implanted through peratrial access. The VSD was left untouched. Serial echocardiograms showed complete closure of the ASD and PDA, with progressive normalization of the pulmonary artery (PA) pressures within three months. The child rapidly gained weight and was weaned from sildenafil and oxygen administration. After 12 months, the VSD closed spontaneously and the child remained well, with normal PA pressures. A hybrid approach without the use of CPB should be considered in the management of infants with congenital heart disease, associated with chronic lung disease and pulmonary hypertension.
  6,196 282 3
Patent foramen ovale closure
Zahid Amin
January-June 2010, 3(1):35-39
DOI:10.4103/0974-2069.64372  PMID:20814474
  5,137 528 3
Clinico-morphological correlations in the categorization of holes between the ventricles
Brad A Friedman, Anthony Hlavacek, Karen Chessa, Girish S Shirali, Eowyn Corcrain, Diane Spicer, Robert H Anderson, Sinai Zyblewski
January-June 2010, 3(1):12-24
DOI:10.4103/0974-2069.64367  PMID:20814471
Controversy still exists in the categorization of holes between the ventricles, although they are the most common congenital cardiac malformation. Advanced imaging techniques such as three-dimensional echocardiography and computed tomographic angiography offer superb anatomical details of these defects. In this review, we have sought to collate the features highlighted in different categorizations and identify their similarities, but also emphasize their differences. We hope that an analysis of this type, now achievable during life, using advanced imaging, might lead to the appearance of a unified system for diagnosis and description of holes between the ventricles.
  4,820 783 4
Hybrid palliation of interrupted aortic arch in a high-risk neonate
Mohsen Karimi, Ahmed Farouk, Alex Golden, Robert Gilkeson
January-June 2010, 3(1):74-76
DOI:10.4103/0974-2069.64360  PMID:20814480
We report a case of a high-risk neonate with interrupted aortic arch (IAA) and ventricular septal defect who underwent a successful hybrid palliative procedure using a ductal stent and bilateral branch pulmonary artery banding. This case represents not only a successful use of hybrid approach in high-risk neonates with IAA, but also introduces an alternative and safe access for ductal stent insertion through the right ventricular infundibulum.
  5,189 282 5
Veno-venous shunt-assisted cavopulmonary anastomosis
Pramod Reddy Kandakure, Anil Kumar Dharmapuram, Suresh Babu Kale, Vivek Babu, Nagarajan Ramadoss, Ramkinkar Shastri, Avinash Londhe, Ivatury Mrityunjaya Rao, Kona Samba Murthy
January-June 2010, 3(1):8-11
DOI:10.4103/0974-2069.64361  PMID:20814470
Objective : The bidirectional Glenn shunt is commonly performed under cardiopulmonary bypass for conditions that lead to a single ventricle repair. We report our experience of bidirectional Glenn shunt done without cardiopulmonary bypass. Methods : Between June 2007 and May 2009, 186 consecutive patients underwent off-pump bidirectional Glenn shunt for a variety of complex cyanotic congenital heart defects. Age ranged from four months to six years and the median weight was 11.17 kg (range 4.3 - 18). After systemic heparinization, the procedure was done by creating a temporary shunt between the innominate vein and the right atrium connected across a three way connector for de-airing. Fifty one patients had bilateral cavae. All cases underwent complete clinical neurological examination. Results : No case required conversion onto cardiopulmonary bypass. Four patients (2.14%) died in the immediate postoperative period. The mean internal jugular venous pressure on clamping the decompressed superior vena cava was 24.69 ± 1.81 mm Hg. There was no intra-operative hemodynamic instability and oxygen saturation was maintained at more than 70% throughout. Post Glenn shunt, the saturations improved to mid 80s. Seventy four cases had documented forward flow across the pulmonary valve. The mean duration of ventilation was 10.17 ± 8.96 hours and there were no neurological complications. Six patients (3.22%) developed pleural effusions, 4 patients (2.15%) had nodal rhythm and 9 patients (4.83%) had superficial sternal wound infection. Conclusions : Our results show that off-pump bidirectional Glenn shunt can be done safely in patients not requiring associated intra-cardiac correction. It avoids cardiopulmonary bypass and its related complications, is economical and associated with excellent results. In our opinion, this is the largest series of off-pump bidirectional Glenn shunt in the literature.
  4,949 483 2
Successful retrieval of migrated Amplatzer septal occluder
Salil Shirodkar, Sushant Patil, Robin Pinto, Bharat Dalvi
January-June 2010, 3(1):83-86
DOI:10.4103/0974-2069.64365  PMID:20814483
Migration and embolization of the Amplatzer septal occluder (ASO) have been reported. However, there is only limited information on the methods of systematic retrieval of these devices. In this report, we describe the a case of a 4 year old girl who underwent closure of her atrial septal defect (ASD) using a 17 mm ASO. The device migrated in to the right atrium an anteroposterior plane 24 hours later with a resultant residual shunt. The device was successfully retrieved percutaneously and the ASD was closed using a 20 mm ASO.
  4,772 319 8
Multiple coil closure of isolated aortopulmonary collateral
Sumanta S Padhi, Kinjal D Bakshi, Ram K Shastri
January-June 2010, 3(1):65-67
DOI:10.4103/0974-2069.64357  PMID:20814478
A 7-month-old girl was diagnosed to have large aortopulmonary collateral during evaluation for congestive heart failure. There was no other evidence of cardiopulmonary disease. The collateral was successfully closed with multiple coils delivered sequentially. We describe the issues associated during closure of the aortopulmonary collateral in this case. To the best of our knowledge, this is the first reported case of large aortopulmonary collateral presenting with heart failure in an otherwise structurally normal heart that was closed successfully with multiple coils delivered sequentially.
  4,581 272 3
Pulmonary edema following transcatheter closure of atrial septal defect
Anil Kumar Singhi, Kappanayil Mahesh, R Krishna Kumar
January-June 2010, 3(1):90-91
DOI:10.4103/0974-2069.64359  PMID:20814485
Pulmonary edema after device closure of atrial septal defect (ASD) is a rare complication. We present illustrative images of a case of pulmonary edema after device closure of ASD in a 53 year old adult. Older patients undergoing ASD closure can benefit from their left atrial and left ventricular end diastolic pressures measurement before and after temporary balloon occlusion of ASD.
  3,976 321 4
Balloon atrial septostomy through internal jugular vein in a 45-day-old child with transposition of great arteries
Sumanta S Padhi, Kinjal D Bakshi, Avinash P Londhe
January-June 2010, 3(1):77-79
DOI:10.4103/0974-2069.64363  PMID:20814481
Balloon atrial septostomy is a common palliative procedure in D-transposition of great arteries. It is technically easy before 2-3 weeks of age when the septum primum is thin. Femoral vein or umbilical vein, when available, is the common access used for this procedure. In situations when these accesses are not available or in case of inferior vena cava interruption, trans-hepatic access is used. Internal jugular vein (IJV) access is not used as it is difficult to enter the left atrium through this route. We describe a case of successful Balloon atrial septostomy done through IJV in a 45-day-old child with emphasis on the technique, hardware and precautions necessary during the procedure.
  3,925 260 3
Patients, doctors and the medical industry
Bharat Dalvi
January-June 2010, 3(1):1-2
DOI:10.4103/0974-2069.64353  PMID:20814468
  3,790 387 1
Transhepatic approach for rehabilitation of stenosed pulmonary arteries
Makram R Ebeid
January-June 2010, 3(1):25-30
DOI:10.4103/0974-2069.64369  PMID:20814472
Transhepatic cardiac catheterization and intervention is used in selected cases in our institution. A retrospective review of transcatheter interventions for the pulmonary artery was conducted. Forty-five transhepatic procedures were performed. Thirteen involved intervention, to rehabilitate the branch pulmonary arteries. The median weight of the patients was 9.9 Kg ± 3.4. The patients' age ranged from eight months to 86 months (median 23 months). The largest sheath used was 7F. All the patients underwent success intervention with no complication related either to the transhepatic approach or the intervention. The branch pulmonary artery diameter increased from 4.5 ± 2.2 mm to 7 ± 3 mm. Most of the procedures were performed under conscious sedation / deep sedation protocol. Hemostasis was achieved in all patients by gradual sheath withdrawal, followed by application of upward pressure on the tract from the subcostal area. In the absence of patent femoral veins the transhepatic approach can be used to perform successful and safe interventions, to rehabilitate the pulmonary artery system. It may offer the additional advantage of using larger sheaths than would be felt appropriate for the femoral veins.
  3,708 356 2
A rare case of double orifice mitral valve with perimembranous ventricular septal defect: Application of three-dimensional echocardiography for clinical decision making
Rohit Tandon, Shibba Takkar, Shailender Kumbhkarni, Naveen Kumar, Naved Aslam, Bishav Mohan, GS Wander
January-June 2010, 3(1):87-89
DOI:10.4103/0974-2069.64362  PMID:20814484
Double orifice mitral valve (DOMV) is an uncommon anomaly of surgical importance characterized by a mitral valve with a single fibrous annulus with two orifices opening into the left ventricle (LV). Subvalvular structures, especially the tensor apparatus, invariably show various degrees of abnormality. Associated congenital heart defects are common, though DOMV can occur as an isolated anomaly. Two-dimensional echocardiography is useful for diagnosis but combining it with real-time three-dimensional echocardiography helps in a more detailed evaluation of mitral valve and subvalvular structures as is shown in this case description.
  3,725 253 -
Ductal aneurysm masquerading as nonresolving pneumonia: A challenging differential!
Maitri Chodhary, Munesh Tomar, Sitaraman Radhakrishnan
January-June 2010, 3(1):80-82
DOI:10.4103/0974-2069.64364  PMID:20814482
We report here, the case of a six-and-a-half-month-old boy investigated for persistent respiratory distress and homogeneous opacity in the left upper lobe. Echocardiography revealed a giant ductal aneurysm compressing the left pulmonary artery and upper lobe division of the left bronchus. Computerized tomography angiogram delineated the exact anatomy and prompt surgical resection provided a successful cure to this lesser known entity.
  3,518 213 -
Klippel Feil syndrome with isolated hypokinesia of the left ventricle: A rare association
Syed Ahmed Zaki, Prithi Shenoy, Preeti Shanbag
January-June 2010, 3(1):92-92
DOI:10.4103/0974-2069.64354  PMID:20814486
  3,448 216 -
Cardiac Candida krusei infection
Viroj Wiwanitkit
January-June 2010, 3(1):93-93
DOI:10.4103/0974-2069.64355  PMID:20814487
  2,710 177 -
Selected Summaries
Sachin Talwar, Shiv Kumar Choudhary, Balram Airan
January-June 2010, 3(1):94-96
  2,358 180 -