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.
Objective: Pulmonary balloon valvuloplasty is considered as first line of treatment for isolated pulmonary valve stenosis in all age groups. This study aimed at determining immediate results and complications associated with transcatheter pulmonary valvuloplasty in adult (defined as age 18 years or more) patients.
Study Design: Retrospective quasi experimental study.
Place and Duration of Study: Armed Forces Institute of Cardiology/National institute of heart diseases (AFIC/NIHD) Rawalpindi, from Jan 2017 to Jun 2019.
Methodology: This Retrospective Quasi experimental study was done at Paediatric cardiology department of Armed Forces Institute of Cardiology/National institute of heart diseases (AFIC/NIHD) Rawalpindi and comprised of 24 patients with severe pulmonary valve stenosis in whom balloon dilatation was attempted from January 2017 to June 2019. As per guidelines, the intervention was considered as successful if right ventricle to pulmonary artery invasive pressure gradient was reduced to less than 50% of initial value, suboptimal if PG reduced by 25% and failure if PG reduced by less than 25% of pre-procedural value.
Results: Total 24 adults patients (with no history of previous cardiac surgery or pulmonary valve ballooning) underwent balloon pulmonary valvuloplasty for pulmonary valve stenosis with mean age of 30.5 ± 10.1 years, including 11 males & 13 females with 100% success. Balloon to annulus ratio was 1.25:1. The pressure gradient between Right Ventricle to pulmonary artery reduced from 111 mmHg to 39 mmHg after the intervention. The mean procedural time and fluoroscopy time were 40 & 10 minutes respectively and there were no complications. In three patients, ASD device closure was also done in same procedure.
Conclusion: Percutaneous balloon valvuloplasty is an effective and safe option for the treatment of pulmonary valve stenosis in adult patients with excellent results.
Objective: To determine the anatomical characteristics of Patent Ductus Arteriosus, choice of transcatheter occluder device and outcomes of Patent Ductus Arteriosus device closure. Study Design: Analytical Cross-sectional study. Place and Duration of Study: Paediatric Cardiology Department, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Jan-July 2023. Methodology: A total of n=90 patients regardless of age and gender presenting with Patent Ductus Arteriosus, who underwent device closure were enrolled in this study by universal sampling. Data of the patients was collected on pre-designed proforma. Pearson's Chi-square test was applied to find association of morphological type of ductus and the weight of patient with the type of device used. p-value < 0.05 was considered as statistically significant. Results: Among n=90 patients, 56(62.2%) were females and 34(37.8%) were males with median age of 1(IQR=0.6-4.25) years who underwent transcatheter device closure. The most common ductus types treated were Krichenko type-A 70(76.7%). Devices used were VSD device 15(16.7%), ADO-II 6(6.7%) and ADO-I device (conventional duct occluder) 69(76.7%). Median fluoroscopy time was 8.40(7.2-12.07) minutes. Statistically significant relationships were observed between Krichenko classification of Patent Ductus Arteriosus, weight of patient and type of device used to occlude the Patent Ductus Arteriosus (p<0.001). Success rate was 88(97.7%). Complications occurred in only 2(2.2%) patients in the form of device embolization. In 1(1.1%) patient, embolized device was retrieved while, the other patient was referred for surgical retrieval. Conclusion: Transcatheter Patent Ductus Arteriosus device closure is a standard and safe procedure for closure of ductus with vari..
Objective: To share our experience of percutaneous device closure of secundum type ASD in elderly patients (more than fifty years of age) with review of success, technical issues and immediate complications encountered during the procedure at AFIC & NIHD.
Study Design: Case series, retrospective study.
Place and Duration of Study: Department of Paediatric Cardiology, Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, from Jan 2017 to Aug 2018.
Material and Methods: Consecutive sixteen patients (age more than fifty years), who underwent attempted ASD device closure was included in the study.
Results: Total 16 patients (14 females & 2 males) were attempted ASD device closure with mean age of 58 years. In all cases (100%) ASD were successfully occluded with appropriate size device and the mean diameter of ASD was 26 mm. Mean procedural & fluoroscopy times were 31 and 7 minutes respectively. There was no mortality, device embolization, thrombosis, residual leak or peripheral vascular injuries in the study population.
Conclusion: Transcatheter occlusion of ASD by various Occluder devices is safe and very effective therapeutic option in elderly patients.
Objective: Diagnostic cardiac catheterization for Tetralogy of Fallot (TOF) is still commonly practiced in our country. Aim of this study was to compare results and complications of prograde/antegrade and retrograde approach in diagnostic catheterizations of TOF. Methodology: This prospective comparative study was conducted at AFIC/NIHD Rawalpindi from December 2010 to June 2012. 269 consecutive patients who underwent diagnostic cardiac catheterization for TOF were included and divided in three groups. Group A: Prograde study planned, Group B: both venous and arterial accesses were electively obtained at the start and group C, where retrograde study was planned. Group A & C were subdivided: Group Aa, study completed in prograde manner and group Ab where arterial line was subsequently placed for completion of study. Group Ca, study completed in retrograde approach and group Cb where venous line was subsequently placed. Data analysis was computer based using SPSS 17 version. Results: Total 269 patients with mean age of 7.7 years and including 169 males. Group A included 200 cases (Aa 129 & Ab 71), group B: 45 cases and group C included 24 cases (Ca18 & Cb 6). Systemic complications included 9 episodes of hyper-cyanotic spells (Gp Aa 3, Ab 4, B2), transient Arrhythmias (Aa 1, 2 Ab, 2B) and a transient cardiac arrest (Gp B). The group percentage of local vascular complication in group B as 22.2%, group C 12.5%, group Ab 8.4% and none in group Aa. Conclusion: Prograde cardiac catheterization for TOF is safe and preferable option in most cases.
Pentalogy of Cantrell with ectopia cordis is a rare congenital anomaly, first described in 1958 by Cantrell, has a reported incidence of around 5-10 cases per one million live births with wide variety of clinical presentations. We are reporting a child with ectopia cordis along with cleft lower sternum, upper abdominal wall defect, ectopic umbilicus and diaphragmatic defect. Echocardiography in first month of life revealed a restrictive perimembranous ventricular septal defect and a small patent Foramen Ovale, both closed spontaneously in infancy. CT angiography at 10 months of age revealed a defect in the thoracic and abdominal walls along with herniation of left ventricular apex into epigastrium. The two ventriculi formed a tail that looked like a crocodile. This patient underwent surgical correction at our institution at 14 months of age and recovered well with no residual issue.
Objective: To share a single centre experience of percutaneous balloon valvuloplasty for critical pulmonary valve stenosis.
Study Design: A retrospective cross sectional study.
Place and Duration of study: This study was conducted at AFIC/NIHD Rawalpindi, from Aug 2010 to Dec 2015.
Materials and Methods: In this study a retrospective analysis of all consecutive infants who underwent BVP for critical PVS was carried out to assess its immediate efficacy and safety.Results: A total of 28 infants diagnosed with critical PVS were enrolled. Male to female ratio was 1.5:1. Pulmonary valve (PV) annulus mean diameter was 12 ± 4.2. Mean age of pulmonary BVP was 6 ± 8 years and average balloon to PV annulus ratio was 1.35. Immediate success was achieved in 100% by significant reduction of transpulmonary valve peak pressure gradient (p<0.001). One death occurred 5 days after the procedure, 21.4 % hadcomplications and none of our patient needed re-intervention in the immediate post procedure period or before discharge.
Conclusion: Percutaneous BVP was found very effective and safe intervention for critical narrowing of pulmonary valve in order to gain time for further intervention needed in a high risk age group for surgery. Balloon pulmonary valvuloplasty is equally successful in neonates as well as in adult subjects and is the treatment of choice for relief of pulmonary valve stenosis. Surgery should be reserved for unsuccessful BVP. Life-long followup to identify the significance of residual pulmonary insufficiency is indicated.
Atrial flutter (AFL) is a rare arrhythmia in neonatal and infantile period. Potentially, AFL might lead to severe morbidity and even a fatal outcome. However it can have a good prognosis with early diagnosis and prompt appropriate treatment. Synchronized electrical cardioversion or transoesophageal atrial overdrive pacing is recommended in both stable and unstable cases. Antiarrhythmic drugs can be tried in stable newborns though the sinus rhythm takes some time to return to normal.Excellent prognosis has been noted in newborns and infants having AFL after sinus rhythm has been restored. The risk of recurrence is low and prolonged antiarrhythmic therapy is less likely to be required. However follow-up after discharge is essential to look for any possibility of recurrent arrhythmia and possible untoward effects of treatment.
Objective To determine the pattern and profile of Congenital Heart Diseases (CHD) in paediatric patients (age 1 day to 18 years) presenting to a paediatric tertiary referral centre and its correlation to risk adjustment for surgery for congenital heart disease. Study design Descriptive case series. Place and duration of study Paediatric Cardiology Department, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi (AFIC/NIHD). Patients and methods Over a period of 6 months, 1149 cases underwent 2-D echocardiography. It was a non-probability purposive sampling. Results This study showed 25% of all referrals had normal hearts. A male preponderance (38%) was observed from 1 year to 5 years age group. Nineteen percent of the cases were categorized as cyanotic CHD with the remaining as acyanotic variety. Tetralogy of Fallot (TOF) represented 10%, Ventricular Septal Defects (VSD) 24%, followed by Patent Ductus Arteriosus (PDA) and Atrial Septal Defect (ASD), which comprised 6.6% and 6.5% respectively. VSD was the most common association in patients with more complex CHD (10%) followed by PDA in 3% and ASD in 1.2% of the cases. Most of the cases were category 2 in the RACHS-1 scoring system. Conclusion VSD and TOF formed the major groups of cases profiled. Most of the cases recommended for surgery for congenital heart disease belonged to the risk category 2 (28.1%) followed by the risk category 1 (12.7%) of the RACHS-1 scoring system.
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