Summary. Background: During cardiac catheterization (CC) in children, unfractionated heparin (UFH) is used for primary prophylaxis of thrombotic events (TE). However, the optimal UFH dose to minimize TE and bleeding in children has yet to be established. Objectives: To (i) objectively assess the incidence of TE and bleeding during pediatric CC using clinical assessment and ultrasound; and (ii) compare a high-dose vs. low-dose UFH protocol for thromboprophylaxis. Methods: A randomized controlled trial (RCT) comparing high-dose UFH (100 units kg )1 bolus, followed by 20 units kg h )1 continuous infusion) vs. low-dose UFH (50 units kg )1 bolus) during CC.Outcome assessment was by clinical examination and vascular ultrasound, performed by blinded examiners before and within 48 h after CC. Children with no consent for randomization were followed in a cohort receiving standard-of-care UFH (parallel-cohort RCT). Results: A total of 227 children were included; 137 were randomized and 90 followed in the cohort study. The overall incidence of TE was 4.6% and bleeding 6.6%. The RCT was stopped early for futility as there were no differences between the high-dose and the low-dose UFH in TE (5% vs. 3%; risk ratios [RR] 1.5, 95% confidence interval [CI] 0.3; 9) and bleeding (7% vs. 12%, RR 0.6, 95% CI 0.2; 2). There were also no differences when RCT and cohort study populations were combined. Conclusions: The incidences of TE and bleeding during CC in children were low. There were no differences between the high-dose and the low-dose UFH protocols studied. Although Heparin Anticoagulation Randomized Trial in Cardiac Catheterization (HEARTCAT) was not designed as non-inferiority trial, low-dose UFH (50 units kg )1 bolus) appears sufficient for thromboprophylaxis during CC.
Tuberous sclerosis complex (TSC) is a genetic disorder characterized by abnormal cell proliferation and tumor growth in a number
CASE REPORTA 20-year-old primigravida was referred to our center at 23 weeks' gestation with a giant fetal cardiac tumor. Ultrasound examinations revealed a giant tumor mass engulfing the majority of the right ventricle and obstructing the right ventricular outflow tract (Figure 1). Additional tumors were diagnosed in the cavity of the left ventricle. No signs of pericardial effusion or hydrops were observed at the time of diagnosis, however, tricuspid regurgitation was present. The family history of TSC was positive and investigations revealed a splice-site
Perventricular and intraoperative device closure of VSD is as effective as a surgical patch and averts the increased morbidity of conventional surgical repair in a subgroup of high-risk patients.
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