Background: Arrhythmias may complicate congenital heart diseases, such as secundum atrial septal defects. We aimed at following up the rhythm changes in children after closure of ostiumsecundum atrial septal defects. Methods: The current study was conducted in the Pediatric Cardiology Unit, Tanta University, on 60 pediatric patients who had undergone either trans-catheter or surgical closure of secundum atrial septal defects. Complete history taking and full clinical assessment were done. Echocardiographic assessment was performed to detect any residual defects, and assess chamber dimensions, and cardiac functions. Electrocardiographic assessment including Holter monitoring was performed within two months after the procedure, after six months, and after one year. Arrhythmias were classified into major and minor types. All results were statistically analyzed and tabulated. Results: There were no significant differences between the pre-closure rhythm and the rhythm after closure of the defects throughout the follow-up. The percentage of patients with major arrhythmias has increased from 6.7% of the total sample to 13.3%, 11.6%, and 11.6% in the early, midterm and late follow up respectively. The significant risk factors for postoperative arrhythmias were; pre-closure arrhythmia, right atrial dilatation, and serious hemodynamic instability in the early follow up. Conclusions: We concluded that arrhythmias were common before and after atrial septal defect closure, without significant differences. Pre-closure arrhythmia, right atrial dilatation, and serious hemodynamic instability are considered important risk factors of arrhythmias after secundum atrial septal defect’s closure in pediatric patients.
Adrenomedullin has been shown to inhibit proliferation in pulmonary artery smooth muscle cells and to alleviate pulmonary artery collagen accumulation in pulmonary hypertension. We aimed to assess mid-regional proadrenomedullin level in children with pulmonary hypertension due to CHDs. The current study was conducted in the Pediatric Cardiology Unit, Tanta University Hospital, on 50 children with CHDs: twenty-five patients had a complication of pulmonary hypertension and the other 25 patients without pulmonary hypertension. Another 25 children without CHDs were concluded as a control group. We performed complete history taking, full clinical assessment, chest X-ray, electrocardiogram, and echocardiographic assessment. Plasma level of mid-regional proadrenomedullin was assessed using a sandwich enzyme-linked immunosorbent assay test. Our results showed that the mean plasma level of mid-regional proadrenomedullin was significantly increased in patients with pulmonary hypertension. Significant positive correlation was found between mid-regional proadrenomedullin and mean pulmonary artery pressure. The best cut-off point of mid-regional proadrenomedullin as a diagnostic biomarker to discriminate patients with CHDs complicated with pulmonary hypertension was 199.22 nmol/l. Mid-regional proadrenomedullin significantly increased in patients with pulmonary hypertension who died as compared to patients who survived, with the best cut-off point was 428,8 nmol/l. We concluded that plasma levels of mid-regional proadrenomedullin were significantly elevated in children with pulmonary hypertension complicated by the CHDs. It could be used as a cardiac biomarker in these patients, with good diagnostic and prognostic value.
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