Background: Frequency of congenital heart disease (CHD) association with Coronavirus disease 2019 (COVID-19) is lacking. Aim of work: to study difference of frequency and pattern of congenital heart diseases among neonates conceived during the pre-COVID-19 era, and those conceived during the COVID-19 era who were admitted to the Neonatal Intensive Care Unit (NICU), Faculty of Medicine Pediatric Hospitals, Cairo University. Material and Methods: This was a retrospective descriptive study in which we revised the files of all neonates admitted to NICU in a period of 6 months from September 2019 till February 2020 (group 1) and from September 2021 till February 2022 (group 2) who were conceived before and during the COVID era respectively. Results: 162 newborns with CHD were enrolled in this study from a total of 1488 admitted in NICU during the 12 months of the study. 74 CHD patients were conceived in the pre COVID era (group 1) whereas 88 patients were conceived during COVID era (group 2). In group 1: 43 cases were males (58.1%) and 31 were females (41.9%), compared to group 2: where 53 were males (60.2%) and 35 were females (39.8%) (p = 0.785). There was no difference in frequency or type of CHD among the 2 groups. The most common CHD was patent ductus arteriosus (PDA) with and without pulmonary hypertension in 34 cases (45.9%), followed by atrial septal defect (ASD) in 19 (25.7%), then ventricular septal defect (VSD) in 7 (9.5%), which was not different than in group 2, the most common CHD was PDA with and without pulmonary hypertension in 52 cases (59.1%) then VSD in 8 (9.1%), VSD and ASD in 8 (9.1%) (p= 0.555). Conclusion:The frequency and type of CHD among neonates admitted to our NICU was not different in the era before and the COVID-19 era. PDA with and without pulmonary hypertension was the commonest CHD in both eras.
Background: Wilson disease (WD) is an autosomal recessive disease with copper overload. Its clinical picture depends on specific tissue/system damage by the excess copper. Aim of the work:We aimed to study prospectively the phenotypic spectrum of structural and functional cardiac changes among children with WD. Methods: 16 children with confirmed WD underwent electrocardiography (ECG), conventional and tissue Doppler echocardiography. Results: ECG was normal in 11 patients (68.7%), inverted T was detected in 2 (12.5%), ST elevation in 2 (12.5%) while P-pulmonale and inverted T were detected in 1 (6.25%). Five patients (31.25%) had mild and one (6.25%) had severe tricuspid regurgitation. Two girls (12.5%) with WD had underlying congenital heart defects, one had atrial septal defect (ASD) and another had double inlet left ventricle (DILV), malposed great vessels and severe pulmonary stenosis. There was a positive correlation between LV mass and duration of treatment (r=0.559, p=0.030), and a negative correlation between age of onset and LV mass index (r=0.600, p=0.018). There was no significant correlation between age of onset and duration of treatment with myocardial perfusion imaging (MPI) or tissue Doppler parameters. Conclusion: WD in children is associated with cardiac structural and functional changes including congenital structural heart malformations; ASD and DILV. Future research is needed to verify if ASD and DILV in WD are embryonic presentations of copper overload in WD.
Background: Tetralogy of Fallot (TOF) is one of the most prevalent cyanotic congenital heart diseases requiring surgery early in life. Aim of work: Exercise capacity and right ventricular diastolic dysfunction in children after TOF repair. Methods: Cross sectional descriptive study was conducted on 27 cases with TOF after total surgical repair. Cases were subjected to 12 leads ECG, chest X-ray, 6-minute walking test (6MWT) to assess the exercise capacity and transthoracic color Doppler echocardiography with assessment of right ventricle myocardial performance index (RVMPI) and pulmonary regurgitation index (PRi). Results: The mean ± SD age of the our studied was TOF patients 6.59 ± 1.80 years. The mean ± SD age at operation was 2.46 ± 0.95 years. All had dilated right ventricle (right ventricle dilatation index RVDi > 0.5), and moderate to severe pulmonary regurge (PR) estimated by PRi (PRi <0.77). Impaired RVMPI (>0.32) was found in 6 (22%) patients. Exercise capacity measured by 6-MWT was significantly reduced compared to the normal population of the same age group (p= 0.001). Results of 6-MWT did not correlate with the RVMPI (p= 0.44, r= -0.077), the PRi (p= 0.83, r=0.006), QRS (p=0.31, r=0.066), or corrected QT interval (p=0.89, r= 0.169). Conclusion: Exercise capacity was limited in our TOF patients after surgical repair, that was not related to right ventricular diastolic dysfunction as it did not correlate with RVMPI, degree of PR, QRS duration, nor corrected QT interval.
Background: Acute rheumatic fever and rheumatic heart disease are the significant nonsuppurative late sequelae of group A beta hemolytic streptococcal infection. Anti-streptolysin O titer (ASOT) is a streptococcal antibody test that is used for the diagnosis of infections and is particularly useful in the diagnosis of acute rheumatic fever. Aim of the work:To compare ASOT values in normal children to those with rheumatic fever and children with recurrent tonsillitis, and to evaluate its relationship with seasonal variations. Methods: A case-control study conducted on 300 children; 100 children with rheumatic fever, 100 with recurrent tonsillitis and 100 apparently healthy children as a control group. Children were subjected to history taking, echocardiography study and blood specimens for complete blood count, erythrocyte sedimentation rate, C reactive protein and ASOT were assessed using immunoturbidimetric assay tested by Cobas e501/502 (Roche). Human anti-streptolysin O antibodies (any type) agglutinate with latex particles coated with streptolysin O antigens. Results: Mean and SD of age in each group was 10.2±3 years for rheumatic fever group, 7.3± 3.8years for recurrent tonsillitis group and 5.4±2.4 years for control group. Rheumatic fever group included 49 males and 51 females, recurrent tonsillitis group included 58 males and 42 females, control group included 63 males and 37 females. ASOT ranged between 261-860 (mean± SD= 475.1±214.2), 210-813 (mean± SD= 257.6±56.4) and 65-820 (mean± SD= 158.8± 105.4) among those with rheumatic fever, tonsillitis and control group respectively (p=0.001). ASOT level between 400-800 IU/ml were common among patients with rheumatic fever and levels between 200-400 IU/ml were common with recurrent tonsillitis (p<0.001) with lack of diagnostic cut-off. Conclusion: ASOT levels are higher in rheumatic fever patients compared with recurrent tonsillitis and normal children. There is lack of diagnostic cut-off of ASOT, hence the value of ASOT is only within scoring system to avoid over or under diagnosis of acute rheumatic fever. An isolated high ASOT is not sufficient to diagnose or rule out acute rheumatic fever.
Background: The children population who underwent single ventricle repair is growing in number with longer follow up periods and increased frequency of complications. Aim of work: To evaluate the outcome and complications post Glenn and Fontan single ventricle repair in children. Material and Methods: A retrospective study of data within files of all surviving patients post univentricular surgical repair, who were following up at Post Cardiac Interventions Clinic in Cairo University Children Hospital from October 2007 until October 2020.Results: The files of 113 patients were enrolled in the study, 93 (82.3%) of them were post Glenn operation. Their mean± SD age at the time of the operation was 1.4± 0.9years, and mean follow up duration of 8.3 ±3 years. The study included 20 (17.7%) patients post Fontan operation, with a mean age at the time of the operation of 7.82± 1.63years, and mean follow up duration of 4.75 ±0.08 years. They were 77 (68.15%) males, and 36(31.85%) females. Complications post Glenn operation were heart failure in 34(36.5%) patients, pericardial and pleural effusion in 4 (4.3%) and hypoalbuminemia in 2 (2.15%). Complications post Fontan were heart failure in 4 (20%) patients, arrhythmia in 2 (10%), and protein losing enteropathy in 2 (10%). Frequency of complications was not related to the age at the time of the Glenn and Fontan operation (p =0.793) and (p=0.079) respectively. Conclusion: Performing Glenn and Fontan at older age was not related to the frequency of complications in our patients. Heart failure was the most common complication post Glenn and Fontan operations.
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