No abstract

Recent increase in deployment of trans-catheter devices such as septal or ductal occluding coils and devices has been a possible risk factor for infective endocarditis, predominantly in the initial post deployment period before endothelialization has ensued. Though a long-term study of trans-catheter Atrial Septal Defect (ASD) closure revealed no cases of Infective Endocarditis, some case reports of endocarditis in trans-catheter device closure of ASD, VSD and Patent ductus arteriosus(PDA) advocate that residual defect after device occlusion may be a factor in the risk for Infective Endocarditis. We herein describe the case of a 9-month-old female patient who underwent device closure for peri-membranous ventricular septal defect (VSD) and developed fungal infective endocarditis in early post occlusion period which was confirmed on blood culture. Despite treatment with appropriate antifungal as per sensitivity, clinical condition of the patient deteriorated and it was decided to manage her with surgical explanation of device and closure of defect.

Objective: To determine different treatment options in patients of Patent Ductus Arteriosus with pulmonary hypertension beyond neonatal period. Study Design: Descriptive cross sectional study. Place and Duration of Study: This study was carried out in Pediatric Cardiology department of Rawalpindi Institute of Cardiology, from Jan 2017 to Jan 2019. Methodology: Patients having PDA with pulmonary hypertension were included in the study. Treatment options were divided into percutaneous catheter device closure, surgical ligation of patent ductus arteriosus and palliative treatment. Any adverse event during the procedure was documented. Stratification was done in regard to gender and age group. Post stratification chi square test was applied and p-value less than or equal to 0.05 was considered as significant. Results: Total number of patients included in the study were 37. Mean age (years) of patients (Mean ± SD) was 19.21 ± 8.76. Mean ± SD pulmonary artery pressure was 56.43 ± 11.55 mmHg. Percutaneous catheter device closure was successful in 24 (64.9%) patients, in 7 (18.9%) patients primary surgical PDA ligation was done, 3 (8.1%) patients were advised palliative treatment and in 3 (8.1%) patients adverse events occurred during percutaneous device closure and were thus referred for surgical ligation. Patent ductus Arteriosus Occlutech device was used in 18 (48.6%) patients, Occlutech VSD device was used in 7 (18.5%) patients and in 1 (2.7%) patient AGA duct occluder was used. Conclusion: In patients with patent ductus arteriosus and pulmonary artery hypertension, percutaneous catheter device closure is a safe and effective procedure.

We report a 5-year-old boy weighing 11 kg, with severe mitral valve stenosis of rheumatic aetiology, who underwent successful percutaneous transluminal mitral commissurotomy (PTMC) with valvuloplasty balloon. Postprocedural mean pressure gradient across the mitral valve decreased to 6 mmHg from an initially recorded value of 22 mmHg. In addition to symptomatic improvement, the mitral valvular area increased from 0.4 to 0.8 cm(2) without significant change in mitral regurgitation. At 1- and 3-month follow up, transthoracic echocardiography revealed further improvement with an increase in mitral valve area to 1.0 cm(2), a decrease in pulmonary arterial pressure, and a mean mitral valve pressure gradient of 8 mmHg with trivial mitral regurgitation. To best of our knowledge, this is the first successful PTMC procedure performed in the youngest and smallest ever reported child with rheumatic mitral stenosis (MS). We conclude that PTMC with valvuloplasty balloon could be a logical alternative to surgery in young patients with rheumatic MS.