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This prospective cohort study aimed to determine the morbidity and mortality among hyperglycemic pediatric patients after cardiac surgery. The study was conducted in a pediatric intensive care unit (PICU) for cardiac surgery patients at a university-affiliated, referral, heart hospital. A total of 379 postcardiac surgery pediatric patients participated in the study. No interventions were performed. Measurements of blood glucose level together with other clinical and laboratory data were collected on postoperative days 1, 2, 3, and 7. Mean blood glucose level exceeding 126 mg/dl was considered hyperglycemia, and a level exceeding 200 mg/dl determined severe hyperglycemia. These measurements were analyzed for association with major complications and death. Hyperglycemia was common (86%) in this cohort study. There was no statistical correlation between hyperglycemia and death or major complications, but patients with severe hyperglycemia showed a significantly higher mortality rate (16/64 deaths [25%] vs. 13/315 deaths [4.12%]; P < 0.001]) and more morbidities (16/64 [25%] vs. 43/315 [13.65%]; P = 0.022). Severe hyperglycemia was independently associated with mortality according to multivariate logistic regression. Hyperglycemia is quite prevalent among pediatric patients after cardiac surgeries. Severe hyperglycemia is associated with higher morbidity and mortality rates in this patient population.

Few reports have described tachycardia-induced cardiomyopathy secondary to ventricular tachycardia. We present a 12-year-old boy with dilated cardiomyopathy and incessant verapamil-sensitive idiopathic left ventricular tachycardia. Twelve-lead electrocardiogram showed right bundle branch block QRS morphology with superior axis during tachycardia. Electrophysiology study confirmed the diagnosis, and radiofrequency ablation was done and successfully terminated and prevented induction of ventricular tachycardia. During the follow-up period of 18 months, the patient remained free of symptoms and arrhythmia. Three months after ablation, left ventricular ejection fraction improved and cardiac silhouette became normal on chest x-ray.

Aortic valve replacement has been recommended in patients who have severe symptoms, in patients with extreme left ventricle (LV) dilatation (end diastolic dimension >4 SD above normal) or LV ejection fraction <50%. However, the occurrence of advanced symptoms or severe LV dilatation raises concern about irreversible LV dysfunction. This study sought to determine the influence of preoperative symptoms, LV size and function on mortality, and postoperative LV performance in children and adolescence after valve replacement for aortic regurgitation (AR). A total of 49 patients 18 years old or younger (mean, 13.9 +/- 3) who underwent valve replacement for chronic AR between 1991 and 2001 were followed up for 1-10 years (mean, 3.3 +/- 2.1). Baseline and postoperative characteristics were compared between 13 patients (group 1) with extreme LV dilatation and 34 patients (group 2) with a lesser degree of LV enlargement. Preoperative low ejection fraction (p < 0.008), extreme LV dilatation (p < 0.05), and LV end systolic dimension >4 SD above normal (p < 0.05) were predictors of persistent LV dysfunction. Extreme LV dilatation (p < 0.0003), LV end systolic dimension (p < 0.0007), and reduced LV ejection fraction (p < 0.01) predicted persistent LV dilatation. In the setting of chronic AR, preoperative symptoms, LV systolic function, and LV internal dimensions are the main predictors for persistent LV dysfunction and dilatation. Surgical correction should be performed before LV systolic dysfunction and/or extreme LV enlargement occurs.

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Background: Using Doppler echocardiography, one can reasonably determine the ratio of pulmonary (Qp) to systemic (Qs) blood flow in left to right shunts including atrial septal defect (ASD). Objective: Our aim was to evaluate the Qp:Qs ratio in a group of children, and compare the above parameter with Qp:Qs measurement by angiocardiography in those patients. Setting: Pediatric ward of Shahid Rajaie heart center in Tehran, Iran. Methods and Materials: Doppler echocardiography performed for all the children with ASD secundum who required angiocardiography during a two years period. The Qp:Qs ratio was measured by these two techniques and the results were compared. Results: There were 78 cases, 55 were female and 23 were male (F/M = 2.4:1). The most common age group was 4-10 years old (43.6%). Echocardiography missed two cases of ASD. Sensitivity of echocardiography for diagnosis of ASD was 98%, and the positive predictive value was 100%. There was no significant difference between the Qp:Qs calculation by angiocardiography and by echocardiography. The Qp:Qs ratio by angiocardiography ranged from 1.5:1 to 4.5:1 with a mean of 2.16+/-0.58 versus the Qp:Qs ratio by echocardiography ranged from 1.3:1 to 4.3:1 (P = 0.18). Conclusion: The simple noninvasive Doppler calculation of the Qp:Qs ratio which requires less time and no special facilities provides an excellent estimation of the Qp:Qs ratio in children with ASD secundum.

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