Background: The surgical outcomes of tetralogy of Fallot (TOF) have evolved dramatically and have resulted in lower mortality rate. Currently, the many cardiac centers have a trend to early single-stage complete repair more than a staged repair. However, the patients who have an early primary repair were required transannular patch augmentation of a pulmonary valve frequently. This effect has been developed a chronic pulmonary insufficiency may lead to right ventricular dilation, dysfunction. In this era, the aim of treatment of TOF is attempted to preserve pulmonary valve annulus for prevent right ventricular dysfunction in the future. The systemic to pulmonary artery shunt is a palliative procedure or known as staged repair for symptomatic patients with TOF. The modified Blalock-Taussig shunt (mBTS) is the most useful systemic to pulmonary shunt and perform as an initial procedure before complete repair. The mBTS can provide increase pulmonary blood flow as well as improve oxygenation and also promote pulmonary artery (PA) growth. However, the effect of this procedure to promote growth of a pulmonary valve annulus is still debate. Objectives: To compare a growth of pulmonary valve annulus between after staged repair and primary repair in patients with TOF (without pulmonary atresia). Methods: A retrospective case-control study, review of patients with TOF underwent total repair at our hospitals from January 2005 and December 2017 was performed, a total number of 112 patients underwent TOF repair. Twenty-nine patients (26%) underwent a staged repair (mBTS group) and 83 (74%) underwent total repair only or primary repair (PR group). We evaluated diameter of pulmonary valve annulus by using echocardiography at the time of first diagnosis and before complete repair on both groups. Results: The age of diagnosis of mBTS group were younger than PR group (p = 0.011). Therefore, pulmonary valve annuls were smaller in mBTS group. (Z-score, −2.93 ± 1.42 vs. −1.89 ± 0.97; p = 0.001). However, the growth potential of pulmonary valve annulus was increase more than PR group significantly (Z-score, −1.46 ± 1.02 vs. −2.11 ± 1.19; p = 0.009) Even though a patent ductus arteriosus was found commonly in PR group (p = 0.018). Conclusions: Our results suggest the systemic to pulmonary shunt or mBTS can promote growth of pulmonary valve annulus in patients with TOF.

The aim of this study is to determine the correlation between the symptom of heart failure and basic investigations; N-Terminal-Pro-B Type Natriuretic Peptide (NT-proBNP) and cardiothoracic (CT) ratio from chest radiograph in pediatric heart disease. Methods: One-hundred-eighty children (aged 1-15 years) with underlying heart disease were enrolled in this prospective cross-sectional study. The heart failures were categorized based on the Ross classification into 2 groups, non-heart failure (Ross classification I) and heart failure (Ross classification II-IV). The NT-proBNP level was determined and chest radiograph was done in posteroanterior upright position for CT ratio. Results: The mean NT-proBNP level was 223.1 pg/ml (±180.3) and a mean CT ratio was 53.6% (±5.6) in the non-heart failure group. The mean NT-proBNP level was 1,054 pg/ml (±1,840.3) and a mean CT ratio was 58.6% (±6.1) in heart failure group. There was a significantly positive correlation between heart failure symptoms and the level of NT-proBNP and CT ratio. In this study, the cutoff value of NT-proBNP for heart failure was more than 400 pg/ml (OR 6.97, ROC 0.694, sensitivity 52.6%, specificity 86.3%) and CT ratio more than 55% (OR 3.57, ROC 0.654, sensitivity 68%, specificity 62.8%). Conclusion: In pediatric heart diseases, there are strong positive correlations between heart failure with both NT-proBNP and CT ratio. These correlations help in the diagnosis of heart failure. NT-proBNP level more than 400 pg/ml and CT ratio more than 55% are indicative of heart failure in our population. Both investigations are inexpensive, readily available and do not require specialist experts.

Acute rheumatic fever (ARF) remains a major health problem worldwide, especially among the endemic countries. Different kinds of rhythm and conduction abnormalities may be seen during the course of the disease. Although the first-degree atrioventricular block is the most common disturbance reported in ARF, other advanced heart block may be an exceptionally rare manifestation. We reported two cases of ARF; one presented with first- and second-degree AV block (Mobitz II), and the other one presented with supraventricular tachycardia followed by unstable bradycardia due to complete atrioventricular block and required temporary pacemaker. Both cases completely recovered with anti-inflammatory drug regimen for ARF.

Background Congenital heart diseases (CHDs) are the most common types of birth defects and contribute to a large proportion of infant morbidities and mortalities worldwide. These defects may require multiple surgical interventions impacting the infant's quality of life. Objectives To identify risk factors associated with CHD in a population of Thai children. Methods We conducted a case–control study of patients attending the Pediatric Clinic, Naresuan University Hospital, Thailand. We included data from pediatric patients diagnosed with CHDs as cases, and patients without cardiovascular abnormalities as controls. Risk data were collected from July 2019 to April 2020 using face-to-face interviews. Multiple logistic regression was used to analyze parental factors associated with CHDs. Results We included 249 cases classified into 2 groups according to severity and 304 patients as controls. For those less-severely affected (155 patients, 62.2%), ventricular septal defect (27.7%) was the most prevalent, whereas for those with severe CHDs, tetralogy of Fallot was the most prevalent (14.0%). There was no difference in sex distribution or maternal obstetric history between the groups. In multivariable analysis, a family history of CHDs (adjusted odds ratio [AOR] 4.67, 95% confidence interval (CI) 1.61–13.57, P = 0.005) and maternal exposure to second-hand cigarette smoke (AOR 1.58, 95% CI 1.03–2.42, P = 0.002) were identified as significant risk factors for CHDs. Conclusion A family history of CHDs and maternal exposure to second-hand cigarette smoke are associated with having offspring with CHDs in the population studied. These findings help us to encourage affected parents to obtain a fetal echocardiogram.