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IntroductionVascular endothelial growth factor is a potent stimulator of angiogenesis. Children with cyanotic congenital heart disease often experience the development of widespread formation of collateral blood vessels, which may represent a form of abnormal angiogenesis resulting in increased morbidity and mortality. We undertook the present study to determine whether children with cyanotic congenital heart disease have elevated serum levels of vascular endothelial growth factor compared to children with acyanotic heart disease.Material and methodsSerum was obtained from 35 children with cyanotic congenital heart disease and 30 children with acyanotic heart disease. Vascular endothelial growth factor levels were measured in the serum of these patients by sandwich enzyme immunoassay.ResultsVascular endothelial growth factor was significantly elevated in children with cyanotic congenital heart disease compared to children with acyanotic heart disease (150.3 ±48.1 vs. 85.4 ±18.7 pg/ml, respectively, p < 0.001). In the cyanotic group, oxygen saturation (SaO2) was negatively correlated with VEGF (r=–0.631, p < 0.001) while haemoglobin was positively correlated (r=0.781, p = 0.007). No significant correlations were found in the acyanotic group.ConclusionsChildren with cyanotic congenital heart disease have elevated systemic levels of vascular endothelial growth factor directly related to the degree of cyanosis (SaO2 and haemoglobin levels). These findings suggest that the widespread formation of collateral vessels in these children may be mediated by vascular endothelial growth factor.

Background Psychiatric disorders (depression / anxiety) are linked to coronary artery disease (CAD). Coronary slow flow (CSF) is a relatively common form of CAD with the same underlying mechanisms that are attributed to many anatomic and pathophysiologic factors. However, the relationship between psychiatric disorders and CSF is less well-established; and this is the aim of this study. Methods This cross-sectional observational study was conducted on the first 50 consecutive patients diagnosed with CSF by elective coronary angiography (CAG). They were compared with another 50 consecutive patients showing normal coronaries by CAG. Beck Anxiety Inventory and Beck Depression Inventory were used for assessment. CSF was diagnosed by coronary angiography “Thrombolysis In Myocardial Infarction” frame count. Lipid profile was obtained for all patients. Results Traditional risk factors (male gender, smoking, total cholesterol, low-density lipoproteins and triglycerides) were higher in the CSF group. Depression and anxiety scores were also higher in the CSF group. On multivariate analysis, male gender, depression and high triglycerides were the only significant independent predictors of CSF. A significant correlation existed between CSF and both anxiety and depression scores. Both scores were also significantly higher in multivessel vs single vessel affection. Conclusion Psychiatric depression, male gender and high triglycerides are highly associated with CSF in patients undergoing elective CAG. There is a significant correlation between CSF severity and the severity of both anxiety and depression. Further studies are warranted to explore the impact of psychological intervention on CSF and its long-term outcome.

IntroductionThe myocardial performance index (MPI) has been described as a non-invasive Doppler measurement of ventricular function. The aim of this study was to assess MPI following surgical correction of ventricular septal defect (VSD) and to evaluate its impact on postoperative recovery.Material and methodsThis is a prospective study involving 30 children (16 girls and 14 boys) operated on for VSD (group I). The control group (group II) consisted of 30 healthy children (age and sex matched).ResultsWe found that both the right and left ventricular (RV and LV) MPI correlated significantly with the ejection fraction (EF) (r = –0.49, p = 0.006, r = –0.51, p = 0.004, respectively). The LV EF and the LV FS were negatively correlated, while the left and right ventricular MPI was positively correlated with the: LVEDD (p = 0.000), the VSD size (p = 0.000), and the postoperative course of the patients in terms of the duration of ventilation (p = 0.000), the duration of use of inotropics (p = 0.000) and the duration of staying in the ICU (p = 0.000). By linear regression, the factors that correlated with the postoperative course of VSD surgery were the RV MPI pre-surgery, MPI 2 days after surgery and the ejection fraction (p = 0.000).ConclusionsMyocardial performance index is a useful index for measurement of the left and right ventricular function. It correlates significantly with the ejection fraction, fractional shortening, VSD size, and the left ventricular size. It also significantly predicts the outcome of VSD surgery.

In patients with STEMI treated with primary PCI, left coronary artery dominance confers a higher risk of various adverse clinical events after primary PCI, during hospital stay, and at 3 months follow-up compared to right and balanced coronary artery dominance.