Biography:

Sonia El Saiedi has completed her graduation from Medical School, Cairo University in 1987. She was trained in Boston Children Hospital in 1998. Currently, she is working as Professor of Pediatric Cardiology in Cairo University Children Hospital, Egypt as well as she is the Director of Pediatric Cardiac ICU and Cardiomyopathy Clinic.

Abstract:

Pulmonary atresia with intact ventricular septum is an infrequent but enigmatic disorder with significant morphological heterogeneity. In the absence of aright ventricular– dependent coronary circulation, pulmonary valvotomy is a good choice to save the right heart a biventricular repair instead of univentricular repair currently practice in our country. The use of percutaneous RF-assisted perforation of theatretic valve and subsequent balloon dilation provides an easy but expensive overall procedure. The procedure, while technically challenging, can be expected to establish ante-grade flow successfully through the pulmonary valve in most of patients. More than 65 patients presenting with PA-IVS presenting to Cairo University Children Hospital (CUCH) were taken for RF perforation using Baylis RFP 100 generator with trials for cost limitations. For example, to minimize expenses: We stopped using the Protrack microcatheter and replaced this in most cases by the “wire tracks a wire” technique. We also replaced the use of the micro snare from the arterial end to mark the pulmonary valve by looping a coronary wire. Telescopic Luma catheter was replaced by using Mullin long sheath 5 or 6F through which the 4F catheter is passed. Fixing the wire and trying to limit the number of balloons used, replacing the Tayshack Mini balloons which was not always available with regular coronary balloons which are readily available. In case of unavailable 4F sheath with special curve we mostly used either 4F VER and reshaped it. We resorted to Hybrid procedure with the surgeon opening the chest and fixing the sheath in RV directed towards the pulmonary valve in case of failed peripheral vascular access. The challenges faced by the operator in the cath lab (especially in countries with less than optimal facilities) and the different solutions to overcome those challenges will be presented.

Biography:

Chuanxi Cai has completed his PhD from the Institute of Biophysics at Chinese Academy of Sciences in Beijing, China and Post-doctoral studies from UMDNJ-Robert Wood Johnson Medical School (RWJMS). Currently, he is the Associate Professor of Cardiovascular Medicine in the Albany Medical College. He has published 17 papers in reputed journals and has been serving as Editorial Board Member of several scientific journals.

Abstract:

The regenerative potential of c-kit⁺ cardiac stem cells (CSCs) is severely limited by the poor survival of cells after transplantation in the infracted heart. We have previously demonstrated that preconditioning human CSCs (hCSCs) with the HO-1 inducer, CoPP, has significant cytoprotective effects in vitro. Here, we examined whether preconditioning hCSCs with CoPP enhances CSC survival and improves cardiac function after transplantation in a model of myocardial infarction induced by a 45-min coronary occlusion and 35-day reperfusion in immunodeficient mice. At 30 min of reperfusion, CoPP-preconditioned hCSCs^GFP+, hCSCs^GFP+, or medium were injected into the border zone. Quantitative analysis with real time qPCR for the expression of the human specific gene HLA revealed that the number of survived hCSCs was significantly greater in the preconditioned-hCSC group at 24 hours, 7 and 35 days compared with the hCSC group. Co-immunostaining of tissue sections for both GFP and human nuclear antigen further confirmed greater hCSC numbers at 35 days in the preconditioned-hCSC group. At 35 days, compared with the hCSC group, the preconditioned-hCSC group exhibited increased positive and negative left ventricular (LV) dP/dt, end-systolic elastance and anterior wall/apical strain rate (although ejection fraction was similar), reduced LV remodeling, and increased proliferation of transplanted cells and of cells apparently committed to cardiac lineage. In conclusion, CoPP-preconditioning of hCSCs enhances their survival and/or proliferation, promotes greater proliferation of cells expressing cardiac markers, and results in greater improvement in LV remodeling and in indices of cardiac function after infarction.

Biography:

Bala Joshi completed her B.A. degree from Queens College, 1987.  She went on to complete her RRT in Respiratory Therapy from NYU School of Graduate Studies, 1994.  Ms. Joshi began working at NYC Health + Hospitals/Queens in the year 2000 until present.  She has held the position of a pediatric health educator for the last sixteen years.  She has been a member of many organizations and associations and has been a consistent team player within a pediatric practice.

Abstract:

The role of the asthma educator within a pediatric practice has been shown to enhance and improve patient outcomes. Data has shown exactly how much of a change occurs during a pediatric well child visit when there is the intervention of an education specialist. In the New York City database from the 379NYC Department of Health and Mental Hygiene, the percentage of pediatric patients hospitalized due to asthma exacerbations has declined from the high 80% to the lower 30% due to the introduction of an asthma educator providing extensive asthma education, teaching and reinforcement of all medications and devices during the well-child care visit. Additional data has shown a decrease in the number of school absences due to asthma, again upon the proactive intervention of an asthma educator within the pediatric practice. Before the year 2000, at Queens Hospital Center, studies have shown pre-asthma educator involvement lead to higher well-child visit hospital admissions, emergency department (ED) visits and missed days of school. Clearly, there was a need for more intervention. The NYC Department of Health and Mental Hygiene had started to recognize these high rates within their public hospitals and, therefore, established initiatives tailored to meet the needs of these patients and allow them to be more involved with their care. The NYC Asthma Initiative was presented to public hospital outpatient clinics with mandatory requirements at all well-child pediatric visits. Some of these requirements were: The introduction of a written asthma action plan at each visit; the completion of the medications administration form (MAF); the use of a chamber or spacer always with all prescribed inhalers, and; lastly, to have an asthma educator provide teaching and asthma education during the well-child visit. The asthma initiative along with the NYC Asthma Partnership (NYCAP) wanted to improve outcomes of pediatric asthmatic patients with the implementation of these mandatory requirements. Queens Hospital Center, in the year 2000, decided to implement an education specialist within their pediatric practice, in particular as an addition to their pediatric pulmonary clinic. The asthma educator would work with the provider, nurse and team to ensure a well-rounded educational experience for the asthmatic patient. Weekly visits with the introduction of an asthma educator during the well-child visit had started to show more improvements in declining hospitalization rates, ED visits for asthma and school absences. This data was evident over the years by the NYC Department of Health and Mental Hygiene, citywide, as well as, borough to borough. Patients now became more empowered and more connected with their condition, and knew they could always contact the asthma educator for any services they needed. There was also more compliance to keeping all their appointments and follow-up with their providers.

Biography:

Andreas C Petropoulos graduated from Aristotle University’s Medical School, Greece in 1989. Following 30 year career as a medical officer, he joined as a senior Flight Surgeon in the Hellenic Air-Force. He has specialized in Aviation, Hyperbaric Medicine, Pediatrics, Fetal, Pediatrics and Congenital Cardiology in USA and Europe. He holds MSc in Preventive Cardiology. He is AEPC Prevention Working Group member. He has worked and lectured in Athens and Brussels universities. Currently, he consults in Fetal, Pediatrics, Congenital Cardiology in Merkezi Klinika and is Associate Professor at the State University and Post Graduate at CME Center in Azerbaijan. His research focuses on prevention, CVD imaging techniques, fetal cardiology and heart failure.

Abstract:

Bicuspid Aortic Valve (BAov) is the most common congenital heart defect (CHD). It’s prevalence rises from 0.5-2% of the general population. This unique defect can create a variety of clinical conditions presenting from fetal to late adulthood. The aim of this paper is to highlight the many unique clinical presentations of a BAov. These range from nearby asymptomatic mild valve stenosis of incompetence to coactation of the Aorta, aneurysms, dissections of Ascending Aorta or cerebrovascular vessels and sever double valve disease in any age. The extreme spectrum of it can lead in fetal life in Hypoplastic Left heart Syndrome. BAov is commonly seen in Turner’s, William’s and Marfan’s Syndromes as well as related with VSD’s and coronary arteries abnormalities. The paper finally aims to alert the Pediatric Cardiology community on the long life surveillance that individuals with BAov need and address the variety of interventional and surgical techniques that can be used to address the many and in any age clinical presentations of it.

Biography:

Zeinab Salah has completed her MD from Cairo University and Post-doctoral studies from Faculty of Medicine, Pediatric Hospital , Cairo University. She is the Former Head of Pediatric Cardiology Department , Postoperative cardiac ICU as well as cardiomyopathy clinic in the Pediatric Hospital, Cairo University. Currently, she is the Head of Cardiology Department in Children Cancer Hospital, the biggest pediatric health facility for cancer in Egypt and Middle East. She is the Principal Investigator of the project for creating Egyptian Center of Excellence for Pediatric Cardiology in the Children Hospital Cairo University, the biggest health facilty in Egypt.

Abstract:

Aim: To assess the value of novel three dimensional (3D) echocardiography and 3D speckle tracking echocardiography (3D-STE) for early detection of subtle LV myocardial dysfunction in asymptomatic survivors of childhood myeloid leukemia after anthracycline therapy.

Methods: Thirty five survivors of childhood acute myeloid leukemia (mean age 13.5±4.4 years) treated with anthracycline and 23 age-matched controls were studied. The mean period of follow up after anthracylines therapy was 2.3±1.5 years. All patients and control underwent 3D echocardiography and 3D-STE to assess global longitudinal (GLS), circumferential (GCS) and area strain (GAS).

Result: Compared to controls, patients had reduced GLS (16±3.11 vs. 18.30±2.38%, p=0.006), and area strain (24.29±4.12 vs. 26.78±2.64 0.015, p=0.015). No significant statistical difference was found between patients and control regarding GCS.

Conclusions: 3D-STE enables assessment of the deleterious effect of anthracyclines on the longitudinal myocardial deformation thus providing a novel tool for early detection of subtle LV dysfunction in childhood myeloid leukemia survivors.

Biography:

Yang Lei got his Doctorate degree of Pediatrics from Nanjing Medical University. After his graduation, he was engaged in clinical and research work of Congenital Heart Disease in Nanjing Children’s Hospital affiliated to Nanjing Medical University. So far, he has chaired and completed development of science and technology of Nanjing Medical University foundation project. His study has been based on the development mechanism of the occurrence, clinical diagnosis and treatment in children with congenital heart disease. He has published 7 SCI papers. As the first inventor, he obtained 2 national patents (authorized), as the second inventor; he obtained 1 national patent (authorized).

Abstract:

Background: Pulmonary arterial hypertension (PAH) is a cardiovascular disorder associated with enhanced proliferation and suppressed apoptosis of pulmonary arterial smooth muscle cells (PASMCs). The sildenafil can regulate the Connexin (Cx) 43 in the PASMCs and thus inhibit the PASMCs proliferation and the remodeling of pulmonary arterial. However, how sildenafil exert regulation in the Cx40 in the PASMCs in PAH remains unclear.

Methods & Results: Using the rat PAH model induced by the monocrotoline, we demonstrated that the Cx40 in the PASMCs is down-regulated in the PAH. The sildenafil promotes the up-regulation of Cx40 in the PASMCs via bone morphogenetic protein (BMP) signaling, accompanied by an anti-proliferative response in PASMCs. Inhibition of the BMP axis reverses the up-regulation of Cx40 and anti-proliferation of the sildenafil in these cells. In monocrotaline-induced PAH rat models, which display reduced levels of BMP signaling, this study further indicates that the BMP-Cx40 axis is activated in lungs following the sildenafil treatment. Furthermore, we also find in vitro that sildenafil increases the Cx40 expression of PASMCs isolated from MCT-PAH rats and inhibit the proliferation of these cells. These phenomenon are reversed by LDN-193189, the antagonist of type II receptor for bone morphogenetic protein (BMPR2) treatment, providing strong evidence for the protect effect of sildenafil and the BMP-Cx40 axis involvement.

Conclusions: Taken together, these data suggest the sildenafil activate BMP-Cx40 signaling in the PAH. This axis may be a potential therapeutic target in PAH.

Biography:

Naga Venkata Pothineni has completed his MD from Gandhi Medical College, India. He then went on to complete Internal Medicine residency training at the University of Arkansas for Medical Science, where he is currently pursuing a cardiology fellowship. He has achieved multiple academic honors through his medical training. He has published more than 20 papers in reputed journals and has been serving as an Editorial Board Member of 3 repute journals.

Abstract:

Hepatitis C is a common infection worldwide affecting approximately 3 million people in the United States. Though multiple infections have been associated with increased cardiovascular risk, the association between Hepatitis C infection and the risk of coronary artery disease remains unclear. A few previous studies have shown HCV infection to be atherogenic whereas others have shown it to be protective. We performed a retrospective study comparing the risk of incident cardiovascular disease in patients with and without HCV infection. We found that patients who are HCV positive (as detected by a positive HCV RNA) have a significantly higher risk of incident coronary artery disease even after controlling for various other risk factors such as hypertension, diabetes and hyperlipidemia. In addition, we selected a subgroup of patients with and without Hepatitis C infection who had coronary angiograms done and compared angiographic burden of CAD using the modified Gensini score.

Biography:

Ali Dodge-Khatami graduated from medical school in Geneva, Switzerland, trained in cardiovascular surgery in Lausanne, Switzerland and obtained his PhD from the University of Amsterdam, The Netherlands. He is specialized in pediatric and congenital heart surgery to which he is dedicated since 1998, working in academic hospitals in Switzerland, the UK, The Netherlands, Germany, and currently in the USA. He is the Professor of Surgery and since 2011, he has authored more than 100 peer-reviewed articles, written 9 book chapters and goes on yearly global humanitarian surgical missions to promote sustainable pediatric heart programs in developing countries.

Abstract:

Objectives: When wanting to avoid a median sternotomy, the muscle-sparing right axillary thoracotomy has successfully been used for the transatrial repair of more simple congenital heart defects. With additional surgical experience using this approach, the spectrum of defects amenable to a quality repair has expanded.

Methods: Between 2008-2016, 48 patients (26 ASD, 10 ventricular septal defects (VSD) (including 3 with double –chambered right ventricle (DCRV), 8 Warden operations for partial anomalous pulmonary venous return (PAPVR), 3 partial atrio-ventricular canals with mitral valve cleft, and 1 cor triatriatum) underwent surgical repair through the right chest, using either induced ventricular fibrillation or aortic cross-clamping with cardioplegic arrest. The attached surgical video shows closure of a ventricular septal defect in a 10 month old infant girl.

Results: Age ranged between 4 months-18 years, and weight from 5.5-82kg. There was no mortality, no residual defects or peri-operative complications.

Conclusions: The muscle-sparing right axillary approach is a safe and reproducible technique to repair congenital heart defects typically accessible through the right atrium. In our experience, compared to other thoracic incisions, the approach is far away from breast tissue which is easily spared with minimal potential for future asymmetrical breast growth, no muscles are sacrificed with rapid functional recovery of the right arm and shoulder, and the cosmetic results highly appreciated by parents and patients alike. With gained expertise and surgeon comfort, the same high standards as through a median sternotomy are maintained without compromising repair quality.

Biography:

Megan L Ringle is presently working in the Nicklaus Children’s Hospital at Miami, Florida. Her research interests are heterotaxy syndrome, Hypertension, Pulmonary vasodilator therapy etc.

Abstract:

Objective: To describe a unique case of heterotaxy syndrome complicated with Abernethy syndrome and a late diagnosis Methods: Literature review of heterotaxy syndrome, portopulmonary hypertension, and Abernethy syndrome Heterotaxy is a complex set of birth defects in which the normal concordance of asymmetric thoracic and abdominal organs is disturbed1. Typical manifestations include abnormal arrangement of organs, congenital cardiac heart disease, and extracardiac defects involving midline structures2. We report the case of a 14-year-old female in whom exercise-induced dyspnea due to pulmonary hypertension led to a diagnosis of heterotaxy complicated by Abernethy Syndrome and portopulmonary hypertension. After extensive workup she was found to have left isomerism consisting of two anatomic left lungs and hyparterial bronchi, bilateral left atria, an interrupted inferior vena cava with azygos continuation, multiple spleens, hepatic hypertrophy with focal nodular hyperplasia, and absence of the portal vein. Pulmonary vasodilator therapy was initiated resulting in clinical improvement. This case exhibits unique features including a late diagnosis of heterotaxy with Abernethy syndrome and portopulmonary hypertension. The patient’s presentation, medical workup, and future treatment emphasize the importance of multidisciplinary care in pediatrics.

Biography:

Schusterová Ingrid is the Head of the Department of Pediatrics and Adolescent medicine, Children University Hospital P.J.Š. University in Košice, Slovakia. At the same time, she is the head physician in the tertiary center for valvular and congenital heart defects, Eastern Slovak Institute of cardiac and vascular diseases. She took specialization exam from adult and pediatric cardiology at National Institute of Cardiac and Vascular diseases in Bratislava, Slovak Republic. After graduation she took part in fellowship training at Ottawa Civic Hospital and later on performed research work in the area of cardiology at University of Ottawa in Canada. In the period from 11/1999 till 7/ 2004 she completed her training at Cardiologic department, II Internal medicine clinic, General hospital, Vienna under supervision of Prof. Dr. Gerald Maurer. Later in 2005 she broadened her professional knowledge and skills at Cardiac surgery clinic, Kardiocentrum Universitätsklinik in Bad Oyenhausen, Germany. Her research interests focus on preventive cardiology, obesity and disorders of lipid metabolism, atherosclerosis and their prevention in the pediatric age group.

Abstract:

Background: Obesity is global health problem. More studies confirmed that chronic low-grade inflammation is a characteristic for obese state. The role of adenovirus 36 (Ad-36), the most widely studied infectious agent in animals and humans is because of its association with obesity. Experimental animal studies have been clearly demonstrated the association between Ad36 and obesity, but human studies results are not yet been clarified. Aim: The aim of our study is to assess the association between Ad36 and obesity in high-school students in Kosice, region Eastern Slovakia. Methods: In prospective studies, in 224 healthy students, anthropometric parameters, waist circumference (WC), fasting plasma glucose and insulin, lipids, uric acid (UA) and hepatic enzymes were measured. Ad36 antibody was detected by ELISA test. Subsequently, we analyzed the relationship between obesity, lipid and glucose profile, including insulin resistance. Results: Prevalence of obesity in Ad36 positive study group was 20%. No statistical difference was found in prevalence of obesity between Ad36 positive and Ad36 negative study groups (p=0.92). No significant association was found between insulin resistance and Ad36 positivity. Prevalence of Ad36 positivity was significantly higher (p<0.01) in boys (36.9%) to compare the girls (18.1%), Ad36 positive boys were significantly higher. Ad36 positive adolescents with normal body weight had significantly increase body height (p<0.05) and body weight (p<0.05). Ad36 positive high- school students with normal weight had higher concentration of UA. Conclusion: In our study we did not confirm a clear association of Ad36 and obesity and lipids. But we found as a first the relationship of Ad-36 and hyper-uricemia in normal weight children. Further studies with a larger demographic amount of patients and other age categories are required to elucidate this biological mechanism of such complex relationship.

Biography:

Dr. Rima S Bader is currently working in the Dept. of Pediatrics, College of Medicine at King Abdulaziz University, Saudi Arabia. Her research interests are cardiac diseases diagnosis, myocardial diseases etc.

Abstract:

Introduction: Echogenic foci in the prenatal heart is uncommon . Objective: To determine whether prenatally diagnosed intracardiac echogenic foci are associated with neonatal cardiac dysfunction and persistence. Methods: Fetuses in which intracardiac echogenic foci were shown on prenatal sonography at 1 perinatal center from (September 2009 to December 2013) underwent postnatal echocardiography at ages 1 month to1 year.A single pediatric cardiologist assessed cardiac function by measuring the left ventricular shortening fraction and myocardial performance index. Presence of tricuspid valve regurgitation was sought. Results. Prenatally 60 fetuses had intracardiac echogenic foci, mean age ± SD at diagnosis (23 ± 3 .1). 53 (88.3 %) had left ventricular intracardiac echogenic foci(LVIEF), and 7 ( 11.6 %) had right ventricular intracardiac echogenic foci(RVIEF).12 preganant ladies were lost for follow up (2 fetuses of 7 (28,5%) with RVIEF., and 10 fetuses of 53 (18.8%) withLVIEF. Post natally, infants,32 (66.6 %) males and 16 ( 33.3%) females were examined. at a mean age ± SD of 7.4±3.1 months. Prenatally, all infants had a normal left ventricular shortening fraction.. The overall mean left ventricular myocardial performance index (reference value, 0.36 ± 0.06), was normal for both infants with LVIEF (0.32 ± 0.01) and those with RVIEF (0,33 ± 0.05).Trace tricuspid valve regurgitation were noted in 15 (31%) of the infants. LVIEF persisted in 15infants ( 34.8%), RVIEF persisted in 1 infant ( 20 %). Conclusions. Prenatally diagnosed intracardiac echogenic foci can be persistent but is not assosciated with myocardial dysfunction in the first year of life.

Biography:

Claudia Loardi obtained her MD Degree from University of Milano-Bicocca (Italy) in 2005. Her specialization in school for Master Degree Heart Surgery in 2010 from University of Milan (Italy) and PhD from University of Milan (Italy) in 2015. She is a Staff Member for Heart Surgeon Tours University Hospital (France) from 2011-present. She has 16 publications to her credit indexed in Medline.

Abstract:

The radiofrequency maze procedure achieves sinus rhythm in 45%-95% of patients treated for atrial fibrillation. This retrospective study evaluates mid-term results of the radiofrequency maze-performed concomitant to elective cardiac surgery-to determine sinus-rhythm predictive factors, and describes the evolution of patients' echocardiographic variables. From 2003 through 2011, 247 patients (mean age, 64±9.5 yr) with structural heart disease (79.3% mitral disease) and atrial fibrillation underwent a concomitant radiofrequency modified maze procedure. Patients were monitored by 24-hour Holter at 3, 6, 12 and 24 months, then annually. Eighty-four mitral-valve patients underwent regular echocardiographic follow-up. Univariate and multivariate analysis for risk factors of maze failure were identified. The in-hospital mortality rate was 1.2%. During a median follow-up of 39.4 months, the late mortality rate was 3.6%, and pacemaker insertion was necessary in 26 patients (9.4%). Sinus rhythm was present in 63% of patients at the latest follow-up. Predictive factors for atrial fibrillation recurrence were arrhythmia duration (hazard ratio [HR] =1.296, P=0.045) and atrial fibrillation at hospital discharge (HR=2.03, P=0.019). The mono-polar device favored maze success (HR=0.191, P <0.0001). Left atrial area and indexed left ventricular end-diastolic volume showed significant decrease both in sinus rhythm and atrial fibrillation patients. Early sinus rhythm conversion was associated with improved left ventricular ejection fraction. Concomitant radiofrequency maze procedure provided remarkable outcomes. Shorter preoperative atrial fibrillation duration, mono-polar device use, and prompt treatment of arrhythmia recurrences increase the midterm success rate. Early sinus rhythm restoration seems to result in better left ventricular ejection fraction recovery.

Biography:

Maureen B Teves completed her residency in Pediatrics in December 2014 from Jose R. Reyes Memorial Medical Center, where she handled the position of Resident Physicians’ Organization Representative for the Department of Pediatrics.

Abstract:

Background: Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is an inherited condition that can lead to a spectrum of symptoms if exposure to offending agents is not prevented. The newborn screening is a useful tool that detects the presence of this condition, as is the confirmatory test. Non-compliance to confirmatory testing has been attributed to lack of time, poor understanding of the procedure and lack of money. Objective: To determine the compliance to confirmatory testing of patients who tested positive for G6PD Deficiency via Newborn Screening Test at a tertiary government medical center between the years 2013 to 2014. Methods:This is a retrospective cross-sectional study conducted among patients who were born and underwent newborn screening at a tertiary government medical center on January 2013 to December 2014. We conducted a follow-up survey using structured questionnaires over the phone to assess the compliance of the parents and caregivers to confirmatory testing. Results: Out of the 3,570 infants who were delivered at the medical center, 143 (4%) were positive for G6PD deficiency on newborn screening test. We were able to track 62 patients, of which 39 (62.9%) were able to comply with confirmatory testing. The most common reasons for non-compliance to confirmatory testing were the following: “busyness/lack of time” (47.83%), uninformed (21.74%), and lack of funds (21.74%). Conclusions:Reasons for non-compliance are lack of time, lack of knowledge and financial constraints. This shows that there is a need to improve the patient education programs of medical centers, particularly on the newborn screening program.

Biography:

Hannalae Grace M Dulay-See is a graduate of University of Santo Tomas Faculty of Medicine and Surgery. She has undertaken Pediatric Residency in Makati Medical Center, Philippines.

Abstract:

Objective: To determine the effectiveness and safety of oral and intravenous paracetamol compared to oral ibuprofen in the closure of a PDA in preterm infants. Design: A retrospective cohort study was performed involving 28 cases of premature infants at a private tertiary hospital from January 1, 2010 to June 30, 2014. Each patient received either oral paracetamol at a dose of 15 mg/kg every 6 hours for 3 days or oral ibuprofen at an initial dose of 10 mg/kg followed by 5 mg/kg at 24 and 48 hours. Results: The PDA closure rates for both drugs were identical at 64.3% (9/14). The mean days of closure for the paracetamol group was shorter at 1.5 ±.46 days in contrast to the ibuprofen group which is 2.7 ±0.48 days.(P=0.00) There were no significant differences between the two groups in the incidence of adverse events. There were more preterms that had gastrointestinal bleeding in the ibuprofen group (28.6%) compared to paracetamol group (7.1%). (P=0.326). Platelet counts in the ibuprofen decreased after one week of treatment at -87±115.84, while that of paracetamol group increased by 12±92.34. (P=0.048) Conclusions: Paracetamol has its place with equal efficiency in the closure of PDA compared to ibuprofen which is the standard drug for the medical treatment of PDA. Paracetamol with its lower incidence of adverse events may replace ibuprofen as a drug of choice in the treatment of PDA in preterm infants.

Biography:

Yuni Twiyarti Pertiwi completed medical school at the age of 25 years from Padjadjaran University, Bandung, Indonesia and now in her Cardiology residency at at third years from Padjadjaran University, Indonesia.

Abstract:

Congenital complete atrioventricular block (CCAVB) is a rare and potentially lethal disease with an estimated incidence of 1 in 15.000 to 20.000 live born infants. Most of the patients with CCAVB have structurally normal hearts, referred to as an ‘isolated’ CCAVB. We present the case of a premature infant with CCAVB who underwent implantation of a permanent pacemaker. The male infant was born at 33 weeks of gestation and weighed 2150 g. Repeat fetal ultrasound assessment before demonstrated fetal cardiomegaly increased at 30 weeks gestation. The decision was made to deliver the baby by cesarean section at 33 0/7 weeks gestation. After birth, the infant showed respiratory distress despite antenatal corticosteroid therapy. There were no clinical signs of hydrops fetalis. The heart rate ranged between 40 and 50 bpm. An electrocardiogram showed that the rate of P wave was 120 bpm and the rate of QRS wave was 50 bpm. The chest x-ray demonstrated dilated heart and echocardiogram showed dilated chambers, small non significant PDA with left to right shunt, no ASD or VSD, and satisfactory contracted ventricles. Respiratory problem was resolved after supportive treatment with temporary pacing. He underwent succesfull implantation of a permanent transepicardial pacemaker (VVIR mode, stimulation rate 120 bpm, output 1,5 mV and sensitivity 2,6 mA). A unipolar epicardial lead was used and the pulse generator was implanted in a pocket made under at the anterior rectus sheath. Surgery was performed without any complications. There was no respiratory problem associated with pacemaker implantations in the abdominal wall. He was discharged at the age of 31 days with a weight of 2350 g. At the 1-year follow up he remains in well condition without any complications. We have reported a case of a CCAVB with succesfull implantation of permanent pacemaker.

Biography:

Thomas S Mir has completed his PhD from Hamburg University. He is the Vice-Director of Clinic for Pediatric Cardiology at University Heart Center Hamburg. He has published more than 50 papers in reputed journals and has been serving as an Editorial Board Member of repute.

Abstract:

Introduction: MFS is an inherited connective tissue disorder in which aortic root dilatation remains the significant indicator for morbidity and mortality. After recent publication of the pediatric multicenter study and publication of our mono-centric data concerning the effectiveness and tolerability of therapy with ARB vs. beta blocker (BB) we would like to present an actual update after six years of experience. Methods: We identified 126 children with confirmed MFS. Indication for prophylaxis was found in 64 patients and was subjected to standardized diagnostic program including echocardiography, MRI and clinical examination. We examined the effectiveness of therapy with ARB (n=44) on the growth of the sinus valsalvae (SV) with comparison of z-scores of SV before treatment and during follow up and compared these data to patients treated with BB (n=20) only. Results: Treatment by ARB and BB leads to significant reduction of SV dilation (p<0.05). The deviation of SV enlargement from normal as expressed by the rate of change in z-scores was significantly reduced by a mean difference of −0.57±0.65 z-scores (p<0.05) under ARB therapy and by a mean difference of −0.42±0.55 z-scores (p<0.05) under BB therapy. The effect of ARB and BB on aortic root dilation is similar in both groups (p>0.05). Therapy with BB was discontinued in 20% (4/20). No discontinuation in the ARB group (0/34). Conclusion: The prophylactic effect of ARB and BB in pediatric patients with MFS is similar but tolerability of ARB is clearly superior. In addition inhibition of TGF-ß signaling by ARB which is supposed to contribute to the pathogenesis of MFS has to consider.