11^th World Congress on Pediatric Cardiology and Congenital Cardiovascular Disease April 18-19, 2017 London, UK

Biography:

Djindjic Boris has completed his PhD from the University of Nis. He is an Associate Professor at the Institute of Pathophysiology, Medical Faculty, University of Nis and work as a Cardiologist at the Clinic of Cardiology, Clinical Center Nis. He has published more than 25 papers in reputed journals and has been serving as an Executive Editor of medical journal Acta Medica Mediane and Editorial Board Member of few national and international journals. He is the Leader of scientific subproject founded by Ministry of Science Republic of Serbia.

Abstract:

Objectives: Impact of fasting and postprandial blood glucose increments on atherosclerosis through changes of apolipoproteins and oxidative stress in patients with diabetes mellitus (T2DM) and coronary heart disease (CHD) was evaluated.

Methodology: Ninety T2DM patients (60 with CHD and 30 without CHD) treated with metformin and/or sulphonylureas were enrolled in cross-sectional nested case-control clinical study. The areas under the six-point daily glucose curve above the fasting glucose concentrations (AUCpp) and over 5.5 mmol/L (AUCbg) were calculated to determine postprandial (AUCpp) and fasting (AUCbg-AUCpp) glucose increments. Apolipoproteins AII and B (ApoAII and ApoB), serum lipids and malondialdehyde (MDA) were determined.

Results: AUCbg-AUCpp 58.2 (95% CI 40.6-75.8) was higher in CHD group compared to non-CHD 36.9 (95% CI 23.5-50.2) mmol*h/L. They had similar Apo AII (mean±SD) 1.630±0.69 vs. 1.55±0.55 mg/dl and Apo B 1.48±0.48 vs. 1.43±0.62 mg/dl (CHD vs. non-CHD). The MDA was significantly higher in CHD 16.47±4.5 compared to non-CHD patients 13.42±4.01 μmol/g plasma proteins. The values of PCO were similar in booth groups as well as serum lipids (HDL, LDL, total cholesterol and triglycerides). AUCpp positively correlates with MDA (r=0.45) and Apo B (r=0.49) in presence of CHD, AUCbg-AUCpp negatively correlate with Apo AII (r=-0.44) in absence of CHD. The analysis revealed that AUCpp over turning point of 0 mmol*h/L was associated with high MDA and Apo B in CHD.

Conclusion: In T2DM patients with stable CHD, AUCpp at any point significantly contributes to increasing of Apo B and MDA. Serum lipids did not show significant difference according to presence of CHD.

Biography:

Nurul Islam has completed his graduation in Medical Science from Calcutta National Medical College, India. He has done his Post-graduation in Pediatrics from Vivekananda Institute of Medical Sciences under the West Bengal University of Health Sciences in 2010. He completed his Fellowship in Pediatric Cardiology under Diplomate National Board (DNB) from Indraprastha Apollo Hospitals, Delhi and has done his training in Advanced Pediatric Cardiac Intervention from Evelina Children Hospital, Guys and St Thomas Trust in UK. Currently, he is working as a Consultant Interventional Pediatric Cardiologist at the Mission Hospital.

Abstract:

Objective: The transcatheter closure of patent ductus arteriosus (PDA), as well as other pediatric cardiac interventions has raised the concerns regarding radiation exposure, particularly relevant while treating children. The purpose of this study is to show how to perform the transcatheter closure of PDA in children while giving less ionized radiation exposure and to prove that the amount of radiation can be reduced by using pressure trace during catheter manipulation. This is a prospective analysis of feasibility, safety and advantages of doing PDA device closure using only venous access under minimal radiation.

Background: Taking an arterial access for transcatheter device closure has been a standard practice but has some inherent complications. The use of radiation or fluoroscopy is necessary but it has some ill effects on tissues, especially in children because of their greater sensitivity compared to adults and also for health care providers inside catheterization laboratory for continuous exposure.

Method: As per our departmental policy, we decided to go for PDA device closure only through venous access in the beginning of March 2016 till date. We decided to reduce the radiation time during the procedure by different techniques; most important was entry into right ventricle and sometime till pulmonary artery under pressure tracing guidance. Echocardiography was used for patient selection and assessment for sizing of device and procedural outcome.

Result: 112 out of 145 patients underwent PDA device closure from March 2016 over 10 months with only venous access and under minimal radiation technique, weighing 3.8-42 kg with half of them <10 kg. Fluoroscopic time ranged from 0.04 to 2.12 minutes. Twelve patients had difficulty in entering right ventricle from right atrium and required fluoroscopic guidance. Immediate closure was achieved in 105 patients. Two syndromic babies had mild flow acceleration across left pulmonary artery and two patients had small intra-device shunt at 3 months of follow up.

Conclusion: PDA device closure can be comfortably done without an arterial access. Patients can be exposed to significant less radiation if catheter manipulation was done under pressure tracing compared to conventional procedure of fluoroscopic guidance.

Biography:

Muneer Amanullah has done his FRCS in the field of General Surgery at Edinburgh (UK). He was a Fellow Researcher in the Department of Congenital and Pediatric Cardiac Surgery in UK London. Currently, he is an Interim Associate Dean and also an Associate Professor for Congenital and Pediatric Cardiothoracic Surgery at Aga Khan University, Pakistan.

Abstract:

Background & Purpose: Dual chamber permanent pacing in pediatric population can be challenging with consideration of issues such as body growth, patient’s size, lifestyle, presence of coexisting congenital heart disease and intracardiac shunts. There are different approaches in the literature for permanent pacemaker implantation which includes thoracotomy, sternotomy or VATS guided placement, we present another technique for dual chamber pacemaker implantation via the xiphisternal approach.

Materials & Methods: The patient is placed in supine position. A 4-6 centimeter vertical midline incision over the xiphoid process is made to gain entry into the pericardial cavity. A pericardial well is created. The right atrium is held with soft clamps and delivered into the wound. Atrial pacing leads are attached to the body of the right atrium with 5/0 polypropylene. Ventricular pacing leads are implanted on the diaphragmatic surface of the right ventricle using 5/0 polypropylene sutures. For placement of pacemaker generator a pocket is created beneath the rectus abdominis muscle via an incision in the left lumber region. The pacing leads are connected to the generator using a subcutaneous tunnel. After maintaining a satisfactory pacing threshold by an electro-physiologist the anterior rectus sheath, subcutaneous tissue and skin are closed. The pericardium is left open and the xiphoid incision is closed in three layers. Mediastinal drains were not required.

Results: We have used this technique successfully in 15 patients with various indications and had no reported morbidity. Successful atrioventricular synchrony was established along with excellent pacing and sensing thresholds. Compared with thoracotomy and sternotomy this technique is associated with minimal surgical trauma, pain and next day discharge.

Conclusion: This minimally invasive technique of implanting a dual chamber pacemaker is easily reproducible and associated with minimal morbidity.

Biography:

Mary Niu is a Doctor and has 13 years of experience working at Oklahoma City. Her expertise include Pediatrics. Currently, she is working at the OU Medical Center-Everett Tower, Oklahoma. Till now she published many of the articles in the reputed journals.

Abstract:

It is known that hyperactivity of the sympathetic nervous activity plays a critical role in the initiation and maintenance of ventricular tachyarrhythmias in diseases such as long-QT syndrome, catecholaminergic polymorphic ventricular tachycardia (CPVT) as well as electrical storms resulting from any etiology. On the contrary, vagal activity is widely considered to be anti-arrhythmic and anti-inflammatory as well. It has been proposed that therapies aimed at reducing the sympathetic tone and enhancing the vagal tone should provide clinical benefits. However, recent clinical trials of spinal cord stimulation, baroreceptor activation therapy and cervical vagal stimulation, designed to test this hypothesis, have produced conflicting results in patients with heart failure. Low-level transcutaneous vagal stimulation is another promising autonomic neuromodulation showing strong anti-arrhythmic effects on both atrial and ventricular tachyarrhythmias in preclinical studies. Clinical studies are underway to investigate its effects on patients with a propensity for ventricular tachyarrhythmias. The left stellate ganglion (LSG) is viewed as the gateway of the sympathetic innervation to the heart. Various interventions targeting the LSG have been developed, including video-assisted resection of the LSG, epidural anesthesia of the C7-T3 level, and application of local anesthetics to block the LSG. Recent clinical studies demonstrate that sympathetic denervation targeting the LSG is capable of improving the survival in patients with long QT syndrome, reducing the ventricular tachyarrhythmia in CPVT patients and alleviating the arrhythmia burden during electrical storms.

Biography:

Faisal O Alatawi he is affiliated form Taibah University, Saudi Arabia he currently working for the department of medicine and he published many of the research papers in reputed journals.

Abstract:

Background: The incidence of heart disease in pregnancy (HDP) is 0.2% to 4% in Western countries but is unknown in the Kingdom of Saudi Arabia (KSA). Most valvular diseases in pregnancy are due to rheumatic heart disease, which still is common in KSA. Improvements in neonatal and pediatric cardiac surgery in KSA have resulted in children born with complex congenital heart disease reaching reproductive age and becoming pregnant. Congenital heart disease is common in KSA due to widespread practice of consanguineous marriages. Knowledge and experience in HDP are important for health care providers to deliver proper counseling and treatment. We report a proposal to establish the Registry of Saudi Heart Diseases and Pregnancy (ROSHDAP) a national registry program for HDP.

Methods: All pregnant women in KSA who have heart disease will be eligible to enroll in the program. Patients who do not consent to participate will be excluded. Prospective information about demographic, clinical, and social characteristics; laboratory tests, electrocardiography, and echocardiography; gestation; delivery; and maternal, fetal, and neonatal outcomes will be collected confidentially and electronically and transmitted from participating centers to a central coordinating office for data management and analysis.

Results: A 5-phase program plan was developed, including initiation, development, prelude, nationwide, and conclusion phases. A proposal has been submitted for registry funding.

Conclusion: The ROSHDAP will provide information for epidemiology, resource planning for intervention, and clinical research, and will improve health care for patients who have HDP and their children.

Biography:

Cristina Cruz she is affiliated form Saint John Hospital, Portugal, her research interest mainly focus her research interest mainly focus on tetralogy of fallot repair, and she belongs to department pediatric Cardiology. Till now she published many of the articles in reputed journals.

Abstract:

Background: An intrinsic aortopathy can lead to aortic (Ao) dilatation late after tetralogy of fallot (ToF) repair. Its extension and prevalence is not clearly defined.

Objectives: We aimed to compare the proximal aorta dimensions and elasticity assessed by transthoracic echocardiography in ToF and normal controls, and to find possible predictors of Ao dilatation.

Methods: We included 127 consecutive adults after ToF repair and 63 sex- and age-matched healthy controls. We estimated the Ao z-score at the level of the sinuses of Valsalva (SoV) and ascending aorta (AAo) and defined Ao dilation for a z-score >2. We assessed Ao strain, distensibility and stiffness index by transthoracic echocardiography using accepted formula.

Results: One hundred-twenty seven patients (pts) (mean age 30±9 years; 52% males) had a mean follow-up time since ToF repair of 23±7 years. In 59 cases, an aortopulmonary shunt was done prior to repair, with a median interval of 3 years. In 57 patients complete repair used a transannular patch. A right Ao arch coexisted in 29 cases. The prevalence of SoV and AAo dilatation were 29.9% and 23.8%, respectively. No differences were found between ToF pts and controls regarding systolic blood pressure and pulse pressure. ToF pts had a bigger Ao z-score (1.4±1.2 vs. -0.6±1.2, P<0.01 and 1.2±1.1 vs. -0.7±0.7, P<0.01, at the level of SoV and AAo, respectively), lower Ao strain [6.9 (2.6-61.5) vs. 15.4 (3.7-45.0), P<0.01] and distensibility [1.4 (0.4-1.4) vs. 3.7 (0.1-1.4) KPa^-110^-3, P<0.01], and a higher Ao stiffness index [7.4 (0.8-23.6) vs. 3.1 (0.9-14.1); P<0.01]. There was a significant positive correlation between the Ao z-score and left ventricular (LV) mass and volumes indexed to body surface area (AAo z-score and LV mass index in Pearson’s correlation (r)=0.26, P<0.01), Ao stiffness index and SAo (r=-0.21; P=0.007). By multivariate analysis, the sinotubular junction effacement was an independent predictor of AAo dilatation [odds ratio 4.1, 95% confidence interval (CI) 1.4-12.3, P=0.01].

Conclusion: It can be concluded that tetralogy of fallot patients have a bigger and stiffer ascending aorta, and transthoracic echocardiography can be used as a screening tool for this aortopathy.

Biography:

Sadaf Chaudhry has obtained her MBBS from Leiden University in Netherlands. After her experience as a SHO Neonatology at John Radcliffe Hospital in Oxford, she started her Pediatric training at Health Education East of England. During her training, she has participated in small research projects and presented at international conferences. Currently, she is a Senior SpR at the Neonatal Unit at Addenbrooke’s Hospital in Cambridge. She is in her final year of Pediatric training and focusing on Pediatric Cardiology.

Abstract:

Sepsis in infants is a well-recognized entity with clear-cut treatment. However, what if the presenting infant does not respond to antibiotics and fluid treatment? What if the symptoms persist? When does one start thinking about alternative diagnoses? A pediatric team at a small DGH faced this problem. With this case report we would like to share our thought process and the challenges our team faced considering the atypical presentation of Kawasaki disease. Kawasaki disease is an acute febrile systemic vasculitis. Being the most common cause of acquired heart disease in the UK, early diagnosis and treatment is essential. Kawasaki disease remains a clinical diagnosis based on clinical criteria. Some patients do not fully meet these criteria, forming an incomplete form of the disease. This subtype still poses a significant risk of cardiac consequences; hence forming a challenging group of patients. In our case, a five month old boy initially seemed to present with septic shock. Despite appropriate antibiotic treatment his temperature did not settle. In addition the inflammatory markers only increased. He remained extremely irritable and had an extensive maculopapular rash. On day five of his illness, he was suspected to have incomplete Kawasaki disease. ECHO confirmed the presence of cardiac sequelae. This clinically septic child responded remarkably well to intravenous immunoglobulins and high dose aspirin.

Biography:

O Graupner has completed his MD from the Philipps University Marburg. He is an Assistant Doctor in the Department of Obstetrics and Gynecology at the Right the Isar Hospital, Technical University Munich. He has done his Doctoral degree under the supervision of Professor Axt-Fliedner.

Abstract:

Introduction & Purpose: Myocardial function (MF) of the systemic right ventricle (RV) determines the postnatal course of neonates with hypoplastic left heart syndrome (HLHS). Our study examines, whether the presence of endocardial fibroelastosis of the left ventricle (LV EFE) influences MF of the RV in HLHS fetuses.

Materials & Methods: A prospective study was conducted including 10 controls (group 1), 10 HLHS fetuses with (group 2) and 10 without LV EFE (group 3)-all matched for gestational age. M-mode was used to assess tricuspid plane systolic excursion (TAPSE) and the shortening fraction (SF). PW-Doppler and PW-TDI derived velocities were assessed. E/A, E/e', e'/a' ratios and the myocardial performance index (MPI) were calculated.

Results: The examination of MF revealed significantly lowers’ the velocities (p<0.05) and higher values for SF in group 2 compared to group 3. ET (ejection time), E wave velocity, E/e’ and SF showed significantly higher values in group 2 compared to group 1. In group 2 a’ velocity increased significantly over gestational age. TAPSE increased during gestation in group 3 but not in group 2.

Conclusion: These significant differences in MF between the groups might lend support to the notion of negative ventricular-ventricular interaction in case of HLHS with LV EFE possibly influencing surgical outcomes.

Biography:

Rama Kumari has completed her DM in Cardiology from Andhra Medical College and currently working as a Faculty at Nizam's Institute of Medical Sciences, Hyderabad. She has published more than 25 papers in reputed journals and has been serving as an Editorial Board Member of repute.       
 

Abstract:

Objective: To determine the prevalence of rheumatic heart disease (RHD) and congenital heart disease (CHD) using clinical and echocardiographic criteria in rural and urban school children of Andhra Pradesh, South India.

Materials & Methods: A total of 4213 school children between 5 and 16 years of age were screened. 1177 were from rural schools and 3036 from urban schools. Prevalence of RHD and CHD was estimated.

Results: Clinically, RHD was present in 3 (prevalence 0.7/1000). Using echocardiography RHD was detected in 32 (7.6/1000), 11 (7.3/1000) from rural and 21 (7/1000) from urban schools. (P=0.000, OR=0.093 and CI=0.023-0.317). Total prevalence of RHD is 8.3/1000. Clinically CHD was present in 39 (9.2/1000) children, rural 9 (7.6/1000) and urban 30 (9.9/1000). Using echocardiogram CHD was detected in 44 (10.4/1000) children, rural 11 (9.3/1000) and urban 33 (10.8/1000).

Conclusion: RHD was detected several fold using echocardiographic screening than by clinical examination alone. Longitudinal follow-up of children with echocardiographically diagnosed subclinical RHD is needed.

Biography:

Muneer Amanullah has done his FRCS in the field of General Surgery at Edinburgh (UK). He was a Fellow Researcher in the Department of Congenital and Pediatric Cardiac Surgery in UK London. Currently, he is an Interim Associate Dean and also an Associate Professor for Congenital and Pediatric Cardiothoracic Surgery at Aga Khan University, Pakistan.

Abstract:

Background & Aim: Abnormalities of right ventricular outflow tract continuity are one of the most commonly encountered entities in congenital cardiac surgery. Various strategies utilize homografts, synthetic valve conduits, Contegra, or patch enlargement with valve replacement ($2500) to restore anatomical and functional continuity between right ventricle and pulmonary artery. In countries like Pakistan, these conduits may not be easily available or affordable. We report the experience of our short observational study of using a handmade tri-leaflet valve conduit to establish right ventricular outflow tract and pulmonary artery continuity ($700).

Materials & Methods: From September 2015 to December 2016, a total of 15 patients with different diagnoses of congenital heart disease in the pediatric age group underwent corrective surgery along with restoration of RV to PA continuity, by using a handmade valved conduit. The size of the conduit is determined by using an available nomogram. A 10x10 cm bovine pericardial sheet is used to construct the conduit and a 0.5 mm thin polytetrafluoroethylene (PTFE) sheet is used to construct the valve.

Results: Patients ranged from 1 year to 16 years. Seven patients had previous palliation. One patient underwent 3^rd time redo procedure for RV to PA homograft stenosis. Late postoperative complications were observed in 2 patients. One patient developed aneurysm at RVOT-conduit junction requiring surgical repair and the other underwent conduit dilatation for moderate stenosis (gradient 60 mmg). No significant regurgitation was observed and the gradients were a mean of 25 mmHg.

Conclusions: This short report highlights that the handmade valve conduits are a cost effective alternative where well-established conduits have cost implications and questionable availability.

Biography:

S U Kadirova works in the Department of Pediatric Cardiology at the University National Research Center for Cardiac Surgery, Kazakhstan. She has many published papers in reputed journals. She is a Leading Expert in Structural Heart Interventions at NCRC and her research interests mainly deals with Minimally Invasive Procedures.

Abstract:

Background & Purpose: In infants and young children with congenital heart disease, post-operative branch pulmonary artery stenosis is a major cause of morbidity and mortality. While angioplasty is a standard treatment option, high rates of restenosis is reported. We report our experience of using stents to treat branch pulmonary artery stenosis in small children (<14 kg).

Materials & Methods: From November 2014 to December 2016, percutaneous stent implantation was performed in 15 small children (10 males and 5 females) with mean weight of 9.6±3.3 kg (2.2 kg-13.9 kg), mean age 2.2±1.5 years (1.5 month-5 years). Stents used included the Valeo Vascular stent, Palmaz Genesis XD, and genesis stent pre-mounted on OPTA PRO via 6 Fr-8 Fr Cook sheath. One patient had a left pulmonary artery occlusion; other 14 patients had pulmonary artery ostial and proximal stenosis after cardiac surgery.

Results: Interventional correction was successful for all 15 patients. Valeo Vascular stents were implanted in 10 patients, Palmaz Genesis XD stents in 4, and Genesis stent pre-mounted on OPTA PRO in 1. One patient required a second stent due to residual ostial stenosis. The minimum diameter post stent increased from 2.6±1.3 mm to 7.5±1.4 mm. Mean right ventricular to pulmonary artery gradient decreased from 62±10.4 mm Hg to 19±4.3 mm Hg. Five infants who required mechanical ventilation prior to stenting was successfully weaned off in 1-3 days.

Conclusion: Stent treatment of post-operative branch pulmonary artery stenosis in children under 14 kg is safe and effective, and may shorten mechanical ventilation support post operatively.

Biography:

Ogunkunle Oo is a Graduate of the University of Ibadan and a Fellow of the National Postgraduate Medical College of Nigeria, as well as of the West African College of Physicians. She is an Associate Professor in the Department of Pediatrics, College of Medicine, University of Ibadan, Nigeria, and a Consultant Pediatrician and Pediatric Cardiologist at the University College Hospital, Ibadan, Nigeria. She has published over 50 articles in reputable journals.

Abstract:

The first case of open-heart surgery in the University College Hospital, Ibadan took place on December 19, 1978. Since then, various attempts have been made to provide definitive solutions for patients with structural cardiac diseases, but up till now, no permanent regular service exists. We present our initial experience with interventional cardiology and open-heart surgery in a resource-challenged setting. The challenges encountered are discussed and the solutions we have proffered with each situation are presented as we forge ahead towards achieving a more regular service for interventional cardiology and open-heart surgery in our center. In January 2016, eight children underwent diagnostic cardiac catheterization with a view to perform possible corrective intervention. Two subsequently had device closure of patent ductus arteriosus, the first in the history of the hospital. Four patients (one with a large atrial septal defect, one severe pulmonary stenosis, and two with Fallot’s tetralogy) were deemed to be more suitable for open-heart surgery. One with muscular ventricular septal defect was thought to be too small to need intervention. The last patient, initially thought to have a coarctation of the aorta, was found to have normal cardiac anatomy. The patient with large ASD and VSD, and one of the two with Fallot’s tetralogy, subsequently underwent successful total repair of their lesions in our facility. The successful outcome in the four patients has encouraged us to be optimistic that despite various resource challenges, it will soon be possible to establish a regular service for interventional cardiology and open-heart surgery in our center.

Biography:

Christian Enzensberger works as a Consultant Obstetrician in the Division of Prenatal Medicine at University Hospital Giessen, Germany. His research interests include the assessment of cardiac function by speckle tracking and tissue doppler in fetal echocardiography.

Abstract:

Introduction & Purpose: Frame rates (FR) used for strain analysis assessed by speckle tracking in fetal echocardiography show a huge variation. Due to higher heart rates compared to adults, much higher FR is requested in fetuses. The aim of this study was to investigate the influence of the FR on strain analysis in two-dimensional (2D) speckle tracking.

Material & Methods: A prospective cross-sectional study was performed. Based on an apical or basal four-chamber view of the fetal heart, cine loops were acquired on a Toshiba Aplio 500 system. Each loop was digitally stored twice: firstly as a DICOM (digital imaging and communications in medicine) file with a FR of 30 frames per second (fps), secondly with the original FR (acoustic FR=AFR). For each loop, fetal global longitudinal peak strain values of both, left (LV) and right ventricle (RV), were assessed by 2D wall motion tracking. Strain analysis was performed offline by two investigators. Interobserver variability was analyzed.

Results: A total of n=11 healthy fetuses with an echocardiogram performed between 19 and 34 weeks of gestation were included. The AFR was 126±16 fps. Relating to global longitudinal peak strain values of both ventricles, there was no significant difference between DICOM FR and AFR (LV: -18.22% (DICOM FR) vs. -17.77% (AFR), RV: -16.30% (DICOM FR) vs. -15.28% (AFR); p>0.05). The interobserver variability showed a strong agreement with an intraclass correlation coefficient (ICC) of >0.8.

Conclusions: The influence of the FR on global longitudinal peak strain values in 2D speckle tracking seems to be less important than expected. For strain analysis in fetal echocardiography FR of >100 fps seem to be non-essential.

Biography:

Sara Ranchordás has completed her Medical degree in Porto University Medical Faculty in 2012 and is a Cardiac Surgery Resident in Santa Cruz Hospital, Lisbon, since 2014. She has been working with a team of congenital heart disease surgeons, having participated in diverse pediatric surgeries. She has presented poster and oral presentations in national conferences and published case reports in the area of Cardiology and Cardiac Surgery.

Abstract:

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiovascular defect that can range from being fatal early in life to presenting in adulthood asymptomatically. We present the case of a teenager whose diagnosis was incidental during examination for sports practice. The echocardiogram raised the suspicion of an anomalous flow in the coronary arteries and showed mitral valve prolapse with mild regurgitation. Magnetic resonance imaging revealed a very ectasia right coronary artery and low signal intensity in the usual location of the left anterior descending artery. The diagnostic hallmark of ALCAPA syndrome is the visualization of the left coronary artery originating from the main pulmonary artery, which was only possible in this case with coronary angiography, that showed an aneurismatic right coronary artery with retrograde filling from the left coronary artery, ending in the pulmonary artery and multiple vascular connections between the right and left coronary system. Surgical techniques can be broadly divided into one-coronary and two-coronary-system repairs. Surgery allows correction of chronic subendocardial ischemia, improvement of ventricular function, and minimizes the risk for malignant dysrhythmias and sudden death. Two-coronary-system repairs are preferred and include coronary button transfer, the Takeuchi procedure, or placement of a coronary artery bypass graft with ligation of the origin of the left coronary artery. This patient was submitted to coronary artery button transfer with excellent result.

Biography:

Eva Marwali has done her specialization in Pediatric Cardiac Intensive Care from the National Cardiovascular Center, Indonesia. She is a member of the Society of Critical Care Medicine. She is a member of Extracorporeal Life Support Organization.

Abstract:

Objectives: To evaluate the efficacy and safety of oral triiodothyronine for infants and children undergoing cardiopulmonary bypass in an Indonesian population.

Methods: We performed a single center, randomized, double-blind, and placebo-controlled trial in children age≤3 years undergoing congenital heart disease surgery with cardiopulmonary bypass. We administered oral triiodothyronine (T3, Tetronine^®) 1 μg/kg-body weight/dose or placebo (saccharum lactis) via nasogastric tube every 6 hours for 60 hours since induction of anesthesia. The primary endpoint, time to extubation, was compared with Cox regression.

Results: The modified intention to treat group included 101 placebo and 104 treated subjects. The stratified log-rank test did not show a significant treatment difference (p=0.061) for time to extubation, but after adjustment for age, nutritional Z-score, and Aristotle surgical complexity, the hazard ratio (HR) was 1.33 (95% confidence interval (CI)=1.00, 1.76, p=0.049). The effect of T3 was stronger in the strata ≤5 months of age (HR: 1.86, 95% CI: 1.02, 3.39, p=0.043). Median intubation time for the placebo and T3 group in ≤5 months were 47.3 hours and 32.1 hours, respectively. Adverse events rates including arrhythmia were similar between groups, though sepsis was more frequent with placebo.

Conclusions: Oral T3 supplementation may shorten time to extubation in children undergoing congenital heart disease surgery, particularly infants ≤5 months. Administration is relatively safe, simple and inexpensive.

Biography:

Cheng Wang works in the Department of Pediatric Cardiovasology, Children's Medical Center, Second Xiangya Hospital, Central South University, China. He is a Professor, Chief Physician, Doctoral Tutor, and the Deputy Director for Children's Medical Center and Pediatric Teaching and Research Section at the Second Xiangya Hospital, Central South University and Institute of Pediatrics, Central South University.

Abstract:

Objectives: The objective is to discuss ventricular late potentials (VLPs) in children with vasodepressor response of vasovagal syncope (VVS-V).

Methods: 184 children diagnosed as VVS-V by head-up tilt test (HUTT) were enrolled as VVS-V group, 105 age and gender matched healthy individuals without syncope were used as control group, then signal-averaged electrocardiogram were measured.

Results: Heart rate was decreased [(83.98±12.27) vs. (87.28±13.75) bpm, P<0.05] in VVS-V group compared with control group. The prevalence of positive VLPs was not significantly different between the two groups. However, the absolute value of TQRS [(84.89±12.05) vs. (81.21±8.23) ms, P<0.01], RMS₄₀ [(28.73±7.23) vs. (26.89±7.36) μV, P<0.05] and LAS₄₀ [(62.43±19.17) vs. (56.79±1.83) ms, P<0.05] were significantly prolonged in VVS-V group compared with control group, and more patients in VVS-V group had abnormal prolonged LAS40 (94.57% vs. 83.80%, P<0.01).

Conclusions: The prevalence of positive VLPs was not significantly different, TQRS, RMS₄₀, LAS₄₀ were longer in children with VVS-V in comparison with healthy individuals, and the abnormal LAS₄₀ occurred in a higher proportion of VVS-V group.

Biography:

Veronique Diane has completed her Doctor of Medicine degree from the Faculty of Medicine and Pharmaceutical Sciences, University of Douala. She is currently working as a General Medical Practitioner at the Limber Regional Hospital in Limbe, Cameroon. She intends to be a Cardiac Specialist in the future and has been researching on Cardiac Medicines both at the University of Douala and at the Cardiac Centre of St. Elizabeth Catholic General Hospital Shisong, Cameroon.

Abstract:

Objectives: To evaluate the child development and evaluate a possible association with the commitment by bio-psychosocial factors of children with congenital heart disease and those without the infection.

Methods: This research is an observational case-control study comparing the development of children with and without heart disease, categorized in three groups. Group 1(G1): children 0-10years of age both male and female genders with congenital heart disease awaiting surgery; Group 2 (G2): children of age 0-10years of both genders who have undergone at least one surgical procedure for congenital heart disease correction between 6 months and 1 year before the application of the instruments of this study; Group 3 (G3): Children 0-10 years, healthy and both genders. As instruments, we used a bio- psychosocial data questionnaire that includes social, demographic, psychological and clinical factors, and a development screen test divided into four fields of functions i.e. personal-social, fine-motor-adaptive, language and gross motor.

Results: Ninety six children were evaluated, 19 (22.66%) belonging to the G1 (preoperative children with heart disease), 32 (33.59%) in Group 2 (postoperative children with heart disease) and 45 (43.75%) in G3 (healthy children). Of the total, 55.56% are girls and age ranged from 2 months to 10 years. The children with heart disease had more suspicious and abnormal ratings and in the group of healthy children 53.6% were considered with normal development (P≤0.0001). The biopsychosocial variables that were related to a possible developmental delay were gender (P=0.042), child's age (P=0.001) and income per capita (P=0.019).

Conclusion: The results suggest that children with congenital heart disease are likely to have a developmental delay with significant difference between children who have undergone surgery and those awaiting surgery under clinical follow-up.