Day 1 :
Keynote Forum
Michael Sammaan
Royal Manchester Children Hospital, UK
Keynote: Accurate assessment of the ventricular function in Neonates
Time : 10:00-10:45
Biography:
Dr Michael has completed his residency training at the age of 25 years from Ain Shames University in Egypt, and postgraduate studies from Royal Collage of Paediatric and Child Health. He is currently one of speciality trainee in paediatrics in the United Kingdom. He has a passion toward paediatric cardiology and haemodynamic assessment.
Abstract:
Ventricular function may be the depressed in neonatal disease processes such as hypoxia, sepsis, haemolytic disease of new-born, surfactant deficiency lung disease, PPHN and transient tachypnoea of new-born. In contrast to adult patients, little is known about the best way to assess ventricular function. Invasive monitoring of central venous pressure, capillary wedge pressure and cardiac output are seldom done in the neonate especially the preterm.
Usually heart rate and blood pressure are the only measured indices of cardiac function and they may be misleading. A dysfunctional heart maybe tachycardic, bradycardic, or have a normal rate. In hypotensive neonatal cardiac function may be depressed, normal, or even hyperdynamic.
Therapeutic interventions may modify cardiac function or cardiac output intentionally or incidentally, so an index of ventricular performance is needed to make sure that such interventions are appropriate this is now possible by echocardiography serial measurements allow rapid assessment of the effectiveness of therapeutic interventions.
In this presentation, or poster, I will discuss how to assess:
Systolic function of both Left ventricle and right ventricle including new principles in assessing right ventricular function.
Diastolic functions; especially that in recent years have seen an enormous increase in interest in other cardiology and the role of the diastole in ventricular performance particularly in ischemic heart disease, ventricular hypertrophy cardiomyopathy, and pericardial disease. Now that diabetic cardiomyopathy and dexamethasone induce cardiac hypertrophy are recognised in neonates, the assessment of the diastolic function should be an important subject of research.
Keynote Forum
Hissa Mohammed
Hamad Medical Corporation, Qatar
Keynote: Radiological proedures for pediatric patients with Down Syndrome
Time : 10:45-11:20
Biography:
Hissa has completed her Master degree in medical imaging at the age of 33 years from Aberdeen University. She is the Radiology supervisor in Communicable disease Centre, member of HMC. She has published 1 paper in online OMICS Journal of Radiology and member of Quality team in CDC.
Abstract:
Introduction
Down syndrome is a condition of the chromosomes that is caused when an error occurs during cell division creating an extra chromosome 21 (Gardiner et al., 2010). People with Down syndrome especially pediatric patients may develop several health conditions that may require to be diagnosed through imaging (Bull, 2011).
Purpose
This research was used to identify environmentally friendly methods for pediatric patients with Down syndrome. These methods are aimed at reducing the radiation dose for a patient during a radiological procedure. Additionally, the methods should be able to provide the best quality images to improve diagnosis and hasten recovery.
Method
We used the PRISMA guidelines to perform a systematic review of the current literature obtained from various databases. We searched for several articles and found a total of 51 articles related to environmentally friendly radiological procedures. Out of the 51 articles, 17 were analyzed in detail.
Result
Caring for pediatric patients with Down syndrome requires environmentally friendly methods to improve the quality of care. Patients may not respond well to high dosages of radiation because they sometimes cause irritations. Both patients and clinicians need improved image quality of the radiological procedures to make the diagnosis of the condition easier and hasten the process of recovery.
Conclusion
Methods that create a friendly environment for pediatric patients with Down Syndrome during radiological procedures such as CT scans and X-rays are important in the diagnosis of disease. High radiation dosages may not suit patients sometimes thus affecting the quality of care. Improving image quality is also important in the diagnosis and management of the condition.
- Pediatrics | Clinical Pediatrics | General Pediatrics | Pediatric Cardiology | Pediatric Cardiac Tumors | Pediatric Congenital Heart Disease
Location: Paris, France
Session Introduction
Suryakanthi
Rainbow Children’s hospital and Birth right, India
Title: Infants with acute pulmonary hypertensive crisis: a case series
Biography:
Dr Suryakanthi completed her postgraduate training in Pediatrics under Diplomate National Board, New Delhi, and is currently doing fellowship in Pediatric Critical Care in Rainbow Children’s Hospital and Birth right, Telangana, India.
Abstract:
Introduction
Pulmonary hypertension (PH) refers to an abnormal elevation of blood pressure in the pulmonary vascular circulation, and has multiple etiologies. The condition is potentially life threatening and can have varied presentations. We present our experience with 3 infants who were admitted in our tertiary level PICU over a span of 3 months.
Case description
Three infants presented to us in early infancy with severe PH. All 3 were exclusively breast-fed young infants with normal birth and family histories, and came in respiratory and circulatory failure with severe metabolic acidosis. An observation made retrospectively after the management of the first case led to the prompt diagnosis of the succeeding 2 cases. In view of severe metabolic acidosis in the first infant, as part of workup and management of inborn errors of metabolism, Thiamine was added to the treatment along with mitochondrial cocktail therapy. Reversal of metabolic acidosis and pulmonary hypertension happened over the next 48 hours. All other etiological workup came normal. And retrospectively the possibility of Thiamine deficiency as the cause of PH was thought of. In the other 2 patients, thiamine levels were sent before adding vitamin supplementation, and early intervention reduced the morbidity and hospital stay.
Discussion and Implications
Before labelling any PH as idiopathic, it is important and life-saving to rule out Thiamine deficiency as a possible etiology. Thiamine is an integral component of cellular metabolism. And it has been found that it can cause severe pulmonary hypertension in exclusively breast-fed infants. It can be easily reversible with the simple intervention of adding Thiamine supplementation. Awareness of this condition is important for early recognition and prevention of mortality.
Irfan Oguz Sahin
Ondokuz Mayıs University Faculty of Medicine, Turkey
Title: A rare reason of sudden cardiac arrest in children: Cardiac rhabdomyoma
Biography:
Irfan Oguz Sahin has completed his MD at the age of 24 years from Atatürk University. He had completed pediatrics education and pediatric cardiology education. He is the director of “Division of Pediatric Cardiology, Ondokuz Mayıs University”. He has published more than 15 papers in reputed journals.
Abstract:
Sudden cardiac arrest (SCA) is a rare but devastating condition. The most common cause of out-hospital SCA is ventricular tachycardia (VT). Major causes of VT in children are congenital heart diseases, cardiomyopathies, myocarditis, channelopathies, electrolyte imbalances. We present a case of benign cardiac tumor of which the first symptom was SCA.
Sixteen year-old previously healthy male had a SCA after he worked at farm. He was resuscitated for 10 minutes and admitted to pediatric intensive care. After initial stabilization, patient was evaluated for possible cardiac diseases. Electrocardiography and echocardiography was found normal. 24 hour Holter monitoring showed lots of ventricular ectopic beats and two nonsustained left-sided VTs (Figure 1). Magnetic resonance (MR) imaging showed a mass on left ventricle apex (Figure 2). Mass (2.5x1.5x1 cm) was resected surgically from the left ventricle (Figure 3). Holter tests after surgery were completely normal and resection of mass was seemed to be effective for elimination of VT. Histopathologic diagnosis was rhabdomyoma.
Primary cardiac tumors are rare with an incidence of 0.2%. They are mostly asymptomatic but may result to cyanosis, respiratory distress, heart failure. Although the mechanism has not been well characterized, cardiac tumors can lead to distinct electrocardiographic changes, VT and SCA. Data regarding arrhytmias associated with cardiac tumors are limited with small series. Management strategies include antiarrhytmics, cardioverter defibrillator and surgery but which is optimal remains unclear. We conclude that clinicians should keep benign cardiac tumor in mind as a cause of SCA and VT in children.
Biography:
Ahmad Pandu Pratama is a Cardiology trainee in National Cardiovascular Center Harapan Kita, teaching hospital of Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia.
Abstract:
Introduction. Anomalous left coronary artery arising from pulmonary artery (ALCAPA) is a very rare congenital anomaly. The incidence is about 1:300.000 live births and accounts for 0.25%–0.5% of all congenital heart defects. ALCAPA is one of the most common causes of myocardial ischemia and infarction in children. If left untreated, up to 90% of patients with ALCAPA syndrome will die within the first year of life. In patients who live to adulthood, ALCAPA syndrome may cause myocardial infarction, left ventricular dysfunction and mitral regurgitation, or silent myocardial ischemia, which can lead to sudden cardiac death. Early diagnosis and prompt surgical intervention with an aim to restore two-coronary-arteries circulatory system have shown an excellent results and lead to gradual myocardial recovery.
Case Report. Here we have 3 babies with ALCAPA came with signs and symptoms of heart failure. First and third case patients developed symptoms during 2-3 month of age, while second case patient at the 6 month of age. Diagnosis of ALCAPA confirmed by echocardiography in the first case patients. The second case beside echocardiography examination, also underwent multi-slice computed tomography (MSCT) scan examination. The third case patient have to underwent coronary angiography because coronary sinus was not well visualized by echocardiography. First and third case patient underwent ALCAPA repair with LCA implantation into Aortic root technic, showing favorable result, while second case patient scheduled to receive ALCAPA repair.
Conclusion. Diagnosing ALCAPA is challenging, but features like episodes of irritability during feeding that associated with sweating or pallor should alert us to suspect ALCAPA. Echocardiography is the most important non-invasive diagnostic tool and has replaced coronary angiography as the standard method of diagnosis. However, if it fails to visualized coronary sinus, other modalities such as MSCT Scan and magnetic resonance imaging (MRI) could be useful in order to make an early and accurate diagnosis. ALCAPA repair with left coronary artery (LCA) implantation was chosen due to favorable results found following re-establishment of the dual coronary system.