Amplatzer septal occluder and atrioventricular block: A case report and literature review

AbstractTranscatheter closure of secondum atrial septal defect (ASD) is an alternative option to open heart surgery with good short and long-term outcomes. For this purpose, the Amplatzer septal occluder (ASO) device is widely used. Arrhythmias are known complications of ASD device closure including atrial ectopy and heart block.We report a seven-year-old female patient who developed second degree atrioventricular block (AVB) within few hours after ASD device closure using ASO device. At the seventh post-procedure day; while under close observation; patient regained sinus rhythm which was maintained thereafter. A 3-day course of prednisolone was given

Waiting time for transfer of patients with prostaglandin dependant congenital heart defects to tertiary cardiac centers

AbstractWorldwide congenital heart defects (CHD) are the leading cause of infant deaths owing to congenital anomalies. Delay in diagnosing and operating in neonates with prostaglandin dependant CHD may lead to significant morbidity and mortality.Objectives: To assess the time interval needed for acceptance and transfer of patients with critical CHD to a tertiary cardiac center and the impact on the patient’s survival.Study design: Retrospective database reviews of all cases diagnosed to have prostaglandin dependant (PG) CHD at Prince Sultan Cardiac Center-Qassim during a 43months period (from May 2007 to December 2010).Results: During the study period 104 patients were diagnosed to have PG dependant CHD. Patients with PG dependant systemic circulation constitute 60% of patients. Patients with ventricular septal defect (VSD) associated with coarctation of the aorta constituted 16% of patients. The mean waiting time for transfer to a tertiary cardiac center was 10±10days. Twenty-two (21%) patients died while waiting for acceptance and transfer. Eleven patients were diagnosed with hypoplastic left heart syndrome (HLHS). There was no significant difference in the waiting time for those with or without HLHS, with a mean of 9days for both. Six of our patients had infections with positive blood cultures. The mean waiting period for those with proved infection was 25days compared with 8days for those with no proved infection (p value<0.005).Conclusion: There are a significant number of patients with severe CHD who die while waiting for acceptance and transfer to a tertiary cardiac center. The causes for delay could be the presence of infection, prematurity and low birth weight. The limited numbers of tertiary cardiac centers in Saudi Arabia as well as cardiac ICU beds are among the factors delaying the acceptance of patients requiring cardiac surgery

Safety and usefulness of outreach clinic conducted by pediatric echosonographers

Background: Outreach echocardiographic services led by cardiac sonographers may help district level hospitals in the management of patients suspected to have cardiac anomalies. However, the safety and utility of such an approach is not tested. Methods: We retrospectively reviewed our experience of patients seen in the outreach visits by the echocardiographers alone and subsequently reviewed in the pediatric cardiology clinic. Comparison between the diagnosis made by the echocardiographer and the consultant pediatric cardiologist were done. We defined safety as no change in patient management plan between the outreach evaluation and the pediatric cardiology clinic evaluation, and we defined usefulness as being beneficial, serviceable and of practical use. Results: Two senior echocardiographic technicians did 41 clinic visits and over a period of 17 months, 623 patients were seen. Patients less than 3 months of age constitute 63% of the total patients seen. Normal echocardiographic examinations were found in 342 (55%) of patients. These patients were not seen in our cardiology clinic. Abnormal echocardiographic examinations were found in 281 (45%) of patients. Among the 281 patients with abnormal echos in the outreach visits, 251 patients (89.3%) were seen in the pediatric cardiology clinic. Comparing the results of the outreach clinic evaluation to that of the pediatric cardiology clinic, 73 patients (29%) diagnosed to have a minor CHD turned to have normal echocardiographic examinations. In all patients seen in both the outreach clinics and the pediatric tertiary cardiac clinics there was no change in patient′s management plan. Conclusions: Outreach clinic conducted by pediatric echo sonographers could be useful and safe. It may help in reducing unnecessary visits to pediatric cardiology clinics, provide parental reassurance, and help in narrowing the differential diagnosis in critically ill patient unable to be transferred to tertiary cardiac centers provided it is done by experienced echosonographers

Electrocardiogram screening for school children: a cross-sectional, population-based study

BACKGROUND: Identification of life-threatening arrhythmogenic disorders, which may present during infancy, childhood, or later stages, enables the early initiation of effective preventive therapies. Electrocardiogram (ECG) screening may detect conditions that elevate risk of sudden cardiac death (SCD) at an early stage. OBJECTIVES: This study aims to assess the prevalence, clinical significance, and characteristics of ECG abnormalities in a large population of schoolchildren. It also aims to determine whether ECGs performed during childhood can aid in the early detection of conditions associated with the risk of SCD. DESIGN: Population-based cross-sectional study SETTING: A multicenter study conducted at King Faisal Specialist Hospital & Research Centre (KFSHRC) in Riyadh and Prince Sultan Cardiac Center-Qassim (PSCC-Q), Qassim, Saudi Arabia. METHODS: The study analyzed 12-lead ECGs performed on elementary school students 6-15 years old in Buraidah, Qassim region, Saudi Arabia. ECGs were recorded and interpreted following international standards. Children with abnormal ECG results were referred for full pediatric cardiology evaluation. MAIN OUTCOME MEASURES: Prevalence of normal and abnormal ECG findings, including long QT intervals SAMPLE SIZE: 14 403 students RESULTS: During the study period, ECGs were performed on 14 403 students (53.8% females). The mean age was 9.5±1.9 years, and the mean weight was 32.1±16.1 kg. Abnormal ECGs were identified in 468 students (3.3%), 271 of whom had complete clinical evaluation, including repeat ECG and echocardiography. The most common ECG abnormality was a prolonged QTc interval. The overall prevalence of abnormal ECG findings ranged from 0.7% to 2.04%, with long QTc intervals (460 msec or more) found in 0.4% to 1.6% of students. CONCLUSIONS: Long QTc intervals (460 msec or more) were the most common ECG abnormality in school children, with an estimated prevalence of 0.4% to 1.6%. This study may serve as a model for large-scale, community-based, 12-lead ECG screening programs for children. LIMITATIONS: Causality cannot be derived given the design, the potential for false positive and false-negative results, and the lack of genetic studies for children with prolonged QT intervals

Predicting self-efficacy in light of school Engagement for gifted students at the secondary stage in the Kingdom of Saudi Arabia

هدفت الدراسة معرفة القدرة التنبؤية للانغماس المدرسي بالكفاءة الذاتية لدى الطلبة الموهوبين في مدينة الرياض، والتعرف على دلالة الفروق في مستوى الانغماس المدرسي والكفاءة الذاتية لدى الطلبة الموهوبين تُعزى لمُتغيّرات الجنس والصف. استخدمت الدراسة المنهج الوصفي، وتكوَّنت العينة من (350) طالبًا وطالبةً من الطلبة الموهوبين، اختيروا عشوائيًا من مدارس مدينة الرياض في المملكة العربية السعودية، وجرى استخدام مقياس الانغماس المدرسي، إعداد طربية (2016)، ومقياس الكفاءة الذاتية الأكاديمية، إعداد الشبول (2016). تبين من النتائج أن بُعدين من أبعاد الانغماس المدرسي (المعرفي، والسلوكي) استطاعا التنبؤ بالكفاءة الذاتية لدى الطلبة الموهوبين، حيث فسرا معًا بما نسبته (47.3%) من التباين. كما أظهرت النتائج عدم وجود فروق ذات دلالة إحصائية في الانغماس المدرسي والكفاءة الذاتية لدى الطلبة الموهوبين تُعزى لمتغير الجنس، وللتفاعل بين الجنس والصف الدراسي، في حين تبين وجود فروق ذات دلالة إحصائية تُعزى لمتغير الصف الدراسي، لصالح الصف الثالث ثانوي والأول ثانوي. بناءً على النتائج أوصت الدراسة بزيادة الاهتمام بتوعية الطلبة الموهوبين في السعودية بالانغماس المدرسي وتأثيراته الإيجابية على الكفاءة الذاتية، وتضمين المناهج الدراسية أنشطة تركز على الانغماس المدرسي والكفاءة الذاتية.The study aimed to determine the predictive ability of school engagement and self-efficacy among gifted students in the city of Riyadh, and to identify the significance of differences in the level of school engagement and self-efficacy among gifted students due to the variables of gender and grade. The study used the descriptive approach, and the sample consisted of (350) gifted male and female students, who were randomly selected from schools in the city of Riyadh in the Kingdom of Saudi Arabia. The school engagement scale, prepared by Tarabiyah (2016), and the academic self-efficacy scale, prepared by Al-Shaboul (2016) were used. The results showed that two dimensions of school engagement (cognitive and behavioral) were able to predict self-efficacy among gifted students, as they together predicted (47.3%) of the variance. The results also showed that there were no statistically significant differences in school engagement and self-efficacy among gifted students attributable to the gender variable and the interaction between gender and grade, while it was found that there were statistically significant differences attributable to the academic grade variable, in favor of the third year of secondary school and the first year of secondary school. Based on the results, the study recommended increasing attention to educating gifted students in Saudi Arabia about school engagement and its positive effects on self-efficacy, and including activities that focus school engagement and self-efficacy in the school curriculum