Determination of TOF characteristics in Iranian patients

Objective: Tetralogy of fallot (TOF) is one of the most common forms of cyanotic congenital heart disease (CHD). The aim of this study was determination of demography, associated anomalies, peripheral pulmonary stenosis (PPS), blood grouping, Rh typing, operation results and complications in TOF. Material & Methods: The records of 270 patients were reviewed. These patients were admitted from 1993 to 2003, in Shaheed Rajaei Hospital. Findings: Male patients were 60.37% and females were 39.63%. Incidence of patent foramen ovale (PFO), Right Aortic Arch (RAA), coronary artery (CA) anomalies and other anomalies were 44.81%, 21.11%, 9.25% and 36.30% respectively. Single ostium coronary artery (SOCA) was the most common CA anomaly. The most common PPS was bifurcation stenosis. TOF was more common in 0 blood group patients. The mean age at the first palliative operation was 5.21 years and for TC was 7.19 years. Post surgical mortality rate was about 3% and morbidity rate, 12.18%. Conclusion: Trend toward earlier total correction (TC), and single stage early TC of TOF should be recommended as the preferred management strategy

Balloon Angioplasty Versus Surgical Repair of Coarctation of Aorta in Infants

Background: Coarctation of the aorta is a discrete stenosis of the proximal thoracic aorta. The common clinical pattern is congestive heart failure in infancy. Treatment methods include balloon angioplasty and surgical repair in this age group. Percutaneous balloon angioplasty is a less invasive method for the repair of discrete coarctation but remains controversial as a primary treatment strategy for a native coarctation. This study aimed to compare the effectiveness and outcome of balloon angioplasty and surgical repair in coarctation infants younger than 1 year old.Methods: This retrospective study evaluated the results of the two methods in 167 patients younger than one year old admitted into a tertiary heart center pediatric ward with the diagnosis of coarctation of the aorta: Balloon angioplasty was done for 55 and surgical repair for 112 infants. Patients with previous interventions were not included in this study. Results: Primary results revealed no significant difference in the effectiveness of the two methods (p value = 0.0601). While the rate of recurrent coarctation was significantly lower in the surgery group [19 (17%) vs. 11 (20%), p value = 0.0470], the mortality rate was lower in the balloon angioplasty method [5 (5.5%) vs. 13 (11.6%), p value = 0.039]. Our multivariate logistic regression model, however, showed no statistically significant difference (p value = 0.120).Conclusion: Because of the incidence of re-coarctation, balloon angioplasty compared with surgical repair did not confer an improved outcome for our infants’ coarctation

Clinical presentation of coronary arteriovenous fistula according to age and anatomic orientation

Background: Coronary arteriovenous fistulas (CAVFs) are direct connections from one or more coronary arteries to cardiac chambers or a large vessel. They are mostly of congenital origin. The aim of this study was to describe clinical presentation and also delineate the course and management of CAVF. Methods: Clinical data, chest x-rays, echocardiographic and angiographic evaluation of 40 patients with congenital CAVF during 1990 to 2008 were reviewed retrospectively. Results: Seventeen patients were ≤ 20 years old (42.5%) were mostly asymptomatic, and twenty tree cases were older than 20 years old (57.5%), mostly symptomatic (P<0.05). Twenty one (52.5%) patients had pure CAVF and nineteen (47.5%) patients with associated intarcardiac congenital heart disease (15%) or acquired valvular and coronary arteries diseases (32.5%). CAVFs mostly originated from left anterior descending artery (LAD) (42.5%) and mostly drained into the main pulmonary artery (MPA) (35 %). Twenty-four patients underwent CAVF surgical ligation. From twenty-one patients with pure CAVF, eight (38%) patients were complicated by congestive heart failure and aneurism formation of fistula.Conclusion: Unlike some previous reports, in our study, the most prevalent origin site for CAVFs was the left anterior descending (LAD). Most patients with CAVFs especially those who went first diagnosed before 20 years old were asymptomatic. On the other hand, as the continuous murmur is not always detected in children or infants, consequently, cases of spontaneous closure may remain undetected. All symptomatic and asymptomatic patients with moderate to severe shunting should be operated on and minimal morbidity and good surgical results could be expected