Cost-effectiveness analysis of different devices used for the closure of small-to-medium-sized patent ductus arteriosus in pediatric patients

Aims: In this study, we examined the differences in cost and effectiveness of various devices used for the closure of small to medium sized patent ductus arteriosus (PDA). Setting and Design: We retrospectively studied 116 patients who underwent closure of small PDAs between January 2010 and January 2015. Subjects and Methods: Three types of devices were used: the Amplatzer duct occluder (ADO) II, the cook detachable coil and the Nit Occlud coil (NOC). Immediate and late complications were recorded and patients were followed up for 3 months after the procedure. Statistical Methods: All statistical calculations were performed using Statistical Package for the Social Science software. P <0.05 were considered significant. Results: We successfully deployed ADO II devices in 33 out of 35 cases, cook detachable coils in 36 out of 40 cases and NOCs in 38 out of 41 cases. In the remaining nine cases, the first device was unsuitable or embolized and required retrieval and replacement with another device. Eleven patients (9.5%) developed vascular complications and required anticoagulation therapy. Patients who had hemolysis or vascular complications remained longer in the intensive care unit, with consequently higher total cost (P = 0.016). Also, the need for a second device increased the cost per patient. Conclusions: The cook detachable coil is the most cost.effective device for closure of small.to medium.sized PDAs. Calculations of the incremental cost.effectiveness. (ICE) revealed that the Cook detachable coil had less ICE than the ADO II and NOC. The NOC was more effective with fewer complications

Parameters affecting outcome of paediatric cardiomyopathies in the intensive care unit: Experience of an Egyptian tertiary centre over 7 years

Introduction: Paediatric cardiomyopathies are rare but serious and often life-threatening conditions. In the absence of cardiac transplant and ventricular assist device as treatment options in our region, it is very important to identify patients at higher risk. The aim of this study was to determine the outcome of patients diagnosed with cardiomyopathies and their prognostic indicators. Patients and methods: This study included 92 cases representing all patients diagnosed with cardiomyopathy who were admitted into the pediatric cardiac intensive care unit during the period from January 2012 to September 2018. The patients were classified into two groups according to the outcome: the first group comprised 69 patients who survived, and the second group comprised 23 patients who died. All medical records were reviewed, and data were recorded and analysed. Results: Patients with cardiomyopathies represented 8.6% (92/1071) of all patients with cardiac diseases who were admitted in the study period and in the target age group (0.5–12 years). Dilated cardiomyopathy (DCM) was the most frequent type of cardiomyopathy among the admitted patients (80 patients), while 6 patients were diagnosed with hypertrophic cardiomyopathy (HCM), 4 were diagnosed with restrictive cardiomyopathy (RCM), and only 2 were diagnosed with mixed DCM-RCM. Seventy patients required inotropic support (76.1%). Assisted mechanical ventilation was used on 15 patients (16.3%). Twenty-three patients (25.0%) died during the 7-year study period. Conclusions: The occurrence of hypotension, abnormally high liver enzymes, the need for mechanical ventilation and the need for multiple inotropic drugs were found to be statistically significant predictors of mortality, while age, sex, fractional shortening, ejection fraction, presence of mitral regurgitation, mural thrombus, electrolyte disturbance and arrhythmias did not predict or affect patients’ outcomes

35. Incomplete right ventricular remodeling after transcatheter atrial septal defect closure in pediatric age

Published data showing the intermediate effect of transcatheter device closure of atrial septal defect (ASD) in the pediatric age group are scarce. Objective: To assess the effects of transcatheter ASD closure on right and left ventricular functions by tissue Doppler imaging (TDI). Patients &Methods: The study included 37 consecutive patients diagnosed as ASD II by TTE and TEE and referred for transcatheter closure at Cairo University Specialized Pediatric Hospital, Egypt from October 2010 to July 2013. 37 age and sex matched was selected as control group. TDI was obtained using the pulsed Doppler mode, interrogating the right cardiac border (the tricuspid annulus) and interventricular septum (lateral mitral annulus) and myocardial performance index (MPI) was calculated at 1, 6 and 12 months post device closure. Results: Transcatheter closure of ASD and echocardiographic examinations were successfully performed in all patients. There were no significant differences between two groups as regards age, gender, weight or BSA. By TDI, patients with ASD had significantly prolonged IVCT, IVRT and MPI compared to control group. Decreased tissue Doppler velocities of RV and LV began at 1 month post-closure compared to the controls. Improvement of RVMPI and LVMPI began at 1 month post-closure but still they are prolonged till 1 year. Conclusion: Reverse remodeling of right and left ventricles began 1 month after transcatheter ASD closure but didn’t completely return to normal even after 1 year follow-up by TDI

Biomarkers of acute kidney injury in children with congenital heart disease after cardiopulmonary bypass

Background: Acute kidney injury (AKI) is a serious postoperative complication after cardiac surgery in children and is a major contributor to patient outcome. This study aims to identify the incidence of AKI in children undergoing cardiac surgery and the role of Interleukin 18 (IL-18) and Kidney Injury Molecule 1 (KIM-1) in diagnosis of AKI in comparison to creatinine. Methods: Forty-four children who underwent open heart surgery using cardiopulmonary bypass) for congenital heart disease were assessed for AKI diagnosis according the KDIGO criteria, urinary IL-18 and KIM-1 were determined by Enzyme Linked Immunosorbent Assay in addition to the assessment of length of stay in PICU and outcome and the effect of AKI on these parameters. Results: twenty three percent of the patient developed AKI, there were no statistical correlation between AKI and the factors (Age, gender, CBP and Risk adjustment for congenital heart surgery (RACHS-1) complexity score). Eight of our patients needed peritoneal dialysis (PD), seven of them developed AKI and the 8th patient didn’t develop due to the early initiation of PD. There was strong correlation between the development of AKI and the Length of stay in ICU