Congenital Blood Cyst of a Child: A Case Report and Review of Literature

Blood-filled cysts of the heart valves are frequently reported at postpartum autopsies of infants. They are seen as round nodules mostly in the paediatric age group in infants less than two months of age and disappear spontaneously within six months of life. We present a unique case of an 11-month-old girl with a blood-filled cyst on the posterior leaflet of the pulmonary valve that was successfully treated. This case report highlights the characteristics and course of a paediatric patient with blood-filled cysts. Further studies are yet needed to better understand the diagnostic approaches to blood-filled cysts as well as treatment modalities to fill the gap in clinical settings. Keywords: Blood filled cysts; Pulmonary valve; Pulmonary artery; Paediatrics; Cardiac tumor; Cardiology

Treatment of Heyde’s Syndrome by Aortic Valve Replacement

Heyde’s syndrome is the association between calcific aortic stenosis and gastrointestinal bleeding due to angiodysplasia. Alterations in von Willebrand factor due to turbulence across the diseased aortic valve have been incriminated in the pathophysiology of this syndrome. Replacement of the aortic valve has been reported to stop the bleeding, but this is debatable. Along with a review of the relevant medical literature, we hereby report a 68 year old patient with aortic stenosis and severe recurrent gastrointestinal bleeding that completely subsided following aortic valve replacement

Three-dimensional printing of mitral valve models using echocardiographic data improves the knowledge of cardiology fellow physicians in training

BackgroundHigh fidelity three-dimensional Mitral valve models (3D MVM) printed from echocardiography are currently being used in preparation for surgical repair.AimWe hypothesize that printed 3DMVM could have relevance to cardiologists in training by improving their understanding of normal anatomy and pathology.MethodsSixteen fellow physicians in pediatric and adult cardiology training were recruited. 3D echocardiography (3DE) video clips of six mitral valves (one normal and five pathological) were displayed and the fellows were asked to name the prolapsing segments in each. Following that, three still images of 3D MVMs in different projections: enface, profile and tilted corresponding to the same MVs seen in the clip were presented on a screen. Participating physicians were presented with a comprehensive questionnaire aimed at assessing whether the 3D MVM has improved their understanding of valvular anatomy. Finally, a printed 3D MVM of each of the valves was handed out, and the same questionnaire was re-administered to identify any further improvement in the participants' perception of the anatomy.ResultsThe correct diagnosis using the echocardiography video clip of the Mitral valve was attained by 45% of the study participants. Both pediatric and adult trainees, regardless of the year of training demonstrated improved understanding of the anatomy of MV after observing the corresponding model image. Significant improvement in their understanding was noted after participants had seen and physically examined the printed model.ConclusionPrinted 3D MVM has a beneficial impact on the cardiology trainees' understanding of MV anatomy and pathology compared to 3DE images

Pathogenesis and distribution of infective endocarditis in the pediatric population: a 20-year experience in a tertiary care center in a developing country

IntroductionInfective endocarditis is an infection of the endothelial surfaces of the heart. It is more prevalent in adults but its incidence in the pediatric population has been on the rise. The most important factor remains congenital heart disease and the most isolated pathogen is viridans group streptococcus.MethodsIn this manuscript, we present a 20-year experience of a major referral tertiary care center in diagnosing and treating pediatric patients with endocarditis. A retrospective analysis of records of patients who were diagnosed with infective endocarditis under the age of 18 years is presented in this study. Variables relating to the demographic, imaging, microbiologic and pathologic data are described. Outcomes relating to complications and need for surgical repair are also portrayed.ResultsA total of 70 pediatric patients were diagnosed with endocarditis in this time interval. The medical records of 65 patients were comprehensively reviewed, however the remaining 5 patients had severely missing data. Of the 65 patients, 55.4% were males, and the mean age at diagnosis was 7.12 years. More than half of the population (58.5%) had vegetation evident on echocardiography. The pulmonary valve was the most commonly affected (50%), followed by the mitral valve and tricuspid valves (15.6%). Most patients received empiric treatment with vancomycin and gentamicin. Viridans group streptococcus was the most frequently isolated organism (23.4%).ConclusionAmong pediatric patients diagnosed with endocarditis in this study, data pertaining to valve involvement and microbiologic information was consistent with the published literature. The incidence of complications and the need for surgical repair are not significantly correlated with demographic and clinical variables

Neurally adjusted ventilatory assist for children on veno-venous ECMO.

peer reviewedNAVA may improve veno-venous ECMO weaning in children. This is a retrospective small series, describing for the first time proof-of-principle for the use of NAVA in children on VV ECMO. Six patients (age 1-48 months) needed veno-venous ECMO. Controlled conventional ventilation was replaced with assisted ventilation as soon as lung compliance improved, and could trigger initiation and termination of ventilation. NAVA was then initiated when diaphragmatic electrical activity (EAdi) allowed for triggering. NAVA was possible in all patients. Proportionate to EAdi (1.8-26 μV), initial peak inspiratory pressures ranged from 21 to 34 cm H(2)O, and the tidal volume (Vt) from 3 to 7 ml/kg. During weaning, peak pressures increased proportionally to EAdi increase (5.2-41 μV), with tidal volumes ranging from 6.6 to 8.6 ml/kg. ECMO was weaned after a median time of 1.75 days on NAVA. Following ECMO weaning, the median duration of mechanical ventilation, and intensive care unit stay were 4.5 days, and 13.5 days, respectively. Survival to hospital discharge was 100%. In conclusion, combining NAVA to ECMO in paediatric respiratory failure is safe and feasible, and may help in a smoother ECMO weaning, since NAVA allows the patient to drive the ventilator and regulate Vt according to needs

ECMO is in the air: Long distance air/ground transport of a child on extra corporeal membrane oxygenation

Background: Extracorporeal membrane oxygenation (ECMO) is a temporary mechanical support system that handles the function of the heart and/or lungs in patients with a variety of cardiac and respiratory problems. Veno-arterial ECMO is most commonly used for patients recovering from heart surgery, suffering from cardiac shock, or awaiting a heart transplant. Case report: A 7 year old boy with a single ventricle physiology was admitted for a Fontan procedure with repair of the common valve. At the end of surgery, transesophagal echocardiography showed a severely depressed myocardial function, and weaning of bypass required a high inotropic support. During the following week, the heart never recovered, with an ejection fraction at 24%. Veno-Arterial ECMO was decided on postoperative day 9 with a 19 Fr venous cannula inserted through the right jugular vein into the intracardiac Fontan baffle, and a 15 Fr arterial cannula into the right carotid artery.On ECMO day 7, after failure to wean from ECMO, he was listed for an urgent heart transplant, with the suggestion of a transfer to Europe, for a shorter transplantation delay.The ECMO team from Hamad Hospital in Qatar accomplished the transfer successfully, on a humanitarian basis. The transfer was done on ECMO Day 10. The child was safely admitted to a hospital in Belgium, and listed again for an urgent heart transplant. Conclusion: With an experienced team, and the proper equipment, on-ECMO air transport of critical patients over thousands of kilometers is today safely feasible. Keywords: ECMO, Medical air transport, Critical care, Levosimenda