Midterm results of bovine jugular vein conduit for right ventricular outflow tract reconstruction

Objective: To evaluate the midterm results of Contegra conduit. Methods: The retrospective study comprised patient record at Aga Khan University Hospital, Karachi, of conduits implanted between May 2007 and June 2012. Data collection was made from the clinical notes and from serial echocardiograms by a single cardiologist. The last followup echocardiography was done at the time of data collection in June 2012. SPSS 19 was used for statistical analysis. Results: A total of 18 conduits had been implanted (16-22mm) during the study period. Median age at the time of surgery was 9 years (range: 2.5-16 years). Early mortality was seen in 3 (16.66%) patients, but none was Contegra related. Of the remaining 15 patients, 2 (13.33%) with a diagnosis of Pulmonary Atresia-Ventricular Septal Defect with hypoplastic peripheral Pulmonary Arteries (PA), developed severe distal pressure gradient (50mmHg) across Contegra over a median period of 18 months (range: 12-24 months), with resultant severe regurgitation and needed percutaneous intervention. There was no thrombosis, calcification, anuerysmal dilation or late deaths. Conclusion: At midterm followup, Contegra conduit was associated with low re-intervention rates with satisfactory haemodynamic results. However, long-term durability must be determined for this conduit, especially in patients with Pulmonary Atresia-Ventricular Septal Defect with hypoplastic peripheral Pulmonary Arteries

Anthracycline-induced cardiotoxicity: prospective cohort study from Pakistan

Objectives: To identify anthracycline-induced acute (within 1 month) and early-onset chronic progressive (within 1 year) cardiotoxicity in children younger than 16 years of age with childhood malignancies at a tertiary care centre of Pakistan. Design: Prospective cohort study. Setting: Aga Khan University, Karachi, Pakistan. Participants: 110 children (aged 1 month–16 years). Intervention: Anthracycline (doxorubicin and/or daunorubicin). Outcome measurements: All children who received anthracycline as chemotherapy and three echocardiographic evaluations (baseline, 1 month and 1 year) between July 2010 and June 2012 were prospectively analysed for cardiac dysfunction. Statistical analysis including systolic and diastolic functions at baseline, 1 month and 1 year was carried out by repeated measures analysis of variance. Results: Mean age was 74±44 months and 75 (68.2%) were males. Acute lymphoblastic leukaemia was seen in 70 (64%) patients. Doxorubicin alone was used in 59 (54%) and combination therapy was used in 35 (32%). A cumulative dose of anthracycline /m2was used in 95 (86%). Fifteen (14%) children developed cardiac dysfunction within a month and 28 (25%) children within a year. Of these 10/15 (66.6%) and 12/28 (43%) had isolated diastolic dysfunction, respectively, while 5/15 (33.3%) and 16/28 (57%) had combined systolic and diastolic dysfunction. Seven (6.4%) patients expired due to severe cardiac dysfunction. Eight of 59 (13.5%) children showed dose-related cardiotoxicity (p= Conclusions: Incidence of anthracycline-induced cardiotoxicity is high. Long-term follow-up is essential to diagnose its late manifestations

Transcatheter Closure of a Patent Ductus Arteriosus in a Patient With an Anomalous Inferior Vena Cava

A Patient with a patent ductus arteriosus (PDA) was catheterized for device closure. Anomalous systemic venous drainage was found with interrupted inferior vena cava and persistence of hepatic vessel plexus. Using the superior vena cava route, the PDA was closed successfully

Complex heart disease with interrupted aortic arch: Echocardiography diagnosis with successful single-stage repair in a low-resource setting

Background: Congenital heart disease (CHD) is the most common of all birth defects. Interrupted aortic arch (IAA) is rare, attributing to 1% of all CHD and exhibits left sidedness in most cases. It usually presents in the first 2 weeks of life with heart failure and shock. Early recognition, preoperative stabilization with prostaglandin infusion, and timely surgery are necessary to prevent mortality. Single-stage repair has proven to have good outcomes. However, resource constraints in low- and middle-income countries can hinder diagnosis and intervention by single-stage repair due to a paucity of state of the art centers and inventory. Case Description: We present the experience of a low-resource center with two children with rare complex forms of IAA, both of whom underwent successful single-stage cardiac surgeries; a 6-week-old infant was admitted with difficulty in feeding and heart failure signs. Moreover, a 2-year-old boy was referred with failure to thrive, chronic respiratory problems, and feeding problems since early infancy. Both children were diagnosed with IAA with associated defects including patent ductus arteriosus by transthoracic echocardiography. Management: After stabilization with anticongestive medication, single-stage repair was attempted in both. The postoperative course was uneventful, and the postsurgical echocardiogram showed no residual defect. Both cases were discharged. They are under follow-up, are symptom free, have gained weight, and have not shown any need for reintervention yet. Conclusion: If preparative diagnosis is made correctly and surgery planned meticulously, the immediate and short-term outcome of single-stage repair can be favorable