Left ventricle myocardial performance in Down Syndrome children with clinically and anatomically normal hearts: Relationship to oxidative stress

Oxidative stress is implicated in many organs pathophysiologies in Down syndrome. Scarce data exist concerning left ventricular (LV) performance in DS children with normal hearts. Tissue Doppler derived myocardial performance index (TDI-Tei index) is a reliable method for ventricular performance evaluation. Myeloperoxidase (MPO) enzyme plays a crucial role in oxidants production and is a marker of cardiovascular risk.Aim: To evaluate LV myocardial performance in DS children with normal hearts using TDI-Tei index and correlate it with plasma MPO as a marker of oxidative stress.Patients and methods: This cross-sectional study included 120 DS children recruited from Children s Hospital, Ain Shams University. Out patients clinic and echocardiography unit (mean age, 8.35 ± 4.25 years) who were subjected to: history taking, clinical examination, laboratory investigations (Complete blood count, serum Alanine Transaminase, serum creatinine, Thyroid profile, 12 lead Electrocardiogram and conventional Doppler echocardiography). DS children with congenital or acquired heart diseases, dysrhythmias, anaemia, pulmonary hypertension, thyroid, renal disease, diabetes were excluded. The remaining 50 DS children with normal hearts (group I) were compared to 50 age. Sex matched healthy children as control (group II) Studied groups were subjected to: plasma MPO using ELISA technique and TDI LV-Tei index assessment using Vivid E9 Echocardiography machine (GE, Horton, Norway).Results: LV TDI-Tei was significantly increased in group I compared to group II (0.46 ± 0.02 vs 0.32 ± 0.08, p < 0.001). Plasma MPO was increased in group I than group II (64.4831 ± 0.6 ng/ml vs 50.4 ± 30.2 nglml, p < 0.001). A significant positive correlation was found between plasma MPO and LV TDI-Tei (r = 0.877, p = 0.001) in group I.Conclusion: Subclinical Left ventricle dysfunction evidenced by increased TDI Tei index was detected in DS children with normal hearts. This dysfunction correlated with plasma MPO level which mandates antioxidants treatment and tissue Doppler myocardial performance regular evaluation for early identification, monitoring and early intervention.Keywords: Left ventricle, Tissue doppler, Tei index, Oxidants, DS with normal heart

Corrected qt interval in normal egyptian neonates: Comparison to corrected qt interval of other ethnic groups

Long QT syndromes (LQTs) is a familial cardiovascular disorder characterized by abnormal cardiac repolarization and sudden death from ventricular fibrillation Possible acquisition of standardized neonatal screening method to identify children with (LQTs) has led to interest in establishing normal values for neonatal QT intervals.Aim of the workto compare corrected QT interval in normal Egyptian neonates to published values of other ethnic groups.Subjects and methodsThis cross sectional study was conducted on neonates following up in Children’s Hospital Ain Shams University, with post natal ages ranging from 8 to 28days (mean 13.91±3.97days). They were subjected to: history taking, clinical examination, Echocardiography and 12 lead ECG assessment of corrected QT interval using Bazetts formula Results: Cut off point of LQTc was >0.44s, while that of short QTc was< 0.29s significant increase in mean QTc values and LQTc %was found in upper Egypt than Delta (p 0.026, 0.01). Eighty five percent of neonates had normal QTc (0.300–0.450s), 9% had LQTc (>0.45s) and 6% had short QTc (<0.300s) significant increase in short QTc was found in PT than FT while significant increase in LQTc was found in FT (P=0.020, 0.019).ConclusionCut off point was >0.44s for LQTc and < 0.29s for short QTc in studied Egyptian neonates A higher percentage of patients with LQTc was found in Upper Egypt than Delta, and in FT than PT. Higher percentage of SQTc was found in PT than FT. Further studies are needed to confirm our results

Three Dimensional (3D) Echocardiography as a Tool of Left Ventricular Assessment in Children with Dilated Cardiomyopathy: Comparison to Cardiac MRI

BACKGROUND: Left ventricular (LV) volumes and ejection fraction (EF) is Strong prognostic indicators for DCM. Cardiac MRI (CMRI) is a preferred technique for LV volumes and EF assessment due to high spatial resolution and complete volumetric datasets. Three-dimensional echocardiography is a promising new technique under investigations. AIM: Evaluate 3D echocardiography as a tool in LV assessment in DCM children about CMRI. PATIENTS AND METHODS: A group of 20 DCM children (LVdiastolic diameter &lt; 2 Z score, LVEF &lt; 35%) at Children s Hospital, Ain-Shams University (gp1) (mean age 6.6 years) were compared to 20 age and sex-matched children as controls (gp2). Patients were subjected to: clinical examination, conventional echocardiography, automated 3D LV quantification, 3D speckle tracking echocardiography (3D-STE) (VIVID E9 Vingmed, Norway) and CMRI (Philips Achieva Nova, 1.5 Tesla scanner) for LV end systolic volume (LVESV), LVend diastolic volume (LVEDV) that were indexed to body surface area, EF% and wall motion abnormalities assessment. RESUTS: No statistically significant difference was found between automated 3D LV quantification echocardiography, 3D-STE, and CMRI in ESV/BSA and EDV/BSA assessment (p = 1, 0.99 respectively), between automated LV quantification echocardiography and CMRI in EF% assessment (p = 0.99) and between CMRI and 3D-STE in LV Global hypokinesia detection (P = 0.255). As for segmental hypokinesia CMRI was more sensitive [45% of patients vs. 40%, (P = 0,036), basal septal hypokinesia 85% vs. 75%, (p = 0.045), mid septal hypokinesia 80% vs. 65%, (p = 0.012) and lateral wall hypokinesia 75% vs. 65%, (p = 0.028)]. CONCLUSION: Automated 3D LV quantification echocardiography and 3D-STE are reliable tools in LV volumetric and systolic function assessment about CMRIas a standard method. 3D speckle echocardiography is comparable to CMRI in global wall hypokinesia detection but less sensitive in segmental wall hypokinesia which mandates further studies

The Prevalence and Risk Factors of Early Arrhythmias Following Pediatric Open Heart Surgery in Egyptian Children

AIM: This study aimed to assess the prevalence of early postoperative arrhythmias after cardiac operation in the pediatric population, and to analyse possible risk factors.MATERIAL AND METHODS: Cross-sectional study included 30 postoperative patients, with age range four up to 144 months. They were selected from those admitted to the Cardiology Unit in the Pediatric department of Ain Shams University hospitals, after undergoing cardiopulmonary bypass (CPB) surgery for correction of congenital cardiac defects. All patients had preoperative sinus rhythm and normal preoperative electrolytes levels. All patients’ records about age, weight, type of surgery, intraoperative arrhythmias, cardiopulmonary bypass time, ischemic time and use of inotropic drugs were taken before they were admitted to the specialised pediatric post-surgery intensive care unit (ICU).RESULTS: Arrhythmia was documented in 15 out of 30 patients (50%). Statistically significant difference between the arrhythmic and non-arrhythmic group were recorded in relation to the age of operation (23 vs 33 months), weight (12 vs. 17 kg), ischemic time (74.5 vs. 54 min), cardiopulmonary bypass time (125.5 vs. 93.5min), inotrope use (1.6 vs. 1.16) and postoperative ICU stay (5.8 vs. 2.7 days), P&lt;0.05.CONCLUSION: Early postoperative arrhythmias following surgery for congenital heart disease are relatively frequent in children (50%).Younger age, lower body weight, longer ischemic time and bypass time, and more inotrope use are all risk factors for postoperative arrhythmias and lead to increase the hospital stay