Safety and efficacy of Amplatzer duct occluder II and konar-MF™ VSD occluder in the closure of perimembranous ventricular septal defects in children weighing less than 10 kg

IntroductionDevice closure of perimembranous ventricular septal defects (pmVSD) is a successful off-label treatment alternative. We aim to report and compare the outcomes of pmVSD closure in children weighing less than 10 kg using Amplatzer Duct Occluder II (ADOII) and Konar-MF VSD Occluder (MFO) devices.MethodsRetrospective clinical data review of 52 children with hemodynamically significant pmVSD, and sent for transcatheter closure using ADOII and MFO, between January 2018 and January 2023. Baseline, procedural, and follow-up data were compared according to the implanted deviceResultsADOII devices were implanted in 22 children with a median age of 11 months (IQR, 4.1–14.7) and weight of 7.4 kg (IQR, 2.7–9.7). MFO devices were implanted in 30 children with a median age of 11 months (IQR, 4.8–16.6) and weight of 8 kg (IQR, 4.1–9.6). ADOII were implanted (retrograde, 68.1%) in defects with a median left ventricular diameter of 4.6 mm (IQR, 3.8–5.7) and right ventricular diameter of 3.5 mm (IQR, 3.1–4.9) while MFO were implanted (antegrade, 63.3%) in defects with a median left ventricular diameter of 7 mm (IQR, 5.2–11.3) (p > 0.05) and right ventricular diameter of 5 mm (IQR, 2.0, 3.5–6.2) (p < 0.05). The procedural and fluoroscopy times were shorter with the MFO device (p < 0.05). On a median follow-up of 41.2 months (IQR, 19.7–49.3), valvular insufficiency was not observed. One 13-month-old child (6.3 kg) with ADOII developed a complete atrioventricular heart block (CAVB) six months postoperative and required pacemaker implantation. One 11-month-old child (5.9 kg) with MFO developed a CAVB 3 days postoperative and the device was removed. At 6 months post-procedure, only one child with MFO still experiences a minor residual shunt. There was one arterio-venous fistula that resolved spontaneously.ConclusionBoth the MFO and ADOII are effective closure devices in appropriately selected pmVSDs. CAVB can occur with both devices. The MFO is inherently advantageous for defects larger than 6 mm and subaortic rims smaller than 3 mm. In the literature, our series represents the first study comparing the mid-term outcomes of MFO and ADOII devices in children weighing less than 10 kg

Role of Food Allergy in Children with Chronic Constipation

Objective: We aimed to evaluate the role of food allergies in the etiology of constipation in children who presented with chronic constipation. We investigated the effects of the allergens on constipation by eliminating the relevant allergen from diet in cases with positive food allergy testing in the study

Assessment of risk factors for congenital heart disease through prenatal fetal echocardiography and the correlation with postnatal diagnoses

Background: Congenital Heart Disease (CHD) constitutes a significant cause of morbidity and mortality in newborns. Identifying CHD prenatally and understanding associated risk factors can aid in early diagnosis, intervention, and postnatal management. This study aims to assess risk factors for CHD using prenatal fetal echocardiography (FE) and investigate their correlation with postnatal diagnoses. Patients and Methods: In this study, we included 993 pregnant women presenting to the pediatric cardiology outpatient clinic between December 2018 and December 2020, considered at risk for CHD. We retrospectively evaluated the cases’ postnatal echocardiography data with detected CHD during fetal echocardiography. Results: The average age of the patients was 29.8±5.7, and the mean gestational week was 23.61±3.9. Among the pregnant women, 253 (25.47%) were primiparous, 740 (74.53%) were multiparous, 103 cases (9.32%) involved multiple pregnancies, and 259 (26.08%) had chronic diseases. The most common reason for fetal echocardiography referral was the suspicion of CHD in fetuses with dysmorphic findings detected during obstetric ultrasonography. Among the cases, 329 (33.1%) were classified as low-risk, while 664 (66.9%) as high-risk. Among all patients, the most commonly observed prenatal CHD were Ventricular Septal Defects (VSD) (8.2%), Hydrops Fetalis (6.1%), and large Atrial Septal Defects (ASD) (3.9%). The overall prevalence of CHD was 31.6%. The accuracy of postnatal echocardiography in confirming the diagnoses made with fetal echocardiography was 94%. Conclusion: Prenatal diagnosis of congenital heart diseases is crucial for planning prenatal and postnatal management and providing families with the option of pregnancy termination in severe anomalies. Fetal echocardiography has shown significant potential for early diagnosis of CHD, even in low-risk fetuses, and its inclusion in routine prenatal screenings by increasing the number of experienced specialists and centers could play a crucial role in reducing CHD-related mortality and morbidity rates