Acyanotic Congenital Heart Disease Research Articles

Relationship between G protein level with left ventricular systolic function in children with acyanotic heart disease

Heart failure is a pediatric emergency caused by the heart's inability to adequately meet the body metabolic needs and the most common cause is congenital heart disease (CHD). The G protein is the most prominent family of membrane-bound protein known to act in major regulatory events of the cardiovascular system, one of which is heart failure. The aim of this study was to determine the level of G protein and its relationship with left ventricular systolic function in children with acyanotic CHD. A cross-sectional study was conducted in Dr. Zaionel Abidin Hospital, Banda Aceh, Indonesia. The patients aged 0 to 18 years and had acyanotic CHD diagnosis by echocardiography were included. Anthropometry measurement was performed according to standard WHO procedures and G protein level was measured using the ELISA method. The Chi-squared test was used to measure the relationship between G protein level and left ventricular systolic function. Out of a total of 38 children with acyanotic CHD, the mean level of G protein was 36.25 ng/mL and the mean of left ventricular systolic function was 73.1%. There was no relationship between G protein and left ventricular systolic function in children with acyanotic CHD. However, further study with a larger sample size and considering other variables are needed to confirm this finding.

Congenital Heart Disease in a Tertiary Care NICU; Pattern, Risk Factors and Outcome

Background: Identification of congenital heart disease (CHD) is increasing, may be due to advancement of diagnostic technology and availability of trained man power. Several studies have been conducted in Bangladesh to identify the prevalence and pattern of CHD but paucity of data regarding etiology and outcome. Objective: The aim of this study is to identify the frequency and risk factors of so that preventive measures can be taken. Methods: This retrospective case control study was conducted in the neonatal intensive care unit (NICU), BSMMU, Dhaka from January 2021 to June 2022. All admitted neonates in NICU with the diagnosis of CHD were considered as cases. Twice number of newborn having gestational age and birth weight matched neonates diagnosed other than CHD in NICU were considered as control. Data were extracted from the Medical records of patient files and computer electronic data records of “Newborn Birth Defect (NBBD) surveillance in Bangladesh.” The level of significance was set at 5% (P <0.05). Result: Total 914 patient were admitted during the study period among them 119 patient were CHD (frequency rate 13%). Mean birth weight and gestational age of CHD group were 2376±783.85g & 35.80±3.26 weeks respectively. About 85.7% had acyanotic CHD, among them most prevalent were atrial septal defect (42%) then patent ductus arteriosus (11.8%). Cyanotic CHD were 17 (14.3%). Maternal DM significantly increase the risk of developing CHD, Odd’s ratio 1.971 (CI: 1.182 - 3.285). Death were more in CHD group (34.5%) than control group (20.4%), p values = 0.005. Conclusion: Frequency (13%) of congenital heart disease was high. Maternal diabetes mellitus increases the risk of developing CHD of their baby. Death were more among babies with CHD. BANGLADESH J CHILD HEALTH 2022; VOL 46 (3) : 122-129

Anemia in Children with Congenital Heart Disease: A Finding from Low-Resource Setting Hospitals.

Congenital heart disease (CHD) is the most common birth defect. Anemia is the prevailing manifestation of micronutrient deficiency. It has been demonstrated that anemia in children increases morbidity and has a negative impact on psychomotor development. Despite its negative consequences, which have been documented for a long time in clinical practice, the issue does not gain sufficient attention in developing countries, specifically in children with CHD. Thus, this study is aimes to assess the prevalence of anemia and the factors associated in children with CHD. Institutional-based cross-sectional study was conducted on CHD children at selected governmental hospitals in Addis Ababa, Ethiopia, from February to March 2021. During this period, 373 children with acyanotic and cyanotic heart disease between 0 months and 15 years of age were included in this study. All children were assessed using structured questionnaires and anthropometric measurements. Recent hemoglobin results that are avaliable in the medical charts of children were used to diagnose anemia. The data were analyzed using SPSS version 25. From randomly included 373 children with CHD, 298 (79.9%) had acyanotic congenital heart disease (ACHD) and 75 (20.1%) had cyanotic congenital heart disease (CCHD). Twenty-five (33.3%) CCHD and 192 (64.4%) ACHD cases of children were malnourished. The most common type of CCHD and ACHD defects were ventricular septal defects and tetralogy of fallout, respectively. Overall, the prevalence of anemia in ACHD and CCHD was 24.5% and 72%, respectively. In children with ACHD, the frequency of anemia was reported to be significantly higher in the malnourished group than in the well-nourished. A high prevalence of anemia is observed in children with CHD. This study highly suggests further evaluation to determine the frequency and complications of blood indices and other hematological impairments in ACHD, CCHD, and children with both problems. Moreover, the findings of this study on illness profiles in children with CHD prompt further research into the cellular and molecular mechanisms underlying immune system dysfunction.

Changes in Nutritional Status of Children Under Five with Acyanotic Congenital Heart Disease Left to Right Shunt Type After Defect Closure by Catheterization

Highlights: 1. The nutritional status of children with CVD after therapy is interesting to discuss especially because children antibody varies. 2. Changes in their nutrition intake after the surgery would help for future treatments with related disease and same operation. - Background: One of the impacts that occur in patients with congenital heart disease (CHD) is malnutrition. Malnutrition will affect the growth of the child. Closure therapy with catheterization can improve nutritional status after a few months. This study aims to determine the nutritional status of toddlers with simple left to right shunt-type acyanotic CHD before and after closure therapy with catheterization. Material and Methods: This study is an analytical observational study with a retrospective cohort method using medical record data involving pediatric patients less than 5 years old with simple left to right shunt-type acyanotic CHD who received closure by catheterization at Dr. Soetomo General Hospital from January 2020 to December 2020. Results: From 10 samples, the characteristics of the most samples were women (90%), age group 2-5 years (60%), and PDA abnormalities (50%). In addition, nutritional status after closure by catheterization improved. Conclusion: There was an improvement in nutritional status (W/H) after defect closure with catheterization in patients aged less than 5 years with simple left to right shunt type acyanotic CHD within several months.

Congenital Heart Disease among Children Undergoing Echocardiography in the Department of Paediatrics of Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Congenital heart disease in children are a major cause of infant mortality and morbidity. It is important to detect and manage these disorders timely as they are preventable. The objective of this study was to find out proportion of congenital heart disease in children in paediatric department in a tertiary hospital.Methods: This is a descriptive cross-sectional study carried out in the Department of Paediatric at Nepal Medical College and Teaching Hospital where all children (0-18 years) suspected to have congenital heart disease who underwent echocardiography were studied over a period of 1 year (2020-2021). The presence or absence of congenital heart disease were confirmed by echocardiography performed by paediatric cardiologist. The socioeconomic variables,clinical features and echocardiography findings were noted.Results: Out of total 249 patients,the proportion of patients diagnosed to have cardiac disorders was 73 with male predominance of 165 (66.26%). The most common age group was found to be neonates 111 (44%).The notable clinical features were murmur 47 (18.87%), tachypnoea 27 (10.84%) ,tachycardia 27 (10.84%) and cyanosis 9 (3.61%), clubbing 2 (0.80%), oedema 1 (0.40%), hypertension 9 (3.65%), murmur 47 (18.87%).Out of the total, there were 49 (19.67%) cases of acyanotic congenital heart disease, and 27 (10.84%) cases of cyanotic congenital heart disease.Conclusions: Our study focuses on early recognition of cardiac diseases which is crucial for preventing morbidity and mortality.

Non-thyroidal Illness in Children with Congestive Heart Failure.

To estimate the proportion and risk factors of non-thyroidal illness (NTI) in children with congenital heart disease (CHD) with congestive heart failure(CHF). This study enrolled children (6 weeks to 60 months age) with CHD and CHF. The clinical profile and disease severity using Pediatric Early Warning Score (PEWS) was recorded. Baseline blood samples were taken within 24hours of hospitalization and evaluated for fT3, fT4, TSH, NT pro-Brain natriuretic peptide (NT pro-BNP) and reverseT3. A total of 80 (64 acyanotic CHD) children of median (IQR) age 5 (2.5, 8.0) months were enrolled. NTI was seen in 37 (46%)- 27 with low fT3 levels. The proportion of NTI was maximum in children with severe disease (20/30), than moderate (4/9) or mild disease (13/41); p=0.018. Ten (27%) patients with NTI expired as compared to 2 (4.7%) without NTI with unadjusted odds ratio (95% CI) 7.593(1.54, 37.38); p-value=0.006. After adjusting for NTI, shock and NT-pro-BNP levels, PEWS was the only significant predictor of mortality (OR 1.41, 95% CI 1.03, 1.92; p=0.032).Linear regression for fT3 showed significant relation with log NT-BNP [beta -3.541, (95% CI -1.387, -0.388)] and with TSH [beta 2.652 (95%CI 0.054, 0.383)]. The cutoff (AUC, 95%CI) that predicted mortality were fT4 <14.5 pmol/L (0.737, 0.60, 0.88), fT3/rT3 index <1.86 pg/ng (0.284, 0.129, 0.438) and NT pro-BNP >3725 pg/mL (0.702; 0.53, 0.88). NTI was seen in a significant proportion of children with CHD and CHF. Free T3 level was significantly affected with NT-BNP levels (severity of CHF).

Comparison of CIMT and FMD in the Brachial Artery between Children with Acyanotic Congenital Heart Disease and Healthy Controls: A Case-Control Study.

Congenital heart disease (CHD), a developmental abnormality of the heart and vessels, is encountered in the pediatric age group frequently. Brachial artery flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT) are indicators of subclinical cardiovascular disease and are used as surrogate measures of subclinical atherosclerosis. The present study aimed to compare CIMT and FMD between children with acyanotic congenital heart disease (ACHD) and healthy controls. A case-control study on 50 children with ACHD and 43 healthy individuals was done in Isfahan, Iran, between 2021 and 2022. The case group was selected via non-random sampling, and healthy controls were recruited from the relatives of the patients. A checklist, including age, sex, body mass index, and blood pressure, was filled out for all the participants. Then, FMD and CIMT were measured with brachial and carotid artery ultrasonography. Fifty children with ACHD and 43 healthy individuals (controls) under 18 years old participated in this study. Of these, 44 (47.3%) were girls and 49 (52.7%) were boys. The mean FMD was significantly higher in the ACHD group than in the control group (0.084±0.027 vs 0.076±0.042; P=0.021; 95% CI, 007 to 0.122;). CIMT was significantly higher in the ACHD group than in the control group (0.39±0.12 vs 0.34±0.1; P=0.037; 95% CI, 0.009 to 0.102;). However, systolic and diastolic blood pressure did not show differences between the groups. Based on our results, CIMT and FMD assessment may help detect early changes in peripheral vessels associated with atherosclerosis in the future in ACHD. Further studies are needed to confirm our findings.

Accuracy of Transthoracic Echocardiography in Detecting Persistent Left Superior Vena Cava against the Cardiac Computed Tomography Scan

Abstract Introduction: Detection of the persistent left superior vena cava (LSVC) is essential to diagnosing pediatric congenital heart diseases (CHDs). Transthoracic echocardiography is the most commonly used diagnostic tool for CHDs. This study compares transthoracic echocardiography and cardiac computed tomography (CT) to detect LSVC. Methods: Retrospective review of 49 pediatrics patients with CHDs who underwent echocardiography and cardiac CT. Results: Forty-nine pediatric patients with CHDs who underwent CT scans were included. In acyanotic CHD patients, CT identified four with bilateral superior vena cava (SVC), while echocardiography picked up three and missed one. In the remaining 16 patients with acyanotic CHDs, CT found single right-sided SVC; however, two of these were misidentified as having bilateral SVC during echocardiography. In the cyanotic CHD group, four patients had bilateral SVC. All four were picked up by echocardiography as well. However, echocardiography diagnosed one additional patient as having bilateral SVC, while the patient actually had a single SVC on CT scan. Conclusion: Transthoracic echocardiography can reasonably detect persistent LSVC in pediatric CHD patients.

Association between type of congenital heart disease with child growth and development status: A cross-sectional study in Medan, Indonesia.

Congenital heart disease (CHD) is a congenital disorder primarily affecting newborns and children. Children with CHD have a greater risk of experiencing growth delays or disorders compared to healthy children. CHD also affects various aspects of a child's development. The aim of this study was to determine the association of CHD types (cyanotic and acyanotic) with the growth and development status of children. A cross-sectional study was conducted among CHD patients at a national reference hospital in Sumatra, H. Adam Malik General Hospital in Medan, Indonesia. The children's growth status was assessed using the WHO growth chart, and the developmental condition was evaluated through the Denver Developmental Screening Test-II. Chi-squared test and Fisher's exact test were used to assess the association between the type of CHD with growth and development status in children. Using a consecutive sampling method, a total of 53 individuals were included in this study. Almost half of CHD patients (48.1%) were within the age group of 0-2 years and more than half (61.1%) were girls. Acyanotic CHD (74.1%) was more prevalent than cyanotic CHD (25.9%), with ventricular septum defect (VSD) as the most common diagnosis. A total of 37% of children with CHD suffered from malnutrition, whereas the remaining 62.9% had good nutrition. The Denver Developmental Screening Test-II indicated that 81.4% of the children were normal, whereas 18.5% had developmental disorders. Our data suggested a significant association between cyanotic CHD and poor growth status in children based on weight-for-age, weight-for-length, and body mass index (BMI)-for-age. However, there was no association between the type of CHD and developmental status in children. This study highlights that the type of CHD is significantly associated with the growth status of children, but not with their developmental status.

Comparison of Multiple Injection Costotransverse Block and Erector Spinae Plane Block for Post-Sternotomy Pain Relief in Pediatric Patients Undergoing Cardiac Surgery: A Prospective Randomized Comparative Study

ObjectiveThe aim of this study was to evaluate efficacy of ultrasound-guided Multiple Injection Costotransverse block (MICB) and compare it with Erector spinae Plane block (ESPB) for post-sternotomy pain relief in paediatric cardiac surgical patients. DesignA prospective, randomized, double-blind, comparative study. SettingSingle-institution tertiary referral cardiac centre. ParticipantsStudy comprised of 90 children with acyanotic congenital heart disease requiring surgery via sternotomy. InterventionsChildren were randomly allocated to 1 of the 3 groups: ESPB (Group1), MICB (Group 2) or Control (Group 3). Participants in Group 1 and 2 received 4 mg/kg of 0.2% ropivacaine for bilateral ultrasound-guided block after induction of anaesthesia. Postoperatively, intravenous paracetamol was used for multimodal analgesia and fentanyl/tramadol was used for rescue analgesia. Measurements and Main ResultsModified objective pain score (MOPS) was evaluated at 0, 1, 2, 4, 6, 8, 10, and 12 hours post-extubation. After all exclusions, 84 patients were analysed. MOPS score was found to be significantly lower in ESPB and MICB Group compared to Control Group till 10 hours post extubation (p<0.05), with no statistically significant difference at 12th hour (p=0.2198). Total intraoperative fentanyl consumption (p=0.0005), need for fentanyl supplementation on incision (p<0.0001) and need for rescue opioid requirement in postoperative period (p=0.034) was significantly lower in both ESPB Group and MICB Group than Control Group. There was no statistically significant difference in both primary and secondary outcomes between ESPB and MICB Groups. ConclusionUltrasound guided MICB was effective and comparable to ESPB for post-sternotomy pain management in paediatric cardiac surgical patients.

Case Report: A prenatal diagnosis of osteogenesis imperfecta in a patient with a novel pathogenic variant in COL1A2

Osteogenesis imperfecta is considered a rare genetic condition which is characterized by bone fragility. In 85% of cases, it is caused by mutations in COL1A1 and COL1A2 genes which are essential to produce type I collagen. We report the case of a female neonate delivered to a 27-year-old women at San Bartolomé Teaching Hospital with a family history of clavicle fracture. A prenatal control with ultrasound was performed to the mother at 29 weeks. A fetus with altered morphology and multiple fractures was found. Therefore, a prenatal diagnosis of osteogenesis imperfecta was performed. The neonate was born with a respiratory distress syndrome and an acyanotic congenital heart disease. Therefore, she remained in NICU until her death. We highlight the importance of prenatal diagnosis, genetic counseling and a multidisciplinary evaluation in this type of pathologies and report a new probably pathogenic variant in the COL1A2 gene detected by exomic sequencing in amniotic fluid.

Factors linked with the delayed diagnosis of congenital heart diseases. A single center experience from a tertiary care hospital of Pakistan.

Objective: To note the factors linked with delayed diagnosis of congenital heart diseases (CHDs) among children. Study Design: Cross-sectional study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan. Period: September 2022 to February 2023. Material &amp; Methods: We analyzed children aged up to 15 years who presented for the first time with echocardiographic evidence for the diagnosis of CHDs. Socio-demographic data along with clinical information like gender, age, residential status, maternal education status, history of maternal fetal echocardiography and the frequency of delayed diagnosis of CHDs were noted on a specially made proforma. Parent or guardians were asked for possible reasons of delayed diagnosis for CHDs. Results: In a total of 250 children, the mean age was 2.33±3.81 years while 162 (64.8%) children were aged below 2 years. There were 138 (55.2%) boys. Residential status of 159 (63.6%) children was rural while maternal educational status of 99 (39.6%) was illiterate. There were 164 (65.6%) children who were diagnosed to have cyanotic CHDs while 86 (34.4%) had acyanotic CHDs. Frequency of delayed diagnosis was noted among 182 (72.8%) children. In these 182 cases, delayed first consultation was the commonest factor behind delayed diagnosis noted in 78 (42.9%) children while missed diagnosis by the pediatrician was the 2nd most common factors linked with the delayed diagnosis of CHDs as described by 62 (34.1%) parents. Conclusion: Almost 3/4th of the studied children had delayed diagnosis of CHDs while cyanotic CHDs were the most common CHD types. Delayed first consultant and missed diagnosis by the pediatrician were the most common factors linked with delayed diagnosis of CHDs.

Effect of cardiopulmonary bypass on thiol/disulfide homeostasis in congenital heart surgery

Background: This study aims to investigate whether thiol/disulfide homeostasis parameters measurements could be used as a new biomarker to predict the pre- and post-cardiopulmonary bypass oxidative status of pediatric patients undergoing congenital heart surgery. Methods: A total of 40 children with congenital heart disease (17 males, 23 females; mean age: 39.6±40.0 months; range, 2 to 216 months) who underwent open-heart surgery were included. The control group consisted of 40 age- and sex-matched healthy children (18 males, 22 females; mean age: 42.8±46.6 months; range, 12 to 156 months). The patients with congenital heart disease were divided into two groups as cyanotic patients (n=18) and acyanotic patients (n=22). Thiol/disulfide parameters were compared among the cyanotic, acyanotic congenital heart disease patients, and control group preoperatively (pre-CPB). The effects of cardiopulmonary bypass on thiol/disulfide parameters, pre-CBP, immediately after cardiopulmonary bypass (post-CPB0), and 24 h after cardiopulmonary bypass (post-CPB24) were investigated. Results: The mean native and total thiol levels in the cyanotic patients were significantly lower than those in the acyanotic patients and control group (p&lt;0.0001). The cyanotic group exhibited higher disulfide levels than the acyanotic group (p&lt;0.01). The mean native thiol and total thiol levels significantly decreased in the post-CPB0 (p&lt;0.0001). The mean disulfide levels significantly increased in the post-CPB0 than the pre-CPB values (p&lt;0.001). Post-CPB24 native and total thiol levels were elevated compared to post-CPB0 (p&lt;0.0001). The mean disulfide levels significantly increased in the post-CPB24 period than the post-CPB0 values (p&lt;0.001). The survivor patients responded better to oxidative stress than non-survivor patients. Conclusion: Thiol/disulfide measurement is a promising biomarker in determining the pre- and post-cardiopulmonary bypass oxidative status of pediatric patients undergoing congenital heart surgery. The interpretation of thiol/disulfide levels, pre- and postoperatively, may be used in predicting mortality and outcomes of these patients earlier.

Seasonality and risk factor analysis of respiratory syncytial virus infection in children in Taiwan-A retrospective study from 1995 to 2005.

Respiratory syncytial virus (RSV) is one of the important pathogens leading to acute respiratory tract infection in infants and young children. We aimed to investigate the seasonality of RSV infection in different parts of Taiwan and to delineate the risk factors for severe RSV infections. We collected RSV-infected patients' data by retrospective chart review. A total of 1740 RSV-infected children aged under 18 years were enrolled. The infection was acquired during hospitalization in 103 (7.1%) children, while none of them required ventilator support or needed intensive care before RSV infection. The need for intensive care or ventilator support was significantly associated with congenital heart disease (CHD), chronic lung disease, and neuromuscular diseases. Age <1 year and nosocomially acquired infection are also significant predictors for the need of intensive care. Only the presence of CHD, especially acyanotic CHD, was significantly associated with a fatal outcome. RSV infection occurs all year round. Monthly distribution of RSV infections in Northern Taiwan showed a bimodal pattern, with one peak from March to May, and another from August to October. The distribution in Southern Taiwan showed a single peak from April to July. The occurrence of RSV correlates positively with temperature and rain. The bimodal seasonal distribution pattern in Northern Taiwan may be a transitional pattern shifting from a single high winter peak in temperate areas to a wider summer peak in tropical areas. Continuous surveillance is needed to explore the possible effect of global warming on the seasonality of RSV infection.

Clinical profile of congenital heart diseases detected in a tertiary hospital in China: a retrospective analysis.

Congenital heart diseases (CHDs) are conditions that involve structural problems to the heart's structure existing at birth, with an incidence of approximately 8 per 1,000 live births globally. CHD is one of the leading causes of maternal, fetal, and neonatal morbidity and mortality worldwide. The present study sought to examine the clinical profiles of CHD patients and provide important implications for therapeutic interventions. This was a retrospective, observational, cohort study. The medical records of all CHDs patients aged between 0 and 18 years were collected from July 1, 2021 to June 30, 2022. Clinical profiles and demographic data were collected from cardiology and pediatric department registers for analysis. Of the 265 children with CHDs, 201 were diagnosed with acyanotic CHD (ACHD), while 64 children had cyanotic CHD (CCHD). Based on the eleventh revision of the International Classification of Diseases (ICD-11), "congenital anomaly of a ventricle or the ventricular septum" was the most common CHD. The most common symptom was failure to thrive, accounting for 18.5% of all CHD cases. The most frequent symptom in ACHD was murmur (93.53%) and sweating (80.60%), whereas the most common symptom in CCHD was sweating (95.31%) and cyanosis (84.38%). This study retrospectively analyzed CHD clinical characteristics from children receiving care at the seventh center, which forms a proper basis for appropriate clinical treatments and further studies.

Is maternal pre-pregnancy Body Mass Index associated with type of Congenital Heart Disease in offspring?

HIGHLIGHTS The most common CHD was atrial septal defect for acyanotic CHD and Tetralogy of Fallot for cyanotic CHD. There was no association between maternal pre-pregnancy BMI and type of CHD in offspring. ABSTRACT Objectives: This study aimed to determine the association between maternal pre-pregnancy BMI and type of congenital heart disease (CHD) in offspring. Materials and Methods: This retrospective cross-sectional study involved all mothers of children with CHD who visited Pediatric Outpatient Unit at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, from January to December 2019. The maternal data were obtained from the KIA's (Maternal and Child Health) book or through anamnesis by telephone, while the offspring’s data were collected from medical records. The data were analyzed using the Chi-Square test. Significance was determined at a 5% level (p &lt;0.05). Results: We studied 117 mothers of children with CHD. The most frequent maternal pre-pregnancy body mass index (BMI) was normal (BMI 17-23 kg/m2) accounting for 56.4% of the study population. The most common CHD was atrial septal defect (33.3%) among acyanotic patients and Tetralogy of Fallot (8.5%) among cyanotic patients. The Chi-Square test showed p=0.958 for the association between maternal pre-pregnancy BMI and type of CHD in offspring. Conclusion: There was no association between maternal pre-pregnancy BMI and type of CHD in offspring.

Congenital heart diseases pattern among children presenting to tertiary care hospital

Aim: To determine the pattern of congenital heart diseases among children presenting to tertiary care hospital. Material and Methods: A cross sectional study was carried out at Department of Paediatrics Cardiology, National institute of Cardiovascular Disease Karachi in the duration from November, 2022 to April, 2023. Total 171 patients were presented with CHD. Patients aged between 1 to 12 months of both genders. Pattern of CHD among the patients was determined. Results: Acyanotic CHD was seen in 74.26% patients. Cyanotic CHD was seen in 25.73% patients. Atrial Septal Defect (48.8%) was the most common presentation in acyanotic CHD patients while Tetralogy of Fallot was common presentation (40.9%) in cyanotic CHD patients. Conclusion: From our study we conclude that majority of the patients had acyanotic CHD as compared to cyanotic CHD, Ventricular Septal Defect and Atrial Septal Defect were more prevalent in cyanotic CHD while Tetralogy of Fallot was more common in cyanotic CHD.

Neurodevelopmental assessment of children with congenital heart diseases using Trivandrum developmental screening chart.

Congenital heart diseases (CHDs) are one of the most important congenital anomalies in children which have high-risk for neurodevelopment delay. This study was conducted to determine the proportion of developmental delay in children with CHD and comparison of delay between acyanotic and cyanotic heart diseases in children. A cross-sectional study was conducted on children admitted in pediatric ward of rural hospital from 6 month to 6 years of age who are diagnosed with CHD by 2D ECHO and further classified into acyanotic congenital heart disease (ACHD) and cyanotic congenital heart disease (CCHD). Neurodevelopmental assessment was done using Trivandrum development screening chart (TDSC). Out of total 50 children in study population, 24 children had TDSC delay, distribution as 11 (22%) ACHD and 13 (26%) CCHD. Out of 24 children in the age group of 0-3 years, 13 (54.2%) were ACHD and 11 (45.8%) were CCHD. Out of 26 children in the age group of 3-6 years, 15 (57.7%) were ACHD and 11 (42.3%) were CCHD. Among different ACHD included in the study population (0-3 years) children with ventricular septal defect (VSD) were maximum (n = 5) next in the decreasing order was atrial septal defect (ASD) (n = 3). ACHD included in the study population (3-6 years) children with VSD was maximum (n = 6) next in the order was ASD (n = 4). Proportion of delay in children with ACHD was 22% as compared to 26% in children with CCHD. There is a high proportion of neurodevelopmental delay in children with CHD which can be detected using TDSC which is a simple screening tool and can be used by any health-care professional without training for the assessment of neurodevelopmental outcome in these children. Delay was more in children with CCHD than ACHD.

Preanesthesia carbohydrate loading in pediatric patients with acyanotic congenital heart disease: a case series

Children with acyanotic congenital heart disease need cardiac catheterization for various indications, ranging from diagnostic procedures to innovative interventional therapy. Although preanesthesia fasting is widely accepted to minimize the risk of regurgitation and aspiration during induction, studies have shown that fasting also has a negative impact. Some studies have reported the incidence of anxiety in pediatric patients in the operating room to be 75.44% and 34–56% of it was caused by hunger.&#x0D; We report 4 of our patients, who were allowed maltodextrin drinks as much as 5–10 ml/kg 2 h before anesthesia and the patient's anxiety level, vital signs, blood sugar before and during the procedure, and the incidence of complications were observed. The results showed a low level of anxiety, with good vital signs, and normal blood sugar. Carbohydrate drinks given up to 2 h before the procedure to the patients reduced hunger and thirst so that they were more comfortable, had reduced anxiety and stable blood sugar levels during the procedure. No complications were found due to the administration of carbohydrate drinks; therefore, routine administration of carbohydrate drinks can be considered in pediatric patients with acyanotic congenital heart disease who will undergo cardiac catheterization.&#x0D; Key words: Pediatric; Congenital heart disease; Carbohydrate loading; Anxiety&#x0D; Citation: Kurnia A, Hidayat J. Preanesthesia carbohydrate loading in pediatric patients with acyanotic congenital heart disease: a case series. Anaesth. pain intensive care 2023;27(4):585−589; DOI: 10.35975/apic.v27i4.2156&#x0D; Received: February 17, 2023; Reviewed: March 05, 2023; Accepted: May 27, 2023

Anesthetic management of pediatric patients with congenital heart disease posted for cochlear implant: a case series

Congenital heart disease (CHD) is the most common birth defect which might be a part of a broader syndrome. Such patients pose many challenges when subjected to anesthesia for non-cardiac surgery. Therefore, a patient-specific peri-operative management plan needs to be employed to reduce peri-operative morbidity.&#x0D; We conducted 10 pediatric cases with CHD posted for cochlear implant surgery. The study was conducted in GMERS Medical College, Gandhinagar, India. Each case was managed peri-operatively with a standardized protocol. All patients had acyanotic CHD, and no patient had complex CHD. They were pre-operatively assessed in detail and optimized if required. As part of intra-operative management, care was taken to avoid sudden hemodynamic fluctuations by using etomidate as induction agent and atracurium as muscle relaxant. Inj. lignocaine was used to prevent hemodynamic response to intubation. Adequate analgesia was achieved. None of the patients had any adverse cardiac event peri-operatively. We were able to manage each patient successfully without any untoward consequences.&#x0D; Key words: Congenital heart disease; Cochlear implant; General anesthesia; Pulmonary hypertension; Pulmonary vascular resistance; Systemic vascular resistance&#x0D; Citation: Gadani HN, Jariwala ND, Kureshi MM, Shah VM, Thakkar PD. Anesthetic management of pediatric patients with congenital heart disease posted for cochlear implant: A case series. Anaesth. pain intensive care 2023;27(4):590−595; DOI: 10.35975/apic.v27i4.2272&#x0D; Received: May 11, 2023; Reviewed: May 25, 2023; Accepted: Jun 07, 2023