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CAR/01(P) PROFILE OF CHILDREN WITH ACUTE RHEUMATIC FEVER
K.K.Locham, Puneet Jairath, Kamaljeet Kaur, Shalini Soi
Deptt. of Pediatrics, Govt. Medical College/Rajindra Hospital, Patiala - 147001
Objectives : To evaluate the clinical profile of children with acute rheumatic fever . Methods : The
study included 9 children with acute rheumatic fever admitted in department of Pediatrics, Govt.
Medical college/ Rajindra Hospital, Patiala. Age, sex, presenting complaints and clinical profile was
recorded in a predesigned proforma. Laboratory parameters in the form of ASO titre, CRP, ECG and XRay chest were done in every case. Results : Out of the 9 children of acute rheumatic fever, 7(77.77%)
were in the age group of 5-10 years and 2 (22.22%) were in age group of 10-15 years. 5 (55.55%)
children were male and 4 (44.44%) were female. 7 (77.77%) children had fever, 3 (33.33%) had
arthralgia and 1 (11.11%) child each had fatigue, breathlessness and oedema as the presenting
complaints. 8 (88.88%) children had carditis. Out of 8 children of carditis, 3 (33.33%) were having
carditis and arthritis, 1 (11.11%) was having carditis and subcutaneous nodules and 1 (11.11%) was
having carditis and chorea. Carditis alone was observed in 3(33.33%) cases while chorea alone was seen
in 1(11.11%) case. ASO titre was positive in all the 9 (100%) cases, CRP was positive in 7 (77.77%)
cases and ECG abnormality was seen in 1 (11.11%) case only. Congestive heart failure and infective
endocarditis was present in 1 (11.11%) child each as a complication of rheumatic fever. Conclusions :
Carditis was the most common clinical presentation of rheumatic fever.
CAR/02(P) ROMANO-WARD SYNDROME IN A FAMILY WITH INDEX CASE
PRESENTING AS CARDIAC ASYSTOLE
Rajniti Prasad, OP Mishra, BD Bhatia, Narendra Reddy
Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005,
Romano-ward syndrome is an autosomal dominant disorder, which may present with cardiac events
such as syncope, cardiac arrest and sudden death in healthy children. We present this case because of
rarity and index child presenting as cardiac asystole who had survived with cardiopulmonary
resuscitation and symptom free on atenolol therapy. Objective: to present a family of Romano-ward
syndrome with index case presenting as cardiac asystole. Design: a case report Setting: pediatric ward,
Institute of Medical Sciences, BHU. Case summary: 5 year male child presented with fever, cough,
running nose for one day, vomiting (2 episodes) for 1 hour and altered sensorium with gasping
respiration for 5 minutes. There is no history of drug intake, choking, convulsions and similar episodes
in the past. There is no family history of deafness, sudden death, syncopal attacks or convulsions. On
examination child was cyanosed with occasional gasping respiration and heart rate was 0.
Cardiopulmonary resuscitation was initiated with PPV by bag and mask and chest compression. ECG
leads were attached, which showed absence electrical activity. Intravenous adrenaline was given
(1:10000 dilution, 0.1ml/Kg). After 30 seconds of IV adrenaline, normal sinus rhythm with a heart rate
of 130/minute was restored. Child became fully conscious in 30 minutes. ECG done showed prolonged
QTc (0.61), inverted T waves in all the precordial leads, and a large amplitude inverted T wave which
was followed by a small amplitude T wave(V4,V5) or upright/flat T waves(L2)(T wave alterans). Holter
monitoring showed a minimum heart rate of 52/minute, T wave changes mentioned above and no
evidence of ventricular arrhythmia. Serum calcium, phosphate, sodium, potassium and magnesium were
normal. 24 hours. Audiometric examination of the child was normal. ECG of the siblings and parents
showed prolonged QTc (>0.47) in two sisters and mother. ECG of the grand parents could not be done.
The diagnosis of congenital Long QT syndrome, Romano-Ward syndrome was made. Patient and his
two sisters were put on atenolol as they could not afford an ICD. Conclusion: Patients with Romanoward syndrome usually presents with sudden cardiac events in healthy children which may be prevented
by ICD and / or beta-blocker such as atenolol, propranolol.
CAR/03(P) CLINICAL PROFILE OF PATIENTS WITH CONGESTIVE CARDIAC FAILURE
WITH EMPHASIS ON ETIOLOGY AND OUTCOME
Sheikh Samir S., Vyas B. R.
Department of Pediatrics, Shri M. P. Shah Medical College and Guru Gobind Singh Hospital,
Jamnagar-361008
Objectives: A prospective study concerning the patients of congestive cardiac failure (CCF) with
respect to the incidence, etiology and outcome of management in different age groups. Method: 246
admitted patients diagnosed to have CCF of age group >1 month to <12 years were included in the
study. Detailed history, complete physical examination and relevant investigations inclusive of
echocardiography were recorded on prestructured proforma. Symptomatic management along with
treatment of causative factors and ensuing complications was done and daily note of clinical progress
was maintained. All the observations were tabulated in 3 age groups; I - ≤ 1 year (107 cases), II - >1
year to ≤5 years (70 cases) and III - >5 years (69 cases) and subjected to statistical analysis. Results:
Total cases studied constituted 4.35% of total admissions with male:female ratio of 1.17:1. Pie diagram
depicted congenital heart disease (CHD) (44.86%) followed by severe anemia (40.20%) as the main
etiology of CCF in age group I. In age groups II and III, severe anemia (64.31% and 65.24%
respectively) remains the commonest cause. Poverty, malnutrition, tuberculosis etc. contributed to the
high incidence of cor pulmonale (Cor P) and acute rheumatic fever (ARF) as causative factors.
Breathlessness (100%) and fever (78.45%) were the major presenting complains while raised JVP
(100%), tachypnoea (100%) and tachycardia (97.15%) were the prominent signs. Patient outcome was
favorable with the cure rate of 63% on the whole. Referral (29.56%) and mortality (23.36%) was high in
age group I attributed mainly to CHD. Conclusions: General incidence of CCF is 4.35% with ≤1 year
age group been the most affected due to high incidence of CHD. Severe anemia followed by Cor P and
ARF affected all age groups. Clinical features remain diagnostic and outcome is favorable with modern
investigation techniques and management modalities.
CAR/04(O) ROLE OF CARDIAC CATHETER INTERVENTIONS IN MANAGEMENT OF
CONGENITAL HEART DISEASE: EXPERIENCE IN OUR INSTITUTION
Manisha Chakrabarti,S. Radhakrishnan,Savitri Shrivastava.
Escorts Heart Institute, New Delhi
Introduction : Catheter interventions have changed the management of congenital heart disease. We
share our experience of interventions done in palliative and therapeutic management of congenital heart
disorders. Objective: To assess how cardiac catheterization help in the management of CHD. Methods:
A retrospective study was carried out with 1010 patients of CHD who underwent cardiac Catheter
Intervention . Time period: January 1999 - April 2005. The interventions were as follows: Balloon
atrial septostomy: 90, Balloon aortic valvotomy: 110, Balloon pulmonary valvotomy: 69, ASD Device
closure: 381, PDA Coil /Device closure: 260, PFO Device closure: 1, VSD Device closure: 11,
Balloon dilatation of coarctation of aorta:
6, Stent of coarctation of aorta:
4, Peripheral PA stent:
2, PA branch balloon dilatation: 3, Coil embolization of coronary AV fistula: 3, RSOV closure by
device:
1, Coil embolization of collaterals: 60. Results: Out of 110 patients of balloon aortic
valvotomy 33 were infants, of which 21 patients were neonates. Balloon pulmonary valvotomy was
done in 26 infants out of which 5 were neonates. There were only two mortalities in 5 years i.e. 0.002%
of which one in a neonatal balloon aortic valvotomy and the other in critical pulmonary stenosis .ASD
device failed in 22 cases and PDA device in 3 patients which were referred for surgery. Three cases of
PDA coil and two cases of MAPCA coil got embolized but snared out successfully. Minor
complications include loss of femoral pulse, fever, local hematoma which were managed
conservatively. Conclusion: Cardiac catheter intervention is generally safe with very low morbidity and
mortality and excellent overall results. However it should be done only with definite indications.
CAR/05(O) STUDY OF LIPID PROFILE IN CHILDREN AGED 5 TO 18 YEARS WHOSE
ONE OF THE PARENTS HAS EARLY CORONARY ARTERY DISEASE BELOW 50 YEARS
Anuj Sehgal, M. L. Kulkarni
HOD, Department Of Pediatrics, J J M MEDICAL COLLEGE, Davangere, Karnataka 577004
Various studies have established that LDL-cholesterol, total cholesterol and triglyceride levels were
found to be high in offspring of parents who had premature Coronary artery disease (CAD) and also
HDL cholesterol levels were low in these children. It is with this interest to know the lipid profile of
children of parents who have an early CAD we conducted the study in our region comprising of a rural
to semi urban population. METHODS: This study was conducted in the Department of Pediatrics and
Department of Cardiology JJM Medical College.100 children were taken in study and 25 in the control.
The controls were age and sex matched children of parents with no history of coronary artery disease
age less than 50 years. Results: The mean total cholesterol for the children of parents with the early
CAD was significantly high (140.8 ± 22.5mg%) when compared to that of children in the control group
(130.0 ± 17.8 mg%) (p<0.05). The mean HDL was significantly low is the children in the test group
when compared to children in the control group (37.8±2.0mg% vs 39.6 ± 2.3mg%) (p<0.001). Serum
LDL cholesterol was significantly higher (80.1 ± 19.6mg%) in the test group when compared to the
control group. In control group (66.2±18.6 mg%) (p<0.01). Serum triglyceride however was not raised
in the test group and there was no significant difference in triglyceryde levels between the test and the
control group (113.7±27.6mg% vs 120.6±22.6 mg%). Conclusion: Serum total cholesterol low density
lipoprotein cholesterol (LDL cholesterol), were significantly higher in offspring of young ischemic
heart disease parents as compared to those of normal parents. Their high density lipoprotein cholesterol
was significantly less than the children of normal parents. We suggest a follow up of these children and
see the tracking of cholesterol levels in this ‘lipid risk group’.
CAR/06(O) VALUE OF ECHOCARDIOGRAPHY IN A TERTIARY CARE NEONATAL
INTENSIVE CARE UNIT
Chopra A, Kulkarni A, Kaul S, Gupta V, Balan S, Kohli V
Division of Neonatology, Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospitals, New
Delhi.
Background : It may be difficult to rule out congenital heart disease in a sick newborn on clinical
grounds alone. In addition persistent pulmonary hypertension can complicate RDS and diagnosis can
only be confirmed by echocardiography. Objectives: a)To evaluate the indications of echocardiography,
b) Co-relate the clinical signs with echo findings, c) Evaluate response to specific management.
Methods: A retrospective analysis was carried out on all the echocardiograms performed in the neonatal
ICU between Jan 2000 and Dec 2004. Results: The total no. of neonates admitted during the study
period was 1580. The no. of echocardiograms performed were 410 of which 280 (68%) were done on
outborns and 130 (32%) on inborns. The commonest indication for an echo was birth asphyxia followed
by respiratory distress with shock, suspicion of congenital heart disease and sepsis. Persistent
pulmonary hypertension (PPHN) was the commonest finding (34 %) followed by acyanotic heart
disease (17 %), cyanotic heart disease (8 %) and cardiomyopathy (6 %). Patent ductus arteriosus (PDA)
was the commonest acyanotic heart disease needing pharmacological closure in 93% cases and ligation
in 7 % cases. d-TGA was the commonest among the cyanotics. The echocardiogram was normal in 35
% of the neonates done for pre-anesthetic check up to rule out cardiac malformation, in very low birth
weight babies and for family history of congenital heart disease and high risk pregnancies. Conclusion:
Echocardiography certainly helps in diagnosis of congenital heart disease, assessment of cardiac
function and timely management. Echo forms an integral part of NICU management especially in
preterms with an open ductus and in terms with high pulmonary pressures.
CAR/07(O) PATTERN OF CONGENITAL HEART DISEASE IN INFANTS ATTENDING
PRIVATE MEDICAL COLLEGE
Ravinder K. Gupta, Arjun Singh, Ashok Bakaya
Department of Pediatrics, Acharya Shri Chander College of Medical Sciences and Hospital(ASCOMS),
Sidhra,Jammu
Objective: To detect different types of cogenital heart diseases among the infants attending private
medical college and to study the clinical profile. Design: Prospective Study Setting: Indoor and Outdoor
wings of Department of Pediatrics and Cardiology, ASCOMS and Hospital, Sidhra, Jammu. Methods
and Subjects: The prospective study was conducted over a period of one year. About fifty infants
presenting with features of congenital heart disease were enrolled for the study. Besides detailed history
and clinical examination, relevant investigations were done. Echocardiography was done in all the
cases. Results: Among the fifty infants having congenital heart diseases enrolled for the study males
slightly outnumbered females (27males:23females). There were about 12 neonates. About 40%
presented in late infancy. About 32% presented with cyanosis and rest 68% were considered as
acyanotic heart disease. About 62% had isolated cardiac lesions while rest 38% had complex lesions.
Acyanotic group consisted of VSD (32%) ASD (16%) PDA (12%) while cyanotic group had tetralogy
of fallot (TOF) (12%), transposition of great arteries (6%), pulmonary stenosis (6%), pulmonary atresia
(4%), total anomalous pulmonary venous connection (TAPVC) (4%).Eight neonates had cyanotic heart
disease. Four cases of Down’s syndrome were part of the study and the cardiac lesion among three such
cases was VSD while rest had ASD. Recurrent chest infections, feeding difficulties, failure to gain
weight and excessive sweating while feeding were the common presenting features in acyanotic group.
Cyanosis, exertional dyspnea (hypercyanotic spells) and poor weight gain were the presenting features
in the cyanotic group. About nine cases of VSD, three cases of PDA were complicated by congestive
failure. Conclusion: Acyanotic congenital heart diseases far outnumber the cyanotic counterparts. VSD
is the commonest acyanotic heart disease and TOF is the commonest in cyanotic variety. Infants with
feeding difficulty, poor weight gain and recurrent chest infections should make one suspect of
congenital heart disease. Cyanotic heart disease can present in early infancy.