Pattern of paediatric congenital heart diseases.

Objective: To find out pattern along with age and gender wise distribution of congenital heart disease (CHD). Study Design: Cross Sectional study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Narowal. Period: January 2019 to February 2020. Material & Methods: During the study period, a total of 151 children aged between 1 month to 15 years as confirmed case of CHD according to echocardiography were enrolled for this study. Gender, age categories, area of residence and types of CHDs were represented as frequency and percentages. Patients with different types of CHDs were distributed between both gender and different age categories. SPSS version 26.0 was used to handle and analyze all study related data. Results: During the study period, a total of 151 confirmed cases of CHD were enrolled. There were 82 (54.3%) male and 69 (45.7%) female representing a male to female ratio of 1.2:1. Most of the cases were aged less than 1 year. There were 118 (78.1%) children below 1 year of age while 22 (14.6%) between 1 to 5 years of age and 11 (7.3%) above 5 years of age. Ventricular septal defect (VSD) and ASD were noted to be the most frequent types of acyanotic heart lesions in 41 (27.2%) and 29 (19.2%) cases respectively whereas TOF was the most frequent type of cyanotic heart lesion in 23 (15.2%) cases. Conclusion: VSD followed by ASD and TOF were noted to be the most frequent types of CHD.

COVID-19 associated changes in the right departments of the heart in the elderly people

Purpose of the work: to study the indicators characterizing heart lesions in elderly patients who had carried COVID-19. Materials and methods: 86 patients older than 60 years old, were examined, of whom 56 (32 women and 24 men) who have carried COVID-19 between 3 and 6 months before the study, and 30 patients (12 men and 18 women) who did not have COVID - 19 in the anamnesis. The patients have been examined clinically, electro and echocardiography have been performed. The results. Elderly patients during the post-covid period have complaints of shortness of breath, pain in the heart, swelling, coughing, weakness, which are more stable and intense than before the infection. Patients who have carried COVID-19 demonstrate the signs of a chronic pulmonary heart disease: increase in the size of a right ventricle and decrease of its contractile ability, increase in pressure in a pulmonary artery. Signs of a statistically significant moderate decrease of the contractility in the left ventricular were also identified. Conclusions. The statistically significant changes in the right departments of the heart among the patients with carried COVID-19 with persistent symptoms after infection were defined. Patients who have carried COVID-19 but have no symptoms did not differ statistically from the control group. Key words: COVID-19, old age, post- COVID period, right departments of the heart.

Post-COVID-19 infections and evolution of pulmonary and cardiac lesions – the battle has just started

Talking only about the acute phase of COVID-19 infection is not enough. A multitude of complications has arisen after viremia, which has been generating problems for experts. Of these, lung and heart lesions remain important, and interventions, and their prevalence pose real problems for practitioners. The authors analyze these post-COVID-19 complications as well as appropriate recommendations for diagnostic and therapeutic interventions

Pregnancy Outcome in Women with Heart Disease in a Tertiary Care Centre in Kolkata, India

BACKGROUND The incidence of cardiac lesions is less than 1 % amongst hospital deliveries. The commonest cardiac lesion is of rheumatic origin followed by the congenital ones. Heart diseases have a significant impact on maternal and perinatal morbidity and mortality. The purpose of the study was to find out the specific heart lesion in pregnancy in a particular demographic area and evaluate the maternal and perinatal outcome. METHODS This was a two-year retrospective observational study done by reviewing the records of all the mothers with heart diseases admitted for pregnancy from April 2016 to March 2018. RESULTS The study included 42 patients. The majority of heart lesions was mitral stenosis of rheumatic origin. Prophylactic forceps in second stage of labour was the major method of delivery. As far as the perinatal outcome is concerned, low birth weight and prematurity were the major problem in the babies born to these mothers. CONCLUSIONS With advances in medical care and surgical approach, the obstetricians should be prepared to manage an increasing number of women with heart disease during pregnancy. A combined multidisciplinary care is essential in managing these cases. KEY WORDS Rheumatic Heart Disease, Congenital Heart Disease, Cardiac Failure, Forceps Delivery, Prematurity

PATHOLOGY OF FOOT AND MOUTH DISEASE (FMD) OUTBREAD IN CATTLE, SHEEP AND PIGS IN IBADAN

The death of 18 calves (mostly of exotic breeds) during an outbreak of FMD (SAT-2) was attributed to sever heart lesions consisting of nonsuppurative myo cardial degeneration, haemorrhage and calcification. Mouth and feet lesions were also present. In adult cattle as well as sheep and pigs, mortality was very low and was attributed mainly to some other concurrent or secondary conditions. In view of the unusual susceptibility of exotic cattle (especially calves) it is suggested that extra precautionary measures be taken against FMD when pregnant cows are imported to enzootic areas.

Multivalvular destruction as the primary presentation of aggressive infective endocarditis with subaortic valve membrane

Multivalvular destruction may be a clinical manifestation of infective endocarditis (IE), which is a devastating infection of the heart either alone or superimposed with congenital subaortic membrane as in this case report. Here, we report a case of multivavular destruction with severe vegetation presented as a manifestation of infective endocarditis (IE) in a neglected case of 18-year-old male with previous rheumatic heart disease. Transesophageal echocardiography is an important imaging modality for diagnosis of superimposed aortic and heart lesions. Early necessary investigation and correct diagnosis is mandatory to prevent bad complications. doi: https://doi.org/10.12669/pjms.37.2.2798 How to cite this:Alshoabi SA, Aljaber NN, Gameraddin MB, Omer AM. Multivalvular destruction as the primary presentation of aggressive infective endocarditis with subaortic valve membrane. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.2798 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Small heart anomalies as cardiac manifestations of hereditary connective tissue disorders

Introduction. Small heart anomalies (SHA) are the morphological basis for functional changes in cardiac activity and can exacerbate the course of organic heart lesions. The most studied SHA include false chords of the left ventricle (FCLV) and mitral valve prolapse. Prevalence, association with external signs of dysembryogenesis, as well as the predictive value of SHA are not sufficiently studied. Materials and methods. We examined 611 people between the ages of 18 and 23 (average age 20.3 1.6 years), including 257 boys and 354 girls. All of the surveyed performed phenotypic, anthropometric and echocardiographic examinations. To identify the SHA links to heart rhythm disorders, the 205 surveyed performed Holters ECG monitoring. Results. SHA identified in 90% of the individuals surveyed: atrial septum aneurysm (24%), tricuspid valve prolapse (23.4%), asymmetry of the aortic valve (20.6%), additional papillary muscles (39.4%) and FCLV (75,1%). Correlation analysis showed the presence of links between these SHA and bone signs of dysembryogenesis (chest deformities, arachnodactyllia, dolistennomely and high palate), as well as heart rhythm disorders (supraventricular and ventricular extrasystoles, rhythm driver migration and episodes of AV-blockade 1 degree). Patients with marfanoid habitus have a higher average number of SHA (2.1 1.4 vs 0.9 0.7, p 0.005). Conclusions. SHA are identified in the vast majority of healthy people. Bone signs of dysembryogenesis are associated with significant SHA and can serve as a marker for the involvement of the heart in the dysplastic process. Patients with SHA have significant cardiac arrhythmias.

Cardiomyopathy Associated With Coronary Arteriosclerosis in Free-Ranging Eurasian Lynx (Lynx lynx carpathicus)

The Eurasian lynx (subspecies Lynx lynx carpathicus) was reintroduced to Switzerland in the 1970's. Health monitoring of the reintroduced population started in the late 1980's. Since then, six lynx have been found affected by a myocardial disease. The earliest case was an animal that died after a field anesthesia. Two lynx were found dead, two were euthanized/culled because of disease signs, and one was hit by car. Two had a heart murmur at clinical examination. At necropsy, the first animal showed only lung edema but the other five had cardiomegaly associated with myocardial fibrosis. Three had multisystemic effusions. Histological examination of all six lynx showed mild to severe, multifocal, myocardial interstitial and perivascular fibrosis along with multifocal myocyte degeneration and loss, and replacement fibrosis. Moderate to severe multifocal arteriosclerosis with associated luminal stenosis of the small and medium-sized intramural coronary arteries and the presence of Anitschkow cells was also observed. The heart lesions may have led to sudden death in the first case and to a chronic right-sided heart failure in the remaining. None of the lynx showed lesions or signs suggestive of an acute or subacute infection. Given the common geographic origin of these animals and the severe loss of heterozygocity in this population, a genetic origin of the disease is hypothesized.

Characteristics of the pulmonary circulation in infants with complete atrioventricular septal defect

Objective: Infants with complete atrioventricular septal defect occasionally accompany pulmonary hypertension; however, the pulmonary circulation can be altered by pulmonary vascular conditions as well as the left heart lesions. This study aimed to explore whether the left heart lesions were related to the pulmonary circulation among them. Methods: We performed echocardiography and cardiac catheterisation in 42 infants with complete atrioventricular septal defect and studied relationships between the pulmonary haemodynamic parameters and the left heart morphology. Results: Age and weight at preoperative evaluation were 65 days (47-114) (the median following interquartile range) and 5.5 kg (4.0-7.1), respectively. There were 27 individuals with Down syndrome. Gestational age was 38 weeks (37-39). Catheterisation showed mean pulmonary arterial pressure: 36 (29-46) mmHg, the ratio of pulmonary to systemic blood flow: 3.45 (2.79-4.98), pulmonary vascular resistance: 2.20 Wood units·m2 (1.53-3.65), and pulmonary arterial compliance: 2.78 (1.86-4.10) ml/Hg/m2. Echocardiography showed the Rastelli classification type A in 28 and type C in 14, moderate or severe left atrioventricular valve regurgitation in 19 patients (45%), atrioventricular valve index of 0.67 (0.56-0.79), left ventricular end-diastolic volume z score of 4.46 (1.96-7.78), and aortic valve diameter z score of −0.70 (−1.91 to 0.20). Multivariable regression analysis revealed that preoperative pulmonary vascular resistance was significantly correlated to gestational age (p = 0.002), and that preoperative pulmonary arterial compliance was significantly correlated to gestational age (p = 0.009) and Down syndrome (p = 0.036). Conclusions: The pulmonary circulation does not depend upon the presence of left heart lesions but gestational age and Down syndrome in infants with complete atrioventricular septal defect.