CAR/01(P) PATENT DUCTUS ARTERIOSUS STENTING IN NEW BORN BABIES
Prabhat Kumar
Head Deptt of Pediatric, Cardiology Military Hospital (Cardio thoracic centre), AFMC, Pune
drprabhat_cardio@yahoo.co.in
Introduction: Neonates with duct dependant circulation present as life threatening emergency.
There survival depends on patency of the ductus arteriosus ( PDA ) till the time of cardiac
surgery. We present our experience of three new born babies who were successfully managed
with ductal stenting. Case report : Three babies with birth weight of 2.4 kg - 3.6 kg, noticed to
have cyanosis on day of birth were transferred to our centre . Systemic examination was normal
except a grade II / VI systolic murmur over left II intercostal space. Echocardiography showed
PDA of 2 mm diameter. One patient had Pulmonary atresia while two had hypoplastic left heart
syndrome( HLHS ) . Prostaglandin E1 infusion was immediately started at the rate of. 01 mcg /
kg / min. Ductal stenting was performed due to its obvious advantages. In patient with
pulmonary atresia a coronary stent with diameter 3.5 mm and length of 20 mm and in HLHS a
stent size 10 mm X 30mm were deployed. It was ensured that length of the stent was longer than
the duct so that it covered full length of duct including both ends adequately . In future these
patients will get single ventricle repair. Result and Conclusion: The procedure of ductal stenting
is performed at very few centers. The successful procedure highlights the importance of early
recognition of new born babies with duct dependant circulation and their referral to a tertiary
care centre.
CAR/02(P)
CONGENITAL
HEART
DISEASE:
CLINICOECHOCARDIOGRAPHICAL PROFILE OF INFANTS ATTENDING PRIVATE
MEDICAL COLLEGE
Ravinder K. Gupta, Vikas Sharma , Prenika Shangloo , Ashok Bakaya
Department of Pediatrics & Cardiology Acharya Shri Chander College of Medical Sciences and
Hospital(ASCOMS), Sidhra, Jammu
drrk_gupta2000@yahoo.com
Objective: To detect different types of congenital heart diseases among the infants attending
private medical college and to study the clinical and echocardiographical 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 two years ,i.e Mar 2008 to Feb. 2010. One hundred
twenty infants suspected to have 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 120 infants enrolled for the
study 100 were having congenital heart disease as per echocardiographic findings. In rest 20
patients echocardiography was normal. In this study males slightly outnumbered female (54
males:46 females). 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%),
complex lesions (4%).Eight neonates had cyanotic heart disease. Six 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.
CAR/03(O) COMPARISON OF BOSENTAN VS SILDENAFIL IN CHILDREN WITH
PULMONARY HYPERTENSION
Brig Mukti Sharma, Maj Suprita Kalra, Col KS Rana
Department of Pediatrics, AFMC Pune
kalrasuprita@gmail.com
Introduction: Pulmonary hypertension(PAH) is a rare cause of morbidity & mortality in children
with incidence ranging from one to two new cases per million.Use of sildenafil,a
phophodiesterase inhibitor for PAH has been a common practice due to ease of administration &
low cost . Aim & objectives: This was a pilot study conducted to compare the efficacy of
Bosentan vs Sildenafil in children with PAH.Bosentan is a specific and competitive antagonist of
endothelin receptor types ETA and ETB causing selective pulmonary vasodilatation. Materials &
methods: 21 children with idiopathic PAH were studied in a tertiary care centre from Jun 2008 to
Jun 2010.Children with congenital heart disease with left to right shunt &/or any underlying
pulmonary disease were excluded. These children were in the age group of newborn to 12 yrs
with mean age group being 2 yrs ± 9.3yrs.Male to female ratio was 1:1.5.The children were
randomized to sildenafil or Bosentan group depending upon the affordability. Echocardiographic
measurement of TR gradients was taken as marker of PAH. Baseline Echocardiography was
done in all children & repeated at the end of 2 wks & 4 wkly thereafter. Results: In 10 children
(group 1) initial pulmonary pressures were 40-60mmHg & >60 mmHg in remaining (group II).In
children given Bosentan at the end of 2 wks the TR gradients decreased by an average of 10-20
mmHg in group I & 20-30mm in group II.In children on sildenafil in group I l there was only a
negligible fall in pulmonary pressure & by 10-20mm Hg in group II. After 2 months the total TR
gradients dropped by 30 -40mm in Bosentan group & by 10-20mm in sildenafil group.
Conclusion:This study shows that use of Bosentan in children with Pulmonary hypertension has
a modest advantage over Sildenafil however a larger study will be required to validate this
statement.
CAR/04(P) GROWTH OF ECONOMICALLY DISADVANTAGED
FOLLOWING CARDIAC SURGERY
Praveen S Lal, Pankaj Kasar, J Vimala, R Suresh Kumar
Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai.
praveenslal99@gmail.com
CHILDREN
Introduction: Malnutrition and consequent poor somatic growth are rampant in economically
underprivileged children. Children with CHD from underprivileged families have the double
burden of poverty and heart disease. Very little is known about the impact of CHD surgery on
their subsequent growth. Aims and Objectives: To assess the impact of congenital heart surgery
on anthropometric scores of growth in economically disadvantaged children. Materials and
Methods: A cohort of 100 economically disadvantaged children was followed up after cardiac
surgery for their nutritional recovery. Weight, height and body mass index for age were
measured just before surgery and at a median period of 48.1 months (range 9 to 59.9 months)
after surgery. Z scores of the age adjusted variables were compared using paired‘t’ tests and the
McNemar chi square test wherever appropriate. Results: The mean weight for age of the cohort
increased from 14.7±5.76 to 23.8±7.83. In malnourished children (weight for age Z score less
than -2) the mean weight changed from -3.1 to -1.6 (p <0.05). The median improvement in
weight for age Z score was 0.85. The change in other parameters was not statistically significant.
The proportion of malnourished children decreased from 61% to 27% after surgery. Subgroup
analysis of the children with malnutrition showed significant improvement in weight for age Z
scores (p=0.002) compared to non-malnourished children, those with worse malnutrition faring
better. Children with residual malnutrition tended to have extreme economic backwardness,
surgery for cyanotic CHD or associated syndromes. Conclusion: Congenital heart surgery
resulted in a salutary improvement in the growth of children from an economically
underprivileged background. Residual malnutrition was likely to be associated with extreme
economic backwardness, surgery for cyanotic congenital heart disease or coincidental
syndromes.
CAR/05(P) RECOMBINANT ACTIVATED FACTOR VII IN THE MANAGEMENT OF
EXCESSIVE
BLEEDING
FOLLOWING
OPEN-HEART
SURGERY
FOR
CONGENITAL HEART DISEASE
Praveen S Lal, Deepak Changlani, Uday Charan Murmu, G Selvakumar,
J Vimala, R
Suresh Kumar
Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai.
praveenslal99@gmail.com
Introduction: Post-operative bleeding requiring the administration of blood products, haemostatic
drugs, and re-exploration are associated with increased morbidity, mortality, and resource
consumption. Recombinant activated Factor VII (rFVIIa) is new therapeutic agent, which offers
an effective treatment strategy for patients with excessive bleeding. Aims And Objectives: To
evaluate the efficacy of recombinant activated Factor VII for excessive bleeding following openheart surgery for congenital heart disease. Materials And Methods: This is a prospective study of
8 consecutive cases of excessive post-operative bleeding following surgery for congenital heart
disease admitted to pediatric ICU from August 2009 to August 2010. Median age of patients was
1 year 4 months. Their demographic, procedural, and hematologic data were analyzed. Three
patients underwent intracardiac repair for Tetralogy of Fallot, one patient underwent intracardiac
repair for DORV/VSD, three patients underwent arterial switch operation for dTGA/VSD and
one patient underwent truncus arteriosus repair. Median cardiopulmonary bypass time was 251
min. All patients had persistent intraoperative bleeding not responding to blood products or
excessive postoperative chest tube drainage (>10ml/kg/hr). All eight patients received 8090mcg/kg single dose of rFVIIa intravenously over 2-3 min. Time to cessation of bleeding or
chest tube drainage <1ml/kg/hr was assessed. Results: In the eight patients who underwent
complex open-heart surgery for congenital heart disease, rFVIIa was effective in controlling
excessive bleeding within a mean period of 45mins. None of the patients required surgical reexploration. Conclusion: Recombinant FVIIa is a useful drug in the pharmacologic management
of excessive post-operative bleeding following open heart surgery for congenital heart disease.
CAR/06(P) EVALUATION OF BALLOON ATRIAL SEPTOSTOMY V/S PGE1
INFUSION AS A PALLIATION IN NEONATES WITH TGA
Brigadier Mukti Sharma, Major Gururaja R, Colonel Rakesh Gupta
Department of Pediatrics, Armed Forces Medical College, Pune – 410040
yashguruafmc@rediffmail.com
Introduction: Transposition of great arteries (TGA) with intact ventricular septum present as
medical emergency. Such cases require palliation before definitive surgery. Palliation options
available are prostaglandin infusion (PGE1) or balloon atrial septostomy (BAS). Our study aims
to evaluate the effectiveness of BAS against PGE1 infusion as a palliation in neonates with TGA
with intact septum. Aims and Objectives: To evaluate the effectiveness of BAS against PGE1
infusion as a palliation in neonates with TGA. Material and Methods: This study was conducted
at a tertiary care centre over period of two years from Jan 2008. All consecutive neonates
diagnosed as TGA with intact septum were enrolled in the study and analysed. Results: 15
neonates with TGA with intact septum were evaluated in the study. Based on their presentation
and clinical profile, they were divided into 3 groups:- Group A: 4 neonates with PDA and ASD.
These neonates did not require any form of palliation and directly underwent definitive surgery.
2 neonates survived and one neonate died while awaiting surgery due to sepsis. Group B: 3
neonates with restrictive ASD underwent BAS. All neonates survived during subsequent follow
up. Group C: 8 neonates – 4 had non restrictive ASD and 4 Patent ductus arteriosus (PDA).
Among these neonates, 02 presented in shock and were started on PGE1 after resuscitation.
PGE1 was started in rest 6 babies pending definitive surgery. 2 neonates underwent Pulmonary
artery banding to prepare the left ventricle. Rest were taken up for definitive surgery over next 46 weeks. 2 babies died of sepsis. Conclusions: There was no difference in the septostomy or
PGE1 group in the outcome of definitive surgery. Both BAS and PGE1 infusions are equally
effective as a palliation pending surgery. PGE1 infusion has the advantage in terms of
convenience, less invasive and does not require high skill, but has side effects like apnoea and
requires early definitive surgery. While septostomy is more invasive, requires highly skilled staff
and cardiac cath lab, however neonate can be taken up for surgery in due course of time.
CAR/07(P) NORMATIVE VALUES FOR HEART RATE VARIABILITY IN CHILDREN
Vykunta Raju K.N, Sheffali Gulati, Navita Choudhary, Ashok Kumar Jariyal, K. K. Deepak
C/o. Dr.Vykunta Raju K.N. DM, Consultant Pediatric Neurologist, Institute of Neurosciences,
BGS Health and Education City, #67, Uttarahalli Road, Kengeri, BGS Global Hospital,
Bangalore-560060
drknvraju@hotmail.com
Purpose -HRV is beat to beat variation in heart rate under resting conditions. It has good tool to
quantify the tone of autonomic nervous system to the myocardium. It has been associated with
high predictive value in many diseases. As there is no normative data in children, we did this
study to document normative HRV data in children. Methods- children of 2 to 15 years were
included. Heart disease, diabetes and uremia were excluded. ECG was recorded in supine
position for 5 min after 15 min of supine rest. Tests were done when child was comfortable.
wave detection and RR intervals were done by software. Results: Mean age was 9.10 ±3.3 (4-15)
years, 18(45%) were male. Values were skewed, therefore we expressed in median and range.
Low Frequency (LF)Power(ms2)-602(91-2880), High Frequency(HF) Power(ms2)-1303(9110707), LF/HF-0.56(0.13-9.65), Standard deviation of differences between adjacent RR intervals
-48(13-1850), Co. of variance-7(4-1073), Variance- 2447(387-12924), Standard deviation of the
R-R intervals-37(7-389), Root square of the mean of the sum of the squares of differences
between adjacent RR intervals -47(13-931),Number R-R interval differences ≥ 50 ms - 60(1306), Total power ms- 2192(529-15352), very low frequency nu-50(5-138),low frequency nu36(11-90), high frequency nu-55(9-85),Total power nu-145(83-231), percentage of very low
frequency-21(5-59), percentage of low frequency-26(8-57) and percentage of high frequency 46(6-75). Discussion-our study results are comparable with Longin E et al (pediatr
cardiol.2009.30:311-24). Conclusion-HRV normative data is useful reference date to assess
autonomic dysfunction in pediatric neurological disorders like, Guillain -Barre syndrome,
refractory epilepsy, autonomic neuropathy and others.
CAR/08(P) SITUS INVERSUS WITH CHILDHOOD STROKE WITH INTRACRANIAL
VASCULAR
MALFORMATION
AND
DIABETES
MELLITUS
WITH
HYPOTHYROIDISM
Vykunta Raju K.N, Gupreet Singh, Sheffali Gulati, Vandana Jain
C/o. Dr.Vykunta Raju K.N. DM, Consultant Pediatric Neurologist, Institute of Neurosciences,
BGS Health and Education City, #67, Uttarahalli Road, Kengeri, BGS Global Hospital,
Bangalore-560060
drknvraju@hotmail.com
Purpose- We report a rare association of situs inversus child with type I diabetes mellitus
presenting with childhood stroke with intracranial vascular malformation. Method and results:
Four year old male child was a case of Diabetes mellitus since the age of 2 years, presented with
weakness of right sided upper and lower limb with right sided complex partial seizures of 4
months duration. On examination, right sided upper motor neuron type of weakness and heart
sound better heard on right side of the chest with normal rest of the examination. Investigation
shows dextrocardia on chest X ray, which was confirmed by echocardiography, abdominal
ultrasonogrpahy shows liver on left side and spleen on right side. His diabetes mellitus controlled
with 1.5 U/kg/day human insulin. His thyroid function shows increased thyroid stimulating
hormone -8 IU, for that started on thyroxin. Screening for celiac disease was normal. Liver and
renal function tests were normal. Electroencephalograph shows, epileptiform discharges from
left frontocentral areas. MRI and MRA revealed mild diffuse let cerebral atrophy with absent of
left sided A1 segment of anterior cerebral artery and left posterior communicating artery. Carotid
Doppler was normal. Metabolic work for stroke, complete blood counts, coagulation profile,
lupus anticoagulant, lipid profile, arterial lactate was normal. Cause of stroke doesn’t revealed
any apparent cause, however complete left cerebral involvement can be explained on basis of left
middle cerebral involvement with absent left anterior cerebral artery. Conclusions- Intracranial
vascular malformation should be suspected any child presenting with stroke with situs inversus.
CAR/09(O) ELECTROCARDIOGRAPHIC CHANGES IN BIRTH ASPHYXIA AND ITS
CO-RELATION WITH CARDIAC TROPONIN I
Goel Manjusha, Mahawer J, Dwivedi R
Department of Paediatrics, Kamla Nehru Hospital and Gandhi Medical College, Bhopal- 462001
manjushagoel@rediffmail.com
Introduction: Perinatal asphyxia is one of the leading causes of neonatal mortality with the
incidence varying from 1.8 to 7.7 per 1000 live births. The incidence of cardiac dysfunction in
birth asphyxia varies from 24-31%. The present study was conducted to find out the ECG
changes in birth asphyxia and cardiac troponin I level. Aims: The aim of this study is to
determine if any relationship exists between cardiac troponin I (cTnI) level and ECG
abnormalities in newborns with birth asphyxia. Objective: To compare the cardiac troponin I
level & ECG findings in healthy neonates and neonates with birth asphyxia. Material and
method: Forty term babies with birth asphyxia without any congenital malformation were
selected as cases. They were compared with twenty healthy term babies without asphyxia.
Myocardial dysfunction was evaluated using clinical examination, electrocardiography and
cardiac troponin I level.ECG findings were graded according to Jedeikin’s criteria. Results:
Among the 40 cases, 21 had evidence of myocardial involvement. Grade I ECG changes were
present in 3 (7.5%), Grade II in 11 (27.5%), Grade III in 5 (12.5%), Grade IV in 1 (2.5%). While
9 babies in control group had Grade I ECG changes. Mortality increased with severity of ECG
changes. All the cases and control had normal sinus rhythm. Cardiac troponin I level was <1
ng/ml in all cases and controls. Conclusion: ECG is useful in evaluating the severity of
myocardial dysfunction and because of wide range of cardiac troponin I, rapid card test has less
predictive value.
CAR/10(O) DEVICE CLOSURE OF LARGE PDA IN INFANTS. CAN IT BE CLOSED
IN INFANTS BELOW 6 Kgs?
Chitra Narasimhan, I.B. Vijayalakshmi, Praveen Jayan, C.N.Manjunath
Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore- 560069.
chitradr@gmail.com
Transcatheter closure of PDA has practically replaced surgery. Despite the improvement in
technique and hardware, closure of large PDAs in small infants, remains a challenge. Aim : To
know the feasibility, efficacy of closing large PDA in infants especially in infants weighing  6
kgs. Materials and Methods: 748 cases of PDA were catheterized between January 1997 September 2010. PDA closure done with coils in 232, Duct Occluder in 309, PFM Nit Occlud in
8, surgery in 173 and managed medically in 26 cases of small PDA. 203/748 (27.1 %) were
infants. 61 infants (30.1%), underwent device closure, 38 (18.7%) coil closure and remaining
surgery. Of the 61 infants, 38 (62.3%) were < 6 kgs. PDA was closed with duct occluders in 30
and modified duct occluder in 8. Age ranged - 4 - 12 months (mean 8.2 months), weight - 3.9 - 6
kgs (mean 4.5 kgs), PDA measured 4.1 - 8.6 mm (mean 6.3 mm). Fluoroscopy time - 3-18 min
(m 13 min). Results: No residual shunt or LPA stenosis in any patient. Average weight gain, one
month, post procedure was 1 Kg + 250 mgs. Aortic obstruction occurred in two cases, managed
with balloon dilatation (0.05%). One patient with single kidney had device embolisation, latter
died due to uraemia (0.02%). 3 patients (0.08 %) had minor vascular complications.
Conclusions: Transcatheter closure of very large PDA, in sick malnourished , infants, with LV
failure is possible, safe and effective. Aortic and LPA stenosis can be avoided with suitable
modifications in the device.
CAR/11(P) RIGHT VENTRICULAR OUTFLOW OBSTRUCTION DUE TO FUNGAL
MASS IN A NEONATE
Aradhana Dwivedi, Daljit Singh, R Ghuliani, Prabhat kumar,
Dept of Pediatrics, AFMC & Command Hospital, Pune-411002
aradhanakd@gmail.com
Systemic fungal infection occurs in approximately one percent of infants in neonatal intensive
care units. Fungal endocarditis is an uncommon manifestation of systemic fungal infections and
is usually related to the presence of indwelling catheters in the right atrium. Candida is the usual
organism isolated from these cases. Cases due to aspergillus though rare, are the second most
common cause of fungal endocarditis. We report a 30 day old infant who developed right
ventricular mass due to aspergillus fungus ball in the absence of any indwelling catheter. Case
Summary: 4 weeks old infant was admitted with recurrent seizures and hypoglycemia. He
required NICU care at birth due to perinatal asphyxia.His birth weight was 5 kg and liver was
palpable 5 cm below right costal margin.Other general and systemic examination and
investigations to rule out various causes of recurrent hypoglycemia revealed no abnormality.
Baby was managed with dextrose infusion. On day 5 of admission, the baby developed features
of respiratory distress and shock. Clinical examination and x-ray chest were normal.
Echocardiography revealed a mass 2 cm in circumference occupying tricuspid valve and rt
ventricle outflow. Baby succumbed to his illness on day 7 of admission. Post mortem was carried
out and histopathology revealed the mass to be aspergillus mycelia. A very few cases have been
reported in literature of a fungal mass presenting as right ventricular outflow obstruction.
CAR/12(O) PERCUTANEOUS DEVICE CLOSURE OF ATRIAL SEPTAL DEFECTS IN
CHILDREN <5 YEARS IN A SINGLE CENTRE.
Krishnamoorthy KM, Sivasankaran S, Titus T, Bijulal S, Ajithkumar VK, Harikrishnan S,
Namboodiri KKN, Anees T, Sanjay S, Tharakan JA.
Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum
kmkm@sctimst.ac.in
Introduction: Device closure (DC) of secundum atrial septal defects (ASD) is generally not
performed in small children. Objectives: To study the feasibility and results of DC of ASD in
children <5 years. Methods: Children <5 years who underwent DC of ASD were studied.
Morphology of ASD, haemodynamics and procedural details were noted. Results: Among 850
patients who had DC in the last 11 years, 116 were <5 years (13.6%). 78 were girls (67.2%).
Mean age was 4.62+1.6 years (range 1.5-5). Mean weight was 12.3+5.4 kg (range 6-22).
Multiple ASD was noted in 7 patients prior to and 3 others during DC. DC was successful in 107
(92.2%). Defect size was 13.7+4.8 mm (range 7-20). Mean pulmonary artery pressure was
22.1+7.9 mm Hg (range 12-46). Mean left to right shunt was 1.94+0.64 l/min (range 1.4-3.5).
Mean device size was 14.7+5.2 mm (range 8-22). 12 (10.3%) patients had DC under sedation
alone, without intubation and transoesophageal echocardiography. Associated patent ductus
arteriosus was closed by coil in 2 and device in another. Elective surgery was required in 9
patients (9.4%) due to improper device position (n=4), inadequate rims (n=2) and multiple
defects (n=3). There were no major complications. 82 patients (95.3%) had immediate closure.
Abolition of residual shunt and right ventricular regression was seen on follow-up of 3.2+4.1
years (range 6 months-9 years). None developed atrioventricular block. Conclusion:
Percutaneous DC of ASD is a safe and effective option in carefully selected children <5 years.
Size of the child is not a contraindication.
CAR/13(O) CLINICO-EPIDEMIOLOGICAL& FOLLOW- UP STUDY(FOR ONE
YEAR) ON VENTICULAR SEPTAL DEFECT IN CHILDERN
M.L Gupta, Brijmohan, Vijay kumar
Associate Professor, Department Of Pediatric Medicine; SMS Medical College, Jaipur
vijay.ks83@gmail.com
Aims: 1.To Identify various types of VSDs based on site &size of defect 2.To find out the
proportion of isolated VSD& VSD associated with other cardiac lesion 3.To study the
mortality& morbidity of a case of VSD over a follow up of one year duration Material&
Methods: 100 Childern were included in this study in whom diagnosis of VSD was made on 2D
Echocardiography done at SPMCHI; JAIPUR during a period of 2007-09 Results: 1.62% of the
case were having isolated VSD&38% were having associated cadiac lesion.TOF(28.95%)
followed by ASD(21.05%) were commonly associated lesion. 2.Most common type of VSD was
perimembranous(68%) followed by muscular(13%) then multiple(9.6%). 3.Perimembranous
&muscular VSD were mostly of small size while inlet VSDs were of large size. 4.Mortality in
case with isolated VSD was 14.52% but it increased to 26% associated lesion was also included.
Conclusion: .Small VSD and muscular VSD are having good prognosis, while large VSD& inlet
VSD are having bad prognosis until surgical correction is done. .Most deaths inVSD occurs
before age of one year. So early intervention is recomonded for improving survival of children
with VSD.
CAR/14(P) FIRST EPISODE OF RHEUMATIC CARDITIS IN CHILDREN:
ECHOCARDIOGRAPHIC MORPHOLOGY AND
PULMONARY ARTERY
PRESSURES.
Prasanth K.S, Vijayakumar B, Zulfikar Ahamed M*, Geetha S, Rajamohanan K, Lalitha Kailas
Dept. of Paediatrics, SAT Hospital, Govt. Medical College, Thiruvananthapuram.
drprasanthks01@gmail.com
We have studied the morphologic pattern of cardiac involvement and the pulmonary artery
pressure changes in the first episode of rheumatic carditis in children by echocardiography.We
have observed that mitral valve involvement was universal and pulmonary artery pressure was
elevated significantly in children with acute rheumatic carditis. Objectives: To characterize the
morphologic pattern of cardiac involvement in the primary episode of rheumatic carditis in
children and to compare with normal children, the pulmonary artery (PA) pressure changes in the
primary episode of rheumatic carditis by echocardiography. Settings: Tertiary care teaching
hospital. Design: Hospital based Descriptive Study. Methods: All 16 consecutive cases of
primary episode of acute rheumatic carditis in the paediatric age group admitted to the paediatric
wards of S.A.T. Hospital, Thiruvananthapuram from 2009 June to 2010 May were included in
the study. For comparing the pulmonary artery pressure, an equal number of age and gender
matched normal children were also inducted into the study. All chidren had undergone Doppler
Echocardiography study by the same Paediatric Cardiologist. All the cases underwent
echocardiographic examination within 24 to 48 hours of establishment of the diagnosis of first
episode of rheumatic carditis and before starting anti-inflammatory treatment.In addition to PA
pressure, various other echocardiographic indices were studied. Data was compared using SPSS
version 11.0 and t test was used for analyzing the significance. Results: In children with acute
rheumatic carditis, mitral valve regurgitation was present in 100% while isolated aortic
regurgitation was present in none. None had pericardial involvement.The pulmonary artery
pressures were significantly elevated in all children with initial episode of rheumatic carditis (p <
0.001).62.5% had mild pulmonary artery hypertension (PA pressure 30 - 50 mm Hg).
Conclusion: In children with initial episode of rheumatic carditis PA pressure is elevated, and the
effect of this on long term outcome needs to studied.
CAR/15(P) ABSENCE OF THE RIGHT COMMON CAROTID ARTERY AND RIGHT
INTERNAL CAROTID ARTERY-A RARE VASCULAR ANOMALY IN ASSOCIATION
WITH DYKE DAVIDOFF MASSON SYNDROME.
Pushpalatha, C.N Reddy, Abdul Razak
Department of Paediatrics: Bowring and Lady Courzon Hospital, Bangalore
dr.razak_007@hotmail.com
Cerebral hemiatrophy or Dyke-Davidoff-Masson syndrome (DDMS) is a rare clinical picture,
characterized by unilateral cerebral atrophy and facial asymmetry, hemiparesis, seizures and
mental retardation(1). Although absence of the common carotid artery (CCA) is a rare anomaly,
the specific configuration in our case makes it extremely rare. In our case there is absent Right
CCA and Right ICA with separate origin of Right ECA from Arch of Aorta, this makes our case
extremely rare. We report a case of DDMS in relation with a rare vascular anomaly in an 18month old boy who presented with left sided focal seizures, hemiparesis of the same side.
CAR/16(P) SINGLE SYNCOPE IN A YOUNG GIRL : TURNS OUT TO BE A RARE
CARDIAC TUMOR
Barnali Mitra, Prabhat Kumar
Resident Pediatrics, Department of Pediatrics, AFMC, Pune
drprabhat_cardio@yahoo.co.in
Introduction : Syncope in children are not uncommon. Mostly syncopes occurring in school
assembly area or play ground turn out to be vaso vagal syncope which do not require special
investigations and therapy. Myxoma arising from left ventricle in a young child presenting as
syncope is not reported in children. Case Report: A 12 year old girl presented with history of
an episode of syncope while playing in school. The patient reported to busy Pediatric outdoor
where general examination of the child did not reveal any abnormality except a grade II / VI
systolic murmur in left parasternal area. Patient was referred to Pediatric cardiologist for further
evaluation. Echocardiography revealed a round pedunculated mass( 18 X 30 mm ) in left
ventricle arising from middle of interventricular septum with a pedicle measuring 4 mm at its
base. Echo images were interesting to observe as the large tumor was projecting through aortic
valve with contraction of left ventricle in each systole.and could have embolised any moment.
With a provisional diagnosis of myxoma patient was taken up for emergency surgery and
complete excision of tumor was done through transmitral approach. Histopathology of the
tumor confirmed it to be a myxoma. Conclusion : Syncope in children should always be
investigated for a possible etiology . Vaso vagal syncope should be an exclusion diagnosis.
Myxoma arising from left ventricle in a young girl presenting as syncope is reported in this case
report.