Objectives To determine clinical, laboratory features and outcomes of Multisystem Inflammatory Syndrome in children (MIS-C) and its comparison with historic Kawasaki Disease (KD) and Viral Myocarditis (VM) cohorts. Methods All children (1 month– 18 years) who fulfilled the World Health Organization criteria of MIS-C presenting to two tertiary care centers in Karachi from May 2020 till August 31st were included. KD and VM admitted to one of the study centers in the last five years prior to this pandemic, was compared to MIS-C. Results Thirty children with median age of 24 (interquartile range (IQR)1–192) months met the criteria for MIS-C. Three phenotypes were identified, 12 patients (40%) with KD, ten (33%) VM and eight (26%) had features of TSS. Echocardiography showed coronary involvement in 10 (33%), and moderate to severe Left Ventricular dysfunction in 10 (33%) patients. Steroids and intravenous immunoglobulins (IVIG) were administered to 24 (80%) and 12 (41%) patients respectively while 7 (23%) received both. Overall, 20% children expired. During the last five years, 30 and 47 children were diagnosed with KD and VM, respectively. Their comparison with MIS-C group showed lymphopenia, thrombocytosis, and higher CRP as well as more frequent atypical presentation in MIS-C KD group with less coronary involvement. The MIS-C VM was more likely to present with fulminant myocarditis. Conclusions Our MIS-C cohort is younger with higher mortality compared to previous reports. MIS-C is distinct from historic cohorts of KD and VM in both in clinical features and outcomes.

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Objective: To evaluate common clinical presentation, complications and poor prognostic outcomes in children with acute myocarditis. Study Design: Prospective longitudinal study. Place and Duration of Study: Pediatric Cardiology Department, National Institute of Cardiovascular Disease Karachi Pakistan, from Feb to Aug 2020. Methodology: The children aged one month to 16 years were included in the study. Clinical, demographic features, Electrocardiogram, Echocardiography, management, complications, and immediate outcomes were recorded. Results: The total number of patients enrolled was 161. The median age was 5.01 ± 3.38 years for 66.4% of males and 33.5% females, mean Duration of symptoms was 8.35 ± 3.49 days. Upper respiratory tract infection was present in 84 (52.2%) and diarrhea in 8 (5%) in the preceding illness. Symptoms and signs include loss of appetite in 153 (96.27%), irritability in 148 (91.9%), vomiting in 132 (82%) and abdominal pain in 112 (69.6%), tachycardia in 148 (91.9%) and pallor in 143 (88.8%). Low voltage ECG was present in 125 (77.6%), arrhythmias in 12 (7.45%) and heart block in 6 (3.7%). Left ventricle end-diastolic dimensions (LVIDD)>4SD were present in 30.2% and LV end-systolic dimensions (LVIDS)>4SD in 19.5%, Left ventricular ejection fraction (LVEF)mean was 21.13 ± 5.07 vs 23.45 ± 3.31 at discharge. 9.21% of patients expired, out of which 78.5% had Left bundle branch block (LBBB), mean LVEF was 16.24 ± 3.16, LVID d>4SD in 78%, and LVIDs>4SD in 30%. Conclusion: The most frequent presentations were loss of appetite, difficulty breathing, irritability and abdominal pain. Tachycardia and pallor were......

Objective: The purpose of this study was to ascertain how the patent ductus arteriosus will respond to trans catheter closure on the pulmonary artery pressure. Methods: All patients having clinical and echocardiographic evidence of hemodynamically significant isolated PDA and patients with PASP > 20 mmHg will be labelled as PDA with PAH, while patients with mean PASP > 60 mmHg will be labelled as PDA with severe PAH. These patients were all included in the research. Both pulmonary artery pressure measurements and echocardiography were done. Once the patient has been assessed, the viability of a transcatheter closure PDA has been confirmed. Results: The Mean age of the patients were 10.6±8.18 years. Out 40 participants 35% were males and 65% were females. A significant variation (p=0.003) in MPA pressure was observed in patients after balloon occlusion. A significant variation in RV higher (0.007) and lower (0.003) pressure was observed in patients after balloon occlusion. A significant variation (p=0.005) in LV Higher pressure was observed in patients after balloon occlusion. A significant variation (p=0.003) in higher Aorta pressure was observed in patients after balloon occlusion. Conclusion: After PDA closure, some individuals with borderline hemodynamic data with PDA and PAH may get worse or continue to have PAH. Care must be taken while providing these individuals with permanent closure.

The arterial switch operation is considered as standard therapy for isolated D-transposition of the great arteries. However, in under-developed countries, patients still present with D-transposition of the great arteries beyond the neonatal age redering them unsuitable for anatomical repair. These children are often offered physiological repair, i.e. Senning or Mustard procedure. We describe our experience of a successful Senning procredure in a 4.6-year girl, who had atrial and visceral situs inversus totalis, dextrocardia and d-transposition of the great arteries. To our knowledge, this is the first reported case of this operation in a patient with such unique anatomy.