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Junctional ectopic tachycardia (JET) is a major cause of postoperative morbidity after complete repair of tetralogy of Fallot (TOF). Propranolol is a known medication used in patients with TOF to prevent and control hypercyanotic spells. Despite this, there is little information regarding the relation between preoperative use of propranolol and the incidence of postoperative JET. The aim of this study was to examine the effect of preoperative use of propranolol on the incidence of postoperative JET after full surgical repair of TOF. A retrospective analysis of 109 patients in whom 57 patients received preoperative propranolol (propranolol group) was compared with 52 patients who did not receive propranolol preoperatively (control group). The incidence of postoperative JET was significantly higher in the control group (38%) than the propranolol group (21%) P=0.042. The propranolol group had significantly less mechanical ventilation time, less ICU stay and less total hospital stay than the control group (P<0.05). Our findings suggest that the preoperative use of propranolol may decrease the incidence of JET after full surgical repair of TOF. A prospective randomized study may help to elucidate the exact relationship between the preoperative use of propranolol and the incidence of postoperative JET.

Objectives: To evaluate the associated risk factors and to determine the impact of management strategies on the outcome of PPHN.Study Design: Prospective descriptive study in tertiary center included 40 neonates having PPHN. All patients received the conventional therapy for PPHN, sildenafil as adjuvant therapy was added in cases of failure. Results:The study included 23 males, 17 females with a mean gestational age 37.25 ± 2.6 weeks. Male patients had significantly higher systolic pulmonary artery pressure (SPAP) and higher mortality rate compared to females [7/23 (30.4%) versus 1/17 (5.9%), p = 0.04]. Infants of diabetic mothers had significantly higher mortality rate (p = 0.003). Components of the blood gases; PH, PCO 2 , HCO 3 improved dramatically after completion of the different lines of treatment (p = 0.001). A statistical significant drop of SPAP after application of the different modalities of treatment (p = 0.001). Addition of sildenafil was effective in the reduction of the duration of NICU stay and SPAP below 40 mmHg and (p = 0.001, p =0.0001, respectively). The overall mortality rate was 8/40 neonates (20%), however, the mortality among the patients who received sildenafil in addition to conventional therapy was 1/14 neonates (7.14%) of those group with p = 0.001).

Introduction Type 1 diabetes is a major cause of cardiovascular death; diabetic cardiomyopathy (DCM) is the most important cause of mortality among diabetic patients. There is an increasing body of evidence that the most important inducer of DCM is microvascular injury. The aim of this study is to establish a potential relationship between low frequency/high frequency (LF/HF) ratio and DCM and to set a possible predictive cutoff of LF:HF ratio for early detection of DCM. Methods 75 type 1 diabetic patients together with 75 controls were assessed using tissue Doppler imaging for left ventricular (LV) and right ventricular (RV) diastolic function, and heart rate variability (HRV) indices including LF/HF ratio. Type 1 diabetic patients were also assessed for parameters of glycemic and lipid profile control. Results Cases showed a statistically significant increase in LF/HF ratio compared to controls reflecting reduced HRV. Also, LV and RV diastolic function were reduced in cases compared to controls, there was a significant correlation between LV E/E’ ratio (ratio of early transmitral velocity and average early mitral annular and basal septal velocities) and LF/HF ratio. LF/HF ratio was able to predict LV diastolic dysfunction as expressed by the LV E/E’ ratio with a sensitivity of 96%. Conclusion HRV indices notably LF/HF ratio seem to be an early and sensitive predictor of DCM, the latter finding not only underlines the role of microvascular injury in the induction of DCM but might help also for the early detection and reversal of it.

Background: Complete heart block (CHB) remains a foremost complication post cardiac surgery with subsequent medical, social, and financial burden. Aim of work: To evaluate the frequency of early permanent CHB in children and assess the contributing risk factors among children with congenital heart disease (CHD) who underwent surgical correction. Material and Methods: A prospective descriptive study included 1668 patients post cardiac surgery, they were enrolled from two tertiary centers; Cairo University Children Hospitals and Atfal Misr Insurance Hospital, from February 2019 to February 2020. Medical history, examination, perioperative data as aortic clamp time and cardio bypass times and electrocardiogram were recorded. Results: from a total of 1668 patients, 50 (3%) developed early permanent CHB. Their mean age at the time of the operation was 59.37 ± 41.91months (median:19 months, range: 5-144 months), 62% were males and 38% females. They underwent total surgical repair for Fallot tetralogy in 25 (50%) patients, ventricular septal defect in 14 (28%), atrial septal defect in 3 (6%) and common atrioventricular canal in 6 (12%). All 50 patients had undergone clamping of the aorta for a mean ± SD of 42.6 ±16.05 min, (median: 42 min, range: 5-105 min) and cardio bypass with a mean ± SD of 65.4±20.34 min, (median:60, range:10-145min). Prolonged aortic clamp (p=0.001) and cardio bypass times (p=0.003) were important risk factors of CHB. Thirty-eight (76%) patients were scheduled for pacemaker implantation, 12 (24%) died from complications of prolonged surgery. Mortality was related to younger age (p=0.027), and prolonged ICU stay (p=0.001). Conclusion:The frequency of CHB post open cardiac surgery was 3%. Early permanent CHB is related to perioperative parameters as aortic clamp time and cardio bypass time. Mortality in patients with CHB is linked to younger age, and prolonged ICU stay.