BackgroundJunctional ectopic tachycardia is a serious arrhythmia that frequently occurs after tetralogy of Fallot repair. Arrhythmia prophylaxis is not feasible for all pediatric cardiac surgery patients and identification of high risk patients is required. The objectives of this study were to characterize patients with JET, identify its predictors and subsequent complications and the effect of various treatment strategies on the outcomes in selected TOF patients undergoing total repair before 2 years of age.MethodsFrom 2003 to 2017, 609 patients had Tetralogy of Fallot repair, 322 were included in our study. We excluded patients above 2 years and patients with preoperative arrhythmia. 29.8% of the patients (n = 96) had postoperative JET.ResultsJET patients were younger and had higher preoperative heart rate. Independent predictors of JET were younger age, higher preoperative heart rate, cyanotic spells, non-use of B-blockers and low Mg and Ca (p = 0.011, 0.018, 0.024, 0.001, 0.004 and 0.001; respectively). JET didn’t affect the duration of mechanical ventilation nor hospital stay (p = 0.12 and 0.2 respectively) but prolonged the ICU stay (p = 0.011). JET resolved in 39.5% (n = 38) of patients responding to conventional measures. Amiodarone was used in 31.25% (n = 30) of patients and its use was associated with longer ICU stay (p = 0.017). Ventricular pacing was required in 4 patients (5.2%). Median duration of JET was 30.5 h and 5 patients had recurrent JET episode. Timing of JET onset didn’t affect ICU (p = 0.43) or hospital stay (p = 0.14) however, long duration of JET increased ICU and hospital stay (p = 0.02 and 0.009; respectively).ConclusionJET increases ICU stay after TOF repair. Preoperative B-blockers significantly reduced JET. Patients with preoperative risk factors could benefit from preoperative arrhythmia prophylaxis and aggressive management of postoperative electrolyte disturbance is essential.

Published data showing the intermediate effect of transcatheter device closure of atrial septal defect (ASD) in the pediatric age-group are scarce. The objective of the study was to assess the effects of transcatheter ASD closure on right and left ventricular functions by tissue Doppler imaging (TDI). The study included 37 consecutive patients diagnosed as ASD secundum by transthoracic echocardiography and TEE and referred for transcatheter closure at Cairo University Specialized Pediatric Hospital, Egypt, from October 2010 to July 2013. Thirty-seven age- and sex-matched controls were selected. TDI was obtained using the pulsed Doppler mode, interrogating the right cardiac border (the tricuspid annulus) and lateral mitral annulus, and myocardial performance index (MPI) was calculated at 1-, 3-, 6- and 12-month post-device closure. Transcatheter closure of ASD and echocardiographic examinations were successfully performed in all patients. There were no significant differences between two groups as regards the age, gender, weight or BSA. TDI showed that patients with ASD had significantly prolonged isovolumetric contraction, relaxation time and MPI compared with control group. Decreased tissue Doppler velocities of RV and LV began at one-month post-closure compared with the controls. Improvement in RVMPI and LVMPI began at 1-month post-closure, but they are still prolonged till 1 year. Reverse remodeling of right and left ventricles began 1 month after transcatheter ASD closure, but did not completely normalize even after 1 year of follow-up by tissue Doppler imaging.

Diaphragmatic paralysis is a relatively rare complication of congenital cardiac surgery in children. Its occurrence is associated with increased morbidity and mortality. A high index of clinical suspicion, utilization of bedside diagnostic tools, and a policy of early plication for certain patients may lead to improved outcomes.

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Objectives: To determine the safety, efficacy, and cost of a second course of oral ibuprofen (OI) in closure of patent ductus arteriosus (PDA) in preterm infants.Material and methods: Preterm infants ≤34 weeks gestational age (GA) who had clinically significant PDA at a postnatal age from 48-120 hours were subjected to initial oral ibuprofen course and evaluated by echocardiography. Failure of PDA closure was followed by a second course of three doses of OI. Results of echocardiography and laboratory investigations were compared before and after each ibuprofen course. The cost of ibuprofen was calculated for each patient.Results: One-hundred patients were enrolled; their mean gestational age was 31.3 ± 1.3 weeks and mean birth weight was 1350 ± 271 g. A total of 76 infants (76%) had PDA closed after the first course and an additional 9/19 patients (47.5%) had PDA closure after the second course. Respiratory improvement and significant decrease in the fraction of inspired oxygen were observed (P < 0.001 and P = 0.02, respectively). Nonsignificant changes regarding urine output, renal function and platelet count were encountered after the second course. Among the 19 infants who received two courses of ibuprofen, only one (5%) had intraventricular hemorrhage. The cost of oral ibuprofen dosage was trivial ($0.20).Conclusion: Oral ibuprofen is an inexpensive drug that can be used effectively for PDA closure in premature infants. A second course of ibuprofen further improves the efficacy of the drug without clear short-term complications. Large scale trials are needed to examine side effects and long term sequelae.