On the basis of the results, it could be concluded that delayed presentation for fetal echocardiography was not associated with the educational status of females. By contrast, referral personnel were found to be responsible for the delayed referral of females. Therefore, we strongly recommend that both pregnant women and gynecologists be educated about the importance of timely diagnosis for identification of congenital heart diseases.

Crisscross heart (CCH) is a rare anomaly characterized by twisting of the inflow streams of right and left ventricles. The etiology of CCH is not known. Its frequency is less than 8/10, 00,000 live births. Cyanosis is common in neonatal age, while shortness of breath is the main presenting complaint in older children. We present a case series of CCH with array of associations, diagnosed by echocardiography. CCH is a rare heart defect that can be diagnosed by echocardiography by a vigilant operator. Early diagnosis is the key to successful management resulting in increased survival rate, better outcomes and improved quality of life. Keywords: Criss-Cross heart, mitral valve lesions, coarctation of aorta, Echocardiography, case series.

Objective: To determine different treatment options in patients of Patent Ductus Arteriosus with pulmonary hypertension beyond neonatal period. Study Design: Descriptive cross sectional study. Place and Duration of Study: This study was carried out in Pediatric Cardiology department of Rawalpindi Institute of Cardiology, from Jan 2017 to Jan 2019. Methodology: Patients having PDA with pulmonary hypertension were included in the study. Treatment options were divided into percutaneous catheter device closure, surgical ligation of patent ductus arteriosus and palliative treatment. Any adverse event during the procedure was documented. Stratification was done in regard to gender and age group. Post stratification chi square test was applied and p-value less than or equal to 0.05 was considered as significant. Results: Total number of patients included in the study were 37. Mean age (years) of patients (Mean ± SD) was 19.21 ± 8.76. Mean ± SD pulmonary artery pressure was 56.43 ± 11.55 mmHg. Percutaneous catheter device closure was successful in 24 (64.9%) patients, in 7 (18.9%) patients primary surgical PDA ligation was done, 3 (8.1%) patients were advised palliative treatment and in 3 (8.1%) patients adverse events occurred during percutaneous device closure and were thus referred for surgical ligation. Patent ductus Arteriosus Occlutech device was used in 18 (48.6%) patients, Occlutech VSD device was used in 7 (18.5%) patients and in 1 (2.7%) patient AGA duct occluder was used. Conclusion: In patients with patent ductus arteriosus and pulmonary artery hypertension, percutaneous catheter device closure is a safe and effective procedure.

Objectives: This study aims to measure changes in left ventricular systolic function after closure of patent ductus arteriosus and to find out echocardiographic predictors for LV dysfunction.  Methods: A prospective study was conducted from July 01, 2021, till June 30, 2022. The study included all patients who experienced percutaneous closure of PDA in this duration. LV function was assessed before and then one day, one month and three months after the transcatheter closure. Patients with preexisting LV dysfunction and significant associated cardiac lesions were excluded from study.  Results: PDA was occluded in 86 children by transcatheter intervention. Average age of the cohort was 65 ± 58 months with 70% female patients. The mean size of the ductus was 3.67 ± 1.78. LV systolic function remained normal in 65 patients (86%) while 21 patients (24%) suffered from a fall in systolic function of left ventricle after PDA occlusion. LVEDd, FS, and EF significantly dropped within 24 hours after occlusion of the ductus. LV- systolic dysfunction improved in almost all the patients at 3 months follow up except for 4 (4.6%) patients who had persistently poor systolic function of LV. Conclusion: Trans-catheter closure of PDA can cause a significant but temporary decline in LV systolic function. Large PDAd, LAd, higher PDAd/AOd, LAd/AOd and larger LV dimensions can predict LV dysfunction in high-risk patients. More prospective studies are imperative to verify these observations and to determine the predicting parameters for dysfunction of left ventricle after closure of PDA.

Objective: To evaluate the level of anxiety and depression in children and adolescents with congenital heart disease in pre and post-surgical intervention period. Study Design: Quasi experimental study. Place and Duration of Study: Rawalpindi Institute of Cardiology, Rawalpindi Pakistan, from Jan to Dec 2019. Methodology: After written informed consent from parents and approval of hospital ethical committee 152 children and adolescents with congenital heart disease were included in the study. Demographic and clinical data was recorded on relevant proforma. In addition to clinical assessment the level of anxiety and depression were objectively measured with the help of Urdu version of Hospital Anxiety and Depression Scale by the mental health specialist a day before and 15 days after surgery. Results: The mean age of participants was 14.5 ± 3.3 years. Out of 152 participants, 80 (52.6%) were females, while 72 (47.4%) were males. Level of anxiety and depression was found higher in the preoperative period being 44 (28.9%) and 52 (34.2%) which dropped significantly in the postoperative period to 16 (10.5%) and 8 (5.3%) respectively. Majority of the patients had Tetralogy of Fallot i.e., 52 (34.2%) followed by Ventricular Septal Defect in 24 (15.7%) and Atrial Septal Defect in 18 (11.2%). Females were more likely to have depression than males (p-value=0.01). Conclusion: We found significant decrease in anxiety and depression in the postoperative period.