Objective: To evaluate the relation between balloon size and outcome of patients undergoing pulmonary valvuloplasty. Study Design: A quasi-experimental study. Place and Duration: Pediatric Cardiology Department of Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, Pakistan from January 2021 to June 2022. Methodology: Children of both genders aged less than 15 years having severe pulmonary stenosis and who underwent pulmonary valvuloplasty during the study period were analyzed. After 24 hours post procedure, echocardiography was done to see echo gradient across pulmonary valve, tricuspid regurgitation, pulmonary regurgitation, right ventricular dysfunction or pericardial effusion. Procedure was considered successful if the residual gradient across pulmonary valve was < 40 mmHg, pulmonary regurgitation < moderate and patients had no major complications. Results: In a total of 75 children, 42 (56.3%) were male. The mean age was 6.24 ± 4.81 years. Cyanosis was observed in 10 (13.3%) children while there was right ventricular dysfunction in 6 (8.0%) children. The pulmonary valvuloplasty procedure was successful in 53 (70.6%) cases while in remaining 22 (29.4%) cases, the procedure was partially successful because of infundibular obstruction. We observed that the degree of pulmonary regurgitation was greater when annulus- balloon ratio was 1.3 or more than that (p<0.0001). Practical Implications: Large balloons do not impart advantages beyond that produced by balloons between 1.2-1.4 times of the annular size but further research is required to ascertain these findings Conclusion: Signification relation exists regarding balloon size and outcome of children undergoing pulmonary valvuloplasty as the degree of pulmonary regurgitation was greater when annulus- balloon ratio was 1.3 or more. Keywords: Cyanosis, pulmonary regurgitation, pulmonary valvuloplasty, right ventricular dysfunction.

Objective: To share our experience of transcatheter device closure of secundum atrial septal defect in children and adults. Methods: This descriptive cross-sectional study was conducted at department of Paediatric Cardiology Ch. Pervaiz Elahi Institute of Cardiology Multan from 2011 to September 2019. Patients with moderate to large ASD secundum without severe pulmonary hypertension were studied. All procedures were performed under general anaesthesia and trans-Oesophageal echo guidance. Success and safety of procedure were evaluated. Results: During study period, a total of 75 patients underwent ASD device closure. Mean age was 25 ± 1.53 (4 -54 years) and male to female ratio 1:2. Mean defect was 20.38 ± 0.58 (09 to 32 mm). Large defects (> 25 mm) were 17 (22.7 %). Significant PS (> 30 mm Hg) observed in three and valvuloplasty performed. Device size was selected on the basis of TOE measurement + 4-5 mm. Balloon sizing was performed in only three patients. Amplatzer   septal occluder was used in 80 %. Balloon assisted technique was used in 09 (12 %) patients. All the procedures were successful except two (2.7 %) where device embolized and retrieved by surgery. Transient arrhythmias were observed in 05 (6.6 %) and small pericardial effusion which was managed conservatively in one patient. There was no procedure related mortality. Conclusion: Transcatheter closure of moderate to large ASD secundum in children and adults is a safe procedure. Among the major events, device embolizaion was common. Other complications were rare including small pericardial effusion and transient arrhythmias. Continuous...