AbstractBackground:The standard transthoracic echocardiography has some limitations in emergent and community-based situations. The emergence of pocket-sized ultrasound has led to influential advancements.Methods:In this prospective study, in the hospital-based phase, children with suspected structural heart diseases were enrolled. In the school-based phase, healthy children were randomly selected from six schools. All individuals were examined by experienced operators using both the standard and the pocket-sized echocardiography.Results:A total of 73 individuals with a mean age of 9.9 ± 3.2 years in the hospital-based cohort and 143 individuals with a mean age of 12.8 ± 2.9 years in the school-based cohort were examined. The agreements between the standard and the pocket-sized echocardiography were good or excellent for major CHDs in both cohorts (κ statistics > 0.61). Among valvular pathologies, agreements for tricuspid and pulmonary valves’ regurgitation were moderate among school-based cohorts (0.56 [95% confidence interval 0.12–1] and 0.6 [95% confidence interval 0.28–0.91], respectively). The agreements for tricuspid and pulmonary valves’ regurgitation were excellent (>0.9) among hospital-based population. Other values for valvular findings were good or excellent. The overall sensitivity and specificity were 87.5% (95% confidence interval 47.3–99.7) and 93.8% (95% confidence interval 85–98.3) among the hospital-based individuals, respectively, and those were 88% (95% confidence interval 77.8–94.7) and 68.4% (95% confidence interval 56.7–78.6) among the school-based individuals, respectively. The cost of examination was reduced by approximately 70% for an individual using the pocket-sized device.Conclusions:When interpreted by experienced operators, the pocket-sized echocardiography can be used as screening tool among school-aged population.

The aim of this study was to assess the effect ofmetoprolol on cardiac function in children with heart failure. This randomized double-blind placebo controlled clinical trial was performed in children with heart failure due to left ventricle volume overload structural heart disease such as VSD, PDA, AI and MR who referred to pediatric cardiology clinics in sari in 2007. The patients divided into case and control groups. All cases were matched as viewpoints of age, sex, weight, kinds of primary disease and cardiac drugs (except for metoprolol).Metoprolol with single daily dose of 1 mg kg(-1) and placebo were given to patients in case and control groups respectively. Echocardiography with cardiac indices of systolic and diastolic function was done as baseline and monthly for 3 months in all the patients. Data were analyzed using SPSS software and statistical t-test. Thirty patients (16 cases and 14 controls) were enrolled in the study. CI, MPI and dv/dt (dt) decreased significantly at first month. Significant changes in LVEF and EPSS appeared on the second month and in E wave and E/A appeared on the third month. The results were in favor of systolic and diastolic improvement. Metoprolol causes improvement of cardiac systolic and diastolic function in children with heart failure due to cardiac defect. Therefore, metoprolol is recommended in patients with heart failure in above mentioned diseases that have not been controlled adequately in spite of receiving standard cardiac failure drug therapy such as an inotrope, a diuretic and a vasodilator agent.

Background: Structural heart disease (SHD) has great impacts on healthcare systems, creating further public health concerns. Proper data are scant regarding the magnitude of the affected population by SHD. Objectives: This study aimed to determine the prevalence of SHD among children and adolescents in an Iranian population. Methods: In this population-based study, a multistage cluster-random sampling was used to choose schools from the Tehran urban area. All students were examined using a handheld Vscan device by echocardiographer, and the results were concurrently supervised and interpreted by cardiologists. All the major findings were reevaluated in hospital clinics. Results: Of 15,130 students (6–18 years, 52.2% boys) who were examined, the prevalence of individuals with congenital heart disease (CHD) and cardiomyopathy was 152 (10.046 per 1,000 persons) and 9 (0.595 per 1,000 persons), respectively. The prevalence of definite and borderline rheumatic heart disease (RHD) was 30 (2 per 1,000 persons) and 113 (7.5 per 1,000 persons), correspondingly. Non-rheumatic valvular heart disease (VHD) was also detected in 465 (30.7 per 1,000 persons) students. Of all the pathologies, only 39 (25.6%) cases with CHD and 1 (0.007%) cases with RHD had already been diagnosed. Parental consanguinity was the strongest predictor of CHD and SHD (odds ratio [OR]: 1.907, 95% CI, 1.358 to 2.680; P < 0.001 and OR, 1.855, 95% CI, 1.334 to 2.579; P < 0.001, respectively). The female sex (OR, 1.262, 95% CI, 1.013 to 1.573; P = 0.038) and fathers’ low literacy (OR, 1.872, 95% CI, 1.068 to 3.281; P = 0.029) were the strongest predictors of non-rheumatic VHD and RHD, correspondingly. Conclusions: The implementation of echocardiographic examinations for detecting SHD among young population is feasible which detected SHD prevalence in our population comparable to previous reports. Further studies are required to delineate its economic aspects for community-based screening.

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