Introduction: In Bangladesh, 25/1000 cases of neonates are born with mild to severe type of congenital heart disease. Significant numbers of cases from new born to adult age group are reporting to OPD clinics with broad spectrum of congenital and grown up untreated heart diseases. This study will cover pattern of diseases among cases selected for cardiac catheterization and intervention in study group in a cardiac hospital with limited facility for children. Objectives: To analyze all the cases who had cardiac catheterization and intervention in said period and to see the outcome. Materials and Methods: It is a retrospective study conducted in a cardiac hospital from December 2014 to December 2019. All cases of cardiac catheterization and interventions were included in the study. Pattern of diseases, interventions, management and outcomes were analyzed. Results: Out of 1179 cases, 44.87% were male and 55.13% were female. Two hundred fifty four cases(21.54%) were in 0-1 year age group, 44.02% were in >01-05 year age group, 18.66% cases were in > 5 to 10 year , 8.48% cases were in >10 to 20 years, 4.83% cases were in> 20 to 30 years and 2.46% cases were in more than 30 year age group. Among trans-catheter closure patent ductus arteriosus (PDA) was the commonest type of intervention (44.68%), followed by atrial septal defect (ASD) (25.20%), ventricular septal defect (VSD) (11.83%) and balloon valvoplasty (BVP) for pulmonary stenosis (11.63%). Neonatal interventions were minimum as the coronary care unit used as post cathward had limited facility for neonatal care. PDA stenting was performed in 0.81% cases and BAS in 0.91% cases. Many patients underwent more than one intervention at a time; most common was ASD device closure and pulmonary valvoplasty. Cardiac Catheterization studies were minimum in this series and most of the cath study cases were VSD or/with other combinations (4.48%). Among infants (254), PDA device closure was the commonest intervention (64.56%) followed balloon valvoplasty for PS (15.35%) and balloon dilation of Coarctation on aorta (7.87%). Among implants, most commonly used were 8/6 mm (14.59%) Amplatzer Duct occluder (ADO), 6/4 ADOII, MF-Konar (9.79%) device and most common balloon used for valve or vessel dilation was 10x3 mm Tyshak II (3.26%). Only one mortality was noticed in a case of double intervention of critical Aortic and pulmonary valve stenosis. Conclusion: Commonest and established interventions were performed in this study other than few life saving interventions in neonates and outcome was excellent. Skilled team of pediatric cardiologist and technician in catheterization laboratory can bring success at the end of the day in spite of challenges. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 3-9
Isolated patent ductus arteriosus (PDA) is seen in approximately 1 in 2000 full-term life birth neonate. Transcatheter device closure is widely considered as the treatment of choice for the patient diagnosed with PDA considering the safety, efficacy and less invasiveness. Residual flow following transcatheter device closure of PDA can result in haemolysis. Our patient was a case of 9.5 years old female child weighing13 kg diagnosed as a case of large tubular PDA with severe pulmonary hypertension by echocardiography. The patient had history of recurrent chest infection, breathlessness on exertion, and growth failure. The PDA was closed by transcatheter approach using Cera-duct occluder. The patient subsequently developed hemolysis which started 18 hrs after the intervention and the resolution of hemolysis achieved by conservative management within 72 hours. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 90-92
Introduction: The objectives of the present study are to describe the institutional experience, technical aspects and outcome of right ventricular outflow tract (RVOT) stenting in Tetralogy of Fallot type lesions as the initial palliation in a Bangladeshi centre. Methods: This is a retrospective, single-center study of nonrandomized, consecutive 32 patients over a 12-year period. Selected patients underwent cardiac catheterization for implanting a stent into an obstructed RVOT to improve pulmonary blood flow.Statistical data analysis was performed using SPSS 20. Results: Thirty cases had stenting in RVOT and two cases were postponed. Median age was 8.1 (3-40) months, median weight was 4.8 (3.3-11.4)kg, median procedure time was 65 (26-210) minutes and fluoroscopy time was 16 (10-75) minutes.Stents were implanted through 5F Judkins coronary guide catheter and 5F or 6F delivery sheath of ADOII device. Median stent diameter was 6 (4-7) mm. Stent length varies from 12-22 mm with median 14 mm. Oxygen saturation of the patients increased from median 60 (30 - 75)% to 91 (85-98)%. In one patient stent was embolized to aorta and was fixed to descending aorta. Two cases were postponed for short infundibular length. One patient died from non cardiac cause two months after palliation. No procedure related mortality recorded. Conclusion: Right ventricular outflow tract stenting is a good option of palliation for small babies with reduced pulmonary blood flow. In our setting we did most of the palliation to offer better quality of life who could not afford surgery or who was detected late. Bangladesh Heart Journal 2020; 35(1) : 1-5
We report two critically ill children (aged 5–8 years), presented with features of multisystem inflammatory syndrome in children (MIS-C) from January 1 to February 2, 2021 at a tertiary-care center (Combined Military Hospital) in Dhaka, Bangladesh. Both of the previously healthy children tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Clinical presentations were similar in both with fever, gastrointestinal complaints, respiratory distress, rash, headache and myalgia. Laboratory values were high levels of C-reactive protein, D-dimers, B-type natriuretic peptide (Pro-BNP), troponin I and low albumin levels in both patients. Evaluations for other infectious diseases werenegative. Both the patients were critically ill, requiring admission to the pediatric intensive care unit (P-ICU) due to circulatory shock and needed inotropes. One of the patients had respiratory failure and required mechanical ventilation. Both patients received steroids, Intravenous Immunoglobulin (IVIG), Remdesivir, Tocilizumab. MIS-C is a recently recognized pediatric illness spectrum in association with SARS-CoV-2 infection. As for manifestations of COVID-19 infection and its consequences in children is myriad and knowledge about MIS-C is evolving, reporting is essential for better understanding of clinical clues of MIS-C and finding out a panacea through experience sharing. JAFMC Bangladesh. Vol 15, No 1 (June) 2020: 76-79
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