Objectives: To identify the pattern of un-operated grown up congenital heart defects at our tertiary care cardiac institute. Methods: This is a prospective observational study. All un-operated GUCH patients who presented to Faisalabad Institute of Cardiology (FIC) from May 2017 to 30th July 2017 were enrolled. Diagnosis was established on Transthoracic Echocardiography done by dedicated pediatric cardiologist at FIC. The mode of presentation, presenting complaints, type, severity, complications and co-morbid conditions of CHD were recorded. Results: A total of 200 consecutive patients were enrolled. Mean age was 29.92 ± 11.21 years. There were 104 females (52%) and 96 males (48%). Majority of patients presented in Out-Patient Department (84%) while 16% presented in emergency (n=32). The most common cardiac anomalies were: Atrial Septal Defect (ASD) 41.5% (83), Tetralogy of Fallots (TOF) 42 (21%), Ventricular Septal Defect (VSD) 28 (14%) and Patent ductus arteriosus (PDA) 8 % (16). Cyanotic CHD was present in 43% (86) while TOF was the most common of it. The disease was of moderate complexity in 77.5% patients. Certain complications like Pulmonary hypertension 69(34.5%), Eisenmenger 33(16.5%), Rhythm disturbances 15 (7.5%), Infective endocarditis 5(2.5%) were also present along with co-morbid conditions like coronary artery disease (1.5% and systemic hypertension (2.5%). Dyspnea on exertion (59.5%) followed by cyanosis (41%) were the most common presenting complaints. The most common reason for hospital admission was cardiac signs and symptoms (19.5%) followed by cardiac catheterization (10.5%). Conclusion: The ASD, TOF, VSD and PDA remain the most common CHD in descending order while pulmonary hypertension, Eisenmenger, heart failure, arrhythmias, infective endocarditis and stroke were the common complications of CHD at this particular age. doi: https://doi.org/10.12669/pjms.35.4.878 How to cite this:Mughal AR, Tousif R, Alamgir AR, Jalal A. Pattern of un-operated Grown Up Congenital Heart (GUCH) patients presenting to a Tertiary Care Cardiac Institute of Punjab. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.878 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Background: Device closure of Patent ductus arteriosus (PDA) using AmplatzerDuct Occluder (ADO) is a well-known modality to treat PDA with limited complicationsObjectives: To assess the efficacy, safety and immediate complications of percutaneous deviceclosure of PDA using Amplatzer Duct Occluder. Study Design: Descriptive case series. Placeand Duration of Study: Paediatric Cardiology Department of Faisalabad Institute of Cardiology,Faisalabad from May, 2012 to July, 2017. Methods: All consecutive patients undergoingcardiac catheterization for device closure were included. Detailed Echocardiography was doneby dedicated pediatric cardiologist before the procedure. Successfulness of procedure andproblems were recorded. Results: Out of 74 patients two had unsuitable anatomy for deviceocclusion so were excluded while 72 patients underwent successful device closure. Completeocclusion was achieved in all cases (100%) without any residual leak. There was not a singlecase of device embolization, LPA obstruction or Coarctation of aorta while upper end of deviceprotruded in descending aorta in12 patients (8.45%) with no obstruction in descending aorta.Three patients lost lower limb arterial pulse (4.17%) and one patient had week pulse (1.39%)but pulses revived after injection heparin and streptokinase. Conclusion: Device closure ofPDA using Amplatzer Duct Occluder is a safe and effective therapeutic modality with minimalcomplications