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Answer added in Interventional Cardiologist38 What is you opinion about large Persistent Ductus Arterious in newborn: Indometacin or immediate surgery?I like the answer of Dr. Fabi. Because the real answer to your question is It depends; as in real life situation. If you mean preterm baby, intubated... [more]
Publications (123) View all
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Article: Intra-coronary thrombus in an infant with Kawasaki disease and giant coronary aneurysm.
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ABSTRACT: A previously healthy 5 months-old girl presented to our emergency department with history of fever for two weeks, skin rash, red and cracked lips and bilateral redness of the eyes appeared 4 days after fever started. On physical examination the general condition was stable including good peripheral perfusion. There was no lymphadenopathy. Chest and abdominal examinations were unremarkable. Electrocardiography, apart from mild sinus tachycardia (HR 110 bpm), was normal with no sign of myocardial ischemia or hypertrophy. Chest x-ray showed cardiomegaly. Her blood investigations: WBC 16.2 x 100/μL (neutrophils 36.7%), normal hemoglobin, platelets 1356 x 100/μL. The kidney function and liver function tests were normal. Troponin T 27 μg/L (lab normal value 14 μg/L) and CKMB 42 μg/L (lab normal value 25 μg/L). The diagnosis of Kawasaki disease (KD) was established according to the combination of the clinical picture and blood investigations. Echocardiogram was performed and showed severe dilatation of and left anterior descending coronary artery with giant aneurysm (Figure 1) and intra coronary thrombus (Figure 2). Additionally normal myocardial function and moderate pericardial effusion with no sign of cardiac tamponade. Despite of the late presentation, immunoglobulin infusion was started combined with heparin, warfarin and low dose aspirin. It was planned after two days to discontinue heparin. An elective cardiac computerized tomography (CT) with contrast injection was done and shows giant aneurysmal dilatation of right coronary artery (RCA) (Figure 3). A repeated echocardiography, directed on the RCA confirms the CT finding (Figure 4 A and Figure 4 B). The critical evaluation of the initial echocardiography examination revealed that the RCA aneurysm was there from the start but was missed as it is very adjacent to and almost as large as right atrium. ©2013 The Author(s)/Acta Paediatrica ©2013 Foundation Acta Paediatrica.Acta Paediatrica 01/2013; · 2.07 Impact Factor -
Article: Paediatricians' referral preference of patients with embolised intravascular foreign bodies: a survey-based study.
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ABSTRACT: Background: Central line insertion is a routine procedure in medical practice. Dislodgement of lines into the vascular system is a rare complication. We noticed that paediatric health care providers (PHCP) contact the cardiac or general paediatric surgeon for extraction of dislodged lines more frequently than using the less invasive percutaneous approach. Aim: To study the referral preference of PHCP for patient with embolised intravascular foreign bodies. Methods: A questionnaire with three questions was distributed to PHCP of all paediatric subspecialties, including surgery, in two tertiary care centres. The questions were about the total number of patients seen with central line, experience with complications, and preferred specialty for removal of dislodged central lines. Results: The questionnaire was distributed to 128 professionals. The response rate was 79% (n=101). Incomplete answers (n=14) were excluded. The grades of responders were senior consultants 18%, junior consultants 38%, and residents 43%. Thirty nine percent of care providers experienced dislodgement or fragmentation of central lines. The majority (82%) prefer to refer the patients for surgical removal. Conclusions: Most PHCP in the selected hospitals prefer to refer patients with embolised foreign bodies in the vascular system for surgical removal. The local health policy should be updated for the use of the alternative percutaneous approach.Libyan Journal of Medicine 01/2013; 8:1-3. · 0.18 Impact Factor -
Article: Hypoplastic left heart syndrome, cor triatriatum and partial anomalous pulmonary venous connection: Imaging of a very rare association
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ABSTRACT: A newborn is presented with an association of hypoplastic left heart syndrome, cor triatriatum and partial anomalous pulmonary venous connection. The diagnosis was established with echocardiography and further confirmed with computed tomography. To our knowledge the images of such an association have never been reported before.Journal of the Saudi Heart Association 01/2012; 24:137-140. -
Article: Angiotensin converting enzyme inhibitor as an additive treatment after success ful balloon dilation of a critical pulmonar y valve stenos is
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ABSTRACT: A 2 days old, 2.7 kg heavy baby boy with critical pulmonary stenosis, underwent successful balloon dilation. After the uneventful procedure, he remained oxygen dependent. The baby was given oral angiotensin converting enzyme inhibitor (ACE inhibitor), instead of an infusion of alpha blocker. Within few hours, in the afternoon of the same day after administration of ACE Inhibitor, the baby could be weaned off oxygen, maintaining on room air, oxygen saturation between 87% and 92%. At follow-up, two months later, his saturation was 99% on room air. We believe that some neonates with critical pulmonary valve stenosis who remain oxygen dependent despite successful ballo on dilation, could benefit from such management.Journal of the Saudi Heart Association 10/2011; -
Article: Doppler echocardiographic signs to differentiate between chronic lung disease and right ventricular dysfunction in a child with calcified pericardium.
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ABSTRACT: A 7 year-old girl was admitted with history of low-grade fever, weight loss and occasional cough for the last 6 months. Tuberculosis was suspected, for which antituberculous treatment was initiated. Chest X-ray demonstrated calcification of the pericardium with chest miliary shadowing. CT chest was done showing very fine sharply defined miliary nodularity throughout both lungs without mediastinal lymphadenopathy. The patient was referred to paediatric cardiology service to rule out constrictive pericarditis. Clinical cardiac examination as well as the electrocardiogram was normal. Echocardiography and Doppler were done showing normal cardiac anatomy and function apart from the detected pericardial calcification. Doppler tracing in the hepatic vein as well as in the superior vena cava could clearly exclude any negative effect on diastolic cardiac function, which could occur in the setup of pericardial calcification. Doppler, instead helped to identify the chronic pulmonary disease by showing increased inflow velocity throughout inspiration.Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 09/2009; 19(8):518-9. · 0.34 Impact Factor
