Journal of the Saudi Heart Association - Articles in Press

Successful management of fungal pericarditis and endocarditis in a neonate: A case report - Corrected Proof

Ahmad Azhar — 2012-04-09

Abstract: Neonatal fungal endocarditis is a rare but serious infection, which does not have a well-accepted management method. This is the second report of this condition in Saudi Arabia. A preterm, very low birth weight, female neonate presented with fever and shortness of breath. An echocardiogram showed moderate pericardial effusion and two masses in the heart, one in the right ventricle and the other in the inferior portion of the posterior mitral valve of the left ventricle. Blood and pericardial fluid cultures revealed an infection with Candida albicans. The patient received a 60days course of intravenous fluconazole and amphotericin B lipid complex. At the conclusion of treatment, she was discharged in good condition with no echocardiographic evidence of pericardial effusion or fungal vegetations. Thus, a successful outcome to a serious case of fungal endocarditis was achieved through aggressive antifungal therapy with intravenous fluconazole and amphotericin B lipid complex.

Ultrasonography assessment of vocal cords mobility in children after cardiac surgery - Corrected Proof

2012-03-16

Abstract: Objectives: Upper airway obstruction after pediatric cardiac surgery is not uncommon. In the cardiac surgical population, an important etiology is vocal cord paresis or paralysis following extubation. In this study, we aimed to evaluate the feasibility and accuracy of ultrasonography (US) assessment of the vocal cords mobility and compare it to fiber-optic laryngoscope (FL).Material and methods: A prospective pilot study has been conducted in Pediatric Cardiac ICU (PCICU) at King Abdulaziz Cardiac Center (KACC) from the 1st of June 2009 till the end of July 2010. Patients who had cardiac surgery manifested with significant signs of upper airway obstruction were included. Each procedure was performed by different operators who were blinded to each other report. Results of invasive (FL) and non-invasive ultrasonography (US) investigations were compared.Results: Ten patients developed persistent significant upper airway obstruction after cardiac surgery were included in the study. Their mean±SEM of weight and age were 4.6±0.4kg and 126.4±51.4 days, respectively. All patients were referred to bedside US screening for vocal cord mobility. The results of US were compared subsequently with FL findings. Results were identical in nine (90%) patients and partially different in one (10%). Six patients showed abnormal glottal movement while the other four patients demonstrated normal vocal cords mobility by FL. Sensitivity of US was 100% and specificity of 80%.Conclusion: US assessment of vocal cord is simple, non-invasive and reliable tool to assess vocal cords mobility in the critical care settings. This screening tool requires skills that can be easily obtained.

Clinical presentation and short-term outcome of acute coronary syndrome in native young Saudi population - Corrected Proof

2012-03-14

Abstract: Objectives: To investigate acute coronary syndromes (ACS) in the young Saudi population in Aseer Region, southwestern Saudi Arabia.Materials and methods: We retrospectively reviewed our database between January 2006 and May 2009, 924 patients were diagnosed to have ACS. Among them 107 patients (11.6%) met our definition of young [66 (61.7%) male <45years, and 41 (38.3%) female <55years]. We compared this study population to a control group of 50 elderly patients consecutively enrolled in a contemporary period.Results: The overall age was 42.3±7.9 and 68.7±10.1years in the study population and control respectively. 100% of the population and 92% of the control group presented with chest pain. Diabetes mellitus (DM) prevalence was 46.7% in the study population (63.4% in females), and 62% in the control group. Hypertension, smoking, dyslipidemia and overweight/obesity were reported in 31.8%, 25.2%, 21.5% and 44.9% of the study population and 58%, 6%, 26% and 42% of the control group, respectively. Past history of coronary artery disease was documented in 16.8% of the study population and 38% of the control group. The discharge diagnoses were ST-segment elevation myocardial infarction (STEMI) in 41 (38.3%) (representing 4.4% of the whole ACS population) and 11 (22%) patients of the study population and control group respectively, non-ST-segment elevation myocardial infarction in 36 (33.6%) and 23 (46%) patients of the study population and control group, respectively, and unstable angina in 30 (28.0%) and 15 (30%) patients of the study population and control group, respectively. Coronary angiography was performed in 86 (80.4%) and 41 (82%) patients in the study population and control group respectively. In hospital, one young patient had acute ischemic stroke and one elderly patient died, 22.4% of the study population and 32% of control group were discharged with clinical diagnosis of heart failure or in need for diuretics.Conclusion: In our study, the young Saudi population with ACS had chest pain as the leading symptom. STEMI was the major final diagnosis and among one of the highest reported worldwide. There is a high prevalence of DM; however, they have favorable in hospital and short-term outcome.

Effects of a preoperative individualized exercise program on selected recovery variables for cardiac surgery patients: A pilot study - Corrected Proof

2012-03-14

Abstract: Objective: Research on preoperative individualized exercise prescription (PIEP) for heart surgery patients in Taiwan is lacking. Thus, the purpose of this study was to examine the feasibility of a PIEP in the Taiwanese population.Method: A quasi-experimental design, using purposive sampling, was conducted. Thirty-five patients were recruited, of whom 15 chose to participate in the experimental (PIEP training plus usual care) group, and 20 chose to participate in the control (usual care) group. The effects of the intervention were determined by pulmonary complication-related parameters and quality of life.Results and conclusion: The development and process of PIEPs suitable for cardiac patients was described in this study. The results reveal that the two-week exercise-training program contributed to a decreased peak respiratory exchange ratio (RER) after the surgery and earlier ambulation. The effectiveness of PIEPs in improving the quality of life in cardiac surgery patients was validated. This study may also contribute as a reference of the PIEP effect on patients to the healthcare providers.

Coronary anomaly with a left ventricular accessory chamber: Is it left ventricular aneurysm or diverticulum? - Corrected Proof

Prashanth Panduranga, Abdullah Amour Al-Riyami — 2012-02-24

Abstract: A 60-year-old male hypertensive was suspected to have post myocardial infarction left ventricular aneurysm. His transthoracic echocardiogram performed elsewhere reported an inferior wall left ventricular aneurysm. He was referred for coronary angiography. His coronary angiogram and repeat transthoracic echocardiogram demonstrated an accessory chamber arising from mid-inferior wall synchronously contracting with the left ventricle suggesting a diverticulum. In addition, he had anomalous coronary arteries with coronary artery disease. His electrocardiogram did not reveal any features suggestive of a post infarct aneurysm. This case illustrates the importance of a comprehensive clinical and echocardiographic examination with a broad differential thought process.

Caseous mitral annular calcification: Is it a benign condition? - Corrected Proof

Mohammad Akram, Adel M. Hasanin — 2012-02-16

Abstract: Caseous mitral annular calcification (CMAC) is a variant of mitral annular calcification (MAC) with a central liquefaction necrosis. The echocardiographic prevalence of CMAC is approximately 0.6% in patients with MAC and 0.06–0.07% in large series of patients of all ages. However, the prevalence in necropsy series has been reported to be 2.7%, which indicates that this condition is yet under-recognized. Furthermore CMAC is probably underappreciated as a source of potentially serious conditions. We report a case of recent stroke associated with CMAC diagnosed by trans-thoracic and confirmed by trans-esophageal echocardiogram (TEE). The importance of correct diagnosis of CMAC extends beyond the possible complications; since several misdiagnoses of CMAC as abscesses and cardiac tumors have been reported leading to inappropriate interventions.

Visualization of patent ductus arteriosus using real-time three-dimensional echocardiogram: Comparative study with 2D echocardiogram and angiography - Corrected Proof

Alaa Roushdy, Azza El Fiky, Dina Ezz el Din — 2012-02-15

Abstract: Purpose: To determine the feasibility and accuracy of real time 3D echocardiography (RT3DE) in determining the dimensions and anatomical type of the patent ductus arteriosus (PDA).Methods: The study included 42 pediatric patients with a mean age of 3.6years (ranging from 2months to 14years) who were referred for elective percutaneous PDA closure. All patients underwent full 2D echocardiogram as well as RT3DE with off line analysis using Q lab software within 6h from their angiograms. The PDA was studied as regard the anatomical type, length of the duct as well as the ampulla and the pulmonary end of the PDA. Data obtained by RT3DE was compared against 2D echocardiogram and the gold standard angiography.Results: Offline analysis of the PDA was feasible in 97.6% of the cases while determination of the anatomical type using gated color flow 3D acquisitions was achieved in 78.5% of the cases. The pulmonary end of the duct was rather elliptical using 3D echocardiogram. There was significant difference between the pulmonary end measured by 3D echocardiogram and angiography (P<0.001). There was no significant difference between either the length or the ampulla of the PDA measured by 3D echocardiogram and that measured by angiography (P value=0.325 and 0.611, respectively). There was a good agreement between both 2D or 3D echocardiogram and angiography in determining the anatomical type of the PDA (K=0.744 and 0.773, respectively). However 3D echocardiogram could more accurately determine type A and type E ductus compared to 2D echocardiogram.Conclusion: 3D echocardiogram was more accurate than 2D echocardiogram in determining the length and the ampulla of the PDA. The morphologic assessment of the PDA using gated 3D color flow was achieved in 78.5% of the patients. Nevertheless the use of 3D echocardiogram in assessment of small vascular structures like PDA in children with rapid heart rates is still of limited clinical value.

Pseudoaneurysm of mitro-aortic intervalvular fibrosa during the course of mitral valve endocarditis with aorto-left ventricle outflow tract fistula - Corrected Proof

A. Fazlinezhad, H. Fatehi, S. Tabaee, M. Alavi, L. Hoseini, H. Yousefzadeh — 2012-02-15

Abstract: The mitro-aortic intervalvular fibrosa (MAIVF) connects the anterior mitral leaflet to the posterior portion of the aortic annulus.The pseudoaneurysm of MAIVF is one of the uncommon but catastrophic complications of native or prosthetic aortic valve endocarditis or chest trauma.We report a case of infective endocarditis of mitral valve complicated by development of pseudoaneurysm of MAIVF, and fistulous formation causing massive shunt flow from the ascending aorta above the non-coronary cusp to the left ventricle outflow tract.

Outcome of tracheostomy after pediatric cardiac surgery - Corrected Proof

2012-02-03

Abstract: Objective: To investigate the incidence, timing indications and outcome of tracheotomy in children who underwent cardiac surgeries.Methods: All pediatric cardiac patients (under 14years of age) who underwent cardiac surgeries and required tracheotomy from November 2000 to November 2010 were reviewed. The data were collected and reviewed retrospectively.Results: Sixteen children underwent tracheotomy after cardiac surgery. Fifteen of these cases had surgery for congenital heart disease, and one had surgery for an acquired rheumatic mitral valve disease. The mean±SEMs of the durations of ventilation before and after tracheotomy were 60.4±9.8 and 14.5±4.79days respectively (P value 0.0002). The means±SEM of the lengths of ICU stay before and after tracheotomy were 63.31±10.15 and 22±5.4days respectively (P value 0.0012). After the tracheotomy 12/16 patients (75%) were weaned from their ventilators and 10/16 were discharged from the PCICU. Six patients were discharged from the hospital and 3 were successfully decannulated. The overall survival rate was 9/16 (56%).Conclusion: Tracheostomy shortens the duration of mechanical ventilation and facilitates discharge from the ICU. The mortality of tracheotomy patients is still significant but is mainly related to the primary cardiac disease.

The fate of post-myocardial infarction thrombi - Corrected Proof

Abdulhalim Jamal Kinsara, Adel M. Hasanin — 2012-02-03

Abstract: We are reporting a patient who sustained a large myocardial infarction with large kissing thrombi in echocardiogram that disappeared within 1month without the administration of thrombolytic, anticoagulation or antiplatelet therapy. The patient did not manifest any embolic events. This unusual course calls for specific studies on the natural history of thrombi post myocardial infarction and the best modality to treat such thrombi.

WITHDRAWN: Prevalence of coronary artery disease risk factors in Saudi children - Corrected Proof

2010-05-31

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

WITHDRAWN: Consanguinity as a risk factor in congenital heart disease in Saudi Arabia - Corrected Proof

Susan M. Becker — 2010-05-11

Effect of oral ibuprofen on patent ductus arteriosus in premature newborns - Corrected Proof

Sabry Ghanem, Mansour mostafa, Mohamed Shafee — 2010-03-02

Abstract: Background aim of the study: Patent ductus arteriosus (PDA), a common finding among premature infants, is conventionally treated by intravenous indomethacin. Intravenous ibuprofen was recently shown to be as effective and to have fewer adverse reactions in preterm infants. If equally effective, then oral ibuprofen for PDA closure would have several important advantages over the intravenous route. This study was designed to determine whether oral ibuprofen treatment is efficacious and safe in closure of a PDA in premature infants.Patients and methods: Thirty-three premature group I (study group) were treated with ibuprofen 10mg/kg administered through a feeding tube. Thirty-three premature group II (control group) receive placebo the two imaging procedures were again performed 24h after each ibuprofen dose. When the PDA was still hemodynamically significant, as demonstrated by echocardiography, and there was no evidence of deterioration in brain ultrasonography, a second dose of ibuprofen 5mg/kg (placebo for control) was administered. A third equivalent dose was given after another 24h if necessary. Cranial ultrasound was repeated 1week after the last ibuprofen dose and again before discharge from the ward. Hematochemical analysis was preformed daily in the unit during the first days of life.Results: In the study group the rate of PDA closure was 93.9% (31 of 33 cases) while in the control group the rate of PDA closure was 30.3% (10 of 33 cases) with significant difference in between. There was no reopening of the ductus after closure had been achieved. No infant required surgical ligation of the ductus in study group while in the control group 24.2% (8 of 33 cases) were required surgical ligation (). Twenty-one newborns were treated with 1 dose of ibuprofen, nine were treated with 2 doses, and the remaining three were treated with 3 doses.Conclusion: Oral ibuprofen is an effective and safe alternative to intravenous ibuprofen for PDA closure in premature infants.