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Background: Cardiac conduction disorders are rare syndromes in neonates and children. According to the literature atrial septal defect, especially ostium secundum type, is associated with atrioventricular (AV) block. Wenckebach conduction heart block is very rare in a neonate; however, there is a dearth of research on the prevalence of this type of heart block regarding the neonates and pediatrics literature. This disorder has only been addressed earlier in thalassaemia major and dengue fever in Pediatrics. There have been different anatomical and metabolic and genetic etiologies for this condition. Wenckebach block is a gradual delay in sending the electrical signal from the sinoatrial node to the ventricles with each beat until there is a single dropped beat, which could be uneventful or problematic later in life. This study aimed to present a deep investigation of a rare case of congenital Wenckebach conduction heart block. Case report: The case in this study was a 52-hour-old female neonate who was diagnosed to suffer from Mobitz type 1 or Wenckebach heart block possibly due to a small ostium secundum atrial septal defect. Therefore, it was suggested to provide supportive care and regular follow-up visit. Conclusion: Precise antenatal care and investigation are required to reduce the morbidity and mortality rate of such condition. [ABSTRACT FROM AUTHOR]

Micro-bubble transcranial Doppler ultrasound is a study used for the identification and quantification of a right-to-left circulatory shunt which can be implicated in stroke. It is an underused technique in many centres. Micro-bubble transcranial Doppler ultrasound is non-invasive, innocuous, quick and requires no fasting or sedation. Published literature also suggests almost perfect concordance with transoesophageal echocardiography and potentially greater sensitivity. We believe there is a great potential for neuroradiologists to provide this service as part of the diagnostic workup in patients with cryptogenic stroke. [ABSTRACT FROM AUTHOR]

Background: Transcatheter closure of atrial septal defect secundum (ASD-II) has become an alternative method for surgery. We sought to compare the two-dimensional transesophageal echocardiography (TEE) method for measuring atrial septal defect with balloon occlusive diameter (BOD) in transcatheter ASD-II closure. Methods: A total of 39 patients (71.1% female, mean age: 35.31 ± 15.37 years) who underwent successful transcatheter closure of ASD-II between November 2005 and July 2008 were enrolled in this study. Transthoracic echocardiography (TTE) and TEE were performed to select suitable cases for device closure and measure the defect size before the procedure, and BOD measurement was performed during catheterization via TEE. The final size of the selected device was usually either equal to or 1 - 2 mm larger than the BOD of the defect. Results: The mean defect size obtained by TEE and BOD was 18.50 ± 5.08 mm and 22.86 ± 4.76 mm, respectively. The mean difference between the values of ASD size obtained by TEE and BOD was 4.36 ± 2.93 mm. In comparison with BOD, TEE underestimated the defect size in 94.9%, but TEE value being equal to BOD was observed in 5.1%. There was a good linear correlation between the two measurements: BOD = 0.773 × ASD size by TEE+8.562; r2 = 67.9.1%. A negative correlation was found between TEE sizing and the difference between BOD and TEE values (r = -0.394, p value = 0.013). Conclusion: In this study, BOD was larger than ASD size obtained by two-dimensional TEE. However, TEE maximal defect sizing correlates with BOD and may provide credible information in device size selection for transcatheter ASD closure. [ABSTRACT FROM AUTHOR]

Background: There is some evidence indicating improvement in myocardial performance after atrial septal defect closure, either device closure or surgical, but ventricular dyssynchrony has not been evaluated before and after surgical closure. The aim of this study was to evaluate ventricular mechanical dyssynchrony in patients with atrial septal defect before and after surgical closure. Methods: Twenty patients (mean age: 23°11years) with isolated secundum or sinus venosus type atrial septal defect, unsuitable for device closure, were evaluated before and after successful surgical closure. Interventricular and intraventricular dyssynchrony (using 6 basal and 6 mid-segmental models) were determined. Results: A significant reduction in the right atrial and right ventricular dimensions and the tricuspid regurgitation peak gradient was noted after atrial septal defect closure (3.6°0.54 cm versus 4.2°0.7, P=0.009; 3.5°0.29 cm versus 4.3°0.41, P=0.02; and 20.4°10.5 mmHg versus 35.3°6.5, P<0.002; respectively). There was no significant difference in the maximum difference in time-to-peak systolic velocity and the standard deviation of time-to-peak systolic velocity of the l2 left ventricular myocardial segments in the patients with atrial septal defect before and after surgical closure in comparison with the normal subjects (normal: 26°10.64 ms versus before closure: 21.0°33.9 versus after closure: 27°29.5, both P=0.68) and the left ventricular asynchrony index after atrial septal defect closure (normal: 14.9°8.7 versus before closure: 11.46°8.5 versus after closure: 18.12°13.6, both P=0.2). There was a significant positive relation between the tricuspid regurgitation peak gradient and the left ventricular asynchrony index (r=0.67, P=0.03) and an insignificant negative relation between the left ventricular ejection fraction and the asynchrony index before atrial septal defect closure (r=-0.53, P=0.11). No significant relation was found between the total asynchrony index and the atrial septal defect size, the degree of left-to-right shunt, and the tricuspid regurgitation peak gradient. Conclusion: There was no significant ventricular dyssynchrony in the patients with atrial septal defect before and after surgical closure. [ABSTRACT FROM AUTHOR]

Background: Pulmonary arterial hypertension is a complication of most congenital heart diseases. We sought to assess the effect of sildenafil on patients suffering from pulmonary arterial hypertension in association with congenital heart disease on the basis of clinical and echocardiographic parameters and compare the catheterization and treatment results so as to evaluate the predictive value of sildenafil on the operability of patients. Methods: After primary echocardiography, 21 patients were selected for the final study with a diagnosis of moderate-to-large ventricular septal defect and pulmonary artery hypertension. They were divided into 3 age groups: younger than one year, 1 to 2 years, and older than 2 years. Before and one hour after the consumption of sildenafil, the patients had their oxygen saturation and blood pressure measured. Additionally, the patients underwent echocardiography and cardiac catheterization. The patients' operability was determined on the basis of their clinical condition and their response to oxygen inhalation in the catheterization room. Finally, the results of the drug response and final treatment were analyzed statistically. Results: The 21 patients, who had ventricular septal defect and pulmonary arterial hypertension, were comprised of 8 (38%) boys and 13 (62%) girls. The patients aged from 2.5 to 204 months (mean 30 months). It was clear that the younger patients had a more positive response to the drug. All the patients who had a positive response to the drug were considered operable after catheterization and all of them had a positive response to treatment. There was no significant correlation between operable/inoperable conditions and response to treatment (P value=0.262), while there was a very significant correlation between response to treatment and response to drug (P value=0.005). Conclusion: According to the results of this study and given the low cost and availability of sildenafil and its oral consumability on the one hand and the availability and non-invasiveness of echocardiography on the other, it seems that sildenafil is useful in determining the pulmonary vascular bed reactivity via echocardiographic parameters and facilitating the decision-making process for surgery in patients with pulmonary arterial hypertension and congenital heart diseases. [ABSTRACT FROM AUTHOR]

Tako-tsubo cardiomyopathy is a form of reversible left ventricular dysfunction, with a clinical and electrocardiographic picture of acute myocardial infarction in the absence of significant coronary disease. The precise clinical features and etiologic basis of this syndrome remain unclear, although an association with emotional or stressful triggers has been recognized. We describe the first case of this syndrome complicated with a ventricular septal perforation and dissection. [ABSTRACT FROM AUTHOR]