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The objective of our study was to investigate the safety and efficacy of high-dose methyl prednisolone (MP) in modifying the systemic inflammatory response (SIR) to cardiopulmonary bypass (CPB) and to compare its efficacy with low-dose MP in children undergoing cardiac surgery for congenital heart disease. Thirty children with congenital heart disease undergoing CPB were randomly assigned to two groups: group 1 (n = 15) received 30 mg/kg MP by an intravenous infusion for 30 minutes and group 2 (n = 15) received 2 mg/kg intravenously, before the onset of CPB. Postoperative clinical parameters were recorded, and serum interleukin (IL)-6 and 8 levels, acute phase reactants, and blood biochemistry were determined serially for both groups. In both groups plasma IL-6 and 8 levels were elevated above the preoperative levels at 2 and 24 hours after declamping. The peak levels were obtained at 2-hour samples. The difference between the two groups in terms of postoperative IL-6 and 8 levels was not statistically significant. C-reactive protein (CRP) levels and polymorphonuclear leukocyte counts, postoperative core temperature, duration of mechanical ventilation, period of stay in intensive care unit, oxygenation indices, and biochemical parameters of patients did not significantly differ in the two groups. Only 1 patient in group 1 had elevated liver enzymes, blood urea nitrogen, and creatinine in the postoperative period. No significant complications were observed due to treatment with high-dose MP. Although postoperative IL and CRP levels indicated a SIR in our patients, the clinical picture was apparently affected in only 1 patient and she was in the high-dose MP group. CPB initiates a SIR that is associated with an increase in neutrophil count, CRP, and IL-6 and 8 levels. High-dose (30 mg/kg) MP was not superior to low-dose (2 mg/kg) in blunting the SIR to CPB in pediatric patients undergoing open-heart surgery.

Aim To investigate the effect of several types of congenital heart disease (CHD) on nutrition and growth. Patients and methods The prevalence of malnutrition and growth failure was investigated in 89 patients with CHD aged 1-45 months. They were grouped according to cardiac diagnosis: group aP (n = 26), acyanotic patients with pulmonary hypertension; group ap (n = 5), acyanotic patients without pulmonary hypertension; group cp (n = 42), cyanotic patients without pulmonary hypertension; and group cP (n = 16), cyanotic patients with pulmonary hypertension. Information on socioeconomic level, parental education status, birth weight and nutrition history, number of siblings, and the timing, quality, and quantity of nutrients ingested during weaning period and at the time of the examination were obtained through interviews with parents. Results There was no significant difference between groups in terms of parental education status, socioeconomic level, duration of breast feeding, and number of siblings (p > 0.05). Group cP patients ingested fewer nutrients for their age compared to other groups. 37 of the 89 patients were below the 5th centile for both weight and length, and 58 of 89 patients were below the 5th centile for weight. Mild or borderline malnutrition was more common in group aP patients. Most group cp patients were in normal nutritional state, and stunting was more common than wasting. Both moderate to severe malnutrition and failure to thrive were more common in group cP patients. Conclusion Patients with CHD are prone to malnutrition and growth failure. Pulmonary hypertension appears to be the most important factor, and cyanotic patients with pulmonary hypertension are the ones most severely affected. This study shows the additive effects of hypoxia and pulmonary hypertension on nutrition and growth of children with CHD.

Aim: There is wealth of data on the echocardiographic evaluation of prosthetic valves in the aortic or mitral position. Similar data are missing for the Melody percutaneous pulmonary valve system (MPPV). We aimed to correlate the anatomic appearance of the MPPV with the haemodynamic result on invasive and echocardiographic assessment. Patients and Methods: All 45 patients who underwent MPPV implantation at our institution between 2007-2013 were studied (median age 30 [range 11-61] years). All patients had complex congenital heart disease. The narrowest dimensions of the MPPV system were taken from the final biplane orthogonal fluoroscopic images to calculate the effective valve opening area (EOA). The post implantation invasive peak-to-peak gradient (ΔPp-p) and the maximal and mean Doppler gradient (ΔPmax and ΔPmean) on the pre-discharge echocardiogram (within 72 hours of implantation) were also obtained. Results: ΔPp-p after valve implantation was low (11.5±5.2 [range 2-20] mmHg) and there was no significant residual pulmonary regurgitation. The peak and mean gradient across the valve by Doppler assessment were significantly higher than ΔPp-p (ΔPmean: 19.3±6.5, ΔPmax: 33.3±8.2 mmHg; P<0.0001 for both vs. ΔPp-p). Both Doppler gradients correlated significantly with the invasive peak gradient (ΔPp-p vs. ΔPmean: r=0.37, P=0.03; ΔPp-p vs. ΔPmax: r=0.39, P=0.02) The EOA of the valve system indexed to body surface area was 132±30 mm2/m2. There were only weak relationships between the indexed EOA and the invasive and Doppler gradients (correlations with EOA: ΔPp-p: r=-0.32, P=0.06; ΔPpeak: r=-0.33, P=0.045; ΔPmean: r=-0.23; P=0.16). Conclusion: Doppler assessment of the percutaneous Melody valve early after implantation consistently overestimates the invasive peak-to-peak gradient. Simple estimates of valve size do not allow prediction of central haemodynamics. These results reflect the complex and variable anatomy of the right ventricular outflow tract/ main pulmonary artery in this group of patients.