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Objectives: To compare the diagnostic accuracy of cardiac Computed Tomography (CT) and echocardiography for the diagnosis of congenital heart diseases (CHD) at Rehman Medical Institute (RMI), Peshawar. Methodology: We conducted a cross sectional study at Rehman Medical Institute between January 2020 to July 2022. Patients of different ages referred for suspicion of congenital heart diseases were enrolled. The data was collected prospectively which included demographics, Echocardiography findings, CT scan results and procedure notes. Data was analyzed on SPSS the results of descriptive variables expressed as median and percentile. A p-value <0.05 was considered significant. Results: We included 129 patients, with 73 male and 56 females having age from few days to 18 years. The malformations were divided into intra and extra cardiac groups. 665 malformations were confirmed and analyzed keeping surgical and conventional angiography findings as gold standard. Among these 283 were intra and 99 extra cardiac findings. The echo and CT scan missed 2 and 4 intracardiac anomalies respectively. In case of extracardiac anomalies echo missed 14 anomalies however CT correctly diagnosed all. Both intra and extracardiac results are significant with a p value <0.05. Conclusion: We conclude that Echocardiography is preferred modality for intracardiac anomalies evident by 99.3% diagnostic accuracy while CTA provides better demonstration of extra cardiac abnormalities having diagnostic accuracy of 99.9%. Echocardiography and CTA are both complementary for assessment and evaluation of congenital heart diseases acting as guide to surgery. [ABSTRACT FROM AUTHOR]

Objective: To study the spectrum of Tetralogy of Fallot (TOF) and its association with various congenital anomalies based on CT angiography. Methodology: This cross sectional study was conducted in Cardiology division of Lady Reading Hospital Peshawar from 1st January 2016 to 31 March 2019. All TOF patients were subjected to CT angiography for detailed assessment.The data was analyzed via SPSS version 21. Results: A total of 195 of Tetralogy of Fallot (TOF) were included in the study. Their mean age was 3.2±0.8 years. Coronary anomalies were present in 16(8.2%) cases. LAD arising from right coronary artery in 4(2.05%) patients, of which 03(1.5%) was crossing RVOT. TOF with hypo-plastic pulmonary arteries were documented in 79(40.5%) patients. Of them severe main pulmonary artery hypoplasia was present in 32(16.4%), Isolated hypoplastic left pulmonary artery in 24(12.3%), right pulmonary hypoplasia in 14(7.1%) and bilateral hypoplastic pulmonary arteries in 09(4.6%) patients. Single or multiple aorto-pulmonary collaterals were documented in 65(33.3%) patients and Patent ductusarteriosus(PDA) in 45(23.1%) patients.Bilateral SVC were present in 8(4.1%) patients. Right sided aortic arch was documented in 24(12.3%) patients. Conclusion: A right aortic arch was present in one-eighth and PDA in one-quarter of patients with TOF. One third of TOF patients had one or more aorto-pulmonary collaterals of various sizes. Left anterior descending coronary artery crossing right ventricular outflow tract (RVOT) was present in 1.5%patients. [ABSTRACT FROM AUTHOR]

Objective: To find out correlation of age and defect size of isolated secundum atrial septal defect with pulmonary artery pressure measured by cardiac catheterization. Methodology: It was a cross-sectional study conducted at Cardiology department, Lady Reading Hospital, Peshawar from January 2012 to December 2016. Eligible patients were included in the study through cardiology out patient department. Patients with other causes of raised PAP were excluded. Diagnosis was made by transthoracic echocardiography while size of defect was measured with trans-esophageal echocardiography. Pulmonary artery pressures (PAP) were measured with right heart catheterization. The data was analyzed by SPSS 20. Correlation of age and ASD size with PAP groups were examined by Pearson correlation (2-tailed) and R value was calculated.Results:A total of 104 consecutive patients were included with 65.4 % of females. Mean age and defect size were 23.25 ± 12.2 years and 23.36 ± 5.81 mm, respectively. Average systolic and mean PAP were 37.88±12.3 and 24.48 ± 8.19 mmHg, respectively with 49 (47.1%) patients had raised PAP. Age and size were positively correlated with systolic (R=0.220 & 0.198) and mean PAP (R=0.288 & 0.218) respectively , with most significant results in second and third decade of life and defect size of>20mm(p <0.002). Conclusion:Age and ASD size were positively correlated with pulmonary artery pressure. Moreover PAP can be predicted by the age of patients with ASD secundum. [ABSTRACT FROM AUTHOR]

Objectives: To study the frequency and spectrum of congenital cyanotic heart disease among patients attending pediatric cardiology department for suspected cardiac problem. Methodology: This was an observational study, conducted in Pediatric Cardiology Department Lady Reading Hospital Peshawar, from 1st September 2012 to 31st August 2013.Every patient with suspected cardiac problem was subjected to echocardiographic study to know frequency and spectrum of congenital cyanotic heart disease in these patient. Results: Total number of patient studied with congenital heart disease (CHD) was 2342. Of them 434(18.53%) were found to have cyanotic congenital heart disease (CCHD). Of these CCHD patients males were 262(60.36%). Mean age was 34.42±30.34 months (from 1 day to 18 years). Tetrology of fallot (TOF) patients were 205(47.23%) which forms 8.8% of total CHD. 0f these TOF patients 09 were already corrected. Transposition of great arteries (TGA) was found in 83(19.12%). Ebstein with cyanosis were found in 12(2.76%) patients. Double Outlet Right Ventricle (DORV) was found in 38 (8.75%). Total anomalous pulmonary venous drainage (TAPVD) patients were 27(6.22%). Of these supracardiac TAPVD were 15(3.45%), Cardiac TAPVD were 7(1.61%) and Infracardiac TAPVD were 5(1.15%). Pulmonary atresia with intact pulmonary septum was found in 15(3.4%).Single ventricle was found in 21(4.84%) patients. Eisenmenger syndrome was found in 11(2.6%). Hypoplastic left heart was found in 14 (3.22%) and 8(1.84%) having truncusarteriosus. Conclusion: About 18% of CHD in our population comprises of CCHD. TOF is the major CCHD in our population. [ABSTRACT FROM AUTHOR]

Pulmonary atresia with intact interventricular septum(PA-IVS) is a rare congenital lesion. PA-IVS involves complete blockage of the pulmonary valve located on the right side of the heart. This blockage thus prevents the flow of blood to the lungs. Because of this lack of blood flowing through the right side of the heart, the structures on that side, such as the pulmonary valve and the tricuspid valve, may be abnormally small. The genetic cause of PA-IVS is unknown. We report a 6- month-old infant with congenital heart disease including; pulmonary atresia, intact ventricular septum, right ventricular hypoplasia, and vertical persistant ductus arteriosus (PDA) arising from left subclavian artery with stenosis at pulmonary end. PDA stenting was performed with successful hemodynamic after procedure. [ABSTRACT FROM AUTHOR]

Objective: To study the frequency and spectrum (echocardiographic picture) of congenital venticular septal defect (VSD) among patients attending Paediatric Cardiology Department for suspected congenital heart disease (CHD). Methodology: This descriptive study was conducted in Pediatric Cardiology Department Lady Reading Hospital Peshawar, from 01 September 2012 to 31 August 2013. All patient with suspected CHD was subjected to transthoracic echocardiographic examination. The frequency and spectrum of VSD was determine in these patients. Results: A total of 2342 patients with suspected CHD were studied. Among them 708(30.2%) were having isolated congenital VSD. Males were 433(61%) and females were 275(39%). Mean age was 42.32±40.64 months (range: 1 day to 30 years). Patients below 2 years were 54%. Out of this 708 patients, 447(63.1%) were of perimembranous type,169(23.86%) were having muscular VSD, 48(6.78%) were Doubly committed subarterial type, and 44(6.21%) were having multiple VSDs. Two hundred and thirty-three (32.9%) of total VSD patients were have already developed complications including severe pulmonary artery hypertension(PAH) in 157(22.17%) patients, aortic cusp prolapse in 50(7.06%) cases including 30(6.86%) with perimembranous and 20(41.6%) with doubly committed subarterial type of VSD, AR in 40(5.64%) of Aortic cusp prolapse, Acquired right and left ventricular outflow tract obstruction in 10(1.4%) and 05(0.70%) respectively, 04(0.56%) patients had Echo evidence of infective endocarditis and 2 had already developed Eisenmenger syndrome with severe PAH. Conclusion: VSD account for about 30% of the congenital cardiac defects. About one third of them had already developed complications at the time of diagnosis. [ABSTRACT FROM AUTHOR]

Patent ductusarteriosus (PDA) constitutes 6 to 11% of all congenital heart defects. While surgical ligation and video-assisted, thoracoscopic interruption of PDA are still available, transcatheterocclusion of PDAs has recently assumed a major role in closure of PDA. Most of the centreuse Amplatzer duct occluder device for PDA closure. Here we report a large PDA that was not amenable to close by largest Amplatzer duct occluder, so we used successfully 24mm Amplatzerpost infarct VSD occluder. Patient discharged home with stable hemodynamics and without complication as assessed by echocardiography 24 hoursafterprocedure. [ABSTRACT FROM AUTHOR]