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Abstract Background Ventricular septal defect (VSD) is the most common congenital cardiac malformation, accounting for approximately 30% of congenital heart defects. Conventional surgical repair using cardiopulmonary bypass is invasive and associated with morbidities and prolonged hospital stay. With the advent of interventional approaches and availability of different occluding devices, the technique of perventricular device closure is evolving and being implemented successfully in larger groups of patients. We present herein, our initial experience of perventricular device closure for the ventricular septal defects in children to assess risks and benefits. Methods From March, 2023 to February, 2024, we have performed perventricular closure of ventricular septal defects in 13 children, under guidance of transesophageal echocardiography without cardiopulmonary bypass support. The median age at operation was 2 year (range 1.3–10 years) with the median body weight 11 kg (range 8.7–16.6 kg). Sixty-nine percent were males. The ventricular septal defect sizes ranged from 2.7 to 6 mm (mean 4.7 mm). Seven defects were perimembranous, four sub-aortic and two were muscular. One patient also underwent pulmonary artery de-banding with pulmonary artery balloon angioplasty and other one patent ductus arteriosus ligation, concomitantly. For defect closure, we used ventricular septal defect occlusion device (MemoPart™, Lepu Medical Technology Company, China) through a 3-cm skin incision in the lower- third of the sternum. The device sizes ranged from 5 to 8 mm (mean 6.9+-1.8 mm) and all patients except for two required symmetrical devices. Results All patients underwent device closure successfully. The procedural duration ranged between 32 and 52 min. None of the patients required cardiopulmonary bypass. The mean ventilation time and intensive care unit stay was 3 and 24 h, respectively. None of the patients required inotropic support or blood transfusions. Moreover, no patients developed any arrhythmias including heart block. The average length of hospital stay was 4.4 days. At the latest follow up, there were no residual shunts, conduction disturbances, device dislodgement or major aortic or tricuspid valve complications seen in any patients. There was no mortality. Conclusions Perventricular device closure of ventricular septal defects is a less invasive, extremely safe and effective method in children. It is associated with very fast recovery, shorter hospitalization time and better cosmetic incision. Moreover, it avoids cardiopulmonary bypass. The modifications and refinements in the design, material and implantation techniques will help in expanding the indications and prevent complications in the long-term.

Abstract Background COVID-19 vaccines have been a game changer in the pandemic, their extensive use was favorable compared to the burden of COVID-19 complications. Despite the low incidence of complications, it was important to analyze them carefully to understand the underlying mechanisms and predisposing factors. For instance, myopericarditis especially from mRNA vaccines, and its relatively higher prevalence in young adults and adolescents has raised a public concern about the use of this vaccine in this group. We aimed through this review to compare the age likelihood of ADEM from COVID-19 vaccines, with that reported in myopericarditis cases; secondary outcome parameters included the gender and number of doses needed to induce COVID-19 vaccines related to ADEM. Methodology A literature search has been conducted on relevant databases to retrieve all case reports/series and systematic reviews describing ADEM with possible linkage to COVID-19. Exclusion criteria included any report not including the desired outcome parameters. Our results were then qualitatively compared with a similar systematic review reporting myopericarditis from COVID-19 vaccines. Results In 38 cases with ADEM, mean age was 49 ± 16 compared to 25 ± 14 in myopericarditis, females were more likely to be affected, and while most of myopericarditis cases develop after the second dose, most of ADEM cases develop after the first dose (76%). Moreover, age > 56 years was more predictive of negative outcome after ADEM in the form of death or permanent vegetative state. Short conclusion The discrepancy in age, gender and number of doses needed to induce complications between ADEM and myopericarditis, signify that the tissue affected is the major orchestrator of the age, gender, and dose characteristics, and not the type of vaccines. A leakier blood brain barrier with aging, might allow easier passage of autoantibodies and cytokines into the brain while lack of inhibitory immune checkpoints in the myocardium in young age might explain the higher prevalence of those cases in young adults and adolescents.

Abstract Background Congenital portosystemic shunt (CPSS) is a vascular malformation in which portal blood drains toward the systemic circulation, leading to pulmonary hypertension. Case presentation A 10-year-old patient was brought for evaluation because of dyspnea on exertion. Echocardiography revealed a pulmonary hypertension of 75 mmHg, and multi-slice CT angiography revealed the presence of a CPSS. Closure was finally implemented using a muscular ventricular septal defect device. Follow-up of the patient revealed a gradual decline in pulmonary hypertension. Conclusions CPSS is an overlooked cause of reversible pulmonary hypertension (PH). Closure of such lesions and reversal pulmonary hypertension are possible via catheterization. The preferred device type depends largely on the intervening team. Plugs are the first choice for interventional radiologists, while ventricular and atrial septal occluder devices and duct occluders are preferred by pediatric cardiologists.

Abstract Background Conventional signs of tamponade include right ventricular and atrial collapse and respiratory variation in mitral inflow velocities. Despite being reliable, they are qualitative in nature and are not well correlated with clinical signs of deterioration or improvement. Tamponade is invariably preceded and associated with diastolic dysfunction, and tissue Doppler imaging (TDI) can help in early detection of it, earlier than conventional signs. For this purpose, 36 patients presenting with pericardial effusion have been subjected to echocardiography, including effusion dimensions, presence or absence of routine signs of tamponade and TDI-derived LV and RV E/E′ ratios, as well as clinical signs of tamponade to test the diagnostic accuracy of echocardiographic parameters against them. Results Right atrial and ventricular collapse were the least accurate in the detection of tamponade, while effusion dimension > 14 mm was the most accurate among conventional parameters to point toward tamponade. RV and LV diastolic dysfunction as evidenced by E/E′ ratio showed 100% sensitivity in predicting tamponade, while LV E/E′ ratio showed the highest specificity (100%) in the same context. The higher diagnostic accuracy of LV E/E′ ratio might be also related to the presence of chronic kidney disease patients, with an already jeopardized LV function. Conclusions TDI technology is now available in most of the portable echocardiography machines and can serve as part of point-of-care echocardiography in the early detection of cardiac tamponade and in decision making for pericardiocentesis. Larger studies can help in consolidating the impression driven from our small-scale cross-sectional study.

Abstract Background Differentiating acute myocarditis (AMY) from dilated cardiomyopathy (DCM) in a patient presenting with acute heart failure and poor systolic function is of utmost importance to initiate timely anti-inflammatory treatment in AMY. Using cardiac magnetic resonance (CMR) or endomyocardial biopsies (EMB) as gold standards might be limited due to the likelihood of hemodynamic compromise. Eccentric myocardial remodeling as measured by sphericity index (SPI) might be useful in differentiating AMY from DCM, due to the progressive increase in transverse LV diameter in DCM. The primary outcome parameter of our study was to test the diagnostic accuracy of SPI in the differentiation of AMY from DCM, while the secondary outcome parameter was to compare the diagnostic accuracy of SPI to troponin I in the same context. For this purpose, we conducted a retrospective study involving a chart review of the files of sixty patients admitted with acute heart failure due to hypokinetic left ventricle in our hospital. Patients were divided after CMR imaging into two groups: group 1 with AMY (n = 30) and group 2 with DCM (n = 30). Demographic and clinical characteristics of the patients, including heart rate, need for mechanical ventilation, use of milrinone, epinephrine and norepinephrine, troponin I, and 2D-derived sphericity index, were collected from patients’ files. Results Patients with AMY had a higher need for mechanical ventilation inopressors and vasopressors; 73% of AMY patients required mechanical ventilation and epinephrine use, compared to less than 50% of DCM patients. Troponin I elevation was more marked in AMY compared to DCM patients (0.25 ± 0.04 vs. 0.21 ± 0.03, respectively). SPI was significantly higher in DCM compared to AMY cases, denoting a spherical configuration of the myocardium acquired due to progressive remodeling, because of the chronicity of the pathology. ROC analysis revealed that an SPI ≤ 0.38 was 100% sensitive in differentiating DCM from AMY, compared to a 53% sensitivity with the commonly used troponin I. Conclusion AMY diagnosis can be achieved by the assessment of sphericity index rather than troponin I. The bedside nature and noninvasiveness of SPI should reshape the practice in this context. SPI assessment can be part of point-of-care echocardiography, taught to emergency room (ER) physicians and intensivists.

Abstract Background Weight re-gain (which is also known as re-obesity) is an overwhelming challenge many dieters face in their pursuit to maintain consistent results following successful weight loss. This frustrating pattern of weight cycling can have various mental and physical implications, which further puts another roadblock in any weight reduction program. Main body of the abstract A comprehensive analysis of the causes behind the phenomenon of re-obesity has been widely conducted in literature, exploring the importance of creating the right mindset for weight loss maintenance and identifying the hormonal role, specifically of insulin–leptin resistance and ghrelin enhanced affinity, on appetite and food intake regulation. Insulin–Leptin resistance, due to circulating prostaglandins and prostaglandin metabolites, along with a decline in leptin-producing adipocytes following body mass reduction, cuts off leptin’s satiety signals to the brain. The persistence of this hormonal dysregulation after weight loss is collectively called obesogenic memory, and it seems to be largely mediated by dysbiosis. Short conclusion In conclusion, understanding of the influence of hormonal dysbiosis on re-obesity is fundamental in targeting the culprits behind ineffective attempts at weight loss sustenance, optimization of diet duration, use of synbiotics. Fecal and oral microbial transplantation hold high potential in improving long-term management interventions in obesity patients.

Background Intravascular catheters used during cardiac catheterization require frequent flushing with heparinized solutions. Fluid overload is more common in pediatric patients with congenital heart diseases. This study aimed to determine the safe volume of fluids that can be used without congestion using the lung ultrasound score.Methodology A total of 42 patients aged from 1 month to 6 years undergoing diagnostic cardiac procedures were included in this study. The total volume of infused fluids, the volume of fluids used for flushing intravascular sheaths and catheters, the lung ultrasound score, and PaCO2 and PaO2 /FiO2 ratio were documented.Results There was a very strong positive relationship between the total fluid volume infused in ml/kg and the difference in the lung ultrasound score before and after fluid infusion (r = 0.841, P 11.3 ml/kg has a high probability of inducing volume load in pediatric patients undergoing cardiac catheterization. A flushing volume of 3.478 ml/kg affects the lung ultrasound score. Hence, we recommend reducing the volume of intravenous fluids if higher volumes are required for flushing.

Abstract Background Several reports of unheeded complications secondary to the current mass international rollout of SARS-COV-2 vaccines, one of which is myocarditis occurring with the FDA fully approved vaccine, Pfizer, and others. Main body of the abstract Certain miRNAs (non-coding RNA sequences) are involved in the pathogenesis in viral myocarditis, and those miRNAs are interestingly upregulated in severe COVID-19. We hypothesize that the use of mRNA-based vaccines may be triggering the release of host miRNAs or that trigger the occurrence of myocarditis. This is based on the finding of altered host miRNA expression promoting virus-induced myocarditis. Short conclusion In conclusion, miRNAs are likely implicated in myocarditis associated with mRNA vaccines. Our hypothesis suggests the use of miRNA as a biomarker for the diagnosis of mRNA vaccine-induced myocarditis. Additionally, the interplay between viral miRNA and the host immune system could alter inflammatory profiles, hence suggesting the use of therapeutic inhibition to prevent such complications.

Abstract Background On the 5th of April 2022, cases of adenovirus-induced hepatitis were reported in Scotland and then reached multiple parts of the world. While adenovirus normally presents with diarrhea, vomiting, and fever, these novel cases also resulted in the development of fulminant hepatitis in non-immunocompromised cases. Main body The responsible pathogen “Adenovirus 41” is an enterovirus. Enteroviruses are spread by the fecal-oral route and are resistant to drying. As such, they predominate in sewage water. Hepatitis is normally restricted to poorer countries, yet this new wave seems to be confined to mostly high-income countries in Europe and the USA. These countries treat and recycle a higher percentage of sewage water. We also propose that the fulminant nature of this strain could be due to either a cross-species mutation or the general decrease in trained immunity post-COVID-19 lockdown. Short conclusion Evidence strongly suggests that the link between these new hepatitis cases is recycled sewage water. This should warrant further investigations on the origin of this outbreak by re-visiting the role of recycled sewage water in causing such outbreak.

Abstract Background On the staggering emergence of the Omicron variant, numerous questions arose about the evolution of virulence and transmissibility in microbes. Main body of the abstract The trade-off hypothesis has long speculated the exchange of virulence for the sake of superior transmissibility in a wide array of pathogens. While this certainly applies to the case of the Omicron variant, along with influenza virus, various reports have been allocated for an array of pathogens such as human immunodeficiency virus (HIV), malaria, hepatitis B virus (HBV) and tuberculosis (TB). The latter abide to another form of trade-off, the invasion–persistence trade-off. In this study, we aim to explore the molecular mechanisms and mutations of different obligate intracellular pathogens that attenuated their more morbid characters, virulence in acute infections and invasion in chronic infections. Short conclusion Recognizing the mutations that attenuate the most morbid characters of pathogens such as virulence or persistence can help in tailoring new therapies for such pathogens. Targeting macrophage tropism of HIV by carbohydrate-binding agents, or targeting the TMPRSS2 receptors to prevent pulmonary infiltrates of COVID-19 is an example of how important is to recognize such genetic mechanisms.

Abstract Background Single-cell sequencing studies on the lung microenvironment have revealed that the outcome of COVID-19 depends largely on the immune system response rather than the viral load. A robust innate immune response and a regulated adaptive immunity can prevent the worst outcomes such as hospitalization and the need for mechanical ventilation. Main body Intriguingly, several vaccines pertaining to the routine vaccination schedule, not only BCG, can skew the immune response towards the aforementioned beneficial effects. Short conclusion This means that routine immunization not only can help in the current pandemic but can also offer a rapid rescue in the subsequent epidemics or pandemics until a vaccine is developed.

Abstract Objectives Mitral Valve Prolapse (MVP) is a common valvular abnormality accounting for 2% of the population. There is a reported association between pes planus (PP) and MVP in some syndromes such as Marfan. However, this association has not been tested in non-syndromic cases. The primary outcome of this study is to measure the prevalence of MVP in a population of patients with PP. The secondary outcome parameter is to determine if the Meary angle (MA), a measure of the severity of flat foot, can be effectively used in the prediction of the presence of MVP. Forty-one patients with PP were screened using a lateral x-ray foot to determine MA while echocardiography was utilized to identify the presence and grade of MVP. Results 88% of screened patients were diagnosed with MVP. MA was correlated with the grade of MVP and showed high diagnostic accuracy (sensitivity 100% and specificity 90%) in predicting MVP risk when higher than 5. Children with PP are at a higher risk for MVP than the general population. Accordingly, the utilization of MA in such a specific population for the determination of patients at a higher need for echocardiography seems to be a worthwhile strategy in diagnosing MVP.

Abstract Background With the rapid rise in COVID 19 cases incomparable to the number of vaccinations available, there has been a demand to prioritize the older age groups receiving the vaccine as they have more risk of morbidity and mortality and thus better outcome from vaccination. Main body Some studies showed a lower seroconversion rate in older group patients; thus, we discuss the necessity to reprioritize vaccinations to younger age groups who have better seroconversion rates, but we may face some ethical dilemma that could hinder our hypothesis. Decreased seroconversion rates in adults are attributable to immuno-senescence which involves a decrease in humoral and cellular-mediated immunity with age. Despite this fact, there remains some ethical dilemma that can hinder widespread vaccination of younger generations, the most important of which is the unknown long-term effects of COVID-19 vaccines due their fast-tracking under the pressure of the pandemic. Short conclusion Prioritizing children vaccination against COVID-19 seems an interesting strategy that can help in containing the pandemic. Resolving some ethical dilemma needs to be done before implementing such strategy.

Abstract Background Although myocardial dysfunction in the context of longstanding steroid-resistant nephrotic syndrome (NS) has been the focus of many series, the detection of myocardial involvement in recent-onset NS has not taken sufficient attention. The primary outcome parameter of our study is the detection of myocardial dysfunction in the initial episode of NS (first 4 weeks after the onset), while the secondary outcome parameter is the determination of the best predictor of such dysfunction among systolic blood pressure, diastolic blood pressure, the duration of the initial episode of NS, and biochemical parameters such as serum albumin and cholesterol. Methods Forty NS patients during the initial episode of NS (first 4 weeks from the onset) were examined for anthropometric data as well as for serum albumin and cholesterol. Motion-mode echocardiography was used to determine Fractional shortening, while 3D echocardiography was applied to determine left ventricular (LV) ejection fraction (EF) and GLS (global longitudinal strain). Finally, we employed combined conventional and tissue doppler to determine LV E/e′ ratio (ratio of early transmitral inflow and average early diastolic basal septal and mitral annular velocities). Forty healthy, age- and sex-matched controls were enrolled to control advanced echocardiographic parameters. Results LV GLS was markedly reduced in cases compared to controls, denoting subtle systolic dysfunction, while, LV E/e′ ratio was significantly higher in cases denoting diastolic dysfunction in early NS. Hypoalbuminemia was found to be the best predictor of both LV GLS and LV E/e′ ratio. Conclusion Myocardial dysfunction should be considered in any NS patient even in recent-onset NS, the severity of hypoalbuminemia seems to be the best determinant of this dysfunction either by increasing endothelial dysfunction or through triggering inflammation. Further studies are needed on the mechanism by which hypoalbuminemia induces myocardial dysfunction in NS patients

Abstract Background Several vaccines have been fast-tracked in an attempt to decrease the morbidity and mortality of COVID-19. However, post-exposure prophylaxis has been overlooked in battling COVID-19. Main text Inhaled nitric oxide is a potential tool in post-exposure prophylaxis of COVID-19. It decreases cytosolic calcium levels, which impairs the action of Furin. SARS-CoV-2 uses Furin to replicate in the respiratory tract. Short conclusion Inhaled nitric oxide could decrease the viral load in the upper respiratory tract, abort clinically symptomatic infection, and prevent subsequent complications. Nitric oxide might be a tool for post-exposure chemoprophylaxis in at-risk groups, especially medical personnel.

Abstract Background Tetralogy of Fallot (TOF) is a common congenital cyanotic heart disease in which arrhythmias could develop even after successful operative repair. Pulmonary regurgitation and right ventricular dilatation develop in many cases. The relation between arrhythmias and right ventricular dilatation is not established. Our aim is to assess the relation in between the degree of right ventricular volume affection and the severity of the pulmonary regurgitation, associated arrhythmias and the need for pulmonary valve repair in Egyptian pediatric and adolescent cases after successful TOF repair. Results A cross sectional descriptive study was conducted on 32 cases after successful surgical repair. Transthoracic Doppler echocardiography, 24 h Holter monitoring and cardiac MRI for assessment of pulmonary regurgitation fraction (PRF), ventricular volumes and function were measured. Cases were classified according to right ventricular end diastolic volume index (RVEDVI) into 2 groups with cut off value 150 ml/m2. Mean age of the studied cases was (12.96 ± 3.384) years, mean age at time of surgical repair was (34.23 ± 22.1) months, and mean duration postoperatively was (121.72 ± 41.028) months. Eighteen cases (56%) had RVEDVI ≥ 150 ml/m2, PRF was significantly higher in cases with increased RVEDVI (p value 0.007), with positive significant correlation between RVEDVI and PRF (p value = 0.0001, r = 0.61). Arrhythmias were detected in 18 cases (56%), the most common of which was infrequent supraventricular ectopy. No significant difference in incidence of arrhythmias between the 2 groups (p value = 1) with also no significant correlation between arrhythmias and increased RVEDVI (p value = 0.76, r = 0.05). No difference between cases with and without arrhythmias regarding RVEDVI (p value = 0.56) or PRF (p value = 0.5). Conclusion Holter detected arrhythmias after successful surgical repair of TOF were significantly associated with increased postoperative duration but not with PRF or RVEDVI.

Abstract Background COVID-19 is the largest outbreak to strike humanity. The wide scale of fatalities and morbidities lead to a concurrent pandemic of uncertainty in scientific evidence. Conflicting evidences are released on daily basis about the neonatal outcomes of COVID-19-positive mothers. The aim of this study was to use the relevant case reports and series to determine the percentage of newborns who test positive for COVID-19 who are born to COVID-19-positive mothers. Secondary outcomes included examining laboratory abnormalities among COVID-19-positive neonates, and any depicted placental abnormalities in COVID-19-positive mothers. For this purpose, systematic review was performed on all studies reporting primary data on fetus-mother pairs with COVID-19. Data bases were searched for studies that met our inclusion and exclusion criteria. Results Final screening revealed 67 studies, from which the primary data of 1787 COVID-19 mothers were identified and had their pregnancy outcome analyzed. Only 2.8% of infants born to COVID-19-positive mothers tested positive, and this finding is identical to percentages reported in former Coronaviridae outbreaks, whereas 20% manifested with intrauterine hypoxia alongside placental abnormalities suggestive of heavy placental vaso-occlusive involvement. Conclusions These findings suggest that while vertical transmission is unlikely, there appears to be an underlying risk of placental insufficiency due to the prothrombotic tendency observed in COVID-19 infection. Guidelines for proper prophylactic anticoagulation in COVID-positive mothers need to be established.

Abstract Background Patent ductus arteriosus poses diagnostic and therapeutic dilemma for clinicians, diagnosis of persistent PDA, and determination of its clinical and hemodynamic significance are challenging. The aim of this study is to determine the prevalence of PDA in preterm infants admitted to our NICU, to report cardiac and respiratory complications of PDA, and to study the management strategies and their subsequent outcomes. Result Echocardiography was done for 152 preterm babies admitted to neonatal intensive care unit (NICU) on day 3 of life. Eighty-seven (57.2%) preterms had PDA; 54 (62.1%) non-hemodynamically significant PDA (non-hsPDA), and 33 (37.9%) hemodynamically significant PDA. Hemodynamically significant PDA received medical treatment (paracetamol 15 mg/kg/6 h IV for 3 days). Follow-up echocadiography was done on day 7 of life. Four babies died before echo was done on day 7. Twenty babies (68.9%) achieved closure after 1st paracetamol course. Nine babies received 2nd course paracetamol. Follow-up echo done on day 11 of life showed 4 (13.7%) babies achieved successful medical closure after 2nd paracetamol course; 5 babies failed closure and were assigned for surgical ligation. The group of non-hsPDA showed spontaneous closure after conservative treatment. Pulmonary hemorrhage was significantly higher in hsPDA group. Mortality was higher in hsPDA group than non-hsPDA group. Conclusion Echocardiographic evaluation should be done for all preterms suspected clinically of having PDA. We should not expose vulnerable population of preterm infants to medication with known side effects unnecessarily; we should limit medical closure of PDA to hsPDA. Paracetamol offers several important therapeutic advantages options being well tolerated and having more favorable side effects profile.

Objectives. To demonstrate safety and efficacy of using different generations of softer Amplatzer™ devices for ventricular septal defect (VSD) closure to avoid serious complications at follow-up. Background. Transcatheter closure of perimembranous ventricular septal defects (PmVSD) is a well-established procedure; however, it is associated with unacceptable incidence of complete heart block. Great advantages have been achieved by using softer devices for VSD transcatheter closure. The first and second generation of Amplatzer™ occluders (AVP II, ADO, and ADO II) seem to offer a safe and attractive alternative for this procedure. These devices can be delivered using either an arterial (retrograde) or venous (prograde) approach. Methods and Results. Patients with congenital PmVSD who underwent transcatheter closure using ADO, ADO II, and AVP II devices were included. Primary end point was to determine efficacy and safety of these generations of devices and to determine the incidence of complications at follow-up (complete AV block and aortic/tricuspid/mitral regurgitation). One hundred and nineteen patients underwent VSD closure at a median age of 5 years (8 months–54 years). During the catheterization, there were only minor complications and at follow-up of 36 ± 25.7 months (up to 99 months), the closure rate was high of 98.3% and freedom from AV block was 100%. Conclusions. The use of softer Amplatzer™ devices is a good alternative to achieve PmVSD closure safely with no risk of AVB during the procedure or at midterm follow-up.