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Congenital heart disease (CHD) is the most common congenital abnormality in children and often requires surgical intervention. These children are vulnerable to nosocomial infections (NIs), particularly bloodstream infections (BSIs), after surgery. In this study, we aimed to investigate the incidence of bloodstream infections BSIs after cardiac surgery. This retrospective study was conducted on pediatric patients refered to Children's Medical Center Hospital, affiliated with Tehran University of Medical Sciences, from March 2022 to March 2023 for cardiac surgery. The records of 449 patients were reviewed, with 436 meeting inclusion criteria. Data were extracted from medical records, including age, weight, gender, clinical diagnoses, and blood culture results. Statistical analysis was performed using descriptive statistics (including frequency, percentage, mean, and standard deviation) and inferential statistics (including Chi-square and Independent t-test) in SPSS version 23. The results showed that the incidence of BSIs in pediatric CHD patients after cardiac surgery was 3.21%. Postoperative blood cultures revealed that Klebsiella pneumoniae was the most common pathogen (42.9%), followed by Escherichia coli and Staphylococcus epidermidis (14.3% each). No significant association was found between BSIs and gender (P=0.70), weight (P=0.06), or diagnosis (P=0.44). However, age was significantly associated with BSI incidence (P<0.001). This study provides important insights into the incidence of nosocomial BSIs in pediatric CHD patients after cardiac surgery. Our results highlight the need for stronger infection control measures and targeted antibiotic therapies to effectively manage BSIs. Further research is recommended to validate these results and improve preventive measures in pediatric cardiac units. [ABSTRACT FROM AUTHOR]

Absent pulmonary valve syndrome (APVS) is a rare congenital anomaly characterized by rudimentary PV tissue with variable degrees of PV stenosis and regurgitant pulmonary blood flow. In most cases, it is associated with tetralogy of Fallot. In a minority of APVS cases, with an unknown frequency, intact ventricular septum (IVS), patent ductus arteriosus, and possible tricuspid atresia are present. This condition is known as non-Fallot type APVS. We describe a case of an antenatal diagnosis of APVS with IVS, a large patent ductus arteriosus, and ascending aorta dilatation. The mother was referred to our center at 32 weeks of gestation due to cardiomegaly on sonography. Fetal echocardiography revealed cardiomegaly, right atrial and ventricular enlargement, aneurysmal dilatation of the main pulmonary artery, and mild dilatation of the pulmonary artery branches. Also observed were IVS, rudimentary PV tissue with severe to-and-fro turbulence across the PV, a widely open ductus arteriosus, ascending aorta dilatation, and levorotation of the heart. After childbirth, our diagnosis was confirmed by echocardiography and surgery. The baby experienced severe respiratory distress. At 15 days of life, surgical intervention in the form of pulmonary artery arterioplasty was performed, resulting in good outcomes. The patient underwent follow-up for 6 months and showed reasonable health. [ABSTRACT FROM AUTHOR]

Background: Children with congenital heart diseases (CHDs) often require cardiac surgery, whose outcome depends on many preoperative, intraoperative, and postoperative factors. Objectives: We aimed to investigate the factors associated with in-hospital mortality among patients undergoing pediatric heart surgery for CHDs. Methods: This retrospective cross-sectional study included patients younger than l8 years who underwent cardiac surgery due to CHDs at the Children's Medical Center of Tehran University of Medical Sciences and were admitted to the open-heart surgery intensive care unit (OH-ICU) between March 2018 and March 2019. Patients with incomplete records were excluded. The collected data included age (months), weight (kg), type of congenital defect, duration of intensive care unit (ICU) stay, cardiopulmonary bypass (CPB) time, aortic cross-clamping (XCT) time, postoperative (day 1) platelet count and neutrophil-to-lymphocyte ratio (NLR), and mortality. Results: This study included 275 CHD patients who underwent cardiac surgery. The mean age and weight were 32.54 ± 37.4 months and 11.01 ± 8.43 kg, respectively. Those who died were younger (P = 0.05) and had lower weights (P = 0.001). An inverse relationship existed between thrombocytopenia and mortality. The NLR was higher in those who survived (mean 4.08 vs. 2.87), while the deceased patients had an extended duration of hospitalization, longer CPB time, and longer XCT time. Conclusions: Younger age, lower body weight, lower NLR ratio, lower platelet count, longer intraoperative CPB time, and XCT time were not associated with increased in-hospital mortality following cardiac surgery for CHDs. The Risk Adjustment for Congenital Heart Surgery (RACHS-1) score was not significantly related to mortality. Also, CPB and XCT times were significantly longer in cyanotic than in non-cyanotic patients. Cyanotic patients also had significantly lower platelets than non-cyanotic patients after the operation. Large, multicenter studies are needed to further investigate the predictors of mortality following surgery for CHDs. [ABSTRACT FROM AUTHOR]

Introduction: The people worldwide have been affected by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection since its appearance in December, 2019. Kawasaki disease-like hyperinflammatory shock associated with SARS-CoV-2 infection in previously healthy children has been reported in the literature, which is now referred to as a multisystem inflammatory syndrome in children (MIS-C). Some aspects of MIS-C are similar to those of Kawasaki disease, toxic shock syndrome, secondary hemophagocytic syndrome, and macrophage activation syndrome. Case Presentation: This study reported an 11-year-old boy with MIS-C presented with periorbital and peripheral edema, abdominal pain, elevated liver enzymes, severe right pleural effusion, moderate ascites, and severe failure of right and left ventricles. Conclusions: Due to the increasing number of reported cases of critically ill patients afflicted with MIS-C and its life-threatening complications, it was recommended that further studies should be carried out in order to provide screening tests for myocardial dysfunction. Adopting a multidisciplinary approach was found inevitable. [ABSTRACT FROM AUTHOR]

Case Presentation: This report describes a 7 years old boy who has had chronic and recurrent respiratory distress and wheezing episodes since infancy. He had been treated for hyper-reactive airway disease and asthma, with partial response. The problem had been associated with cyanosis and did not improve with asthma treatment; therefore, we consider other underlying diseases, such as cardiovascular problems. In "double aortic arch" the ascending aorta bifurcates and ends to a right and left sided arch which surround the esophagus and trachea and then join together to compose the descending aorta. The right arch is often larger than the left one. The diagnostic work-ups revealed the "double aortic arch" which had not been diagnosed for years. Vascular ring is among the differential diagnoses of chronic cough. Other possible causes of chronic cough include: Gastroesophageal reflux disease, cystic fibrosis, inhaled foreign body, infection, tracheomalacia, immune deficiency, vocal cord dysfunction, bronchiectasia, chronic sinusitis with or without postnasal drip, allergic disease, and branchial cleft cysts. The clinical signs and symptoms of vascular ring in children vary from a completely asymptomatic patient to severe respiratory distress in a neonate. The most prevalent presentations in children are nonspecific and include; choking, vomiting, dysphagia, cough, stridor, wheezing and episodes of upper respiratory tract infection. The clinical presentation of double aortic arch most often occurs in infancy. External pressure on the airway by vascular ring causes respiratory and feeding problems. Feeding problems such as slow feeding, difficult swallowing, hyperextension of head during eating, may occur later in life, since these problems typically present when solid foods are introduced. Chronic wheezing is aggravated by eating, crying and neck flexion, while neck extension alleviates the noisy breathing. Severe problems such as apnea and cyanosis may also occur. Conclusion: Patients with vascular rings usually present with nonspecific and vague complaints and can mimic asthma or hyper-reactive airway disease. Physicians should consider vascular rings in the list of differential diagnosis of chronic cough, respiratory problems and refractory asthma to prevent the unnecessary interventions and procedures and delaying the diagnosis. [ABSTRACT FROM AUTHOR]

Absent pulmonary valve syndrome (APVS) is a rare congenital anomaly characterized by rudimentary PV tissue with variable degrees of PV stenosis and regurgitant pulmonary blood flow. In most cases, it is associated with tetralogy of Fallot. In a minority of APVS cases, with an unknown frequency, intact ventricular septum (IVS), patent ductus arteriosus, and possible tricuspid atresia are present. This condition is known as non-Fallot type APVS. We describe a case of an antenatal diagnosis of APVS with IVS, a large patent ductus arteriosus, and ascending aorta dilatation. The mother was referred to our center at 32 weeks of gestation due to cardiomegaly on sonography. Fetal echocardiography revealed cardiomegaly, right atrial and ventricular enlargement, aneurysmal dilatation of the main pulmonary artery, and mild dilatation of the pulmonary artery branches. Also observed were IVS, rudimentary PV tissue with severe to-and-fro turbulence across the PV, a widely open ductus arteriosus, ascending aorta dilatation, and levorotation of the heart. After childbirth, our diagnosis was confirmed by echocardiography and surgery. The baby experienced severe respiratory distress. At 15 days of life, surgical intervention in the form of pulmonary artery arterioplasty was performed, resulting in good outcomes. The patient underwent follow-up for 6 months and showed reasonable health., (Copyright© 2024 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)