Lower case en ; Congenital heart disease, NOS ; New Guinea ; Child

Chronic Disease ; Down Syndrome ; complications ; Heart Defects, Congenital ; complications ; Humans ; Infant, Newborn ; Leukemia ; congenital ; Male

Heart failure (HF) is a major cause of significant morbidity, mortality, and hospitalization worldwide including the Philippines. Congenitally corrected transposition of the great arteries (C-TGA) occurs when the right atrium enters the morphological left ventricle which gives rise to the pulmonary artery and the left atrium communicates with the right ventricle which gives rise to the aorta. Heart failure can occur in C-TGA especially if associated with other heart defects. Ideal management is anatomic correction via surgery to prevent or address heart failure. Peritoneal dialysis has been used as a therapeutic intervention for patients with refractory heart failure and kidney injury with or without kidney failure due to its gentler fluid removal compared to conventional ultrafiltration resulting in less myocardial stunning and neurohormonal activation. We present the case of a patient with heart failure who started on peritoneal dialysis (PD) as an adjunct therapy for fluid management after failing to satisfactorily achieve volume control with diuretics. The patient is a 56-year-old man with C-TGA admitted for decompensated heart failure. He was initially treated with intravenous diuretics on the first admission but was readmitted after 3 months for decompensation this time with borderline low blood pressure making diuresis difficult. The patient was given loop diuretics, tolvaptan, and angiotensin receptor neprilysin inhibitor (ARNI) but still with decreasing trends in urine output and inadequate symptom control. PD was initiated before discharge with subsequent improvement in heart failure symptoms. The patient was on regular follow-up for PD maintenance and titration of heart failure medication. In this case report, we have shown how PD can be an effective adjunct to guideline-directed medical therapy in patients with severely symptomatic heart failure who have an unstable hemodynamic status and for which volume management cannot be satisfactorily achieved with diuretics.
peritoneal dialysis ; heart failure ; congenital heart disease ; congenitally corrected transposition of the great arteries ; diuresis ; ultrafiltration

OBJECTIVES: To determine prevalence of coronary artery disease (CAD) among adult patients with congenital heart disease (CHD), who underwent Coronary Angiography (CA) at the UP-PGH. Secondary: to determine severity of CAD lesions among these patients.

METHODS: This is a descriptive study of adult patients with Congenital Heart Disease who underwent selective coronary angiography from September 1998 to December 2010 at the Philippine General Hospital.

RESULTS: 52 adult patients with CHD underwent CA, Ten (19%) had angiographic evidence of coronary atherosclerosis visually. Significant CAD was found in 11.5% (n=6), all patients being ≥ 40 years old (mean age 54 ± 7.9 years; range 47 -61); 4 (66%) are female; Five (83%) have documented traditional CVD risk factors, mostly hypertensive (33%). None with significant CAD had cyanosis, 4 patients (66%) have typical chest pain. Majority of CHD's were simple (61%), mostly atrial septal defects (36%). Four (n=4)(70%) patients with Simple CHD, 2 (30%) patients with Intermediate CHD and none of those with Complex CHD had significant CAD.

CONCLUSION: Prevalence of CAD among ACHD patients using CA in this study is 11.5%. This study supports the notion of routine CA among patients with ACHD ≥ 35 years old with traditional CV risk factors. Need for primary prevention of CAD and modification of traditional CV risk factors among these patients is emphasized, as important with the general population.

Arterio-Arterial Fistula ; congenital ; therapy ; Coronary Artery Disease ; congenital ; therapy ; Follow-Up Studies ; Heart Defects, Congenital ; therapy ; Humans ; Male ; Middle Aged ; Treatment Outcome

Anomalous origin of the left coronary artery from pulmonary artery was first described in a child by Brooks. This ALCAPA syndrome is a rare congenital anomaly occuring in approximately 0.25~0.50% of children having congenital heart disease. Although approximately 80 to 90% of patients develop congestive heart failure and die in infancy, some pateints may present this syndrome in adolescents or adults. This anomaly was detected during elective coronary angiogram in a 63 year-old female patient with typical angina. Down-sloping ST depression was demonstrated on exercise stress ECG. Coronary angiogram and pulmonary angiogram revealed an anomalous origin of left coronary artery from pulmonary artery.
Adolescent ; Adult* ; Bland White Garland Syndrome ; Child ; Congenital Abnormalities ; Coronary Angiography ; Coronary Disease ; Coronary Vessels* ; Depression ; Electrocardiography ; Female ; Heart Defects, Congenital ; Heart Failure ; Humans ; Middle Aged ; Pulmonary Artery*

PURPOSE: Infective endocarditis (IE) is a serious complication in children with structural heart disease. We reviewed 35 cases of IE to identify the recent changes in the pattern of preexisting heart diseases, the spectrum of causative organisms and prognosis. METHODS: The clinical records of children diagnosed as IE at the Seoul National University Children's Hospital from January 1987 through December 1997, were reviewed retrospectively. Duke criteria was used for diagnosis. Cases were categorized into primary group(PG) IE in an unoperated heart and post operative group(POG), and the latter further into early POG(within 2 months after operation) and late POG. RESULTS: There were 35 cases of IE developed in 34 patients; 18 cases in the PG, 6 cases in the early POG, and 11 cases in the late POG. Male to female ratio was 16 : 19. Mean age of POG, especially early POG was less than that of PG (early POG : late POG : PG=1.65 years : 6.5 years : 8.34 years, P=0.0267). Preexisting heart diseases were identified in 30 cases; rheumatic heart disease 1 case and congenital heart disease (CHD) 29 cases. Causative organisms were identified in 80%; viridans streptococci, 10 cases (33.3%); pneumococci, 2 cases; Group-D streptococci, 3 cases; staphylococci, 8 cases; Gram (-) organisms, 5 cases and Candida albicans, 2 cases. Vegetation was detected in 88.9% of PG and 64.7% of POG. The most common indication for surgery was uncontrolled infection, which were required in 9 cases. The overall mortality rate was 12.1%. Mortality in POG was higher than that of PG (23.5% versus 0%, P=0.033). CONCLUSION: The discrepancy of mean age among patient groups and the high proportion of patients belonging to POG, were consistent with the increase in the number of newly risky population that survived after cardiac surgery. A more aggressive consideration for operative management may improve the treatment results.
Candida albicans ; Child* ; Diagnosis ; Endocarditis* ; Female ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Male ; Mortality ; Prognosis ; Retrospective Studies ; Rheumatic Heart Disease ; Seoul ; Thoracic Surgery ; Viridans Streptococci

BACKGROUND: Valve replacement in children has many problems such as the durability of prosthetic valve, thomboembolism and hemorrhage. But recently, the necessity of valve replacement in children increased and the above problems were solved party. So the number of valve replacement in children increased progressively. RESULTS: Valve replacement in 47 children were done at Seooul National University Chidren's Hospital from March 1986 to July 1991. The patients were composed of 25 males and 33 females. 25 patients had congenital heart disease and 22 patients rheumatic heart disease. 45 patients received single valve repalcement, 2 patients double valve repalcement, and among all of them, 2 patients redo-replacement. The major valve lesion was mitral insufficiency and post-operative status in view of NYHA functinonal class was improved in most patients. The mechanical valves were applied to 45 patients and tissue valves to 2 patients. The indication of valve replacement were progressive increase in ventricular volume, major regurgitant fraction over grade III decrease in exercise tolerance and vegetation. The overall early mortality was 8.5% and late mortality 0%. There were post-operative complication rate of 30% and late complication rate 14%, and among the later, valve faliure was reported in 2 pantients and thromboembolism in 1 patient. The complication-free rate was 97.7% at post-operative 1 month, 91.3% at 12 months, 90% at 36 months and 60% at 48 months. 43 patients received anticoagulation and/or antiplatelet therapy, but there was no critical indication for this. CONCLUSION: These results suggest that cardiac valve replacement in children have been effective therapeutic modality even though various problems still remain, but we propose that sufficient long-term follow-up and clinical research be needed.
Child* ; Exercise Tolerance ; Female ; Follow-Up Studies ; Heart Defects, Congenital ; Heart Valves* ; Hemorrhage ; Humans ; Male ; Mitral Valve Insufficiency ; Mortality ; Rheumatic Heart Disease ; Thromboembolism

OBJECTIVE: To explore the management of heart failure, the timing of delivery in pregnancy, and the influence on pregnant prognosis. METHODS: We retrospectively analyzed the incidence of heart failure, treatment results, pattern of termination, and time of termination in 356 cases of pregnancy with heart disease. RESULTS: One hundred and thirty-six (38.20%) cases were diagnosed as heart failure and 76 (55.88%) were moderate or severe heart failure. Heart failure tends to occur more easily in rheumatic heart diseases than in congenital heart diseases. Heart failure occurred more frequently in pregnancy with rheumatic heart diseases without the heart operation before pregnancy than that of pregnancy with congenital heart diseases. The occurence of the moderate and severe heart failure in pregnancy decreased in rheumatic heart diseases with surgical therapies compared with those without surgical therapies (P <0.05). Compared with pregnancy with heart failure controlled inadequately, pregnancy with effectively controlled heart failure had better tolerance during delivery and through the pregnancy, and puerperium. CONCLUSION Congenital heart diseases and rheumatic heart diseases are the chief causes of heart failure during the gestation. Therapy before pregnancy, especially surgery to the rheumatic heart diseases, may improve the cardiac function during pregnancy. Monitoring heart function and selecting the proper timing to terminate pregnancy after controlling the heart failure in late pregnant period will be helpful to improve the prognosis of pregnant and perineonate.
Adult ; Delivery, Obstetric ; Female ; Heart Defects, Congenital ; complications ; Heart Failure ; etiology ; therapy ; Humans ; Pregnancy ; Pregnancy Complications, Cardiovascular ; therapy ; Pregnancy Outcome ; Retrospective Studies ; Rheumatic Heart Disease ; complications ; Time Factors

Adolescent ; Arteriovenous Fistula ; therapy ; Catheter Ablation ; methods ; Coronary Artery Disease ; therapy ; Female ; Heart Defects, Congenital ; therapy ; Humans ; Male ; Middle Aged