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P2-69 MULTIPLE CORONARY ARTERY TO PULMONARY ARTERY FISTULAE: CASE OF ANOMALOUS CONNECTIONS
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Abstracts of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13-16 December, 2007
P2-69 MULTIPLE CORONARY ARTERY TO PULMONARY ARTERY FISTULAE: CASE OF ANOMALOUS CONNECTIONS
colostrums milk powder. This initial observation may need further multi center double blind studies.
Leahdette Padua, Gilbert Vilela, Viannely Berwyn Flores, Frederick Vicente, Neil Gomez, Rommel Cariño, Jonathan Morley Ramirez, Kathleen Go, Francoise May Sarmiento. Departments of Adult Cardiology and Cardiovascular Surgery, Philippine Heart Center, Philippines
P2-71
Background: Coronary artery fistulas (CAF) are rare coronary anomalies that can originate from any of the coronary arteries and drain in any of the cardiac chambers or great vessels. CAF originating from both coronaries and terminating into the main pulmonary artery, is one of the uncommon presentation of such anomaly. Case Presentation: We present a case of a 51-year old asymptomatic male who was evaluated for a continuous murmur at the base of the heart. A transthoracic echocardiogram revealed a continuous mosaic color flow display from the aortic root draining into the pulmonary artery. Coronary angiography revealed multiple fistulas, all terminating into the main pulmonary artery. He underwent surgical clipping of these fistulae. Post-operatively, there is absence of murmur and the mosaic color flow display on echocardiography. Conclusion: Fistulas originating from both coronaries and draining to the pulmonary artery is rare since bicoronary fistulae happens in only 5% of cases and drainage into the pulmonary artery occurs in about 17% of cases. It should be considered as a differential in patients presenting with continuous murmurs and aortopulmonary shunt. Echocardiography and coronary angiography are complementary diagnostic procedures. Intervention in asymptomatic cases is influenced by the age, risk of complications and good outcome of intervention. Decision as to the type of intervention is dictated by the anatomy of the fistula and the institutional experience.
Saji Philip 1 , Prem Sekar 2 , Cherian Kottureth Mamen 1,2 . 1 Division of Pediatric Cardiology, St. Gregorios Cardiovascular Center, Dr. K.M. Cherian Heart Foundation, Parumala, Kerala; 2 International centre for Cardio-thoracic and Vascular Disease Chennai, India
P2-70 POTENTIAL PROPHYLACTIC VALUE OF BOVINE COLOSTRUM IN CHILDREN WITH CONGENITAL HEART DISEASE PRESENTING WITH FREQUENT RESPIRATORY TRACT INFECTIONS; AN INITIAL EXPERIENCE FROM A RURAL HEART CENTRE
Saji Philip, K.M. Cherian. Division of Pediatric Cardiology, St. Gregorios Cardiovascular Center, Mannar, Kerala, and International Center for Cardio-Thoracic & Vascular Diseases, Dr. K M Cherian Heart Foundation, Chennai, India Objective: To evaluate the efficacy of bovine colostrum in preventing frequent allergic episodes and respiratory tract infections in children with congenital heart disease. Methods: 75 children aged 1month to 5 years of congenital heart disease having recurrent episodes of respiratory tract infections, including Test group (n=53) children with acyanotic heart disease without heart failure and 14 were with heart failure on decongestive regime and 13 children with cyanotic heart disease with frequent wet cough waiting electively for intra cardiac repair, received supplementation Bovine Colostrum (Pedimune® ) 3gm per serving per day for 3months and the Control group with frequent chest infections (n=22) not due to cardiac cause were received placebo 3gm milk powder. Total no of episodes of recurrent infections, hospitalization rate, overall well being and adverse events were assessed at every 4 weeks. Results: Respiratory infections, including frequent wet cough and wheezy episodes were reduced significantly by 80 to 86% at the end of therapy. Frequent therapy with antibiotics in test group was significantly reduced and better oxygen saturation was observed when supplemented with colostrums milk powder when compared to control group was needed frequent antibiotic therapy, and had less oxygen saturation due to recurrent infections. High to average improvement in overall well-being in 86% of the patients in both cyanotic and acyanotic congenital heart disease were found by pediatrician while overall well-being stated by the patient/care taker was very good to good in 80.56% of the patients. Conclusion: Bovine colostrum was highly effective in preventing recurrent chest infections, frequent wet cough and wheezy episodes in association with congenital heart disease. The number of hospital admissions and antibiotic therapy were significantly reduced and better oxygen saturation level was observed in both acyanotic and cyanotic congenital heart disease when supplemented with
AN EVALUATION OF EFFICACY OF ORAL IBUPROFEN IN CLOSING MODERATE TO LARGE DUCTUS IN TERM BABIES WITH HEART FAILURE: AN INITIAL EXPERIENCE FROM A RURAL HEART CENTRE
Aim: The purpose of this study was to evaluate the efficacy of oral ibuprofen suspension in closing large patent ductus arteriosus (PDA) in 5-14-days old term babies presented with signs of heart failure. Methods: Total 14 term-babies, aged 5-14days who were referred from the peripheral neonatology units with heart murmur, respiratory distress and difficulty in feeding were evaluated. The cases diagnosed with other structural heart diseases other than small patent foramen ovale were excluded from this study. Clinical evaluation with chest x-ray, 2-D colour doppler echocardiography was performed in all cases for accessing the size of PDA, including other echocradiographic parameters such as ventricle diameter, La/Ao ratio etc. Out of 14 cases, 8 cases (Group A) had received oral ibuprofen 10mg/kg/Bwt/dose in two doses per day for 7days in addition to decongestive regime for heart failure, and other 6 cases (Group B) were retrospectively evaluated from the data base of cardiac registery had received decongestive regime alone. Result: Both Groups were evaluated before and after 10days of oral ibuprofen with decongestive regimen for weight, size of the PDA, La/Ao ratio, LVdiameter and the result of GroupA (n=8) showed 2500±565 gm/2300±260 gm, 3.21±0.4/2.2±0.1 mm, 1.3±0.18/1.1±0.12, 1.8±1.1m/1.6±0.7 and Group B (n=6) with decongestive measures showed 2600±425/2200±200 gm, 3.5±1.2/3.2±0.6 mm, 1.2±0.27/1.2±0.17, 1.9±0.9/1.8±0.9 respectively. No babies showed any adverse effect except feed regurgitation in 3 children was managed symptomatically. Closure of PDA was achieved in 5 of 8 (62.5%), size of PDA was reduced to less than 2.5mm in three cases, where as none of them was closed in Group B and the reduction in size of PDA was observed after 2 months of follow up. In Conclusion The seven days of oral ibuprofen therapy in addition to the decongestive regimen we used in this study was easy to administer and no significant adverse effects observed. It was successful for either pharmacological closure or reduction in size of moderate to large ductus in term babies with heart failure, and decongestive regime was tapered in group A much earlier than group B. None of them was closed in Group B.
P2-72 CASE REPORT: ISOLATED CONGENITAL LEFT VENTRICULAR DIVERTICULUM IN AN ADULT PATIENT
Gerard S. Razon, Joyce S. Jumangit, Eleanor A. Lopez, Edwin S. Tucay, Joel Paz, Aquileo Rico. Philippine Heart Center, Philippines Congenital isolated left ventricular (LV) diverticulum is a rare disease and has only been documented by a few case reports and a small series of retrospective analyses. Presented is a 22-year old male patient, previously well and with no risk factors for coronary heart disease, who complained of a one month history of chest heaviness and easy fatigability, physical findings revealed a dynamic precordium and a grade 3/6 mid systolic murmur at 5th intercostal space left parasternal border and apical areas. Chest radiography showed a large convex density in the left side of the cardiac silhouette and interstitial and alveolar edema in the right middle and lower lung. Both transthoracic and transesophageal echocardiography showed a non-contractile out pouching from the basal left ventricle suggestive of a LV diverticulum. Coronary angiography showed normal coronaries with the LV angiogram showing the left ventricular out pouching with a narrow neck consistent with the findings of a diverticulum. Diverticulectomy with Dacron patch closure adopting the Dor procedure was done. Postoperative course was unremarkable and patient symptoms improved.
Abstracts of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13-16 December, 2007
P2-69 MULTIPLE CORONARY ARTERY TO PULMONARY ARTERY FISTULAE: CASE OF ANOMALOUS CONNECTIONS
colostrums milk powder. This initial observation may need further multi center double blind studies.
Leahdette Padua, Gilbert Vilela, Viannely Berwyn Flores, Frederick Vicente, Neil Gomez, Rommel Cariño, Jonathan Morley Ramirez, Kathleen Go, Francoise May Sarmiento. Departments of Adult Cardiology and Cardiovascular Surgery, Philippine Heart Center, Philippines
P2-71
Background: Coronary artery fistulas (CAF) are rare coronary anomalies that can originate from any of the coronary arteries and drain in any of the cardiac chambers or great vessels. CAF originating from both coronaries and terminating into the main pulmonary artery, is one of the uncommon presentation of such anomaly. Case Presentation: We present a case of a 51-year old asymptomatic male who was evaluated for a continuous murmur at the base of the heart. A transthoracic echocardiogram revealed a continuous mosaic color flow display from the aortic root draining into the pulmonary artery. Coronary angiography revealed multiple fistulas, all terminating into the main pulmonary artery. He underwent surgical clipping of these fistulae. Post-operatively, there is absence of murmur and the mosaic color flow display on echocardiography. Conclusion: Fistulas originating from both coronaries and draining to the pulmonary artery is rare since bicoronary fistulae happens in only 5% of cases and drainage into the pulmonary artery occurs in about 17% of cases. It should be considered as a differential in patients presenting with continuous murmurs and aortopulmonary shunt. Echocardiography and coronary angiography are complementary diagnostic procedures. Intervention in asymptomatic cases is influenced by the age, risk of complications and good outcome of intervention. Decision as to the type of intervention is dictated by the anatomy of the fistula and the institutional experience.
Saji Philip 1 , Prem Sekar 2 , Cherian Kottureth Mamen 1,2 . 1 Division of Pediatric Cardiology, St. Gregorios Cardiovascular Center, Dr. K.M. Cherian Heart Foundation, Parumala, Kerala; 2 International centre for Cardio-thoracic and Vascular Disease Chennai, India
P2-70 POTENTIAL PROPHYLACTIC VALUE OF BOVINE COLOSTRUM IN CHILDREN WITH CONGENITAL HEART DISEASE PRESENTING WITH FREQUENT RESPIRATORY TRACT INFECTIONS; AN INITIAL EXPERIENCE FROM A RURAL HEART CENTRE
Saji Philip, K.M. Cherian. Division of Pediatric Cardiology, St. Gregorios Cardiovascular Center, Mannar, Kerala, and International Center for Cardio-Thoracic & Vascular Diseases, Dr. K M Cherian Heart Foundation, Chennai, India Objective: To evaluate the efficacy of bovine colostrum in preventing frequent allergic episodes and respiratory tract infections in children with congenital heart disease. Methods: 75 children aged 1month to 5 years of congenital heart disease having recurrent episodes of respiratory tract infections, including Test group (n=53) children with acyanotic heart disease without heart failure and 14 were with heart failure on decongestive regime and 13 children with cyanotic heart disease with frequent wet cough waiting electively for intra cardiac repair, received supplementation Bovine Colostrum (Pedimune® ) 3gm per serving per day for 3months and the Control group with frequent chest infections (n=22) not due to cardiac cause were received placebo 3gm milk powder. Total no of episodes of recurrent infections, hospitalization rate, overall well being and adverse events were assessed at every 4 weeks. Results: Respiratory infections, including frequent wet cough and wheezy episodes were reduced significantly by 80 to 86% at the end of therapy. Frequent therapy with antibiotics in test group was significantly reduced and better oxygen saturation was observed when supplemented with colostrums milk powder when compared to control group was needed frequent antibiotic therapy, and had less oxygen saturation due to recurrent infections. High to average improvement in overall well-being in 86% of the patients in both cyanotic and acyanotic congenital heart disease were found by pediatrician while overall well-being stated by the patient/care taker was very good to good in 80.56% of the patients. Conclusion: Bovine colostrum was highly effective in preventing recurrent chest infections, frequent wet cough and wheezy episodes in association with congenital heart disease. The number of hospital admissions and antibiotic therapy were significantly reduced and better oxygen saturation level was observed in both acyanotic and cyanotic congenital heart disease when supplemented with
AN EVALUATION OF EFFICACY OF ORAL IBUPROFEN IN CLOSING MODERATE TO LARGE DUCTUS IN TERM BABIES WITH HEART FAILURE: AN INITIAL EXPERIENCE FROM A RURAL HEART CENTRE
Aim: The purpose of this study was to evaluate the efficacy of oral ibuprofen suspension in closing large patent ductus arteriosus (PDA) in 5-14-days old term babies presented with signs of heart failure. Methods: Total 14 term-babies, aged 5-14days who were referred from the peripheral neonatology units with heart murmur, respiratory distress and difficulty in feeding were evaluated. The cases diagnosed with other structural heart diseases other than small patent foramen ovale were excluded from this study. Clinical evaluation with chest x-ray, 2-D colour doppler echocardiography was performed in all cases for accessing the size of PDA, including other echocradiographic parameters such as ventricle diameter, La/Ao ratio etc. Out of 14 cases, 8 cases (Group A) had received oral ibuprofen 10mg/kg/Bwt/dose in two doses per day for 7days in addition to decongestive regime for heart failure, and other 6 cases (Group B) were retrospectively evaluated from the data base of cardiac registery had received decongestive regime alone. Result: Both Groups were evaluated before and after 10days of oral ibuprofen with decongestive regimen for weight, size of the PDA, La/Ao ratio, LVdiameter and the result of GroupA (n=8) showed 2500±565 gm/2300±260 gm, 3.21±0.4/2.2±0.1 mm, 1.3±0.18/1.1±0.12, 1.8±1.1m/1.6±0.7 and Group B (n=6) with decongestive measures showed 2600±425/2200±200 gm, 3.5±1.2/3.2±0.6 mm, 1.2±0.27/1.2±0.17, 1.9±0.9/1.8±0.9 respectively. No babies showed any adverse effect except feed regurgitation in 3 children was managed symptomatically. Closure of PDA was achieved in 5 of 8 (62.5%), size of PDA was reduced to less than 2.5mm in three cases, where as none of them was closed in Group B and the reduction in size of PDA was observed after 2 months of follow up. In Conclusion The seven days of oral ibuprofen therapy in addition to the decongestive regimen we used in this study was easy to administer and no significant adverse effects observed. It was successful for either pharmacological closure or reduction in size of moderate to large ductus in term babies with heart failure, and decongestive regime was tapered in group A much earlier than group B. None of them was closed in Group B.
P2-72 CASE REPORT: ISOLATED CONGENITAL LEFT VENTRICULAR DIVERTICULUM IN AN ADULT PATIENT
Gerard S. Razon, Joyce S. Jumangit, Eleanor A. Lopez, Edwin S. Tucay, Joel Paz, Aquileo Rico. Philippine Heart Center, Philippines Congenital isolated left ventricular (LV) diverticulum is a rare disease and has only been documented by a few case reports and a small series of retrospective analyses. Presented is a 22-year old male patient, previously well and with no risk factors for coronary heart disease, who complained of a one month history of chest heaviness and easy fatigability, physical findings revealed a dynamic precordium and a grade 3/6 mid systolic murmur at 5th intercostal space left parasternal border and apical areas. Chest radiography showed a large convex density in the left side of the cardiac silhouette and interstitial and alveolar edema in the right middle and lower lung. Both transthoracic and transesophageal echocardiography showed a non-contractile out pouching from the basal left ventricle suggestive of a LV diverticulum. Coronary angiography showed normal coronaries with the LV angiogram showing the left ventricular out pouching with a narrow neck consistent with the findings of a diverticulum. Diverticulectomy with Dacron patch closure adopting the Dor procedure was done. Postoperative course was unremarkable and patient symptoms improved.