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Jadczak EA, Jnah AJ. Wolff-Parkinson-White Syndrome in the Preterm Neonate. Neonatal Netw 2024; 43:212-223. [PMID: 39164096 DOI: 10.1891/nn-2023-0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
Abstract
Wolff-Parkinson-White (WPW) syndrome is a rare cardiac condition arising from abnormal embryologic development of the annulus fibrosus in combination with the cardiac conduction system. The abnormality results in the development of accessory pathways and preexcitation changes which can provoke episodes of tachyarrhythmias. The most common presentation of WPW syndrome is supraventricular tachycardia. Beyond customary abortive therapy, chronic management strategies vary based upon timing and clinical severity of the initial disease presentation. Prompt diagnosis and rate control have a dramatic impact on the outcomes of morbidity and mortality. The purpose of this article is to present a case study of a preterm infant who manifested with WPW syndrome. Additionally, the article will explore the pathophysiology of WPW syndrome and the timing and presentation of common clinical manifestations of the disease, along with current diagnostic and treatment strategies to achieve optimal patient outcomes in the neonatal population.
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Zhu W, Yuan H, Lv J. Advancements in the diagnosis and management of premature ventricular contractions in pediatric patients. Front Pediatr 2024; 12:1373772. [PMID: 38571703 PMCID: PMC10987820 DOI: 10.3389/fped.2024.1373772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
Background Premature ventricular contractions (PVCs) are relatively common arrhythmias in the pediatric population, with implications that range from benign to potentially life-threatening. The management of PVCs in children poses unique challenges, and recent advancements in diagnostic and therapeutic options call for a comprehensive review of current practices. Methods This review synthesizes the latest literature on pediatric PVCs, focusing on publications from the past decade. We evaluate studies addressing the epidemiology, pathophysiology, diagnosis, and treatment of PVCs in children, including pharmacological, non-pharmacological, and invasive strategies. Results The review identifies key advancements in the non-invasive detection of PVCs, the growing understanding of their genetic underpinnings, and the evolving landscape of management options. We discuss the clinical decision-making process, considering the variable significance of PVCs in different pediatric patient subgroups, and highlight the importance of individualized care. Current guidelines and consensus statements are examined, and areas of controversy or limited evidence are identified. Conclusions Our review underscores the need for a nuanced approach to PVCs in children, integrating the latest diagnostic techniques with a tailored therapeutic strategy. We call for further research into long-term outcomes and the development of risk stratification tools to guide treatment. The potential of emerging technologies and the importance of multidisciplinary care are also emphasized to improve prognoses for pediatric patients with PVCs.
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Affiliation(s)
- Wenjing Zhu
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Clinical Research Center for Children's Health and Disease Office, Jinan, Shandong, China
| | - Hui Yuan
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Clinical Research Center for Children's Health and Disease Office, Jinan, Shandong, China
| | - Jianli Lv
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Clinical Research Center for Children's Health and Disease Office, Jinan, Shandong, China
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Goto L, Witkowska O, Slusarczyk ME, Grotek AM, Dziubinski MJ, Clark BC. Diagnostic yield of ambulatory cardiac monitoring in pediatric patients with palpitations. Ann Pediatr Cardiol 2023; 16:109-113. [PMID: 37767173 PMCID: PMC10522156 DOI: 10.4103/apc.apc_107_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/01/2022] [Accepted: 02/04/2023] [Indexed: 09/29/2023] Open
Abstract
Background Palpitations are a frequent reason for referral to pediatric cardiology providers and diagnostic workup includes ambulatory cardiac monitoring. While common practice, the diagnostic yield is unknown in the pediatric population. The objective is to evaluate the diagnostic yield of 24-h Holter and extended ambulatory cardiac monitoring in pediatric patients with palpitations. Methods and Results All pediatric patients aged 10-18 years who had ambulatory cardiac monitoring (1-30 days) through the Pocket Electrocardiogram (PocketECG™) system (Medi-Lynx) between January 2016 and July 2020 were included. Patients with an International Classification of Diseases-10 diagnosis code of palpitations (R00.2) during enrollment were evaluated separately. Tachyarrhythmia diagnoses included atrial fibrillation (AF), nonsustained supraventricular tachycardia (nSVT), supraventricular tachycardia (SVT), nonsustained ventricular tachycardia (nVT), and ventricular tachycardia (VT). Age, heart rates, arrhythmia type, and symptomatic transmission data were collected and analyzed. A total of 2388 patients (mean age 11.6 years, 58% F) with the R00.2 code had ambulatory cardiac monitoring (28% 24-h Holter, 72% extended) performed during the study period and there were 6287 total patients (mean age 13.9 years, 54% F) that underwent ambulatory cardiac monitoring (42% 24-h Holter, 58% extended) during that time. Of 2388 patients, 321 (13%) were diagnosed with tachyarrhythmia: AF (9), nSVT (192), SVT (59), and nVT (61). In the overall cohort, 764 (12%) patients were diagnosed with tachyarrhythmia: AF (22), nSVT (478), SVT (85), nVT (177), and VT (2). Symptomatic transmissions with normal cardiac rhythm were common in the R00.2 (n = 1697, 71%) and overall (n = 3848, 61%) groups. No episodes of nSVT, SVT, nVT, or VT were associated with symptomatic transmissions. Conclusion Ambulatory cardiac monitors are an integral part of the diagnostic workup for pediatric palpitations patients and have demonstrated a high yield of combined positive arrhythmia diagnoses and symptomatic normal transmissions. Further prospective study of this population with the integration of clinical information is warranted.
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Affiliation(s)
- Lisa Goto
- Department of Pediatrics, Children’s Hospital at Montefiore, Bronx, NY, USA
| | | | | | | | | | - Bradley C. Clark
- Division of Pediatric Cardiology, Children’s Hospital at Montefiore, Bronx, NY, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
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Begic Z, Begic N, Granov N, Vila H, Berberovic-Hukeljic B, Begic E, Rebic D. Pacemaker implantation in the pediatric population: Bosnian and herzegovinian experience. HEART AND MIND 2023. [DOI: 10.4103/hm.hm_12_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Akca T, Uysal F, Bostan OM, Genc A, Turkmen H. The Role of External Loop Recorders in Arrhythmia-Related Symptoms in Children: A Single Center Experience. Pediatr Cardiol 2022; 43:147-154. [PMID: 34389905 DOI: 10.1007/s00246-021-02705-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/08/2021] [Indexed: 11/25/2022]
Abstract
In this study, we report our experience with the use of external loop recorders (ELRs), in terms of diagnostic efficiency according to symptoms and symptom-rhythm correlation in pediatric patients. We evaluated ELRs applied to 178 patients between April 2017 and November 2020 at our center. The mean age of 172 patients included in the study was 13.6 ± 3.8 years, and 69.8% were female. ELR indications were palpitations in 98 (56.9%) cases, chest pain and palpitations in 43 (25%) cases, presyncope/syncope in 28 (16.2%) cases, and pacemaker/ implantable cardioverter-defibrillator (ICD) problems in 3 (0.2%) cases. ELR recording times were 14.2 ± 9.7 days on average, ranging from 2 to 67 days. While the symptom-rhythm correlation was 29.1% in total, when the indications were evaluated one by one, this correlation was found to be 30.2% in palpitations, 34.7% in chest pain and palpitations, and 10.7% in presyncope/syncope. The total diagnostic efficiency was 68.1%. In the follow-up of ELR cases, a total of 139 (80.8%) patients received clinical follow-up without medication, 15 (8.8%) patients received medical treatment, and 18 (10.4%) patients underwent EPS. The cardiac ELR system is useful in detecting underlying arrhythmias. Demonstrating sinus tachycardia at the time of the symptom may be seen as negative finding, but while experiencing symptoms, it is diagnostically valuable and may help avoid further investigation with costly and invasive diagnostic procedures. For diagnostic efficiency and cost effectiveness, the optimal recording time is 2 weeks, but it should be extended to 4 weeks in cases such as of presyncope/syncope that cannot be explained with a 2-week ELR use.
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Affiliation(s)
- Tugberk Akca
- Faculty of Medicine, Department of Pediatric Cardiology, Bursa Uludag University, Gorukle Campuss, Nilufer, Bursa, Turkey.
| | - Fahrettin Uysal
- Faculty of Medicine, Department of Pediatric Cardiology, Bursa Uludag University, Gorukle Campuss, Nilufer, Bursa, Turkey
| | - Ozlem Mehtap Bostan
- Faculty of Medicine, Department of Pediatric Cardiology, Bursa Uludag University, Gorukle Campuss, Nilufer, Bursa, Turkey
| | - Abdusselam Genc
- Faculty of Medicine, Department of Pediatric Cardiology, Bursa Uludag University, Gorukle Campuss, Nilufer, Bursa, Turkey
| | - Hasan Turkmen
- Faculty of Medicine, Department of Pediatric Cardiology, Bursa Uludag University, Gorukle Campuss, Nilufer, Bursa, Turkey
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Comparison of Holter With Zio Patch Electrocardiography Monitoring in Children. Am J Cardiol 2020; 125:767-771. [PMID: 31948666 DOI: 10.1016/j.amjcard.2019.11.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 11/21/2022]
Abstract
The standard for ambulatory arrhythmia detection in children is the Holter monitor. The Zio XT (Zio) patch has been FDA-approved for use in adults. However, its utility in children has not been directly compared with the Holter. We studied the ability to detect arrhythmias and patient comfort of the Zio versus the Holter in children. Patients <22 years old were prospectively enrolled to wear the Holter and Zio simultaneously for 48 hours at our institution. Detection of clinically significant arrhythmias was compared using McNemar's test. Wear-time and artifact time was compared using Wilcoxon sign test. Patient satisfaction ratings were analyzed with paired t tests. Two hundred patients (57% male) were included for analysis. The median age was 13.5 years (range 23 days to 21.7 years), and 40% had heart disease. The Zio and Holter had comparable median wear-times, 48.2 hours (interquartile range [IQR] 45.8 to 50.2]) versus 48.0 (48.0 to 48.0), respectively, p = 0.14, but the Zio had less artifact than the Holter, 2.8% (IQR 1.1 to 8.6) versus 5.6% (2.4 to 15.7), respectively, p <0.001. There was no difference in detection of clinically significant arrhythmias for the Zio versus the Holter (p = 0.23), however 75% of patients preferred the Zio over the Holter (p <0.001) due to lack of wires and the ability to shower. In conclusion, the Zio patch is as good as the Holter monitor in detection of clinically significant arrhythmias in children with less artifact. Patients/parents more often preferred the Zio over the Holter.
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Pradhan S, Robinson JA, Shivapour JK, Snyder CS. Ambulatory Arrhythmia Detection with ZIO® XT Patch in Pediatric Patients: A Comparison of Devices. Pediatr Cardiol 2019; 40:921-924. [PMID: 30937502 DOI: 10.1007/s00246-019-02089-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/13/2019] [Indexed: 11/26/2022]
Abstract
Ambulatory electrocardiogram monitoring devices can be used for 24-72 h to detect arrhythmias. A new device, the ZIO® XT Patch has cardiac monitoring capabilities that can be utilized for up to 14 days. The purpose of this study is to describe duration of ZIO use by age, and to compare its time to arrhythmia detection with the Holter monitor in a pediatric population. A single-center, retrospective review of patients < 18 years of age who underwent clinical investigation with ZIO from October 2014 to February 2016 was performed. An age-matched cohort was utilized to compare ZIO to Holter monitor results. Demographic and diagnostic data, time to first arrhythmia, and arrhythmia burden were analyzed. A total of 406 ZIO were prescribed; median age 12.7 years and 50% male subjects. Median duration of ZIO monitoring significantly increased with age (p < 0.001). 499 Holter monitors were prescribed on a statistically different age group. Arrhythmia detection rates were similar between groups, 10% (n = 42) by ZIO and 9% (n = 45) by Holter (p = NS). The majority of arrhythmias (57%) detected by ZIO were after 24 h (p < 0.0001). All arrhythmias detected by Holter monitor occurred within 24 h (p < 0.0001), mean duration of wear was 24.1 h, range 0.5-48 h. The ZIO® XT Patch may be considered as an ambulatory ECG monitor to diagnose arrhythmia in pediatric patients of all ages. Increasing patient age resulted in increasing duration of ZIO monitoring. Majority of arrhythmias detected with ZIO were identified after 24 h, which would have been missed by other short-term monitors.
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Affiliation(s)
- Sarah Pradhan
- The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Jeffrey A Robinson
- The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
- Pediatric Cardiology, Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Jill K Shivapour
- The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
- Pediatric Cardiology, Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Christopher S Snyder
- The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA.
- Pediatric Cardiology, Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
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Abstract
Introduction Mitral Valve Prolapse (MVP) is the most common cardiac valve pathology of to day. Aim of article was to identify the types and frequency of potentially malignant arrhythmia and atrial brillation in patients with MVP, to determine the differences in these arrhythmias between classical and non-classical MVP, to evaluate the correlation of potentially malignant arrhythmia and atrial fibrillation with MVP with possible clinical complications of arrhythmogenic sudden cardiac death and potential risk of thromboembolic vascular incident. Patients and methods Article has retrospective-prospective analytical character and present observational study on 239 patients (120 with MVP (66 with classical and 54 with non-classical MVP), who had a subjective feeling of palpitations and/or pain in the chest, and/or episode of syncope, and did not have ischemic heart disease or another valve pathology) and 119 healthy patients in the control group. All patients were analyzed by 24-hour ECG Holter. Results Signifficant difference in all analyzed arrhythmias between classical MVP and control group (p <0.001) between non-classical and control group in the presence of preexcitation signs (p = 0.047), and between classical and non-classical in presence of QT prolongation and AV block of II and III degree (p = 0.023), ventricular arrhythmias of the 3rd, 4th and 5th grade at scales according to Lown (p = 0.002) and atrial brillation in favor of classical MVP (p = 0.016). Conclusion The potential risk of cardiac death and vascular incidence is signi cantly higher in classical MVP than in non-classical MVP, implying the need for routine ECG-Holter monitoring in their diagnosis for timely prevention of clinical arrhythmogenic complications.
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Affiliation(s)
- Enisa Hodzic
- Clinic for Heart, Blood Vessel and Rheumatic Diseases. University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
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Begic E, Begic Z, Naser N. Clinical Course and Treatment of Dilated Cardiomyopathy During Twenty Years of Follow-up. Med Arch 2018; 72:68-70. [PMID: 29416222 PMCID: PMC5789567 DOI: 10.5455/medarh.2018.72.68-70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/05/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Demonstration of idiopathic dilated cardiomyopathy with unusual flow, unpredictable clinical picture and complex therapy. CASE REPORT Patient A.P., female, 38 years old, had symptoms of dilated cardiomyopathy (with possible infectious myocarditis in the background) at age 17. After hospitalization for ten months and ten days, while waiting for heart transplantation (with threatening death outcome), without a clearly pronounced threatening arrhythmia, but with a low ejection fraction and a poor general condition, remission occurred. The therapy focused primarily on the treatment of heart failure, prevention of arrhythmia and thromboembolism. Normalization of the disease by improving the function of the left ventricle (expected in 16% of patients) occurred and lasted for 4 years, followed by an exacerbation of the disease that lasted for two years. In the next few years the patient was stable, had a first child with normal pregnancy. During the second trimester of the second pregnancy, there was an exacerbation (postpartum dilatation cardiomyopathy) lasting for couple of months. At the time of case report (May 2017), the patient is stable on therapy (ACE inhibitor, beta blocker, diuretics, If channel blocker), without limitation of physical capacity, mother of two children, unemployed. CONCLUSION The clinical course of dilated cardiomyopathy is extremely unpredictable and therapy is very complex and demanding.
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Affiliation(s)
- Edin Begic
- Faculty of Medicine, Faculty of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Zijo Begic
- Pediatric Clinic, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nabil Naser
- Polyclinic “Dr. Nabil”, Sarajevo, Bosnia and Herzegovina
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Masic I, Begic Z, Naser N, Begic E. Pediatric Cardiac Anamnesis: Prevention of Additional Diagnostic Tests. Int J Prev Med 2018; 9:5. [PMID: 29441182 PMCID: PMC5801572 DOI: 10.4103/ijpvm.ijpvm_502_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/18/2017] [Indexed: 11/23/2022] Open
Abstract
Pediatrics is defined as the science of a healthy and sick child from birth to end of adolescence. Diseases of the cardiovascular system are the leading causes of mortality in adults, with frequent onset in childhood. The cardiologic examination starts with anamnesis in a pleasant atmosphere, refined space, enough time and patience, detailed measurements, and preferably a noncrying child. Anamnesis, regardless of the development of diagnostic procedures, still constitutes the basis of every clinical examination. The basic characteristics of pediatric cardiac anamnesis are comprehensiveness, that is, details, clarity, concurrency, and chronology. Proper and conscientiously taken anamnesis with a thorough clinical examination of a sick child is a solid protection against dehumanizing the relationship between a physician and patient. Pediatric cardiac anamnesis can be variable, completely negative, but very rich. Anamnesis should, first of all, clarify whether only a child is sick or it is perceived like that be his or her environment. Preschool and school-age children are normally attending anamnesis. High-quality, comprehensive medical history can keep the patient at one level of health care, with a strict focus primarily on the diagnostic processes, reduce crowds in specialist and subspecialist institutions, and make economic savings. A large number of patients in specialist and subspecialist clinics can be reduced by proper screening and by developing primary health-care system (from the local health-care center). Taking patient's medical history with thoroughness has a strong educative character for young doctors at the beginning of their careers.
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Affiliation(s)
- Izet Masic
- Department of Science Editing, AMNuBiH, Sarajevo, Bosnia and Herzegovina
| | - Zijo Begic
- Department of Cardiology, Pediatric Clinic, CCU Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nabil Naser
- Department of Cardiology, Polyclinic Dr. Nabil, Sarajevo, Bosnia and Herzegovina
| | - Edin Begic
- Department of Pharmacology, Faculty of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
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Begic Z, Pandur S, Omerbasic E, Kadic A, Halimic M. Evaluation of Congenital Heart Defects Treatment Options-Establishment of Pediatric Cardiology/Cardiosurgery in Bosnia and Herzegovina. Mater Sociomed 2017; 29:73-75. [PMID: 28484359 PMCID: PMC5402366 DOI: 10.5455/msm.2017.29.73-75] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Modern pediatric cardiology mainly deals with congenital heart defects (CHD), as the most common congenital anomalies. In most cases CHD requires surgical or interventional treatment. GOAL The goal of the research was to evaluate CHD treatment at Pediatric Clinic, University Clinical Center (UCC) Sarajevo, Bosnia and Herzegovina (B&H). UCC Sarajevo is the only institution in B&H where cardiac treatment of CHD in pediatric population is performed. Pediatric cardiosurgery has started to develop in Bosnia and Herzegovina in April 1997. PATIENTS AND METHODS Study included 745 patients (period from April 1997 to January 2017). RESULTS Cardiac treatment was performed on 745 patients with CHD, 541 (72.6%) of them were acyanotic patients and 204 (27.4%) were cyanotic patients. Reoperation was performed in 49 (6.5%) of patients. Out of total number of patients, 59 (7.9%) died. In 660 children (88.5%) a complete correction and in 85 (11.5%) a palliative operation/correction was performed. Defects with left to right shunt were present in 397 (53.2%) patients, complex heart defects with Tetralogy of Fallot in 173 (23.2%), obstructive heart defects in 106 (14.2%), obstructive heart defects with shunt in 53 (7.1%), and others in 16 (2.1%) of patients. During surgery, extracorporeal circulation was regulated in 554 (74.3%) patients. Peri and early postoperative complications occurred in 180 (24.1%) of patients. During this period 24 pacemakers were implanted and 24 radiofrequency ablations were performed. CONCLUSION Results of CHD cardiac treatment in childhood, which took place simultaneously, followed by the contractual joint programs and individual work of the Bosnian and Herzegovinian team has reached the highest level in the last two years, not only by the number, type and complexity of corrected CHD, but also by the age and body weight of the patients who underwent surgery, and development of invasive procedures, arrhytmology, pacemaker placement, intensive peri and postoperative treatment. That led pediatric cardiac surgery of UCC Sarajevo, to a position of leading center in the region.
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Affiliation(s)
- Zijo Begic
- Pediatric Clinic, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Sanko Pandur
- Heart Center, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Edo Omerbasic
- Heart Center, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Almira Kadic
- Pediatric Clinic, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Mirza Halimic
- Pediatric Clinic, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
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