OAR@UM Community:

The first case of the Reveal LINQ™ Insertable Cardiac Monitor implanted in a child in Malta

Sun, 01 Oct 2017 00:00:00 GMT

Title: The first case of the Reveal LINQ™ Insertable Cardiac Monitor implanted in a child in Malta Authors: Aquilina, Annelise; Aquilina, Oscar; Sammut, Marvic; Grech, Victor E. Abstract: Background: The Reveal LINQ™ Insertable Cardiac Monitor (ICM) or Implantable Loop recorder (ILR), is a miniaturized, subcutaneous, single lead, electrocardiographic monitoring device which has been extensively used in the differential diagnosis of unexplained syncope and palpitations in adults. Patient Description: We describe an asymptomatic 20-month-old boy, noted to have incidental bradycardia on routine examination and in whom Holter monitoring revealed complete heart block (CHB). Over 1 year, the longest recorded pause lengthened from 1.8 seconds to 3.6 seconds. Results: The Reveal LINQ™ ICM was inserted for long-term monitoring of the CHB. The device will record the electrocardiogram (ECG) continuously for up to 3 years, freezing in its memory any significant arrhythmic events. This will enable the diagnosis of the longest pauses, confirm whether they are lengthening over time and assist with the decision of pacemaker implantation. Conclusion: The Reveal LINQ™ ICM is much smaller than the conventional loop recorder and has been shown to be ideal for close monitoring of asymptomatic yet potentially dangerous arrhythmias in young children.

Mycotic aneurysm : a lesser known complication of coarctation repair in a child, managed by endovascular aneurysm repair

Sun, 01 Oct 2017 00:00:00 GMT

Title: Mycotic aneurysm : a lesser known complication of coarctation repair in a child, managed by endovascular aneurysm repair Authors: Tomar, Munesh; Parakh, Rajiv; Bhan, Aparna Abstract: We report a 12-year-old child diagnosed with mycotic aneurysm at the site of coarctation of aorta (CoA) repair. Surgical intervention, though very high risk, is the mainstay of management. In selected cases endovascular stenting is being reported in adults. Here we report the use of an endovascular stent in a child.

An update work of pulse oximetry screening for detecting critical congenital heart disease in the newborn

Sat, 01 Jul 2017 00:00:00 GMT

Title: An update work of pulse oximetry screening for detecting critical congenital heart disease in the newborn Authors: Taksande, Amar M.; Meshram, Rewat; Lohakare, Amol; Purandare, Sadhana; Biyani, U.; Vagha, Jayant Abstract: Background: Congenital Heart Disease (CHD) is the commonest group of congenital malformations and affects 7-8 per 1000 live born newborns. Nevertheless, it is estimated that more than 50% of babies with undiagnosed CHD are not detected by routine neonatal cardiac examination. Aim: To find the incidence of CHD in newborns and to determine the accuracy of pulse oximetry for detecting clinically unrecognized critical congenital heart disease (CCHD) in the newborns. Methods: Pulse oximetry was performed on clinically normal newborns within 4 hours of first day of life. Inclusion criteria: All newborns who were admitted in postnatal ward & Neonatal Intensive care unit (NICU). Exclusion criteria: babies and neonates with a prenatal diagnosis of duct dependent circulation. If oxygen saturation (SpO2) was below 90%, then echocardiography was performed. Results: During the study period, 4926 live born neonates were examined. Nine out of 12 neonates with SpO2<90% had CCHD. Four neonates had tetralogy of Fallot (TOF), two had tricuspid atresia, two had transposition of great arteries (TGA) and one had truncus arteriosus. The incidence of CHD was 33.49 per 1000 live births and CCHD was 1.82 per 1000. A pulse oximetry cut-off value of below 90% for detecting CCHD showed 90% sensitivity, 99.94% specificity, 75% positive predictive value (PPV) and 99.98% negative predictive value (NPV). Conclusion: Pulse oximetry is safe, feasible and noninvasive and also used to screen for CCHD. It is the nice method to detect the CHD along with the physical examination of neonates by medical personal.

Aortic coarctation : never too late to diagnose, never too late to treat

Sat, 01 Jul 2017 00:00:00 GMT

Title: Aortic coarctation : never too late to diagnose, never too late to treat Authors: Conti, Luca; Borg Savona, Sarah; Spiteri, T.; Giovanni, Joseph de; Borg, Alexander; Caruana, Maryanne Abstract: We present two cases of severe aortic coarctation detected in adulthood and who underwent successful relief by transcatheter stent deployment using a new covered stent, Optimus® stent (AndraTec GmbH Koblenz, Germany). One patient is a 46-year old female with resistant arterial hypertension, in whom coarctation was suspected on a follow-up transthoracic echocardiogram for bicuspid aortic valve disease and subsequently confirmed on magnetic resonance imaging. The second patient is a 68-year old male whose coarctation was diagnosed incidentally at coronary angiography being performed as part of the preoperative work-up for severe aortic stenosis. Suprasternal views to assess aortic arch and flows in the proximal descending aorta should be a standard part of every transthoracic echocardiogram. Treatment of aortic coarctation should be considered irrespective of patient’s age.