Removal of scatter radiation in paediatric cardiac catheterisation: a randomised controlled clinical trial.

Objective: This study sought to determine if DNA integrity was compromised by ionising radiation from paediatric cardiac catheterisations and if dose optimisation techniques allowed DNA integrity to be maintained.

Materials And Methods: Children were imaged using either: (i) an anti-scatter grid (current departmental protocol), (ii) no anti-scatter grid or, (iii) no anti-scatter grid and a 15 cm air-gap between the child and the x-ray detector. Dose area product and image quality were assessed, lifetime attributable cancer risk estimates were calculated and DNA double-strand breakages quantified using the γH2AX assay.

Protein-losing enteropathy in biventricular circulation precipitated by mild stenosis of the inferior caval vein in conjunction with total occlusion of the superior caval vein: a word of caution.

We report the case of a young boy with a history of total occlusion of the superior caval vein, diagnosed early after complex neonatal cardiac surgery, who developed severe protein-losing enteropathy. Protein-losing enteropathy was precipitated by a relatively mild stenosis at the junction of the inferior caval vein with the right atrium. Percutaneous stent dilation of the veno-atrial junction definitively relieved the stenosis, and the protein-losing enteropathy subsequently resolved.

Diagnosing Left Coronary Ostial Atresia: Sometimes the Old Ways Are Best.

A 12-year-old boy with intermittent syncope associated with exercise. Exercise stress testing suggested myocardial ischemia and 2D echocardiography failed to confirm antegrade flow in the left main stem. Advanced imaging techniques including cardiac-gated computed tomography angiography and stress cardiac magnetic resonance imaging were falsely reassuring.

Stent implantation to relieve native obstructed left partial anomalous pulmonary venous connections.

Obstructed partial anomalous pulmonary venous connections (APVC) are rare but may be associated with severe pulmonary hypertension (PHTN) and warrant urgent relief. There are a number of case reports of successful catheter intervention for obstructed total APVC. We present the first reported case of catheter intervention to relieve obstructed, left sided PAPVC in a neonate with Turner syndrome.

Survey of paediatricians' opinions on a regional paediatric telecardiology service.

Aim: The aim of this study is to evaluate consultant general paediatricians' opinions of a UK paediatric telecardiology service.

Methods: A structured questionnaire was developed and sent to all consultant paediatricians working in a district general hospital in Northern Ireland.

Results: Paediatricians (n = 35) regarded the regional paediatric telecardiology service as very useful and of good value for money.

A fetal telecardiology service: patient preference and socio-economic factors.

Objective: The aims of this study were to evaluate patients' opinions on a fetal cardiology telemedicine service compared with usual outpatient care, the effect of the telemedicine consultation on maternal anxiety and its impact on travel times and time absent from work.

Methods: Prospective study over 20 months. Eligible patients attended for routine anomaly scan followed by fetal echocardiogram transmitted to the regional centre with live guidance by a fetal cardiologist, followed by parental counselling.

Fetal diagnosis of congenital heart disease by telemedicine.

Objectives: This study aimed to evaluate the feasibility, accuracy and user acceptability of performing remote fetal echocardiograms (FEs).

Setting: A regional fetal cardiology unit and a district general hospital (DGH).

Design: A prospective study over 20 months.

Remote diagnosis of congenital heart disease: the impact of telemedicine.

Objectives: To determine the accuracy of remote diagnosis of congenital heart disease (CHD) by real-time transmission of echocardiographic images via integrated services digital network (ISDN) lines, to assess the impact on patient management and examine cost implications.

Design: Prospective comparison of echocardiograms on infants with suspected significant CHD performed as follows: (1) hands-on evaluation and echocardiogram by a paediatrician at a district general hospital (DGH) followed by (2) transmission of the echocardiogram via ISDN 6 with guidance from a paediatric cardiologist and finally (3) hands-on evaluation and echocardiogram by a paediatric cardiologist. The economic analysis compares the cost of patient care associated with the telemedicine service with a hypothetical control group.

Home support for children with complex congenital heart disease using videoconferencing via broadband: initial results.

We originally developed a home support service for babies with complex congenital heart disease, in which videoconferencing was delivered via three ISDN lines. We have now investigated the feasibility of using broadband (Internet protocol) transmission instead of ISDN lines. Five patients were enrolled (age range 14-58 days) and 78 videoconferences were conducted over a six-month period.

Diagnosis of congenital heart disease in neonates by videoconferencing: an eight-year experience.

Over an eight-year period, echocardiograms were transmitted by ISDN at 384 kbit/s for a total of 132 patients suspected of having congenital heart disease (CHD). Five transmitted scans were inadequate. Hands-on echocardiograms were performed subsequently on 116 of the remaining 127 cases (91%).

Down syndrome, achondroplasia and tetralogy of Fallot.

This paper describes a female infant with achondroplasia, Down syndrome and tetralogy of Fallot. Down syndrome and achondroplasia were confirmed by karyotyping and presence of a common fibroblast growth factor receptor 3 mutation (Gly380Arg), respectively. The clinical course was complicated by pulmonary hypoplasia and subsequent intractable respiratory failure secondary to the combination of congenital conditions, which resulted in the patient's death at 5 months.

Selective fluconazole prophylaxis in high-risk babies to reduce invasive fungal infection.

Objectives: To evaluate the impact of selective fluconazole prophylaxis on incidence of invasive fungal infection and emergence of fluconazole resistance in neonatal intensive care.

Design: Retrospective study of very low birthweight (VLBW) babies (<1500 g birth weight) admitted to a neonatal intensive care unit (NICU) in the period 1 year before and after the implementation of an antifungal prophylaxis guideline.

Patients: VLBW babies with an additional risk factor: colonisation of Candida species from surface sites with a central venous catheter; third generation cephalosporin treatment; or total duration of antibiotic treatment >10 days.