Bernard Gerbaka

Development of catheter-based treatment of patent ductus arteriosus: a medium-sized centre experience.

BACKGROUND Despite the availability of effective devices, percutaneous closure of patent ductus arteriosus (PDA) can be challenging in some situations. AIM To describe our initial experience of percutaneous PDA closure. METHODS Between 2001 and 2007, 73 consecutive patients aged 3 months to 70 years underwent transcatheter PDA closure. An Amplatzer duct occluder (ADO) was chosen for ducts greater than 2 mm (n=50) and a Detachable coil (DC) for smaller ducts (n=23). RESULTS The diameter of the ducts ranged from 1 to 7.2 (mean 2.9+/-1.3) mm. The prostheses were implanted successfully in all patients. The complete closure rate reached 98% in the ADO group and 100% in the DC group at 12 months. Four (5.4%) patients showed asymptomatic device protrusion: three patients (5, 6 and 10 kg) into the aortic isthmus and one patient (7 kg) into the pulmonary artery (PA). One patient (7 kg) experienced transient severe bradycardia due to pulmonary air embolism. Another patient (3.3 kg) had a permanent asymptomatic occlusion of the femoral artery. In a third patient (17 kg), the ADO migrated asymptomatically into the descending aorta and was discovered 12 months later. CONCLUSION Even during the learning curve, percutaneous PDA closure can give excellent results. Strict adherence to protocols and careful follow-up assessments are mandatory. In small infants, the use of the ADO may lead to obstruction in the aorta or PA, or to device migration. Cautious surveillance for untoward events is essential, especially in small infants with large ducts.

Corporal punishment of children: discipline or abuse?

ABSTRACT Introduction: Corporal punishment is a public health problem due to its impact on the physical, psychological, and social interactions of children. Objectives: To determine the knowledge of pediatricians in Lebanon regarding corporal punishment, their preventive, educational, and legal role. Methods: A cross-sectional descriptive study conducted on 153 pediatricians in Lebanon, by a questionnaire distributed at the 12th Annual Congress of the Lebanese Pediatric Society and the North Lebanon Pediatric Society. Results: Less than 50% and less then 60% of pediatricians know the effects of physical punishment on the physical and psychic health of the child, respectively. About 74.2% and 23.2% of pediatricians disagree with Article186 of the Lebanese Criminal Code and Lebanese Law422/02 (Article25), respectively. Only 76.2% of Lebanese pediatricians always advise the abandonment of corporal punishment and 4.7% advise its use for discipline. Conclusion: Pediatricians play a fundamental role in the abolition of corporal punishment, but this cannot be accomplished without improving their skills in this area. They are invited to seek legal reforms in Lebanon to abolish the use of corporal punishment as a means of disciplining children.

Insertion Linéaire des Valves Auriculo-Ventriculaires Chez les Enfants Avec et Sans Syndrome de Down

RÉSUMÉ • OBJECTIF : Étudier différents paramètres rencontrés dans l’insertion linéaire des valves auriculoventriculaires (ILVAV) chez les patients indemnes de trisomie 21 (T21 ou syndrome de Down) et ceux porteurs de cette anomalie. MATÉRIEL : Un groupe de patients (n = 6240) âgés de 1 à 16 ans, avec et sans cardiopathie congénitale (CC), inscrits au cours d’une période de 6 ans (1 juillet 200530 juin 2011) au Registre national de cardiologie pédiatrique et congénitale, Société libanaise de cardiologie. MÉTHODE : Les enfants ont été divisés en 2 groupes. Groupe I : enfants porteurs de T21 ; groupe II : enfants indemnes de T21. Dans les deux groupes, la fréquence de l’ILVAV isolée ou associée à d’autres CC (en dehors du canal atrioventriculaire), la répartition garçon-fille ainsi que les différentes anomalies cardiaques associées ont été étudiées. Les groupes ont été comparés par les tests non paramétriques. Une valeur de p < 0,05 est considérée significative. RÉSULTATS : Le groupe I comprend 155 patients dont 31 (20%) avec une ILVAV, isolée dans 22 cas (14,2%) et associée à une CC dans 9 cas (5,8%). Le groupe II comprend 5995 patients dont 14 (0,2%) sont porteurs d’une ILVAV avec p < 0,00001. Une nette prédominance masculine existe : 78% dans le groupe I et 56% dans le groupe II. Chez les patients avec ILVAV isolée, 86% étaient des garçons. Des antécédents de T21 sont retrouvés chez 3/7 des enfants sans T21 avec ILVAV isolée. Un patient T21 et chez qui une communication interauriculaire (CIA), type ostium primum avec ILVAV fut diagnostiquée durant le 1 mois de vie, a vu son défaut septal disparaître cinq mois plus tard. CONCLUSION : L’ILVAV isolée est beaucoup moins fréquente dans la population sans T21 mais ayant fréquemment des antécédents familiaux de T21 avec une nette prédominance masculine. Mots-clés : Liban, cardiopathie congénitale, sex ratio, ostium primum ABSTRACT • OBJECTIVE : Study various parameters encountered in the linear insertion of the atrioventricular valves (LIAVV) in patients with and without Down’s syndrome (DS). MATERIAL : A group of patients (n = 6240) aged from 0 to 16 years with and without congenital heart disease (CHD) registered over 6 years (1.07.2005-30.06.2011) in the National Registry of the Pediatric and Congenital Heart Disease of the Society of Cardiology in Lebanon. METHOD : Children were divided in two groups; Group I : children with DS and group II : children without DS. In the two groups, the frequency of LIAVV whether isolated or associated with other CHD (excluding the atrioventricular canal), the distribution boy-girl and the various associated cardiac anomalies were studied. We used nonparametric tests for comparing the two groups. The p value < 0.05 was considered significant. RESULTS : Group I consists of 155 patients including 31 (20%) with LIAVV, isolated in 22 cases (14.2%) and associated with CHD in 9 cases (5.8%). Group II was composed of 5995 patients ; the incidence of LIAVV was 0.2% (14 patients) with a p value < 0.00001. Regarding sex, there was a marked male predominance : respectively 78% and 56% in groups I and II. In patients with isolated LIAVV, 86% of patients were males. Family history of DS is found in 3/7 children without T21 with isolated LIAVV. A patient, in whom an atrial septal defect ostium primum type with LIAVV was diagnosed during the first month of life, has seen his septal defect closed spontaneously five months later. CONCLUSION : Encountered predominantly among a male population, the isolated LIAVV is less frequent in children without DS but often with family history of Down’s syndrom.