الفهرس 
Congestive Heart Failure
CLINICAL PICTURE:Only 14 pages are availabe for public view
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Abstract
Congestive heart failure (CHF) in children is a clinical syndrome in which the heart fails to pump blood with normal efficacy due to abnormality of cardiac structure or function, leading to failure of the heart to deliver sufficient oxygen to meet the requirements of the metabolizing tissues, and is accompanied by symptoms of pulmonary and /or systemic congestion. In heart failure, damage to cardiac myocytes occurs with cell necrosis and apoptosis which stimulates proliferation of cardiac fibroblasts, healing by fibrous scar, replacement of myocardial cells with collagen and deposition of extracellular matrix that lead to cardiac myocyte hypertrophy resulting in increased wall mass and chamber enlargement. Connective tissue growth factor (CTGF) is involved in multiple cellular events such as cell adhesion, cell proliferation, and extracellular matrix (ECM) production. It is highly expressed in myocardial fibroblasts and is responsible for fibrosis, apoptosis and cardiac remodeling. The objectives of the present work were to evaluate the plasma levels of connective tissue growth factor (CTGF) in children with CHF to examine its relationship to pathophysiology of heart failure to assess the diagnostic and prognostic value of CTGF in these patients, and to correlate its levels with clinical and echocardiographic assessment of CHF. This study was conducted from August 2017 to August 2018, at the Pediatric Cardiology Unit, Pediatric Department, Tanta University Hospital. The study included twenty (20) children with CHF due to congenital heart disease (9) and dilated cardiomyopathy (11). They were 11 males and 9 females, and their ages ranged from three months to 12 years. Patients were classified according to Ross classification system of CHF into class I (no patients), class II (8 patients), class III (7 patients), and class I𝑉 (5 patients) . Twenty (20) apparently healthy children, matched for age and sex were enrolled as a control group. They were 10 males and 10 females, and their ages ranged from 2 months to 13 years. All children in this study were subjected to the following: Ι- Complete history taking. Π- Complete physical examination: including heart rate, respiratory rate, complete local cardiac examination, and clinical assessment of severity of CHF according to ( Ross classification for heart failure). Ш- Investigations: i- Plain X-ray chest & heart (CTR% was measured). ii- ECG. iii- Echocardiography: Doppler, two-dimensional and M-mode echocardiographic evaluation of the following parameters: 1) Cardiac causes of CHF. 2)Systolic function of left ventricle: -LV fractional shortening { FS% }. -LV ejection fraction { EF% }. 3) Diastolic function of left ventricle by (pulsed transmitral Doppler): -Peak early filling velocity { E wave }. -Peak late filling velocity { A wave }. -E/A ratio. 4) Calibrated integrated backscatter (CIB) measurement of myocardial fibrosis. iv- Estimation of plasma level of Connective Tissue Growth Factor (CTGF) by (ELISA).