الفهرس 
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Abstract
Pulmonary hypertension is a common serious complication of CHD with significant mortality and morbidity. Recent studies have shown that higher RDW is associated with increased mortality risk in patients with clinically significant cardiovascular disease including PH. The aim of the work was to assess the predictive value of RDW in children with PAH-CHD and to correlate RDW with various clinical and echocardiographic data. Sixty children with CHD with and without PAH were enrolled in this study .They were chosen from those admitted at Pediatric department, Tanta University during the period from April 2022 to April 2023. They were classified into two groups; group 1: which included 30 children with PAH-CHD as the patient group, and group 2: which included 30 children with CHD and no PH of matched age and sex as the control group. All children were subjected to: 1-Full history taking: name, age, sex, complaint, past history and family history. 2- Thorough clinical examination: including heart rate, respiratory rate, oxygen saturation, signs of CHD, signs of PH, and complete local cardiac examination. 3-Investigations: A. Electrocardiography (ECG). B. CBC: to assess hemoglobin level, hematocrit, MCV, and RDW C. Plain X-ray: chest and heart to assess CTR. D. Echocardiographic assessment to evaluate: - Type of congenital heart disease. - Mean pulmonary artery pressure (mPAP). - Right ventricular (RV) diameter. - Right ventricular systolic function. - Right ventricular diastolic function. -Left ventricular ejection fraction. The results of the present study showed the following: There was no statistically significant difference between the studied groups as regards age, sex, or weight. the most common diagnosis of CHD in group I was VSD which represented 30% of cases, while the most common diagnosis of CHD in group II is ASD only which represented 50% of cases There was a statistically significant increase in HR and RR in group I compared to group II (P<0.001) There was a statistically significant decrease in O2 saturation in group I compared to group II (P<0.01). There was a statistically significance increase in cardiothoracic ratio in group I compared to group II (P<0.001) There was a statistically significant increase in RDW, TLC, and CRP in patient with PAH-CHD compared to CHD only group, while no significant difference was present regarding other laboratory parameters between the two groups. There were statistically significance increases in mPAP and RV diameter in group I compared to group II There was a statistically significance decrease in RV systolic function (FAC) in group I compared to group II There was no statistically significant difference between the two studied groups as regards RV diastolic function (E/A ratio) and LV EF% There was a statistically significant bad prognosis in group I compared to group II, with 26.7% of cases died in group I vs 6.7% in group II. While there were 93.3% of cases improved in group II vs 73.3% of cases in group I. There was a significantly higher RDW in survivors compared to that in the non-survivors among children with PAH-CHD. There was a significant positive correlation between RDW and HR, RR, and mPAP in the two studied groups. While, there was a significant negative correlation between RDW and HB, MCV, and MCH in the two studied groups The best cutoff point of RDW to predict mortality in children with PAH- was ≥ 17.58%, with a sensitivity of 80% and a specificity of 66.7%. RDW was an independent significant predictor of mortality in children with PAH-CHD (OR=1.4, P=0.008).