Repetitive ventricular tachycardia in a syncopal child: Cause or incidental finding ?

A 15-year-old girl suffered recurrent syncopal episodes during 7 years. Events were precipitated by exercise or emotional stress, leading to the diagnosis of reflex syncope. Exercise testing induced recurrent salvos of nonsustained right ventricular outflow tract tachycardia. This arrhythmia is often asymptomatic, reflex syncope is very frequent and both causes are related to the same triggering situations. It was therefore essential to obtain recordings during syncopal events and to observe the clinical evolution under effective treatment in order to make the right diagnosis.

Paediatric presentation of cardiac involvement in hypereosinophilic syndrome.

Eosinophilic endomyocarditis is extremely rare in paediatrics. This case report aims to present the sequential changes from thrombotic to fibrotic stages of the cardiac involvement in a child with hypereosinophilic syndrome. Endomyocardial fibrosis progressively aggravated the severity of the mitral regurgitation. Bioprosthetic valve replacement was finally performed without recurrence of cardiac complications despite a late relapse of the underlying disease.

Long-term conservative management of a giant cardiac fibroma.

A giant cardiac fibroma was discovered during evaluation for a soft systolic murmur in an asymptomatic 2-week-old girl. Echocardiography and magnetic resonance imaging showed a large intraventricular solid mass developed at the expense of the left ventricular lateral wall. Tumour progression resulted in failure to thrive and ventricular arrhythmia between 2 and 18 months of age. At that time, complete resection seemed unfeasible and conservative management with heart failure and antiarrhythmic medications was chosen. All drugs were discontinued when the patient was 5 years old. Since that time, the mass is stable and the patient is strictly asymptomatic. Conservative strategy seems to be acceptable in selected cases but close follow-up is mandatory.

Effects of flecainide therapy on inappropriate shocks and arrhythmias in catecholaminergic polymorphic ventricular tachycardia.

We report the case of a child with catecholaminergic polymorphic ventricular tachycardia, who had inappropriate electric shocks by an implantable cardioverter defibrillator and from recurrence of arrhythmias despite an appropriate ß-blocking treatment. An additional treatment by flecainide completely suppressed inappropriate shocks due to sinusal tachycardia and ventricular tachyarrhythmias. We briefly discuss the potentially interesting effect of flecainide in this specific arrhythmia.

Shoshin Beriberi and Severe Accidental Hypothermia as Causes of Heart Failure in a 6-Year-Old Child: A Case Report and Brief Review of Literature.

Severe accidental hypothermia has been demonstrated to affect ventricular systolic and diastolic functions, and rewarming might be responsible of cardiovascular collapse. Until now, there have been only a few reports on severe accidental hypothermia, none of which involved children. Herein, we describe here a rare case of heart failure in a 6-year-old boy admitted to the emergency unit owing to severe hypothermia and malnutrition. After he was warmed up (core temperature of 27.2°C at admission), he developed cardiac arrest, requiring vasoactive amines administration, and veno-arterial extracorporeal membrane oxygenation. Malnutrition and refeeding syndrome might have caused the thiamine deficiency, commonly known as beriberi, which contributed to heart failure as well. He showed remarkable improvement in heart failure symptoms after thiamine supplementation. High-dose supplementation per os (500 mg/day) after reconstitution of an adequate electrolyte balance enabled the patient to recover completely within 2 weeks, even if a mild diastolic cardiac dysfunction persisted longer. In conclusion, we describe an original pediatric case of heart failure due to overlap of severe accidental hypothermia with rewarming, malnutrition, and refeeding syndrome with thiamine deficiency, which are rare independent causes of cardiac dysfunction. The possibility of beriberi as a cause of heart failure and adequate thiamine supplementation should be considered in all high-risk patients, especially those with malnutrition. Refeeding syndrome requires careful management, including gradual electrolyte imbalance correction and administration of a thiamine loading dose to prevent or correct refeeding-induced thiamine deficiency.

Pediatric gastric lymphoma: a rare entity.

Primary gastric lymphoma is a rare event in childhood. We describe a 13-year-old boy with gastric Burkitt-like lymphoma localized in the fundus. Symptoms mimicking gastritis-epigastric pain, hypochromic anemia, anorexia, and weight loss had been present for a few months before diagnosis. No Helicobacter pylori infection was shown at diagnosis. Biopsies obtained by ultrasound gastroscopy proved the diagnosis; F-fluorodeoxyglucose-positron emission tomography detected an isolated large gastric hypermetabolic mass. According to the international FAB/LMB 96 trial, the patient was treated with chemotherapy alone and is in first complete remission 2(1/2) years after diagnosis.