Cardiac Evaluation in Children with Multisystem Inflammatory Syndrome Associated with SARS-CoV-2.

Objectives: The heart is one of the organs frequently affected by the multisystem inflammatory syndrome in children (MIS-C), associated with severe acute respiratory syndrome coronavirus 2 infection. Cardiac involvement in patients with MIS-C was evaluated with physical examination findings, biochemical test, and cardiological imaging tests. We reported the degree of cardiac involvement in patients with MIS-C. Methods: In this retrospective study, the complaints, physical examination, and cardiac findings of patients with MIS-C were evaluated. Results: Sixteen patients (four males and 12 females) with MIS-C were included in the study. The median age was 6 (5-17) years. In patients, palpitations (6%), chest pain (12%), ECG changes (50%), valve insufficiency (50%), low ejection fraction (6%), coronary dilatation (6%), troponin (38%), and d-dimer (88%) elevation were detected. One patient died. Valve insufficiency persisted in 5 (31%) patients. Conclusion: Severe cardiac involvement can be seen in MIS-C patients. Due to its serious effects on mortality and morbidity, cardiac involvement should be evaluated with cardiac imaging tools such as echocardiography and ECG in all MIS-C patients.

A rare coronary anomaly with masked diagnosis: Anomalous left circumflex artery from right pulmonary artery.

Anomalous origin of the circumflex coronary artery from the pulmonary artery is a rare congenital coronary anomaly. While it generally follows an asymptomatic course, if undiagnosed it may lead to severe clinical outcomes, including sudden death. The condition can be masked by associated defects, so when it is clinically suspected, diagnosis must be confirmed by conventional and/or magnetic resonance angiography, even if echocardiography clearly shows coronary roots. This report describes a patient who underwent neonatal surgery for aortic coarctation and was diagnosed with coronary artery anomaly at 15 months old.

A randomized case-controlled study of recombinant human granulocyte colony stimulating factor for the treatment of sepsis in preterm neutropenic infants.

BACKGROUND: To investigate the efficacy and safety of recombinant human granulocyte colony-stimulating factor, recombinant human granulocyte-macrophage colony-stimulating factor (rhG-CSF) to treat sepsis in neutropenic preterm infants. METHODS: Fifty-six neutropenic preterm infants with suspected or culture-proven sepsis hospitalized in Zeynep Kamil Maternity and Children's Educational and Training Hospital, Kozyatagi/Istanbul, Turkey between January 2008 and January 2010 were enrolled. Patients were randomized either to receive rhG-CSF plus empirical antibiotics (Group I) or empirical antibiotics alone (Group II). Clinical features were recorded. Daily complete blood count was performed until neutropenia subsided. Data were analyzed using SPSS version 11.5. RESULTS: Thirty-three infants received rhG-CSF plus antibiotic treatment and 23 infants received antibiotic treatment. No drug-related adverse event was recorded. Absolute neutrophil count values were significantly higher on the 2(nd) study day and 3(rd) study day in Group I. Short-term mortality did not differ between the groups. CONCLUSION: Treatment with rhG-CSF resulted in a more rapid recovery of ANC in neutropenic preterm infants. However, no reduction in short-term mortality was documented.

Multiple giant aneurysms and stenoses of the coronary and systemic arteries in an infant with kawasaki disease at the early stage of convalescent period.

Myocardial infarction and systemic arterial aneurysms are rarely seen during the course of the Kawasaki disease (KD). Herein, we report the case of a 4-month-old Turkish infant who was diagnosed with KD on the 17th day of the illness. On admission, echocardiogram showed multiple coronary arterial aneurysms (CAAs) and massive pericardial effusion. He was given intravenous immunoglobulin, aspirin and anticoagulant drugs. However, the aneurysms progressed to "super giant" CAAs, multiple huge coronary arterial thromboses developed recurrently and caused myocardial ischemia. Furthermore, the conventional angiography revealed multiple giant aneurysms and stenoses in the subclavian, celiac, and iliac arteries, besides CAAs.

Native aortic valve endocarditis complicated by pseudoaneurysm of mitral-aortic intervalvular fibrosa.

Pseudoaneurysm of mitral-aortic intervalvular fibrosa (PA-MAIVF) is a rare complication of native aortic valve endocarditis. This region is a relatively avascular area and prone to infection during endocarditis and subsequent aneurysm formation. The rupture into the pericardial cavity and left atrium or aorta, systemic embolism, myocardial infarction secondary to left coronary compression, and sudden death are the reported complications. Herein, we present a 9-year-old boy who was diagnosed with bicuspid aortic valve endocarditis complicated by PA-MAIVF, cerebral embolism, and hemorrhage. PA-MAIVF was visualized by both two- and three-dimensional transthoracic echocardiography and ruptured into pericardial space causing a fatal outcome.

Three-dimensional echocardiographic evaluation of a patient with double-orifice mitral valve, bicuspid aortic valve, and coarctation of aorta.

A 16-year-old male patient was diagnosed with bicuspid aortic valve and coarctation of aorta, and had a history of a subclavian patch plasty operation at 1 year of age. In addition, we detected double-orifice mitral valve (DOMV) at a routine evaluation and demonstrated by both two-dimensional and three-dimensional (3D) echocardiographic examinations. DOMV should be kept in mind in cases with left ventricular obstructive lesions and 3D echocardiography may provide a more detailed assessment of mitral valve and subvalvular apparatus.