RESUMO
Multisystem inflammatory syndrome in children (MIS-C) secondary to COVID-19 infection in previously healthy children often results in subtle but persistent echocardiographic abnormalities despite complete clinical recovery. This study was done to investigate medium-term cardiovascular outcomes of patients with MIS-C using cardiovascular magnetic resonance imaging (CMR). This is a single-center retrospective study of patients aged less than 21 years, diagnosed with MIS-C who received an outpatient CMR, around 6 months after discharge. CMR was done in patients with significant troponin leak or depressed LVEF. CMR performed on a GE Signa HDxt 1.5 Tesla magnet with a myocarditis protocol. Diagnosis of myocarditis was determined by the original Lake Louise Criteria. There were 21 patients with a median age of 11 years, (IQR 8-13 years), who underwent CMR at median follow-up duration of 6 months (IQR 5-7 months). At the peak of illness during admission, there were 95.2% patients with abnormal Troponin I and BNP. By echocardiogram, 76.2% had left ventricular systolic dysfunction and 9.5% had coronary ectasia, which all resolved by 6 months. By CMR, there were five patients (23.8%) with abnormal left atrial volume, one patient (4.8%) with an abnormal indexed left ventricular end-diastolic volume, and three patients (15%) with abnormal LVEF. There was no evidence of myocardial edema in T2-weighted image sequence. There were three patients with persistent late gadolinium enhancement (14.3%). Follow-up CMR is a useful tool in diagnosing subtle myocardial abnormalities and guide necessity for future follow-up.
Assuntos
COVID-19 , Miocardite , Disfunção Ventricular Esquerda , Criança , Humanos , Adolescente , Miocardite/diagnóstico por imagem , Seguimentos , Gadolínio , Meios de Contraste , Estudos Retrospectivos , Troponina I , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Imagem Cinética por Ressonância Magnética , Função Ventricular Esquerda , Volume SistólicoRESUMO
Tricuspid atresia with an absent pulmonary valve is a rare congenital cardiac defect. Although extensive pathological reviews have been published in the past, there are only a handful of cases that have been successfully palliated to the stage of Fontan. We hereby describe the successful management of one such case and review the surgical strategies described in the literature.
Assuntos
Técnica de Fontan , Atresia Pulmonar , Valva Pulmonar , Atresia Tricúspide , Humanos , Atresia Pulmonar/diagnóstico por imagem , Atresia Pulmonar/cirurgia , Valva Pulmonar/anormalidades , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/cirurgia , Atresia Tricúspide/diagnóstico por imagem , Atresia Tricúspide/cirurgiaRESUMO
Cardiac disease is the primary cause of death in sickle cell disease (SCD). Cardiac abnormalities begin in childhood and progress throughout life. Right and left ventricular (RV, LV) myocardial strain are early markers of systolic dysfunction but are not well investigated among individuals with SCD. The objectives of this review were to (1) identify all published studies that have evaluated ventricular myocardial strain, (2) summarize their values, and (3) compare findings with those obtained from controls. From search results of four electronic databases-Medline, Embase, Scopus, and Web of Science-42 potential articles were identified, of which 18 articles and 17 studies met eligibility criteria for inclusion. The evaluated studies demonstrate that RV and LV myocardial strain are generally abnormal in individuals with SCD compared with controls, despite having normal ejection/shortening fraction. Myocardial strain has been inconsistently evaluated in this population and should be considered any time an echocardiogram is performed.
Assuntos
Anemia Falciforme/patologia , Cardiomiopatias/patologia , Disfunção Ventricular Esquerda/patologia , Disfunção Ventricular Direita/patologia , Adulto , Criança , Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Lactente , Pessoa de Meia-Idade , Volume Sistólico/fisiologiaRESUMO
Cardiac disease is the primary cause of death in sickle cell disease (SCD). Right and left ventricular global longitudinal strain (RVGLS, LVGLS) are early markers of systolic dysfunction but are not well investigated among children with SCD. One hundred and forty-three patients with HbSS or HbSß0 -thalassaemia (median age 11 years, range 5-19 years) and 71 controls matched for age and sex were compared. RVGLS and LVGLS were measured and compared with conventional measures of echocardiography and markers of haemolysis and inflammation. RVGLS was higher in children with SCD than in controls (-25·72% ± 3·45% vs. -24·54% ± 2·41%, P = 0·005); LVGLS was not different. RVGLS decreased with older age in children with SCD (ρ = 0·338, P < 0·001) but not among controls. Decreased RVGLS was associated with increased left atrial end diastolic volume (ρ = 0·181, P = 0·04); RVGLS increased with cardiac output (r = -0·279, P = 0·01). RVGLS and LVGLS were not associated with disease-modifying therapies, degree of anaemia or haemolysis markers. Elevated RVGLS may indicate an early RV compensatory mechanism in response to upstream myocardial insults and elevated cardiac output. Global longitudinal strain may serve as an early marker of altered myocardial function in children with SCD.
Assuntos
Anemia Falciforme/complicações , Coração/fisiologia , Disfunção Ventricular Esquerda/etiologia , Adolescente , Anemia Falciforme/fisiopatologia , Cardiomiopatias/diagnóstico , Cardiomiopatias/etiologia , Cardiomiopatias/fisiopatologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Ecocardiografia , Feminino , Ventrículos do Coração , Humanos , Masculino , Estresse Fisiológico/fisiologia , Volume Sistólico/fisiologia , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologia , Adulto JovemRESUMO
BACKGROUND: The porcine small intestinal extracellular matrix reportedly has the potential to differentiate into viable myocardial cells. When used in tetralogy of Fallot repair, it may improve right ventricular function. We evaluated right ventricular function after repair of tetralogy of Fallot with extracellular matrix versus bovine pericardium. METHOD: Subjects with non-transannular repair of tetralogy of Fallot with at least 1 year of follow-up were selected. The extracellular matrix and bovine pericardium groups were compared. We used three-dimensional right ventricular ejection fraction, right ventricle global longitudinal strain, and tricuspid annular plane systolic excursion to assess right ventricular function. RESULTS: The extracellular matrix group had 11 patients, whereas the bovine pericardium group had 10 patients. No differences between the groups were found regarding sex ratio, age at surgery, and cardiopulmonary bypass time. The follow-up period was 28±12.6 months in the extracellular matrix group and 50.05±17.6 months in the bovine pericardium group (p=0.001). The mean three-dimensional right ventricular ejection fraction (55.7±5.0% versus 55.3±5.2%, p=0.73), right ventricular global longitudinal strain (-18.5±3.0% versus -18.0±2.2%, p=0.44), and tricuspid annular plane systolic excursions (1.59±0.16 versus 1.59±0.2, p=0.93) were similar in the extracellular matrix group and in the bovine pericardium group, respectively. Right ventricular global longitudinal strain in healthy children is reported at -29±3% in literature. CONCLUSION: In a small cohort of the patients undergoing non-transannular repair of tetralogy of Fallot, there was no significant difference in right ventricular function between groups having extracellular matrix versus bovine pericardium patches followed-up for more than 1 year. Lower right ventricular longitudinal strain noted in both the groups compared to healthy children.
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BACKGROUND: In 2007, the American Heart Association modified the infective endocarditis prophylaxis guidelines by limiting the use of antibiotics in patients with cardiac conditions associated with the highest risk of adverse outcomes after infective endocarditis. Our objective was to evaluate current practice for infective endocarditis prophylaxis among paediatric cardiologists. METHODS: A web-based survey focussing on current practice, describing the use of antibiotics for infective endocarditis prophylaxis in various congenital and acquired heart diseases, was distributed via e-mail to paediatric cardiologists. The survey was kept anonymous and was distributed twice. RESULTS: Data from 253 participants were analysed. Most paediatric cardiologists discontinued infective endocarditis prophylaxis in patients with simple lesions such as small ventricular septal defect, patent ductus arteriosus, and bicuspid aortic valve without stenosis or regurgitation; however, significant disagreement persists in prescribing infective endocarditis prophylaxis in certain conditions such as rheumatic heart disease, Fontan palliation without fenestration, and the Ross procedure. Use of antibiotic prophylaxis in certain selected conditions for which infective endocarditis prophylaxis has been indicated as per the current guidelines varies from 44 to 83%. Only 44% follow the current guidelines exclusively, and 34% regularly discuss the importance of oral hygiene with their patients at risk for infective endocarditis. CONCLUSION: Significant heterogeneity still persists in recommending infective endocarditis prophylaxis for several cardiac lesions among paediatric cardiologists. More than half of the participants (56%) do not follow the current guidelines exclusively in their practice. Counselling for optimal oral health in patients at risk for infective endocarditis needs to be optimised in the current practice.
Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia/tendências , Cardiologistas/estatística & dados numéricos , Endocardite/prevenção & controle , Cardiopatias Congênitas/complicações , Adolescente , American Heart Association , Cardiologia , Criança , Pré-Escolar , Correio Eletrônico , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Pediatria , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos , Adulto JovemRESUMO
Hypoplastic left heart complex presents a diverse spectrum of variants. Traditional management has been dichotomous, involving either single ventricle palliation or high-risk biventricular repair. Surgical approaches to achieve biventricular repair in children with borderline left ventricle are continually evolving. One such method is the staged left ventricular recruitment (SLVR) strategy. Here, we illustrate a unique surgical approach to SLVR, achieving biventricular repair over 22 months in a neonate with hypoplastic left heart variant.
RESUMO
The development of echocardiographic ventricular wall motion abnormalities and ST segment changes with exercise may enhance the detection of myocardial ischemia in children with aortic valve stenosis (AS). This study aimed to assess the relationship between the exercise wall motion index (WMIe), ST segment depression (STd), and overall functionality in asymptomatic children with isolated AS. A prospective interpretation of collected stress echocardiographic images was performed. The 98 children who met the inclusion criteria had a mean age of 12.8 years and a male/female ratio of 4/1. Group 1 (mild AS) was composed of 70 children, and group 2 (moderate or severe AS) was composed of 28 children. Abnormal WMIe was seen in 8 patients (5 in group 1 and 3 in group 2), and significant STd was observed in 13 children (3 in group 1 and 10 in group 2). Four (50 %) of the eight patients with abnormal WMIe also had significant STd. Severity of stenosis was associated with STd (odds ratio [OR], 12.0; 95 % CI 3.0-49.0), logistic regression). A significant association also existed between abnormal WMIe and STd (OR, 9.0; 95 % CI 1.9-42.0, logistic regression). Exercise duration was significantly shorter in group 2 (12 ± 4.52 min) than in group 1 (13 ± 5.28 min) (p = 0.02, analysis of covariance). The appearance of wall motion abnormalities and STd during exercise may be helpful in detecting inducible, functionally important myocardial ischemia in asymptomatic children with AS. Stress echocardiography may be a useful adjunct to more traditional exercise testing in risk stratifying asymptomatic children with AS.
Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Ecocardiografia sob Estresse , Isquemia Miocárdica/diagnóstico por imagem , Adolescente , Estenose da Valva Aórtica/fisiopatologia , Criança , Teste de Esforço , Feminino , Humanos , Masculino , Isquemia Miocárdica/fisiopatologia , Estudos Prospectivos , Índice de Gravidade de DoençaRESUMO
The transcatheter closure of patent ductus arteriosus (TCPC) has been demonstrated to be feasible even in infants weighing ≤1000 g. However, other percutaneous cardiac interventions (PCI) for such small infants born with congenital heart defects (CHD) or acquired heart defects (AHD) have not been well described. The purpose of this study was to describe the feasibility and safety of PCI in infants ≤1000 g. A retrospective review was conducted between June 2015 and May 2021, looking at 148 consecutive PCIs performed on infants weighing ≤1000 g at the time of the procedure. The procedural success rate was 100%. The major adverse event (AE) rate for TCPC was 3%, while there were no major AEs for other PCI. It is feasible to perform PCIs in infants weighing ≤1000 g with CHD and AHD using currently available technologies.
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Anomalous aortic origin of the right coronary artery from the left aortic sinus is a rare congenital anomaly that is generally repaired during adolescence when the condition is associated with symptoms. It is rarely diagnosed in infancy. Similarly, a quadricuspid pulmonary valve is also a rare finding, and there are scant data to evaluate whether this malformation of the pulmonary valve is suitable to be used for a Ross operation. This report describes a case in which both these anomalies coexisted in an infant who underwent a successful Ross-Konno operation.
Assuntos
Anormalidades Múltiplas/cirurgia , Anomalias dos Vasos Coronários/cirurgia , Cardiopatias Congênitas/cirurgia , Valva Pulmonar/anormalidades , Valva Pulmonar/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Humanos , Lactente , MasculinoRESUMO
Echocardiographic imaging provides real-time guidance during transcatheter patent ductus arteriosus (PDA) closure in extremely low birth weight (ELBW) infants. Transthoracic echocardiogram provides detailed assessment of the PDA and surrounding structures prior to, during, and after transcatheter closure. This article aims to review the different echocardiographic techniques and concepts utilized during transcatheter PDA closure in ELBW infants.
Assuntos
Permeabilidade do Canal Arterial/cirurgia , Ecocardiografia Doppler/métodos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Cirurgia Assistida por Computador/métodos , Permeabilidade do Canal Arterial/diagnóstico , Idade Gestacional , Humanos , Recém-NascidoRESUMO
A case of bilateral spontaneous chylothorax with respiratory syncytial virus (RSV) bronchiolitis has never been reported. We report the case of a 7-month-old boy born at 33 weeks gestation with a history of Down syndrome, atrial septal defect, pulmonary hypertension, and chronic lung disease, hospitalized due to RSV bronchiolitis who developed bilateral spontaneous chylothorax with exacerbation of pulmonary hypertension (PH). The patient died after 9 weeks of mechanical ventilation and treatment for PH. The autopsy showed acute infectious signs, a chronic interstitial lung disease with pulmonary hypertensive changes and subpleural cysts with no evidence of congenital lymphangiectasia. The cause of chylothorax in this child could be multifactorial. However, worsening pulmonary hypertension with RSV infection might have partially contributed to the development of chylothorax through elevated superior venous cava pressure. Thoracentesis should be considered for patients with Down syndrome and PH associated with congenital heart disease who develop persistent pleural effusion during RSV bronchiolitis to rule out chylothorax.
RESUMO
The hemodynamic effects of a patent ductus arteriosus (PDA) are well known including systemic hypoperfusion and volume overload on the left ventricle. This article aims to provide a review of the long-standing effect of a hemodynamically significant PDA on the pulmonary vasculature and the role of cardiac catheterization in preterm infants with a PDA and pulmonary hypertension.
Assuntos
Permeabilidade do Canal Arterial/fisiopatologia , Hipertensão Pulmonar/fisiopatologia , Recém-Nascido Prematuro , Artéria Pulmonar/fisiopatologia , Circulação Pulmonar/fisiologia , Resistência Vascular/fisiologia , Cateterismo Cardíaco , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/diagnóstico , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/etiologia , Lactente , Recém-NascidoRESUMO
OBJECTIVE: To study neurological outcome of Moya Moya disease treated surgically with Encephaloduroarteriosynengopsis (EDAS). DESIGN: Prospective observational study. SETTINGS: Community and General with tertiary care facility. SUBJECTS: Eight children diagnosed with Moya Moya disease by Magnetic Resonance Angiogramover 4 years of period were selected for EDAS. Children who were not able to sustain surgery excluded from study. METHODS: Treatment modality selected were surgery in form of EDAS. After surgery subjects were followed up for minimum of 2 year period to know neurological out come. Outcome was reported as poor, fair, good and excellent. No statistical analysis performed due to small sample size. RESULTS: After surgery no episode of stroke or TIA was observed in any patient during 2 year follow up period and all patients are living without any new neurological deficit. CONCLUSION: Long term outcome of EDAS is promising.
Assuntos
Revascularização Cerebral/métodos , Doença de Moyamoya/cirurgia , Adolescente , Circulação Cerebrovascular , Criança , Pré-Escolar , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Doença de Moyamoya/diagnóstico , Doença de Moyamoya/fisiopatologia , Estudos ProspectivosRESUMO
Mycotic aneurysms of the aorta are uncommon life-threatening lesions. Sporadic cases have been reported in adults after surgical intervention for native and recurrent coarctation of the aorta. We report a case of a rapidly progressive, large mycotic pseudoaneurysm in a 13-year-old boy 3 months after a bare-metal stent was used to treat native coarctation. The boy presented with slurred speech, bacteremia, and systemic septic embolization. During an emergency operation, the pseudoaneurysm was resected, and the infected aorta was replaced with an interposition graft. This rare complication may occur early or late after stent placement for coarctation of the aorta.
Assuntos
Falso Aneurisma/cirurgia , Aneurisma Infectado/cirurgia , Aneurisma Aórtico/cirurgia , Coartação Aórtica/terapia , Stents/efeitos adversos , Adolescente , Falso Aneurisma/diagnóstico por imagem , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
The first-time appearance of a murmur in an adolescent can create a substantial amount of anxiety in the parents and the teenager. The appropriate evaluation and diagnosis is very important in decision-making regarding sports participation in this population. Accurate identification of the innocent murmurs can obviate the need for echocardiography. Identification of a pathologic murmur may reduce morbidity and, possibly, mortality in critical lesions such as hypertrophic cardiomyopathy. This article discusses the physiology and characteristics of different murmurs, and outlines an approach to cardiac murmurs in adolescents.