Left ventricular thrombus in the multisystem inflammatory syndrome in children associated with COVID-19.

A 3-year-old girl presenting with fever, mucocutaneous inflammation, and acute gastrointestinal symptoms met criteria for the multisystem inflammatory syndrome in children associated with COVID-19 (MIS-C). Echocardiography showed severely decreased left ventricular (LV) function with an apical mass. After treatment with intravenous (IV) immunoglobulin, IV steroids, anakinra, milrinone, and systemic anticoagulation, her LV function rapidly improved and the mass became increasingly mobile. Given the risk of systemic embolization, the mass was excised through left ventriculotomy and pathology confirmed a thrombus.

Optimal head position during transesophageal echocardiographic probe insertion for pediatric patients weighing up to 10 kg.

No data exists for the optimal head position during transesophageal echocardiography (TEE) probe insertion in children. Turning the head to the side closes the ipsilateral pyriform sinus and dilates the contralateral pyriform sinus, theoretically making probe insertion safer and easier. In this study, 94 children (weight, 5 kg), II (weight, 4-5 kg), and III (weight, <4 kg). The difference was statistically significant only for subgroup III (p = 0.0001). Insertion failed in four children with the head in the midline position but was successful when the head was turned leftward. Children undergoing TEE who weigh less than 10 kg should have the head positioned to the side rather than in the midline position during probe insertion. If insertion is unsuccessful or difficult with the head in the midline position, the authors recommend turning the head to the side and reattempting probe insertion.

Intermediate-term results of repair for aortic, neoaortic, and truncal valve insufficiency in children.

OBJECTIVE: Repair of aortic valve insufficiency is difficult, and durability is relatively unknown in children. This study evaluates the intermediate-term results of repair of the systemic semilunar valve, including the native aortic valve, neoaortic valve (anatomic pulmonary), and truncal valve. METHODS: We reviewed the records of 54 children (aged 2 days to 18 years) who underwent repair of the functional aortic valve for moderate or greater insufficiency from 1991 to 2005. Valve anatomy was tricuspid aortic in 26 patients, bicuspid aortic in 11 patients, tricuspid neoaortic in 9 patients, bicuspid neoaortic in 1 patient, and truncal valve in 7 patients. Multiple surgical techniques were used in most of the 54 patients, including leaflet plication in 17, leaflet repair in 15, commissuroplasty in 32, pericardial cusp augmentation in 8, and sinus of Valsalva reduction in 3. RESULTS: There was 1 early death and no late deaths. Actuarial freedom from reoperation was 68% at 5 years and 58% at 10 years. Freedom from aortic valve replacement was 82% at 5 years and 73% at 10 years. Duration of cardiopulmonary bypass was the most significant risk factor for reoperation with multivariate analysis. Of the 40 patients who have not undergone reoperation, 37 have had follow-up echocardiograms with the latest study (4.5 +/- 4.2 years) demonstrating trace to 1+ insufficiency in 23 patients, 1 to 2+ in 12 patients, 2 to 3+ in 1 patient, and 3 to 4+ in 1 patient. CONCLUSION: Repair of the insufficient systemic semilunar valve offers acceptable 10-year freedom from reoperation and functional results, and should be considered for most children.