Clinical course and treatment of children and adolescents with the preexcitation syndrome - own studies.

INTRODUCTION: Essentially, preexcitation syndrome is the presence of an accessory pathway in the heart, which can lead to serious consequences, ranging from atrioventricular reentrant tachycardia to sudden cardiac death. Wolff-Parkinson-White syndrome is the most common preexcitation syndrome. AIM OF THE STUDY: The aim of the study was to evaluate the clinical course of the disease, as well as the treatment of children and adolescents hospitalized in the Department of Pediatric Cardiology in the years 2008-2015. MATERIALS AND METHODS: The study was carried out in 45 children (62 % male, 38% female; the mean age 11 years). During the study we analyzed 12-lead ECG, 24-hour Holter ECG, echocardiography and the cycloergometric exercise test. The results of treatment were also discussed. RESULTS: Apart from the typical features of preexcitation, the most prevalent abnormality found in ECG was atrioventricular reentrant tachycardia. In 24-hour Holter ECG the most frequently detected disorders were premature ventricular beats and premature atrial contractions. Structural heart defects were detected in 8.9% of the children. The cycloergometric exercise test was positive in 8.9% of patients. The mean duration of symptoms before the diagnosis was 2.5 years. 25% of the patients were asymptomatic. 42.2% of the children needed antiarrhythmic therapy, while 44.4% had accessory pathways ablated. CONCLUSIONS: The most common symptom of preexcitation in the study group were heart palpitations. The most frequent type of arrhythmia in children with preexcitation syndrome was orthodromic atrioventricular reentrant tachycardia. For the majority of older children ablation of the accessory pathway was a recommended form of treatment. In younger children the standard preventive pharmacological treatment was applied for 6 to 12 months.

[Preexcitation Syndromes in Children and Adolescents].

Preexcitation syndromes are becoming a more often detected disease in the pediatric population. Their essential feature is the presence of additional paths / pathways in the heart, through which the impulse is conducted faster than physiologically. This leads to faster ventricular excitation and may lead to creating dangerous arrhythmias. The most common preexcitation syndrome is Wolff - Parkinson-White syndrome, which affects 2/ 1000 people. The presence of an accessory pathway could result in serious consequences, ranging from supraventricular tachycardia to sudden cardiac death. There are both invasive and non-invasive methods of diagnosing preexcitation syndromes. Therapeutic treatment includes pharmacotherapy and ablation, which makes it possible to permanently remove the cause of the arrhythmia.

Time domain parameters of heart rate variability in children born as small-for-gestational age.

According to metabolic programming theory, small-for-gestational age patients are at high risk of cardiovascular diseases also because of the possible malfunction of the autonomic nervous system. Autonomic disorders can be assessed by heart rate variability. The aims of this study were to compare time domain parameters of heart rate variability in children born as small-for-gestational age and appropriate-for-gestational age and to assess the correlation of the postnatal and current somatic parameters with the time domain parameters. The small-for-gestational age group consisted of 68 children aged 5-10 years who were born with birth weight below the 10th percentile. The appropriate-for-gestational age group consisted of 30 healthy peers, matched in terms of gender and age. On the basis of Holter monitoring, slightly higher average heart rate was observed in the small-for-gestational age group than in the appropriate-for-gestational age group. It was found that all the time domain parameters (SDNN, SDNNi, SDANNi, rMSSD, pNN50) were lower in the small-for-gestational age group than in the appropriate-for-gestational age group. In the small-for-gestational age group, girls had lower heart rate and some of the heart rate variability parameters (SDNN, SDNNi, SDANNi) in comparison with boys. Children born as small-for-gestational age have impaired function of the autonomic nervous system. Moreover, in the small-for-gestational age group, autonomic balance moved towards the sympathetic component, which was evidenced by higher heart rate. Children with faster heart rate and lower heart rate variability parameters may be at risk of cardiovascular disease.

Serum Adipocytokines Profile in Children Born Small and Appropriate for Gestational Age-A Comparative Study.

BACKGROUND: Adipose tissue is not only a storage place for fat, but also an endocrine organ, secreting bioactive molecules which influence body metabolism. Such molecules are known as adipocytokines. In the past years the coincidence between adipocytokines and fetal growth restriction disorders was found. The aim of the study was to estimate serum levels of adiponectin, leptin and resistin in children born small for gestational age, compared to children born at an appropriate size for gestational age. METHODS: The study consisted of 35 children aged seven to nine years, born SGA (small for gestational age) on term and 25 healthy children (14 girls, 11 boys), born with proper birthweight (AGA-appropriate for gestational age)-control group. RESULTS: Adiponectin and leptin levels were significantly higher in the SGA group compared to the AGA group (p = 0.023, p = 0.018 respectively). The resistin values were comparable in both groups of patients. There was a positive correlation between serum leptin concentration and current body weight in SGA group (r = 0.28; p = 0.108). In turn, adiponectin levels in this group of patients negatively correlated with actual body weight (r = -0.51; p = 0.002). The negative correlation between body mass index and plasma adiponectin levels was found only in children born SGA. SGA children had significantly higher values of diastolic blood pressure. There was negative correlation between serum adiponectin level and systolic blood pressure in SGA children. In the SGA group the phenomenon of catch-up growth was observed in 32 children. CONCLUSIONS: Children born SGA have abnormal adipose tissue biomarkers profiles.

Why and How Should We Assess the Cardiovascular Risk in Patients with Juvenile Idiopathic Arthritis? A Single-Centre Experience with Carotid Intima-Media Measurements.

BACKGROUND: Children diagnosed with juvenile idiopathic arthritis (JIA) are thought to be more likely to develop cardiovascular disease in adulthood. The factors modulating the cardiovascular risk, involving exposure to secondhand smoking, sedentary lifestyle and abnormal body mass index, might have had a stronger impact during the COVID-19 pandemic. The lack of reliable prognostic markers for a higher probability of cardiovascular events might be solved by carotid intima-media thickness (cIMT) measurement. The paramount goal of the study was to assess its usefulness in JIA patients. MATERIALS AND METHODS: The results of cIMT measured by a single physician in 45 children diagnosed with JIA were compared to 37 age- and sex-matched healthy counterparts. The analysis also involved anthropometric parameters, laboratory tests, and a survey regarding lifestyle-related factors. RESULTS: Four JIA patients appeared to have cIMT above the 94th percentile. A positive correlation between erythrocytes sedimentation rate (ESR) and right carotid artery percentiles was found. Passive smoking increased the cardiovascular risk regardless of JIA. Doubling the daily screen time during the pandemic led to a significant reduction in children's physical activity. However, the number of enrolled subjects was not enough to make significant recommendations. CONCLUSIONS: cIMT measurements remain an interesting perspective for future cardiovascular screening of children with JIA. It has yet to be determined whether it should be considered in all JIA patients on a reliable basis.

Lipid Profile in Children Born Small for Gestational Age.

BACKGROUND: Lipid disorders are one of the risk factors for cardiovascular diseases. The aim of the study was to estimate the lipid profile in early childhood in the population of Polish children born small for gestational age (SGA). MATERIALS AND METHODS: The study included 140 patients (93 SGA children and 47 controls) aged 5 to 11 years. All the subjects underwent a physical examination and blood laboratory tests for the glucose and lipid profiles. The SGA group was divided into subgroups, i.e., symmetrical and asymmetrical intrauterine growth restriction (IUGR). RESULTS: Blood sample analysis revealed higher levels of total cholesterol (SGA group 190.61 ± 24.66 mg/dL vs. controls 143.23 ± 23.90; p < 0.001). The analysis of particular cholesterol fractions showed significantly higher mean values of triglycerides and LDL cholesterol as well as lower mean values of HDL cholesterol in SGA children. Children in both groups did not differ significantly in terms of weight or body mass index. A statistically significantly higher glucose concentration was observed in SGA patients with the symmetrical type of IUGR. Analyzing the differences regarding metabolic factors, we obtained a statistically significant difference only in fasting glucose concentration (asymmetrical IUGR = 90.56 ± 10.21 vs. symmetrical IUGR = 98.95 ± 14.79; p < 0.001). CONCLUSIONS: Children born SGA, even those not suffering from overweight or obesity in their early childhood, have an abnormal lipid profile, which may contribute to the development of cardiovascular diseases in adulthood.

Assessment of Cardiovascular Risk Factors in Patients with Juvenile Idiopathic Arthritis.

INTRODUCTION: The aim of this study was to assess the exposure to cardiovascular disease (CVD) risk factors in patients with juvenile idiopathic arthritis (JIA). Intima-media complex thickness (IMT), selected metabolic parameters and health behaviors were assessed in the course of the study. METHODS: The study included study group, which consisted of 45 patients with JIA and 37 healthy age- and sex-matched children in the control group. Analyses in both groups included anthropometric parameters, laboratory tests, IMT and a questionnaire on exposure to modifiable CVD risk factors. RESULTS: The study confirmed that CVD risk factors were present in both groups of patients. Significantly more children with JIA had abnormal BMI (p = 0.006) compared to the control group. Children in the study group were more likely to consume fruit regularly (p = 0.021) and less likely to consume fast food (p = 0.011) and sweetened beverages (p = 0.042) than children in the control group. Only 1 patient with JIA met criteria for ideal cardiovascular health. Dietary habits were not associated with IMT values, BMI, presence of joint pain or biochemical parameters in the study group. CONCLUSIONS: Patients with JIA are exposed to cardiovascular risk factors equally to their healthy peers. Ideal cardiovascular health should be pursued in the pediatric population with particular attention paid to patients with chronic diseases (i.e., JIA). The application of carotid artery IMT measurement in the assessment of CVD risk requires studies on a larger group of patients.

Takayasu's arteritis mimicking Kawasaki disease in 7-month-old infant, successfully treated with glucocorticosteroids and intravenous immunoglobulins.

Takayasu's arteritis (TA) rarely occurs in infants. There are only four reports on TA in children below 1 year of age, revealing diversity of its symptoms. We describe a 7-month-old female infant hospitalized for hectic fever, irritability, high acute phase indices, and coronary artery dilatations found on echocardiography, which suggested Kawasaki disease (KD). Despite of standard treatment, rapid development of thoracic and abdominal aorta aneurysms occurred, while coronary artery abnormalities regressed. The initial diagnosis was changed for TA. Subsequently implemented glucocorticosteroids led to clinical and laboratory normalization. However, 2 months after treatment discontinuation, TA relapsed. Glucocorticosteroid therapy was restarted with additional introduction of intravenous immunoglobulins (IVIG), resulting in full and stable remission lasting over 1 year. Thus, diagnosis and treatment of infant TA pose a big challenge to physicians. TA onset in infants may mimics KD. Prolonged glucocorticosteroids and IVIG administration can be recommended in the youngest patients with TA.

Changes in the cardiovascular system in children with pediatric multisystem inflammatory syndrome temporally associated with COVID-19 - A single center experience.

Background Pediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS-TS) is a serious complication of a previous SARS-CoV-2 infection in the group of pediatric patients. Despite the fact that this disease affects only about 1 of 1000 children, it may be severe, and changes in the cardiovascular system may cause long-term complications and the need for longitudinal patient care. Methods It is a single-center retrospective study considering 51 patients with PIMS-TS. The aim of this study was to analyze patients with PIMS-TS, taking into account demographic data, clinical course, laboratory tests and cardiovascular system assessment (electrocardiography, echocardiography, etc.). Results From June 2020 to October 2021, 51 patients with PIMS-TS were hospitalized in our center. In the studied group, 26/51 children (51%) were girls. The mean age of patients was 7 years. Changes in electrocardiograms were found in 21/51 patients. Echocardiography revealed pericardial fluid in most patients. In addition, heart valve insufficiency was found. Changes in the coronary vessels in the form of dilatations and even aneurysms were found in 42 patients. Myocardial hypokinesis was visualized in more than 1/4 of the patients. Sixteen patients (31.3%) required transfer to the intensive care unit (ICU) due to severe hypotension. Laboratory tests revealed increased levels of markers of heart failure and enzymes of myocardial damage. Conclusions Changes in the cardiovascular system in the course of PIMS-TS are of various nature, but in most patients they require close cardiac supervision and long-term follow-up.

Evaluation of Health-Promoting Behaviors in the Prevention of Cardiovascular Diseases in the Preschool Children of Polish Health Care Professionals.

BACKGROUND: The aim of the study was to evaluate the health-promoting behavior of the preschool children (aged 3-6 y) of Polish health care professionals (HCPs). METHODS: The study was conducted by means of quantitative research on a group of 386 individuals, using an Internet-based survey. RESULTS: The ideal cardiovascular health model was determined in the case of 22 children (5.6%). The collected data revealed that, when regarding the recommended level of physical activity, children from HCP families meet the American Heart Association criteria much more often than their peers from other study populations (56.5% vs. 16.6%). In our study, more girls than boys participated in organized activities (60.2% vs. 50.3%, p = 0.05). There was no correlation between achieving adequate levels of physical activity and the BMI (p > 0.1). Overweight children had a more balanced diet than children with a normal body weight (p = 0.009). CONCLUSIONS: The obtained results allowed us to make the conclusion that there is a need to implement educational and preventive measures on a large scale, while some health-promoting behaviors, especially those concerning proper nutrition, require major modifications, even in HCP families.

Prenatal diagnosis and follow-up of 23 cases of cardiac tumors.

OBJECTIVE: To evaluate the prenatal characteristics and postnatal outcome of cardiac tumors diagnosed at two prenatal Polish cardiology centers. METHODS: Descriptive analysis of 23 fetuses with cardiac tumors (12 multiple and 11 single) diagnosed over 16 years (from 1993 to 2009). Congestive heart failure was diagnosed when the cardiovascular profile score was seven or less. RESULTS: Associated structural congenital heart defects were present in three fetuses, extracardiac anomalies in three, and chromosomal anomalies in two. Congestive heart failure developed in five cases. Perinatal survival was not different between cases with and without cardiac failure (2/5 vs 12/18, p = 0.28). The main ultrasonographic signs observed prenatally in association with cardiac tumors were cardiomegaly, left ventricular outflow tract obstruction, pericardial effusion, and hypokinesis. A diagnosis of tuberous sclerosis was eventually made in all 12 fetuses with multiple tumors. Perinatal death occurred in 4/11 cases with single tumors and in 5/12 with multiple tumors (p = 0.57). Surgical resection of the tumor was performed in 3/11 neonates with single tumors (histopathologically: rhabdomyoma, teratoma, and fibroma) and in 2/12 with multiple tumors (both rhabdomyomas). CONCLUSIONS: Survival is not different between neonates with single and multiple tumors and between those with and without congestive heart failure.

Myocardial dysfunction in children with intrauterine growth restriction: an echocardiographic study.

INTRODUCTION: The prevalence of intrauterine growth restriction (IUGR) is about 3-10% of live-born newborns and can be as high as 20% in developing countries. It may result in the occurrence of cardiovascular diseases later in life. METHODS: The aim of this study was echocardiographic evaluation, with the use of conventional and tissue Doppler parameters, of cardiac function in children born with IUGR, and comparison with healthy peers born as normally grown foetuses. RESULTS: In the IUGR group, E wave and E/A ratio were significantly lower compared to the control group. A wave, isovolumetric relaxation time, deceleration time, myocardial performance index as well as E/E' septal and E/E' lateral indices were significantly higher compared to healthy peers. CONCLUSION: Children with IUGR presented with subclinical myocardial dysfunction.

[Prenatal diagnostics of congenital heart disease--own results]. / Zastosowanie diagnostyki prenatalnej w wykrywaniu wrodzonych wad serca--ocena wybranych parametrów echokardiograficznych.

OBJECTIVES: Congenital heart defects (CHD) are the most common congenital malformation. They are still often overlooked in fetuses during the routine obstetric scanning. DESIGN: The aim of our study was to present our results in detecting CHD in high risk pregnancies. MATERIAL AND METHODS: The echocardiograms of 135 fetuses and case history of neonates who had prenatal diagnosis of CHD were revied retrospectively. RESULTS: We diagnosed CHD in 135 fetuses. The most common CHD were: atrio-ventricular canal (32 fetuses-23,7%), hypoplastic left heart syndrome (17 fetuses--12.6%), ventricular septal defect (11 fetuses--8.2%), and aortic stenosis (10 fetuses--7.4%). There were 15 intrauterine deaths (11.1%) and 8 neonatal deaths. CONCLUSIONS: Prenatal echocardiography enables early detecting and adequate treatment of congenital heart defects.

[Intrauterine growth restriction]. / Hipotrofia plodu.

Intrauterine growth restriction (IUGR) is found in 1-10% of all pregnancies, and among women with risk factors even twice often. It is connected to worse obstetric results, and its complications can arise long time after delivery. In the paper we described etiology, diagnostics and monitoring of IUGR and its consequences for the child and for the course of neonatal periode.

Myocardial dysfunction measured by tissue Doppler echocardiography in children with primary arterial hypertension.

BACKGROUND AND AIM: To evaluate myocardial function with the use of tissue Doppler echocardiography in children with primary hypertension. METHODS: A total of 64 subjects (34 with hypertension, 30 control) underwent echocardiographic evaluation of systolic and diastolic function with the use of standard and tissue Doppler echocardiography parameters. RESULTS: The left ventricular myocardial performance index was higher in children with hypertension (0.46 ± 0.08 vs. 0.35 ± 0.03; p < 0.01). The value of the A wave was higher in the hypertensive children group (0.59 ± 0.12 m/s vs. 0.49 ± 0.09 m/s; p < 0.01), while the E/A ratio was significantly lower in this group (1.58 ± 0.31 vs. 1.77 ± 0.28; p < 0.01). The values of isovolumetric relaxation time and deceleration time were significantly higher in patients with blood pressure elevation. The velocity of mitral flow propagation was lower (0.61 ± 0.08 m/s vs. 0.72 ± 0.10 m/s; p < 0.01) and E/Vp ratio was higher (1.50 ± 0.27 vs. 1.21 ± 0.23; p < 0.01) in hypertensive children. Evaluation of the left ventricle function with the use of tissue Doppler echocardiography showed significantly worse values of S' and E' septal, and S' and E' lateral in hypertensive children. The value of septal E'/A' ratio was lower in children with hypertension (1.52 ± 0.24 vs. 1.69 ± 0.25; p < 0.01), while the value of this index for lateral wall was similar. The values of E/E' septal and E/E' lateral were higher in patients with hypertension. CONCLUSIONS: In children with primary arterial hypertension, with the use of tissue Doppler echocardiography there are significantly lower values of diastolic and systolic parameters observed, which may be a sign of myocardial function deterioration.

[Intrauterine growth retardation--cardiologic diagnosis]. / Diagnostyka kardiologiczna u plodów z zahamowaniem rozwoju wewnatrzmacicznego.

OBJECTIVES AND DESIGN: Intrauterine growth retardation (IUGR) of a fetus is one of the most important problem of modern perinatal medicine. It is generally known that low birth weight predisposes to certain disease in later life, including diseases of the cardiovascular system. The aim of this study is to present own results of cardiology diagnostics in fetuses with IUGR. MATERIALS AND METHODS: 46 echocardiographic examinations of fetuses with IUGR were analysed. RESULTS: In the analysed group 21 fetuses (45.4%) presented anomalies of the cardiovascular system: 6 fetuses (13%)-congenital heart diseases; 5 (10.8%)-redundant foramen ovale; 4 (8.6%)-tricuspid regurgitation; 1 fetus (2.2%)-myocarditis. CONCLUSION: Fetuses with IUGR make the group of high risk of cardiovascular abnormalities.

[Prenatal diagnosis of arrhythmias and conduction disturbances]. / Prenatalna diagnostyka zaburzen rytmu i przewodnictwa.

OBJECTIVES AND DESIGN: Cardiac arrhythmias are one of the most frequent indications for the fetal echocardiographic assessment. The objective of this work is to present our own results of diagnosing and treating the fetuses with arrhythmias. MATERIALS AND METHODS: The 1485 prenatal echocardiographic examinations were performed in 1302 fetuses. The 109 of fetuses suffered from arrhythmias. RESULTS: 68 fetuses (62.8%) in the analysed group presented with arrhythmias in the form of extra-systoles, 19 fetuses (17.4%) with tachycardia and 22 (20.2%) with a complete atrioventricular block. CONCLUSIONS: We concluded, that arrhythmias can be diagnosed precisely in the early prenatal period, which enables the introduction of the adequate pharmacological treatment and the coexistence of the fetal complete a-v block and structural heart defect in a fetus is associated with poor prognosis.

Intra-uterine growth restriction as a risk factor for hypertension in children six to 10 years old.

INTRODUCTION: Intra-uterine growth restriction (IUGR) is present in about 3-10% of live-born newborns and it is as high as 20-30% in developing countries. Since the 1990s, it has been known that abnormalities during foetal growth may result in cardiovascular disease, including hypertension in adulthood. METHODS: This study evaluated blood pressure parameters (using ambulatory blood pressure monitoring) in children aged six to 10 years old, born as small for gestational age (SGA), and compared them to their healthy peers born as appropriate for gestational age (AGA). RESULTS: In the SGA group, an abnormal blood pressure level (prehypertension or hypertension) was present significantly more often than in the AGA group (50 vs 16%, p < 0.01). This relationship also occurred in association with the type of IUGR (asymmetric p < 0.01, symmetric p < 0.05). CONCLUSIONS: In SGA children, abnormal blood pressure values occurred more frequently than in AGA children.

[Assessment of cardiac function in fetuses with intrauterine growth retardation using the Tei Index]. / Zastosowanie wskaznika Tei do oceny funkcji miesnia sercowego u plodów z zahamowaniem rozwoju wewnatrzmacicznego.

UNLABELLED: The aim of the study was to evaluate cardiac function in foetuses with IUGR, using the Tei Index. MATERIAL AND METHODS: Prenatal echocardiographic examination was performed in 64 foetuses with intrauterine growth retardation between 25-27, 30-32, and 34-37 weeks of gestation. The control group included 30 healthy foetuses. Flow velocity waveforms of mitral and tricuspid valve and flow velocity waveforms of the aortic and pulmonic valves were obtained. The Tei Index for left and right ventricle was calculated. The heart rate was measured in all foetuses. RESULTS: The Tei Index for left ventricle in foetuses with intrauterine growth retardation was significantly higher than in healthy foetuses (25-27 hbd - 0.6 vs. 0.58; p<0.05: 30-32 hbd -0.59 vs. 0.52; p<0.05: 34-36 hbd - 0.58 vs. 0.48; p<0.001). The Tei Index for right ventricle was also significantly higher in foetuses with intrauterine growth retardation than in the control group. The Tei Index decreased gradually with advancing gestational age and is independent of heart rate. CONCLUSIONS: l. Foetuses with intrauterine growth retardation have abnormal cardiac function in later part of gestation. 2. The Tei Index may be applied to evaluate cardiac function in foetuses.