Changes in Strain Pattern and Exercise Capacity after Transcatheter Closure of Atrial Septal Defects

BACKGROUND AND OBJECTIVES: Assessment of left ventricle (LV) function by using strain and strain rate is popular in the clinical setting. However, the use of these echocardiographic tools in assessing right ventricle (RV) failure, and the manner in which they both reflect the functional capacity of the patient, remains poorly understood. This study aimed to investigate the change in exercise capacity and strain between before and (1 month) after the transcatheter closure of atrial septal defects (ASDs). SUBJECTS AND METHODS: Thirty patients who underwent transcatheter closure of ASD between May 2014 and June 2015 at the Division of Pediatric Cardiology, Severance Cardiovascular Hospital, were enrolled. We compared and analyzed the results of the following examinations, before and (1 month) after the procedure: echocardiography, cardiopulmonary exercise test (CPET), and N-terminal pro-brain natriuretic peptide level. RESULTS: There were no mortalities, and the male-to-female ratio was 1:2. The mean defect size was 22.3±4.9 mm; the mean Qp/Qs ratio, 2.1±0.5; and the mean device size, 22.3±4.9 mm. Changes in global RV longitudinal (GRVL) strain and LV torsion were measured echocardiographically. Exercise capacity improved from 7.7±1.2 to 8.7±1.8 metabolic equivalents (p=0.001). These findings correlated to the change in GRVL strain (p=0.03). CONCLUSION: The average exercise capacity increased after device closure of ASD. The change in strain was evident on echocardiography, especially for GRVL strain and LV torsion. Further studies comparing CPET and strain in various patients may show increased exercise capacity in patients with improved RV function.

Clinical outcome of transcatheter closure of patent ductus arteriosus in small children weighing 10 kg or less / 소아과

PURPOSE: Transcatheter closure has become an effective therapy in most patients with patent ductus arteriosus (PDA). However, there are difficulties in transcatheter closure of PDA in small children. We reviewed clinical outcomes of transcatheter closure of PDA in children weighing less than 10 kg in a single center. METHODS: Between January 2003 and December 2009, 314 patients with PDA underwent transcatheter closure in our institute. Among them, 115 weighed less than 10 kg. All of these patients underwent transcatheter closure of PDA using either COOK Detachable Coil(R), PFM Nit-Occlud(R), or Amplatzer duct occluder(R). A retrospective review of the treatment results and complications was performed. RESULTS: The mean age of patients was 9.1+/-5.9 months (median, 8 months), and mean weight was 7.6+/-1.8 kg (median, 7.8 kg). The mean diameter of PDA was 3.2+/-1.4 mm (median, 3 mm). Complete occlusion occurred in 113 patients (98%). One patient was sent to surgery because of a failed attempt at device closure, and another patient had a small residual shunt after device placement. The average mean length of hospital stay was 3.0+/-3.3 days, and mean follow-up duration was 21.0+/-19.6 months. There were no major complications in any of the patients. CONCLUSION: Transcatheter closure of PDA is considered safe and efficacious in infants weighing less than 10 kg. With sufficient experience and further effort, transcatheter closure of PDA can be accepted as the gold standard of treatment for this group of patients.

A Case of Posterior Reversible Encephalopathy Syndrome with Post Streptoccocal Glomerulonephritis / 대한소아신경학회지

Posterior Reversible Encephalopathy Syndrome(PRES) mainly develops in patients under immunosuppressive therapy after transplantation, or patients who suffer hemato-oncologic diseases, eclampsia, acute hypertensive encephalopathy related with nephrotic disease. Sudden headache, nausea, mental derangement, convulsion, vision problems are the main symptoms shown in PRES. It typically shows edema of occipito-parietal area of cortex or subcortex in Magnetic Resonance Imaging(MRI). A 10-year-old male was hospitalized with the chief complaint of headache, vomiting and dizziness for 3 days. He was treated for upper respiratory infection for 1 week before the hospitalization. Initial blood pressure was 145/95 mmHg, which was high for his age. Uninalysis showed microscopic hematuria(3+). The hypertension persisted even after the hospitalization, and re-checked blood pressure was 175/115 mmHg. The patient complained of headache, and after that, he suffered from alteration of mental status with dysarthria and generalized type of seizure events. The MRI showed lesions suggestive of PRES. He recovered to alertmental status after the blood pressure was controlled. Antistreptolysin-O(ASO) titer was increased and complement 3(C3) titer was decreased. The follow up MRI taken 1 month after the event became normal. We report a case of PRES related with contemporary hypertensive event in Acute Post-Streptococcal Glomerulonephritis(APSGN).

Prevalence of Allergic Diseases among Primary School Children in Ilsan, Gyeonggi and Changes of Symptoms After Environmental Control in 2005 / 소아알레르기및호흡기학회지

PURPOSE:The purpose of this study was to determine the prevalence of asthma, allergic rhinitis, atopic dermatitis and allergic conjunctivitis among primary school pupils in Ilsan, Gyeonggi province. We also investigated change of symptoms after environmental control. METHODS:In April 2005, a cross-sectional study was performed among 2,745 1st to 6th graders of 3 primary schools in Ilsan, Gyeonggi province. International Study of Asthma and Allergies in Childhood (ISAAC) standardized questionnaires and additional questionnaires about environmental changes were distributed to their parents. RESULTS:Data were collected from 2,535 children (1,279 boys and 1,256 girls). The most common allergic symptom was rhinorrhea (43.0%), and atopic skin lesions, ocular lesions and wheezing were 24.5%, 19.7% and 18.2%, respectively. There was no significant relationship between allergic diseases and environmental status. One thousand four hundred nineteen children moved to a new place or had new interior decorations within the last 2 years. Of these children, 352 (24.8%) had allergic symptoms (OR=2.76, CI= 1.96-3.41, P=0.001). Interestingly, we found that children who had moved into apartments experienced more symptom changes than those who had not (P=0.022). CONCLUSION:The results of this study demonstrated that the prevalence of allergic conditions in primary school children in Ilsan, Gyeonggi province in 2005 was higher than those of nation-wide studies in 2000. We found the results of our study is similar to those of Seoul in 2005. We found a significant relationship between environmental status and changes of symptoms in primary school children in Ilsan, Gyeonggi province.

Prevalence of Allergic Diseases among Primary School Children in Ilsan, Gyeonggi and Changes of Symptoms After Environmental Control in 2005 / 소아알레르기및호흡기학회지

PURPOSE:The purpose of this study was to determine the prevalence of asthma, allergic rhinitis, atopic dermatitis and allergic conjunctivitis among primary school pupils in Ilsan, Gyeonggi province. We also investigated change of symptoms after environmental control. METHODS:In April 2005, a cross-sectional study was performed among 2,745 1st to 6th graders of 3 primary schools in Ilsan, Gyeonggi province. International Study of Asthma and Allergies in Childhood (ISAAC) standardized questionnaires and additional questionnaires about environmental changes were distributed to their parents. RESULTS:Data were collected from 2,535 children (1,279 boys and 1,256 girls). The most common allergic symptom was rhinorrhea (43.0%), and atopic skin lesions, ocular lesions and wheezing were 24.5%, 19.7% and 18.2%, respectively. There was no significant relationship between allergic diseases and environmental status. One thousand four hundred nineteen children moved to a new place or had new interior decorations within the last 2 years. Of these children, 352 (24.8%) had allergic symptoms (OR=2.76, CI= 1.96-3.41, P=0.001). Interestingly, we found that children who had moved into apartments experienced more symptom changes than those who had not (P=0.022). CONCLUSION:The results of this study demonstrated that the prevalence of allergic conditions in primary school children in Ilsan, Gyeonggi province in 2005 was higher than those of nation-wide studies in 2000. We found the results of our study is similar to those of Seoul in 2005. We found a significant relationship between environmental status and changes of symptoms in primary school children in Ilsan, Gyeonggi province.