One-Year Follow-Up Results of MIS-C Patients with Coronary Artery Involvement: A Multi-center Study.

Multisystem inflammatory syndrome (MIS-C) in children is a rare complication of SARS-CoV-2 infection. Knowing the course of the affected or unaffected coronary arteries in the patients under follow-up is important in terms of defining the long-term prognosis of the disease and determining the follow-up plan. This is a multicenter and retrospective study. The data were obtained from nine different centers. Between May 2020 and August 2022, 68 of 790 patients had coronary artery involvement. One-year echocardiographic data of 67 of 789 MIS-C patients with coronary artery involvement were analyzed. Existing pathologies of the coronary arteries were grouped as increased echogenicity, dilatation and aneurysm according to Z scores, and their changes over a 1-year period were determined. The data of all three groups are defined as frequency. SPSS Statistics version 22 was used to evaluate the data. In our study, aneurysm was observed in 16.4%, dilatation in 68.7% and increased echogenicity in 13.4% of the patients. All of the patients with involvement in the form of increased echogenicity recovered without sequelae by the end of the first month. No progression to aneurysm was observed in any of the patients with dilatation. No new-onset involvement was observed in patients with previously healthy coronary arteries during the convalescent period. In addition, from the sixth month follow-up period, there was no worsening in the amount of dilatation in any of the patients. At least 94% of the patients who completed the 12th month control period returned to normal.

Effect of Piracetam and Iron Treatment on Heart Rate Variability in Patients With Breath-Holding Spell.

BACKGROUND: Breath-holding spells are a benign condition primarily seen in 3% to 5% of healthy children aged between six months and five years. Although no specific treatment is recommended due to its benign nature, iron and piracetam are used in severe or recurrent cases. We planned to compare the heart rate variability (HRV) before and after treatment with 24-hour Holter monitoring in patients receiving iron and piracetam treatment and investigate the treatment's effectiveness. METHODS: Twenty-five patients who applied to the outpatient clinic between 2013 and 2015 due to breath-holding spells were included in the study. The patients who received piracetam and iron therapy and underwent 24-hour rhythm Holter monitoring were evaluated retrospectively. RESULTS: Fourteen (56%) of these patients were evaluated as having cyanotic-type and 11 (44%) patients were assessed as having pale-type breath-holding spells. A significant difference was found only between hourly peak heart rate and total power in the group receiving iron treatment. Significant differences were also found among the minimum heart rate, mean heart rate, the standard deviation of RR intervals, the mean square root of the sum of the squares of their difference between adjacent RR intervals, spectpow, and low frequency before and after the treatment in the patients who started piracetam treatment (P < 0.05). CONCLUSIONS: Our study is critical as it is the first to investigate the effects of treatment options on various HRV in patients with breath-holding spells. There were statistically significant changes in HRV parameters in patients receiving piracetam, and the number of attacks decreased significantly. Piracetam treatment contributes positively to the breath-holding spell with regard to efficacy and HRV, therefore it can be used to treat breath-holding spells.

Fechamento transcateter de fístula de artéria coronária com dispositivo Amplatzer Piccolo™ / Transcatheter closure of coronary artery fistula with Amplatzer Piccolo™ device

As fístulas das artérias coronárias são anomalias congênitas raras e caracterizam uma comunicação anormal entre as artérias coronárias e as câmaras cardíacas ou grandes vasos. Muitos dispositivos que incluem vários coils, plugues vasculares, oclusores e stents recobertos têm sido usados no fechamento transcateter de fístulas de artérias coronárias. Neste relato, realizamos com sucesso o fechamento de uma fístula de artéria coronária, entre a artéria descendente anterior e o ápice do ventrículo direito, usando o dispositivo Amplatzer PiccoloTM, anteriormente chamado de tamanho adicional do AmplatzerTM Duct Occluder. Em nossa opinião, o dispositivo Amplatzer PiccoloTM é adequado para oclusão transcateter de fístula da artéria coronária, podendo ser usado no lugar de plugues vasculares.

Coronary artery fistulas are rare congenital anomalies and characterize an abnormal communication between coronary arteries and cardiac chambers or major arteries. Many devices, including various coils, vascular plugs, occluders, and cover stent, have been used in transcatheter closure of coronary artery fistulas. In this report we successfully closed coronary artery fistula, between left anterior descending artery and right ventricle apex, by using Amplatzer PiccoloTM device, formerly called as AmplatzerTM Duct Occluder additional size. In our opinion, Amplatzer PiccoloTM device is suitable for transcatheter occlusion of coronary artery fistula and can be used instead of vascular plugs.