Giant congenital coronary artery fistula to left superior vena cava and right atrium with compression of left pulmonary vein simulating cor triatriatum--diagnostic value of magnetic resonance imaging.

A 3-year-old girl with a continuous murmur on auscultation was found to have left coronary artery to right atrial fistula simulating cor triatriatum sinister on echocardiography. Coronary angiography of the patient was also insufficient to clarify the exact pathologic anatomy. Magnetic resonance imaging showed that the main drainage of the aneurysmal coronary artery was to the left superior vena cava, resulting in a diffuse arteriovenous fistula in the lower lobe of the left lung by compressing its pulmonary vein.

Congenital coronary arteriovenous fistula in a ten-year-old boy with angina pectoris.

Congenital arteriovenous fistula (CAVF) is a rare cardiac lesion. Angina pectoris is uncommon in younger patients with CAVF. Fistula-related symptoms, complications of this anomaly and surgical complications have a strong correlation with the age of the patient. A ten-year-old male patient with angina pectoris in whom the diagnosis of CAVF was established, and who, following surgical ligation recovered, is presented.

Pericardial mesothelioma. A pediatric case report.

A nine and a half year old boy was brought to the hospital because of a cough, dyspnea and mild fever. He was well-nourished and had an uneventful history. His chest X-ray and electrocardiographic findings suggested pericarditis but further examinations and an open pericardial biopsy revealed a mass histologically diagnosed as pericardial mesothelioma, a very rare tumor in this age group.

Transcatheter embolization of a residual congenital coronary arteriovenous fistula with a detachable balloon; superiority of interventional cardiology?

A ten-year-old girl who presented with a continuous murmur was diagnosed with a right coronary to right ventricular fistula with colored Doppler echocardiography and selective arteriography. She underwent traditional treatment-ligation of the fistula by sternotomy. Afterwards, the systolic component of the murmur persisted and repeat arteriography showed a residual shunt through the fistula, with no change in the diameter of the right coronary artery. We describe the first case in which a residual fistula was treated with a detachable balloon embolization.

Transcatheter closure of the ductus arteriosus in children and young adults.

Transcatheter occlusion of persistent patent ductus arteriosus (PDA) was attempted in 32 patients (22 female and 10 male, mean age 5.12 +/- 3.98 years, range 9 months to 19.2 years) using Rashkind's occluder device (USCI). Implantation of a second occluder device was attempted in three of the patients. Device embolization to a pulmonary artery occurred in three patients, all with the 12 mm occluder device; two of these devices were retrieved by grabber catheter and the last with thoracotomy without adverse sequelae. Embolization to the right atrium occurred in another patient during a second device implantation attempt because of fluoroscopy problems; this patient required open-heart surgery with sequala of 2 (+) tricuspid insufficiency. In another patient with a significant shunt after the implantation of a 17 mm occluder device, mechanical hemolysis developed, but surgical intervention was not required. The overall complication rate was five out of 35 implantation procedures (14.3%). Besides these, sublingual nifedipine was required for two patients whose systolic blood pressure exceeded 160 mmHg just after the implantation procedure. Sixteen 12 mm and fifteen 17 mm occluder devices were successfully and uneventfully implanted in the first procedure, except for two patients in whom a 17 mm occluder device was implanted after retrieval of an embolized 12 mm occluder. Overall early and mid-term complete occlusion was achieved in 24 patients (75%). Complete occlusion of PDA in the first days after the procedure was achieved in all patients, with the narrowest ductal diameter of less-than 3 mm with the 12 mm occluder device, and less than 6 mm with the 17 mm occluder device.(ABSTRACT TRUNCATED AT 250 WORDS)

A case with acute leukemia presenting with cardiac tamponade.

Pericardial effusions and cardiac tamponade are rare and severe complications of leukemia. They often develop during the radiation therapy, chemotherapy, or infections in the course of leukemia. However, some cases present with pericardial effusion and tamponade. We report a three-year-old girl who was admitted with cardiac tamponade and needed urgent pericardiocentesis. Clinical evaluation and laboratory results revealed myeloid markered-T cell acute lymphoblastic leukemia (ALL) and pericardial invasion. She is the youngest patient with cardiac tamponade who was diagnosed acute lymphoblastic leukemia in the English-language literature.

Cardiac extension of Wilms' tumor.

Two children who were brought to the Istanbul Children's Hospital with congestive heart failure caused by extension of Wilms' tumor to the right atrium are presented. In both cases a large mass was noted in the right atrium by two-dimensional echocardiography. The tumors were successfully removed at open heart surgery, and chemotherapy and radiotherapy were started postoperatively. The patients are both alive and symptom-free; one, three and a half years and the other two years postoperatively.

Late development of dissecting aneurysm following balloon angioplasty of native aortic coarctation.

Acute aortic dissection during balloon angioplasty for coarctation of the aorta or aneurysm formation during follow-up are well-known complications of this procedure. Dissecting aneurysm development during long-term follow-up after balloon angioplasty of a native coarctation has not been previously reported. We report a case in which a huge dissecting aneurysm developed 3 years after the native coarctation angioplasty procedure. The aneurysm required surgical repair.

Sublingual isosorbide dinitrate-stimulated tilt test for diagnosis of vasovagal syncope in children and adolescents.

Vasovagal syncope is the most likely cause of syncope in the young. Head-up tilt-table test (HUT) provides the ability to provoke vasovagal syncope under controlled laboratory settings. In adult populations, pharmacologic stimulation with intravenous/sublingual isosorbide dinitrate (ISDN) has been shown to be an alternative to isoproterenol for increasing the diagnostic yield of HUT. In this study, 40 patients aged 9-18 years with unexplained syncope and 12 healthy age-matched children were evaluated by HUT to 70 degrees for 45 minutes. If tilting alone did not induce symptoms (syncope and presyncope), 0.1 mg/kg ISDN was given while the patient lay supine. After 5 min, the table was tilted to 70 degrees for 15 min or until the symptoms occurred. The control group consisted of 12 healthy age-matched children studied in a similar manner. Six patients (15%) had a positive basal tilt test. Twenty-five patients (62.5%) lost consciousness following ISDN administration. In the control group, nobody had a syncopal episode during the basal tilt test. However, ISDN administration resulted in 1 positive response (8.3%). The sensitivity of the test was 77.5% and its specificity was 91.6%. It is concluded that sublingual nitroglycerin HUT is suitable for routine clinical practice in children and adolescents with unexplained syncope.

Continuous muscle fiber activity syndrome.

A 5.5 year old Turkish boy who suffered from progressive muscle stiffness was diagnosed as having continuous muscle fiber activity syndrome. Electromyography showed continuous motor neuron activity at rest and following intravenous injection of diazepam. Peripheral nerve block, spinal and general anesthesia diminished the spontaneous activities. The clinical and electrophysiological findings of our case were compared to the previously reported cases with emphasis on the heterogeneity of the syndrome.