Noncardiac comorbidities of congenital heart disease in children

Background: Noncardiac conditions may complicate heart disease care, contribute to the progression of the disease and alter the response to treatment. The aim of this prospective study was to evaluate the proportion of cardiac children with such significant conditions. Methods: Of the 1058 children with congenital heart disease primarily diagnosed during a 10-year-period in one hospital, we identified those patients who had significant congenital and acquired comorbidities. Results: Associated problems were diagnosed in 224 children (21.2%). Among them, 118 children (11.2%) had genetic or syndromic conditions, of which 38 had Trisomy 21. Six subspecialty areas accounted for the vast majority of the cases: neurology (n = 140), pulmonology (n = 36), orthopaedics (n = 26), nephro-urology (n = 19), gastroenterology (n = 14) and endocrinology (n = 13). The most frequent associated conditions were mental retardation, asthma, epilepsy and scoliosis. During the study period, death occurred in 46 of the children (4.3%) and was not related to the cardiac disease in 20 cases (1.9%). Conclusion: A substantial proportion of children with congenital heart disease have significant noncardiac comorbidities. Close collaboration between paediatric cardiologists and paediatricians of other subspecialties is imperative to optimize care for these children. © 2007 The Author(s).SCOPUS: ar.jFLWINinfo:eu-repo/semantics/publishe

Epidemiology of heart failure in a tertiary pediatric center

Background: In contrast to the adult age group, epidemiologic studies on heart failure (HF) in the pediatric population are lacking. The aim of this prospective study was to analyze the epidemiology of HF during infancy and childhood. Methods: Of the 1,196 children with congenital and acquired heart diseases, primarily diagnosed during a 10-y period in one hospital, we identified those patients who developed HF. Results: Within 10 y, 1,196 children with heart disease were indexed. Heart failure occurred in 124 of these patients (10.4%): 64 out of 1,031 children with congenital heart diseases (6.2%), 13 out of 96 children with rhythm or conduction disturbances (13.5%), 23 out of 39 children with acquired heart diseases (59.0%), and 24 out of 30 children with cardiomyopathies (80.0%). Heart failure occurred in 72 cases (58.1%) during the first year of life. The incidence in infancy was much more pronounced for congenital heart diseases than for other cardiac conditions. The mortality associated with HF and its cause was also lower for children with congenital heart disease (4.7%) than for the other cardiac conditions (8.7%, 23.0%, and 25.0%, for acquired heart diseases, rhythm disturbances, and cardiomyopathies, respectively). Conclusion: Clear differences exist between HF in infants and HF in children. Our study supports the observation that congenital heart disease is the most common causative factor of HF during infancy. Older children with HF are more likely to have acquired heart diseases, cardiomyopathies, and arrhythmias, and these conditions have a considerable mortality. © 2008 Wiley Periodicals, Inc.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Pericarditis as a rare complication of pneumococcal pneumonia in a young infant

Purulent pericarditis is an exceptionally rare complication of pneumococcal pneumonia in infants but a rapidly fatal disease if left untreated. A previously healthy 4-month-old boy presented at our emergency department with a 10-day history of fever and non-productive cough. No signs of heart failure or cardiac friction rub were evidenced. Chest radiography showed lobar pneumonia, right pleural effusion and cardiomegaly. Echocardiography revealed a massive pericardial effusion, and an emergency drainage was performed. Streptococcus pneumoniae grew up from purulent pericardial fluid and blood cultures. After intravenous antibiotherapy, the outcome was favourable. The introduction of the pneumococcal vaccine may favour an increase in the incidence of non-vaccine serotypes which most commonly cause empyaema and perhaps pericarditis. Therefore, pericarditis should always be considered a possible complication in patients with pneumococcal pneumonia and empyaema.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Rare form of protection against ventricular deconditioning in transposition of the great arteries

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Implantation of an Absorb bioresorbable vascular scaffold in the stenotic aortopulmonary collateral artery of a young child with Alagille syndrome

Stent implantation in children can be problematic due to the possibility of growth incapacity and difficulties during later surgery. For these reasons, bioresorbable stents may be a good alternative to conventional stents. We report our experience with implantation of an Absorb bioresorbable stent in the stenotic major aortopulmonary collateral artery (MAPCA) of a 1-year-old girl born with pulmonary atresia with ventricular septal defect.SCOPUS: ar.jFLWINinfo:eu-repo/semantics/publishe

Use of a new low profile Occlutech PLD device for closure of Fontan fenestrations

For some higher risk patients, fenestrations are still created in total cavopulmonary connection conduits completing the Fontan circulation for univentricular hearts. If these fenestrations remain patent and hemodynamics are favorable, they are closed to improve oxygenation and exercise tolerance and to decrease the risk of paradoxical emboli. Depending on the type of fenestration, different devices are used. Unfortunately, the search for the ideal device is still ongoing. We propose the first experience with the off-label use of the new Occlutech paravalvular leak device. This device offers the combination of a small delivery sheath size, high flexibility, less material, and a low profile. The low profile in particular could be an advantage in order to reduce the risk of thrombus formation in the low velocity flow environment of the Fontan circulation.SCOPUS: ar.jFLWINinfo:eu-repo/semantics/publishe

Diagnostic des cardiopathies congénitales.

Most of the relevant congenital heart defects are recognized by the neonatal clinical screening or even in utero by fetal echocardiographic screening. Nevertheless, a substantial percentage of defects are missed in the early screening and are diagnosed after discharge from hospital during childhood or even during adulthood. Often, this delay in making the correct diagnosis affects the overall outcome of the cardiac children. In almost all patients, cardiac findings are present that should have alerted the physician. This article reviews the importance of history and physical examination in the early diagnosis of congenital heart disease.SCOPUS: re.jinfo:eu-repo/semantics/publishe

First trimester fetal echocardiography: Where are we now?

The detailed study of the fetal cardiac anatomy in the first trimester of pregnancy by means of ultrasound is feasible whether using a transvaginal or a transabdominal approach. There is nowadays enough evidence that ultrasound in the first trimester of pregnancy is a safe procedure provided thermal and mechanical indices are taken into account. The best timing for successful imaging of the four chambers and great arteries in early gestation appears to be between around 13 to 14 weeks rather than 11 to 12 weeks. In experienced hands, first-trimester fetal echocardiography is quite sensitive for the detection of major structural cardiac abnormalities. Besides the nasal bone, markers for first trimester screening of chromosomal abnormalities such as nuchal translucency thickness, the flow in the ductus venosus and the flow through the tricuspid valve constitute also markers for cardiac abnormalities. The finding of an increased nuchal translucency, an abnormal flow in the ductus venosus or a tricuspid regurgitation constitutes an indication for more detailed fetal cardiac assessment. Other indication for a detailed cardiac assessment is the finding of an aberrant right subclavian artery and vascular anomalies. The emerging importance of these markers has caused renewed interest in the early study of the fetal heart.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Management of cardiac emergencies in children

Children with heart disease may present to the Emergency Department in many stages of life, with a range of cardiovascular manifestions, from minimally irritating palpitations to the life-threatening derangements of shock or lethal dysrhythmia. Cardiac emergencies are rare in children in comparison to adults. The pathophysiology differs: ischemic heart disease is virtually unknown, whereas most cases occur secondary to congenital heart disease. Their successful management requires an accurate diagnosis and timely interventions to achieve optimal outcomes in this heterogeneous and complex patient population. The diagnosis, however, is not always straightforward, as evidenced by the non-specific clinical picture that can be presented by pediatric heart diseases. This article reviews pertinent issues concerning diagnosis and management of cardiac disorders with which children present to the emergency department. The initial diagnostic and specific therapeutic approach to these patients will be discussed.SCOPUS: re.jinfo:eu-repo/semantics/publishe