Amiodarone-induced thyroid dysfunction in the developmental period: prenatally, in childhood, and adolescence — case reports and a review of the literature

Introduction: Amiodarone is an important antiarrhythmic drug used in paediatric practice, mainly in children with complex congenital cardiac diseases and/or severe arrhythmias. One of the side effects of amiodarone therapy is thyroid dysfunction, which is observed in about 20% of patients. The thyroid dysfunction may present with various forms: from subclinical changes in hormone levels to amiodaroneinduced thyrotoxicosis (AIT) and amiodarone-induced hypothyroidism (AIH). Material and methods: We reported six patients in the age range from two weeks to 14 years, with complex congenital cardiac diseases and severe arrhythmias, who developed amiodarone-induced thyroid dysfunctions: thyrotoxicosis or hypothyroidism or both together. The clinical signs and symptoms of all thyroid dysfunctions were atypical, most patients presented with an aggravation of heart insufficiency. Our patients with thyrotoxicosis were treated with combined therapy including thionamides and corticosteroids due to the presentation of mixed-identified type of AIT. Results: Currently, five patients (one patient’s status is unknown) are in biochemical and clinical euthyreosis; however, in one of them it was impossible to discharge amiodarone treatment. Three of them are still treated with levothyroxine, and two do not need thyroid treatment. Conclusions: Amiodarone-induced thyroid dysfunction is usually atypical; therefore, monitoring of thyroid status before, during, and after amiodarone is demanded. AIH could significantly influence the development of the child, while AIT could significantly deteriorate the clinical status of children with complex cardiac diseases. Early and proper diagnose of AIT and AIH allows the introduction of immediate and appropriate treatment considering the cardiac condition of the young patient

Hybrid, perventricular closure of muscular ventricular septal defects

Muscular ventricular septal defects (VSD) located below the trabecula saepto-marginalis are difficult to approach for surgical closure through the tricuspid valve. We present the hybrid technique of perventricular closure of VSD in 2- and 5-year old children with complex congenital heart defects, employing an Amplatzer septal occluder, dedicated to muscular type of VSD. The procedures were performed during cardiopulmonary bypass in one patient and on beating heart in the other one. The perventricular device technique may be the method of choice for closing hard to reach muscular VSD

Hybrydowe, przezkomorowe zamknięcie mięśniowych ubytków międzykomorowych

Muscular ventricular septal defects (VSD) located below the trabecula saepto-marginalis are difficult to approach for surgical closure through the tricuspid valve. We present the hybrid technique of perventricular closure of VSD in 2- and 5-year old children with complex congenital heart defects, employing an Amplatzer septal occluder, dedicated to muscular type of VSD. The procedures were performed during cardiopulmonary bypass in one patient and on beating heart in the other one. The perventricular device technique may be the method of choice for closing hard to reach muscular VSD.Muscular ventricular septal defects (VSD) located below the trabecula saepto-marginalis are difficult to approach for surgical closure through the tricuspid valve. We present the hybrid technique of perventricular closure of VSD in 2- and 5-year old children with complex congenital heart defects, employing an Amplatzer septal occluder, dedicated to muscular type of VSD. The procedures were performed during cardiopulmonary bypass in one patient and on beating heart in the other one. The perventricular device technique may be the method of choice for closing hard to reach muscular VSD

Oxidative stress biomarkers and left ventricular hypertrophy in children with chronic kidney disease

Cardiovascular diseases remain the most frequent cause of morbidity and mortality in patients with chronic kidney disease (CKD). The aim of the study was to assess the association between oxidative stress biomarkers and cardiovascular risk factors and left ventricular hypertrophy in children with CKD. Material and Methods. The studied group consisted of 65 patients aged 1.4–18.6 (mean 11.2) years with stages 1 to 5 CKD. Serum oxidized low-density lipoprotein (oxLDL), protein carbonyl group, creatinine, cystatin C, albumin, lipids, high-sensitivity C-reactive protein, intercellular adhesion molecule-1, insulin, plasma renin activity, and aldosterone levels were measured. Patients were divided into groups depending on CKD stage. Anthropometric measurements, ambulatory blood pressure (BP) measurements, and echocardiography with left ventricular mass (LVM) calculation were performed. Results. Serum oxLDL strongly correlated with creatinine (R=0.246; p=0.048), cystatin C (R=0.346; p=0.006), total cholesterol (R=0.500; p<0.001), triglycerides (R=0.524; p<0.001), low-density lipoprotein concentrations (R=0.456; p<0.001), and 24 hour BP values of systolic (R=0.492; p=0.002), diastolic (R=0.515; p<0.001), and mean arterial pressure (R=0.537; p<0.001). A significant correlation between oxLDL levels and LVM z-scores (R=0.299; p=0.016) was found. Conclusions. Hypertension and dyslipidemia correlated with lipid oxidation in children with CKD. oxLDLs seem to be valuable markers of oxidative stress in CKD patients, correlating with left ventricular hypertrophy

Origin of right pulmonary artery branch from descending aorta : case report of the successful treatment

This report describes an extremely rare case involving anomalous origin of part of the right pulmonary branch from the thoracic aorta in a 3 month-old boy and its successful repai

Nieprawidłowe odejście gałęzi prawej tętnicy płucnej od aorty zstępującej. Opis pomyślnego przebiegu leczenia

This report describes an extremely rare case involving anomalous origin of part of the right pulmonary branch from the thoracic aorta in a 3 month-old boy and its successful repair.This report describes an extremely rare case involving anomalous origin of part of the right pulmonary branch from the thoracic aorta in a 3 month-old boy and its successful repair