Catecholaminergic Polymorphic Ventricular Tachycardia in Chinese Children

Free Paper Session: Paediatric Cardiology IIpublished_or_final_versio

The evolved management of neonates with major congenital heart disease

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Clinical and genetic profile of catecholaminergic polymorphic ventricular tachycardia in Hong Kong Chinese children

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Posterior Reversible Encephalopathy Syndrome: paediatric heart transplant with cyclosporine neurotoxicity

Posters: no. P8Posterior reversible encephalopathy syndrome (PRES) is associated with a specific disorder of cerebrovascular autoregulation. Clinical features of PRES consisted of headache, decreased consciousness, altered mental functioning, seizures, visual loss or cortical blindness. Characteristic findings on neuroimaging included high signal intensity on T2-weighted as well as diffusion-weighted imaging MRI in the posterior cerebral hemispheres, indicative of vasogenic subcortical oedema without infarction. Cyclosporine neurotoxicity had been described following bone marrow and organ transplantation; however, there are few reports of PRES in children especially post-paediatric heart transplantation. We report a case of cyclosporine-related PRES in a paediatric heart transplant recipient. She made a good recovery with no residual neurological deficits after withdrawal of cyclosporine, control of possible risk factors as well as symptomatic control of seizure.published_or_final_versionThe 1st Hong Kong Neurological Congress cum 22nd Annual Scientific Meeting of the Hong Kong Neurological Society, Hong Kong, 6-8 November 2009. In Hong Kong Medical Journal, 2009, v. 15 n. 6, suppl. 7, p. 42, abstract P

Evolving management for critical pulmonary stenosis in neonates and young infants

Over the years, management of critical pulmonary stenosis in young infants has evolved from surgical reconstruction of the right ventricular outflow tract and closed pulmonary valvotomy to transcatheter balloon valvoplasty. Our study aimed at evaluating how the changing policy for management had affected the immediate and long term outcomes of babies with this cardiac lesion. Interventions were made in 34 infants at a median age of 8.5 days (2-90 days). Reconstruction of the right ventricular outflow tract reconstruction was performed in 10 patients, closed pulmonary valvotomy in 13, and balloon valvoplasty in 11. Initial procedure-related mortality was 50%, 15% and 0% respectively. Multivariate analysis revealed transannular patching of the right ventricular outflow tract, and male sex, to be significant factors for death. For the 27 survivors, the ratio of right ventricular to systemic systolic pressure decreased from 1.6 ± 0.3 to 0.3 ± 0.2 after reconstruction of the outflow tract, 1.8 ± 0.5 to 0.8 ± 0.4 after closed valvotomy, and 1.8 ± 0.6 to 0.9 ± 0.3 after balloon valvoplasty. The decrease was significantly greater after patch reconstruction (p=0.025) that required no further reinterventions. The overall rate of reintervention for the survivors was 37% (10/27). The freedom from reintervention after closed valvotomy was 82%, 64% and 51% at 1, 5 and 10 years respectively. The figure remained at 78% at both 1 and 5 years (p=0.66) after balloon valvoplasty. The higher reintervention rate for closed valvotomy corresponded to the significantly greater residual gradient across the pulmonary valve noted on follow-up (p=0.01). Reinterventions included balloon dilation (n=6), reconstruction of the outflow tract (n=4), and 1 each of ligation of an arterial duct and systemic-pulmonary arterial shunting. The risk factor for reintervention was a hypoplastic right ventricle. In conclusion, transcatheter balloon valvoplasty appears to be the optimum initial approach in view of its low mortality, efficacy at relieving the obstruction, and low rate of reintervention. © Greenwich Medical Media Ltd.published_or_final_versio

Quinidine for Brugada syndrome: Panacea or poison?

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The role of transesophageal echocardiography in the diagnosis and management of children and young adults with valvar diseases of the left heart

Summary The role of transesophageal echocardiography in the diagnosis and management of left-sided cardiac valvar disease in children and young adults was assessed in terms of whether additional information (over transthoracic echocardiography) could be obtained, and whether the added information contributed to the better management of the patients. Between January 1991 to August 1992, 27 consecutive patients were studied. Their age ranged from 2.5 to 20 years (mean 12.7), with body weights ranging between 12 and 60 kg (mean 35.6). Twelve of the children suffered from atrioventricular valvar disease, 13 had predominant aortic valvar lesions and two had mixed valvar pathologies. Additional information was obtained by transesophageal over that of transthoracic echocardiography in 18 children (67%). Transesophageal echocardiography clarified the etiologies or mechanism of valvar regurgitation in eight and seven children with atrioventricular and aortic pathologies, respectively. The technique correctly diagnosed severe mitral regurgitation underestimated by conventional technique, detected a missed eccentric aortic regurgitant jet and convincingly excluded bacterial vegetations in one case each. The investigation contributed to the better management of three children (11%) by providing information that allowed the appropriate choice of therapy. Transesophageal echocardiography, therefore, is a useful technique for the diagnosis and management of valvar disease of the left heart in children and young adults.published_or_final_versio

Bleeding in early pregnancy

This article exists in Singapore edition and Hong Kong editionVaginal bleeding commonly occurs in pregnancy. More than 20% of pregnant women with successful deliveries experienced vaginal bleeding during the antenatal course. Two of the most important differential diagnoses for patients presenting because of bleeding in early pregnancy are miscarriage and ectopic pregnancy. This article reviews causes and management of bleeding in early pregnancy.published_or_final_versio

Optimising antimicrobial prescription in hospitals by introducing an antimicrobial stewardship programme in Hong Kong: Consensus statement

Objective. To discuss the implementation of an 'antimicrobial stewardship programme' as a means to improve the quality of antimicrobial use in a hospital setting in Hong Kong. Participants. Consensus working group on 'antimicrobial stewardship programme', The Scientific Committee on Infection Control, Centre for Health Protection, Department of Health, comprised 11 experts. The remit of the working group was to discuss the rationale and requirement for optimising antimicrobial prescriptions in hospitals by the introduction of an 'antimicrobial stewardship programme'. Evidence. PubMed articles, national and international guidelines, and abstracts of international meetings published between January 2000 and December 2004 on programmes for improving the use of antimicrobials in hospitals. Only English medical literature was reviewed. Consensus process. Data search was performed independently by three members of the working group. They met on three occasions before the meeting to discuss all collected articles. A final draft was circulated to the working group before a meeting on 3 January 2005. Five commonly asked questions about an 'antimicrobial stewardship programme' were selected for discussion by the participants. Published information on the rationale, components, outcome measures, advantages, and disadvantages of the programme was reviewed. Recent unpublished data from local studies of an 'antimicrobial stewardship programme' were also discussed. The timing, potential problems, and practical issues involved in the implementation of an 'antimicrobial stewardship programme' in Hong Kong were then considered. The consensus statement was circulated to and approved by all participants. Conclusion. The continuous indiscriminate and excessive use of antimicrobial agents promotes the emergence of antibiotic-resistant organisms. Antimicrobial resistance substantially raises already-rising health care costs and increases patient morbidity and mortality. Pattern of prescriptions in hospitals can be improved through the implementation of an 'antimicrobial stewardship programme'. A 'universal' and 'continuous' 'antimicrobial stewardship programme' should now be established in Hong Kong hospitals.published_or_final_versio