PROGRESS IN PEDIATRIC CARDIOLOGY最新文献

Background

Black widow spider (BWS) bites account for 0.5 % of global poisonings and 21 % of poisonings in North-East Iran. In addition to local reactions, systemic cardiovascular manifestations are likely to occur.

Objective

This study aims to present cases of patients who experienced cardiac symptoms after being envenomed by BWS.

Methods

A descriptive retrospective cross-sectional evaluation was conducted on all patients who were bitten by a BWS in 2020 and presented with cardiac manifestations. They were referred to our tertiary pediatric cardiology center in Mashhad, Iran for evaluation. All accessible variables including history, physical examination, laboratory tests prioritizing cardiology, as well as electrocardiography and echocardiography findings, were evaluated.

Result

Six patients, ranging in age from 5.5 to 13 years old, were bitten by BWS. None of the patients had a past or drug history and were admitted due to pain complaints at various bite sites that radiated in different directions. Four patients showed signs of tachycardia, and two showed hypertension, but no signs of infection were observed. Half of the patients experienced systemic complications. Upon arrival at the hospital, four patients showed elevated CKMB levels, which decreased during their hospitalization. Troponin I and N-Terminal Pro B-type Natriuretic Peptide levels were high in all patients. One patient with unstable hemodynamics showed pro-BNP over 35,000. T wave inversion was observed in six patients, ST segment depression in three patients, and ST-segment elevation in one patient, with overlap between them.

Conclusion

Taking notice of cardiovascular presentations after a BWS bite is considerable.

Background

Beta-2 agonists are the standard of care for asthmatic patients. Racemic albuterol and levalbuterol are two of the most commonly used bronchodilators in this category. Although their efficacy has been tested excessively, their effects on heart rate remain debatable in the medical literature.

Aim of review

This review aims to summarize all available data in the literature concerning the effects of Racemic Albuterol versus Levalbuterol on heart rate in asthmatic children.

Key scientific concepts of review

Our search covered five different databases: PubMed, SCOPUS, Wiley Online Library, Web of Science, and Cochrane Library. We included clinical trials investigating heart rate in asthmatic pediatric patients, either as a primary or secondary outcome. The primary outcome was heart rate changes. Secondary outcomes were respiratory rate, FEV1 peak percent changes, potassium serum levels, SpO2 peak changes, asthma score, and adverse effects. Eight clinical trials were included; seven of them were eligible for meta-analysis. In a dosing ratio of levalbuterol: albuterol =1:4, levalbuterol showed better outcomes on heart rate changes when compared with racemic albuterol (mean difference = −5.97, p = 0.02). However, this difference was dose-dependent as it vanished with equivalent dosing of levalbuterol: albuterol = 1:2. Levalbuterol also had a better effect on FEV1 changes (mean difference = 3.72, p = 0.003). However, there was no statistically significant difference between the two drugs regarding changes in respiratory rate, SpO2, asthma score, or adverse effects. In conclusion, levalbuterol and racemic albuterol have almost the same effect on heart rate in asthmatic children when they are used in equivalent dosing.

A 15-month-old infant was diagnosed with massive pericardial effusion with hemodynamic compromise. A percutaneous pericardiocentesis was performed to evacuate the fluid, revealing purulent content. Pericardial fluid cultures showed Streptococcus pneumoniae, so she was treated with intravenous Cefotaxime during 4 weeks. The patient's hemodynamic situation improved following the evacuation, but 72 h later, there was a deterioration in the cardiac function related to the reappearance of the effusion and the presence of fibrin tracts. Intrapericardial fibrinolysis with rt-PA was performed using the initial pericardial drain, resulting in the evacuation of purulent content and, subsequently, serosanguineous fluid. The patient remained stable after fibrinolysis without recurrence of the effusion, and surgical pericardiectomy was not necessary.

Background

The serial follow-up of Fontan-associated liver disease is challenging, as laboratory values are frequently normal, especially with mild to moderate liver disease.

Objective

We investigated a composite index's correlation with hepatic biopsy total fibrosis scores in extracardiac Fontan patients.

Methods

We identified extracardiac Fontan patients undergoing cardiac catheterization and transvenous hepatic biopsies between June 2013 and September 2023 and liver shear wave elastography between January 2017 and July 2023. We developed a composite index from the following: 1) elastography values, 2) sex, 3) history of a neonatal aortopulmonary shunt for pulmonary flow obstruction, 4) pacemaker, 5) Fontan duration, 6) bilirubin values, 7) univentricular dysfunction, 8) atrioventricular valvar regurgitation, 9) mean Fontan pressures, and 10) venovenous collaterals presence. We correlated the index with hepatic total fibrosis scores (0–8), the sum of pathology grading (0 to 4) performed for sinusoidal and portal fibrosis. We defined a hepatic total fibrosis score of 0–3 as none to mild and 4–8 as moderate to severe fibrosis.

Results

We identified 62 patients who underwent 92 transvenous liver biopsies, with 30 patients undergoing 2 biopsies. The average age at biopsy was 15 ± 2 years. We found a strong correlation (rho = 0.8, p = .00001) between liver total fibrosis scores and composite index values. A receiver operating characteristic analysis demonstrated that an index cut-off value of ≥26 predicted a total fibrosis score of ≥4 with a sensitivity of 71 % and a specificity of 75 % (AUC = 0.73, 95 % CI 0.63, 0.83, p = .0001).

Conclusions

We developed a composite index with a moderate predictive ability to discriminate none to mild from moderate to severe hepatic fibrosis. Nevertheless, additional data is needed to assist further validation and determine its clinical utility in the serial follow-up of Fontan associated liver disease.

Background

Young adults with congenital heart disease (CHD) are more likely to exhibit executive dysfunction and maladaptive coping yet are less likely to get diagnosed than the general population for psychiatric disorders. The etiology of psychiatric diagnosis is inconclusive amongst CHD populations, and more research is needed to evaluate risk factors contributing to psychiatric disorders, including executive function, coping mechanisms, anxiety, depression, fatigue and sleep disorders, parental style/involvement, and sense of coherence.

Objectives

The study proposed to demonstrate the presence of risk for psychiatric diagnoses amongst young adults with CHD and evaluate factors contributing to mental health and executive dysfunction comorbidities.

Methods

We used a mixed methods study of quantitative scales and a guided interview on a cohort of 11 young adults (18–24) with CHD who are considered in the American Heart Association high-risk group for developmental disorders or disabilities. We assessed for risk of anxiety and depression, maladaptive and disengagement coping, executive dysfunction, and other factors associated with mental health using the Reponses to Stress (RSQ), Patient Reported Outcomes Measurement Information System (PROMIS), and the Amsterdam Executive Function Inventory (AEFI) scales. Qualitative interviews focused on experiences living with CHD, social and family support, and executive functioning skills.

Results

Our mean participant age was 20 years, and 36 % had some college education. PROMIS scoring showed increased risk for poor physical function (mean r = 31.8), anxiety (mean r = 64.9), depression (mean r = 66.8), and pain interference (mean r = 66.6). AEFI results also showed poor executive functioning skills, particularly in Self-Control/Self-Monitoring (mean 18.1) and Planning and Initiative (mean 5.3). 27 % of participants had medical record documentation of depression. Interviews showed participants overinflated sense of coherence and poor executive functioning, leading to two main themes: 1) perceptions of their disability, including denial of their CHD diagnosis and disengagement with mental health needs, and 2) challenges in transition care.

Conclusions

Our study indicates a need for larger scale interventions for psychological young adults with CHD as part of the transition process to adult care.

Background

Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart defects and typically requires intracardiac repair to correct cardiac anomalies. Postoperative TOF patients have compromised exercise capacity, which tends to decline over time. We assessed cardiopulmonary function using serial exercise testing and echocardiographic findings from childhood to adolescence in patients with repaired TOF.

Methods

This was a retrospective study. We recruited children with TOF who underwent at least two treadmill cardiopulmonary exercise tests (CPET) (with >1-year interval between the tests) between 2005 and 2022. Serial echocardiography results were evaluated to compare long-term changes in ejection fraction and pulmonary arterial pulse wave velocity. Healthy controls who underwent serial CPETs with intervals >1 year were also recruited.

Results

A total of 86 participants and 86 age-, sex-, and body mass index-matched healthy peers were identified. Significant decreases were observed in the CPET parameters between the initial and final CPETs, including peak VO₂% (p < 0.001), peak MET (p = 0.027), peak heart rate (p = 0.009), and MET at AT (p = 0.001). In comparison to the control group, the patient group exhibited inferior aerobic capacity in the initial CPET, characterized by smaller peak MET (p = 0.049), peak VO₂ (p = 0.001), and peak VO₂% (p < 0.001). Furthermore, a notable decline in exercise capacity was noted in the patient group during the follow-up. No significant differences were observed between the serial ejection fraction and pulmonary arterial pulse wave velocity.

Conclusions

Patients with repaired TOF had inferior exercise capacities to their healthy peers, and the peak exercise load capacities tended to decline over time. However, they were safe to engage in exercise training since the CPET results exceeded the standard for moderate-to-vigorous physical activity.

Background

Some children with congenital heart disease (CHD) are at risk of poorer neuro-developmental outcomes. Developmental delays are often subtle, requiring formal evaluation using valid, reliable, and responsive assessments to identify those children with congenital heart disease at risk.

Objectives

This was a service improvement activity that aimed to assess the feasibility of screening children with CHD within current resources, establish the number of infants and young children with CHD over a 12-month period identified with gross motor delay and requiring ongoing physiotherapy intervention, and developing a care pathway to assess and triage for physiotherapy intervention within current available resources.

Methods

This was a health service implementation project. A care-pathway designed to identify, assess, and triage to treatment of children with CHD and at risk of developmental delays was developed by nursing and physiotherapy and trialed for a 12-month period. Outcomes included identification of children at risk using validated screening assessments and the feasibility to implement the care pathway within current resources.

Results

The care-pathway was able to be implemented effectively. Eight nine children were eligible for screening for risk of development concerns. Of those, 69 (88 %) accepted and attended appointments. Fifty-two percent of the children screened required ongoing physiotherapy input.

Conclusion

More than half the children screened required follow-up, confirming the need for the care pathway. The care pathway was efficient, enabling the service to be implemented with current resources. Establishing pathway processes to engage families who declined or did not attend a screening assessment is required.

Background

During the peak of the COVID pandemic, there was a high degree of awareness around myocarditis as a potential manifestation. However, it is not very clear if hospitalizations related to myocarditis increased pre- and during the COVID era and if there was an impact on outcomes of the same.

Objectives

The objective of this study was to assess the epidemiology of hospitalizations for pediatric myocarditis between 2019 and 2022 (COVID era) compared to the prior era. An additional objective was to assess the outcomes for COVID and non-COVID myocarditis for hospitalized patients.

Methods

PHIS database was utilized to identify patients diagnosed with myocarditis from 2006 to 2022 using appropriate diagnostic codes. To assess and compare the outcomes, such as in-hospital mortality, ICU hospitalization, and length of stay (LOS), mixed model multivariable logistic regression analysis was performed.

Results

A total of 5084 patients were diagnosed with myocarditis from 2006 to 2022. The incidence of myocarditis patients increased significantly from 4.23 % in 2006 to 15.2 % in 2021 (p < 0.001). Specifically, during the post-COVID era from 2020 to 2022, the incidence of myocarditis (n = 1298, 28.7 %) increased significantly. Out of which, one-third (n = 366, 28.1 %) of the patients were also diagnosed with COVID-19. Patients having COVID-19 along with myocarditis had two times (OR: 2.13 (95 % CI: 1.55–2.92), and patients utilizing mechanical ventilation had 13 times higher odds of ICU hospitalization. In contrast, patients visiting ED had 35 % lower odds of ICU hospitalization. Although patients diagnosed with COVID and myocarditis are twice as likely to be hospitalized in the ICU, there were comparable rates of discharge mortality between COVID era and non-COVID era among pediatric myocarditis cases.

Conclusion

Despite the increase in the incidences of myocarditis patients and increased hospitalizations during post-COVID era, rates of mortality among these patients were comparable.

Background

Altered biological and environmental factors have been linked to the development of pulmonary vascular remodeling in pulmonary arterial hypertension (PAH) pathogenesis.

Objectives

We determined the association between prognostic biomarkers and clinical parameters of pulmonary arterial hypertension (PAH) in adult Atrial Septal Defect (ASD) patients with right heart failure who were treated with sildenafil and beraprost combination therapy.

Methods

We conducted an observational study using a cross-sectional design and examined the correlation between prognostic biomarkers (superoxide dismutase (SOD) and Platelet-derived growth factor-BB (PDGF-BB)) and clinical parameters (6 minute walking distance (6MWD) and echocardiography parameters (tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP)) in 41 adult patients with ASD diagnosed as pre-capillary pulmonary hypertension (WHO group 1) who were treated at the congenital outpatient clinic at Dr. Soetomo General Hospital Surabaya, Indonesia from October 1st to November 30th 2022. A Pearson correlation test was used to determine the correlation between normal distribution variables. Statistical analyses were done using SPSS software.

Results

The results indicated a moderately negative relationship between PDGF-BB and 6MWD (Pearson, r = −0.320, p = 0.041) and a medium significantly negative relationship between PDGF-BB and TAPSE/PASP (Pearson, r = −0.347, p = 0.026).

Conclusions

Lower circulating PDGF-BB is associated with better functional capacity and echocardiographic parameters in adult ASD-PAH patients receiving sildenafil and beraprost combination therapy. PDGF-BB may strongly be used as a treatment progress monitoring and prognostic biomarker.

Background

Echocardiography plays a pivotal role in assessing pediatric heart conditions, necessitating tailored reference parameters considering age, body size, gender, and ethnicity. Existing standards often lack representation for diverse populations like Uzbek children, requiring region-specific echocardiographic references.

Objectives

This study aimed to establish echocardiographic Z-score nomograms specifically designed for healthy Uzbek children, filling a crucial gap in reference values for cardiovascular measurements in this demographic.

Methods

A cohort of 246 healthy Uzbek children aged 4 days to 11 years (with body surface area from 0.2 to 1.0 m²) underwent echocardiographic assessments. Various regression models were applied to measured parameters to determine the best fit, ensuring comprehensive coverage of cardiovascular structures. The study adhered to strict inclusion and exclusion criteria to ensure data integrity.

Results

The study presented 23 Z-score nomograms based on body surface area, offering an improved approach for interpreting echocardiographic measurements in Uzbek children. Different regression models were employed, showcasing variations in optimal models for specific cardiac structures. These norms highlight potential disparities compared to international standards, emphasizing the need for region-specific reference values.

Conclusion

The established Z-score nomograms serve as a foundational tool for precise assessment and diagnosis of cardiac health in Uzbek children, potentially benefiting broader Central Asian populations. However, further validation and exploration of additional parameters are recommended to enhance their applicability and clinical significance.