Pediatric cardiology
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Pediatric cardiology · Jul 2010
Myocardial performance in asphyxiated full-term infants assessed by Doppler tissue imaging.
The aim of this study was to assess myocardial performance of full-term infants with perinatal asphyxia using Doppler tissue imaging (DTI) and to correlate it with serum cardiac troponin T (cTnT) concentrations. Twenty-five asphyxiated and 20 nonasphyxiated term infants were investigated. Serum cTnT concentrations were measured between 12 and 24 h of life. ⋯ Mitral and tricuspid systolic (Sm) velocities were significantly lower in asphyxiated neonates (mean +/- SD: 5.06 +/- 0.89 vs. 6.89 +/- 0.94 cm/s, P < 0.001 and 5.78 +/- 0.58 vs. 6.69 +/- 0.87 cm/s, P < 0.001, respectively). cTnT concentrations were significantly higher in asphyxiated neonates [median (range): 0.17 (0.05-0.23) vs. 0.03 (0-0.07) microg/l, P < 0.001)], and they correlated positively with the LV Tei index (r = 0.67, P < 0.001) and the RV Tei index (r = 0.68, P < 0.001) and negatively with the mitral systolic (Sm) velocity (r = -0.68, P < 0.001) and tricuspid systolic (Sm) velocity (r = -0.41, P = 0.01). A higher cTnT was a significant predictor of mortality, whereas fractional shortening (FS) and DTI measurements did not show any significant predictive value. The DTI technique appears to be more sensitive than conventional echocardiography in the early detection of myocardial dysfunction induced by perinatal asphyxia in full-term infants.
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Pediatric cardiology · Jul 2010
Outcome predictors of pediatric extracorporeal cardiopulmonary resuscitation.
Extracorporeal cardiopulmonary resuscitation (ECPR) allows clinicians to potentially rescue pediatric patients unresponsive to traditional cardiopulmonary resuscitation (CPR). Clinical and laboratory variables predictive of survival to hospital discharge are beginning to emerge. In this retrospective, historical cohort case series, clinical, and laboratory data from 31 pediatric patients (<21 years of age) receiving ECPR from March 2000 to April 2006 at our university-affiliated, tertiary-care children's hospital were statistically analyzed in an attempt to identify variables predictive of survival to hospital discharge. ⋯ A classification tree analysis, using, in part, a pre-ECPR phosphorus concentration threshold and a CPR ABG base excess concentration threshold, yielded a 96% nominal accuracy of predicting survival to hospital discharge or death. A large, multicenter, prospective cohort study aimed at validating these predictive variables is needed to guide appropriate ECPR patient selection. This study reveals the potential survival benefit of ECPR for pediatric patients, regardless of CPR duration prior to ECPR cannulation.
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Pediatric cardiology · Jul 2010
Case ReportsMyopericarditis associated with varicella zoster virus infection.
Acute myopericarditis is a major cause of acquired heart disease worldwide in pediatric patients. Various viruses have been reported as the etiology, of which varicella zoster virus was first reported in 1953. However, since nationwide administration of the varicella vaccine, reports of varicella-associated myopericaridits have become sporadic. ⋯ Intravenous acyclovir effectively controlled the progression of the disease, and both clinical symptoms and electrocardiographic changes subsided soon after the use of an antiviral agent. Varicella zoster virus serum IgM antibody also showed positive test results. On the following visit, the patient's myocardial function had fully recovered from this episode.