Evaluation of serum nitrate levels in infants and children with congenital heart diseases

This study was carried out on 100 patients having congenital heart disease [CHO], 63 males and 37 females, their age ranged from 4 months to 12.5 years. In addition, 20 apparently healthy children were taken as a control group. This study was done at AI-Azhar University Hospital on patients attending the cardiology and pediatric cardiology outpatient clinic as well as children admitted to the inpatient department. The CHO patients were divided into groups according to: pulmonary artery systolic pressure [PASP] [normal PASP, mild, moderate or severe pulmonary hypertension], presence or absence of heart failure [HF]: [patients with or without heart failure], correction of the cardiac defect: [patients with or without surgical correction] and cyanosis [cyanotic or non-cyanotic CHO]. All patients were subjected to the following: full history taking, complete physical examination [general and cardiac], plain x-ray chest and heart, electrocardiography, echo cardiography and measurement of serum nitrate levels. Our results showed statistically significant differences in serum nitrate levels particulary between patients with severe pulmonary hypertension and those without and between patients with heart failure and those without. The levels were higher in the HF group compared to non-HF group and the control group. No statistically significant differences in serum nitrate levels were found between patients who previously underwent operations for correction of the cardiac defects and those who did not nor between cyanotic and non-cyanotic groups

Subclinical involvement of cardiovascular system in juvenile collagen diseases

Cardiovascular lesions are commonly found in children and adolescence with different collagen diseases with relevant implication in mortality and morbidity. The purpose of the study was to verify whether there is any sign of cardiovascular involvement in juvenile collagen diseases using electrocardiography [ECG] and echocardiography [ECHO]. The study was carried out on 77 patients, 52 juvenile idiopathic arthritis [JIA], 20 systemic lupus erythematosus [SLE], 3 spondylarthropathy [SPA] and 2 juvenile dermatomyositis [JDM]. They were free of any clinically evident of cardiac manifestations. Thirty six healthy children were enrolled as control group All subjects underwent complete history and physical examinations, x ray chest, ECG and two dimensional, M mode, continuous wave [CW], pulse wave [PW] and color flow Doppler examinations. The following investigations were done erythrocyte sedimentation. rate[ESR], antistreptolysin O titre [ASOT], C reactive protein[CRP], rheumatoid factor[RF], antinuclear antibodies[ANA] and anti double stranded DNA[anti ds DNA]. Minor ECG changes were detected in 3 SLE and 2 JDM. ECHO showed pericardial effusion in 2 [3.3%] JIA and 3[15%] SLE. Aortic insufficiency was detected in 5[9.6%] JIA, 4 [20%] SLE. Mitral regurge was found in 7[13.4%] JIA, 5 [25%] SLE. Mild tricuspid regurge was detected in 3[15%] SLE. Mild pulmonary hypertension was found in 4[20%] SLE. Significant systolic dysfunction was elicited in JIA in form of increased left ventricular end diastolic diameter [LVEDD], left ventricular end systolic diameter[LVESD], left ventricular end diastolic volume[LVEDV] and left ventricular end systolic volume[LVESV] and reduction of ejection fraction [EF] and fractional shortening [FS]. In SLE .there was significant reduction, of EF and FS. Significant diastolic dysfunction was manifested in JIA by decreased peak early [E], E acceleration time [Eat], E duration [Edur], Total duration [Tdur], [E/A] ratio and A acceleration time [Aat] and increased peak atrial filling velocity [A], E deceleration time [Edt], isovolumic relaxation time [IVRT] and A deceleration time [Adt] and in SLE by decreased [E] and [E/A] ratio and increased [Edt] and in JDM by decreased [E] and [E/A] ratio and increased [IVRT]. In JIA, there was a positive correlation between age and [LVEDD] and disease duration with both [LVEDD] and [LVESD] and negative correlation between disease duration and EF. Cardiovascular involvement in juvenile collagen diseases is common. Regular cardiac evaluation using [ECG] and [ECHO] is recommended for early diagnosis of cardiac involvement. Key words: Cardiovascular-juvenile-collagen diseases