Impact of fetal diagnosis of congenital heart disease on parents / 소아과

PURPOSE: This study was performed to assess how a fetal diagnosis of congenital heart disease affects parents, as regards pregnancy management and care of infants after birth. METHODS: Database search to find out abnormal fetal echocardiography performed at Seoul National University Children's Hospital from July 1988 to June 2003 revealed 370 examinations. After excluding both arrhythmias without structural cardiac disease and multiple pregnancies, 299 pregnancies remained and this data formed the basis of this analysis. We retrospectively reviewed the medical records with special attention to pregnancy outcomes and also tried to find out factors influencing parental decisions on whether to continue or terminate pregnancy. RESULTS: In this study, the mean gestation age at diagnosis was 28+/-6.0 weeks. The mean age of mothers was 30+/-3.9 years old. Younger gestational ages at diagnosis(P=0.000), more severe grades of fetal heart disease(P=0.002) and younger mothers(P=0.014) correlated with terminations of pregnanies. But the grades of fetal status, the grades of associated anomaly, whether in-vitro-fertilization was carried out or not and numbers of previous children were not significant. CONCLUSION: This study found that the earlier gestational ages at diagnosis, younger maternal age and higher grades of fetal heart disease tended to lead parent to select abortions. Fetal echocardiographies were performed too late. Moreover Koreans have a biased view that malformation is a something incurable and a tragedy not only to oneself, but also to a family. So parents select terminations of pregnancy, even in curable cases. This is very unethical.

Changes of Interleukin-10 and Granulocyte Colony-Stimulating Factor in Cerebrospinal Fluid of Children with Aseptic Meningitis

PURPOSE: Interleukin(IL)-10 is an antiinflammatory cytokine produced by monocytes/macrophages. Granulocyte colony-stimulating factor(G-CSF) plays an important role, not only as a hemopoietic factor but also as a regulating factor for a biologic defense system by neutrophils, in the foci of infection. We studied G-CSF and IL-10 levels in the serum and cerebrospinal fluid(CSF) of patients with aseptic meningitis and investigated the relationship of G-CSF and IL-10 with other inflammatory cells. METHODS: We measured IL-10 and G-CSF levels in the serum and CSF of children with or without aseptic meningitis using ELISA and compared them with other inflammatory cells in the CSF. RESULTS: CSF levels of IL-10 & G-CSF on admission were significantly higher in the aseptic meningitis group than in the control group. IL-10 and G-CSF levels in the CSF were higher than those in the serum(P<0.001). Mean CSF IL-10 & G-CSF levels during the recovery stage decreased significantly compared to those of the symptomatic stage(P<0.001). Significant correlations were found between CSF IL-10 levels and mononuclear cell counts(r=0.26, P<0.05), and between G-CSF levels and neutrophil counts in the CSF(r=0.44, P<0.005). CSF levels of G-CSF were highest on the 1st day of the illness, although CSF IL-10 levels reached its peak on the 3rd day of the illness. CONCLUSION: IL-10 and G-CSF are produced in the CSF of patients with aseptic meningitis and may play an immunoregulatory role by recruiting inflammatory cells from the peripheral blood at the initial stage of aseptic meningitis.

Changes of Interleukin-10 and Granulocyte Colony-Stimulating Factor in Cerebrospinal Fluid of Children with Aseptic Meningitis

PURPOSE: Interleukin(IL)-10 is an antiinflammatory cytokine produced by monocytes/macrophages. Granulocyte colony-stimulating factor(G-CSF) plays an important role, not only as a hemopoietic factor but also as a regulating factor for a biologic defense system by neutrophils, in the foci of infection. We studied G-CSF and IL-10 levels in the serum and cerebrospinal fluid(CSF) of patients with aseptic meningitis and investigated the relationship of G-CSF and IL-10 with other inflammatory cells. METHODS: We measured IL-10 and G-CSF levels in the serum and CSF of children with or without aseptic meningitis using ELISA and compared them with other inflammatory cells in the CSF. RESULTS: CSF levels of IL-10 & G-CSF on admission were significantly higher in the aseptic meningitis group than in the control group. IL-10 and G-CSF levels in the CSF were higher than those in the serum(P<0.001). Mean CSF IL-10 & G-CSF levels during the recovery stage decreased significantly compared to those of the symptomatic stage(P<0.001). Significant correlations were found between CSF IL-10 levels and mononuclear cell counts(r=0.26, P<0.05), and between G-CSF levels and neutrophil counts in the CSF(r=0.44, P<0.005). CSF levels of G-CSF were highest on the 1st day of the illness, although CSF IL-10 levels reached its peak on the 3rd day of the illness. CONCLUSION: IL-10 and G-CSF are produced in the CSF of patients with aseptic meningitis and may play an immunoregulatory role by recruiting inflammatory cells from the peripheral blood at the initial stage of aseptic meningitis.

Midterm Follow-up of Children with Corrected Transposition of the Great Arteries

BACKGROUND AND OBJECTIVES: Corrected transposition of the great arteries (C-TGA) is a rare congenital heart disease, of which prognosis depends on the associated cardiac defects, systemic ventricular function, competency of atrioventricular valves, and the presence of conduction disturbances. This study was aimed to assess the midterm follow-up status of C-TGA. PATIENTS AND METHODS: Retrospective review was performed on 89 cases with C-TGA and two ventricles of adequate size, which were diagnosed between January 1980 and June 1997. RESULTS: Study subjects consisted of 56 males and 33 females (average age at diagnosis, 9 months). Mean follow-up duration was 98 months (range, 2 months - 23 years 8 months). Based on the associated cardiac anomalies, there were 6 simple C-TGA and 83 complex C-TGA patients. Surgery including 19 palliative and 47 corrective operations was attempted on 61 cases at mean age of 69 months. Tricuspid regurgitation (TR) was noted at the time of first examination in 52 (mild in 39; moderate in 8; severe in 5) and progressed in 18 patients. TVR was done on 5 patients and double switch on 7 patients. Arrhythmia was noted preoperatively (complete AV block in 3) in 11 and postoperatively (postoperative complete AV block in 3) in 22 patients. A total of 13 cases died including 10 perioperative deaths during follow-up. Actuarial survival rate at 10 year was 84.5%. CONCLUSION: In this study, the midterm outcome of corrected TGA is acceptable. However, long-term follow-up is required in respect to the function of atrioventricular valve and the systemic ventricle.

Atrial Ectopic Tachycardia in Infant

PURPOSE: Atrial ectopic tachycardia (AET) in older children and adult is characterized by being chronic, incessant and intractable. However, the nature of infantile AET is not defined yet. The purpose of this study was to evaluate our experience of infantile AET. METHODS: We retrospectively reviewed the medical records of 13 infants (mean onset age, 2.8 +/- 2.3 months) diagnosed at Seoul National University Children's Hospital from June, 1988 to June, 1996. Multifocal atrial tachycardia (AT) and postoperative AT were excluded. RESULTS: AET was presented with congestive heart failure in 8, fast heart rate in 4 and associated cardiac defect in 1. During tachycardia, atrial rates ranged 150-300 beats/min (mean +/- SD, 214 +/- 45 beats/min). Four had associated cardiac anomalies: atrial septal defects in 3, multiple cardiac tumor associated with tuberous sclerosis in 1. All infants with AET were received medical therapy: digoxin (D) only (4), D+beta-blocker (1), D+amiodarone (4), D+flecainide (3), D+amiodarone+flecainide+beta-blocker (1). Conventional drug with digoxin was partially effective. In intractable 7 cases, combination of D, amiodarone and/or class Ic drug (flecainide) was necessary to control AET. This medical regimen suppressed AET in all. During follow up (mean +/- SD, 37.1 +/- 15.8 months), all except 1 recovered from AET. In 1 with large atrial septal defect, AET could be controlled only after operation. A case died of sepsis. CONCLUSION: In this study, infantile AET showed good prognosis and resolved during follow up. Medical management was possible in all cases. However, proper selection and combination of complex antiarrhythmic drug, including amiodarone and class Ic drugs were necessary to control AET in almost all the cases.

Aortic insufficiency after Arterial Switch Operation in Transposion of the Great Arteries

BACKGROUND: The arterial switch operation (ASO) has become a procedure of choice for transposition of the great arteries (TGA) with or without ventricular septal defect (VSD). In spite of current low surgical mortality in immediate surgical period, there are potential problems of late morbidity and mortality. In this study, we evaluate the prevalence and severity of aortic insufficiency (AI) and associated factors with AI. METHOD: We retrospectively reviewed medical records and echocardiogram of 125 patients (M89, F36) underwent ASO for TGA at Seoul National University Children's Hospital from July, 1987 to June, 1997. To evaluate for associated factors, we divided patients of TGA to four hemodynamic groups (Group I, simple TGA (n-53); Group II, associated with ventricular septal defect (VSD) (n-50); Group III, associated with VSD and PS (n-18); Group IV, associated with PS (n-4)). Grade of AI was assessed by color Doppler analysis (Perry's et al). RESULTS: Total prevalence rate of AI was 35.2% (31/88) and grade of AI were mild in 61%, moderate in 39%. The incidence of AI in each group was: Group I 25.0% (10/40), Group II 26.0% (9/36), Group III 92.0% (12/13). According to this study, pulmonary stenosis was the only significant factor to AI. During follow-up (39+/-24 Months), in spite of the normal left ventricular function in most patients with AI, a few patients (3 cases) suffered from progressive AI and some moderate AI patients (2 cases) showed slightly decreased LV function. Two moderate and progressive AI lossed. CONCLUSION: In this study, AI (after ASO) was not uncommon and pulmonary stenosis was an important factor to AI. In some cases, AI became worse and developed decreased LV function. This suggests that meticulous follow-up after ASO is necessary.

Total Protein, Albumin and IgG Analysis of Serum and Cerebrospinal Fluid in Control and Aseptic Meningitis

No abstract available.

A Case of Anesthesia for a Patient of Pulseless Disease / 대한마취과학회지

A case of anesthesia for a patient of "pulaeless disease" (Takayasu's disease) was reported. During her general anesthesia, blood pressure was measured at the femoral artery by auscultatory method. There are numerous problems to evaluate the result of indrect measurements of arterial blood pressure obtained by auscultatory method. For accurate measurements of blood pressure, the relationship between the circumference of the arm and the blood pressure should be considered, which was emphasized by Ragan and Bordley. The auscultatory method of blood pressure measurement was reviewed.