ABSTRACT
Purpose - To report the result of patients treated with IV methylprednisolone divided into three groups and compare their follow-up during the last 12 years. Methods - Seventy children with active rheumatic carditis (76 episodes) in heart failure Class III and IV (NYHA) were studied. The diagnosis was based on modified Jones' criteria. After rulling out infections and stronglyoidiasis, treatment with IV methylprednisolone bolus was started three times a week until the laboratory tests became negative. Patients were divided into 3 groups, according to the time of hospital admittance: Groups 1,2 and 3, comprising of 40, 18 and 12 children, respectively. Results - Eighteen children in Group 1 (45 per cent) were in their 1st attack: 2 series of pulsetherapy were used in 10 (25 per cent), 3 in 9 (23 per cent) and 4 in 21 (52 per cent). In Group 2, 14 cases (77 per cent) were in their 1st attack: 2 series were used in 7 (39 per cent), 4 in 9 (50 per cent) and 5 in 2 (11 per cent). The echocardiogram showed a flail mitral valve in 12 (66 per cent) of these patients (1 death occurred after mitral valvoplasty). In Group 3,6 patients needed 5 or more series of pulsetherapy and a flail mitral valve was present in 5 (41 per cent). One child underwent mitral valve replacement while still in the active phase, after 8 series of pulsetherapy, and another died. The number of patients who needed 5 or more series was significantly higher in Group 3. Conclusion - There were variations in the presentation and evolution of the cases during these 12 year. The established pulsetherapy protocol continues to be useful to treat severe cases.
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Anti-Inflammatory Agents/therapeutic use , Methylprednisolone/therapeutic use , Myocarditis/drug therapy , Rheumatic Heart Disease/drug therapy , Injections, Intravenous , Prospective Studies , Treatment OutcomeABSTRACT
PURPOSE: To describe the cardiac findings in children with AIDS, the follow-up with treatment and the correlation between clinical and pathological features. METHODS: We studied prospectively 25 children with clinical-laboratorial diagnosis of AIDS, ages between 3 months and 11 years, even those without cardiac symptoms. We classified the signs of AIDS following that of CDC-Atlanta 1994. Eight children died and it was done necropsy in six with macro and microscopic examinations. RESULTS: Fifteen cases had already complications of AIDS and were classified as C2 and C3, 5 as B2, 3 B1 and 2 as A1. Beside the symptoms related to the disease and infections we found signs of congestive heart failure III and IV (NYHA) in 5 children, pericardial effusion in 5, (one of them had cardiac tamponade). In the electrocardiogram (EKG), 8 children had repolarization abnormalities. In 1st echocardiogram (ECHO) we found some features of dilated myocardiopathy in 8 (6 were asymptomatic) 5 of those had pericardial effusion, one child had huge amount of pericardial liquid and also increased measures of intraventricular septum and posterior wall of left ventricle by ECHO and confirmed by necropsy examination. All cases of diagnosis of myocardiopathy received treatment with captopril and 4 also received furosemide and digoxina. Even under oral treatment three of them had deterioration of heart failure but after combined anti-retroviral drugs they showed better cardiac functions. From the six necropsied cases, two had increased heart weight without myocarditis, one had toxoplasma pancarditis and other one had fibrocalcic vasculopathy. CONCLUSION: We found several assymptomatic cases already with decreased ventricular function. Some worsened of heart failure even under apropriate treatment and showed better cardiac index after combined anti-retroviral drugs.