ABSTRACT
Resumen Describimos una paciente con COVID-19, con derrame pericárdico, taponamiento cardíaco y depresión miocárdica grave. Mujer de 51 años, sin enfermedad previa, COVID-19 leve que presentó tres episodios de síncope en domicilio. El electrocardiograma mostró ritmo sinusal, ST de concavidad superior difuso 2 mv; en la tomografía se observó derrame pericárdico y parénquima pulmonar normal. Ingresó a terapia intensiva con shock y requerimiento de asistencia ventilatoria mecánica (AVM). En el ecocardiograma se obser vó derrame pericárdico y taponamiento; se realizó drenaje. El ecocardiograma transesofágico mostró deterioro moderado de función sistólica biventricular; strain longitudinal global -14.2%, Fey estimada: 43%; deformación global circunferencial: -10.1%. A los 7 días del ingreso, la tomografía reveló infiltrados bilaterales y engrosamiento pericárdico con realce post-contraste y derrame pericárdico leve. El día 12 posterior al ingreso, se suspendió el soporte inotrópico; y la paciente, hemodinámicamente estable, se desvinculó de la AVM.
Abstract We describe a patient with COVID-19, with pericardial effusion, cardiac tamponade and severe myocar dial depression. A 51-year-old woman, previously healthy, with mild COVID-19 presented with three episodes of syncope. She was admitted to the emergency room. An electrocardiogram showed sinus rhythm, diffuse superior concavity ST 2 mv; a CT scan showed pericardial effusion, without lung pathological findings. Due to shock, dyspnoea and encephalopathy, the patient was admitted to intensive care, where she received vasopressor support and mechanical ventilation. A bedside ultrasound showed pericardial effusion and tamponade; drainage was performed; transoesophageal ultrasound showed moderate deterioration of biventricular systolic function; global longitudinal strain -14.2%, estimated Fey 43%; global circumferential strain -10.1%. Seven days after admission, CT scan revealed bilateral infiltrates and pericardial thickening with post-contrast enhancement and mild pericardial effusion. On day 12 post admission, inotropic support was discontinued; patient on mechanical ventilation weaning and haemodynamically stable.
ABSTRACT
Objective To discuss the risk factors for cardiac complications in infants of diabetic mothers (IDMs).Methods One hundred and seventy-one out of 228 IDMs hospitalized in Department of Pediatrics,Shenzhen Hospital of Peking University from Jan.2011 to Apr.2014,were involved,among them,there were 171 cases who had the complete mother's data during pregnancy,and they were received B ultrasonography whin 1 week after birth.All the infants were divided into 2 groups according to echocardiography within 1 week after birth:the observation group (the patients had cardiac complications) and the control group (the patients had normal heart).Conditions of IDMs and their mothers between the 2 groups were recorded and compared.Results In the 171 IDMs,there were 69 cases(38male and 31 female) in the observation group and 102 cases(59 males and 43 females) in the control group.There were 24 preterm infants,16 large for gestational age(LGA) infants in the observation group,while 47 preterm infants and 15 LGA in the control group,and which had no statistical difference between the both groups(x2 =0.129,2.163,1.995 ; all P ＞ 0.05).In the observation group,there were 7 (4.1％) newborns with hypoglycemia,24 (14.0％) women with advanced maternal age,24(14.0％) women with other gestational complications,19(11.1％) women having good control of their glucose serum levels,and 9(5.3％) women with impaired glucose tolerance.All the mentioned factors had statistical differences when compared with the control group[1 (0.6％) case,19 (11.1％) cases,15 (8.8％) cases,80(66.8％) cases,26(15.2％) cases] (x2 =7.752,5.707,9.423,43.735,3.917 ;all P ＜ 0.05,0.01).Logistic regression showed that women with other gestational complications as risk factors(OR =3.29,95％ CI 1.248-8.671),while having a good control of the glucose serum levels acted as a protectable factor(OR =0.098,95％ CI 0.045-0.217).Conclusions IDMs are prone to have cardiac complications if their mothers couldn't control the glucose serum levels during pregnancy,with other gestational complication and advanced maternal age and with more serious diabetes.
ABSTRACT
PURPOSE: We performed the study to evaluate the risk factors associated with cardiac complication and the outcome of coronary lesions after high-dose (2g/kg, 1dose) gammaglobulin (IVIG) treatment in patients with Kawasaki disease (KD). METHODS: Retrospective studies were performed on 338 cases of KD treated with high-dose IVIG at this hospital from May 1994 to March 1999. RESULTS: Among 338 patients, fever was persistent for 8.09+/-3.45 days in all patients and after IVIG infusion, fever subsided in 26.5+/-26.4 hours. Forty-five patients (13.3%) with abnormal baseline echocardiogram remained febrile for 9.09+/-4.09 days, significantly longer than normal baseline echocardiogram group. There was no significant differences in age, sex and other clinical findings. In 7 patients (2.1%) usage of medications above 12 months were needed. Eleven cases(3.3%) with persistent fever after their first course of IVIG therapy became afebrile post-second course of IVIG in 5 of the 11 cases with cardiac complication and in 1 case with recurrence. Twelve (male 11, female 1) of the 338 cases recurred after 8.45+/-4.39 months. Three of those 12 cases had cardiac complication. CONCLUSION: The overall prevalence of persistent coronary abnormalities in KD patients treated with high-dose IVIG and aspirin remains low. Even if patients had cardiac complication, they improved later.