Infective endocarditis in childhood: a single-center experience of 18 years

Abstract Introduction: We aimed to present the risk factors, clinical and laboratory findings, treatment management, and risk factors for morbidity and mortality of infective endocarditis (IE) as well as to relate experiences at our center. Method: We retrospectively analyzed data of 47 episodes in 45 patients diagnosed with definite/possible IE according to the modified Duke criteria between May 2000 and March 2018. Results: The mean age of all patients at the time of diagnosis was 7.6±4.7 years (range: 2.4 months to 16 years). The most common symptoms and findings were fever (89.3%), leukocytosis (80.8%), splenomegaly (70.2%), and a new heart murmur or changing of pre-existing murmur (68%). Streptococcus viridans (19.1%), Staphylococcus aureus (14.8%), and coagulase-negative Staphylococci (10.6%) were the most commonly isolated agents. IE-related complications developed in 27.6% of the patients and the mortality rate was 14.8%. Conclusion: We found that congenital heart disease remains a significant risk factor for IE. The highest risk groups included operated patients who had conduits in the pulmonary position and unoperated patients with a large ventricular septal defect. Surgical intervention was required in most of the patients. Mortality rate was high, especially in patients infected with S. aureus, although the time between the onset of the first symptom and diagnosis was short. Patients with fever and a high risk of IE should be carefully examined for IE, and evaluation in favor of IE until proven otherwise will be more accurate. In high-risk patients with prolonged fever, IE should be considered in the differential diagnosis.

Del soplo inocente a la hipertensión arterial pulmonar / From an innocent heart murmur to pulmonary arterial hypertension

Resumen Introducción: La detección de cardiopatías congénitas en la etapa neonatal a partir de un soplo cardiaco o cianosis no es efectiva. Las cardiopatías congénitas críticas, como el tronco arterioso común (TAC), causan la mayoría de las muertes neonatales por malformaciones congénitas. El tamizaje por oximetría de pulso en los recién nacidos detecta hasta el 70% de estas cardiopatías. El TAC presenta una alta mortalidad en el primer año de vida. Caso clínico: Se presenta el caso de un paciente de sexo femenino de 4 años de edad con soplo cardiaco, palpitaciones, disnea y cianosis perioral, con diagnóstico al nacimiento de soplo inocente. Se detectó TAC mediante una ecocardiografía. Las resistencias vasculares pulmonares fueron evaluadas por medio de cateterismo cardiaco derecho, con hallazgo de hipertensión arterial pulmonar y vasorreactividad pulmonar. Se realizó corrección quirúrgica. A la fecha, la hipertensión arterial pulmonar continúa presente, por lo que se implementó Bosentan® (Actelion, USA) como tratamiento a largo plazo. Conclusiones: En recién nacidos, el tamizaje por oximetría de pulso después de las 24 horas de vida es un método efectivo para el diagnóstico oportuno de cardiopatías congénitas críticas antes de los signos de colapso cardiovascular. Por ello, resulta una herramienta diagnóstica fundamental para reducir la morbimortalidad. Aunque la corrección quirúrgica de cardiopatías congénitas con hipertensión arterial pulmonar es factible en algunos pacientes, su manejo subsecuente es complejo e impacta de manera adversa en la calidad de vida.

Abstract Background: The detection of congenital heart disease in newborns, based on a heart murmur or cyanosis is not effective. Critical congenital heart diseases, such as truncus arteriosus (TA), cause most of neonatal deaths due to congenital malformations. The screening for pulse oximetry in newborns detects up to 70% of these heart diseases. TA presents high mortality in the first year of life. Case report: A 4-year-old female patient with a heart murmur, palpitations, dyspnea, and perioral cyanosis was diagnosed with an innocent heart murmur at birth. TA was detected by echocardiography. Pulmonary vascular resistances were evaluated through right cardiac catheterization, and pulmonary arterial hypertension and pulmonary vasoreactivity were diagnosed as well. Surgical correction was performed. Currently, pulmonary arterial hypertension persists, for which Bosentan® (Actelion, USA) has been implemented as a long-term treatment. Conclusions: In newborns, the pulse oximetry screening after 24 hours of life is an effective method for suitable diagnosis of critical congenital heart disease before the signs of cardiovascular collapse. Therefore, it has become an essential diagnostic tool to reduce morbidity and mortality. Although the surgical correction of congenital heart disease with pulmonary arterial hypertension is feasible in some patients, its subsequent management is complex and has an adverse impact on the quality of life.

Value of heart murmurs and transcutaneous oxygen saturation in screening for neonatal congenital heart disea-ses / 中华实用儿科临床杂志

Objective To compare the importance of heart murmurs and transcutaneous oxygen saturation (SpO2)in screening neonatal congenital heart diseases(CHD),and to explore a reliable and easy-to-use method for the screening of CHD. Methods All infants (16 070 cases) born in Changzhou Maternal and Child Health Hospital from May 1 st 2011 to April 30 th 2013 were screened of CHD for heart murmurs and SpO2 . The screen-positive infants were divided into 3 groups:heart murmurs group,abnormal SpO2 group and mixed group. All screen-positive infants re-ceived cardiac color ultrasound to make a definite diagnosis of CHD,so as to compare the values of heart murmurs and SpO2 . Results Eight thousand seven hundred and ninety-nine boys and 7 271 girls were screened,in which the ratio was 1. 21:1. 00. One hundred and eighteen infants were screened positive,including 76 murmurs of which 45 were confirmed as CHD,28 with abnormal SpO2 of which 18 were confirmed and 14 mixed of which 13 were confirmed,so the confirmation rates were 59. 21%,64. 29% and 92. 86%,respectively. The diagnostic rate of CHD in mixed group was higher than other 2 groups,which had statistical significance(P=0. 045). The top three formation types of CHD were ventricular septal defect (VSD) (29/76 cases,38. 16%),patent ductus arteriosus (PDA) (13/76 cases, 17. 11%) and atrial septal defect (ASD) (11/76 cases,14. 48%). Conclusions The combination of heart murmurs and SpO2 was useful in increasing detection and decreasing misdiagnosis of CHD.

Características clínicas de los pacientes con soplos atendidos en una consulta de cardiopediatría / Clinical characteristics of patients with murmurs cared in a pediatric cardiology consultation

Fundamento: La auscultación de un soplo cardíaco durante el examen físico de un niño es frecuente, por lo que constituye el principal motivo de interconsulta en cardiología pediátrica. Objetivo: Identificar las características clínicas de los pacientes con soplos atendidos en una consulta de cardiopediatría. Metodología: Se estudiaron 118 niños durante el periodo de septiembre 2011 a diciembre 2012. Las variables utilizadas fueron edad, sexo, antecedentes patológicos familiares, síntomas asociados, localización del soplo, intensidad, complementarios (telecardiograma, electrocardiograma y ecocardiograma doppler). Resultados: Predominó el grupo de cero días a cinco años, y el sexo masculino. El dolor precordial, las palpitaciones y la disnea constituyeron los síntomas más frecuentes asociados al soplo. En 94 niños el soplo se ubicó en la región mesocárdica y en 106 fueron grado II. Conclusiones: La auscultación de un soplo cardíaco durante el examen físico de un niño es un hecho frecuente, por lo que constituye motivo de interconsulta periódicamente en la cardiología pediátrica.

Background: auscultation of a heart murmur during a physical examination of a child is common, which is the main interclinical reason in pediatric cardiology. Objective: To identify clinical characteristics of patients with murmurs cared in a pediatric cardiology consultation. Methodology: 118 children were studied from September 2011 to December 2012. The variables used were age, gender, family medical history, associated symptoms, location of the murmur, intensity, complementary exams (telecardiogram, electrocardiogram and echocardiogram doppler). Results: The group of 0 days to five years and male sex predominated. Chest pain, palpitations and dyspnea were the most common symptoms associated with the murmur. In 94 children the murmur was located in the mesocardiac region and 106 were grade II. Conclusions: Auscultation of a heart murmur during a physical examination of a child is frequent, that is why it is a periodically interclinical reason in pediatric cardiology consultation.