A comparative study of established z score models for coronary artery diameters in 181 healthy Korean children / 소아과

PURPOSE: The aim of this study was to investigate the statistical properties of four previously developed pediatric coronary artery z score models in healthy Korean children. METHODS: The study subjects were 181 healthy Korean children, whose age ranged from 1 month to 15 years. The diameter of each coronary artery was measured using 2-dimensional echocardiography and converted to the z score in the four models (McCrindle, Olivieri, Dallaire, and Japanese model). Descriptive statistical analyses and 1-sample t tests were performed. RESULTS: All calculated z scores had P values of ≥0.050 using the Kolmogorov-Smirnov test. The one sample t test showed that the mean z scores did not converge to zero except in 1 model, and the mean right coronary artery (RCA) z score was less than zero in all 4 models. The smaller RCA diameter in this study could be associated with the more distal measuring point used to avoid the conal branch. The percentage of subjects with extreme z score values (≥2.0 and ≥2.5) for the left main coronary artery (LMCA) seems to be higher in the Dallaire (4.9% and 3.3%) and Japanese models (7.1% and 3.8%). CONCLUSION: All 4 models showed statistical feasibility of normal distribution. More precise instructions would be needed for the measurement of the RCA. The higher percentage of extreme z scores for the LMCA is compatible with the basic understanding of anatomic variation in the LMCA.

A Case Demonstrating a Percutaneous Closure Using the Amplatzer Duct Occluder for Paravalvular Leakage after Tricuspid Valve Replacement

There has been a dramatic increase in the number and type of procedures performed in the field of cardiac intervention in the past decade. Percutaneous intervention is becoming an increasingly recognized modality for the management of prosthetic paravalvular leakages (PVLs) in severely symptomatic non-surgical candidates. Herein, we report our experience of percutaneous closure using the Amplatzer duct occluder for a PVL in a patient who underwent tricuspid valve replacement.

A Case of Liver Abscess Associated with Umbilical Venous Catheterization in Preterm Infant

Umbilical venous catheter (UVC) insertion is a life-saving procedure in neonates who require neonatal intensive care unit (NICU). It is a relatively easy procedure and it is routinely performed on the NICU. This life-saving yet relatively easy procedure, however, can yield some undesirable complications if it is not administered correctly. One of them is a liver abscess. This is a case report of a preterm infant who developed a liver abscess after UVC insertion. We inserted UAC and UVC to a preterm of 35 weeks of gestational age and birth weight of 2,720 g for treatment of respiratory distress syndrome, patent ductus arteriosus, and sepsis. A liver abscess associated with UVC was suspected on screening abdominal sonogram performed for evaluation of infection at 8 days of life. UAC was removed at 5 days of life, however, UVC was still being used. The patient recovered after 4 weeks of antibiotic treatment with prompt elimination of UVC. This case along with a brief review of literature illustrates an importance of proper maintenance and casuistic use of UVC for preterm infants.

Survival Outcome of Neonatal Intensive Care Units in Korea by Gestational Age (2002-2009)

PURPOSE: There has recently been improvement in treatment skills and outcomes of patients in neonatal intensive care units (NICUs) of Korea. According to several studies, such results of very to extremely low birth weight infants were markedly improved in comparison to that of Japan or USA. In speculation, the authors reviewed the survival outcomes by gestational age from 2002 to 2009. METHODS: We extracted the survival outcomes of NICU patients by gestational age from the data of previous studies. Data from Japanese Perinatal Care Center Research Network and NICHD Neonatal Research Network of US were used for comparison. RESULTS: The survival rates by gestational age are as follows (2002, 2007, and 2009 respectively): 22-23 weeks (3.4, 19.0, 28.6%), 24 weeks (21.3, 44.0, 59.3%), 26 weeks (59.4,77.8, 78.0%), 28 weeks (79.0, 88.0, 91.2%), 30 weeks (93.8, 95.3, 93.6%), 32 weeks (95.3, 97.1, 98.2%), 34 weeks (98.8, 99.0, 99.0%), 36 weeks (99.2, 99.1, 99.2%), 38 weeks (99.7, 99.5, 99.2%), 40 weeks (99.7, 99.4, 99.2%), longer than 42 weeks (100.0, 96.3, 94.7%). For infants with a gestational age lesser than 28 weeks, the survival rates of Korea (2009), Japan (2009), and US (2003-2007) were 77.5, 89.0 and 71.6% respectively. The statistics of Korea ranked between those of Japan, USA. CONCLUSION: The survival rate of neonates admitted to NICU in Korea markedly improved from 2002 to 2009. The present study is the first report of survival rate by gestational age in Korea and will become a fundamental basis for further improvement in neonatal care.