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We present a case in which transthoracic echocardiography was the first diagnostic tool to suspect mediastinal Hodgkin's lymphoma by revealing a change in the hemodynamic of left pulmonary artery flow, and it was used as a follow-up method for monitoring treatment efficacy by demonstrating a normalization of pulmonary artery hemodynamics
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Objectives: The main aim of this study is to evaluate the significance of several clinical and laboratory findings presented by a large number of pediatric patients who were suspected to have acute rheumatic fever [ARF] by physicians who ordered echocardiogram for confirmation and for avoiding overuse of unnecessary antibiotics. These suspecting reasons include elevated ASO titers and recurrent tonsillitis. Another aim is to stress the role of Doppler echocardiogram in confirming the diagnosis of ARF by detecting rheumatic heart disease [RHD] in suspected cases
Materials and Methods : 401 patients were registered in the National Registry of the Pediatric and Congenital Heart Disease [RNCPC] from April 1, 2002 until the end of March 2013 as suspected cases of ARF. The clinical reasons that brought suspicion are discussed and evaluated in accordance to modified Jones criteria. The patients are distributed into two groups : 1] confirmed ARF and 2] different diagnosis. All patients underwent echocardiogram. Patients came from different geographic areas and were referred by a variety of physicians
Results : 48 patients out of 401 suspected cases turned to have confirmed ARF [12%]. In this group, the predominant suspecting reasons are reported as heart murmur in 29/48 [60.4%], arthritis in 28/48 [58.3%], arthralgia with reduced physical activity in 15/48 [31%] and chorea in 5/48 [10%]. In the different diagnosis group with a high ASO titer 174/353 [49.3%], isolated arthralgia 91/353 [25.8%] and combined elevated ASO with arthralgia in 44/353 [12.5%] were the predominant suspecting reasons. Doppler echocardiography could detect 38/48 cases of active carditis and subclinical carditis [SCC]
Conclusion: Heart murmur, arthritis, arthralgia with reduced physical activity and chorea are the main clinical reasons that lead to suspicion in the ARF group. High ASO titers, arthralgia, and combination of high ASO titers with arthralgia are the main presenting symptoms in the group with a different diagnosis. We concluded that elevated ASO titer and normal ESR with arthralgia not reducing physical activity can exclude ARF. Doppler echocardiography is found to be a gold standard key to confirm acute rheumatic heart disease and ARF
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This study aims to analyze several parameters concerning the supravalvular aortic stenosis [SVAS] in children such as age of diagnosis, place of residence, the existence of a metabolic disorder or dysmor-phic syndrome and possible damage to the coronary ostia, the means of diagnosis and outcome of these patients. A large group of patients [2868] with congenital heart disease enrolled between 1 May 1999 and 30 April 2010 at the National Register of Pediatric and Congenital Heart Disease, Lebanese Society of Cardiology. SVAS were found in 14 patients [0.5%] aged 8.5 months to 15 years. The Williams Beuren syndrome was the most common etiology [6 cases] without ostial stenosis, asymptomatic and not treated, followed by forms without dysmorphic syndrome [5 cases] and without ostial stenosis, one patient was operated because of severe SVAS ; finally, 3 cases of homozygous familial hypercholesterolemia treated differently: a patient had a successful liver transplantation at age of 4.5 years but has developed, despite the normalization of cholesterol level, a SVAS associated with severe ostial lesions 10 years after transplantation, another treated by coronary artery bypass graft surgery and the latter treated medically. SVAS is a very rare disease, but its discovery must lead to search for coronary lesions especially in presence of homozygous familial hypercholesterolemia. The ultrasound monitoring is mandatory and is designed to detect this anomaly and early coronary lesions. The slightest suspicion should carry out more extensive explorations to detect ostial stenosis
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Coarctation of the aorta in neonates and small infants is, in most cases, a severe congenital malformation and requires a rapid surgical treatment or interventional catheterization. To our knowledge, and so far, no cases of coarctation of the aorta have spontaneously improved. We report three cases of coarctation diagnosed in young infants and considered as moderate forms on physical exam and/or ultrasound study which evolved to partial or complete regression without any treatment
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To describe the characteristics and outcome of children with an isolated silent patent ductus arteriosus [SPDA], with comparison to non-silent ducts. Between 1999 and 2004, all consecutive cases of isolated silent and non-silent-patent ductus were recorded at the National Register of Pediatric and Congenital Heart Disease, Lebanese Society of Cardiology. Patients with a SPDA were followed clinically and by Doppler echocardiography while all non-SPDA were percutaneously or surgically closed. Twenty-four cases of isolated SPDA and 50 cases of isolated non-SPDA ducts were recorded. Male sex was significantly predominant in the silent group [70%]. First-cousin consanguinity rates were not different between both groups, with 20.4% for the silent group versus 22% for the non-silent group. Down's syndrome was associated in three cases of SPDA. No cases of endocarditis were noted during a mean follow-up of 33.3 months. Four patients with a SPDA experienced spontaneous closure at the age of 25,30,36 and 58 months. SPDA is a relatively benign disease. The risk of endocarditis cannot be totally ignored, but the systematic closure of the SPDA is not warranted. Larger series and longer follow-up are needed in order to draw conclusions. Spontaneous closure occurred in four patients with SPDA
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Humanos , Masculino , Femenino , Evaluación de Resultado en la Atención de Salud , Niño , Ecocardiografía DopplerRESUMEN
Analyze the role of parental consanguinity and/or maternal age on the occurrence of congenital cardiac anomalies in infants with Down's syndrome [DS]. A large group of patients with or without congenital heart disease, registered between May 1[st], 1999 and June 30[th], 2006, at the National Register of Paediatric and Congenital Heart Disease, Lebanese Society of Cardiology. 217 children with DS have been enrolled over this period. Group I: DS with cardiac anomalies [n: 119]. Group II: DS without cardiac anomalies [n: 98]. The consanguinity rate was compared to a study made in 2000 by UNICEF in Lebanon, in which the consanguinity rate was 14.9% of 1st degree cousins and 25% of all degrees together. Congenital cardiac anomalies were found in 54.2% of babies with DS. First degree cousins in both groups I and II was 143% [close to the general population], and it was lower in group I compared to group II [11.8% and 17.3% respectively ; p = 0.205] ; this difference was not statistically significant for all degrees together. Maternal age ranged from 20 to 47 years, with a mean of 29.5 +/- 5.3 years. The risk of congenital cardiac anomaly was greater [p < 0.05] when maternal age was equal or below 32 years. As in the international literature, complete atrioventricular canal and ventricular septal defect were the most frequent cardiac anomalies. In children with DS, the risk of congenital cardiac anomalies was not associated with the parents consanguinity. Maternal age above 32 years seem to be associated with a lesser occurrence of congenital cardiac anomaly in children with DS
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Diagnosis, initial workup and immediate prognosis in congenital or acquired heart diseases revealed by cardiogenic shock [CS] in a Lebanese paediatric multicentric study. During a six-year period [is. January 1999 to 31 December 2004], 56 paediatric patients aged between 0 and 7 years have been admitted to the emergency departments or neonatal and intensive care units in ten different Lebanese hospitals, for high degree of CS suspicion with underlying cardiac disease. All diagnoses were confirmed by echocardiography.All children were initially in a critical condition with signs of CS. Congenital heart diseases [CHD], specially left obstructive diseases [coarctation of the aorta, critical aortic stenosis, hypoplastic left heart syndrome] were the main etiologies found in newborns, followed by dilated cardiomyopathies in infants and children. Mortality was higher in the following two groups of patients : intubation, no diuresis after the first hour of admission despite therapeutic measures [prostaglandines in newborns, dopamine, dobutamine and furosemide]. Beside those pathologies necessitating specific treatment, all the CHD [excluding hypoplastic left heart syndrome, one case of critical aortic coarctation and one case of congenital mitral regurgitation] were transferred to the catheterization laboratory or to surgery in a good hemodynamic condition. CS remains a notable medical problem observed in the emergency and paediatric intensive care units in Lebanon. Immediate prognosis is related to : immediate recognition of the CS, nature of the car-diopathy and initial response to therapeutic procedures such as rapid improvement of respiratory status and rapid diuresis. Echocardiography is a reliable, quick and non-invasive procedure for initial diagnosis
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We describe here the first Lebanese experience of percutaneous closure of a large patent ductus arteriosus in a 15-year-old female. The ductus arteriosus was successfully occluded using the new Amplatzer[R] Duct Occluder system. The procedure time was 40 minutes and the young patient was discharged home the next day. This new device, conceived since 1997 gives very encouraging results according to the recent medical literature
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Humanos , Femenino , Prótesis e Implantes , PielRESUMEN
Percutaneous closure of the patent ductus arteriosus [PDA] has become an efficient and safe technique in children. We report the first Lebanese series of 8 children who had their PDA closed percutaneously with a coil or an Amplatxer Duct Occluder. Patients median age was 3.2 years [range 1.2 to 12 years]. The median minimal diameter of the PDA was 2.1 mm [1.2 to 4 mm]. A coil was used in 4 children and an Amplatxer occluder in the 4 other patients. The device was chosen according to the diameter of The PDA The results were excellent in all patients. A trivial shunt present in 3 cases, disappeared within 8 weeks. No complication were noted in this series. Percutaneous closure of the PDA in children, using interventional radiology, is a simple and reproducible technique. It is now the treatment of choice in most pediatric cardiac centers worldwide