Plasma levels of nitric oxide in children with congenital heart disease and increased pulmonary blood flow.

BACKGROUND: Development of pulmonary hypertension commonly accompanies congenital heart disease; nitric oxide (NO) is evidently an important mediator of pulmonary vascular reactivity. OBJECTIVE: Investigate the effect of pulmonary hypertension (PH) associated with congenital heart disease on NO production. MATERIAL AND METHOD: The authors measured plasma levels of nitric oxide-related compounds in 28 patients, aged 3 months to 12 years with congenital heart disease (CHD) and increased pulmonary blood flow. Blood samples were obtained during their cardiac catheterization. The subjects were subsequently divided into two groups, namely: group 1 CHD were those with left-to-right shunt; and group 2, CHD with right-to-left shunt. RESULTS: Four patients had severe pulmonary hypertension (mean pulmonary arterial pressure > 60 mmHg). The total levels of NO-related compounds between the two groups were not statistically different as well as the levels in pre- and post-pulmonary artery. In patients with left-to-right shunt with mild to moderate pulmonary hypertension, the levels of total NO-related compounds were directly correlated with the level of pulmonary arterial pressure and pulmonary vascular resistance (r = 0.67; p-value < 0.05, and r = 0.75; p-value < 0.05). Additionally, in patients with severe pulmonary hypertension, the levels of total NO-related compounds decreased when compared to the levels in patients with mild to moderate pulmonary hypertension. CONCLUSION: The present results suggested that the hemodynamic status of the pulmonary circulation in congenital heart defect is at least partly correlated with the blood levels of nitric oxide.

Infective endocarditis in pediatric patients: an eighteen-year experience from King Chulalongkorn Memorial Hospital.

OBJECTIVES: To review the clinical features and outcome of the pediatric patients diagnosed with infective endocarditis (IE) at King Chulalongkorn Memorial Hospital over an 18-year period. MATERIAL AND METHOD: From January 1987 to December 2004, 57 pediatric patients; 28 females and 29 males, age ranged from 2 months to 15 years, mean of 8.64 +/- 3.82 years, classified as "definite" IE according to the Duke criteria were reviewed. RESULTS: Of the 57 patients, 42 patients (74%) had underlying congenital heart diseases, 7 patients (12%) had underlying rheumatic heart disease, 8 patients (14%) had previously normal heart. Nine patients had history of previously palliative or corrective surgery. Blood cultures were positive in 26 patients (46%). Streptococci and staphylococci were the most commonly isolated organisms. Two-dimensional echocardiography demonstrated vegetations in 56 patients (98%). The location of the vegetations was in the right heart in 30 patients (54%) and in the left heart in 26 patients (46%). Complications occurred in 28 patients (49%). Common complications included congestive heart failure, cerebral emboli, septic shock, and mycotic aneurysm. The overall mortality was 11% (6 patients). By statistical analysis, vegetations in the left heart had a higher incidence of complication than that in the right heart. The vegetation size of > or =10 mm had a significant higher incidence of embolic events. CONCLUSION: The clinical features and outcomes of the present study have a similar pattern as the earlier studies. The rates of complications and mortality are still high.

Hyperlipidemia in children at risk for coronary heart disease.

High blood cholesterol in childhood associated with early development of atherosclerotic plaques has been well established. To find the prevalence of hyperlipidemia in children at risk for coronary heart disease, the authors performed cholesterol screening in children aged between 5-18 years from families with a history of premature coronary heart disease and/or parental hypercholesterolemia. All children were measured for non-fasting capillary blood total cholesterol level by Reflotron dry chemistry method, and lipoprotein analysis was done in children whose capillary blood cholesterol level was > or = 170 mg/dl. One hundred and sixty-five children participated in this study. Eighty-seven (52.7%) of the total had a non-fasting capillary blood cholesterol level > or = 170 mg/dl, and 75 (87.2%) of these children were measured for lipoprotein analysis. Total cholesterol level > or = 200 mg/dl, low density lipoprotein cholesterol (LDL-C) > or = 130 mg/dl, and high density lipoprotein cholesterol (HDL-C) < 35 mg/dl were found in 43 (57.3%), 50 (66.7%) and 9 (12.0%) children respectively. As a result of this study, Thai children at risk for coronary heart disease had a high prevalence of abnormal lipid profile, which may predict the high prevalence of premature coronary heart disease in the future.