ABSTRACT
BACKGROUND: The impact of the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in low- and middle-income countries remains poorly understood. Our aim was to understand the characteristics and outcomes of PIMS-TS in Argentina. METHODS: This observational, prospective, and retrospective multicenter study enrolled patients younger than 18 years-old manifesting PIMS-TS, Kawasaki disease (KD) or Kawasaki shock syndrome (KSS) between March 2020 and May 2021. Patients were followed-up until hospital discharge or death (one case). The primary outcome was pediatric intensive care unit (PICU) admission. Multiple logistic regression was used to identify variables predicting PICU admission. RESULTS: Eighty-one percent, 82%, and 14% of the 176 enrolled patients fulfilled the suspect case criteria for PIMS-TS, KD, and KSS, respectively. Temporal association with SARS-CoV-2 was confirmed in 85% of the patients and 38% were admitted to the PICU. The more common clinical manifestations were fever, abdominal pain, rash, and conjunctival injection. Lymphopenia was more common among PICU-admitted patients (87% vs. 51%, p < 0.0001), who also showed a lower platelet count and higher plasmatic levels of inflammatory and cardiac markers. Mitral valve insufficiency, left ventricular wall motion alterations, pericardial effusion, and coronary artery alterations were observed in 30%, 30%, 19.8%, and 18.6% of the patients, respectively. Days to initiation of treatment, rash, lymphopenia, and low platelet count were significant independent contributions to PICU admission. CONCLUSION: Rates of severe outcomes of PIMS-TS in the present study agreed with those observed in high-income countries. Together with other published studies, this work helps clinicians to better understand this novel clinical entity.
Subject(s)
COVID-19 , Lymphopenia , Mucocutaneous Lymph Node Syndrome , Thrombocytopenia , Child , Humans , Adolescent , COVID-19/complications , SARS-CoV-2 , Argentina , Prospective Studies , Systemic Inflammatory Response Syndrome/complications , Mucocutaneous Lymph Node Syndrome/complications , Thrombocytopenia/complications , Lymphopenia/complicationsABSTRACT
Transcatheter pulmonary valve replacement has become an attractive alternative to surgical approach in patients with dysfunctional right ventricular outflow tract. However, in certain cases, an unfavorable anatomy might complicate optimal valve deployment and stability. Several techniques have been described to reshape the landing zone and allow proper implantation of the transcatheter valve. Among them, the hybrid approach has gained attention as an interesting method for off-pump pulmonary valve replacement in patients with dilated right ventricular outflow tract. But to date, there is no standardized method to resize and reshape the landing zone for the stented valve. Here, we describe a reproducible method based on simple geometric rules to allow adequate remodeling of the main pulmonary artery to the desired dimensions in a single attempt, followed by perventricular implantation of a Venus P-valve.
Subject(s)
Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Pulmonary Valve Insufficiency , Pulmonary Valve , Cardiac Catheterization , Humans , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/surgery , Pulmonary Valve/diagnostic imaging , Pulmonary Valve/surgery , Pulmonary Valve Insufficiency/diagnostic imaging , Pulmonary Valve Insufficiency/surgery , Treatment OutcomeABSTRACT
Introduction: Hypertension (HTA) is an important comorbidity in children with aortic coarctation (COAO) and 24-hour ambulatory blood pressure monitoring (ABPM) allows an accurate diagnosis. Objective: Describe the prevalence of HTA in the office and its recategorization with ABPM Material and methods: Descriptive, observational, retrospective study; It included children between 4 and 18 years with COAO who performed ABPM. PA was registered in the office and ABPM, echocardiogram and medication. Results: 33 patients, 26 men, age 10.2 ± 3.8 years, By PA in the office: 22 normotensive; 8 HTA controlled; 2 preHTA; 1 HTA not medicated. With 32 complete MAP records, they were categorized: normotensive 11, preHTA 7, nocturnal HTA 3, masked HTA 4; HTA controlled 3; Uncontrolled HTA 3 and 1 HTA. Conclusion: The prevalence of hypertension in this population in the office was low. The ABPM recategorized and detected nocturnal HTA and masked HTA.
Introducción: La hipertensión arterial (HTA) es una comorbilidad importante en niños con coartación de aorta (COAO) y el monitoreo ambulatorio de presión arterial de 24horas (MAPA) permite un diagnóstico preciso. Objetivo: Describir la prevalencia de HTA por presión arterial (PA) en consultorio y su recategorización con MAPA Material y Método: Estudio descriptivo, observacional, retrospectivo; incluyó niños entre 4y18 años con COAO que realizaron MAPA. Se registró PA en consultorio y MAPA, ecocardiograma y medicación. Resultados: 33 pacientes, 26 varones, edad 10,2 ± 3,8 años, Por PA en consultorio: 22 normotensos; 8 HTA controlada; 2 preHTA; 1 HTA no medicado. Con 32 registros completos de MAPA, se recategorizaron: normotensos 11, preHTA 7, HTA nocturna 3, HTA enmascarada 4; HTA controlada 3; HTA no controlada 3 y 1 HTA. Conclusión: La prevalencia de HTA en esta población en consultorio fue baja. El MAPA recategorizó y detectó HTA nocturna e HTA enmascarada.
Subject(s)
Aortic Valve Stenosis , Blood Pressure Monitoring, Ambulatory , Hypertension , Blood Pressure , Child , Follow-Up Studies , Hospitals, Pediatric , Humans , Hypertension/diagnosis , Hypertension/epidemiology , Male , Retrospective StudiesABSTRACT
La taquicardia ventricular polimórfica catecolaminérgica es un tipo de taquicardia ventricular que se presenta en corazones estructuralmente sanos,Se caracterisa por desencadenarse ante episodios de liberación de catecolaminas,es decir,ante situaciones de estrés físico o emocional.Esta taquicardia puede dar lugar a episodios sincopales y puede derivar en fibrilación ventricular con reisgo de muerte súbita.se encuentran antecedentes familiares de síncope o muerte súbita en el 40 por ciento de los casos.El tratamiento crónico con beta-bloqueantes es de elección y evita las recurrencias.Se describe una paciente de 14 años con síncopes a repetición,relacionados con estados emocionales,tratada inefectivamente con anticolvusionantes,con electroencefalograma normal,sin cardiopatía estructural y QTc normal,El holter demostró la relacion entre la taquicardia ventricular y el síncope.El tratamiento con nadolod fue efectivo en la prevención de nuevos síncopes
Subject(s)
Adolescent , Adrenergic beta-Antagonists , Catecholamines , Death, Sudden, Cardiac , Syncope , Tachycardia, Ventricular , PediatricsABSTRACT
La taquicardia ventricular polimórfica catecolaminérgica es un tipo de taquicardia ventricular que se presenta en corazones estructuralmente sanos,Se caracterisa por desencadenarse ante episodios de liberación de catecolaminas,es decir,ante situaciones de estrés físico o emocional.Esta taquicardia puede dar lugar a episodios sincopales y puede derivar en fibrilación ventricular con reisgo de muerte súbita.se encuentran antecedentes familiares de síncope o muerte súbita en el 40 por ciento de los casos.El tratamiento crónico con beta-bloqueantes es de elección y evita las recurrencias.Se describe una paciente de 14 años con síncopes a repetición,relacionados con estados emocionales,tratada inefectivamente con anticolvusionantes,con electroencefalograma normal,sin cardiopatía estructural y QTc normal,El holter demostró la relacion entre la taquicardia ventricular y el síncope.El tratamiento con nadolod fue efectivo en la prevención de nuevos síncopes
