The use of B-type natriuretic peptide in paediatric patients: a review of literature.

OBJECTIVE: Plasma levels of brain natriuretic peptide (BNP) and its inactive fragment N-terminal pro-BNP are recognized as reliable markers of ventricular dysfunction in adults. We aimed to verify BNP applications in children. METHODS: A review of the literature on this subject was carried out. RESULTS: When dealing with paediatric patients, age and sex-related normal values must be considered. Higher BNP plasma levels are reported in children with chronic heart failure; they are related with the type of dysfunction and with prognosis. Moreover, increased BNP levels have been reported in asymptomatic children and adolescents pretreated with anthracyclines, who are at risk for ventricular dysfunction. CONCLUSION: BNP and pro-BNP also seem to be effective markers of ventricular dysfunction in paediatric patients. Clinical use may be extended not only for the characterization of heart dysfunction, but also for monitoring asymptomatic patients at specific risk. To this purpose, wider application in clinical trials appears warranted.

Prenatal diagnosis and postnatal outcome in patients with absent pulmonary valve syndrome not associated with tetralogy of Fallot: report of one case and review of the literature.

Echocardiographic diagnosis of absent pulmonary valve syndrome and muscular ventricular septal defect was made in a fetus of gestational age 25 weeks referred for marked dilation of the right ventricle at obstetric ultrasound examination. Delivery was planned in a tertiary-level center. The neonate became severely symptomatic for respiratory distress and heart failure during the second day of life. His clinical condition dramatically improved after surgical closure of a large ductus arteriosus. The child is still asymptomatic 30 months later. In the minority of cases with absent pulmonary valve not associated with tetralogy of Fallot, irrespective of the presence of muscular ventricular septal defect, early closure of the ductus may be crucial to improve hemodynamic conditions and postpone surgical correction.

Usefulness of integrated imaging in the diagnosis of a rare coronary artery anomaly in a young athlete.

Congenital coronary artery anomalies are a rare cause of major cardiovascular events in adolescents who practise sports activities. Therefore, symptoms suggestive of cardiac ischaemia should always be carefully considered and subjects should undergo a complete cardiovascular assessment. We describe the case of a young non-competitive athlete, referring episodes of exertional chest pain and syncope, in whom multiple imaging techniques allowed the diagnosis of intramural course of the left anterior descending coronary artery.

An unusual case of tricuspid lesion in congenital corrected transposition of the great arteries.

An unusual case of severe supravalvular stenosing ring of the left atrium associated with tricuspid valve dysplasia in an adult symptomatic patient affected by congenitally corrected transposition and unrestrictive ventricular septal defect is reported. The stenosis of the systemic atrioventricular valve possibly prevented the development of obstructive pulmonary vascular disease; removal of the membrane, attached to the tricuspid annulus, together with pulmonary banding was carried out. Clinical conditions improved after surgery. The unusual stenotic lesion of the systemic right ventricular inflow allowed conservative surgical palliation in this adult patient.

Hyponatraemic-hypertensive syndrome in a 15-month-old child with renal artery stenosis.

In this report we present the case of a 15-month-old girl with hyponatraemic-hypertensive syndrome (HHS) caused by stenosis of the left renal artery. On sonographic examination the contralateral non-stenotic kidney appeared enlarged and with cortical hyperechogenicity mimicking a parenchymal lesion. After successful percutaneous transluminal angioplasty, when the girl became normotensive, her serum electrolyte and acid-base balance became normal within a few days. The contralateral non-stenotic kidney hyperechogenicity also disappeared, but only after a period of 6 months, suggesting parenchymal damage due to tubulointerstitial injury, even though reversible. Our case confirms that renovascular hypertension may rarely also be present with HHS in children and that metabolic and morphological alterations are reversible after the resolution of arterial stenosis.

[Usefulness of Doppler ultrasound in the diagnosis of renal artery stenosis in hypertensive children. Two case reports and review of the literature]. / Utilità dell'ecografia Doppler per la diagnosi di stenosi delle arterie renali nel bambino con ipertensione arteriosa. Descrizione di due casi e revisione della letteratura.

Renal artery stenosis, mainly due to fibromuscular dysplasia, is the second more common cause of arterial hypertension in children, after aortic coarctation. Two children sent to our Center of Pediatric Cardiology, one for arterial hypertension and the other for renal failure (associated with severe hypertension not previously recognized) are reported. In both of them the diagnosis of renal artery stenosis was established at Doppler ultrasonography, performed at the time of Doppler echocardiography. Both children were submitted to successful percutaneous transluminal angioplasty; short- and medium-term results are evaluated by Doppler ultrasonography. Renovascular disease is a potentially curable cause of renal artery stenosis in children. Renal artery evaluation by Doppler ultrasound is recommended in all hypertensive children who undergo Doppler echocardiography.

The effectiveness of octreotide in the treatment of post-operative chylothorax.

UNLABELLED: Chylothorax may be spontaneous or a complication of thoracic surgery. Treatment of this potentially harmful condition is not well established and may comprise dietary interventions and surgery. Somatostatin seems effective in the management of chylothorax, although its mechanism of action is unclear. CONCLUSION: octreotide, a somatostatin analogue, may be effective in the treatment of post-operative chylothorax.