ABSTRACT
The presumed limited growth potential of saphenous vein grafts has led many authorities to discourage their use in young children. We documented excellent growth and patency of a saphenous vein graft 13 years after operation in a 7-year-old child with coronary artery obstruction caused by Kawasaki disease.
Subject(s)
Coronary Artery Bypass , Mucocutaneous Lymph Node Syndrome/surgery , Saphenous Vein/transplantation , Age Factors , Body Height , Body Weight , Child , Collateral Circulation , Coronary Disease/etiology , Coronary Disease/surgery , Coronary Vessels/pathology , Follow-Up Studies , Humans , Male , Mucocutaneous Lymph Node Syndrome/complications , Saphenous Vein/growth & development , Vascular PatencyABSTRACT
A 10-year-old boy with congestive heart failure died in five months in spite of comprehensive medical treatment. Autopsy showed patchy areas of endocardial fibroelastosis of the left ventricle. The sister of this patient had followed a similar course at 13 years of age with death within six months of the onset of congestive failure. Her postmortem examination also showed endocardial fibroelastosis. The clinical presentation of familial endocardial fibroelastosis in the preteen and teenage years is a rare event. Probably the endocardial fibroelastosis was secondary to a familial nonobstructive cardiomyopathy.
Subject(s)
Endocardial Fibroelastosis/genetics , Heart Diseases/genetics , Adolescent , Cardiomegaly/diagnostic imaging , Child , Electrocardiography , Endocardial Fibroelastosis/etiology , Endocardial Fibroelastosis/pathology , Female , Heart Diseases/complications , Heart Failure/complications , Heart Ventricles/pathology , Humans , Male , RadiographyABSTRACT
Nine children with endocardial fibroelastosis were followed from the time of admission with congestive heart failure until either death or discharge. Review of multiple clinical features showed that only the electrocardiographic pattern could be correlated with death or survival. The presence of a delayed transition zone with anterior force loss on the initial electrocardiogram ('infarct pattern') was noted in all the children who died. Progression of these changes with a pattern of anterolateral 'infarct' in two and inferior wall 'infarct' in two occurred before death. Necropsy on three of the four children confirmed the diagnosis of endocardial fibroelastosis. There was extensive fibrosis and thinning of the left ventricular myocardium as well as involvement of the mitral valve structures. Review of published cases supports the view that an 'infarct' pattern in a child with endocardial fibroelastosis is usually associated with death and that this pattern is a negative prognostic sign for survival.
