Bacterial pericarditis in infancy and childhood.

The authors report on a cooperative study of 43 cases of bacterial pericarditis observed in children. This disorder was suspected in patients with septicemia who developed symptoms and signs of pericarditis (precordial pain, muffled heart sounds, pericardial friction rub, cardiomegaly). Early diagnosis of this condition is now facilitated by echocardiography. A combination of medical and surgical treatments (appropriate antibiotic therapy after culture and sensitivity tests and early pericardial drainage) led to complete recovery in almost all of the cases (42 of 43). After long-term follow-up, no cases of constrictive pericarditis were observed.

[Idiopathic asymmetric heart hypertrophy in a newborn infant]. / Idiopathische asymmetrische Herzypertrophie bei einem Neugeborenen.

A sporadic case of idiopathic asymmetric heart hypertrophy in a newborn infant is reported. Despite drug therapy the baby died in progressive heart failure at 23 days of age. At necropsy there was cardiac hypertrophy with features similar to those of the usual asymmetric from observed in adults. On gross examination the myocardium of the ventricular septum and the free wall of the left ventricle showed a disorganized structure. Microscopically, the changes consisted of an abnormal arrangement of muscle cells and muscle bundles with areas of hypertrophied myofibers. In agreement with other authors myocardial disorganization ("disarray") is interpreted as a form of dysplasia, hypertrophy being a secondary phenomenon. The hypothesis that these abnormalities represent the persistence of the embryonic myocardial structure is discussed. The pathogenetic significance of focal myocardial dysplasias is apparently related to the amount of myocardium involved.

[Percutaneous transluminal angioplasty in stenosis of Blalock-Taussig pulmonary systemic shunt in an adult patient]. / Angioplastía percutánea transluminal en estenosis de la derivación sistémico pulmonar de Blalock-Taussig en paciente adulto.

AIM: The report of a female patient with tricuspid atresia and severe stenosis of the pulmonary artery, stenosis of the left pulmonary-systemic shunt and occlusion of the right systemic-pulmonary shunt. BACKGROUND: The use of transluminal angioplasty has been extended to the treatment of several congenital cardiopathies and, in some of them, it is the therapeutic procedure of choice. METHODS: Dilatation of the distal stenosis of the pulmonary-systemic shunt with a coaxial system composed initially by an 8 French right Judkins carrier catheter with a soft tip through which a 0.014" (0.036 cm) coronary angioplasty guidewire and 3 and 4 mm balloon catheters were advanced successively. Subsequently a 0.028" interchange Rosen guide was advanced, gradually introducing balloon catheters up to 8 mm of diameter. RESULTS: The dilatation with balloon catheter systems of increasing diameter allowed to amplify the stenosis zone, improving arterial oxygen partial pressure and saturation without evidences of left lung hyperflux. Considering the anatomic characteristics of the pulmonary systemic shunt, the use of carrier catheters facilitates the penetration of balloon catheters to the stenosis zone. CONCLUSION: Percutaneous transluminal angioplasty may be used with success in patients with stenosis of Blalock-Taussig shunts, independent of the anastomosis curvature and even if the magnitude of the stenosis is significant.

[Neonatal infectious endocarditis. Apropos of 5 cases]. / Endocardites infectieuses néonatales. A propos de cinq observations.

Five cases of neonatal infective endocarditis are reported. The mitral, tricuspid and pulmonary valves were involved either alone or in association. The predisposing factors were multiple: umbilical catheter, respiratory distress with assisted ventilation, septicemia, osteoarthritis or gastroenteritis. Only one child had a minor cardiac malformation. The causal organism was a staphylococcus aureus in all cases. All children had disseminated intravascular coagulation and a cardiac murmur. The diagnosis was confirmed by echocardiographic demonstration of bacterial vegetations. Three of the 5 children died despite long-term antibiotic therapy. In one case, a vegetation embolised to the pulmonary artery. In the two cured neonates the vegetations disappeared. These cases illustrate the value of echocardiography which should be performed in all neonates with septicemia or disseminated intravascular coagulation, especially when there is an associated cardiac murmur.

[Cardiac involvement in Kawasaki disease]. / Compromiso cardíaco en la enfermedad de Kawasaki.

Cardiovascular complications (CVC) of Kawasaki disease (KD) are described in 15 affected children (10 boys, mean age 18.5 months). Clinical records, electrocardiographic tracings (ECG) and bidimensional echocardiograms (BDE) were analysed. In each case the first BDE was done at clinical diagnosis (mean time 10 days from initial symptoms of disease), then at weekly intervals for the first month and each two weeks along the second month. In children showing persistent coronary artery lesions (CAL) BDE was repeated monthly and in patients without CVC at three month intervals. During follow up, no definite clinical evidence of miocardial ischemia was found, but abnormal BDE recordings were obtained from 12/15 patient: CAL in 9/15; right ventricular, left ventricular and aortic enlargement in 3/15. CAL were located at the left coronary artery (LCA) in 3/9 (one LCA aneurysm) and at both coronary arteries in 6/9 (including 3 cases with bilateral aneurysms). All patients were given aspirin and seven were also treated with intravenous gammaglobulin, this last at day 9 (mean) of disease, but 5 of them developed CVC, including 3 cases of CAL.

[Transient myocardial ischemia in newborn infants]. / Ischémie myocardique transitoire du nouveau-né.

Thirty new born babies with Apgar scores of 5 or less were randomly selected for clinical and electrocardiographic study. Twenty five had electrocardiographic changes of myocardial ischaemia (ST and T wave abnormalities). Generalised low voltage was a common finding (21 cases) whilst pathological Q waves were observed more rarely (5 cases) but did not seem to carry a poor prognosis. Seventeen babies had cardiac clinical signs: isolated tricuspid regurgitation or associated with cardiac failure. Five babies died; autopsy showed subendocardial infarction in all cases. The electrocardiogram of the survivors returned to normal within 15 days in 80% of cases. The authors discuss the physiopathology and demonstrate a clear relationship between neonatal hypoxia and myocardial ischaemia. Attentive clinical examination and systematic electrocardiography in these babies at risk seem to be justified for the detection and treatment of myocardial ischaemia.

Comunicacion interauricular tipo ostium secundum analisis y seguimiento de 80 casos. / Interatrial defect type ostium secundum. Analysis and follow-up of 80 cases

Se exponen los hallazgos clinicos y hemodinamicos en 80 ninos portadores de Comunicacion Interauricular tipo Ostium Secundum (CIA-OS). Se efectua un seguimiento post - operatorio en 61 de ellos, durante un periodo de tiempo que fluctuo entre 1 mes y 6 anos. Se concluye que la CIA-OS es una cardiopatia poco sintomatica en la infancia cuyo diagnostico infrecuentemente se realiza en los primeros anos de la vida. Sin embargo existen elementos clinicos caracteristicos para diagnosticarla que incluso permiten predecir el grado de shunt. Contrariamente con lo que sucede en el adulto, el tratamiento quirurgico en ninos con CIA-OS es de bajo riesgo y de baja mortalidad (0% de mortalidad y 4,9% de morbilidad en nuestra serie). De ahi la importancia de diagnostico y tratamiento quirurgico precoces