ABSTRACT
Because intravenously administered immune globulin (IVIG) is effective in reducing the incidence of coronary artery aneurysms in Kawasaki syndrome when given at a dose of 400 mg/kg daily for 4 days, we undertook a multicenter clinical trial comparing two dosage regimens of IVIG. Patients were randomly assigned to receive IVIG at either 400 mg/kg daily for 4 days (22 patients) or 1 gm/kg as a single dose (22 patients). All patients received aspirin therapy, and all were enrolled within 7 days of onset of fever. The presence of coronary artery aneurysms was evaluated by means of two-dimensional echocardiography before infusion; at days 4 to 6, 14 to 21, and 42 to 49 after infusion; and at 1 year. Coronary artery aneurysms were detected in 3 of the 44 patients, including one patient receiving 400 mg/kg and two patients receiving 1 gm/kg (p value not significant). No giant aneurysms were detected. No major side effects occurred with either dosage regimen. Patients receiving the 1 gm/kg dose had a faster resolution of fever and were discharged from the hospital approximately 1 day sooner than the 400 mg/kg group (p = 0.01). Although the relatively small sample size in this trial does not allow for a more definitive statement regarding the occurrence of coronary artery aneurysms, it appears that the 1 gm/kg dose is associated with a more rapid clinical improvement and a shorter hospital stay.
Subject(s)
Coronary Aneurysm/prevention & control , Immunoglobulin G/administration & dosage , Mucocutaneous Lymph Node Syndrome/therapy , Aspirin/therapeutic use , Child , Child, Preschool , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/etiology , Echocardiography , Female , Humans , Immunoglobulin G/therapeutic use , Infant , Infusions, Intravenous/methods , Length of Stay , Male , Random AllocationABSTRACT
Complex ventricular anomalies are frequently associated with abnormalities of thoracic and abdominal situs, arterioventricular connection, and venous connection. The definition of all components of these anomalies is difficult to accomplish with imaging techniques. This study compared the effectiveness of electrocardiographic (ECG) gated spin-echo magnetic resonance imaging (MRI) with cardiac angiography for the evaluation of all components of central cardiovascular anatomy in patients with the clinical diagnosis of single or common ventricle or complete atrioventricular (AV) septal (canal) defect. MRI studies and angiograms of 29 patients were evaluated independently. A sequential approach was used to define cardiac anatomy assessing nine anatomic features in each patient. MRI provided 261 observations and angiography provided 209 observations. In the mutual 209 observations, only 17 discrepancies were found. Comparison of MRI and angiography in individual cases showed that MRI was as effective as angiography in the depiction of ventricular anomalies, including determination of morphology and evaluation of the size of the ventricles, the orientation of the ventricular septum relative to the AV valves, as well as the origins and spatial relationships of the great arteries. MRI was more informative for the determination of thoracic and abdominal situs and systemic and pulmonary venoatrial connections, but was not as effective for the evaluation of semilunar valves. Thus MRI provides complete evaluation of central cardiovascular anatomy and is effective in the anatomic assessment of most components of complex ventricular anomalies.
Subject(s)
Heart Defects, Congenital/diagnosis , Heart Septal Defects, Ventricular/diagnosis , Magnetic Resonance Imaging , Adolescent , Adult , Angiography , Child , Child, Preschool , Female , Heart Defects, Congenital/diagnostic imaging , Heart Septal Defects, Ventricular/diagnostic imaging , Humans , Infant , Male , Terminology as TopicABSTRACT
In conclusion, CPR at home can be successfully performed by parents who have been given adequate training. As a result of the findings of this study, our recommendation is that training in CPR should be taught to all parents of children with life-threatening dysrhythmias and complex congenital heart disease.
Subject(s)
Arrhythmias, Cardiac/therapy , Heart Arrest/therapy , Heart Defects, Congenital/complications , Parents , Resuscitation , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/mortality , Heart Arrest/etiology , Heart Arrest/mortality , Home Nursing , Humans , InfantABSTRACT
Thirteen patients, aged 3-31 years, with coarctation of the thoracic aorta were examined by magnetic resonance (MR) imaging (total of 14 studies). Eight studies were performed preoperatively and six postoperatively. Catheterization data were available on 12 patients for verification of MR imaging findings. Electrocardiographically gated sagittal and left anterior oblique images best depicted the coarctations; however, involvement of arch vessels was best evaluated on transaxial images. MR imaging readily identified all coarctations but one, their site and extent, and involvement of the arch vessels. In addition, MR images depicted poststenotic dilatation and dilated collateral vessels. In patients studied postoperatively, restenosis could be evaluated, and complications such as postoperative aneurysm and perianastomotic hematoma were identified. MR imaging provides excellent anatomic detail of coarctation of the aorta, potentially obviating the need for angiography.
