ABSTRACT
BACKGROUND: Dilated cardiomyopathy is the primary indication for heart transplantation in children beyond infancy. Although beta-blockers improve symptoms, ejection fraction, and survival in adults with congestive heart failure, little is known of their effects in children. METHODS: This study reviews our pediatric experience with the beta-blocker, metoprolol, at 3 institutions. We gave metoprolol to 15 children, age 8.6 +/- 1.3 years (range 2.5 to 15 years), with idiopathic dilated cardiomyopathy (n = 9), anthracycline cardiomyopathy (n = 3), and Duchenne muscular dystrophy cardiomyopathy, postmyocarditis cardiomyopathy, and post-surgical cardiomyopathy (n = 1 each). All had been treated with conventional medications (digoxin, diuretics, and ACE inhibitors) for 22.5 +/- 9 months before starting metoprolol. Metoprolol was started at 0.1 to 0.2 mg/kg/ dose given twice daily and slowly increased over a period of weeks to a dose of 1.1 +/- 0.1 mg/kg/day (range 0.5 to 2.3 mg/kg/day). RESULTS: Between the time point of stabilization on conventional medications and the initiation of metoprolol therapy, there was no significant change in fractional shortening (13.1 +/- 1.2% vs 15.0 +/- 1.2%) or ejection fraction (25.6 +/- 2.1% vs 27.0 +/- 3.4%). However, after metoprolol therapy for 23.2 +/- 7 months, there was a significant increase in fractional shortening(23.3 +/- 2.6%) and ejection fraction (41.1 +/- 4.3%) (p < 0.05). CONCLUSIONS: Metoprolol improves ventricular function in some children with dilated cardiomyopathy and congestive heart failure. Further study is warranted to better define which children may benefit most from beta-blocker therapy and which beta-blockers are most efficacious.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Cardiomyopathy, Dilated/drug therapy , Heart Failure/drug therapy , Metoprolol/therapeutic use , Adolescent , Cardiomyopathy, Dilated/complications , Cardiomyopathy, Dilated/physiopathology , Child , Child, Preschool , Echocardiography , Heart Failure/complications , Heart Failure/physiopathology , Humans , Stroke Volume , Ventricular Function, LeftABSTRACT
We describe a patient with protein-losing enteropathy who presented 6 months after undergoing a modified Fontan operation. After failing to respond to medical therapy, the Fontan tunnel was fenestrated by catheter intervention with immediate improvement and resolution of hypoproteinemia and enteric protein loss.
Subject(s)
Fontan Procedure/adverse effects , Heart Defects, Congenital/surgery , Postoperative Complications/etiology , Protein-Losing Enteropathies/etiology , Angiography , Cardiac Catheterization , Child, Preschool , Echocardiography, Transesophageal , Follow-Up Studies , Heart Defects, Congenital/diagnosis , Humans , Male , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Pulmonary Artery/diagnostic imaging , ReoperationABSTRACT
Seventeen consecutive patients undergoing bidirectional cavopulmonary anastomosis (BDCPA) using normothermic, noncardioplegic, cardiopulmonary bypass were studied preoperatively and early postoperatively (12.2 days) using transthoracic echocardiographic techniques. The purpose of the study was to assess the changes in left ventricular mechanics associated with the change in blood flow related to the BDCPA. Of the 17 patients, pulmonary atresia and tricuspid stenosis was present in 7, tricuspid atresia in 6, double inlet left ventricle in 3, and severe pulmonic stenosis with straddling of the tricuspid valve in 1. All other forms of single ventricle type anatomy and other patients undergoing BDCPA were excluded for the purposes of this study. The mean left ventricular end-diastolic volume index fell from 120 mL/m2 to 91.1 mL/m2 (p < 0.05). Similarly the left ventricular end-systolic volume index fell from 55.8 mL/m2 to 42.3 mL/m2, respectively (p < 0.05). The stroke volume index also fell from 64.5 mL/m2 to 48.8 mL/m2. Left ventricular ejection fraction was preserved and was unchanged in every patient. It was concluded that BDCPA, performed as described above, preserves left ventricular function and that the systolic and diastolic volumes as well as the stroke volume are significantly decreased as evidence of improvement of left ventricular mechanics. The continued use of the BDCPA either as a definitive procedure or as a staged procedure in preparation for total cavopulmonary connection is therefore endorsed.
Subject(s)
Heart Ventricles/abnormalities , Pulmonary Artery/surgery , Vena Cava, Superior/surgery , Ventricular Function, Left , Anastomosis, Surgical , Child , Child, Preschool , Echocardiography , Female , Heart Defects, Congenital/physiopathology , Heart Defects, Congenital/surgery , Humans , Infant , Male , Stroke VolumeABSTRACT
A study of a sample of 251 children aged between 1 and 10 was carried out in 6 districts of Cubatão county, S. Paulo State, Brazil. This study showed the presence of organochlorine pesticides in the blood serum of 242 children. p-p' DDE was detected in 73 of the samples (30%) and HCH in 47 of them (19%). The mean value of p-p' DDE was 0.85 +/- 2.13 micrograms/l. and that of HCH was 0.28 +/- 0.79 micrograms/l. Lead and mercury were also detected in the blood serum. The mean value for lead was 17.8 +/- 5.8 micrograms/l. and for mercury was 9.1 +/- 0.79 micrograms/l. The levels found in consumers of aquatic organisms taken from the rivers of Cubatão showed a mean mercury level (mean = 14.7 +/- 7.1 micrograms/l.) higher than (p < 0.04) that of those who did not consume any aquatic organisms at all (mean = 10.0 +/- 6.5 micrograms/l.).
