[Repeated electrical cardioversions and amiodarone for recurrent neonatal atrial flutter]. / Réduction d'un flutter atrial néonatal récidivant par chocs de cardioversion et amiodarone.

Perinatal atrial flutter is a serious arrhythmia. Its management continues to pose a challenge during the fetal period but also, in rare intractable cases, during the postnatal period. This report describes the case of a neonate who required multiple electrical external cardioversions and amiodarone to resolve a recurrent atrial flutter. This case report suggests that neonatal atrial flutter may be recurrent at short term, that repeated electrical cardioversions with low energy are safe for a neonate, that amiodarone is effective as a premedication before cardioversion and in maintaining sinus rhythm afterward, and finally that the long-term prognosis is good, even when the arrhythmia is initially refractory to therapy.

Prevalence of early postoperative arrhythmias in children with delayed open-heart surgery for severe congenital heart disease.

UNLABELLED: BACKGROUND; Our aim was to determine the incidence, risk factors and outcome of early postoperative arrhythmias in children with delayed treatment of severe congenital heart disease. METHODS: A prospective study was conducted in 141 consecutive children with delayed referral from emerging countries, who underwent open-heart surgery. RESULTS: Sinus node dysfunction was noted in 5 cases. Preoperative moderate extrasystoly was common and its incidence significantly increased in the postoperative phase. Overall, 9 patients required specific antiarrhythmic therapy: 6 for sustained atrioventricular reciprocating tachycardia, and 3 respectively for atrial flutter, atrial fibrillation and junctional ectopic tachycardia. Non-sustained atrioventricular and ventricular tachycardia required no therapy in respectively 6 and 1 case. Postoperative complete atrioventricular block was observed in 6 patients and remained permanent in 3. No major complications resulted from those arrhythmias. Preoperative low oxygen saturation, preoperative arrhythmias, as well as long cardiopulmonary bypass time and aortic cross-clamp time, were risk factors for early postoperative arrhythmias. CONCLUSIONS: Children with delayed surgery for congenital heart disease are at risk of developing early postoperative arrhythmias depending on the complexity of their disease and of its treatment. However, their prevalence (14%) is not higher than in the general population of cardiac children.

Management of cardiac emergencies in children.

Children with heart disease may present to the Emergency Department in many stages of life, with a range of cardiovascular manifestions, from minimally irritating palpitations to the life-threatening derangements of shock or lethal dysrhythmia. Cardiac emergencies are rare in children in comparison to adults. The pathophysiology differs: ischemic heart disease is virtually unknown, whereas most cases occur secondary to congenital heart disease. Their successful management requires an accurate diagnosis and timely interventions to achieve optimal outcomes in this heterogeneous and complex patient population. The diagnosis, however, is not always straightforward, as evidenced by the non-specific clinical picture that can be presented by pediatric heart diseases. This article reviews pertinent issues concerning diagnosis and management of cardiac disorders with which children present to the emergency department. The initial diagnostic and specific therapeutic approach to these patients will be discussed.

Spectrum and workload of consultation activities in a Belgian tertiary paediatric cardiac centre.

BACKGROUND: Few data are available on the spectrum and frequency of issues addressed in the paediatric cardiology consultation service of tertiary academic hospitals. METHODS: Those activities were collected prospectively during 6 months. RESULTS: A total of 967 consultations were performed. The origin was mostly the medical ward (n = 535), the intensive care unit (n = 195), the neonatal unit (n = 97), the operating room (n = 84) and the nursery (n = 44). In 553 cases, a heart disease was previously known and the most common reasons of consultation were postoperative (n = 279) and preoperative evaluations (n = 129). Thirteen newborns had a prenatal suspicion of congenital heart disease, which was confirmed in 11 cases. For the other 401 consultations, the most common clinical concerns included cardiac function in oncological disease (n = 60), murmur (n = 48), syncope (n = 33), diabetes mellitus (n = 28), prematurity (n = 27), syndrome (n = 19), unexplained stridor or respiratory distress (n = 19) and unexplained fever (n = 15). There were new diagnoses of congenital heart disease, acquired heart disease and arrhythmias in 35, 17 and 5 cases, respectively. CONCLUSIONS: The workload of the paediatric cardiology consultation service is increasing alarmingly. These data may be helpful in future planning of consultant manpower and in curriculum development in cardiac training of students and residents.

[The cardiovascular risk in children with congenital heart disease]. / Risque cardiovasculaire chez les enfants atteints de cardiopathie congénitale.

UNLABELLED: We aimed to study the prevalence of risk factors of atherosclerosis as defined in the INTERHEART study, in children with congenital heart disease. PATIENTS AND METHOD: a cross-sectional study performed in 262 children aged from 3 to 18 years old, with an operated or non-operated congenital heart disease. They all responded to a standardized questionnaire on their lifestyle and family history of atherosclerotic disease. RESULTS: A majority of patients presented risk factors: insufficient physical activity (89.0%), lack of daily intake of fruits and vegetables (43.1%), stress (31.3%), familial risk of hypercholesterolemia (14.1%), overweight (7.6%), active smoking (20.6% in teenagers after 14 years old), hypertension (2.3%). These children had a mean of 1.9 + 1.0 risk factors. CONCLUSION: A majority of children with congenital heart disease have risk factors of atherosclerosis. The results of this study highlight the importance of atherosclerotic cardiovascular diseases prevention in these young patients.

Spectrum and frequency of illness presenting to a pediatric emergency department.

BACKGROUND: Knowledge of the spectrum and relative frequencies of pediatric emergencies is an important factor in developing appropriate training curricula for pediatric residents. MATERIAL AND METHODS: To provide these data, we indexed the 11,483 consecutive patients seen in our pediatric emergency department (PED) during the year 2003. RESULTS: Age ranged from 1 week to 27 years, with a mean age of 3.9+/-4.3 years. 52.7% of the visits were by children younger than 3 years, 9.5% by adolescents, and 0,1% by young adults with chronic conditions. 55.1% of the patients arrived on day shift, 32.5% on evening shift and 12.4% on night shift. 61.8% of the patients were seen during the evening/nighttime or on the weekends. 25.2%, 22.1% and 28.6% of the patients seen on night, day and evening shifts respectively were hospitalized. The most common chief complaints were fever (22.1%), upper respiratory tract infection (13.2%) and diarrhea (10%). The most common final diagnoses were upper respiratory tract infection (26.7%), viral syndrome (13.1%) and gastroenteritis (10.7%). The majority of chief complaints and final diagnoses were related to infection (63.9%). CONCLUSION: These data may contribute to curriculum development in training of PED physicians. We especially recommend an emphasis on management of fever and infections to optimize the quality of care delivered in the pediatric emergency department.

Delayed recognition of congenital heart disease.

OBJECTIVE: The aim of this prospective study was to evaluate the proportion of children with delayed recognition of congenital heart disease (CHD). METHODS: Of the 744 children with CHD primarily diagnosed during a 10 year period in one hospital, the patients were identified where the diagnosis of CHD was established with a significant delay. RESULTS: Sixty six patients (8.9%) had delayed diagnosis of CHD. Among patients with cyanotic CHD, 10.4% (7 of 67 cases) were referred after they had initially been discharged home from the birth clinic. Among patients with acyanotic CHD, 8.7% (59 of 677) of all children and 35.1% (59 of 168) of the children who required surgery or interventional catheterisation were referred at an age where elective repair should have already been performed or needed immediate treatment because of their haemodynamic status. Of the 66 patients with delayed diagnosis, one infant with cor triatriatum died at admission because of delayed referral and 10 children had severe complications: preoperative cardiogenic shock in seven cases of aortic coarctation and one case of endocardial fibroelastosis, pulmonary hypertensive crisis in one child after delayed repair of a ventricular septal defect, and infectious endocarditis after dental care in a teenager with undiagnosed moderate aortic stenosis, who required Ross operation a few months later. DISCUSSION AND CONCLUSION: A substantial proportion of CHD was detected with relevant delay. In all cases of late diagnosis, clinical cardiac findings were present that should have alerted the physician on the possible presence of underlying CHD.

Changes in perceived health of children with congenital heart disease after attending a special sports camp.

Sports camps for children with cardiac anomalies have existed for many years. However, no formal evaluation of the benefits of attending such camps has been undertaken heretofore. We assessed potential changes in the self-perceived health of children with congenital heart disease who attended a special sports camp. Thirty-one children with cardiac anomalies attended a 3-day multisports camp. Sixteen children, all of whom were 10 years or older, literate, and Dutch- or French-speaking, completed the Child Health Questionnaire (CHQ-CF87) before and after attending the camp. The scores of the children were compared with those of healthy peers by calculating mean standardized differences. After attendance at the sports camp, the children achieved significant improvements in the self-perception of their physical functioning, role functioning due to emotional problems, role functioning due to behavioral problems, mental health, and general behavior. The children's self-esteem and general behavior after the camp were significantly better than that of their healthy counterparts. We conclude that children with congenital heart disease who participate in activities at special sports camps may reap benefits in terms of their subjective health status. Although further research is needed, we recommend the participation in sport activities by children with heart defects, and more specifically their participation in sports camps.

[Diagnosis of congenital heart diseases]. / Diagnostic des cardiopathies congénitales.

Most of the relevant congenital heart defects are recognized by the neonatal clinical screening or even in utero by fetal echocardiographic screening. Nevertheless, a substantial percentage of defects are missed in the early screening and are diagnosed after discharge from hospital during childhood or even during adulthood. Often, this delay in making the correct diagnosis affects the overall outcome of the cardiac children. In almost all patients, cardiac findings are present that should have alerted the physician. This article reviews the importance of history and physical examination in the early diagnosis of congenital heart disease.

Patterns of physical activity determined by heart rate monitoring among diabetic children.

BACKGROUND: Children with type 1 diabetes should be encouraged to participate in physical activity because exercise can benefit insulin sensitivity and improve known risk factors for atherosclerosis. METHODS: Physical activity patterns of 127 children and adolescents with stable type 1 diabetes were investigated by 24 hour continuous heart rate monitoring. The percentage of heart rate reserve was used to measure the amounts of physical activity at different intensities. The results were compared with normative data. RESULTS: Diabetic preschoolchildren accumulated 192.7 (78.1), 39.1 (24.3), and 21.3 (9.4) minutes/day (mean (SD)) of light, moderate, and vigorous physical activity, respectively. At the same activity levels, diabetic schoolchildren accumulated 168.9 (76.7), 37.9 (15.9), and 19.0 (14.8) minutes/day, and diabetic teenagers accumulated 166.3 (67.5), 45.6 (26.9), and 25.2 (15.3) minutes/day. Diabetic schoolchildren were significantly more active than healthy peers when considering moderate activity; diabetic teenagers were significantly more active when considering moderate and vigorous activity. There was a negative correlation between the most recent glycated haemoglobin and the time spent in light activities in schoolchildren, and a negative correlation between mean glycated haemoglobin for one year and time spent in light and moderate activities in schoolchildren. CONCLUSION: The majority of our diabetic patients meet the classical paediatric guidelines for physical activity and compare favourably with their healthy peers.

[Paroxysmal tachyarrhythmias in pediatrics]. / Les troubles du rythme paroxystiques de l'enfant.

The purpose of this retrospective study was to investigate the clinical characteristics in pediatric patients with supraventricular or ventricular tachycardia. Sixty-nine pediatric patients were included. Age distribution at first episode of tachyarrythmia, most indicative symptoms and signs, associated conditions and long-term prognosis were determined for the different mechanisms of tachyarrythmia. 78% of the children had supraventricular tachycardia and 22% ventricular tachycardia. At diagnosis, 57% of the children with supraventricular tachycardia were younger than 1 year. The majority of infants were detected during routine investigation without having any complaints whereas the majority of children presented with symptoms. Recurrence was rare in cases diagnosed during infancy, but was usual in cases diagnosed beyond infancy.

Long term outcome up to 30 years after the Mustard or Senning operation: a nationwide multicentre study in Belgium.

OBJECTIVE: To assess long term outcome of patients who underwent Mustard or Senning repair for transposition of the great arteries up to 30 years earlier. DESIGN: Retrospective review of medical records. SETTING: The six university hospitals in Belgium with paediatric cardiology departments. PATIENTS: 339 patients were reviewed, of whom 124 underwent the Mustard procedure and 215 the Senning procedure. This represents almost the entire population of patients in Belgium with either simple or complex transposition. MAIN OUTCOME MEASURES: Mortality, morbidity, functional abilities, social integration. RESULTS: Overall mortality was 24.2%. Early mortality (< or = 30 days after surgery) accounted for 16.5%, late mortality for 7.7%. Actuarial survival of early survivors at 10, 20, and 30 years after surgery was 91.7%, 88.6%, and 79.3%, respectively. Patients in the Senning cohort had a slightly better survival rate than those in the Mustard cohort (NS). Baffle obstruction occurred more often after Mustard repair (15.3%) than after the Senning procedure (1.4%). Arrhythmia-free survival did not differ between the two cohorts, but was determined by the complexity of the transposition. Survivors of the Senning cohort had better functional status, and tended to engage in more sports activities. CONCLUSIONS: The long term outcome for patients surviving the Mustard or Senning operation was favourable in terms of late mortality, morbidity, functional, and social status. Overall mortality in the Senning cohort did not differ from the Mustard group, but Senning patients had better functional status, greater participation in sports activities, and fewer baffle related problems.

Patterns of physical activity defined by continuous heart rate monitoring among children from Liège.

Health benefits of a physically active lifestyle are well documented. We therefore investigated the physical activity patterns of 200 children from Liège. They were monitored continuously using a 24-hour Holter monitoring system during normal weekdays and the percentage of heart rate reserve (%HRR) was used to measure the amounts of physical activity at different intensities. Preschool children attained 184.3+/-54.2, 40.7+/-16.1, 15.8+/-6.9 and 6.0+/-7.2 minutes/day (mean+/-SD) between 20% to 40%, 40% to 50%, 50% to 60%, and greater than 60% of HRR, respectively. At the same %HRR intensities, schoolchildren attained 165.6+/-74.6, 32.1+/-12.1, 15.8+/-6.7 and 7.0+/-5.9 minutes/day, and teenagers attained 159.2+/-68.3, 32.1+/-23.5, 13.1+/-6.0 and 6.1+/-6.3 minutes/day. Age was a significant predictor of the intercept and slope of the time spent in physical activity and %HRR relationship. In Liège the average youth accumulates +/-30 to 40 minutes/day of moderate-intensity physical activity and +/-20 minutes/day of high-intensity physical activity. Those children meet the classical revised guidelines for physical activity but do not compare favourably with children from elsewhere. On the other hand, they get more than 2 1/2 to 3 hours/day of low-intensity physical activity. Our findings suggest that children from Liège are not engaged in sedentary behaviour but do not experience the ideal amount and type of physical activity classically believed to benefit the cardiopulmonary system. Public health strategies should be adapted to our findings.

[Catecholaminergic polymorphic ventricular tachycardia in a child: an often unrecognized diagnosis]. / La tachycardie ventriculaire catécholergique du jeune enfant: un diagnostic souvent méconnu.

UNLABELLED: Catecholaminergic polymorphic ventricular tachycardia is important to be diagnosed as an underlying disease in children with syncope and normal heart, because of its poor prognosis. CASE REPORT: A 3-year-old boy was referred for stress and emotion induced syncope. Primary ventricular arrhythmia, consisting of salvos of bidirectional ventricular tachycardia, was reproducibly induced by physical exertion. The syncopal events and severe arrhythmia disappeared with beta-blocking therapy. CONCLUSION: Despite its rare occurrence, catecholaminergic polymorphic ventricular tachycardia is an important cause of stress and emotion induced syncope and sudden death in children.

[Prevention of bacterial endocarditis]. / La prévention de l'endocardite bactérienne.

Because of its severity, it is agreed that infectious endocarditis should be prevented whenever possible. Certain patient populations at risk for endocarditis have been identified. Antibiotic prophylaxis is therefore recommended when these individuals undergo procedures likely to cause bacteremia with organisms that cause endocarditis. In this article we attempt to provide a comprehensive approach to infectious endocarditis prophylaxis based both on the pathophysiology of the disease and on the mechanisms of action of prophylactic drugs. Approaches to the prevention of endocarditis have been recently modified and are reviewed in this paper, especially important issues for the primary care physician.

[Observations and reflections on the management of pediatric emergencies in Belgium]. / Observations et réflexions sur la gestion des urgences pédiatriques en Belgique.

Similar to the findings of other nations, inappropriate utilization of the pediatric emergency departments is a major problem in Belgium. The majority of patients come with non-urgent complaints. Maximum rush is seen in the evening when the outpatient clinic is closed. It results in a waste of resources, stress among the emergency room staff and an increase in waiting time for patients requiring attention. It appears important to adapt to this new situation by improving the organisation of the pediatric emergency departments (triage, human resources, equipment), but also by finding alternative solutions such as health education of families and greater availability of primary care providers. This article describes the present situation and evaluates strategies that could be applied in Belgium.

[Preventive cardiology: strategies in children]. / La cardiologie préventive: stratégies chez l'enfant.

The importance of preventive cardiology in youth has been established by several critical observations: there is evidence that the atherogenic process begins in childhood, and that the degree of atherogenesis is related to measurable risk factors present during childhood. The literature indicated that long-range prevention of atheroselerosis and its sequelae by control of those risk factors should begin in childhood. This article reviews the established risk factors, the identification of high-risk individuals, public health strategies for the promotion of health in the French Community of Belgium and treatment of high-risk individuals.