Subject(s)
Catheterization, Central Venous/methods , Heart Atria/abnormalities , Heart Defects, Congenital/diagnosis , Vascular Malformations/surgery , Vascular Surgical Procedures/methods , Vena Cava, Superior/surgery , Diagnosis, Differential , Echocardiography , Follow-Up Studies , Humans , Infant, Newborn , Male , Phlebography , Tomography, X-Ray Computed , Vascular Malformations/diagnosis , Vena Cava, Superior/abnormalitiesABSTRACT
PURPOSE: Pediatric Kawasaki ocular involvement is dominated by bulbar conjunctival injection and mild, self-limited anterior uveitis. Posterior segment involvement is rare. METHODS/RESULTS: Case Report. Despite early efficient treatment including aspirin and intravenous immunoglobulins, a 12-year-old girl developed a severe bilateral global inflammatory ocular involvement including punctuated keratitis, retrodescemetic precipitates, anterior uveitis, vitritis, and bilateral optic disc swelling with papillitis. DISCUSSION: This is the first description of severe bilateral global inflammatory involvement of the eyes in Kawasaki disease (KD). Usually subclinical and self-limited, eye involvement in KD can lead to severe visual impairment. CONCLUSIONS: Inflammation of both anterior and posterior segments does not seem to respond to KD-specific treatment and could justify a specific ophthalmologic therapeutic approach.
Subject(s)
Eye Diseases/diagnosis , Mucocutaneous Lymph Node Syndrome/diagnosis , Papilledema/diagnosis , Uveitis, Anterior/diagnosis , Vitreous Body/pathology , Child , Female , Humans , Keratitis/diagnosis , Optic Disk/pathology , Vision Disorders/diagnosis , Visual AcuityABSTRACT
We extracted L., the newborn of a diabetic mother, for antenatal diagnostic of myocardial hypertrophy and anomaly of foetal heart rate. Post-natal echocardiography showed severe septal myocardial hypertrophy with latero-basal myocardial akinesia. We did not observe a Doppler gradient through the left ventricular outflow. Selective coronary angiography showed an occlusion of the circumflex artery. Myocardial hypertrophy is a classic complication in newborns of diabetic mothers. The mother's diabetes and neonatal infarction remain an exceptional association. We discuss a different hypothesis to explain coronary occlusion and how myocardial infarction avoided septal obstruction.
Subject(s)
Myocardial Infarction/diagnosis , Myocardial Infarction/etiology , Pregnancy in Diabetics/therapy , Adult , Female , Humans , Infant, Newborn , Male , Myocardial Infarction/therapy , Pregnancy , Pregnancy in Diabetics/diagnosisABSTRACT
BACKGROUND: The proximal isovelocity surface area (PISA) method is validated to quantify mitral regurgitation (MR) and ventricular shunt (VS). However, the two-dimensional echocardiography (2DE) PISA method assumes a hemispherical distribution of velocity factors proximal to the MR or VS orifice. AIM: To assess the PISA shape by three-dimensional echocardiography (3DE) in a paediatric population with MR or VS. According to the true PISA shape, we suggest different models to calculate the MR or VS volume by the 3DE PISA method. METHODS: Thirty-one paediatric patients (aged 1month to 20years, median 69months) were included: 17 had MR and 14 had VS. The orifice area and volume of MR and VS were evaluated by 2DE. 3DE acquired the entire PISA volume at orifice level. The PISA shape was estimated according to three diameters as being hemispherical, prolate hemispheroid, oblate hemispheroid and hemiellipsoid. RESULTS: Data from 28patients were analysed. The PISA shape was variable: hemispherical, 11%; prolate hemispheroid, 43%; oblate hemispheroid, 32%; hemiellipsoid, 14%. Oblate hemispheroids occurred more frequently in the MR group (47%), whereas prolate hemispheroids occurred more frequently in the VS group (62%); hemispheres were scarce in both groups (10%). The mean MR or VS orifices and volumes measured by 2DE and 3DE were significantly different (0.123cm(2) versus 0.094cm(2) and 13.2mL versus 10.1mL, respectively; p=0.019). CONCLUSIONS: 3DE describes the true surface of the PISA shape. In a paediatric population with MR or VS, the PISA is rarely hemispherical but is more often prolate or oblate hemispheroid.
Subject(s)
Echocardiography, Doppler, Color , Echocardiography, Three-Dimensional , Heart Defects, Congenital/diagnostic imaging , Mitral Valve Insufficiency/diagnostic imaging , Adolescent , Child , Child, Preschool , Heart Defects, Congenital/physiopathology , Humans , Image Interpretation, Computer-Assisted , Infant , Mitral Valve Insufficiency/physiopathology , Models, Cardiovascular , Observer Variation , Predictive Value of Tests , Reproducibility of Results , Ventricular Function , Young AdultABSTRACT
BACKGROUND: Evaluation of mitral-regurgitation (MR) severity in infants is challenging. Real-time three-dimensional echocardiography (RT3DE) allows accurate left-ventricular volumetric measurements in adults. AIMS: To validate RT3DE by measuring stroke volume in a normal paediatric population, then to use this new method to calculate regurgitant volume in paediatric patients with MR. METHODS: Fifty-four patients, aged one week to 19 years, (29 without and 25 with MR) had two-dimensional echocardiography coupled with RT3DE left-ventricular volumetric acquisition. Stroke volume was calculated by the Doppler method at the aortic annulus (SV(D)). End-systolic and end-diastolic left-ventricular volumes were measured using the QLab semi-automated method; three-dimensional stroke volume (SV(3D)) was calculated as their difference. In the MR group, regurgitant volume was calculated by the PISA method (RV(PISA)) and as the difference between SV(3D) and SV(D) (RV(3D)). Regurgitant fraction was also evaluated by these methods (RF(PISA) and RF(3D)). RESULTS: Measurement feasibility was 88%. In the normal group, SV(3D) (27.9+/-18.1 ml) was highly correlated with SV(D) (30.7+/-19.6 ml; r=0.98; p<0.000). In the MR group, RV(PISA) (15.7+/-14.4 ml) and RV(3D) (11.0+/-10.2 ml) were well correlated (r=0.83; p<0.001). Regurgitant fractions were also well correlated (RF(PISA)=30.4+/-17.0%; RF(3D)=24.3+/-15.9%; r=0.79, p=0.006). CONCLUSION: RT3DE is a simple, rapid and reliable method for evaluating stroke volume in children and may, therefore, be useful for evaluating regurgitant volume and fraction in paediatric patients with MR.
Subject(s)
Echocardiography, Doppler, Color , Echocardiography, Three-Dimensional , Mitral Valve Insufficiency/diagnostic imaging , Adolescent , Child , Child, Preschool , Feasibility Studies , Humans , Infant , Infant, Newborn , Mitral Valve Insufficiency/physiopathology , Predictive Value of Tests , Reproducibility of Results , Severity of Illness Index , Stroke Volume , Ventricular Function, Left , Young AdultSubject(s)
Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessels/diagnostic imaging , Echocardiography, Doppler, Color , Echocardiography, Three-Dimensional , Heart Failure/etiology , Mitral Valve Insufficiency/etiology , Pulmonary Artery/diagnostic imaging , Cardiac Surgical Procedures , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/surgery , Coronary Vessels/surgery , Heart Failure/diagnostic imaging , Heart Failure/physiopathology , Humans , Infant , Male , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/physiopathology , Myocardial Contraction , Pulmonary Artery/abnormalities , Stroke Volume , Treatment Outcome , Ventricular Function, LeftSubject(s)
Ebstein Anomaly , Fetal Diseases/pathology , Tricuspid Valve/pathology , Adolescent , Adult , Arrhythmias, Cardiac/etiology , Child , Child, Preschool , Ebstein Anomaly/embryology , Ebstein Anomaly/pathology , Ebstein Anomaly/therapy , Echocardiography , Echocardiography, Three-Dimensional , Electrocardiography , Female , Humans , Infant , Infant, Newborn , Pregnancy , Prenatal Diagnosis/methods , Treatment Outcome , Tricuspid Valve/embryologyABSTRACT
Three-dimensional echocardiography (3DE) enables new views of heart valves and the septa to be imaged. While the previous 3DE system was cumbersome, the recent introduction of live 3DE allowed for routine use of the technique in adult patients. Here, we report our initial experiences in adapting live 3DE and the adult matrix probe to the pediatric population. Thirty-four 3DE examinations were performed on children, aged 1 day to 12 years (n = 23; median 4 years) and fetuses 20-33 weeks in gestation (n = 11; median 25 weeks), many of whom had various congenital heart diseases. The pediatric matrix probe (2-7 MHz) was used for 2D, Doppler, and 3DE. New modalities of the Vision 2007 (Philips) were applied: live, full volume, thick slice, 3D color Doppler, the QLAB system for navigation, and cropping. The pediatric matrix probe allows for complete 2D and 3D echocardiography, and new acoustic windows are now available to perform live 3DE. The higher frequency of the probe increases the 3D image resolution obtained in neonates and fetuses. This advancement allows new views of the aorta, pulmonary valve, septa and intra cardiac anatomy to be captured. Real time 3DE is a feasible method in addition to conventional 2D echocardiography for evaluating congenital heart disease.
Subject(s)
Echocardiography, Three-Dimensional/instrumentation , Heart Defects, Congenital/diagnostic imaging , Pediatrics/instrumentation , Transducers , Ultrasonography, Prenatal/instrumentation , Child , Child, Preschool , Echocardiography, Three-Dimensional/methods , Equipment Design , Equipment Failure Analysis , Humans , Image Enhancement/instrumentation , Infant , Infant, Newborn , Reproducibility of Results , Sensitivity and Specificity , Ultrasonography, Prenatal/methodsABSTRACT
OBJECTIVE: An adult trial reported the efficacy of recombinant human erythropoietin in critically ill patients with a 19% decrease in red blood cell transfusion. Our aim was to evaluate the relevance of this prophylactic treatment in children hospitalized in a pediatric intensive care unit (PICU). DESIGN: Cohort study from January 1995 to December 2004. SETTING: University hospital PICU. PATIENTS: Children between 1 month and 18 yrs of age. INTERVENTIONS: We searched through a prospective databank for all children hospitalized in the PICU for > or =4 days (potential recipients of erythropoietin, as proposed in the adult trial) and transfused with red blood cells after day 7 following PICU entry (in whom erythropoietin might prevent anemia, according to results of the adult trial). MEASUREMENTS AND MAIN RESULTS: We found that 799 of 2,578 children (31%) were hospitalized for > or =4 days. The study group comprised 787 patients who were hospitalized for > or =4 days in the PICU and for whom full records were available. One hundred eighty-three children in this study group were transfused during their stay in the PICU (median age, 7 months; weight, 6.60 kg). Hemoglobin levels before transfusion (mean +/- sd) were 7.7 +/- 1.5 g/dL. These transfused children represented 23% of the study group and 7% of the total PICU admissions. Forty-seven children (6% of the study group, 2% of the total PICU admissions) were transfused with red blood cells after 7 days of hospitalization and could have benefited from a prophylactic treatment with erythropoietin. Relative risk to benefit of a prophylactic treatment by erythropoietin was higher in cases of mechanical ventilation (relative risk, 1.18) and inotropic treatment (relative risk, 1.72) and if the main diagnosis involved dermatological (relative risk, 3.03) or oncologic disease (relative risk, 3.94). CONCLUSIONS: If we applied the results of the adult trial to our PICU, we would have to treat 31% of the children with prophylactic erythropoietin and thereby expect a reduction of one red blood cell transfusion for every 17 treated patients.
