[Inflammatory heart diseases in childhood: Lebanese epidemiological survey]. / Cardiopathies d'origine inflammatoire ou infectieuse en pédiatrie. Etude épidémiologique libanaise.

OBJECTIVES: To study the frequency, prevalence, clinical presentation, management and outcome of inflammatory heart diseases (IHD) in Lebanese children. MATERIAL AND METHODS: Prospective survey of a group of children carriers (or at high risk) of an IHD (n: 156) recorded over a period of six years, between May 1st, 1999, and April 30th, 2005, at the National Register of Paediatric and Congenital Heart Disease, Lebanese Society of Cardiology. The diagnosis was confirmed in all cases by echocardiography. Cases related to cardiac surgery were excluded. RESULTS: Acute rheumatic fever (ARF) is the most frequent pathology : 35.9%, followed by Kawasaki disease (KD) : 24.4%, dilated cardiomyopathy (DCM) : 22.4%, pericardial effusion : 10.9% and finally infective endocarditis (IE) : 64%. There is a seasonal predominance for the ARF and KD during fall and early spring. Consanguineous marriage of first degree doesn't seem to be a factor predisposing for ARF and KD. ARF with carditis benefited from steroids with partial to total regression in 41/45 patients (91%), two patients underwent valve repair or replacement, another patient died from severe pancarditis. All children affected with KD (except 2 cases) received IV immunoglobulins (2 g/kg, single dose), and coronary aneurysms were observed in 2 patients (53%). Patients with DCM in whom there was a strong suspicion of viral myocarditis, were treated medically with complete recuperation of the cardiac function in 88% of cases. Among the patients with pericardial effusion, 3 needed urgent drainage because of a tamponnade. A child with IE was operated of his mitral valve and another one with cerebral palsy had a fatal outcome. No case of cardiac disease associated with HIV infection was found. CONCLUSION: In Lebanon, ARF remains the main cause of IHD during childhood, before KD. Currently, non-surgical treatments are highly efficient. Delayed diagnosis increased morbidity. Efforts are necessary for early recognition and primary prevention.

[Cardiac pacing in children with severe form of breath-holding spells, an exceptional treatment. A case report]. / Stimulation cardiaque, traitement exceptionnel dans les formes severes de spasme du sanglot de l'enfant. A propos d'un cas.

Breath-holding spells (BHS) are frequent and benign in children. Medical treatment is rarely needed but exceptionally severe forms require the implantation of a pacemaker. We describe here the case of an 18-month-old girl who presented to our department with severe episodes of BHS associated with loss of consciousness. This child necessitated the insertion of a pacemaker, which resolved her BHS.