Entrance radiation doses during paediatric cardiac catheterisations performed for diagnosis or the treatment of congenital heart disease.

The purpose of this study was to estimate the radiation exposure of children, during cardiac catheterisations for the diagnosis or treatment of congenital heart disease. Radiation doses were estimated for 45 children aged from 1 d to 13 y old. Thermoluminescent dosemeters (TLDs) were used to estimate the posterior entrance dose (DP), the lateral entrance dose (DLAT), the thyroid dose and the gonads dose. A dose-area product (DAP) meter was also attached externally to the tube of the angiographic system and gave a direct value in mGy cm2 for each procedure. Posterior and lateral entrance dose values during cardiac catheterisations ranged from 1 to 197 mGy and from 1.1 to 250.3 mGy, respectively. Radiation exposure to the thyroid and the gonads ranged from 0.3 to 8.4 mGy to 0.1 and 0.7 mGy, respectively. Finally, the DAP meter values ranged between 360 and 33,200 mGy cm2. Radiation doses measured in this study are comparable with those reported to previous studies. Moreover, strong correlation was found between the DAP values and the entrance radiation dose measured with TLDs.

Cardiac adaptation to intensive training in prepubertal swimmers.

BACKGROUND: Despite the increasing involvement of child athletes in intensive training regimens, little is known about the influence of such training on autonomic regulation and cardiac structure and function. PATIENTS AND METHODS: Twenty-five highly trained (12-14 h weekly for at least 4 years) swimmers (aged 11.9 +/- 1.6 years; 15 males, 10 females) and 20 non-training normal children who served as controls (aged 11.3 +/- 0.6 years; 14 males, 6 females) were studied. Heart rate variability analysis in the time and frequency domains was performed on 15 min resting heart rate acquisitions. Left ventricular morphology and systolic function was studied with two-dimensional guided M-mode echocardiography. The transmitral flow velocity profile was assessed with pulsed Doppler. Parameters measured included the peak early (E) and peak late (A) transmitral flow velocity and their ratio (E/A). Left atrial (LA) volumes were determined at mitral valve (MV) opening (maximal, Vmax), at onset of atrial systole (P wave of the ECG, Vp), and at MV closure (minimal, Vmin) from the apical 2- and 4-chamber views, using the biplane area-length method. LA systolic function was assessed with the LA active emptying volume (ACTEV) = Vp-Vmin and the LA active emptying fraction (ACTEF) = ACTEV/Vp. RESULTS: Average NN (967.1 +/- 141.8 vs. 768.4 +/-85.6 ms, P < 0.0001), logSDNN (1.89 +/- 0.14 vs. 1.80 +/- 0.17 ms, P < 0.05), logPNN 50% (1.66 +/- 0.23 vs. 1.46 +/- 0.35, p < 0.05), and logHF power (3.13 +/- 0.32 vs. 2.95 +/- 0.26 ms2, p < 0.05) were greater in swimmers than in controls. Left ventricular end-diastolic diameter was greater (32.3 +/- 3.3 vs. 29.5 +/- 3.3 mm m(-2), P < 0.02) in swimmers than in controls, whereas the left ventricular septal (5.9 +/- 1 vs. 5.6 +/- 0.8 mm m(-2), P = NS) and posterior wall thickness (5.7 +/-0.9 vs. 5.4 +/- 0.8 mm m(-2), P = NS) were similar in the two groups. The E/A ratio was greater (2.2 +/- 0.49 vs. 1.78 +/- 0.36, P < 0.003) whereas the A velocity was lower (0.41 +/- 0.09 vs. 0.50 +/- 0.13 m s(-1), P < or = 0.02) in swimmers than in controls. Vmax was greater (18.6 +/-4.8 vs. 14.9 +/-5.3 cm m(-2), P < 0.03), whereas ACTEF was lower (36 +/- 12% vs. 44.2 +/- 12%, P < 0.04) in swimmers than in controls. CONCLUSION: Cardiac adaptation to intensive training in prepubertal swimmers includes vagal predominance, a mild increase in left ventricular dimensions without significant changes in septal or posterior wall thickness, and increased LA size associated with depressed LA systolic function. Evaluation of LA size and systolic function may contribute to a better understanding of the characteristics of the 'athlete's heart' in children and to the differential diagnosis between left ventricular adaptive and pathologic changes.

Eighteen months' experience with remote diagnosis, management and education in congenital heart disease.

In July 1998, a telemedicine link was established between the Venizelio General Hospital in Crete and the Paediatric Cardiology Department of the Aghia Sophia Children's Hospital in Athens. The telemedicine link used ISDN at 384 kbit/s for diagnosis, management and education in congenital heart disease. Over 18 months, a total of 39 teleconsultations were carried out, concerning 93 children with haemodynamically significant cardiac abnormalities. Forty-four children (47%) were managed locally after teleconsultation, while three children with transposition of the great arteries (3%) were transported as emergency cases to Athens in the first days of life. The other 46 children (50%) had a scheduled appointment at a tertiary centre for cardiac catheterization, angiocardiography, operative treatment or surgical repair. The telemedicine link brought a number of benefits, such as better access to the tertiary centre and the avoidance of patient transportation.

Cardiac troponin I in fulminant adenovirus myocarditis treated with a 24-hour infusion of high-dose intravenous immunoglobulin.

We report a successful outcome on an acute adenovirus myocarditis treated with a 24-hour high-dose intravenous immunoglobulin (24-HDIVIG) in a 4.5-year-old girl. A postviral etiology of acute myocarditis was assessed on the basis of the polymerase chain reaction technique. Among other early markers of cardiac injury, cardiac isoform of troponin-I (cTnI) was significantly correlated to the left ventricular ejection fraction (r = -0.86, p < 0.0001). Follow-up of cTnI, which might also be correlated to the short-term outcome, allows fast, easy, and noninvasive estimation of response to the aggressive treatment with 24-HDIVIG in acute adenovirus myocarditis in children.

Non-Q wave acute myocardial infarction in acute meningococcemia in a 10-year-old girl.

INTRODUCTION: Children with acute meningococcemia may have impaired myocardial function resulting in low cardiac output despite normal intravascular volume. Severe meningococcal infection has been associated with acute interstitial myocarditis, endocarditis, and pericarditis, but not with myocardial infarction. CASE: We present the case of a 10-year-old girl with positive family history for premature myocardial infarction who sustained an acute myocardial infarction temporally related to meningococcemia. DISCUSSION: This is the first pediatric case of non-Q wave acute myocardial infarction associated with purpura fulminans in meningococcemia. Similarly, the association of high troponin I levels and meningococcemia has not been described previously. Although, the patient's genetic predisposition for myocardial infarction might have been a potential contributing factor, there was no angiographic evidence of coronary artery disease in this patient. Thereby, other factors related to shock, endotoxin, microthrombi of meningococcemia, and their treatment might have been also contributing. We propose possible mechanisms for this rare but serious complication of meningococcemia and review the literature.