Kawasaki disease in Greek children: a retrospective study.

BACKGROUND: The studies of series of children with Kawasaki disease (KD) in Greek children are limited. OBJECTIVES: To evaluate the epidemiology, clinical manifestations, laboratory findings, course and outcome of complete KD in Greek children. METHODS: Patients with complete KD who were discharged from our hospital and followed up routinely between 2004 and 2011 were included in the study. The relevant data were collected using a standardized form. RESULTS: There were 49 children (27 boys, 22 girls), mean age: 2.14 years. A seasonal peak of the disease during spring and summer months was detected. Changes of the extremities and cervical adenopathy were the least commonly met criteria for the complete KD diagnosis. The mean time of starting treatment was 6.5 days from the disease onset. The majority of patients, 42/49, responded well to a single infusion of intravenous immunoglobulin (IVIG), while 7/49 patients who had persistent fever despite initial therapy with IVIG needed additional treatment with either a second dose of IVIG(5), intravenous pulse of methyl prednisolone(1) or infliximab(1). Coronary artery abnormalities were detected echocardiographically in 17/49 patients. Most of them (15/17) developed transient dilatations which resolved by the 8(th) week of disease onset while only 2 patients, despite early onset of treatment, developed coronary artery aneurysms which required coronary artery bypass grafts at a later stage. CONCLUSIONS: Major epidemiologic features of KD detected among Greek children are similar to those reported in other populations. This study also demonstrates that significant cardiac complications may still occur following the disease even if it is diagnosed and treated early.

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.

Closure of atrial septal defects with the Amplatzer occlusion device: preliminary results.

OBJECTIVES: This study reports our clinical experience with transcatheter closure of secundum atrial septal defects (ASDs) in children, using the Amplatzer, a new occlusion device. BACKGROUND: None of the devices previously used for transcatheter closure of interatrial communications has gained wide acceptance. METHODS: We examined the efficacy and safety of the Amplatzer, a new self-centering septal occluder that consists of two round disks made of Nitinol wire mesh and linked together by a short connecting waist. Sixteen patients with secundum ASD met established two- and three-dimensional echocardiographic and cardiac catheterization criteria for transcatheter closure. The Amplatzer's size was chosen to be equal to or 1 mm less than the stretched diameter. The device was advanced transvenously into a 7F long guiding sheath and deployed under fluoroscopic and ultrasound guidance. Once its position was optimal, it was released. RESULTS: The mean ASD diameter by transesophageal echocardiography was 14.1+/-2.3 mm and was significantly smaller (p < 0.001) than the stretched diameter of the ASD (16.8+/-2.4 mm). The mean device diameter was 16.6+/-2.3 mm. No complications were observed. After deployment of the prosthesis, there was no residual shunt in 13 (81.3%) of 16 patients. In three patients there was trivial residual shunt immediately after the procedure that had disappeared in two of them at the 3-month follow-up. CONCLUSIONS: The Amplatzer is an efficient prosthesis that can be safely applied in children with secundum ASD. However, a study including a large number of patients and a longer follow-up period are required before this technique can be widely used.