School-based universal screening for hypercholesterolemia in children.

BACKGROUND: In 2011, the American Academy of Pediatrics recommended universal lipid screening during childhood and adolescence. However, this approach was shown to be lacking in adherence. Only 6% of non-high-risk children received lipid screening by age 12. Our study designed a school-based universal screening for hypercholesterolemia in children. The goal was to investigate a feasible strategy for lipid screening of children. METHODS: The study enrolled all the fourth-grade students of 30 elementary schools from 2020 to 2021. Non-fasting non-HDL was used as a screening tool. These students were classified into three groups: acceptable group (non-HDL < 120 mg/dL), borderline group (120-144 mg/dL), and abnormal group (≥145 mg/dL). The abnormal group was referred to our hospital for confirmatory fasting lipid studies. The complete rate and timing were calculated. RESULTS: Six hundred students were enrolled in this study. In the abnormal group (95 children), a total of 92 students received confirmatory fasting lipid studies. These confirmatory studies were completed within three months after the family received their reports. The study had a rate of coverage of 62% and the referred percentage of the abnormal group was 97%. BMI had poor association with fasting LDL (CORR = 0.06752, p = 0.444). In the abnormal group, only 29.5% children had family history of early CVD or dyslipidemia. CONCLUSION: School-based universal screening for hypercholesterolemia in children is a feasible and effective way to identify patients at high-risk for early CVD. Neither BMI nor family history was a good indicator for the screening of dyslipidemia.

Heart disease screening of schoolchildren in Taiwan.

OBJECTIVE: To evaluate the sensitivity of a heart disease screening program for schoolchildren. DESIGN: Prospective cohort study. SETTING: Taitung County, Taiwan. PARTICIPANTS: All first- and fourth-grade elementary school students and first-year junior high school students screened between September 1, 2005, and June 30, 2007. Intervention A 2-level heart disease screening program was undertaken. Level 1 screening included a history questionnaire and phonocardiography and electrocardiography. Level 2 screening consisted of examination by a pediatric cardiologist of all children who had abnormal findings on level 1 screening. A control group comprised children whose level 1 screening results were normal. Children with abnormalities on level 2 screening were referred for a detailed cardiac evaluation. MAIN OUTCOME MEASURES: Previously unsuspected heart diseases. RESULTS: Of 25 816 children undergoing the level 1 screening program, 5330 had positive findings, of whom 5235 underwent level 2 screening, along with 1104 children in the control group. The pediatric cardiologist referred 780 children to the hospital for full evaluation, including 18 controls and 114 patients with a previous diagnosis of heart disease. A total of 292 children, including 2 controls, had evidence of heart disease, which was previously unsuspected in 178 (61.0%). Excluding children with a previous diagnosis of heart disease, the sensitivity of the screening program was 82.6%. The specificity and the positive predictive value were 98.3% and 28.6%, respectively. CONCLUSION: The 2-level heart disease screening program has good sensitivity and detects asymptomatic but potentially life-threatening heart disease in some children.

Clinical investigation of systemic-pulmonary collateral arteries.

Systemic-pulmonary collateral arteries are known to develop in children with congenital heart disease, chronic pulmonary infection, and prematurity. At present, these abnormal connections between the systemic and the pulmonary systems are thought to develop from the vascular plexus, which normally gives rise to the pulmonary and bronchial vasculature. The objective of this study was to review our patients with systemic-pulmonary collateral arteries and evaluate possible risk factors. The records of patients with systemic-pulmonary collateral arteries seen at our hospital over a 4-year period were retrospectively reviewed. They were grouped into one of the following five categories: premature, heart disease, pulmonary disease, healthy, and others. Age, gender, weight, and the results of echocardiography were recorded, as was the condition on follow-up. We reviewed the records of 284 patients: 130 premature, 13 heart disease, 30 pulmonary disease, 92 healthy, and 19 others. Over the same period, 3314 healthy 1-month-old infants had undergone echocardiography for health screening. Among the 92 healthy children with systemic-pulmonary collateral arteries, 52 were diagnosed at the health-screening exam. Therefore, we estimate the incidence of unsuspected systemic-pulmonary collateral arteries in healthy 1-month-old infants to be 1.57% (52/3314). We conclude that systemic-pulmonary collateral arteries may be present normally after birth and then gradually disappear. However, if there are certain predisposing factors, they may persist in order to augment pulmonary flow.

Diffuse type pulmonary arteriovenous malformations: report of one case.

Pulmonary arteriovenous malformations are direct communications between pulmonary arteries and veins via a tortuous vascular space. They can cause severe pulmonary and neurologic complications. Most PAVMs are located in the lower lobes and can be seen on radiography or angiography. However, a few patients with PAVMs have a more severe and diffuse pattern of disease. These patients generally present with more profound cyanosis and a poorer prognosis. The widespread distribution and small size of these lesions make both diagnosis and management very difficult. We report a 12-year-old patient with diffuse bilateral PAVMs confirmed by contrast echocardiography and technetium-labeled macroaggregated albumin perfusion scan.

Cardiac catheterization in low birth weight infants.

BACKGROUND AND PURPOSE: The increased survival of low birth weight infants means that more of these infants may be candidates for cardiac catheterization. There is a lack of data from Taiwan on the results of cardiac catheterization in these infants. This study investigated the outcome of cardiac catheterization in infants weighing less than 2500 g in a single hospital over an 11-year period. METHODS: The records of 41 infants (17 males and 24 females) weighing less than 2500 g at the time of cardiac catheterization from August 1993 to July 2004 were reviewed. Morbidity and mortality were compared between diagnostic and intervention groups. RESULTS: Interventional procedures were performed in 14 and diagnostic catheterizations in 27 infants. These interventional procedures included 5 balloon valvuloplasties for pulmonary stenosis and 1 for aortic stenosis, 1 balloon angioplasty for critical coarctation, 1 aortic valvuloplasty, 1 dilatation for coarctation plus aortic valvuloplasty, 1 temporary pacemaker implantation, and 5 balloon atrioseptostomies. The median age at catheterization was 5 days and the median weight was 2.35 kg. All diagnostic and interventional procedures were successfully performed without mortality. Complications included 2 cases each of arrhythmia, bleeding, apnea, and thromboembolism in the diagnostic group and, in the intervention group, 2 cases each of supraventricular tachycardia and bleeding, and 1 case of linear dissection of a coarctation. CONCLUSIONS: None of the 41 catheterized low birth weight infants died. Furthermore, the complication rate in the intervention group was no higher than in the diagnostic group. We conclude that cardiac catheterization, even with an interventional procedure, can be performed safely in low birth weight infants.

Cardiovascular changes in mucopolysaccharidoses in Taiwan.

From 1991 to 2002, we managed 72 patients with mucopolysaccharidoses. We retrospectively reviewed the records of 37 for whom detailed physical findings and cardiovascular evaluation were available. Twenty patients had serial electrocardiographic (ECG) examinations, and none had arrhythmias. All 20 patients had low R wave voltage in V6. One type VI patient had ischaemic changes secondary to severe cardiomyopathy at the terminal stage of her disease. Among the 37 patients in whom echocardiography was performed, cardiovascular abnormalities progressed with age, although most had mild clinical signs and symptoms. The most common changes were abnormalities of the mitral and aortic valves hypertrophy of the interventricular septum, especially in types I, II, and VI. During the follow-up period of up to 5 years, 3 type II patients and I type VI patient expired. In at least 3 of these patients, death was related to cardiopulmonary failure. As MPS patients are surviving longer, complete cardiac evaluation at regular intervals is mandatory and should be part of their routine assessment.

Acquired aortic regurgitation after coil occlusion of patent ductus arteriosus.

Some patients with patent ductus arteriosus (PDA) may develop new aortic regurgitation (AR) after coil occlusion. This study evaluated the risk factors for the development of AR after coil occlusion of PDA. A total of 23 patients with PDA were managed with coil embolization over a three-and-a-half-year period. Three patients with pre-embolization AR were excluded. A post-occlusion transthoracic echocardiogram was performed within 24 hours after the procedure. Ten patients developed AR and 10 did not. Gender, age, weight, body surface area (BSA), pulmonary artery pressure, and pulmonary vascular resistance did not differ significantly between the 2 groups. Both larger PDA size (either corrected for weight or BSA, p = 0.008 and 0.002, respectively) and a higher ratio of pulmonary to systemic flow (Qp/Qs) [p = 0.013] were significant risk factors for the development of AR after coil occlusion. Re-evaluation of the patients at 3 and 6 months after the procedure revealed 7 patients still had a regurgitant jet. The results of this study suggest that the larger the PDA and larger the shunt, the greater the likelihood of developing AR after coil occlusion.

Subclavian and pulmonary steal phenomenon in isolated left subclavian artery with left lung agenesis.

Isolated left subclavian artery has been documented to be associated with several congenital cardiac defects, including tetralogy of Fallot and transposition of the great arteries. In some cases subclavian or pulmonary artery steal phenomenon may occur when the isolated left subclavian artery connects to the main pulmonary artery via a ductus arteriosus. The isolated left subclavian artery may be part of the cardiac manifestations in multiple congenital anomalies, such as VACTERL association. We describe subclavian and pulmonary steal phenomenon in a neonate with complex congenital heart disease, including an isolated left subclavian artery, and left lung agenesis. An isolated left subclavian artery is rare and its association with agenesis of the left lung has not been reported previously.