An echocardiographic assessment of cardiac functions and structure in children on dialysis.

BACKGROUND: Cardiovascular complications are the most important cause of mortality in end stage renal disease. The aim of this study is to evaluate systolic and diastolic functions of children with chronic renal disease. METHODS: Twenty-five children on renal replacement therapy (16 on peritoneal dialysis, 9 on hemodialysis), 10 children in chronic renal insufficiency group, and 27 healthy subjects were examined by echocardiography. RESULTS: No significant difference was observed in systolic functions between patients and controls. Left ventricular mass index was significantly higher in hemodialysis and peritoneal dialysis patients when compared with controls, where no significant difference was determined between chronic renal insufficiency group and controls. Although left ventricular mass index was tended to be higher in hemodialysis than peritoneal dialysis group, this was not significant. Peak late diastolic flow velocity (A) was significantly higher in dialysis groups when compared to controls. E/A ratios were significantly lower in dialysis groups than controls. CONCLUSION: The finding that the diastolic functions were impaired in both children on peritoneal dialysis and hemodialysis suggests that peritoneal dialysis is not superior to hemodialysis for preserving diastolic cardiac functions. Further studies with larger patient groups are needed to show long-term effects of peritoneal dialysis and hemodialysis on cardiac functions.

Myocardial noncompaction: report of three cases.

Myocardial noncompaction is a rare type of cardiomyopathy which can be an isolated entity or in association with other congenital heart diseases. We present three children with myocardial noncompaction: one male with isolated left ventricular noncompaction, another with right ventricular noncompaction and dysplastic tricuspid valve, and the last with left ventricular noncompaction, ventricular septal defect and coarctation of aorta, to stress especially the different clinical forms of the disorder and the importance of early diagnosis, as it may result in a fatal outcome.

Venous collapsibility index changes in children on dialysis.

AIM: Hypervolemia is an important factor for the development of cardiac failure in end-stage renal disease. The aims of this study are to evaluate whether collapsibility index (CI) is a useful method to assess the volume status in children on haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD), and to test whether the small amounts of fluid removed after a single dialysis exchange will be reflected by a change in CI in peritoneal dialysis patients. METHODS: Sixteen CAPD, nine HD patients aged from 5 to 18 years and 27 age- and sex-matched healthy children were enrolled in the study. Inferior vena cava diameters were measured from subxiphoidal long axis position in 2 cm to its junction to right atrium and CI were calculated. RESULTS: The collapsibility index was significantly lower in HD patients before HD and in the CAPD group before dialysate exchange when compared with the controls. No significant difference was found between the CAPD and HD groups. We observed significant increase in CI after HD, CI values reached nearly to control levels after HD. Ultrafiltrate was 1.93 +/- 0.98 kg in HD, 0.23 +/- 0.09 kg in the CAPD group. Although the change in CI values before and after dialysate exchange was significant in the CAPD group, there was still a significant difference between the CI values of the control group and the CAPD patients after dialysate exchange. CONCLUSION: We suggest that serial measurements of CI in children will be a useful guide to assess the volume changes in an individual instead of a single measurement.

Rheumatic heart disease and coronary vasculitis in children.

UNLABELLED: Rheumatic fever is a systemic inflammatory disease which may also cause vasculitis in multiple organ systems. CONCLUSION: Two children with rheumatic mitral valve disease and mitral valve replacement developed myocardial ischaemia due to coronary vasculitis. One of them had neurological findings that may be attributed to cerebral vasculitis.

LEOPARD syndrome and hypertrophic obstructive cardiomyopathy: a case report.

The LEOPARD syndrome is a rare, autosomal dominant multisystemic disorder characterized by lentiginosis, ocular hypertelorism, abnormal genitalia, growth retardation, sensorineural deafness, and cardiac and electrocardiographic abnormalities. Although it is not cited, hypertrophic cardiomyopathy is often associated with the disease. In this study, we present a nine-year-old boy with LEOPARD syndrome and hypertrophic obstructive cardiomyopathy.

Cardiac abnormalities in children with systemic lupus erythematosus.

Children and adolescents with systemic lupus erythematosus (SLE, n = 14) with no cardiac symptoms were examined for cardiac involvement by physical examination, electrocardiography (ECG) and echocardiography. The indexes of left ventricular (LV) systolic and diastolic function were compared with the findings of 20 healthy, age-matched control subjects. Echocardiographic examination revealed mild tricuspid valve regurgitation in three, and moderate tricuspid and mitral valve regurgitation in two patients. Pericardial thickening was found in one patient. Indexes of LV systolic and diastolic function of SLE patients differed significantly from control subjects, with marked reduced ejection fraction (EF) and fractional shortening (FS) as well as reduced peak early diastolic filling velocity (E) and ratio of early-to-late diastolic filling velocity (E/A). Deceleration time (DT) was longer in the patients than in the control group. Late filling velocity (A) and isovolumic relaxation time (IRT) did not differ between the two groups. Valvular and pericardial involvement was found to be lower than previous reports. We conclude that asymptomatic diastolic and systolic dysfunction is common in children with SLE, most likely representing myocardial involvement. Routine cardiac evaluation by echocardiography can be recommended in the follow-up of children with SLE in order to detect silent cardiac abnormalities.