Accuracy of clinical assessment of heart murmurs by office based (general practice) paediatricians.

AIM: To determine the diagnostic accuracy of physical examination by office based (general practice) paediatricians in the evaluation of heart murmurs. DESIGN: Each of 30 office based paediatricians blindly examined a random sample of children with murmurs (43% of which were pathological). Sensitivity and specificity were calculated and were related to paediatricians' characteristics. RESULTS: Mean (SD) sensitivity was 82 (24)% with a mean specificity of 72 (24)% in differentiating pathological from innocent murmurs, with further investigations requested for 54% of assessments. The addition of a referral strategy would have increased mean sensitivity to 87 (20)% and specificity to 98 (8)%. Diagnostic accuracy was not significantly related to the paediatricians' age, education or practice characteristics, but was related to referral practices and confidence in assessment. CONCLUSIONS: Diagnostic accuracy of clinical assessment of heart murmurs by office based paediatricians is suboptimal, and educational strategies are needed to improve accuracy and reduce unnecessary referrals and misdiagnosis.

Pediatric primary benign cardiac tumors: a 15-year review.

An increase in the incidence of primary cardiac tumors has been reported since the development or enhancement of noninvasive imaging modalities. We identified 56 children with primary cardiac tumors. Forty-four (78%) children had rhabdomyomas, 6 (11%) fibromas, 1 (2%) pericardial teratoma, 1 (2%) epicardial lipoma, 1 (2%) multicystic hamartoma, and 3 (5%) unspecified tumors. The mean age at diagnosis was 19 +/- 35 months (median 4.7 months, range 0.03 to 204 months), excluding 12 patients who were given the diagnosis before birth. Among 27,640 patients assessed for cardiac disease, the incidence of tumors was 0.06% (1980 to 1984), 0.22% (1985 to 1989), and 0.32% (1990 to 1995). Diagnosis was made in 55 of 56 patients by echocardiography. Catheterization was performed in five patients and magnetic resonance imaging in nine. No tumor-related deaths occurred. Nine patients had surgery because of hemodynamically significant obstruction or arrhythmias. Partial or complete regression occurred in 24 (54%) of 44 patients with rhabdomyomas. Overall, the prognosis was excellent. Individualized surgery allowed early safe treatment of symptomatic tumors.

Massive right ventricular fibroma treated with partial resection and a cavopulmonary shunt.

Cardiac fibromas in infants and children may present as intramural or intracavitary masses. Total or partial resection as well as transplantation have been reported as treatment for symptomatic patients. We report an infant, diagnosed prenatally, who underwent partial excision of a massive obstructive right ventricular fibroma and creation of a bidirectional cavopulmonary shunt. The palliative approach has allowed the child to be followed up with the option of transplantation should the tumor continue to increase in size.

Ventricular arrhythmia complicating Kawasaki disease.

Cardiac sequelae account for the major morbidity and mortality related to Kawasaki disease, and subclinical myocarditis is a frequent finding. The unusual finding of ventricular arrhythmia in a 2.5-year-old patient during the acute phase of Kawasaki disease is reported. The arrhythmia resolved during empirical treatment with oral steroids.

Reversible steroid-induced hypertrophic cardiomyopathy with left ventricular outflow tract obstruction in two newborns.

Dexamethasone is now frequently used in the treatment of bronchopulmonary dysplasia. We report on two premature babies receiving dexamethasone who developed symptomatic myocardial hypertrophy and left ventricular outflow tract obstruction, as documented by M-mode echocardiography and Doppler studies. A normal heart was recorded on echocardiography before and after dexamethasone treatment. The patients had no known risk factors associated with the development of obstructive hypertrophic cardiomyopathy.