Mitral valve prolapse in childhood: the incidence and clinical presentations in different age groups.

To elucidate the incidence and natural history of mitral valve prolapse (MVP) during childhood, we investigated a total of 4,238 children (aged from 1 day to 15 years) classified by age into 4 groups: Group 1:1 to 28-day-old full-term normal newborns (n = 108), Group 2: 6 to 18-month-old infants (n = 391), Group 3: 6 to 7-year-old children (n = 2,801), and Group 4: 12 to 15-year-old children (n = 938). The incidence of MVP was determined by videorecorded two-dimensional echocardiography in a double-blind method twice-over. There were 109 cases diagnosed as having MVP. The incidence rates of MVP were as follows: Group 1: 0%, Group 2: 0.25%, Group 3: 2.1% and Group 4: 5.1%. Arrhythmias were detected in 49% (27/55) by Holter ECG, and by exercise stress test in 4.7% (2/43). Eighty-three (77%) of 108 cases in Groups 3 and 4, excluding the 1 case in Group 2, showed no symptoms. Ventricular premature contraction (VPC) was the most common arrhythmia, and was benign in all cases. A mid-systolic click (MSC), late systolic murmur (LSM), MSC + LSM, and a pansystolic murmur were detected in 23.1%, 3.7%, 4.6% and 5.6%, respectively. Symptoms caused by MVP increased and appeared more apparently with age. Further prospective long-term follow-up studies to adulthood are necessary.

[Valvular regurgitation in patients with Kawasaki disease and in healthy children: a pulsed Doppler echocardiographic study].

Valvular lesions in the acute stage of Kawasaki disease were observed using pulsed Doppler echocardiography. The subjects consisted of 65 patients with Kawasaki disease (2 months-6 2/12 years) who had been followed from the acute stage. The age-matched 113 controls were selected from 661 healthy children (2 months-14 years of age). In the acute stage of Kawasaki disease, tricuspid regurgitation (TR) was detected in 31 (48%), pulmonary regurgitation (PR) in 22 (34%) and mitral regurgitation (MR) in 17 (26%). There was no aortic regurgitation (AR). In the convalescent stage, TR was found in 26 (40%), PR in 20 (31%), and MR in 11 (17%), but no AR was detected. The incidence of each valvular regurgitation between the acute and convalescent stages in patients with Kawasaki disease did not differ significantly. Furthermore, there was no significant difference in the incidence of valvular regurgitation between patients with Kawasaki disease and the normal controls. In nine patients, however, valvular regurgitation in the acute stage had disappeared by the convalescent stage, and two patients had developed a new pansystolic murmur in the acute stage. We estimated the incidence of pathologic valvular involvement in Kawasaki disease to be 11/65 (17%). The incidence of valvular involvement in patients with coronary artery aneurysms was significantly higher than that of patients without coronary artery aneurysms (p less than 0.01). It was concluded that mild and transient valvular regurgitation, which cannot be detected by auscultation, may occur in some patients in the acute stage of Kawasaki disease. These may be caused by acute inflammation of the valve related to coronary artery lesions. In view of the Doppler echocardiographic findings in normal controls, these regurgitations should be distinguished from "physiological" ones.

Hemodynamic evaluation and morphological changes of right ventricular out-flow tract and pulmonary valve after balloon pulmonary valvuloplasty.

Balloon pulmonary valvuloplasty (BPV) was attempted in 38 cases of congenital pulmonary valve stenosis. It was effective and was done without complication in 36 cases, however it was not effective in two cases of pulmonary valve dysplasia. The balloon used was 20-50% larger in diameter than the pulmonary valve annulus. In the seven cases in which the transvalvular pressure gradient was above 100 mmHg on cardiac catheterization, right ventriculography demonstrated that the functional obstruction of the right ventricular outflow tract increased immediately after BPV, however it subsequently improved at one year after the procedure. At between one and three months after BPV, two-dimensional echocardiography demonstrated that the morphological obstruction to the right ventricular outflow tract had diminished. In two cases, localized right ventricular septal hypertrophy with severe pulmonary valve stenosis was observed by two-dimensional echocardiography and right ventriculography, and persisted at one year. In all cases, two-dimensional echocardiography and angiography demonstrated doming pulmonary valves with valve stenosis, which was diminished by BPV. The pulmonary valve morphology was observed by two-dimensional echocardiography in three cases following BPV. In one case, partial relief of pulmonary valve obstruction was seen to be due to commissural splitting and in the other two, to tearing of cusp tissue. Inspection of the pulmonary valve at operation was made in one case who underwent elective surgery for repair of an atrial septal defect which was associated with pulmonary valve stenosis. It demonstrated partial relief of pulmonary valve stenosis by tearing of cusp tissue. In conclusion, BPV is as effective a treatment for congenital pulmonary valve stenosis as open valvulotomy. In our follow-up study, it has shown no apparent complications. The transient obstruction in the right ventricular outflow tract immediately after BPV improved within one month and improved further after three months and one year. However, in the more long-standing cases the localized right ventricular septal hypertrophy persisted and these cases will require, a long term follow-up.

[Balloon valvuloplasty for pulmonary valvular stenosis: a long-term follow-up study using pulsed Doppler echocardiography].

From June 1984 to March 1987, percutaneous balloon valvuloplasty (PBV) was performed for 22 patients with congenital pulmonary valvular stenosis. It was successful for 20 patients, and there were significant decreases of transvalvular pressure gradients; 72 +/- 30 mmHg before PBV, and 30 +/- 12 mmHg immediately after PBV (p less than 0.001). In a follow-up study, pulsed Doppler echocardiography and cardiac catheterization were used to examine changes in long-term hemodynamic findings after PBV. One year follow-up evaluation was performed for 14 patients, and two year follow-ups for seven patients. One year after PBV the transvalvular pressure gradients were evaluated during cardiac catheterization in 11 patients, and using pulsed Doppler echocardiography in the remaining three patients. The gradients of the seven patients at two year intervals after PBV were evaluated using pulsed Doppler echocardiography. The pressure gradients of two patients improved further one year later due to the anatomical degradation in the right ventricular outflow tracts. For seven patients, two year follow-up evaluations were performed, and the transvalvular pressure gradient reduced from 84 +/- 23 to 33 +/- 15 mmHg (p less than 0.001) immediately afterwards; to 27 +/- 22 mmHg (p less than 0.01) one year later; and further to 12 +/- 5 mmHg (p less than 0.001) two years after PBV. Second PBV was performed for three patients in whom a residual gradient was recognized, with the good results. On auscultation, a pulmonary regurgitant murmur was recognized in 28% of 18 patients immediately after PBV, but 80% of this resolved one year later. Two patients had pulmonary regurgitation with pulmonary valvular stenosis before PBV.(ABSTRACT TRUNCATED AT 250 WORDS)

Infective endocarditis in children: a current diagnostic trend and the embolic complications.

Twenty-three cases of IE, of which 91% had underlying congenital heart diseases were diagnosed by positive blood culture or vegetative lesion detected by 2-D ECHO when a patient revealed clinically suspicious episodes. VSD and TOF were the most common underlying heart diseases. The vegetation was detected successfully by 2-D ECHO in 91% of the cases. The causative organisms were identified in 83% of the cases. Streptococcus viridans and Staphylococcus aureus were the two major organisms detected. Candida albicans was found in 3 postoperative and fatal cases. Embolic complications occurred in 7 cases (30.5%): five cases of pulmonary infarction and two of cerebral infarction. The overall mortality was 22%. We recommend early surgical intervention whenever a patient reveals a very large vegetation with animated movability, and emphasize the importance of a proper prophylaxic regimen.