Background: The use of high-sensitive cardiac troponin T (hsTnT) in urine as a marker of cardiac damage in children has not yet been reported. Elimination of cardiac troponins is dependent on renal function; persistently increased serum hsTnT concentrations were observed among individuals with impaired renal function. The aim of this study was to investigate serum and urine hsTnT levels and its correlation in infants and children younger than 24 months of age after cardiac surgery. Methods: This study was conducted on 90 infants and children under 24 months of age who were divided into three groups. The experimental group consisted of patients with intracardiac surgery of ventricular septal defect (VSD), first control group consisted of infants with extracardiac formation of bidirectional cavopulmonary connection (BCPC), and the second control group consisted of healthy children. Troponin T values were determined in serum and urine at five time points: the first sample was taken on the day before cardiac surgery (measure 0) and the other four samples were taken after the surgery; immediately after (measure 1), on the first (measure 2), third (measure 3), and fifth postoperative day (measure 5). The first morning urine was sampled for determining the troponin T in the control group of healthy infants. Results: A positive correlation between troponin T values in serum and urine was found. Urine hsTnT measured preoperatively in children undergoing BCPC surgery was higher (median 7.3 [IQR 6.6–13.3] ng/L) compared to children undergoing VSD surgery (median 6.5 [IQR 4.4–8.9] ng/L) as well as to healthy population (median 5.5 [IQR 5.1–6.7] ng/L). After logarithmic transformation, there was no statistically significant difference in urine hsTnT concentration between the groups at any point of measurement preoperatively or postoperatively. Statistically significant negative correlation was found between serum and urine hsTnT concentrations and glomerular filtration rate estimated by creatinine clearance. Patients who underwent surgical repair of VSD had significantly higher concentrations of troponin T in serum on the first three postoperative measurements compared to those who had BCPC surgery. Conclusions: According to the results of this study, renal function after cardiac surgery appears to have a major effect on the urinary hsTnT concentrations, and we cannot conclude that this is an appropriate marker for the assessment of postoperative myocardial damage in children. Nevertheless, more research is needed to reach a better understanding of the final elimination of cardiac troponins in children.
of the palms develops with conjunctival hyperemia and cracking of the lips. Perivascular hyperechogenicity in the coronary arteries snd mild mitral regurgitation was registered on the echo. K.A.B., a 4-year-old girl, her disease started with fever and enlarged cervial lymph nodes on the right measuring 5x3 cm, so she was hospitalized and ceftriaxone therapy was introduced. Diagnosis of KD was made after the development of polymorphic rash, conjunctival hyperemia, edema and erythema of the palms and soles, and dry, cracking lips. Echocardiography revealed mild mitral regurgitation and uniformly broad LCA with hyperechogenicity. I.Š., a 7-year-old girl had fever and right-sided cervical lymphadenopathy four days before admission and was treated as an outpatient with peroral cephalosporin. During hospitalization antibicrobial therapy was changed initially to ceftriaxone and azithromycin, then due to the absence of clinical and laboratory response to cefazolin and clindamycin. On the tenth day of the disease swelling of the hands and feet with conjunctival hyperemia and raspberry tongue were noted. Echocardiographically ectatic proximal part of LCA (3.9 mm) was registered and IVIG with ASA introduced. During the longterm follow-up no residual changes in the coronary arteries were recorded. Conclusion The aim of this paper is showing that in an acute febrile disease one must also think about Kawasaki disease, especially when there is absence of adequate response to antibiotic therapy. Immunoglobulin therapy has been shown to prevent the development of serious cardiovascular complications and remains the first choice in the treatment of children with KD. In case of persistent fever and resistant cases, corticosteroids and other immunomodulatory and biological therapy may be considered.
;11(3-4):135. VII. nacionalni sastanak o kardiovaskularnim intervencijama s međunarodnim sudjelovanjem VI. sastanak intervencijskih kardioloških medicinskih sestara i tehničaraDevelopment of interventional cardiology in treating heart diseases in children in the Reference Centre for Pediatric Cardiology 1 in the last 20 years (1996 -2015) is presented.Constant growth in the number of heart catheterizations (from 160 to 241) is followed by a relatively higher growth in the number of interventional catheterizations (from 12.5% to 38.1%). While the number of catheterizations ( VII. nacionalni sastanak o kardiovaskularnim intervencijama s međunarodnim sudjelovanjem VI. sastanak intervencijskih kardioloških medicinskih sestara i tehničara 3D ECHO and other). Providing we decrease the number if diagnostic catheterizations by applying the mentioned new diagnostic methods, and based on the expected number of interventional catheterizations curve, the 50% level may be expected in about 5 years. All age groups from newborns, including prematures, to the age of 18 are represented. That implies a tremendous body mass span, with the lowest birth mass being 2000 grams at the time of diagnostic catheterization, and 2400 grams at the time of interventional catheterization. In the last twenty years 3695 heart catheterizations have been performed, 937 of which were interventional (averagely 26%).In interventional procedures we employed 12 different surgical procedures, thus equaling the developed pediatric cardiology centers in Europe. Cardiac surgeons and anesthesiologists also participate in the work of pediatric cardiologists. Along with statistic data we are also presenting various interventional skills in pediatric cardiology, from balloon atrioseptostomy to stent implantation. LITERATURE
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