Background:
Coronavirus disease 2019(COVID-19) is responsible for significant lung disease in adults. Despite mild manifestations in most children, multisystem inflammatory syndrome (MIS-C) associated with COVID-19 is well-described in older children with cardiac manifestations. However, MIS-C-related cardiac manifestations are not as well-described in younger children.
Methods:
The study is a retrospective analysis of MIS-C patients under age 5 years admitted between May to November 2020 to a single-center. Included cases fulfilled the case definition of MIS-C according to RCPCH criteria with cardiac laboratory, ECG, or echocardiographic evidence of cardiac disease. Collected Data included patients’ demographics, laboratory results, echocardiographic findings, management, and outcomes.
Results:
Out of 16 MIS-C cases under 5 years, 10 (62.5%) had cardiac manifestations with a median age of 12 months, 9 (90%) were previously healthy. Cardiac manifestations included coronary arterial aneurysms or ectasia in 5 (50%) cases, 2 (20%) with isolated myopericarditis, coronary aneurysm with myocarditis in 2 (20%), and SVT in 1(10%). Intravenous immunoglobulins were given in all cases with coronary aneurysms or myocarditis. The median duration of hospitalization was 7(6-14) days; 2 (20%) cases with cardiac disease were mechanically ventilated and mortality in MIS-C cases below 5years was 12.5%. Normalization of systolic function occurred in half of the affected cases within one week and reached 100% by 30days of follow-up.
Conclusion:
MIS-C associated with SARS-CoV-2 has a high possibility of serious associated cardiac manifestations in children under the age of 5years with mortality and/or long-term morbidities such as coronary aneurysms even in previously healthy pediatric patients.
Background
Cardiac dysfunction is a complication of type 1 diabetes mellitus (T1DM) with primary concern in adults. However, studies have evaluated left ventricle (LV) myocardial changes in pediatrics but not the long‐term effect of T1DM in such vulnerable age. Therefore, we assessed LV functions in pediatric patients with long‐duration T1DM using different echocardiographic modalities.
Methods
Between July 2015 and March 2016, 48 T1DM patients were prospectively compared to 35 healthy controls. Pediatric patients with T1DM for 10 years or more were included in the study. Patients were subjected to history taking, clinical examination, glycated hemoglobin (HbA1c), and microalbuminuria measurements. Moreover, conventional echocardiography, tissue Doppler, and 2D speckle tracking were performed to analyze LV functions.
Results
Mean age of patients was 15.5 ± 2 years, and mean T1DM duration was 11.7 ± 1.8 years. LV dimensions, EF and FS, and mass index did not statistically differ between groups, but E/E′ ratio was significantly higher in the diabetic group. Global longitudinal strain (GLS) and global circumferential strain (GCS) were significantly lower in diabetic patients compared with controls (P = 0.038; P = 0.001, respectively). Mean HbA1c was found to be a significant predictor of decreased GLS in the diabetic population (95% CI, 0.096‐0.244; P = 0.001) but not predicting GCS. Microalbuminuria had no significance in predicting strain.
Conclusions
Despite the long‐duration of affection with T1DM during childhood in our patients, alterations on LV myocardial function could not be detected either clinically or by conventional echocardiography. Tissue Doppler and speckle tracking could be used in the follow up of myocardial status in pediatric diabetic patients.
Background:
Patent ductus arteriosus stenting in duct-dependent pulmonary circulation is a challenging procedure. Percutaneous carotid artery access for ductal stenting has proven to be feasible; however, comparison with femoral artery access in terms of procedure details and complications either immediate or late is scarce. Therefore, we evaluated carotid artery access in comparison with femoral artery for stenting of patent ductus arteriosus.
Methods:
Forty neonates were reviewed, 20 were stented via carotid artery access, and 20 via the traditional femoral artery access. Comparison variables were neonatal demographics at the procedure, angiographic ductal anatomy, procedure details, and immediate complications. Follow-up Doppler ultrasound on access site was performed to document late complications.
Results:
Median age of included cases was 10.5 (3–28) days with complex ductal anatomy more frequently accessed via carotid artery than femoral. Immediate access-related complications were significantly higher with femoral than carotid artery access; 9 (45%) versus 3 (15%) respectively, p = 0.038. With carotid access, we had only one case with small pseudoaneurysm and acute hemiparesis 3 days after the procedure. Delayed local complications were more common with femoral access (15%) than carotid access (5%), mild stenosis in one case, and severe in another with femoral access; while with transcarotid arterial access, only one case had mild narrowing.
Conclusion:
Percutaneous carotid artery access in neonates is a more convenient approach for patent ductus arteriosus stenting especially with complex ductal anatomy. Moreover, local complications are limited and vascular patency is better preserved, in comparison with trans-femoral arterial access. However, the potential for neurological adverse events should not be overlooked.
One of the extremely rare systemic venous anomalies is double left brachiocephalic veins (LBVs). In the current work, a rare association of double LBVs with a vascular ring and normal intracardiac anatomy is described in fetal life with postnatal confirmation using echocardiography and computed tomography. The prenatal diagnosis of such an infrequent lesion is feasible using fetal echocardiography. Despite the smooth prenatal and postnatal course, potential risk during certain interventions or surgeries should be highlighted in parent counseling.
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