Advances in acquired pediatric heart disease.

Acquired heart disease in children may result in significant morbidity and mortality. Advances continue to be made in understanding Kawasaki disease, acute and chronic rheumatic heart disease, infective endocarditis, myocarditis, and dilated cardiomyopathy. The role of superantigens, particularly bacterial toxins, in the pathogenesis of Kawasaki disease continues to be defined.

Postpericardiotomy syndrome in pediatric heart transplant recipients. Immunologic characteristics.

Clinical features of postpericardiotomy syndrome (PPS) occur in pediatric heart transplant recipients despite immunosuppression, which raises questions about the mechanism of PPS. We studied the clinical and immunologic characteristics of 15 pediatric heart transplant patients, ages 1.1 to 17.

Heart transplantation in an 8-month-old girl. 10th anniversary report.

In 1984, Dr. Denton A. Cooley led a surgical team that implanted a cardiac allograft in an 8-month-old girl who had end-stage cardiac disease secondary to endocardial fibroelastosis.

Guidelines for exercise testing in the pediatric age group. From the Committee on Atherosclerosis and Hypertension in Children, Council on Cardiovascular Disease in the Young, the American Heart Association.

Exercise testing of children differs from adult exercise testing in many ways beyond the technical issues related to test performance that are addressed in this report. Disease processes that produce myocardial ischemia are relatively rare in children compared with adults. Exercise testing may be useful in these cases, but the use of testing to assess functional capacity or cardiac rhythms will be encountered more often.

Intermediate follow-up of pediatric heart transplant recipients with elevated pulmonary vascular resistance index.

Objectives: This study examined perioperative and intermediate outcomes in pediatric cardiac transplant recipients who had elevated pulmonary vascular resistance indexes preoperatively.

Background: Elevated pulmonary vascular resistance was associated with poor outcome in previous studies and constitutes a relative contraindication to transplantation. Few studies have evaluated this poor outcome risk factor in pediatric patients.

Acquired heart disease in children.

Recent advances have been made in understanding Kawasaki disease, acute rheumatic fever and rheumatic heart disease, cardiomyopathy, and acquired immunodeficiency syndrome. Immune-mediated tissue injury in Kawasaki disease is likely caused by response to a superantigen. Persistent functional and anatomic coronary abnormalities may lead to silent ischemia and increase the risk of early atherosclerotic heart disease.

Mechanical circulatory support in children.

Nine children (aged 1.2-15 years) have been treated with mechanical circulatory support devices at our institution. Indications for treatment were acute cardiac allograft rejection (n = 4), postcardiotomy cardiogenic shock (n = 4), and bridge to cardiac transplantation (n = 1).

Diuretic-enhanced I-131 clearance after ablation therapy for differentiated thyroid cancer.

The authors assessed whether the whole-body radiation burden can be reduced with diuretic enhancement of iodine-131 excretion in patients with thyroid cancer and slow clearance. Whole-body imaging and quantitative I-131 clearance data obtained before and after ablation therapy were evaluated in 56 patients. Fourteen patients with slow pre-ablation therapy clearance (> 50% retention at 24 hours) received oral diuretics after I-131 therapy.

Transcatheter closure of residual atrial septal defect following cardiac transplantation.

An almost 3-year-old boy had a residual atrial septal defect after cardiac transplantation. The patient was symptomatic and had arrhythmia and cardiac enlargement. An atrial septal defect occlusion device was employed to close the communication with excellent results.

Neurologic complications of heart transplantation in children.

Neurologic complications can add significant morbidity to otherwise successful orthotopic heart transplantations in children. Complications have been reported to occur in up to 50% of children undergoing heart transplantation. The purpose of this study was to identify the prevalence and outcome of neurologic complications of heart transplantation in children.

In vivo evaluation of the adsorptive capacity of activated charcoal for camphor.

Camphor, a cyclic terpene, is the toxic ingredient in many over-the-counter (OTC) products. Early seizure activity due to camphor ingestion often contraindicates the use of traditional decontamination therapies in favor of oral activated charcoal use. No research data supports the affinity of activated charcoal for camphor.

Electrocardiographic criteria for diagnosis of acute myocardial infarction in childhood.

Myocardial infarction (MI), a common occurrence in adults, is generally considered to be rare in children. Electrocardiographic criteria for diagnosis of MI in adults are well known and accepted, but no general criteria exist for children. We report 37 autopsy-proved cases of transmural MI and electrocardiographic evidence of MI in 30 of these cases.

Pulmonary artery banding and subaortic stenosis in patients with single ventricle: surgical alternatives and clinical outcome.

Subaortic obstruction is a potential problem in patients with single ventricle and a subaortic outflow chamber. Previous reports have indicated an association between pulmonary artery banding and the development of subaortic obstruction. The purpose of this study was to determine the incidence of subaortic obstruction in our patients with this cardiac anomaly who have undergone pulmonary artery banding, and to determine the eventual outcome in those who did develop obstruction.

Pseudoconduction of atrial flutter of a recipient atrium.

A nine-year-old girl had an episode of atrial flutter and a nonsustained wide QRS tachycardia during her initial hospitalization after orthotopic heart transplantation. Evaluation of her ECG and telemetric tracing revealed atrial flutter of the recipient atrium and sinus rhythm of the donor atrium. The wide QRS tachycardia was an accelerated ventricular rhythm that was also found on subsequent 24-hour ambulatory ECG monitoring.

Blade atrial septostomy: experience with the first 50 procedures.

We have performed 50 blade and balloon atrial septostomies in 46 patients with diagnoses of transposition of the great arteries--32 patients; mitral atresia or stenosis--10 patients; total anomalous pulmonary venous drainage--2 patients; tricuspid atresia--1 patient; and pulmonary valve atresia with hypoplastic right ventricle--1 patient. The patients' age ranged from 1 day to 72 months (median = 8 months) and weights ranged from 2.7 to 14.

Preseason cardiovascular examination: a review.

The responsibility of the physician performing a preseason sports physical examination includes identifying cardiac disease and giving appropriate guidance about participation in competitive sports. This article reviews the leading causes of sudden cardiac death in young athletes, discusses other common cardiac conditions, assesses recommendations for competitive sports, and discusses the preseason examination as a mechanism for detecting a cardiac problem that should exclude an athlete from competition.