Search

Background Pediatric dilated cardiomyopathy is an uncommon diagnosis. Although significant surgical and medical advances have improved the care of patients with dilated cardiomyopathy, it still carries significant morbidity and mortality. It remains the most common diagnosis requiring pediatric heart transplantation. Aim of Review The etiology of dilated cardiomyopathy, the co-morbidity profile, and response to medications are all vastly different in the adult and pediatric populations. Current medical management is largely extrapolated from adult studies, which is wrought with limitations. Though much progress has been made, there continue to be considerable areas for expansion of knowledge and subsequent management of pediatric dilated cardiomyopathy. This review summarizes the current areas of improvement in risk stratification and acute management and highlights areas for future opportunity, as summarized in the Fifth International Conference on Cardiomyopathy in Children. Key Scientific Concepts of Review This review will describe current echocardiographic and laboratory tools used for risk stratification and prognostication, with a focus on the need for further refinement in their use in determining prognosis and timing of attempts to transition medical therapy. We will also focus on differences in pediatric and adult responses to pharmacotherapy and how this affects the treatment of pediatric decompensated heart failure. Lastly, we will describe surgical interventions for pediatric dilated cardiomyopathy. Mechanical ventricular assist devices are increasingly utilized in end-stage pediatric dilated cardiomyopathy, however, there remains considerable institutional practice variation in device candidacy, transplant listing after device implantation, and assessment for recovery while on device support. Although ventricular assist devices are the current standard of practice once a patient fails medical management, pulmonary artery banding as a temporizing palliative strategy that is emerging as a possible strategy in a select patient population.

Dilated cardiomyopathy (DCM) inevitably afflicts patients with Duchenne muscular dystrophy (DMD). Understanding of the molecular pathophysiology of DCM in DMD has advanced, but correlation of these advances with clinical disease is lacking. We sought to identify echocardiographic changes that occur

Four fungicides used for controlling foliar diseases of potato ( Solanum tuberosum ) were evaluated under field and laboratory conditions for their effects on the infectivity and sporulation of Beauveria bassiana when used as a control for the Colorado potato beetle, Leptinotarsa decemlineata (CPB). We investigated the direct effects of fungicides on B. bassiana -induced CPB mortality and the effect of time between fungicide and B. bassiana application. Effects of fungicide on conidial survival in the soil and on foliage were examined in the field. Significantly more larval mortality was observed when larvae were sprayed with B. bassiana than with the water control. Fungicide had no significant effect on larval mortality in the field. In the laboratory, survival of larvae was significantly lower among larvae fed fungicide-treated foliage. B. bassiana -induced mortality in the laboratory was observed only when larvae were fed foliage treated with copper hydroxide or water. Larvae fed mancozeb- or chlorothalonil-treated foliage experienced high mortality regardless of B. bassiana treatment. While there was no significant effect of fungicide on B. bassiana sporulation on cadavers in the field, a pattern emerged that indicated higher proportions of cadavers producing conidia in plots sprayed with water or copper hydroxide than in plots sprayed with chlorothalonil or mancozeb. Survival of B. bassiana conidia in the soil and on foliage was significantly greater in plots treated with copper hydroxide or water than in plots treated with mancozeb or chlorothalonil. Fungicides such as copper hydroxide may be less deleterious to the fungus than mancozeb and chlorothalonil.