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Unlabelled: All cases of infective endocarditis occurring from January 1990 to December 1996 at our institution were reviewed, with a special focus on fungal endocarditis. Five critically ill children with fungal endocarditis and eleven children with bacterial endocarditis were recorded. The proportion of fungal endocarditis in our series was 5/16 (31%) and Candida albicans (4/5) was the most common fungal pathogen. Only one patient required heart surgery because of a loose patch but all the others were treated only by medical management for cure. The hospital survival rate was 80% (4/5) and the overall long-term survival rate was 60% (3/5) with only one death directly related to fungal infection.Conclusion: Despite the small number of cases, a sole medical approach including amphotericin B and long-term fluconazole prophylaxis for the treatment of fungal endocarditis in critically ill children seems to offer an alternative to surgical treatment which may be kept for failure of medical treatment. [ABSTRACT FROM AUTHOR]

Arrhythmias and sudden death are well-recognized complications that occur late after correction of tetralogy of Fallot. This study, based on the literature and personal work, reviews the numerous investigations prompted by these complications and provides recommendations regarding follow-up. Conduction disturbances and ventricular arrhythmias are both common; although mostly asymptomatic, they are the likely cause of syncopy and sudden death. Supraventricular arrhythmias are less common but cause symptoms more frequently. Detecting patients at risk for life-threatening arrhythmias is an important task. The simple surface electrocardiogram (ECG) gives a host of information regarding patients at risk. Holter recordings, signal-averaged ECG, and invasive electrophysiological studies may all be helpful; the indications to perform these investigations are discussed and propositions are made for the follow-up of the postoperative patient. There is hope that a systematic approach along these lines, together with surgery done at an earlier age, will decrease the incidence of severe arrhythmias and sudden death in the future. [ABSTRACT FROM AUTHOR]

Transient systolic murmurs in neonates and premature infants due to mild left (LPA) and right (RPA) pulmonary branch stenosis is recognized but follow up studies are lacking. We studied echocardiographically 21 neonates with murmur and 10 controls. Diameters of the main pulmonary artery (MPA), LPA and RPA were smaller in patients with murmur. Colour-coded Doppler showed turbulent flow in LPA and RPA in 20/21 (95%) patients and flow velocities of both pulmonary branches were significantly higher than in controls. The follow up study at 3 months in 14/21 (67%) patients showed absent or decreased murmur in 9 (64%). Echographically, absolute and relative diameters of LPA and RPA increased whereas the ratio of MPA/aorta did not change suggesting accelerated growth or dilatation of the pulmonary branches. Flow velocities decreased significantly in the branches. Thus, transient systolic murmurs in neonates are associated with temporary relative hypoplasia of the pulmonary branches which showed increased growth leading to disappearance of the murmur in most cases within 3 months of life. [ABSTRACT FROM AUTHOR]

The hemodynamic effects of amrinone were assessed in seven children following cardiac surgery. Amrinone was administered as a bolus of 1 mg kg body wt., followed by continuous infusion at 10 μg kg min for 1 h and two stepwise increases to 20 and 40 μg kg min for 30 min each. Hemodynamic data were obtained and plasma concentrations of amrinone measured 1 h after the bolus dose and immediately before each increment of the infusion rate. Amrinone levels ranged from 0.7 to 2.3 mgl. Administration of amrinone lowered systemic vascular resistance from 20.0±4.3 to 16.5±4.6 mmHgl minm ( p<0.05) and reduced mean arterial pressure from 71.7±9.5 to 62.6±13.5 mmHg ( p<0.05) at the highest infusion rate, confirming the known vasodilative effect of the drug. However, these effects did not result in a statistically significant increase in stroke volume (35.0±7.5 to 35.5±7.0 ml m, NS) or cardiac index (3.10±0.50 to 3.20±0.40 l min m). One additional patient, in whom a higher loading dose was tried in order to achieve a higher plasma concentration, developed systemic hypotension. A correlation was established between the plasma concentrations of amrinone and the percentage decrease in systemic resistance ( r=0.70, p<0.05). These results suggest that in children after open heart surgery, amrinone acts primarily as a systemic vasodilator, with questionable inotropic effect. Accordingly, its use should be restricted to children with severe cardiac failure and documented highly elevated afterload. [ABSTRACT FROM AUTHOR]

Cardiac chamber size and function indices were studied repeatedly over the first months of life in two groups of babies, born either spontaneously or by caesarian section under peridural anaesthesia. For cardiac chamber size, no significant differences were found between the two groups: cardiac structures increased in size as a linear function of age and weight in all babies. Right ventricular systolic time interval ratios, however, were higher at birth in babies born by caesarian section, and dropped more rapidly during the first 24h. The decrease of RV systolic time interval ratios followed a parabolic function for both groups, thus reflecting the physiological decrease of pulmonary vascular resistance after birth. The possible causes of more rapid decrease in pulmonary vascular resistance in babies born by caesarian section is discussed. [ABSTRACT FROM AUTHOR]

The clinical manifestations and pathological features of an extremely rare cardiac tumour, a mature (benign) teratoma, in a 6 year-old girl are described. These are compared with those reported in the literature. [ABSTRACT FROM AUTHOR]

Congenital cardiac malformations (CCM) are the commonest congenital anomalies. Using ultrasonography (US), the incidence of CCM in a selected group of fetuses and the impact of CCM on perinatal and postnatal care was evaluated. The indication for fetal echocardiography (F-ECHO) in 152 pregnancies was a positive family history in 61, fetal arrhythmias seen by routine obstetrical controls in 53, suspected CCM during obstetrical US in 9, growth retardation in 3 and contracted maternal factors in 6. Twenty pregnancies had no special indication. F-ECHO was performed between the 18th and the 39th gestational week. Twenty-seven cardiac malformations were found (18%), 10 of which were important; 3 succumbed at birth, 2 after surgical intervention, 1 was aborted and 4 needed intensive care at birth. Of 53 cases with arrhythmias, 3 needed special care during pregnancy: Digitalis in a case of atrial flutter, sick leave and bedrest in 2 with supraventricular tachycardia, premature delivery in 1 case with complete AV block due to an intraventricular tumor. The extremely high incidence of CCM in this group proves the need for careful fetal evaluation to detect malformations. Nowadays F-ECHO can and should be performed as early as in the 18th gestational week, allowing either to interrupt a pregnancy or to plan delivery in a well-equipped center which provides the necessary measures for these newborns. [ABSTRACT FROM AUTHOR]

To determine the most reliable echocardiographic criteria of the pulmonary valve echo in predicting pulmonary artery (PA) pressures or PA resistance, 48 children, aged 6 months to 16 years with congenital (CHD) or rheumatic heart disease (RHD), were studied During routine heart catheterization, simultaneously recorded PA pressures and one-dimensional PA valve echograms were obtained. Echocardiographic measurements of the e-f and b-c slopes, the 'a' dip, right ventricular (RV) and left ventricular (LV) systolic time intervals (STI; PEP = pre-ejection period; ET = ejection time), and their ratios were compared with PA systolic, diastolic, and mean pressures as well as with pulmonary arteriolar resistance (PAR) and the ratio PAR to systemic resistance (SR). The e-f slope and b-c slope correlated poorly with PA pressures and PAR. RVPEP/RVET ratio gave a good second-degree polynomial correlation with PA diastolic pressure, PAR and PAR/SR in CHD ( r=.78, .79, .87). The correlation was better for children with CHD than for those with RHD. This correlation was also more significant than RVPEP/LVPEP, and RVET/LVET. The 'a' dip correlated well with the diastolic PA pressure in CHD and RHD ( r=.73). A multivariant analysis of the 'a' dip and RVSTI ratios slightly improves the correlation coefficient and the prediction rate for PA diastolic pressures, PAR, and resistance ratios in CHD and CHD + RHD. [ABSTRACT FROM AUTHOR]

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A 16-month-old girl developed severe pulmonary hypertension after closure of a large ventricular septal defect. All conventional therapeutic measures failed; an attempt to add nitric oxide at a continuous low dose to the inspired gas allowed resolution of pulmonary hypertension and low cardiac output. This report documents that continuous inhalation of low dose nitric oxide is capable of selective resolution of pulmonary hypertension following cardiac surgery for a large septal defect in a child. This suggests that a transient dysfunction in the release of nitric oxide by the pulmonary endothelial cell is responsible for the vasoconstriction. [ABSTRACT FROM AUTHOR]

Despite the high prevalence of sickle cell disease and trait in the black population and its serious potential for microinfarction, there are only a few reports on acute myocardial damage during vasoocclusive crisis. We report a unique case of transient second degree atrioventricular (A-V) block of Mobitz I and II type during a severe sickle cell crisis. Localized high ventricular septum hypoperfusion demonstrated by a 99mTc-MIBI radionuclide study and reversible echocardiographic wall motion abnormalities in the same area were strong indicators for a local ischemic event in the A-V node and His bundle area, explaining the observed transient conduction abnormalities. The present report draws attention to a potentially lethal complication of sickle cell crisis. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Gynecology & Obstetrics is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)