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Background and Objectives:Young patients suffering from rhythm disorders have a negative impact in their quality of life. In recent years, ablation has become the first-line therapy for supraventricular arrhythmias in children. In the light of the current expertise and advancement in the field, we decided to evaluate the quality of life in young patients with supraventricular arrhythmias before and after a percutaneous ablation procedure.Methods:The prospective cohort consisted of patients ™ 4.0 Generic Core Scales self-questionnaire prior to and post-ablation.Results:The final cohort included 88 patients consisted of 52 males (59%), with a mean age at ablation of 12.5 ± 3.3 years. Forty-two patients (48%) had a retrograde-only accessory pathway mediating the tachycardia, 38 (43%) had atrio-ventricular nodal re-entrant tachycardia, 7 (8%) had ectopic atrial tachycardia, and 1 (1%) had atrial flutter. The main reason for an ablation was the patient’s choice in 53%. There were no severe complications. Comparison between the baseline and post-ablation assessments showed that patients reported significant improvement in the scores for physical health, emotional and social functioning, as well as in the total scores.Conclusions:The present study demonstrates that the successful treatment of supraventricular arrhythmias by means of an ablation results in a significant improvement in the quality of self-reported life scores in young patients.

Actinobacillus actinomycetemcomitans is a Gram-negative coccobacillus responsible for blood culture-negative endocarditis. This type of endocarditis is difficult to diagnose because of its insidious evolution and variability of symptoms. Moreover, valvular vegetation may be challenging to detect by echocardiography, especially in children with congenital heart disease. 18F-fluorodeoxyglucose positron emission tomography is frequently used as an additional diagnostic tool for infectious endocarditis in adult patients, and has proved efficient, especially for prosthetic valves. However, its value has been rarely described for the diagnosis of infectious endocarditis in children with congenital heart disease. The authors report the case of an 11-year-old boy with congenital aortic stenosis, who developed severe anemia, thrombocytopenia, hepatosplenomegaly, acute kidney injury, and biological signs of inflammation, with only very mild fever. Renal biopsy revealed the presence of crescentic glomerulonephritis. Transthoracic and transoesophageal echocardiography did not show any vegetation. An 18F-fluorodeoxyglucose positron emission tomography was performed and revealed abnormal 18F-FDG uptake in the area of the aortic valve, supporting the hypothesis of infectious endocarditis. The patient underwent cardiac surgery for the reparation of the aortic stenosis and calcified vegetation was found and resected from the aortic valve. One blood culture yielded Actinobacillus actinomycetemcomitans after 20 days. However, the PCR for the 16S rRNA gene on the resected vegetation was negative. He was treated with 4 weeks of parenteral antibiotics. Follow-up showed the resolution of the clinical and biological abnormalities within a few days. Blood culture-negative endocarditis should be considered in a child with multiorgan manifestations, such as thrombocytopenia, hepatosplenomegaly, and glomerulonephritis. Because echocardiography may not show valvular vegetation, especially in children with pre-existing valvular heart disease, 18F-fluorodeoxyglucose positron emission tomography can be useful to confirm the diagnosis of endocarditis in these patients.

Background Neonatal sepsis is a major cause of morbidity and mortality in preterm infants. Chorioamnionitis is an important risk factor for the development of sepsis, therefore neonates born to mothers developing signs of amnionitis need to be treated with antibiotics immediately after birth. Ureaplasma spp can be a causative agent of vaginal or intra amniotic infection needing antibiotic treatment. Macrolides are frequently used to treat maternal intrauterine infection, but antibiotic treatment of the neonate should be consciously chosen with consideration of potential side effects. Indeed, macrolides are great purveyors of heart rhythm disorders. Case presentation We describe the case of a 29 weeks preterm infant born to a mother with Ureaplasma spp infection. The baby was treated with erythromycin immediately after birth. During the second day of life, the baby presented some episodes of tachyarrhythmia with premature ventricular beats (PVBs) that were followed by a non-sustained ventricular tachycardia as high as 270 bpm leading to a cardiac arrest. After resuscitation, tachycardia resolved but the rhythm was characterised by numerous PVBs and an electrocardiogram (ECG) diagnosed a Long QT Syndrome (LQTS). Erythromycin was discontinued, and the rhythm normalised a few days after withdrawal. Conclusions Erythromycin should be administered in neonates only if no other choice is available, as although generally well tolerated, its administration can be associated with QTc interval prolongation. When no other option is available, paediatricians should be aware to perform cardiac monitoring or at least serial ECGs before and during erythromycin administration.

Over the past 20 years, closure of a secundum Atrial Septal Defect (ASD) has switched from a surgical approach to a transcatheter percutaneous approach...

While percutaneous catheter closure proves an effective treatment for secundum atrial septal defect (ASD2), some child patients require surgical closure. We assessed the risks associated with isolated surgical ASD2 closure by reviewing the outcomes of 120 children operated on between 1999 and 2011 (mean age 4.6 ± 3.9 years, mean weight 17 ± 12 kg). Direct sutures were performed in 4% and patch closures in 96%. The mean cardiopulmonary bypass duration was 38 ± 14 min, aortic cross-clamp time 19 ± 9 min, intensive care unit length of stay 1.6 ± 1.1 days, hospital stay 11.2 ± 5.1 days. There were no complications in 60 patients (50%) and major complications in 8 (6.7%), with 1 patient (0.8%) dying of pneumonia-induced sepsis, 2 (1.7%) requiring revision surgery, 3 (2.5%) requiring invasive treatment (2 pericardial drainage, 1 successful resuscitation), and 2 (1.7%) presenting thromboembolisms (1 cerebral stroke, 1 cardiac thrombus). In hospital minor complications occurred in 22 patients: 17 pericardial effusions (15%), 15 infections requiring treatment (12.5%), 1 sternal instability (0.8%), 4 anemias requiring transfusion (3.3%), 7 pulmonary atelectasis (6%), and 2 post-extubation glottis edema (1.7%). At early outpatient follow-up, complications occurred in 21 patients: 16 (13.3%) pericardial effusions, 4 (3.3%) infections requiring treatment, and 3 (2.5%) keloid scarring. No complications occurred during long-term follow-up. In line with published data, mortality was low (0.8%), yet major complications (6.7%) were more common in these cases than those following percutaneous ASD2 closure. Minor complications were frequent (43%) with no long-term sequelae.