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We report the case of a 17 year-old girl who developed sepsis due to Methicillin-Resistant Staphyloccocus Epidermidis (MRSE) infection of Dacron patch 14 years after ventricular septal defect (VSD) closure and 4 years after pacemaker implantation. Although MRSE grew in many cultures taken and proper antibiotic regimen was administered, no improvement in patient's clinical status was observed. Disseminated intravascular coagulation and multi-organ failure developed. An operation, at which perforated Dacron VSD-patch was replaced with a new Gore-Tex one, was performed by cardiac surgery team. The patient's clinical status improved immediately after the procedure. The girl remained well 12 months after discharge.

A case of a 2-day-old newborn with congenital heart disease, pulmonary atresia and ventricular septal defect is described. The Blalock-Taussig shunt was created 6 days after birth. After the procedure, the newborn developed symptoms of increased pulmonary blood flow and respiratory distress. We decided to close one of the major aortopulmonary collateral arteries with the Gianturco coil on the 41st day after birth, however the results were not satisfactory. On the 66th day of infant life (by that time the patient weighted 3 kg), another procedure with the Amplatzer vascular plug was performed. This procedure was successful. After a few days the infant was discharged from hospital.

The aim of the study was to assess 24-h pulse pressure (PP) and to determine relationships between PP and echocardiographic parameters of left ventricle in children with chronic kidney disease (CKD). The study population included 47 children (mean age: 13.11 yrs) with CKD treated conservatively (n=14), with hemodialysis (HD) (n=13) and automated peritoneal dialysis (APD) (n=20). Retrospectively, antropometrical data, office blood pressure, ambulatory blood pressure monitoring (ABPM) variables and LV parameters in echocardiogaphy were analyzed. In study subjects, hypertension (HTN) was present in 25 (53.19%) and in 29 (61.7%) when based on office blood pressure and ABPM respectively. The prevalence of HTN was the highest in predialysis patients. 21 (44.6%) of children had left ventricular hypertrophy (LVH), which was the most frequently found in HD group. The mean PP value was 45.26 +/- 7.56 mmHg and was similar in all groups. Positive correlations were found between PP and weight (p < 0.001), height (p < 0.05), body surface area (p < 0.01) and LV measures (LV mass, LV posterior wall thickness and diastolic diameter of LV, all p < 0.05). Children with PP above median had tendency for greater LV mass (p = 0.06). There was no difference in severity of blood pressure and PP in children with/without LVH. However, in 45% of patients LVH was noted in whom the value of PP was greater than calculated normative value of PP (95 centile). HTN and LVH is common in children with CKD. A mean PP in children with CKD is lower when compared to adult population with CKD. The results confirm that PP increases with the age and an increasing PP has an influence on the changes of LV geometry. Assessment of PP in ABPM might help in identifying those with abnormal LV geometry.

Objective: Depressed cardiac function after aortoventriculoplasty is well known during the postoperative period. Little data exist concerning the long-term follow-up. The aim of this study is to determine whether septal incision has any permanent effect on the left ventricle function., Methods: From 1988 to 2002, 45 patients received aortic mechanical prosthesis. These patients were divided into two groups. Group A consisted of 26 patients 5-18 years old, who underwent simple aortic valve replacement. Group B consisted of 19 patients 4-20 years old, who underwent the Konno procedure. Systolic and diastolic functions of the left ventricle were analyzed using echocardiography. For the systolic function, the following parameters were assessed: pressure gradient between left ventricle and ascending aorta, shortening and ejection fraction of the left ventricle. For the diastolic function, left ventricle-filling parameters were assessed: ratio of early to late filling velocity, deceleration slope of the early filling velocity and left ventricular isovolumetric relaxation time. Furthermore the percentage fraction of the aortic valve index (AOVI%) was calculated and compared between these two groups., Results: After the surgery in group A, AOVI% dropped from 110+/-21 to 98+/-11%, while in group B it increased from 82+/-16 to 114+/-11%. As a result a higher residual pressure gradient across the aortic valve was noted in group A: 21.26+/-15 as compared to 11.17+/-5 mmHg in group B. A mean pressure above 30 mmHg appeared in group A 2 years after the surgery, while in group B this was obtained after 6 years. As for the diastolic function no significant difference was noted between these two groups. Overall there was one late death in group A, and in group B two early deaths, two reoperations because of excessive drainage and in two patients permanent pacemakers had to be implanted., Conclusions: Improvement of the systolic function after the surgery was noted in both groups. In patients with low AOVI%, postsurgical pressure gradient, either residual or recurrent, appeared during the follow-up. As for the septal incision, it may have some transient effects on the left ventricle function in the postoperative period, but no permanent sequelae were observed in the long-term follow-up.

Measurement of the heart rate variability enables to assess the activity of the autonomous nervous system. The aim of the study was to evaluate the possible relationship between clinical status, serum sodium (Na), potassium (K), calcium (Ca), magnesium concentrations and HRV in children with mitral valve prolapse. The study group consisted of 151 children with MVP (age +/- SD: 12.2 +/- 3.1 years). Thirty patients out of the MVP group were symptomatic and 121 were asymptomatic. The total number of 165 healthy children (age +/- SD: 12.3 +/- 3.7 years) were included into the control group. We assessed power spectrum of HRV (low frequency component--LF, high frequency component--HF, and LF/HF ratio) from 5-minute recording during daytime and night. Serum Mg (p < 0.00001) and K (p < 0.03) concentrations were significantly lower in MVP group as compared to healthy children. A marked decrease in Mg concentration was observed in symptomatic children with MVP as compared to asymptomatic patients (p < 0.0001). A significant positive correlation was found between Mg concentration and HF and HF n.u. components (daytime and night) and significant negative correlation was observed between Mg concentration and LF and LF n.u. (daytime and night) parameters and LF/HF ratio (daytime and night). Symptomatic children with MVP had significantly higher LF n.u. and LF/HF ratio and a lower HF n.u. as compared to asymptomatic patients. The autonomic changes in MVP children (reduction in parasympathetic tone with sympathetic predominance) were associated with decreased serum Mg concentration and higher prevalence of clinical symptoms. Mg supplementation seems to be a prudent approach in symptomatic children with MVP.

Background: Left ventricular (LV) dysfunction has been described in adults with secundum atrial septal defect (ASD II) and heart failure (CHF). This anomaly has been rarely regarded as a cause of CHF in pediatric patients with ASD II., Aim: To assess LV systolic and diastolic function in patients with ASD II before and after cardiosurgery as well as to establish the prognostic value of these parameters in infants, children and adolescents with ASD II., Methods: LV systolic (LVEF) and diastolic function parameters (E/A, DCT, IVRT) were studied using Doppler echocardiography in 104 patients aged between 1-18 years with ASD II before cardiosurgery and 4 years afterwards. These parameters were compared with similar variables in 150 healthy infants, children and adolescents., Results: Before surgery LVEF was significantly lower only in infants with ASD II and CHF when compared with healthy controls. Relaxation abnormalities of LV diastolic function were observed before surgery in 40.4% of patients, especially in infants and adolescents with CHF. These disturbances were still present in about 20% of patients after surgery, especially in infants. Before and after surgery both LV and RV end-diastolic volumes were normal in about 6-10% of patients with LV diastolic dysfunction., Conclusions: In patients with ASD II and CHF diastolic dysfunction of LV is more common than systolic dysfunction. RV volume overload mainly affects LV diastolic function but it is not the only cause of CHF in patients with ASD II, especially in infants and adolescents. After surgery, normalisation of LV diastolic function is not observed in about 20% of patients with ASD II, especially in those who had CHF before operation. Special monitoring of the circulatory system is necessary in patients with ASD II operated in infancy and adolescence.