Beata Kucińska

Ultrasonography of the brain, abdomen, and heart in neonates born to liver or renal transplant recipient mothers.

BACKGROUND Pregnancies in graft recipients are associated with increased risk of a number of pathologies. The aim of the study was to analyze results of brain and abdominal ultrasonography and echocardiography (ECHO) in neonates born to liver (LTx) or renal recipients (RTx). MATERIAL/METHODS The study group consisted of 82 neonates born to transplanted women (46 neonates of liver recipients and 36 neonates of renal recipients), enrolled in a retrospective study. The control group consisted of 74 neonates from the general population. Sonographic examination of the brain was performed to check for the presence of intra-/periventricular hemorrhage (IVH/PVH) according to Papile, and periventricular leukomalacia (PVL).The results of abdominal ultrasonography and 2-dimensional echocardiography (ECHO) were compared between the groups. The immunosuppressive therapy used during pregnancy was also analyzed. RESULTS No significant differences were observed between the frequency of IVH in LTx and RTx groups and LTx, RTx, and control groups. Abdominal ultrasonography revealed 1 case of suprarenal hemorrhage, 1 case of cystic kidney, and 3 cases of pyelocalyceal system dilatation in the study group. There were no abnormalities in the echocardiography in 97.8% of children born to mothers after LTx and in 94.4% after RTx. There were significant differences in the immunosuppressive therapy between the pregnant women after LTx and RTx. CONCLUSIONS The risk was not increased in intra-/periventricular hemorrhage and congenital abnormalities of the gastrointestinal tract and heart in neonates of mothers after organ transplantation, regardless of the immunotherapy used, and risk was similar to that of the general population.

Assessment of right atrial and right ventricular size in children after percutaneous closure of secundum atrial septal defect with Amplatzer septal occluder.

Introduction The aim of this study was to evaluate the right atrial (RA) and right ventricular (RV) size, and the speed of their normalization, in children after percutaneous closure of secundum atrial septal defect with the Amplatzer septal occluder. Material and methods The study group consisted of 42 children, aged 4.5 to 18.5 years. The following measurements (indexed to body surface area) were performed using 2D echocardiography: longitudinal, transverse axis and area of RA, RV inflow dimensions at one-third, and halfway between the tricuspid annulus and the apex (in the apical 4-chamber view), short axis and M-mode RV diastolic dimensions. All measurements were obtained 24 h and 1, 3 and 12 months after the procedure, then annually over 4 years of follow-up, and compared with the values obtained from the control groups. Results A significant decrease in all RA and RV values was observed after 24 h. Right ventricular transverse dimension normalized after 1 month, the RA longitudinal axis and area and the RV inflow dimensions after 3 months, and the RA transverse axis and M-mode RV diastolic dimension after 2 years, but the ratio of transverse to longitudinal RA axis remained significantly higher. Conclusions Right atrial and right ventricular measurements decrease rapidly during the first 24 h, and most of them normalize within a 3-month period. M-mode RV diastolic dimension does not capture the real RV changes. Amplatzer septal occluder closure of ASD influences the RA geometry, which is reflected by the higher transverse to longitudinal RA axis ratio.

Evaluation of left ventricular function in overweight children and teenagers with arterial hypertension and white coat hypertension

BACKGROUND Obesity in childhood is strongly associated with elevated arterial blood pressure and risk of hypertension. The aim of the study was the evaluation of left ventricular function in hypertensive and white coat hypertensive overweight children and teenagers. METHODS The study group consisted of 74 overweight patients aged 10.3 ± 3.1 years (range: 6-16 years) diagnosed as hypertensive in standard blood pressure measurement. The control group consisted of 31 normotensive and normoweight children. Ambulatory blood pressure monitoring (ABPM) and echocardiographic assessment of the left ventricular mass and function were performed in all participants. RESULTS Using ABPM hypertension was confirmed in 20 children (27%). In the 54 remaining children (73%) white coat hypertension was diagnosed. The analysis of echocardiographic parameters revealed higher left ventricular mass index (LVMI) in hypertensive overweight than in normotensive normoweight children (47.5 ± 9.2 g/m2.7 vs. 39.8 ± 12.1 g/m2.7; p < 0.05) and no difference between overweight hypertensive and WCH-hypertensive groups. The deceleration time of mitral early filling (DCT) was longer in hypertensive normoweight children than in normotensive overweight patients (219.5 ± 110.3 ms vs. 197.8 ± 65.8 ms; p < 0.05). A significant correlation between systolic pressure load (SBPL) and DCT (r = 0.57) and moderate correlation between SBPL and LVMI (r: 0.48) as well as between LVMI and isovolumetric relaxation time (r = 0.37) were found. CONCLUSIONS In overweight children the diagnosis of hypertension should be confirmed in ambulatory blood pressure monitoring because of the high prevalence of white coat hypertension. Periodic echocardiographic examinations should be recommended in overweight children with increased systolic blood pressure load and decreased systolic nocturnal deep because of the possibility of left ventricular function impairment.

Zaburzenia emocjonalne u chłopca z wszczepionym kardiowerterem-defibrylatorem

Streszczenie Kardiomiopatia przerostowa jest zlozoną, genetycznie uwarunkowaną chorobą mieśnia sercowego, przebiegającą najcześciej z asymetrycznym przerostem przegrody miedzykomorowej. Charakteryzuje sie roznorodnością obrazu fenotypowego i przebiegu klinicznego. Jest ona czestą przyczyną naglej śmierci sercowej u mlodych osob. Najczestszą przyczyną naglego zgonu są zlozone komorowe zaburzenia rytmu serca. Najskuteczniejszym sposobem zapobiegania naglej śmierci sercowej jest wszczepienie kardiowertera-defibrylatora (Implantable cardioverter-defibrillator; ICD). Metoda ta wiąze sie jednak z pojawieniem licznych problemow i ograniczen związanych z codziennym funkcjonowaniem. Nierzadko pojawiają sie rowniez problemy natury psychologicznej. Przedstawiamy przypadek 16-letniego chlopca z rodzinną kardiomiopatią przerostową, u ktorego w wieku 9 lat wszczepiono ICD, jako prewencje wtorną po zatrzymaniu krązenia w mechanizmie migotania komor serca. Opisano liczne problemy zglaszane przez chlopca i jego matke dotyczące braku akceptacji ICD, leku przed wyladowaniami, ograniczania i unikania aktywności fizycznej, leku przed chodzeniem do szkoly, trudności ze snem oraz zachowan natretnych.

769 Rapid decrease and follow-up of right atrial size after secundum atrial septal defect closure with Amplatzer Septal Occluder in children

Aim: The goal el the study was to assess righl atrial (RA) size aller Atrial Seplal Defect (ASD II) clesurewilh Amplatzer Seplal Occluder (ASO). Palienls and methods: The echo evaluation was pedormed in 42 children (sludy group) aged 4,5-18 years wilh body sudace area 0,69m 2 1,87rn 2 belore ASO implanlalion and 24 hours, 1,3,12 months, 2, 3, 4 years pesl-procedure. In the apical four-chamber view RA longitudinal diameter [RAD1], transverse diameter [RAD2] and RA area [RAA] were measured and presented as an absolute values: RAD1, RAD2, RAA and as an indexed for body surlace area (BSA) values: RAD1/BSA; RAD2JBSA; RAA/BSA. The comparison el RA measurements oblained prior to closure to the values alter the procedure as well as posl-closure values to previous examinalion measurements were perlormed. The control group consisled of 40 healthy children. Results: The comparison el RA pre and 24 hours post closure dimensions in study group revealed significanl reduclion (p 0,05) between absolute and indexed values of RA measuremenls in study and control group: al 24 h for RAA and RAA/BSA, at 3 monlhs lot RAD1 and RAD1/BSA, al 12 monlhs lor RAD2 and at 24 months for RAD2/BSA. Conclusions: 1. Rapid reduclion of RA size occurs during the first 24 hours aller perculaneus closure of ASDII. 2. Slower changes el RAD2 and RAD2/BSA values reflecting RA transverse diameter could resull from big geomelric profile el ASO. 3. Values of RA area seems to reflect better RA size changes than values el RA axis. 771 Coronary sinus atrial septal defect: clinical profile, diagnosis and management in 29 patients