H. Netz

Recurrent pericarditis in children: elevated cardiac autoantibodies

SummaryRecurrent pericarditis is a rare disease in childhood. Nevertheless, it may represent a challenge to the clinician due to its resistance to anti-inflammatory treatment. The initial etiology often remains unclear; specific laboratory parameters predicting the frequency or severity of the recurrences are lacking. We report on four patients with recurrent pericarditis in whom antimyolemmal antibodies (AMLAs) were detected. A prolonged persistence of IgM-type AMLAs was found in three patients: two of them presented with acute inflammation as the initial event and one with 48 recurrences during 5.5 years. The fourth patient showed a fast conversion from IgM to IgG-type AMLAs after a less acute initial presentation and showed 4 mild recurrences during the 48-month follow-up.ConclusionWe were able to detect AMLAs in four children with recurrent pericarditis. This finding may be attributed to an auto-immunological disease following a first, acute event. We propose the detection of AMLAs in all children with unexplained recurrent pericarditis. Pediatric patients with a persistence of IgM-type AMLAs may face frequent recurrences and should be monitored therefore more closely. In addition, medical treatment may be changed in these patients with a slower tapering of the dosage of steroidal and non-steroidal antiinflammatory drugs.

Successful ABO-incompatible heart transplantation in a child despite blood-group sensitization after ventricular assist device support.

Abstract:u2002 In the first twou2003yr of life blood‐group incompatible (ABO‐incompatible) heart transplantation can be performed leading to immune tolerance to donor blood group. Antibody titers should be below 1:4. VAD use is correlated with sensitization toward blood‐group antigens. A boy was diagnosed with dilated cardiomyopathy at nine months of age and listed for 0‐compatible transplantation. Progressive heart failure required implantation of a left VAD. His listing was extended for ABO‐incompatible transplantation despite antibody titers of 1:32 anti‐A and 1:8 anti‐B. After 26u2003days on VAD, he was transplanted with a B donor heart. No hyperacute or acute rejection occurred in 12u2003months post‐transplant. Anti‐B antibodies rose to a maximum of 1:2. No use of rituximab or plasmapheresis was required. There are no signs of graft vasculopathy. This indicates that inclusion criteria for ABO‐incompatible transplantation may be extended to immediate cases. This is the first case with a healthy immune system to show signs of tolerance development after ABO‐incompatible heart transplantation with increased prior antibody titers and without specific treatment.

Short-term testing of heart rate variability in heart-transplanted children: equal to 24-h ECG recordings?

Abstract:u2002 Introduction:u2002 Heart rate variability (HRV) is reduced in adults and children after cardiac transplantation. Testing of HRV has been used to assess re‐innervation of the cardiac graft; its reliability in ruling out acute graft rejection is still under investigation. This study used a short‐term test on HRV in 23 heart and heart–lung transplanted children and adolescents and compared the results with 24‐h ECG recordings.

Moderne Therapieverfahren bei angeborenen Herzfehlern@@@Modern therapy of congenital heart defects

ZusammenfassungDie Therapie angeborener Herzfehler wird heute in zunehmendem Maße durch das Zusammenwirken katheterinterventioneller Eingriffe und Herzoperationen geprägt. Im vorliegenden Beitrag sollen die häufigsten Herzfehler kurz erläutert sowie die aktuellen Therapieoptionen dafür dargestellt werden. Besonderes Augenmerk wird dabei auf neue Therapieverfahren speziell der interventionellen Kinderkardiologie gelegt. Zusätzlich wird auf die Kombination interventioneller und operativer Verfahren, die so genannte „Hybridoperation“, eingegangen. Abschließend werden die jüngsten Therapieentwicklungen etwa im Bereich des perkutanen Aorten- und Pulmonalklappenersatzes beschrieben.AbstractModern therapy of congenital heart defects consists of interventional and surgical procedures. The following report provides information about the most common congenital heart defects and the corresponding therapeutic options. Furthermore, the combined application of interventional and surgical procedures, so-called hybrid procedures, is described in detail as well as the latest developments in percutaneous valve replacement therapy.Modern therapy of congenital heart defects consists of interventional and surgical procedures. The following report provides information about the most common congenital heart defects and the corresponding therapeutic options. Furthermore, the combined application of interventional and surgical procedures, so-called hybrid procedures, is described in detail as well as the latest developments in percutaneous valve replacement therapy.