Henrik Oxhøj

Prevalence of pulmonary arteriovenous malformations (PAVMs) and occurrence of neurological symptoms in patients with hereditary haemorrhagic telangiectasia (HHT)

Abstract. Kjeldsen AD, Oxhøj H, Andersen PE, Green A, Vase P (Odense University and Odense University Hospital, Odense; University of Aarhus, Aarhus; and the Department of Otorhinolaryngology, Svendborg, Denmark). Prevalence of pulmonary arteriovenous malformations (PAVMs) and occurrence of neurological symptoms in patients with hereditary haemorrhagic telangiectasia (HHT). J Intern Med 2000; 248: 255–262.

Late cardiac effects of anthracycline containing therapy for childhood acute lymphoblastic leukemia

At present about 80% of children with acute lymphoblastic leukemia (ALL) will be cured following treatment with multi‐drug chemotherapy. A major concern for this growing number of survivors is the risk of late effects of treatment. The aim of this study was to determine whether signs of cardiomyopathy were present in patients treated in childhood with cumulative anthracycline doses of less than 300 mg/m2.

Kawasaki disease associated with parvovirus B19 infection

In a 9-week-old boy with with Kawasaki disease an active parvovirus B19 infection was diagnosed serologically.

Long-term cardiac follow-up of children treated with anthracycline doses of 300 mg/m2 or less for acute lymphoblastic leukemia†

The cardiotoxic effect of anthracyclines has been well described for moderate to high cumulative doses (>350 mg/m2). However, the question of whether sub‐clinical signs of cardiomyopathy may develop and progress over time in children receiving doses of <350 mg/m2 is controversial. The aim of the present study was to examine cardiac function with serial echocardiography from diagnosis to last follow‐up, relapse, or death, and to investigate whether suspected risk factors (e.g., age at diagnosis, gender, cumulative dose, and length of follow‐up) had a significant influence on cardiac function.

Embolotherapy for Pulmonary Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia (Rendu-Osler-Weber Syndrome)

Purpose: To evaluate the clinical results of embolization of pulmonary arteriovenous malformations (PAVMs) in patients with hereditary hemorrhagic telangiectasia (HHT), the Rendu-Osler-Weber syndrome. Material and Methods: Twelve patients in the county of Fyn, Denmark, were treated with transcatheter embolization of 20 PAVMs using 12 detachable silicone balloons and 26 steel coils. Results: All PAVMs were completely occluded and we observed a significant rise in PaO2 after treatment and a significant decrease in right-to-left shunt estimated by contrast echocardiography. All patients experienced an improved functional level. One patient experienced severe pleurisy and another a rise in temperature following treatment, but otherwise no symptomatic complications were observed. Conclusion: Embolotherapy is a definitive treatment for PAVMs: it is very effective with a high success rate and few complications. Patients with HHT are at risk of PAVM and should be screened and treated for PAVMs when these reach a size that is associated with complications. In the detection of PAVMs, contrast echocardiography is a very sensitive method, and follow-up of these patients can be done with contrast echocardiography.

Diagnostic value of chest radiography and electrocardiography in the evaluation of asymptomatic children with a cardiac murmur

We investigated the diagnostic value of the chest radiograph and ECG in the evaluation of whether asymptomatic children with a cardiac murmur had a heart disease as defined by echocardiography. One hundred children aged 1 month to 15 years (median 30.1 months) were included. After physical examination, a tentative diagnosis was made: 53 children had no heart disease, 24 had a probable heart disease and 23 children were thought to have heart disease on the basis of clinical assessment alone. After information from chest radiography and electrocardiography was obtained, the diagnoses were re‐evaluated. This resulted in a change of the tentative diagnosis in three children. However, the diagnosis in relation to the definite diagnosis by colour Doppler echocardiography was not changed to the correct diagnosis in any of these cases. In 24 cases, radiography suggested the presence of heart disease; however, only 10 of these had heart abnormalities on the colour Doppler echocardiogram (CDE). Three children had an abnormal ECG; all of these had abnormalities on the CDE, but they were already diagnosed as having heart disease by physical examination. We conclude that chest radiography and electrocardiography is of no help in the discrimination between heart disease and no heart disease in asymptomatic children referred for a cardiac murmur.

Management of Spinal Cord Stimulators in Patients with Cardiac Pacemakers

We report a case of spinal cord stimulation (neurostimularion) as treatment for angina pectoris pain in a patient with a demand pacemaker. The precautions to avoid inhibition of the demand pacemaker by the neurostimulator are discussed.

Initial evaluation of children with heart murmurs by the non-specialized paediatrician.

To analyse the ability of the non-specialized paediatrician to evaluate children with a heart murmur and the consequences of this evaluation for the need of further investigations, we undertook a prospective and consecutive study of 100 children, referred for initial evaluation of a heart murmur. Except for 1 child with a slight peripheral pulmonary artery stenosis, 53% of the children were correctly diagnosed as having no heart disease. In a project design where 47% of the children were referred for an echocardiographic study, no clinically significant heart disease was missed.ConclusionClinical evaluation without laboratory tests performed by paediatricians without any special training in cardiology could correctly acquit 50% of the children of heart disease, with no need for further investigation.

Entrapment of a Tined Pacemaker Electrode in the Tricuspid Valve. A Case Report

A tined pacemaker electrode was entrapped in the tricuspid valve apparatus. Nonresponding, sustained ventricular tachycardia, and cardiac arrest necessitated forcible removal of the electrode causing partial avulsion of the tricuspid valve. Hemodynamically insignificant tricuspid regurgitation developed subsequently.

Screening for pulmonary arteriovenous malformations: contrast echocardiography versus pulse oximetry.

Pulmonary arteriovenous malformations (PAVM) cause right-to-left shunt and imply risk of paradoxical embolism and cerebral abscess. These complications can be prevented by appropriate treatment. Detection of PAVMs is therefore important, so simple and reliable screening methods are needed for this purpose. The aim of this investigation was to compare pulse oximetry and contrast echocardiography as screening tools for detection of pulmonary arteriovenous malformations. Eighty-five hereditary haemorrhagic telangiectasia (HHT) patients and first-degree relatives identified in a comprehensive study of HHT-families in the county of Funen, Denmark, were investigated. Standing and supine pulse oximetry in room air was performed in all subjects, and in subjects with symptoms and/or abnormal pulse oximetry in room air, supine pulse oximetry breathing 100% oxygen was also performed. Transthoracic echocardiography with intravenous injection of echo contrast was performed in all subjects. Outcome measures were oxygen saturation change >2% units on changing body position and echo contrast observed in the left-sided heart chambers. Positive contrast echocardiography indicating the presence of PAVM was found in 47 subjects, whereas pulse oximetry was abnormal in only 16. The results strongly suggest that contrast echocardiography is a more sensitive screening tool for PAVMs than pulse oximetry.