Pipit Chiemmongkoltip

Echocardiographic evidence for impaired myocardial performance in children with type I diabetes mellitus

Thirty-three children with type I diabetes mellitus and 51 normal children underwent M-mode echocardiography. Abnormalities of myocardial performance were present in many of the diabetic children. The mean end-systolic volume of the left ventricle was greater in diabetics compared to control subjects. Mean ejection fraction, minor axis shortening, and velocity of circumferential fiber shortening were decreased in the diabetics. There was no evidence of increased myocardial mass in these diabetic children. There was no correlation between myocardial dysfunction, clinical assessment of control, or glycohemoglobin in the diabetic children.

Congenital pulmonary atresia with tricuspid insufficiency: Morphologic study

In an anatomic study of 21 cases of pulmonary atresia with tricuspid insufficiency (pulmonary atresia with intact ventricular septum, type II), the morphologic features of the tricuspid valve and the right ventricle were found to differ greatly from those seen in pulmonary atresia with tricuspid stenosis (pulmonary atresia with intact ventricular septum, type I). Morphologically, pulmonary atresia with tricuspid insufficiency (type II) has a greater resemblance to Ebsteins disease with pulmonary atresia than to type I pulmonary atresia. The anomaly may be more amenable to surgery than pulmonary atresia with tricuspid stenosis because the right ventricle in the former may be converted into a functional chamber by a valvotomy combined with a shunting procedure and atrial septostomy.

Neonatal Lupus with Congenital Atrioventricular Block and Myocarditis

This is a case of a child with neonatal lupus and congenital atrioventricuiar (AV) block, born to a mother with asymptomatic, systemic lupus erythematosus (SLE). The child, despite pacemaker insertion, died of septicemia and myocarditis at the age of three months. Although the association of neonatal lupus with congenital AV block is well‐recognized, there are only few pathologic studies of the conduction system reported in the literature. This is such a study in which we emphasize that, due to an altered immune system in the child, septicemia may be the cause of death in some cases.

The Prosthetic (Teflon) Central Aortopulmonary Shunt for Cyanotic Infants Less Than Three Weeks Old: Results and Long-Term Follow-up

The expanded microporous polytetrafluoroethylene (PTFE) 4 mm vascular prosthesis has been used to create a central aortopulmonary shunt in 20 critically ill infants less than 3 weeks old. The infants ranged from 1 to 18 days old (5.25 days), and from 1.5 to 4.0 kg (2.9 kg). Conduit length ranged from 2 to 6 cm (4 cm). Sixteen patients had atresia of the tricuspid or pulmonary valve. There were 6 early deaths (30%), only 1 of which was shunt related. The mean preoperative arterial oxygen saturation was 62% (range, 33 to 80%), and mean postoperative saturation was 87% (range, 78 to 90%). There were 5 late deaths, 1 probably caused by shunt failure. Nine long-term survivors have done well. Follow-up ranges from 1 to 36 months (18 months). Factors influencing conduit function are length, technical considerations, and pulmonary vascular resistance. Late restudy in 5 of 9 survivors confirms patency and demonstrates bidirectional pulmonary blood flow. Since PTFE shunt flow capability is fixed, the infant may require repair or a second shunt within 24 months of the initial procedure.

Myocardial infarction complicating bacterial endocarditis in rheumatic heart disease. Report of a case and review of the literature.

A case of rheumatic heart disease with massive myocardial infarction from coronary embolism complicating bacterial endocarditis is reported. The rarity of this complication in the pediatric age group as compared to the adult age group remains unexplained. Early recognition depends on serial electrocardiographic and enzymatic determinations.

Hemodynamic studies in children with congenital atrioventricular block

Abstract Eleven children with isolated congenital complete atrioventricular (A-V) block, 3 weeks to 21 years of age, underwent cardiac catheterization, including electrical pacing and isoproterenol infusion studies. The resting ventricular rates of the infants ranged from 60 to 90/min; those of the rest 40 to 55/min. The resting intracardiac pressures were normal or minimally increased. Mean cardiac index was low normal (3.3 liters/min per m2 ± 0.8 SD), but stroke index was abnormally high (65.6 ml/m2 ± 12.1 SD). Electrical pacing of the right ventricle to rates of 60 to 120 beats/min resulted in increased cardiac index (+26 percent), left ventricular minute work (+31 percent) and left ventricular stroke output impedance (+63 percent), but reduced stroke index (−32 percent), left ventricular stroke work (−37 percent), and tension-time index per beat (−36 percent). No significant changes in systemic vascular resistance, left ventricular ejection rate or output/tension-time ratio were observed. Isoproterenol infusion resulted in greater rise in cardiac index (+65 percent), left ventricular ejection rate (+57 percent) and output/tension-time ratio (+45 percent), no change in stroke index, and reduced systemic vascular resistance (−39 percent). The hemodynamic improvement due to isoproterenol infusion reflects the agents combined inotropic, chronotropic and peripheral vasodilatory effects. The overall hemodynamic findings in children with congenital A-V block are better than in adults with acquired block. It is suggested that intrinsic myocardial disease may be a significant feature in symptomatic subjects with this disease.

HEMODYNAMICS OF ENDOTOXIN SHOCK IN NEWBORN PUPPIES

Reports on neonatal hemodynamics in Endotoxin shock(ETX) are sparse. This study reports 58 newborn mongrel puppies, 260-800 grams in whom cardiac output(CO), mean arterial pressure(MAP), systemic vascular resistance(SVR), and minute work(MW), were measured q10 min. in controls (N=30) and 2 experimental groups receiving Ecoli(ETX) at a dosage of 1.5 mg/kg(group A=15), and 10 mg/kg(group B=13). RESULTS: MAP: fell below controls at 50 min. in group B, and at 70 min. in group A with parallel fall thereafter. CO: decreased immediately to 60% of control in both groups, and continued to decrease throughout the experiment, with gradual convergence of both groups at 120 min. SVR: rose to 200% in both groups A and B, and remained elevated throughout. MW: fell in both groups to 55% of control. SUMMARY: Newborn puppies respond to ETX with ↓ CO, ↓ MW, ↑ SVR, and late ↓ MAP, in contrast to adults subjects. Quantifications of interventions are now possible with this model.

1121 ECHOCARDIOGRAPHIC EVIDENCE FOR IMPAIRED MYOCARDIAL PERFORMANCE IN CHILDREN WITH TYPE I DIABETES MELLITUS

Myocardial performance was assessed by M-mode echocardiography in 33 children (6 8/12-19 3/12 yr) with Type I diabetes mellitus and in 51 normal children (6 2/12-18 8/12). Left ventricular end systolic dimension (LVESD), and left ventricular end systolic volume/M2 (LVESV/M2) were greater in diabetics than controls. Left ventricular ejection fraction (LVEF), minor axis shortening (MAS), and velocity of circumferential fiber shortening (VCF) were less in diabetics than controls.Hgb A1 levels in children with diabetes (15.5±0.6%, range 10.1-22.2%, normal 5.9-8.7%) correlated with clinical assessment of control (p<.01). Age, Hgb A1, duration of diabetes, and clinical assessment did not predict myocardial function. We conclude that there is impaired myocardial contractility in some children with insulin-dependent diabetes not correlated with duration of diabetes, age, clinical assessment of control, or Hgb A1. The long-term significance of this finding and the effect of improved control remain to be assessed.

1058 INTRARENAL BLOOD FLOW (RBF) AFTER ENDOtOXIC SHOCK (ES)

The purpose of this study was to determine distribution of IRBF in infant puppies in response to ES. Studies were performed in 18 mongrel puppies age 10-20 days. Cardiac output (CO), total renal blood flow (RBF) and IRBF was determined by dye dilution and the injection of 25 μ radiolabeled microspheres into the left ventricle. ES was produced by IV injection of 10 mgm/kg of E coli 0111 B4.These data demonstrate that RBF falls significantly 5 min. after ES and begins to increase by 20 min. OC and IC flow is initially unchanged; in late ES, IC flow is maintained as a result of a significant fall in OC flow. This response of IRBF may play a role in renal functional response to ES.