Search

Epidemiologic of infective endocarditis (IE) is changing and paediatric population is heterogeneous. We compare clinical characteristics according cardiac status among children. A retrospective multi centric study was conducted over a decade. Clinical presentation, treatment, outcome, microorganism, underlying congenital heart disease data were recorded. We identified 64 cases of definite IE between January 2008 to December 2018 median age was 8.0 [0.8–13.2] and 26 were girls, S aureus was the most common pathogen, n = 22 (34%), presented in Table 1. CHD represented 45 cases of IE and 38 patients had prior cardiac surgery, they were significantly younger and community acquired IE was more common. New cardiac murmur 11 (24%) vs. 11 (58%), P < 0.02, acute ischemic stroke 1 (2%) vs. 4 (21%), P < 0.02, and heart failure 11 (22%) vs. 10 (54%), P < 0.03 were significantly higher in non-CHD group. Major MDC was met more often in patients without CHD than in patients with CHD (84% versus 46%, P < 0.006). There was no difference between IE related to children with or without CHD considering the side of the localisation. Valvular replacement was more frequent in this population [13 (28%) vs. 1 (5%) P < 0.05]. Overall morbidity rate was not significantly different but neurologic complications were significantly more prevalent in patients without CHD 7 (15) vs. 11 (58). Children without CHD presented significantly more neurologic impairment 1 (2%) vs. 4 (21%), P < 0.05. CHD patients seem older, require more valve replacement and present community acquired infection when patients without CHD presented more neurological outcome and more hospital acquired infection. [ABSTRACT FROM AUTHOR]

Background The relation between type 1 diabetes and cardiac structure and function in children is poorly documented. We used 2D speckle strain imaging to investigate whether children and adolescents with type 1 diabetes have early echocardiographic signs of subclinical cardiac dysfunction and whether state of metabolic control and diabetes duration are of influence. Methods Standard 2D echocardiography, mitral TDI and 2D speckle strain imaging were prospectively performed in type 1 diabetic children and compared them to age and sex-matched healthy control subjects. Standard echocardiographic indices of global systolic and diastolic function, early peak diastolic mitral velocity (Ea), longitudinal strain (LS), radial strain (RS) and circumferential strain (CS) were investigated. Results Overall 49 consecutive type 1 diabetic children (age: 12.3 [6-18] years; BMI: 19±2.8; males: 20) were compared to 49 control subjects. There was no difference between two groups for mean arterial blood pressure, heart rate, left ventricular ejection fraction, left ventricular mass, conventional diastolic mitral Doppler parameters (E, E/A, MTD) and Ea. A significant decrease of LS was identified in type 1 diabetic children while RS and CS did not differ. LS was positively correlated with HbA1c (r: 0,28; p<0,001) and with diabetes duration (r: 0,20; p<0,001). Conclusion We demonstrated that left ventricular longitudinal myocardial strain is decreased in young patients with uncomplicated type 1 diabetes. Metabolic control may be the main risk factor for these myocardial changes. This finding might be considered a very early preclinical alteration potentially related to subsequent development of diabetic cardiomyopathy. [ABSTRACT FROM AUTHOR]

Introduction: Pulmonary arterial hypertension (PAH) is a devastating disease with poor survival but there are limited data describing its impact in the paediatric population. Objective: The objectives of this national prospective registry were to collect clinical and epidemiological data and to investigate the outcome of children with PAH. Methods: All consecutive patients <18 years with PAH seen in 16 referral PAH centres in France were included and evaluated after 1 and 2 years of follow-up for WHO functional class (FC), 6-minute walk distance (6MWD) and quality of life (QoL; CHQ-PF50 questionnaire). Persistent pulmonary hypertension of the newborn and PAH due to congenital heart disease (CHD) were excluded. Results: Fifty patients were included between May 2005 and June 2006. Mean age at diagnosis was 8.7±5.4 years and male/female ratio was 1/1. The prevalence of pediatric PAH was 4.2 cases/million. A history of prematurity, cancer and major surgery was noticed in respectively 19%, 6% and 4% of patients. At inclusion, 28% of patients were in WHO FC III or IV. Aetiology of PAH was idiopathic in 60%; familial in 10%, associated with but not due to CHD in 24%, related to connective tissue disease in 4% and to portal hypertension in 2%. Nine patients (018%) died during the 2-year follow up. Survival estimates at 1 and 2 years were 86% and 82%. Seventy three percents of patients improved or did not change WHO FC (n=44). Patients remained stable regarding 6MWD (n=25), hemodynamics (n=11), and QoL (n=19). During the 2-year follow-up, combination of PAH-specific therapies was increasingly prescribed (44% patients vs. 22% at inclusion). Conclusions: This first national paediatric registry showed (1) the presence of multiple PAH aetiologies in children, that could be different from those seen in adults, (2) the association with other co-morbidities, and (3) the stabilization or even improvement in patient''s condition with the therapeutic management recommended in the current era. [Copyright &y& Elsevier]