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Wstep. Koarktacja aorty (CoA) to wrodzona wada serca definiowana jako zwezenie w okolicy cieśni aorty, klinicznie charakteryzująca sie zaburzeniami perfuzji obwodowej w badaniu przedmiotowym. Wiekszośc pacjentow, u ktorych rozpoznaje sie CoA, stanowią noworodki, a korekcja chirurgiczna jest w tej grupie leczeniem z wyboru. Przezskorne interwencje kardiologiczne stanowią terapie rzadkich przypadkow, w ktorych objawy wystepują dopiero w kolejnych latach zycia dziecka. Tetniak aorty, niewydolnośc serca oraz udar to glowne powiklania nieleczonego CoA, co wyjaśnia niski wskaźnik przezywalności niezdiagnozowanych pacjentow. Opis przypadku. Podczas profilaktycznej kontroli pediatrycznej 5-letniej pacjentki w dobrym stanie ogolnym wykazano szmer nad sercem. Chorą skierowano do kardiologa dzieciecego, ale niestety ze wzgledu na trwającą pandemie choroby koronawirusowej 2019 dostepna byla tylko konsultacja telemedyczna, wykluczająca dokladne badanie przedmiotowe. Ostatecznie chorą skierowano na oddzial kardiochirurgii dzieciecej w celu pilnej konsultacji. Badanie echokardiograficzne wykazalo ciągly, niepulsacyjny przeplyw w aorcie brzusznej oraz zwezenie światla aorty zstepującej za lewym przedsionkiem. Angiografia tomografii komputerowej potwierdzila zwezenie światla aorty piersiowej (o dlugości 55 mm do średnicy 2,5 mm) z towarzyszącym krązeniem obocznym. Ze wzgledu na anatomie zmiany aorty pacjentke zakwalifikowano do przezskornej implantacji stent-graftu (Bentley BeGraft © 9 mm/57 mm) w hybrydowej sali operacyjnej z zapleczem krązenia pozaustrojowego. Wykonano wstepną dylatacje aorty do 9 mm, z wyjątkiem obszaru o dlugości okolo 6 mm zwezonego do 5,2 mm. Po 2 miesiącach stent-graft ponownie poszerzono, a badanie echokardiograficzne potwierdzilo dobry wynik zabiegu (średnica aorty piersiowej na calym odcinku 9 mm). Przebieg pooperacyjny bez powiklan, pacjentke wypisano do domu i skierowano na kontrole ambulatoryjną. Wnioski. Rzadko CoA obejmuje nietypowy obszar, wywolując trudne diagnostycznie objawy w warunkach pandemii i ograniczenia dostepności lekarzy specjalistow, szczegolnie u starszych pacjentow pediatrycznych obciązonych ryzykiem wystąpienia powaznych powiklan bez wdrozenia odpowiedniego leczenia.

The criss-cross heart congenital defect (CHD) concomitant with transposition of the great arteries has an incidence of less than 0.1% of all inherited heart anatomy abnormalities. It derives from the anomaly of cardiac rotation around its long axis after ventricular septation, and results in an atypical relation between the ventricles and the atria. Furthermore, such patients may also present with ventricular septal defect (VSD), large vessel malposition, double outflow and/or right ventricular hypoplasia (RV), pulmonary artery stenosis (PA), and tricuspid valve hypoplasia. A 7-month-old patient after a transcatheter pulmonary balloon valvuloplasty and a surgical unilateral modified Blalock-Taussig (BT) shunt was admitted to the paediatric cardiac surgery department for further treatment. CHD had been diagnosed prenatally and confirmed after birth. Echocardiographic study revealed dextrocardia and a criss-cross heart pathology with discordant atrioventricular (AV) and ventriculoarterial relations. Intracardiac pathology was concomitant with transposition of the great arteries [aorta originating from the RV, and PA from above the VSD], subvalvular and valvular pulmonary stenosis (gradient RV/PA approx. 90 mm Hg), and unobstructed BT shunt. Systemic cyanosis was not observed, and the child’s mental and physical development was undisturbed. After diagnostic catheterisation, the patient was referred for further surgery. Using extracorporeal circulation, a bidirectional Glenn anastomosis was performed, and the BT shunt as well as the PA were closed and dissected. The postoperative course was uncomplicated. More than 90% of criss-cross heart co-occur with levocardia and the concomitance with the AV-related transposition of the great arteries and dextrocardia, to the best of our knowledge, is the second described report in the literature. Thus, the diagnosis of a rare congenital heart defect should be always considered, especially in prenatal diagnostics, and precisely defined during qualification for further surgical treatment.

The prevalence of childhood obesity is increasing worldwide. Some obese children can go on to develop metabolic syndrome (MetS), but exactly who among them remains to be determined. The aim of this study was to indicate predisposing factors for metabolic syndrome, especially those that can be modified. The study comprised 591 obese children aged 10&ndash, 12 years. They were all Caucasian residents of Gdańsk, Poland, with similar demographic backgrounds. Clinical examination, anthropometry, biometric impedance analysis, blood tests (including oral glucose tolerance tests (OGTT) and insulinemia), and dietary and physical activity evaluation were conducted. The results of our study show that the risk factors for MetS or any of its components include male sex, parental (especially paternal) obesity, low body mass at birth, as well as omitting breakfast or dinner. There are few risk factors for metabolic syndrome both in obese adults and children. Some of these predictors can be modified, especially those in relation to lifestyle. Identifying and then influencing these factors may help to reduce the development of metabolic syndrome and consequently improve health and quality of life.

Background: Prevalence of childhood obesity increases worldwide. Some of the obese children develop metabolic syndrome (MetS) , who of them - remains to be determined. The aim of this study was indicate predisposing factors for metabolic syndrome,, especially those which can be modified.Methods: The study comprised 591 obese children aged 10-12 years. Clinical examination, anthropometry, biometric impedance analysis, blood works (incl. OGGT and insulinemia) as well as dietary evaluation and physical activity were estimated. Results: The risk factors of MetS or feature of this are: male, parent’s especially father’s obesity, low body mass at birth as well as omitting breakfast or dinner.Conclusions: There are few risk factors of metabolic syndrome in obese subjects, also in obese children. Some of these predictors can me modified, especially those referring to lifestyle. Indicating and then influencing these factors can be one way to diminish metabolic syndrome development, such improving health and quality of life. Besides certain socioeconomic effects could be gain too.