Impact of Obstructive Sleep Apnea on Global Myocardial Performance in Children Assessed by Tissue Doppler Imaging

This study aimed to assess the impact of obstructive sleep apnea (OSA) due to adenotonsillar hypertrophy (ATH) on the global myocardial performance in children using tissue Doppler imaging (TDI) and to evaluate the reversibility of the disorder after adenotonsillectomy (AT). The study included 42 children with OSA due to ATH (mean age, 5 ± 3.14 years) as the study group and 45 age- and sex-matched healthy children (mean age, 5.2 ± 3.08 years) as the control group. Polysomnography and echocardiography were performed. Indexed left ventricular mass (LVMi), pulmonary artery systolic pressure, mean pulmonary artery pressure (mPAP), and pulmonary vascular resistance (PVR) were calculated by echocardiography. Tissue Doppler imaging was used to determine the left ventricular and right ventricular myocardial performance index (MPI) of patients and control subjects before and after AT. The patients were classified into mild OSA (apnea-hypopnea index [AHI] 1–5; n = 18)] and moderate to severe OSA (AHI >5; n = 24) according to polysomnography findings. All the children in the control group had an AHI less than 1. They were treated using AT, then reevaluated by polysomnography and echocardiographic examination 6 to 8 months after surgery. Results are described as mean ± standard deviation. The patients with OSA had higher pulmonary artery systolic pressure, mPAP, PVR, LVMi, and right ventricular diastolic diameter than the control subjects. The patients with moderate to severe OSA showed more prominent changes than the patients with mild OSA, but the latter still differed significantly from the control subjects. The TDI-derived right ventricular MPI and left ventricular MPI measurements of the patients with OSA were higher (mean, 0.40 ± 0.08 vs 0.28 ± 0.01; p < 0.001) than those of the control subjects and (0.45 ± 0.05 vs 0.32 ± 0.05; p < 0.001) and correlated well with AHI and mPAP. In addition, mPAP was significantly correlated with AHI. Postoperatively, relief of OSA was validated by polysomnography, and a repeat of the echocardiographic parameters showed no significant differences between the patients and the control subjects. Tissue Doppler imaging can detect the subtle, subclinical changes in cardiac performance that occur in OSA due to adenotonsillar hypertrophy. Such changes generally are reversible after surgical treatment.     

Mothers' depression and health‐related quality of life in neuromuscular diseases: Role of functional independence level of the children

Background: In the literature there have been studies about quality of life of parents who have children with chronic diseases. Most of these studies have focused on the stress of parents of children with neuromuscular disease (NMD), and there was no evidence to support hypothesized relationships between caregiving demands and health‐related quality of life (HRQOL). The aim of the present study was therefore to evaluate the relations between maternal depression and HRQOL and functional limitations of the children with NMD. Methods: Forty children with a diagnosis of NMD and their mothers were included in the study. HRQOL of the mothers was assessed on the Turkish version of the Nottingham Health Profile (NHP); potential cases of depressive illness were identified on Beck Depression Inventory (BDI); and Wee‐Functional Independence Measure (Wee‐FIM) was used to evaluate of functional independence level of the children. Results: It was found that mean total NHP score of the mothers was moderately correlated with the total FIM score and sphincter control of the child, and weakly correlated with the locomotion of the child (P < 0.001). There was moderate correlation between mothers' social isolation and children's sphincter control, social integration and total Wee‐FIM score and a weak correlation between mobility and communication scores (P < 0.001). In contrast there was no correlation between BDI scores of mothers and Wee‐FIM scores of children (P > 0.05). Conclusion: The functional level of children with NMD is one of the factors that affect the quality of life of mothers.     

情绪调节策略在注意缺陷多动障碍儿童症状与焦虑问题之间的中介作用

目的 探讨注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童情绪调节策略在症状与其焦虑问题之间的中介作用。方法 采用便利整群抽样法从新疆维吾尔自治区喀什市10所小学10 211名在校生中筛选出符合条件的ADHD共435例为研究对象,采用SNAP-Ⅳ评估量表、儿童青少年情绪调节问卷、Conners父母症状问卷进行调查,采用Spearman秩相关分析、有调节的中介法分析数据。结果 ADHD儿童认知重评策略得分与症状得分、焦虑问题得分呈负相关(分别rs=-0.254、-0.270,P<0.001),症状得分与焦虑问题得分呈正相关(rs=0.329,P<0.001)。中介效应分析结果显示,认知重评策略在症状与焦虑问题中起部分中介效应,95%置信区间为0.008～0.027,中介效应占总效应的16.10%;同时性别在该中介模型中起调节作用(P<0.001)。结论 ADHD儿童认知重评策略在ADHD儿童症状与焦虑问题之间起中介作用,同时性别调节了ADHD患儿症状与认知重评策略、焦虑问题的关系。     

Blood pressure in sleep disordered breathing

Aims: To investigate blood pressure (BP) in children with sleep disordered breathing (SDB). Methods: BP was measured during single night polysomnography in 23 suspected SDB child patients with adenotonsillar hypertrophy, but without respiratory or heart failure, or coma. The age related changes of the observed BP were normalised to the BP index. The BP indices were examined in relation to SDB measures, such as the desaturation time (percentage of time with oxygen saturation (SaO₂) <90% against the total sleep time), SaO₂ nadir, apnoea-hypopnoea index (AHI), and arousal index, in addition to age and body mass index (BMI). Results: The systolic BP index during rapid eye movement sleep (REMS) tended to correlate with AHI, while the diastolic index during REM sleep showed a significant correlation with AHI. The BP indices during non-REMS and wakefulness showed no correlation with the parameters obtained. Patients with an AHI of 10 or more (n = 7, AHIhigh) had significantly higher systolic and diastolic BP indices during both wakefulness and REMS, compared with those with an AHI of less than 10 (n = 16, AHIlow). Two patients in AHIhigh showed no sleep related dip of diastolic BP, and three patients in AHIlow lacked the sleep related dip in systolic BP. By means of multiple regression analysis, age, BMI, and AHI were found to be significant predictor variables of the systolic BP index during REMS. Conclusions: BP in paediatric SDB patients is positively correlated with the degree of SDB.     

Contribution of the blood glucose level in perinatal asphyxia

This is a comparative study between 60 asphyxiated newborns (cases) and 60 normal neonates (controls) in respect of their plasma glucose and uric acid levels and also their clinical and neurological status. The mean plasma glucose level was significantly lower (35.1 ± 11.4 mg/dl vs. 56.9 ± 5.5 mg/dl; P < 0.001) and the mean serum uric acid level was higher (8.0 ± 1.2 mg/dl vs. 4.5 ± 0.83 mg/dl; P < 0.001) in the asphyxiated group when compared to the controls. Within the perinatal asphyxia group, the plasma glucose level and Apgar scores showed a significant positive linear correlation (r = 0.740, P < 0.001), whereas a significant negative linear correlation was observed between the glucose level and different stages of hypoxic ischemic encephalopathy (HIE) (r = −0.875, P < 0.001). Although a strong positive linear correlation was found between uric acid and HIE stages (r = 0.734, P ≤ 0.001), the linear correlation between uric acid and Apgar scores (r = −0.885, P < 0.001) and uric acid and the plasma glucose level (r = −0.725, P < 0.001) were found to be significantly negative among the cases. Conclusion: The severity of encephalopathy and cellular damage varies with the severity of hypoglycemia.     

Efficacy of oral methylcobalamin in treatment of vitamin B12 deficiency anemia in children

To demonstrate the efficacy of oral methylcobalamin in treating vitamin B12 (vitB12) deficiency anemia, our prospective observational study enrolled 28 children with both macrocytic anemia and low holotranscobalamin (HoloTC) levels. Their hematological and biochemical parameters pre‐ and posttreatment at 1 month were compared. Hemoglobin showed mean increase of 2.89 g/dl (P < 0.001), rising above 10 g/dl in 24 patients (85.7%). Reticulocytes peaked at 1 week. Mean fall in mean corpuscular volume of 24.83 fl (P < 0.001) and mean improvement in platelets of 122,100/μl (P = 0.001) were noted, and mean rise in HoloTC and vitB12 were 111.36 pmol/l (P < 0.001) and 918.34 pg/ml (P < 0.001), respectively. Thus, initial responses to oral methylcobalamin in children with vitB12 deficiency anemia were adequate.     

Antro-pyloric canal values from early prematurity to full-term gestational age: an ultrasound study

Purpose. To evaluate antro-pyloric canal dimensions from early prematurity to full-term gestational age. Materials and methods. Ninety infants with no signs of regurgitation or vomiting were studied 3–5 days after birth. Their gestational ages ranged from 26 to 41 weeks (mean 33.7 weeks) and the body weight from 670 to 4150 g (mean 2067 g). Antro-pyloric muscle thickness, canal length and canal width were measured. Results. A positive correlation between gestational age, muscle thickness (R = 0.71, P < 0.001), length (R = 0.63, P < 0.001) and width (R = 0.42, P < 0.001) was found. Furthermore, a positive correlation between body weight, muscle thickness (R = 0.82, P < 0.001) length, (R = 0.67, P < 0.001) and width (R = 0.55, P < 0.001) was observed. Conclusions. This study shows that antro-pyloric canal dimensions increase with gestational age. Moreover, it provides normal values for muscle thickness, canal length and canal width from the early gestation to full term. Received: 5 February 1998 Accepted: 17 June 1998     

Mechanism of impaired immunologic response to bacterial antigens in burn wounds in children

Material was obtained from necrotic tissue excised from burn wounds in 60 children and examined immunohistochemically for the percentages of CD3, CD4, CD8, CD20, and CD68 cells. The results were then correlated with the burn surface area (BSA). Bacteriologic studies revealed the presence of bacteria in only 22 wounds with BSA greater than 10% of total body surface area. In this group, the proportion of CD3, CD4, CD8, CD20, and CD68 cells was correlated with the severity of infection, measured as the number of bacteria per g tissue. The results showed a positive correlation between the BSA and the percentage of CD8 cells (P < 0.001) and a negative correlation between CD4 cells and BSA (P < 0.02). The correlation between CD4/CD8 index and BSA was significantly negative. Likewise, a significant negative correlation was also noted between the percentage of CD4 and CD8 cells within the wound (P < 0.001). The severity of infection (bacteria/g tissue) was also positively correlated with the percentage of CD8 cells (P < 0.05) and negatively with the percentage of CD4 cells (P < 0.05). The correlation between CD4/CD8 index and intensity of infection was also highly significant. The results obtained show that in extensive burn wounds bacterial antigens may not be recognized properly due to the decreased percentage of CD4 cells and increased percentage of CD8 cells, which enhances bacterial growth in these wounds. Accepted: 12 July 1999     

Sleep problems in preschool and school aged rural Indian children

We assessed 513 children (2–6 y = 252; 7–12 y = 261) who visited the pediatric outpatient of a rural medical college hospital, for sleep problems using ‘BEARS’ tool. Sleep problems detected in the BEARS domains for preschool (2–6 years, n=252) and school children (7–12 years, n=261) were as follows: bedtime problems (33.3% vs 14.9%, P<0.001), excessive daytime sleepiness (32.5% vs 1.9%, P<0.001), awakening during night (25% vs 11.87%, P<0.001), regularity and duration of sleep (19.84% vs 4.98%, P<0.001), and sleep disordered breathing (4.8% vs 5%, P=0.1). We conclude that sleep problems are common among rural Indian children and should be routinely screened for during health visits.     

Prevalence and overlap of known undernutrition risk factors in children in Nairobi Kenya

We aimed to describe the co-occurrence of known risk factors for undernutrition and the prevalence of modifiable risks in wasted, stunted and healthy children. Quota sampling was used to recruit healthy [weight for age Z scores (WAZ) > ?2 SD] and undernourished [weight for length (WLZ) or WAZ scores ≤ ?2 SD] children aged 6–24 months from seven clinics in low-income areas of Nairobi. Structured interviews were used to identify exposure to socioeconomic, water and hygiene, infant feeding, dietary and behavioural risks (low interest in food, high food refusal and force feeding). We recruited 92 wasted WLZ ≤ ?2 SD, 133 stunted (length for age Z scores LAZ ≤ ?2 SD) and 172 healthy (LAZ and WLZ > 2SD) children. Nearly all children were exposed to hygiene risks (90%) and low dietary diversity (95%) regardless of nutritional status. Stunted children were more likely to be exposed to socio-economic risks (54% healthy, 64% wasted and 72% stunted; P = 0.001). Compared with healthy children, wasted and stunted children were more likely to be exposed to infant feeding (25% healthy, 40% wasted and 41% stunted; P = 0.02) and behaviour risks (24% healthy, 49% wasted, and 44% stunted; P = 0.004). Overall, wasted and stunted children were twice as likely to be exposed to more than three risks (23% healthy, 48% wasted, and 50% stunted; P = <0.001). They were also more likely to be exposed to more than three modifiable risks (dietary, handwashing and behaviour risks). Wasting and stunting are associated with exposure to multiple risk factors, many of which are potentially modifiable using targeted advice.     

Blood pressure in sleep disordered breathing.

AIMS: To investigate blood pressure (BP) in children with sleep disordered breathing (SDB). METHODS: BP was measured during single night polysomnography in 23 suspected SDB child patients with adenotonsillar hypertrophy, but without respiratory or heart failure, or coma. The age related changes of the observed BP were normalised to the BP index. The BP indices were examined in relation to SDB measures, such as the desaturation time (percentage of time with oxygen saturation (SaO2) <90% against the total sleep time), SaO2 nadir, apnoea-hypopnoea index (AHI), and arousal index, in addition to age and body mass index (BMI). RESULTS: The systolic BP index during rapid eye movement sleep (REMS) tended to correlate with AHI, while the diastolic index during REM sleep showed a significant correlation with AHI. The BP indices during non-REMS and wakefulness showed no correlation with the parameters obtained. Patients with an AHI of 10 or more (n = 7, AHIhigh) had significantly higher systolic and diastolic BP indices during both wakefulness and REMS, compared with those with an AHI of less than 10 (n = 16, AHIlow). Two patients in AHIhigh showed no sleep related dip of diastolic BP, and three patients in AHIlow lacked the sleep related dip in systolic BP. By means of multiple regression analysis, age, BMI, and AHI were found to be significant predictor variables of the systolic BP index during REMS. CONCLUSIONS: BP in paediatric SDB patients is positively correlated with the degree of SDB.     

Left Ventricular Systolic Function of Newborns with Asphyxia Evaluated by Tissue Doppler Imaging

The aim of the study was to evaluate the left ventricular systolic function of newborns with asphyxia using tissue Doppler imaging (TDI). Newborns with a history of asphyxia were divided into severe and mild groups based on their Apgar scores; normal newborns without asphyxia served as the controls. Left ventricular ejection fraction (LVEF), fraction shortening (FS), and stroke volume (SV) were measured by M-mode echocardiography at 24, 48, and 72 h after birth. The peak systolic velocity of the anterior mitral valve leaflet (Sm wave) was measured with TDI. Cardiac troponin I (CTnI) was measured. The results revealed that the LVEF and FS of the severe asphyxia group at 24 h were significantly lower than those at later time points (P < 0.01). These parameters were also significantly lower than those of the mild and control groups (P < 0.01). SV was not significantly different among the three groups. Sm wave of asphyxia groups was significantly lower than that of control group (P < 0.001). In the severe asphyxia group, Sm wave at 24 h was significantly lower than that at 48 or 72 h (P < 0.001). CTnI values of the severe asphyxia group were remarkably higher than those of the other two groups (P < 0.01). The findings of this study indicate decreased left ventricular systolic function of newborn children after asphyxia. Sm by TDI is a more sensitive indicator of left ventricular systolic function than LVEF, FS, or SV by M-mode echocardiography.     

Clinical and biochemical manifestations of syndrome X in obese children

The aim of this study was to investigate whether the clinical and metabolic characteristics of syndrome X had their onset in childhood in otherwise healthy but obese children of Greek origin. A group of 25 obese children and 18 age- and sex matched control subjects, aged 6–14 years, underwent an oral glucose tolerance test (OGTT), assessed for determination of plasma glucose and insulin levels. Insulin sensitivity and insulin resistance were estimated by mathematical models using calculations obtained during the OGTT. Body mass index (BMI) and blood pressure were measured, as well as serum lipoprotein and aminotransferase concentrations, after an overnight fast. The obese children had significantly higher blood pressure (systolic and diastolic) (P<0.001), triglycerides, lipoprotein(a) and alanine aminotransferase levels (P<0.05) and significantly lower HDL-cholesterol and apolipoprotein A-1 values (P<0.001). Plasma glucose levels during the OGTT were similar in both obese children and control subjects, while plasma insulin levels were significantly higher in obese children (P<0.01). In mathematical models, mean values of insulin sensitivity predictors: metabolic clearance rate and insulin sensitivity index were significantly lower in obese children (P<0.001). Predictors of beta-cell function: insulin resistance index and insulin release index were significantly higher in obese children (P<0.001). Conclusion:childhood adiposity was associated with all traditional components of syndrome X. The early recognition of these factors as predisposing elements of the appearance of metabolic syndrome requires the development of strategies to manage excess weight gain during childhood, with the ultimate goal being the prevention of type 2 diabetes and cardiovascular disease in adulthood.Abbreviations ApoA-1 apolipoprotein A-1 - ApoB apolipoprotein B - ALT alanine aminotransferase - AST aspartate aminotransferase - BMI body mass index - HDL-C HDL-cholesterol - HOMA-IR insulin resistance index - HOMA-Secr insulin release index - ISI insulin sensitivity index - LDL-C LDL-cholesterol - Lp(a) lipoprotein (a) - MCR metabolic clearance rate of glucose - OGTT oral glucose tolerance test - TC total cholesterol - TG triglycerides     

Inflammatory Response and Neurodevelopmental Outcome After Open-Heart Surgery in Children

Long-term neurodevelopmental sequelae are commonly detectable in children after open-heart surgery with cardiopulmonary bypass (CPB). The objective of the study was to determine the neurodevelopmental outcome in these children in relation to postoperative inflammatory reaction. This is a prospective, observational study on children with congenital heart defects (n = 32) undergoing elective open-heart surgery in a tertiary pediatric cardiac center. Neurodevelopmental outcome was assessed in the median 6 months after CPB. Neurological examination was done in all children before the operation and, additionally, complete neurodevelopmental status was assessed preoperatively in 14 children. Three hours after the end of CPB, plasma concentrations of interleukin (IL)-6 and IL-8 were strongly elevated (p < 0.001). Moreover, there was a rise of neutrophils and C-reactive protein at 24 h postoperatively (p < 0.001). Intellectual performance after surgery was correlated with preoperative performance, r _S  = 0.83, p < 0.001 (mean IQ scores after CPB = 90.4 ± 18.4 and before CPB = 87.5 ± 14.5, p = 0.20). Multiple regression analysis demonstrated that preoperative IQ scores accounted for 83.8% of the variance of postoperative IQ scores (p < 0.0001). Inflammatory variables were not significant predictors of postoperative IQ scores. The frequency of neuromotor abnormalities at 6 months after CPB was influenced by the presence of a cyanotic heart defect, duration of CPB and aortic clamp time, and plasma levels of IL-6 shortly after CPB (R ² = 67.8%, p = 0.002). In conclusion, in the examined population, preexisting neurodevelopmental impairment is frequent and predicts postoperative outcome. The high frequency of postoperative neuromotor disabilities seems to be associated with the type of congenital heart defect but also with the procedure and possible complications of CPB.     

Relation of Left Ventricular Hypertrophy to Microalbuminuria and C-Reactive Protein in Children and Adolescents with Essential Hypertension

Microalbuminuria (MA) and C-reactive protein (CRP) levels are predictors of increased risk for left ventricular hypertrophy (LVH). Whether the strength of association between CRP and LVH is comparable to that of MA in hypertensive children is unknown. CRP and MA were measured in 64 children and adolescents with essential hypertension (HTN). In the entire population, CRP and MA showed positive relations with body mass index (BMI) (r = 0.30, p = 0.04 and r = 0.32, p = 0.04, respectively), systolic blood pressure (SBP) (r = 0.63, p = 0.03 and r = 0.58, p = 0.03, respectively), and LVH (r = 0.86, p < 0.001 and r = 0.81, p < 0.001, respectively). Patients with LVH (n = 23) had significantly higher BMI (p = 0.32), increased SBP (p = 0.031), and higher levels of CRP (p < 0.001) and MA (p < 0.001) compared with those without LVH. Multiple linear regression analysis demonstrated that CRP (r = 2.11, p < 0.001), MA (r = 1.94, p < 0.003), BMI (r = 0.53, p = 0.02), and SBP (r = 0.48, p = 0.04) were significantly associated with LVH. By analysis of covariance, CRP and MA were significantly different between patients who had LVH and those without LVH after adjustment for age, gender, BMI, SBP, SBP index, and diastolic blood pressure (p < 0.001 for the two markers). In conclusion, the strength of association between LVH and CRP is comparable to that of MA in children and adolescents with essential HTN.     

The effects of obstructive sleep apnea syndrome due to adenotonsillar hypertrophy on the cardiovascular system in children

Obstructive sleep apnea syndrome (OSAS) due to adenotonsillar hypertrophy (ATH) is a common and important problem in children. OSAS can lead to significant cardiopulmonary complications, poor growth and problems with learning and behavior. Many studies in the literature show that OSAS due to ATH causes pulmonary hypertension, ventricular hypertrophy and systemic hypertension in the pediatric population. In this review, we discuss the effects of ATH on cardiac function. It is well known that as a child grows, the nasopharyngeal passage becomes enlarged, helping to improve OSAS. Based on this, we discuss the possible positive effect of this age-related improvement on the obstruction of cardiovascular disturbances. Finally, the possible relationship between the duration of OSAS and the timing of surgery with the permanency of cardiovascular disturbances is discussed.     

Evaluation of the North Star Ambulatory Assessment scale and cardiac abnormalities in ambulant boys with Duchenne muscular dystrophy

Aim We evaluated ambulatory patients with Duchenne muscular dystrophy from the cardiovascular standpoint and studied the correlation between the results of electrocardiographic (ECG) findings, left ventricular ejection fraction (LVEF), troponin T and N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) levels and patients' North Star Ambulatory Assessment scores. Methods: Fifty patients of ages 6–12 (8.9 ± 2.8) were enrolled in this cross‐sectional study. Cardiac evaluation included electrocardiography, echocardiography and cardiac enzyme tests. Results North Star scores ranged from 6/34 to 34/34. Twenty‐eight patients (56%) had ECG changes. The most frequently seen ECG abnormalities were short PR interval (14%, n= 7), right ventricular hypertrophy (16%, n= 8), prolonged QTc interval (10%, n= 5), prominent Q wave (10%, n= 5) and T wave inversion (44%, n= 22). In 10 patients (20%), LVEF was below 55%, troponin T and NT‐proBNP levels were significantly elevated (P= 0.003 and P < 0.001, respectively). When North Star scores were compared to patients' age, enzyme levels, ECG and echocardiographic results, we discovered negative correlation with age (P < 0.001) and troponin T levels (P= 0.02) and positive correlation with LVEF (P= 0.02). Conclusion Patients with North Star scores of ≤16 are more at risk of developing cardiomyopathies. Troponin T is a cardiac index that can be used for evaluating myopathic patients and it seems to be correlated with the proBNP levels and LVEF values.     

Effects of a low-calorie diet on resting metabolic rate and serum tri-iodothyronine levels in obese children

The purpose of the study was to examine the effects of weight loss on resting metabolic rate (RMR) and on serum T3 levels in obese children and to investigate whether RMR changes are related to T3 changes. Sixty-four healthy, overweight, children (age: 12.1 ± 1.1 years, body mass index 29.3 ± 4.3 kg/m²) were studied during a 6-week weight reduction programme. RMR (by indirect calorimetry) total T3, total T4, TSH and fat-free mass (FFM) (by anthropometry) were measured at baseline and after 6 weeks of dietary treatment. Weight loss resulted in a 10.1% decline in RMR (P < 0.01) and a 23.4% decrease in serum T3 levels (P < 0.001). RMR was correlated with FFM before (r = 0.78, P < 0.001) and after weight loss (r = 0.76, P < 0.001). The changes in RMR were positively correlated with the changes in FFM (r = 0.48, P < 0.05) but also with the changes in serum T3 levels (r = 0.47, P < 0.05). The initial T3 levels predicted the subsequent fall in T3 that occurred after 6 weeks of dietary treatment (r = −0.60, P < 0.001). Conclusions A significant decrease in serum T3 concentrations and resting metabolic rate occurred as a result of a 6-week weight reduction programme in an obese child population. The decline in T3 levels combined with fat-free mass loss could be responsible for the reduction in resting metabolic rate. Received: 30 June 1998 / Accepted in revised form: 22 October 1998     

Echocardiographic findings in mild and severe forms of sickle cell anemia

M-mode echocardiographic findings were compared between sickle cell anemic and healthy children. Patients were composed of two groups; Group 1: mild group with no crises, no blood transfusions at the ages of 5.0 to 13.0, total of 12 children; Group 2: severe group, with frequent crises with requirement of blood transfusions at the ages of 3.0 to 13.0 years, total of 18 children. Control group was composed of 12 healthy children aged 5.0 to 13.0. When M-mode echocardiographic findings were compared, important findings were as follows: Mean left atrium dimension was increased both in the mild and severe groups (P < 0.001) compared with controls. This finding also supports the increase in the left ventricle end-diastolic dimension in both the severe and mild groups as compared with controls (P < 0.001). The increase in end-diastolic left ventricle dimension could be due to anemia present in the patients, but there was no difference between the two patient groups. Posterior left ventricle thickness and left ventricle mass was increased in both the mild and severe groups compared with controls (P < 0.001, P < 0.05), respectively. Left ventricular fractional shortening was more or less the same with controls. In spite of left ventricular volume load and dilatation, left ventricular contraction was good and systolic function was normal, and there was no correlation between the ECHO findings and hematological indices.