Cardiac abnormalities in end stage renal failure and anaemia.

Thirteen anaemic children on dialysis were assessed to determine the incidence of cardiac changes in end stage renal failure. Nine children had an increased cardiothoracic ratio on radiography. The electrocardiogram was abnormal in every case but no child had left ventricular hypertrophy as assessed by voltage criteria. However, left ventricular hypertrophy, often gross, was found on echocardiography in 12 children and affected the interventricular septum disproportionately. Cardiac index was increased in 10 patients as a result of an increased left ventricular stroke volume rather than heart rate. Left ventricular hypertrophy was significantly greater in those on treatment for hypertension and in those with the highest cardiac index. Abnormal diastolic ventricular function was found in 6/11 children. Children with end stage renal failure have significant cardiac abnormalities that are likely to contribute to the high cardiovascular mortality in this group. Anaemia and hypertension, or its treatment, probably contribute to these changes. Voltage criteria on electrocardiogram are of no value in detecting left ventricular hypertrophy. Echocardiography must be performed, with the results corrected for age and surface area, in order to detect and follow these abnormalities.     

Short term correction of anaemia with recombinant human erythropoietin and reduction of cardiac output in end stage renal failure.

Children with end stage renal failure and anaemia have an increased cardiac index and often gross ventricular hypertrophy. The contribution of anaemia to these abnormalities is uncertain. Eleven children with end stage renal failure and anaemia (haemoglobin concentration < 90 g/l) were enrolled into a single blind, placebo controlled, crossover study to assess the cardiovascular effects of reversing anaemia using subcutaneous human recombinant erythropoietin (r-HuEpo). Each limb lasted 24 weeks; seven children completed both limbs of the study. Haemoglobin increased with r-HuEpo, remaining above 100 g/l for a mean of 11 weeks. Cardiac index fell as a result of a reduction in both left ventricular stroke volume and heart rate. Left ventricular end diastolic diameter also decreased. In five children left ventricular wall thickness and left ventricular mass decreased with r-HuEpo, but this failed to reach significance for the whole group. Blood pressure did not change in six normotensive children completing an r-HuEpo limb; the decrease in cardiac index was therefore balanced by an increase in peripheral vascular resistance. Three children were taking anti-hypertensive treatment at the start of the study; one required an increase, and one a decrease, in treatment during the r-HuEpo limb. Short term treatment with r-HuEpo reduces cardiac index. A longer study is needed to determine whether this will, in time, result in a significant reduction in left ventricular hypertrophy.     

Short term correction of anaemia with recombinant human erythropoietin and reduction of cardiac output in end stage renal failure

Children with end stage renal failure and anaemia have an increased cardiac index and often gross ventricular hypertrophy. The contribution of anaemia to these abnormalities is uncertain. Eleven children with end stage renal failure and anaemia (haemoglobin concentration < 90 g/l) were enrolled into a single blind, placebo controlled, crossover study to assess the cardiovascular effects of reversing anaemia using subcutaneous human recombinant erythropoietin (r-HuEpo). Each limb lasted 24 weeks; seven children completed both limbs of the study. Haemoglobin increased with r-HuEpo, remaining above 100 g/l for a mean of 11 weeks. Cardiac index fell as a result of a reduction in both left ventricular stroke volume and heart rate. Left ventricular end diastolic diameter also decreased. In five children left ventricular wall thickness and left ventricular mass decreased with r-HuEpo, but this failed to reach significance for the whole group. Blood pressure did not change in six normotensive children completing an r-HuEpo limb; the decrease in cardiac index was therefore balanced by an increase in peripheral vascular resistance. Three children were taking anti-hypertensive treatment at the start of the study; one required an increase, and one a decrease, in treatment during the r-HuEpo limb. Short term treatment with r-HuEpo reduces cardiac index. A longer study is needed to determine whether this will, in time, result in a significant reduction in left ventricular hypertrophy.     

Echocardiographic changes and risk factors for left ventricular hypertrophy in children and adolescents after renal transplantation

Long-term consequences of cardiac alteration in children with chronic renal failure and after renal transplantation are largely unknown. In chronic uremia, cardiomyopathy manifests itself as systolic dysfunction, concentric left ventricular hypertrophy (LVH) or left ventricular dilatation. The correction of uremic state by renal transplantation leads to normalization of left ventricular contractility, regression of LVH and improvement of cavity volume and so dialysis patients with uremic cardiomyopathy would benefit from renal transplantation. We studied 73 patients, aged 17 yr or less, who underwent renal transplantation in our center. This cross-sectional study was performed 4.6 yr (median) after transplantation. Of the total, 48 were males and 25 were females. Transthoracic echocardiographic examination was performed for all cases. The effects of clinical, demographic, biochemical and therapeutic data on echocardiographic parameters were assessed. Multivariate analysis was used to assess the relation between the risk factors and the left ventricular muscle mass index. The most common echocardiographic abnormalities were the LVH (47.9%), left atrial enlargement (31.5%) and left ventricular dilatation and systolic dysfunction (13.7% for each). The pretransplant dialysis, arteriovenous fistula, acute rejection, cumulative steroid dose per square meter surface area, post-transplant hypertension, anemia and graft dysfunction were significant risk factors for LVH by univariate analysis. The significant factors by multivariate analysis were pretransplant dialysis, post-transplant hypertension and anemia. From this study we may conclude that LVH is a common problem among renal transplant children and adolescents. Early transplantation, control of hypertension and correction of anemia may be beneficial regarding left ventricular function and structure.     

儿童期至成年期血压变化对成年期心肾功能的影响

目的 分析儿童、成年血压状态对高血压心肾功能的影响.方法对1987年开展的"北京儿童血压研究"队列人群(6～18岁儿童共2505人)于2005年进行随访,随访412例,包括血压测量和心血管相关因素的健康体检.结果该人群成年期高血压患病率14.8%(61/412),高血压患者中超重肥胖者占83.6%,心肾功能异常的检出率为72.1%,随高血压严重程度增加,心肾损害愈严重.Logistic 回归分析示,儿童成年高血压者发生相关器官功能异常的危险度(OR=4.072,95%CI=1.472～11.2.66)高于儿童期没有高血压而成年高血压者(OR=3.509,95%CI=1.548～7.957);儿童期高血压,成年转为非高血压者发生心肾功能损害的危险性与两时期都没有高血压者比较没有明显增加(OR=1.086,95% CI=0.514～2.298,χ2=0.047,P＞0.05).结论单独存在儿童期高血压,成年血压正常后,发生高血压心肾功能异常的危险性没有明显增加,儿童期和成年期持续存在高血压者,成年期发生高血压心肾功能异常的危险性增强.防治儿童高血压有利于成人心血管病的防治工作.     

Systolic and diastolic function in children with chronic renal failure

BACKGROUND: Cardiovascular complications are the most frequent cause of death in patients with end-stage renal failure (ESRF). We aimed to investigate systolic and diastolic functions in children with ESRF. METHODS: Thirty-nine children with ESRF (17 on continuous ambulatory peritoneal dialysis (CAPD), eight on hemodialysis and 14 on predialysis) were examined to assess systolic and diastolic functions by echocardiography and ultrasound Doppler. Left ventricular systolic and diastolic functions were measured both in patients and age-matched healthy controls (n = 20) and the indices of cardiac performance were compared. RESULTS: Increased left ventricular mass index (LVMI) and decreased volume/mass ratio with normal systolic left ventricular function was found in patients, as compared with controls. Left ventricular diastolic dysfunction was observed in dialysis patients. In most of these patients, left ventricular isovolumic relaxation time was prolonged, except in CAPD patients. The peak of late diastolic flow (A) velocities were increased with a reduction of the early diastolic flow velocity (E)--the E/A ratio. The E velocities were unchanged in all patients as compared with controls. Our data indicated an abnormality of myocardial relaxation in patients with ESRF. We found no relationship between E/A ratio and LVMI. Among three groups of patients, the LVMI and diastolic abnormalities were highest in the hemodialysis group indicative of poor control of hypervolemia and hypertension. CONCLUSIONS: The technique of CAPD has some advantages as a renal replacement therapy for preserving cardiac functions as compared with hemodialysis. However, it must be remembered that patients with hemodialysis have features that effects cardiac status, such as higher volume load and higher afterload (hypertension).     

原发性高血压儿童血尿酸水平与心脏亚临床损伤的相关性

目的 评估原发性高血压儿童的心脏亚临床损害情况,并分析血尿酸水平与心脏亚临床损害的相关性.方法 回顾性分析2015年1月至2020年6月于苏州大学附属儿童医院心血管内科住院的55例原发性高血压患儿治疗前的临床资料,并选取该院同期同年龄、同性别的45例健康体检儿童作为对照组.分析两组儿童临床特征、实验室检查、左心结构、收...     

Severe visual loss caused by unrecognized malignant hypertension in a 15‐year‐old girl

A 15‐year‐old girl presented with acute bilateral loss of central visual acuity due to hypertensive retinopathy level IV. She was found to have unrecognized malignant arterial hypertension associated with end‐stage renal failure. At the time of diagnosis she also had severe left ventricular hypertrophy (LVH). Hypertension was successfully treated with combined anti‐hypertensive therapy, but renal function did not recover. The patient underwent successful kidney transplant 4 months later and over a period of 20 months hypertensive retinopathy and LVH gradually resolved. This report emphasizes the importance of routine measurement of blood pressure and describes the possible consequences of unrecognized arterial hypertension in children. Early diagnosis and appropriate treatment are necessary to avoid development and progression of target organ damage and promote better long‐term cardiovascular prognosis.     

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??Abstract??Objective??To investigate the level of serum catecholamine ??CA????including epinephrine??E???? norepinephrine??NE???? dopamine??DA???? and aldosterone??ALD?? in children with left to right shunt congenital heart disease??CHD????and analyze the correlation between the serum CA?? ALD and cardiac function??ventricular volume load?? pulmonary artery pressure and myocardial remodeling. Method??Totally 53 cases of left to right shunt CHD and 20 cases of control group were induded in the study. We measured the content of serum CA and ALD in the control group and CHD group. We applied real-time three- dimensional echocardiogram to measure the left atrium diameter ??LAD???? left ventricular end diastolic inner diameter ??LVEDD???? and cardiac function. Result????1??The level of serum NE and ALD in CHD group was higher than the control group ??P < 0.01??. ??2??The level of serum CA and ALD was higher in heart failure group?? large shunt group and pulmonary artery hypertension group than in non-heart failure group?? small shunt group and non-pulmonary artery hypertension group??P < 0.01??.??3??The left ventricular end diastolic inner diameter index??LVEDDI???? left ventricular end diastolic volume index??LVEDVI?? and left ventricular mass index of heart failure group were larger than those of non-heart failure group??P < 0.01??.??4??There was positive correlation between the serum level of CA and left atrial diameter index ??P < 0.01?? and LVEDDI ??P < 0.01???? LVEDVI ??P < 0.01??. Conclusion??The serum CA and ALD may be regarded as an objective parameter in the early diagnosis of heart failure and pulmonary artery hypertension. There is a positive correlation between the serum CA and myocardial remodeling.     

Cardiac dysfunction in HIV infected children: a pilot study

Twenty six perinatally acquired HAART naive HIV positive children asymptomatic for cardiac disease in age group of 1-9 years were evaluated for cardiac abnormalities by echocardiography. All children were classified according to the revised CDC classification for HIV infection in children. 20 (76.9 percent) patients had evidence of cardiac abnormalities on echocardiography. 18 (69.2 percent) patients in category B had statistically significant abnormal echocardiographic finding . The commonest echocardiographic abnormalities seen were left ventricular dilatation in 10 (38.5 percent) and left ventricular hypertrophy in 10 (38.5 percent) patients. Echocardiographic abnormalities are present even in HIV-infected children who are asymptomatic for cardiac dysfunction.     

Cardiac involvement in congenital acquired immunodeficiency syndrome

Cardiac abnormalities have been reported in 25% to 73% of adult patients with acquired immunodeficiency syndrome (AIDS). We are reporting the clinical course of a child with congenital AIDS who developed similar cardiac complications. He presented with congestive heart failure three months after the diagnosis of AIDS. He had cardiomegaly demonstrated on chest roentgenogram, which was previously normal. He had left ventricular hypertrophy and T-wave abnormalities on electrocardiography and left ventricular dysfunction and dilatation on echocardiography. His subsequent echocardiogram continued to show poor contractility, although his congestive symptoms were stabilized with digitalis therapy and diuresis. After a year of maintenance therapy with digitalis, he developed right ventricular and right atrial enlargement and tricuspid valve thickening and nodularity, similar to the valvular changes reported in adults. Thus, children with AIDS should be monitored for cardiac complications.     

Symptomatic myocardial bridging in a child without hypertrophic cardiomyopathy

Myocardial bridging (MB) is a rare coronary anomaly in children that is typically associated with hypertrophic cardiomyopathy or left ventricular hypertrophy. Several reports, mainly in adults, have suggested an association between MB and sudden death or ischemia without other cardiac abnormalities. In this report, we describe an 11-year-old girl with syncope and manifestations of cardiac ischemia associated with MB of the middle segment of the left anterior descending artery. The coronary anomaly was not associated with left ventricular hypertrophy. Surgical unroofing of the affected coronary artery segment resulted in complete recovery. MB should be included in the differential diagnosis of children presenting with syncope and signs of ischemia even in the absence of ventricular hypertrophy.     

Electrocardiographic Criteria for Left Ventricular Hypertrophy in Children

Previous studies to determine the sensitivity of the electrocardiogram (ECG) for left ventricular hypertrophy (LVH) in children had their imperfections: they were not done on an unselected hospital population, several criteria used in adults were not applied to children, and obsolete limits of normal for the ECG parameters were used. Furthermore, left ventricular mass (LVM) was taken as the reference standard for LVH, with no regard for other clinical evidence. The study population consisted of 832 children from whom a 12-lead ECG and an M-mode echocardiogram were taken on the same day. The validity of the ECG criteria was judged on the basis of an abnormal LVM index, either alone or in combination with other clinical evidence. The ECG criteria were based on recently established age-dependent normal limits. At 95% specificity, the ECG criteria have low sensitivities (<25%) when an elevated LVM index is taken as the reference for LVH. When clinical evidence is also taken into account, the sensitivity improved considerably (<43%). Sensitivities could be further improved when ECG parameters were combined. The sensitivity of the pediatric ECG in detecting LVH is low but depends strongly on the definition of the reference used for validation.     

Primary myocardial disease (cardiomyopathies): A study of 69 cases

The clinical features, hemodynamic data and follow up of 69 children with cardiomyopathy (CM), up to the age of 12 years has been detailed. The diagnosis of CM was based on the report of WHO task force. Of the 69 children dilated CM was found in 64 cases whereas restrictive and hypertrophic cardiomyopathy were present in two and three patients respectively. The patients with dilated CM presented with congestive failure late in the course of the disease. Twenty-four of the 64 patients were found to have a mitral regurgitation murmur. The electrocardiogram was abnormal in each case; the common abnormalities being left or biventricular hypertrophy with nonspecific ST and T changes. Hemodynamic studies showed elevated right and left ventricular enddiastolic pressures and increased left ventricular volumes. In spite of clinical congestive failure right atrial pressure can be normal in infants with CM. Follow up was possible in 26 patients of whom 16 showed recovery. Of the 16 patients who showed recovery 10 have recovered completely (asymptomatic with normal heart size). The clinical, electrocardiographic radiological and hemodynamic data of patients who have recovered did not differ from those who did not show improvement. Vigorous anticongestive measures combined with bed rest was the main stay of treatment. The number of patients with restrictive and hypertrophic CM was too small for meaningful conclusions.     

Cardiac hypertrophy secondary to ACTH treatment in children

The usefulness of ACTH in the treatment of childhood epilepsy is assessed by improvement in the EEG and in the clinical condition. However, pronounced side effects, even serious ones, must be encountered. The most common complications are Cushing syndrome, infections, and arterial hypertension. We report on seven patients with infantile myoclonic seizures, who exhibited myocardial hypertrophy with increased left ventricular function during ACTH treatment. These changes were detected and followed by serial echocardiographic investigations. Within a period of 5 months after the termination of ACTH therapy the abnormal echocardiographic findings disappeared. We believe that the cardiac hypertrophy is ACTH-induced. Based on the various biological effects of ACTH different explanations are proposed: oedema or deposition of glycogen in the myocardial tissue, hyperinsulinism, arterial hypertension and increased inotropic stimulus. Because of our observations, we suggest careful monitoring of children treated with ACTH by performing serial echocardiographic investigations.     

先天性心脏病肺动脉高压手术前后右心功能变化和治疗

目的 了解先天性心脏病左向右分流导致的重度肺动脉高压对右心功能的影响以及手术矫治后右心功能的恢复状态。方法 对室间隔缺损(室缺)合并重度肺动脉高压(全肺循环阻力增加)的40例患儿，用心导管的方法进行术前、术后5～7年右心功能、肺循环的血流动力学随访测定。结果 术前右心心搏指数、作功指数、心排指数显著高于术后；术前右房压、右室收缩压及舒张压、肺动脉压力和阻力均增高，缺损修补后右室舒张压恢复正常，收缩压的降低与肺动脉压力下降有关；大型室缺左向右分流重度肺动脉高压右心功能不全系继发性右室高排出量心力衰竭，且伴有舒张功能障碍。结论 治疗心力衰竭不宜首选正性心肌收缩药物；降低肺动脉压力、减少左向右分流、根治心内畸形是合理的选择；术后右室收缩压持续不能恢复至正常水平，提示继发性肺血管梗阻性病变存在。     

Cardiac manifestations in HIV-infected Thai children

Cardiac complications contribute significantly to morbidity and mortality in HIV-infected children. There have been few reports of cardiac manifestations in HIV-infected children in developing countries. The aims of this study were to evaluate the clinical manifestations and echocardiographic findings in Thai children with HIV infection and determine the clinical predictors of left ventricular dysfunction and pulmonary hypertension. We retrospectively reviewed the medical records of 27 infants infected with HIV perinatally who presented with cardiovascular problems at a tertiary care hospital between 1995 and 2000. The mean age at initial cardiac evaluation was 36 months (range 8-65). Signs and symptoms included dyspnoea in all cases, oedema in 12 (44%), finger clubbing in 11 (41%), cyanosis in 6 (22%) and S(3) gallop in 8 (30%). Echocardiographic abnormalities included pericardial effusion in 12 (44 %), right ventricular dilatation in 12 (44%), pulmonary hypertension in 11 (41%), diminished left ventricular fractional shortening in 10 (37%), left ventricular dilatation in 9 (33%) and combined ventricular dilatation in 2 (7%). Left ventricular dysfunction did not correlate with HIV CDC classification, age, nutritional status or clinical signs and symptoms.     

Myocardial dysfunction in hypothyroid children

Eleven children with primary hypothyroidism were studied by echocardiography. Eight patients had pericardial effusion. Systolic time intervals (preejection period-ejection time ratio and left ventricular isovolumic contraction time) were suggestive of abnormal myocardial function. Asymmetric septal hypertrophy without left ventricular out-flow obstruction (ventricular septal-left ventricular posterior wall diastolic thickness ratio, greater than 1.3) was present in two hypothyroid children. After full replacement therapy, these cardiac abnormalities reversed to normal. Our data suggest that the myopericardial response to hypothyroidism in children is similar to that seen in adults.     

Fibromuscular dysplasia of renal arteries: an important cause of renovascular hypertension in children.

Fibromuscular dysplasia of renal arteries was the cause of hypertension in four consecutive children with renal artery stenosis. Two were asymptomatic, the third had had hypertension for seven years but had not been treated, and the fourth, a 9-month-old infant, presented with cardiac failure. Heart enlargement and left ventricular hypertrophy were present in all. Rapid sequence urograms demonstrated a smaller kidney and delayed appearance and disappearance of the contrast medium on the affected side in all. Angiograms showed left RAS in all. Peripheral plasma renin activity was elevated in only three of the four patients. Antihypertensive and diuretic drugs were not very effective therapeutically. Ischemia of the ipsilateral kidney probably prevented normal growth and led to shrinkage of the kidney in one patient. Following nephrectomy the BP has remained normal without any therapy for 24 to 64 months. With normalization of BP, accelerated growth ensued, the cardiomegaly regressed and the hypertensive retinopathy resolved. These patients demonstrate that: (1) FMD is an important cause of RAS. (2) the well-known radiologic feature of FMD, the beaded appearance, is usually not seen in children. (3) control of BP leads to normalization of linear growth, usually impaired in severe hypertension, and (4) target organ complications such as cardiomegaly, LVH, and hypertensive retinopathy are reversible in one to 10 months.     

Incidence of cardiac abnormalities in children with human immunodeficiency virus infection: The prospective P2C2 HIV study

OBJECTIVE: To describe the 5-year cumulative incidence of cardiac dysfunction in human immunodeficiency virus (HIV)-infected children.Study design: We used a prospective cohort design, enrolling children at 10 hospitals. Group I included 205 vertically HIV-infected children enrolled at a median age of 1.9 years. Group II consisted of 600 HIV-exposed children enrolled prenatally or as neonates, of whom 93 were ultimately HIV-infected. The main outcome measures were echocardiographic indexes of left ventricular dysfunction. RESULTS: In group I, the 5-year cumulative incidence of left ventricular fractional shortening 相似文献