Pediatric Cardiology

Echocardiographic two-dimensional speckle tracking identifies acute regional myocardial edema and sub-acute fibrosis in pediatric focal myocarditis with normal ejection fraction: comparison with cardiac magnetic resonance

Echocardiographic two-dimensional speckle tracking identifies acute regional myocardial edema and sub-acute fibrosis in pediatric focal myocarditis with normal ejection fraction: comparison with cardiac magnetic resonance View Article Chinali M, Franceschini A, Ciancarella P, Lisignoli V, Curione D, Ciliberti P, Esposito C, Del Pasqua A, Rinelli G, Secinaro A. Sci Rep. 2020 Jul 9;10(1):11321. doi: 10.1038/s41598-020-68048-5. PMID: 32647322 Take Home Points: Speckle tracking echocardiography is helpful to systolic functional abnormalities in children with focal myocarditis and normal ejection fraction. Regions of reduced longitudinal strain on echocardiography corresponded to regions of myocardial edema detected by CMR imaging. Reduced global longitudinal strain was associated with a higher percentage of myocardial edema. Commentary from Dr. Inga Voges (Kiel, Germany), section editor of Pediatric Cardiology Journal Watch:  This retrospective study assessed the ability of speckle tracking echocardiography (STE) in children and adolescents with focal myocarditis and normal ejection fraction (EF) to identify acute systolic functional abnormalities and persistent subclinical systolic dysfunction. 33 pediatric patients were included according to the study flow chart (Figure 1). Echocardiography was performed on admission and at discharge. Echocardiographic parameters assessed in this study included left ventricular (LV) diameters and wall thickness, LVEF as well as LV inflow velocities (E, peak early diastolic filling; A, late diastolic peak velocities). Tissue Doppler was performed to calculate E/e’ ratio. STE was used to measure global and regional longitudinal strain. CMR was performed on admission to measure LV function as well as to assess myocardial fibrosis and edema. In all patients, ejection fraction was normal on admission and none of the patients presented with LV hypertrophy or dilatation. There was a normal pattern of diastolic filling with no evidence of increased LV filling pressure. Global longitudinal strain was reduced in 58% of the patients with the most affected regions being the inferoseptal, inferior and inferolateral segments. CMR imaging revealed a similar regional distribution of myocardial edema. Reduction in global longitudinal strain was associated with a higher percentage of myocardial edema (Figure 2). Echocardiography at discharge demonstrated a full recovery in 13 and persistent subclinical dysfunction in 6 children. Patients with persistent dysfunction were found to have more myocardial fibrosis during a follow up CMR study. In summary, the authors were able to demonstrate the usefulness of STE in identifying areas of regional (subclinical) systolic dysfunction corresponding to areas of myocardial edema. This relatively small study motivates for further research in this field.

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Congenital Heart Disease After the Fukushima Nuclear Accident: The Japan Cardiovascular Surgery Database Study

Congenital Heart Disease After the Fukushima Nuclear Accident: The Japan Cardiovascular Surgery Database Study View Article Hirata Y, Shimizu H, Kumamaru H, Takamoto S, Motomura N, Miyata H, Okita Y. J Am Heart Assoc. 2020 Jul 7;9(13):e014787. doi: 10.1161/JAHA.119.014787. Epub 2020 Jul 2. PMID: 32613886 Take Home Points: No increase was observed in the number of first time congenital cardiovascular surgeries between January 2010 and December 2013 in all of Japan and the area of the nuclear accident. The increase of the total number of congenital cardiovascular surgeries between 2010 and 2013 might be explained by a reduction in mortality for the initial surgery. Commentary from Dr. Inga Voges (Kiel, Germany), section editor of Pediatric Cardiology Journal Watch:  This important registry-based study assessed the effect of the Fukushima nuclear accident in March 2011 on the incidence of congenital heart disease. The authors hypothesized that the incidence of congenital heart disease did not increase after the accident. Data from 59 facilities within the Japan Cardiovascular Surgery Database was used for the analyses. Information about patients who underwent all types of congenital cardiovascular surgeries between 1st January 2010 and 31st December 2015 at the 59 facilities were extracted from the database. Patients who were older than 2 years at the time of surgery were excluded from the analysis.  The number of first congenital cardiovascular surgeries by the patients’ birth year–month in all 59 facilities and in the area of the nuclear accident (Tohoku region) was counted. Second, the percentage of live births in Japan that underwent their first congenital cardiovascular surgeries at the 59 facilities was calculated. Third, the total number of operations for complex diseases performed on patients one year old and younger per operation year, regardless of when the patients were born was counted. Between 1st January 2010 and 31st December 2015 26 251 patients underwent 44 818 surgeries. Out of them, 11 919 patients were born between 2010 and 2013, and were 2 years or younger at the time of surgery. The authors did not observe a monthly increase in the number first congenital cardiovascular surgeries in all of Japan (Figure 1A) and in the Tohoku area (Figure 1B). Also no increase in the percentage of live births that underwent congenital heart surgeries was found (Figure 2A and 2B). The total number of all congenital cardiovascular surgeries increased between 2010 and 2013 whereas mortality for the initial operation went down. In summary, this study gives new insights on the effects of the 2011 nuclear accident in Fukushima the incidence of congenital heart disease. It suggests that there was no obvious increase in the number of congenital heart disease patients.    

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Munich Comparative Study: Prospective Long-Term Outcome of the Transcatheter Melody Valve Versus Surgical Pulmonary Bioprosthesis With Up to 12 Years of Follow-Up

Munich Comparative Study: Prospective Long-Term Outcome of the Transcatheter Melody Valve Versus Surgical Pulmonary Bioprosthesis With Up to 12 Years of Follow-Up View Article Georgiev S, Ewert P, Eicken A, Hager A, Hörer J, Cleuziou J, Meierhofer C, Tanase D.  Circ...

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Echocardiographic two-dimensional speckle tracking identifies acute regional myocardial edema and sub-acute fibrosis in pediatric focal myocarditis with normal ejection fraction: comparison with cardiac magnetic resonance

Echocardiographic two-dimensional speckle tracking identifies acute regional myocardial edema and sub-acute fibrosis in pediatric focal myocarditis with normal ejection fraction: comparison with cardiac magnetic resonance View Article Chinali M, Franceschini A,...

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