scholarly journals Short-term Outcomes in Children Recovered from Multisystem Inflammatory Syndrome associated with SARS-CoV-2 infection

2021 ◽  
Author(s):  
Sibabratta Patnaik ◽  
Mukesh Kumar Jain ◽  
Sakir Ahmed ◽  
Arun Kumar Dash ◽  
Ram Kumar P ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Intravenous Immunoglobulins ◽  
Study Data ◽  
Left Ventricular ◽  
Additional Treatment ◽  
Acute Stage ◽  
Post Discharge ◽  
Inflammatory State ◽  
Inflammatory Syndrome

Background: Multi System Inflammatory Syndrome in children (MIS-C) associated with COVID-19 is a recently recognised potentially life-threatening entity. There is limited data on post MIS-C sequelae. Methods: 21 children fulfilling the WHO criteria for MIS-C were included in our study. Data was collected at baseline and at 12-16 weeks post discharge to look for any persistent sequelae mainly relating to the lungs or heart including coronary arteries. Results: Fever was the most common presentation found in 18 (85.7%) patients. All had marked hyper-inflammatory state. Low ejection fraction (EF) was found in 10 (47.6%) but none had any coronary artery abnormality. All received corticosteroids while 7 (33.3%) children required additional treatment with intravenous Immunoglobulins. 20 children improved while 1 left against medical advice. At discharge 3 children had impaired left ventricular function. At median 15 weeks follow-up no persistent complications were found. EF had returned to normal and no coronary artery abnormalities were found during repeat echocardiography. Chest radiographs showed no fibrosis and all biochemical parameters had normalized. Conclusion: The children with MIS-C are extremely sick during the acute stage. Timely and adequate management led to full recovery without any sequelae at a median follow-up of 15 weeks.

scholarly journals Paediatric inflammatory multisystem syndrome temporally associated with COVID-19: a new virus and a new case presentation

2020 ◽  
Vol 13 (12) ◽  
pp. e238531
Author(s):  
Phoebe Makiello ◽  
Sima Svirpliene ◽  
Lisa Finlay ◽  
Jean McKnight
Keyword(s):  
Clinical Symptoms ◽  
Late Phase ◽  
Upper Airway ◽  
Intravenous Immunoglobulins ◽  
Left Ventricular ◽  
Haemodynamic Instability ◽  
Case Presentation ◽  
Full Resolution ◽  
Inflammatory Syndrome

An 11-year-old boy presented with features resembling those described in health alerts on Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS), including persistent fever, haemodynamic instability and abdominal pain. Laboratory tests, including raised inflammatory markers, D-dimer, troponin and a coagulopathy, were consistent with PIMS-TS. Our patient required transfer to the paediatric intensive care unit; an echocardiography revealed left ventricular dysfunction. He was treated with intravenous immunoglobulins (Igs), corticosteroids and aspirin, with full resolution of clinical symptoms. A follow-up echocardiogram 1 month after discharge was unremarkable.Three SARS-CoV-2 PCRs on respiratory samples, taken over the initial 4-day period, were negative, as was a SARS-CoV-2 PCR on faeces 1 month after presentation; titres of IgG were clearly elevated. The negative PCRs in the presence of elevated titres of IgG suggest that the inflammatory syndrome might have developed in a late phase of COVID-19 infection when the virus was no longer detectable in the upper airway.

Outcomes of surgical repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children

2021 ◽  
pp. 1-6
Author(s):  
Tong Feng ◽  
Guo Zhangke ◽  
Bai Song ◽  
Fan Fan ◽  
Zhen Jia ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Pulmonary Artery ◽  
Left Coronary Artery ◽  
Surgical Repair ◽  
Left Ventricular ◽  
Anomalous Origin ◽  
Dimension Index

Abstract Objectives: Anomalous origin of the left coronary artery from the pulmonary artery is associated with high mortality if not timely surgery. We reviewed our experience with anomalous origin of the left coronary artery from the pulmonary artery to assess the preoperative variables predictive of outcome and post-operative recovery of left ventricular function. Methods: A retrospective review was conducted and collected data from patients who underwent anomalous origin of the left coronary artery from the pulmonary artery repair at our institute from April 2005 to December 2019. Left ventricular function was assessed by ejection fraction and the left ventricular end-diastolic dimension index. The outcomes of reimplantation repair were analysed. Results: A total of 30 consecutive patients underwent anomalous origin of the left coronary artery from the pulmonary artery repair, with a median age of 14.7 months (range, 1.5–59.6 months), including 14 females (46.67%). Surgery was performed with direct coronary reimplantation in 12 patients (40%) and the coronary lengthening technique in 18 (60%). Twelve patients had concomitant mitral annuloplasty. There were two in-hospital deaths (6.67%), no patients required mechanical support, and no late deaths occurred. Follow-up echocardiograms demonstrated significant improvement between the post-operative time point and the last follow-up in ejection fraction (49.43%±19.92% vs 60.21%±8.27%, p < 0.01) and in moderate or more severe mitral regurgitation (19/30 vs 5/28, p < 0.01). The left ventricular end-diastolic dimension index decreased from 101.91 ± 23.07 to 65.06 ± 12.82 (p < 0.01). Conclusions: Surgical repair of anomalous origin of the left coronary artery from the pulmonary artery has good mid-term results with low mortality and reintervention rates. The coronary lengthening technique has good operability and leads to excellent cardiac recovery. The decision to concomitantly correct mitral regurgitation should be flexible and be based on the pathological changes of the mitral valve and the degree of mitral regurgitation.

External Reshaping of the Left Ventricle in Off-Pump Surgery

2006 ◽  
Vol 1 (4) ◽  
pp. 155-159
Author(s):  
Sotirios N. Prapas ◽  
Demetrios A. Protogeros ◽  
Vassilios N. Kotsis ◽  
Ioannis A. Panagiotopoulos ◽  
Ioannis P. Raptis ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Ejection Fraction ◽  
Heart Surgery ◽  
Bypass Graft ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Inferior Wall ◽  
Off Pump ◽  
Anterolateral Wall

Background Dyskinetic areas of the lateral and inferior left ventricular (LV) wall are frequently encountered in patients with coronary artery disease. In clinical practice, all of the techniques described for the restoration of shape and function of the LV require cardiopulmonary bypass. A new technique of LV external reshaping that aims to obtain a near-normal ventricular conical shape is described. This technique is performed during an off-pump coronary artery bypass graft (CABG) operation. It is used mainly on the inferior and lateral walls of the ventricle, but also on the anterolateral wall when warranted. This technique can be considered an alternative to classic aneurysmectomy in high-risk cases. Methods All patients underwent total arterial revascularization without aortic manipulation. Intraoperative transesophageal echocardiography was used in all cases to define the dilated akinetic/dyskinetic area. This area was effectively plicated using interrupted mattress sutures reinforced with Teflon felt or pericardial strips. This technique allows near normalization of the geometry of the ventricle and LV end-diastolic volume reduction. In cases of preexisting mitral regurgitation (MR), a reduction of the MR was observed after lateral wall restoration. From September 2002 to April 2005, the external reshaping technique was applied on 56 cases among 949 off-pump CABG cases (5.9%). A detailed transthoracic echocardiogram was obtained preoperatively. The mean ejection fraction of all enrolled patients was 31.2 ± 7%. The location of the plication was: lateral wall in 22, inferior wall in 16, and anterolateral wall in 18. The average number of coronary anastomoses was 2.6. Twelve patients were found to have 2–3 + MR. All patients were followed up during a period of 35 months. Results One patient died due to severe right ventricular dysfunction. Seven patients developed atrial fibrillation, and one had ventricular tachycardia. During the follow-up period, we observed a reduction of left ventricular end-diastolic diameter and a parallel augmentation of ejection fraction (mean 42.2 ± 4%). The ventricular cavity's architecture was normalized. Among the 12 patients with MR, an improvement of regurgitation was noted in 10 (from 2–3+ to 1–2+). One patient died during the follow-up period, and 1 patient required reoperation due to persistent severe MR. Conclusions The external reshaping of the LV during beating heart surgery is technically feasible, has promising results, and can be performed without major complications.

Coronary artery bypass grafting in patients with depressed left ventricular function: Operative results and long-term follow-up

Surgery Today ◽  
1992 ◽  
Vol 22 (4) ◽  
pp. 301-304
Author(s):  
Satoshi Sekine ◽  
Ryosei Kuribayashi ◽  
Toru Sakurada ◽  
Hiroaki Aida ◽  
Hiroyuki Atsumi ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Left Ventricular Function ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Bypass Grafting ◽  
Operative Results ◽  
Long Term Follow Up

Coronary Artery Bypass Surgery without Cardioplegia: Early Results

2000 ◽  
Vol 8 (2) ◽  
pp. 103-108
Author(s):  
Poo Sing Wong ◽  
Simon Vendargon ◽  
Choon Gek Lim
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Left Ventricular ◽  
Operating Conditions ◽  
Left Ventricular Ejection ◽  
Artery Bypass Graft

From November 1996 to April 1999, 348 patients underwent isolated non-cardioplegic coronary artery bypass grafting at a new center. There were 123 (35%) patients aged over 60 years, 48 (14%) were female, 70 (20%) had a left ventricular ejection fraction below 0.3. Coronary artery bypass graft surgery was performed using hypothermic intermittent ischemic fibrillatory arrest of the heart. The left internal mammary artery was used in 97% of cases. Mean grafts per patient was 3.5. Sixty-three patients (18%) underwent 65 coronary endarterectomies. The overall operative mortality rate was 2.3% (8/348). Follow-up was 97% complete. Mean follow-up was 14.9 ± 8 months (range, 1 to 30 months). Freedom from angina was 98.3% at 6 months, 97% at 12 months, and 97% at 24 months. The overall survival was 96.7% at 6 months, 95.8% at 12 months, and 94.4% at 24 months. It was concluded that this method of myocardial protection for isolated coronary artery bypass graft surgery provided excellent operating conditions in this group of patients.

scholarly journals Myocardial Expression of PPARγand Exercise Capacity in Patients after Coronary Artery Bypass Surgery

PPAR Research ◽  
2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Izabela Wojtkowska ◽  
Tomasz A. Bonda ◽  
Jadwiga Wolszakiewicz ◽  
Jerzy Osak ◽  
Andrzej Tysarowski ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Walking Test ◽  
6Mwt Distance ◽  
The Relationship

Activation of PPARs may be involved in the development of heart failure (HF). We evaluated the relationship between expression of PPARγin the myocardium during coronary artery bypass grafting (CABG) and exercise tolerance initially and during follow-up. 6-minute walking test was performed before CABG, after 1, 12, 24 months. Patients were divided into two groups (HF and non-HF) based on left ventricular ejection fraction and plasma proBNP level. After CABG, 67% of patients developed HF. The mean distance 1 month after CABG in HF was397±85 m versus420±93 m in non-HF. PPARγmRNA expression was similar in both HF and non-HF groups. 6MWT distance 1 month after CABG was inversely correlated with PPARγlevel only in HF group. Higher PPARγexpression was related to smaller LVEF change between 1 month and 1 year (R=0.18,p<0.05), especially in patients with HF. Higher initial levels of IL-6 in HF patients were correlated with longer distance in 6MWT one month after surgery and lower PPARγexpression. PPARγexpression is not related to LVEF before CABG and higher PPARγexpression in the myocardium of patients who are developing HF following CABG may have some protecting effect.

scholarly journals Post-Discharge Telephonic Follow-Up of Pediatric Patients Affected by SARS-CoV2 Infection: A Safe and Feasible Way to Monitor Children After Hospitalization. The Experience of a Single Italian Pediatric COVID Center.

2021 ◽  
Author(s):  
Vitangelo Clemente ◽  
Costanza Tripiciano ◽  
Patrizio Moras ◽  
Daniele Deriu ◽  
Martina Di Giuseppe ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Social Issues ◽  
Pediatric Hospital ◽  
Post Discharge ◽  
Pharyngeal Swab ◽  
Viral Shedding ◽  
Discharge From Hospital ◽  
Inflammatory Syndrome

Abstract BackgroundSARS-CoV-2 infection in children is often non severe and in the majority of cases does not require long term hospitalization, nevertheless it is burdened with social issues and managing difficulties. To our knowledge there is no literature on telephonic follow up in pediatric patients with positive PCR for SARS-CoV-2 on rhino-pharyngeal swab after discharge. The aim of the study is to describe our experience in a telephonic follow up which can allow early and safe discharge from hospital while keeping the patients under close clinical monitoring.Materials and Methods65 children were admitted for SARS-CoV-2 infection at Bambino Gesù Pediatric Hospital COVID Center from 16th March to 3rd July. We monitored through a telephonic follow-up, using a specific survey, the patients discharged still presenting a positive PCR for SARS-CoV-2. We checked if any symptoms occurred at home until recovery, defined as two consecutive negative PCR for SARS-CoV-2 on rhino-pharyngeal swabs.ResultsDuring the follow up 7 patients had mild and self-limited symptoms related to SARS-CoV-2 infection, while 2 patients were re-hospitalized. 1 patient had Multisystem Inflammatory Syndrome in Children (MIS-C), the other patient had an increase in troponin and D-dimers. We also monitored the average time of viral shedding, resulting in a median duration of 28 days.ConclusionOur experience describes the daily telephonic follow up as safe in pediatric patients discharged with positive PCR. As a matter of fact it could avoid long term hospitalization and allow to promptly re-hospitalize children with major complications such as MIS-C.

Sign in / Sign up

Export Citation Format

Share Document