scholarly journals Clinical and pathogenetic features of congenital heart disease in newborns with intrauterine infection

2017 ◽  
Vol 98 (2) ◽  
pp. 181-188
Author(s):  
S N Beniova ◽  
S Yu Figol’ ◽  
O A Kornilova ◽  
M L Stolina ◽  
N P Blokhina
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Matrix Metalloproteinase ◽  
Congenital Heart ◽  
Neonatal Period ◽  
Clinical Signs ◽  
Intrauterine Infection ◽  
Early Neonatal Period ◽  
Group 2 ◽  
Metalloproteinase 9

Aim. Investigation of the features of diagnosis and treatment of congenital heart disease in newborns with intrauterine herpes and cytomegalovirus infections. Methods. A comparative analysis of risk factors, clinical signs and dynamics of serum levels of matrix metalloproteinases in 91 newborns with congenital heart disease during the early neonatal period was performed. All patients were divided into 2 groups: group 1 (study group) - 51 patients with congenital heart disease and intrauterine Herpes or Cytomegalovirus infection, group 2 (comparison group) - 40 children with heart disease without the signs of intrauterine infection. The control group consisted of 20 relatively healthy full-term newborns. Results. Mothers of children with congenital heart disease and intrauterine infection more often compared to mothers of children from group 2 had inflammatory disease of reproductive system (49.1 and 22.5% respectively, р ≤0.05), medical abortions in past medical history (84.3 and 27.5% respectively, р ≤0.01), acute respiratory viral infections during pregnancy (21.6 and 7.5% respectively, р ≤0.05). Levels of matrix metalloproteinase 9 in umbilical blood plasm were statistically significantly increased in all newborns with congenital heart disease compared to control levels. The highest concentration of enzyme was registered in patients with congenital heart disease and nervous system disorders associated with intrauterine infection and in newborns with severe heart disease. Inflammatory extracardial changes in patients with congenital heart disease associated with intrauterine infection caused by Herpes Simplex virus and Cytomegalovirus were accompanied by significant increase of matrix metalloproteinase 8. Conclusion. The association between matrix metalloproteinase 9 in blood serum of newborns and clinical signs of a congenital heart disease during early neonatal period was revealed; high levels of metalloproteinase 8 can indicate intrauterine infection in newborns with congenital heart disease during early neonatal period.

Enteral Nutrition in Infants With Congenital Heart Disease and Growth Failure

PEDIATRICS ◽  
1990 ◽  
Vol 86 (3) ◽  
pp. 368-373
Author(s):  
Steven M. Schwarz ◽  
Michael H. Gewitz ◽  
Cynthia C. See ◽  
Stuart Berezin ◽  
Mark S. Glassman ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Nutritional Status ◽  
Congenital Heart ◽  
Growth Failure ◽  
Z Scores ◽  
Group 3 ◽  
Group 2 ◽  
Calorie Density ◽  
Group 1

To determine an effective nutritional regimen for management of growth failure in infants with congenital heart disease and congestive heart failure, the authors studied 19 infants with cardiac anomalies who were not candidates for early corrective surgery. Patients were randomly assigned to one of three feeding groups: group 1 (n = 7) received continuous, 24-hour nasogastric alimentation; group 2 (n = 5) received overnight, 12-hour nasogastric infusions plus daytime oral feedings as tolerated; and group 3 (n = 7) received oral feedings alone. For all patients, commercial infant formula (cow's milk or soy protein) was supplemented to a calorie density of approximately 1 kcal/mL. During a 5.25 ± 0.45 month study period, only group 1 infants achieved intakes > 140 kcal/kg per day (mean = 147 kcal). Serial anthropometric measurements demonstrated that only 24-hour infusions (group 1) were associated with significantly improved nutritional status, when assessed by z scores for weight (P < .01) and length (P < .05). Group 1 infants also showed marked increases in midarm muscle circumference and triceps and subscapular skinfold thicknesses (P < .01, compared with groups 2 and 3). These data suggest that infants with congenital cardiac defects complicated by malnutrition manifest increased nutrient requirements for growth and weight gain. Continuous, 24-hour, nasogastric alimentation is a safe and effective method for achieving both increased nutrient intake and improved overall nutritional status in these infants.

Survival of Patients with High-Risk Pulmonary Arterial Hypertension Associated with Congenital Heart Disease

2021 ◽  
Vol 104 (6) ◽  
pp. 895-901
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Congenital Heart ◽  
First Year ◽  
Pulmonary Arterial ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Pulmonary arterial hypertension (PAH) is a common complication of congenital heart disease (CHD) with uncorrected left-to-right shunts. Currently, no consensus guideline exists on the management of PAH-CHD in children, especially those who do not meet operability criteria. Objective: To compare survival between three groups of high-risk PAH-CHD, group 1: total correction including both surgical and percutaneous intervention, group 2: palliative treatment, and group 3: conservative with medical treatment group. Materials and Methods: All pediatric patients with PAH-CHD that underwent cardiac catheterization between January 1, 2008 and December 31, 2017 were retrospectively reviewed. Inclusion criteria were high risk PAH-CHD patients who had pulmonary vascular resistance (PVR) greater than 6 Wood unit·m² and PVR-to-SVR ratio greater than 0.3 evaluated in room air. Exclusion criteria were younger than three months of age, severe left side heart disease with pulmonary capillary wedge pressure greater than 15 mmHg, obstructive total pulmonary venous return, and single ventricle physiology. The Kaplan-Meier analysis was performed from the date of PAH diagnosis to the date of all-cause mortality or to censored date at last follow-up. Results: Seventy-six patients with a median age at diagnosis of 27.5 months (IQR 14.5 to 69.0 months) were included in this study. The patients were divided into three subgroups and included 38 patients (50.0%) in group 1, six patients (7.9%) in group 2, and 32 patients (42.1%) in group 3. The median follow-up time was 554 days (IQR 103 to 2,133 days). The overall mortality was 21.7%. One-year survival in patients with simple lesion in group 1 and 3 were 79.5% and 87.5% and patients with complex lesions in group 1, 2, and 3 were 93.8%, 83.3%, and 73.1%, respectively. The results showed that most mortalities occurred in the first year. There were no statistically significant differences in survival among difference types of treatment (log rank test, p=0.522). Conclusion: The mortality of high-risk PAH-CHD patients were not different among those who underwent corrective surgery, palliative, or conservative treatment. The mortality was high in the first year after PAH diagnosis and remain stable afterward. Management decision for an individual with high-risk PAH-CHD patients requires comprehensive clinical assessment to balance the risks and benefits before making individualized clinical judgment. Keywords: Pulmonary hypertension; Congenital heart disease; High-risk patients

scholarly journals First-Year Outcomes of Critical Congenital Heart Disease Screening in Maryland

2019 ◽  
Vol 6 ◽  
pp. 2333794X1986822
Author(s):  
Deborah Badawi ◽  
Johnna Watson ◽  
Steven Maschke ◽  
Lawrence Reid
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Newborn Screening ◽  
Pulse Oximetry ◽  
Congenital Heart ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
First Year ◽  
Critical Congenital Heart Disease ◽  
Pulse Oximetry Screening

Objectives. Newborn screening for critical congenital heart disease (CCHD) was added to the Recommended Uniform Screening Panel in 2011, and states have been gradually adding pulse oximetry as point-of-care screening to panels. Few data are available on the effectiveness of pulse oximetry as a mandated screening. This study describes outcomes of the first year of screening in Maryland. Methods. A web-based data collection tool for screening results and outcomes, eScreener Plus, was utilized. Data collected from the start of screening from September 1, 2012, to December 31, 2013, were analyzed. Well-baby nursery data were evaluated separately from neonatal intensive care unit (NICU) data to determine whether setting influenced effectiveness. Results. In the first 15 months of newborn screening for CCHD in Maryland, 4 asymptomatic infants were diagnosed with a critical cardiac condition by newborn screening. Eleven infants passed but were later identified with a primary or secondary target condition. Seventy-one percent of infants with CCHD were identified prenatally or by clinical signs and symptoms. Pulse oximetry screening for CCHD had a specificity of more than 99% in both the well-baby nursery and the NICU. Sensitivity in the well-baby nursery was 10% and 60% in the NICU. Conclusion. Further investigation and interpretation of specific protocols that were used and outcomes of screening is needed for continued refinement of the well-baby algorithm and NICU protocol development. Pulse oximetry screening in newborns provides valuable clinical information, but many infants with CCHD are still not identified with current protocols.

Congenital heart disease in the neonatal period

1964 ◽  
Vol 65 (5) ◽  
pp. 721-726 ◽  
Author(s):  
Ali Mehrizi ◽  
M.S. Hirsch ◽  
Helen B. Taussig
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Neonatal Period

Cerebroplacental and Uterine Doppler Indices in Pregnancies Complicated by Congenital Heart Disease of the Fetus

2019 ◽  
Author(s):  
Oliver Graupner ◽  
Jessica Koch ◽  
Christian Enzensberger ◽  
Malena Götte ◽  
Aline Wolter ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Blood Group ◽  
Congenital Heart ◽  
Ascending Aorta ◽  
Normative Values ◽  
Marginal Means ◽  
Group 2 ◽  
Doppler Indices ◽  
Group 1

Abstract Purpose Children with congenital heart disease (CHD) are known to have impaired neurodevelopment possibly influenced by altered cerebroplacental hemodynamics antenatally. We compared fetomaternal Doppler patterns in different CHD groups with published normative values during gestation. Materials and Methods Retrospective cohort study consisting of 248 CHD fetuses. Subgroups were generated according to the expected ascending aorta oxygen saturation: low portion of high oxygenated umbilical venous (UV) blood (group 1: n = 108), intermediate portion of UV blood due to intracardiac mixing with oxygen poor systemic blood (group 2: n = 103), high (group 3: n = 13) and low portion of UV blood without mixing of blood (group 4: n = 24). Doppler examination included umbilical artery and middle cerebral artery pulsatility index (UA-PI, MCA-PI), cerebroplacental ratio (CPR) and mean uterine artery (mUtA) PI. For mean comparisons at different gestational ages (GA), estimated marginal means from regression models are reported for GA 22 weeks (wks), GA 30 wks and GA 38 wks. Results Z-score transformed values of MCA-PI (zMCA-PI) were significantly lower in group 1 compared to all other subgroups at GA 30 wks (p < 0.05). At 38 wks, group 1 had significantly lower values of zMCA-PI and zCPR compared to groups 2 and 4. Group 1 fetuses showed a significant association between zMCA-PI and zCPR (negative) and GA as well as zmUtA-PI (positive) and GA compared to reference values. Conclusion Our data confirm that CHD fetuses have a higher rate of cerebral redistribution in the third trimester. Changes in Doppler patterns were mainly observed in CHD with a low portion of UV blood in the ascending aorta.

Cardiovascular signs

ESC CardioMed ◽  
2018 ◽  
pp. 17-32
Author(s):  
Stuart D. Pringle ◽  
Samantha Fitzsimmons ◽  
Ingibjorg J. Gudmundsdottir ◽  
Joseph B. Esterson
Keyword(s):  
Heart Failure ◽  
Coronary Heart Disease ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Clinical Signs ◽  
Evidence Based ◽  
Likelihood Ratios ◽  
Prognostic Information ◽  
Great Relevance

Physical examination remains an important part of cardiology practice because it facilitates the further investigation and treatment of those in whom heart disease is confirmed or suspected and helps to reassure those without a heart condition. Clinical signs can provide accurate, valuable diagnostic and prognostic information of great relevance to patients with most cardiac conditions particularly heart failure, coronary heart disease, valvular heart disease, and adults with congenital heart disease. This chapter reviews the most useful clinical signs in cardiology and discusses their relevance and accuracy expressed, wherever possible, as likelihood ratios; the reader should, however, be aware of the limitations of this sort of evidence-based approach because clinical signs should never be interpreted in isolation.

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