Myocardial dysfunction in malnourished children
Faddan NA, El Sayh KI, Shams H, Badrawy H.
Ann Pediatr Card [serial online] 2010 [cited 2010 Dec 16];3:113-8.
 
Background : Malnourished children suffer several alterations in body composition that could produce cardiac abnormalities. Aim : The aim of the present study was to detect the frequency of myocardial damage in malnourished children as shown by echocardiography and cardiac troponin T (cTnT) level. Methods : Forty-five malnourished infants and young children (mean�SD of age was 11.24 �7.88 months) were matched with 25 apparently healthy controls (mean�SD of age was 10.78�6.29 months). Blood sample was taken for complete blood picture, liver and kidney function tests, serum sodium, potassium, calcium levels and cTnT. All the malnourished children were subjected to echocardiographic evaluation. Results : Malnourished children showed a significantly lower left ventricular (LV) mass than the control group. The LV systolic functions were significantly impaired in patients with severe malnutrition. The cTnT level was higher than the upper reference limits in 11 (24.44%) of the studied malnourished children and all of them had a severe degree of malnutrition. The cTnT level was significantly higher in patients with anemia, sepsis and electrolyte abnormalities and it correlated negatively with LV ejection fraction (EF). Six of the studied children with high cTnT levels (54.5%) died within 21 days of treatment while only one case (2.9%) with normal level of cTnT died within the same period. Conclusions: LV mass is reduced in malnourished children. Children with severe malnutrition have a significant decrease in LV systolic functions. Elevated cTnT levels in malnourished children has both diagnostic and prognostic significance for cardiomyocyte damage.

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 http://www.annalspc.com/text.asp?2010/3/2/113/74036

Dr. JM Galdeano Miranda, Dr. C. Romero Ibarra, Dr. O. Artaza Barrios.
S. de Cardiolog�a Pedi�trica. Servicio Cardiovascular
H. de Cruces. Barakaldo. H. V�rgen del Camino. Pamplona. H. Luis Calvo Mackenna. Santiago de Chile 

Introducci�n
Se define la Insuficiencia Card�aca en Pediatr�a (ICP), como la incapacidad del coraz�n para mantener un gasto cardia-co o volumen minuto adecuado a los re-querimientos del organismo.
La insuficiencia cardiaca es en el ni�o la manifestaci�n de una enfermedad grave, generalmente una cardiopat�a cong�nita, que con frecuencia tiene un tratamiento eficaz. Esto hace de sumo inter�s que el pediatra est� familiarizado con sus manifestaciones cl�nicas y con su tratamiento para poder realizar un diagn�stico precoz y adoptar las medidas terap�uticas adecuadas.

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Extracorporeal life support in pediatric cardiac dysfunction.
Coskun KO, Coskun ST, Popov AF, Hinz J, El-Arousy M, Schmitto JD, Kececioglu D, Koerfer R.
Department of Thoracic and Cardiovascular Surgery, University of G�ttingen, G�ttingen, Germany.
J Cardiothorac Surg. 2010 Nov 17;5:112.

Abstract
BACKGROUND: Low cardiac output (LCO) after corrective surgery remains a serious complication in pediatric congenital heart diseases (CHD). In the case of refractory LCO, extra corporeal life support (ECLS) extra corporeal membrane oxygenation (ECMO) or ventricle assist devices (VAD) is the final therapeutic option. In the present study we have reviewed the outcomes of pediatric patients after corrective surgery necessitating ECLS and compared outcomes with pediatric patients necessitating ECLS because of dilatated cardiomyopathy (DCM). METHODS: A retrospective single-centre cohort study was evaluated in pediatric patients, between 1991 and 2008, that required ECLS. A total of 48 patients received ECLS, of which 23 were male and 25 female. The indications for ECLS included CHD in 32 patients and DCM in 16 patients. RESULTS: The mean age was 1.2 � 3.9 years for CHD patients and 10.4 � 5.8 years for DCM patients. Twenty-six patients received ECMO and 22 patients received VAD. A total of 15 patients out of 48 survived, 8 were discharged after myocardial recovery and 7 were discharged after successful heart transplantation. The overall mortality in patients with extracorporeal life support was 68%. CONCLUSION: Although the use of ECLS shows a significantly high mortality rate it remains the ultimate chance for children. For better results, ECLS should be initiated in the operating room or shortly thereafter. Bridge to heart transplantation should be considered if there is no improvement in cardiac function to avoid irreversible multiorgan failure (MFO).

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