Mechanical Circulatory Assistance in Children: Clinical Outcome

BACKGROUND

In countries where organ donation is scarce, mortality in the pediatric heart transplant waiting list is high, and ventricular assist devices (VADs) are therapeutic alternatives in these situations. Berlin Heart EXCOR is currently 1 of the few VADs specific for children.

METHODS

This retrospective study includes pediatric patients who underwent Berlin Heart EXCOR placement in a Brazilian hospital between 2012 and 2021. Clinical and laboratory data at the time of VAD implantation and the occurrence of complications and outcomes (success as a bridge to transplant or death) were analyzed.

RESULTS

Eight patients, from 8 months to 15 years, were included: 6 with cardiomyopathy and 2 with congenital heart disease. Six were on Intermacs 1 and 2 on Intermacs 2. The most common complications observed were stroke and right ventricular dysfunction. Six were transplanted, and 2 died. Those submitted to transplant had a higher mean weight than those who died, with no statistically significant difference. The underlying disease had no impact on the outcome. The group undergoing transplant had lower brain natriuretic peptide and lactate values, but no laboratory variable showed a statistically significant difference in the outcome.

CONCLUSION

A VAD is an invasive treatment with potentially serious adverse effects and is still poorly available in Brazil. However, as a bridge to transplant, it is a useful treatment for children in progressive clinical decline. In this study, we did not observe any clinical or laboratory factor at the time of VAD implantation that implied better outcomes.

Can the atrial septal defect size in newborn patient predict spontaneous closure?

Funding Acknowledgements

Type of funding sources: None.

onbehalf

Hospital Albert Eisntein"s pediatric echocardiogram team

Can atrial septal defect size in newborn predict spontaneous closure?

Introduction

Spontaneous closure of atrial septal defect (ASD) has been reported to occur in 33%-75% of patients. Factors that influence spontaneous closure are size of the ASD and age of the patients.

Purpose

We aimed to investigate if the diameter of ASD measured by echocardiogram in the newborn can anticipate clinical outcome and predict spontaneous closure.

Methods

We reviewed 1012 two-dimensional echocardiograms (2DE) performed in the first days of life of newborn at our hospital from January 2015 to December 2019 with ASD or patent foramen ovale (PFO) as initial diagnoses. The exclusion criteria were associated congenital heart disease, except ventricular septal defect and patent ductus arteriosus both without repercussion. 153 newborns with ASD or PFO in the first 2DE were included in this study. The individual data collected were age at the exam, birth weight, gestational age, height by birth, ASD diameter, total diameter of atrial septum and Septum/ASD ratio (Table 1). The results were expressed as mean ± SD, or percentage. Comparisons of continuous variables between groups of patients were performed using the Student T test. Statistical significance was determined by p <0,05. The newborn was grouped according to the observation or not of spontaneous closure.

Results

ASD or PFO was found in 153 newborns. 60 had PFO, spontaneous closure was reported in 38 (63%). 93 had ASD in the first 2DE, spontaneous closure was reported in 41 (44%). The mean age of diagnosis was 3,37 ±4,39 days of life. The diameter of the ASD in the first exam and the septum/ASD ratio were associated with spontaneous closure. There was no association between spontaneous closure of ASD and birth weight or gestational age in this studied group.

Conclusion

The ASD diameter obtained at the first 2DE in the first days of life was associated with spontaneous closure of the defect.

Table 1 Non-closure group (N = 52) Closure group (N= 41) P Age at the exam (days) 3,48 (±4,52) 3,2 (±4,27) 0,78 Birth weight (grams) 2459,85 (±1098,79) 2350,12 (±1247,70) 0,65 Gestational age (weeks) 34,88 (±5,17) 34,54 (±5,10) 0,75 Height by birth (cm) 44,46 (±6,81) 43,67 (±6,77) 0,57 ASD diameter (mm) 3,66 (± 2,66 (±0,57) <0,01 Septum diameter (mm) 18,74 (±3,9) 18,92(±4,51) 0,83 Septum/ ASD ratio 5,74 (±2,38) 7,28 (±1,96) <0,01 cm = centimeter, mm = millimeter, ASD = atrial septal defect. Unit: Mean and standard deviation.

Relation between three-dimensional and two-dimensional echocardiography and biochemical analysis in patients with ST-segment elevation myocardial infarction percutaneously treated

OBJECTIVE

The prognosis of patients with acute myocardial infarction depends on multiple features that can demonstrate myocardial injury degree (such as serum markers of cardiac necrosis), and also on adaptive mechanisms relative to the acute event. The aim of the study was to assess the relation between biochemical and echocardiographic findings from three-dimensional echocardiographic (3D Echo) analysis and echocardiographic two-dimensional (2D Echo) left ventricular ejection fraction in patients with ST-segment elevation acute myocardial infarction, submitted to primary percutaneous treatment.

METHODS

A prospective study with 2D Echo and 3D Echo of 23 patients (17 males, mean age of 57 ± 13 years) with ST-segment elevation acute myocardial infarction, primarily percutaneously treated (stent). Serum cardiac markers (creatine kinase MB, Troponin I and Myoglobin) and serum brain natriuretic peptide were compared to echocardiographic parameters (volumes, left ventricular ejection fraction and ventricular dyssynchrony index). The statistical analysis was performed using Pearson's correlation coefficient, 95% CI, p < 0.05, linear regression equation and Bland & Altman test.

RESULTS

Pearson's correlation coefficient (r)relative to 3D left ventricular ejection fraction: 1- brain natriuretic peptide: r: - 0.7427, p < 0.0001; 2- creatine kinase MB: r: - 0.660, p = 0.001. Left ventricular ejection fraction 2D (r) : 1- brain natriuretic peptide: r: - 0.5478, p = 0.001; 2- creatine kinase MB: r: - 0.4800, p < 0.0277. Other associations were not significant.

CONCLUSIONS

In this series, it was observed better correlation in regard to serum creatine kinase MB, brain natriuretic peptide and 3D Echo left ventricular ejection fraction, when compared to 2D Echo left ventricular ejection fraction.