Transcatheter Ventricular Septal Defect Closure with Lifetech™ Konar-MF Occluder in Infants Under 10 kg with Only Using Venous Access

Transcatheter closure of VSD remains a complex procedure in infants with technical challenges and carries the risk of significant complications, due to its complex anatomical morphology and closed proximity to the atrioventricular valves and the conduction system. In this article, we presented transcatheter VSD closure in infants under 10 kg using the Lifetech Konar-MF device via only venous route without TEE guidance and arterial access. Between January 2021 and May 2023, a total of 34 patients weighing less than 10 kg who underwent transcatheter VSD closure antegradely with Lifetech™ Konar-Multifunctional (MF) occluder were included in the study. The mean age of the patients was 8.1 (3.5-35) months. Average weight was 6.5 kg (range 4.5-10 kg). VSD was perimembranous in 27 patients (79.4%). Successful device placement was achieved in all 34 patients. However, device embolization occurred in three patients. One of the patients was successfully implanted with a one size larger device, the surgical closure was performed other two cases. TR occurred in seven patients (20.6%) after releasing devices. None of the patients developed complete heart block. Right bundle branch block developed in two patients. Residual shunt was observed in 9 patients (six small, two moderate, and one large). During follow-up, residual shunt disappeared in six of these patients and only mild residual shunt remained in the other four patients which have not required any further intervention. Transcatheter closure of VSD with Lifetech Konar-MF device is safe and effective in infants less than 10 kg via only venous access with a high success rate and low complication rate. In these patients, transcatheter VSD closure can be performed by excluding the risk of complications that may occur due to AV loop formation, arterial intervention, endotracheal intubation and TEE use.

Admission and follow-up cardiac magnetic resonance imaging findings in BNT162b2 Vaccine-Related myocarditis in adolescents

BACKGROUND

There is limited data on the pattern and severity of myocardial injury in patients with COVID-19 vaccination associated myocarditis.

OBJECTIVE

We aimed to define the myocardial damage occurring after BNT162b2 vaccination, raise awareness about adverse reactions developing after vaccination, and determine the patterns and scope of Cardiac magnetic resonance imaging (MRI) findings.

PATIENTS/METHODS

A total of 9 patients diagnosed with vaccine-associated myopericarditis were followed up.

RESULTS

The mean age of the patient at diagnosis was 15.3 ± 1.0 (range: 14-17) years, and all patients were male. Seven patients presented with myocarditis symptoms after their second vaccine dose, one patient presented with pericarditis symptoms after his first dose, and the other patient presented with myocarditis symptoms after his booster dose. The median time at presenting to the hospital was 3 (range: 2-22) days. Seven (77.7%) patients had abnormal electrocardiography (ECG) findings, and the most prevalent finding was diffuse ST-segment elevation. Initial cardiac MRI results were abnormal in all patients, where 8 (88.8%) patients had late gadolinium enhancement, and 5 (55.5%) had myocardial edoema. Three patients showed local left ventricular wall-motion abnormalities. In their follow-up MRIs 3-6 months later, myocardial edoema was present in 2 (28.5%) patients, while late gadolinium enhancement was present in all patients (7/7, 100%, 2 patients did not have control MRI time). Hypokinetic segments were still present in one of the 3 patients. No negative cardiac events were observed in the short-term follow-up of any patient.

CONCLUSION

Further follow-up evaluation and larger multicenter studies are needed to determine the clinical significance of persistent cardiac MRI abnormalities.

The effects of anxiety about their parents getting COVID-19 infection on children's mental health

Although the effects of COVID-19 on children's physical health are relatively less serious, it is known that pandemic has serious effects on children's mental health. Anxiety and related symptoms increase among children during this period. The main purpose of this study is to measure children's anxiety about their parents and themselves with structured scales. Children who applied to the pediatric outpatient clinic were included in the study. Participants were asked questions about their parents' and their own concerns about getting COVID-19. Psychiatric symptoms of the participants were evaluated with the Revised Child Anxiety and Depression Scale, the Coronavirus Anxiety Scale, and Anxiety Sensitivity Index for Children. Increased social phobia, separation anxiety, generalized anxiety, total anxiety, total internalizing disorder scores, increased anxiety sensitivity, and increased coronavirus anxiety were detected among children who have increased subjective anxiety for themselves about getting COVID-19. In addition, increased social phobia, depression, separation anxiety, generalized anxiety, total anxiety, total internalizing disorder scores, and anxiety sensitivity were also detected among children who have increased subjective anxiety for their parents about getting COVID-19. In logistic regression, panic, separation anxiety, and generalized anxiety scores significantly predicted children's anxiety for their parents, and separation anxiety and generalized anxiety were shown to predict anxiety for themselves.

CONCLUSION

Children who have increased subjective anxiety about their parents and themselves also have increased anxiety, anxiety sensitivity, and coronavirus anxiety scores. This is the first study which determines that children who are worried about their parents and themselves have higher levels of anxiety, depression symptoms, and anxiety sensitivity.

WHAT IS KNOWN

• Although COVID19 pandemic's negative effects on the mental health of children and adolescents has been investigated and consistently demonstrated, the children's anxiety about their parents getting infection were less researched.

WHAT IS NEW

• Children's anxiety about their parents getting SARS-Cov-2 infection was investigated with the questionnaires. • The scale scores of the children who expressed their anxiety with open-ended questions were statistically significantly higher.

An unexpected cause of chorea in an adolescent girl: systemic lupus erythematosus

Involuntary movement disorders are rare in childhood. Hyperkinetic movement disorders including chorea stand as the leading cause. Although Sydenham chorea is the major diagnosis in most children and adolescents, appropriate differential diagnosis is fundamental for a final decision. A detailed and careful history as well as physical examination is the principal proceeding for accurate diagnosis. Herein, we report on an adolescent girl who was admitted to our hospital with chorea and subsequently diagnosed with systemic lupus erythematosus (SLE). Accompanying joint complaints in the patient's history, including growth retardation noticed during a physical examination and bicytopenia recognized in laboratory evaluation, increased the suspicion of SLE rather than Sydenham chorea in the patient. Central nervous system involvement defined as neuropsychiatric lupus presents wide clinical findings varying from stroke and seizures to psychosis and cognitive dysfunction. Although disease activity, persistently positive anticardiolipin antibodies, and lupus anticoagulant positivity are reported to be the most important risk factors in neuropsychiatric lupus, they are not always directly correlated. We present this patient in order to draw attention to the importance of physical examination and history in the differential diagnosis of chorea in childhood.

An exploration of parental awareness, knowledge, and concerns related to COVID-19

BACKGROUND

COVID-19 rapidly spread worldwide with high morbidity and mortality. In this study, we aimed to detect parental concerns along with their awareness of and attitudes towards COVID-19 among patients admitted to our inpatient and outpatient clinics.

METHODS

This study was conducted at a children's hospital with 141 parents of children who were patients in the inpatient and outpatient clinics. Parents were asked to complete an anonymous questionnaire and psychiatric scales that included the Beck Depression Inventory, Beck Anxiety Inventory (BAI), and Impact of Events Scale-Revised form (IES-R).

RESULTS

The study sample consisted of 141 parents, of which 59 were parents of inpatients and 82 were parents of outpatients. The most known COVID-19 symptoms were fever, difficulty in breathing, and cough, respectively. The most preferred precaution was "staying at home." We found a significant positive correlation between the number of precautions and BAI score (R = .169, P = .046). Inpatients' parents IES-R scores were significantly higher than outpatients' parents IES-R scores.

CONCLUSIONS

Parents were found to be aware of the COVID-19 pandemic regardless of education status and family income. Participants' IES-R scores revealed significant differences in terms of COVID-19 impact on psychological health between the parents of inpatient and outpatient children; inpatients' parents were more concerned about COVID-19.