We assessed the clinical utility of using diastolic tricuspid annular velocities obtained by Doppler tissue imaging as a noninvasive index of right ventricular function in patients with congenital heart disease. Doppler tissue imaging at the tricuspid annulus and pulsed Doppler echocardiography of the right ventricular inflow were performed in 71 children with congenital heart disease, with and without elevated right ventricular pressure. Cardiac catheterization was performed in all patients with congenital heart disease, and the hemodynamic determinants of the tricuspid annular and inflow velocities were determined. In patients with congenital heart disease, the ratio of the late-to-early diastolic tricuspid annular velocity (Aa/Ea) showed a highly significant correlation with right ventricle pressure/left ventricle pressure (r = 0.79, p < 0.0001), right ventricular end diastolic pressure (r = 0.46, p < 0.0001), and the first derivatives of the change in right ventricle pressure during diastole (r = 0.72, p < 0.0001). However, the late-to-early diastolic tricuspid inflow velocity (A/E) did not correlate with any invasively measured index of right ventricular function. Aa/Ea, derived from tricuspid annular velocities as measured by Doppler tissue imaging, is a valuable, noninvasive tool for detecting an elevated right ventricular pressure in patients with congenital heart disease.

Blood Flow Velocity↗

PubMedDate not supplied

Percutaneous hydrodynamic thrombectomy for congenital deep vein thrombosis in a neonate.

A 1-day-old boy with a complete occlusive inferior vena cava and bilateral renal vein thrombus removed successfully using a hydrodynamic thrombectomy catheter is reported. Although blood flow to the inferior vena cava and bilateral renal veins was restored with no distal embolism or vascular injury, he died of bleeding complications due to fibrinolytic therapy after hydrodynamic thrombectomy. To the best of our knowledge, this is the first report of hydrodynamic thrombectomy of a neonate.

Angioplasty, Balloon↗

PubMedDate not supplied

Doppler echocardiographic evaluation of right ventricular diastolic function in children.

Right ventricular diastolic function was evaluated by flow velocity pattern in the right ventricular inflow tract by means of pulsed Doppler echocardiography. Traditionally used to evaluate this function are peak velocities obtained during early diastole (peak E wave) and during atrial contraction (peak A wave), their ratio (peak E/A ratio), and the deceleration half-time. We conducted pulsed Doppler echocardiographic studies of right ventricular inflow and outflow patterns in 171 children (105 normal children and 66 children who were undergoing total surgical repair of congenital heart defects without sequelae). Results showed that summation flow was present in the right ventricular inflow tract in 43 (25%) of the 171 subjects, which made it difficult to separate the peak E wave from the peak A wave. We noted the presence of antegrade late diastolic flow (DW) in the right ventricular outflow tract of all subjects. DW, measured in 121 subjects in whom both E and A waves were detected in the right ventricular inflow tract, showed a highly significant correlation (p < 0.0001) with A waves in the right ventricular inflow tract. The ratio of DW to right ventricular outflow tract velocities during systole (SW) showed a highly significant (p < 0.0001) correlation with E/A ratio. When evaluating right ventricular diastolic function by pulsed Doppler, especially in children, the analysis of right ventricular outflow tract patterns is helpful in addition to that of inflow tract patterns. The DW and DW/SW ratio may present good alternatives to traditional parameters in children.

Blood Flow Velocity↗

PubMedDate not supplied

Macro creatine kinase in Kawasaki disease.

This report describes a case of Kawasaki disease with macro creatine kinase (CK). A 13-month-old boy developed typical symptoms of Kawasaki disease and was treated with flurbiprofen, dipyridamole, and intravenous gamma-globulin. The serum level of CK increased during treatment from 371 U/L, at 4 days after the onset of Kawasaki disease, to 13,222 U/L 3 days later. Immunofixation electrophoresis identified macro CK as containing immunoglobulin A (kappa, lambda). The presence of macro CK may result from muscle tissue involvement in Kawasaki disease.

Biomarkers↗

PubMedDate not supplied

Rescue of a child with fulminant myocarditis using percutaneous cardiopulmonary support.

This report describes a 14-year-old girl with fulminant myocarditis who was successfully treated with a percutaneous cardiopulmonary support (PCPS). She developed progressive cardiac failure after a 3-week history of progressive fatigue, fever, tachypnea, and dyspnea requiring inotropic support, mechanical ventilation, and intra-aortic balloon pumping. Her condition continued to deteriorate, and she was cannulated for PCPS using a right femoral artery/femoral vein approach, which resulted in rapid improvement and hemodynamic stabilization. This case documents that circulatory support with PCPS is effective for treating children with fulminant myocarditis.

Acute Disease↗

PubMedDate not supplied

Diffuse white matter lesions associated with herpes simplex encephalitis as observed on magnetic resonance imaging.

A 2-year-old boy with herpes simplex encephalitis developed diffuse brain lesions involving the white matter of both cerebral hemispheres. These lesions in the white matter were clearly observed on magnetic resonance imaging (MRI) with the T2-weighted sequence, and were found to have spontaneously disappeared on subsequent MRI performed 7 weeks later. Brain lesions associated with herpes simplex encephalitis in the literature are reviewed and the pathogenesis in the present case is discussed.

Brain↗

PubMedDate not supplied

Paradoxical glucagon response in perifused islets of the diabetic Chinese hamster.

Dynamic insulin and glucagon response to glucose was examined in the perifusion system to investigate the relationship between pancreatic hormone content and the pattern of hormone secretion in diabetic Chinese hamsters of the Asahikawa colony (CHA). Isolated islets of normals and diabetics from the CHA were perifused. When the medium was changed to high glucose (500 mg/dl), a low insulin response and paradoxical glucagon response were seen in diabetics compared with normals. Positive correlations were found between pancreatic insulin and the amount of perifusate insulin, and glucagon content and glucagon release, respectively. It is suggested, accordingly, that pancreatic hormone content is related to the amount of hormone release in CHA. A negative correlation between the amount of perifusate insulin and glucagon release was found. It is suggested, therefore, that an impaired suppression of glucagon release in the diabetic CHA animals could be attributed at least to insulin deficiency. These findings agree with the histological discovery of decreased B-cells and increased A-cells in the diabetic islets. Both decreased B-cells and islet numbers could be the cause of the low insulin response to glucose. Increased numbers of A-cells with hyperfunction resulting from local insulin deficiency could be the cause of the paradoxical glucagon response.

Animals↗

PubMedDate not supplied

Non-selective inhibition of insulin and glucagon release by xenogeneic islet cell surface antibodies.

The influence of xenogeneic islet cell surface antibodies (ICSA) on the hormonal secretion of non-B islet cells has not been completely elucidated. Accordingly, we investigated the influence of xenogeneic antiserum on glucagon release from A cells, as representative of non-B islet cells, together with other characteristics of the antiserum. Anti-islet cell sera were produced in rabbits by xenogeneic immunization with dispersed hamster islet cells. Rabbit anti-hamster islet cell surface antibodies were detected both qualitatively by indirect immunofluorescence analyses and quantitatively by 125I-protein A radioligand assay. However, antiserum did not induce cell surface immunofluorescence on rat or mouse islet cells. As a result of evaluation of the specific cytotoxicity using 51Cr release assay, antiserum was observed to induce a significantly higher release of 51Cr compared with that of normal rabbit serum in complement-dependent antibody-mediated cytotoxicity. Both glucose-stimulated insulin and arginine-stimulated glucagon release were suppressed by xenogeneic antiserum not only in the presence but also in the absence of complement. It is concluded, therefore, that xenogeneic antiserum has a relative species specificity and non-selectively binds to islet cells in contrast with the non-species specificity and preferential binding to pancreatic B cells of human ICSA, although heterogeneity in ICSA-positive sera has been suggested.

Animals↗

PubMedDate not supplied

Metabolic and morphological changes of the heart in Chinese hamsters (CHAD strain) with spontaneous long-term diabetes.

We studied the effect of spontaneous long-term (9-10 months) diabetes on the heart of Chinese hamsters (CHAD strain) to elucidate the relationship between diabetes mellitus and cardiomyopathy. The diabetic hamsters, aged approximately 11 months, showed body weight loss, hyperglycemia (mean fasting plasma glucose 402 mg/dl), hypoinsulinemia, hyperlipidemia and ketonemia. The diabetic hamsters showed reduced activities of cytoplasmic glycolytic key enzymes; hexokinase, pyruvate kinase and phosphofructokinase, increases in cardiac glycogen and glucose-6-phosphate contents and a 40% decrease in cardiac ATP content, indicating decreased energy production. An accumulation of myocardial triglyceride and cholesterol was found in the diabetic hamsters. In addition, the cardiac norepinephrine content was increased in the diabetic hamsters, suggesting the presence of autonomic nervous disorder. Increased heart weight and thickening of the septum and both ventricular walls were found in the diabetic hamsters. Light-microscopic analysis revealed that 42.9% of the diabetic hamsters had myocardial degeneration without any vascular lesion of extramural large and intramural small vessels, whereas the non-diabetic controls had no myocardial or vascular lesions. These data suggest that the diabetic Chinese hamsters had cardiomyopathy, which is possibly caused by extravascular factors such as metabolic or autonomic nervous disorder although conclusive evidence is lacking.

Animals↗