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Endomyocardial biopsy in infants and children
September,
710
AAP Program and Abstracts
CARDIAC INVOLVEMENT IMMUNE DEFIFIENCY.
IN CHILDREN
WITH ACQUIRED
Henry J. Issenberg*, Morris Charytan, Arye Rubinstein, Dept. of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY Acquired Immune Deficiency (AIDS) is frequently complicated by cardiac malignancy, such as Kaposi's sarcoma, endocarditis or pulmonary insufficiency secondary to pneumonia. We prospectively performed cardiac evaluations consisting of physical examination, EKG and echocardiogram, in a total of 22 children ranaina in aae from 6 months to 6 years with AIDS In=12 6.8-5.8 yrs, mean = 2.9 yrs) and AIDS Related Complex (ARC) (n=lO 0.5-6.0 yrs, mean = 3.4 yrs). Echocardioaraphic abnormalities were detected frequently in both groups (64%) and consisted of pericardial effusion in 4 (18%), LV dilation with decreased contractility in 10 (45%), and RV dilation or prolonqed RV systolic time intervals in 2 (9%). -EKG abnormalities were varied and frequent (55%), and included voltaae chanaes consistent with ventricular hypert;ophy in 8 and complete riaht bundle branch block in 1. None of the chrldren studied had Kaposi's sarcoma, or veqetations detected. There were no sianificant differences in the cardiac abnormalities observed between the AIDS and ARC qroup. We postulate that these two groups of-children frequently have cardiac abnormalities, primarily affecting their left ventricle that may complicate their clinical course.
ECHOCARDIOGRAPHIC EVALUATION OF MYOCARDIAL FUNCTIONINPEDIATRICAIDSPATIENTS Patricia Sherron*, Arthur S. Pickoff, FAAP, Pedro L. Ferrer, FAAP, Dolores Tamer, FAAP? Gwendolyn B. Scott. University of Miami School of Medicine, Miami, FL Twenty-three patients (pt) ages 4to 48 months (mo) with Acquired Immune Deficiency Sz;rr;ome (AIDS) or AIDS Related Complex underwent nonlnvaslve cardiac evaluHtion. Ten pt (44%) had symptoms of cardiovascular compromise, 8 pt (35%) had lymphoid interstitial neumonitis of >6 mo duration and 5 pt (21% P had no cardiopulmonary manifestations. M-mode and 2 dimensional echocardiograms (echo) were performed in all pt. Follow up echo studies were obtained in 9 pt at 3 month intervals. Seventeen pt, (74%) showed left ventricular (LV) dysfunction. A shortening fraction of ~28% was found in 15 pt; of these, 8 had LV systolic time interval (LVSTI) ratios of >.37 and 6 pt had increased isovo lumic contraction times (ICT) >40 msec (ages ~36 mo) or '47 msec (>36 mo). Moderate pericardial effusion6 were observed in 5 pt; all had LV dvsfunction. Pulmonary-artery hypertension (PHT) defined b right ventricular systolic time interval YRVSTI) ratio >.35 was found . 4 Pt. All had associated I. v i!sfunction. LV dysfunction preceded RVSTI ratio prolongation. One pt (4%) developed isolated findings of PHT without LV dysfunction. GNLY 5 pt (22%) had normal cardiac function by echo. In conclusion, echo abnormalities are common in pediatric AIDS pt. LV dysfunction is the most frequent finding. Evidence of abnormal RV function usually occurs in association with LV dysfunction and follows reoeated pulmonary infections.
American
MAGNEXIC
-CE
COAHCTATION
Heart
IMAGING STUDIES IN OF TWX AORTA
Robert A. Boxer, MD, FAAP*, Michael A. IaCorte, MD, FLAP, Rubin S. Cooper, MD, FLAP, Sharanjeet Singh, MD, FAX', Mitchell~Goldman, i%, Harry L. Stein, MD, Department of Pediatrics, North Shore University Hospital-Cornell University edical College, Manhasset, NY 11030 mated magnetic resonance imaging (MRI) studies were done on 11 children ages 2-16 yrs treated for coarctation (coax) of the aorta transaxial and left P.0). Coronal, sagittal, anterior oblique imaging planes were obtained using a 0.6 l&la super-conducting magnet employing 0.75-l cm thick sections.In-3 pts, MRI was performed only prior to therapy: in 3 pts, MRI was performed both before andafter therapy; and in 5 pts, MRI was performed only after therapy. In all 6 pretherapy studies, the area of the coarc was well delineated. The use of multiple imaging planes gave excellent visualization of the Ao isthmus, descending m, arch vessels and collaterals when present. The 8 pst treatment studies were performed l16.5 mths after treatment; 1 post surgery and 7 pxt balloon angioplasty. In all 8 pts, the MRI demonstrated satisfactory relief of the coarc . In 3 pts post balloon angioplasty, sagittal and/or left anterior obligue views delineated an abnormal area of dilatation in the previous site of ooarc. Angiography was performed in 1 of these pts and confirmed the presence of an aneurysm. In smry, MRI allows accurate localization of the site of the coarc and is an excellent noninvasive modality for serial follow up after treatment.
ENDOMYOCARDIALBIOPSY IN INFANTS AND CHILDREN Ernerio T. Alboliras, MD*, David J. Driscoll, MD, FAAP, Douglas D. Mair, MD, FAAP, Donald J. Hagler, MD, FAAP, James B. Seward, MD, David R. Holmes, Jr., MD, William D. Edwards, MD Mayo Clinic, Rochester, Minnesota
We assessed the utility
and risks
of endo-
myocardial biopsy (EMB) performed at the Mayo Clinic on 39 pediatric patients (pts) (25 males, 14 females) aged 6 mos - 18 yrs. Histologically adequate specimens were obtained in 36 pts (92%). 7 pts had a clinical diagnosis of acute myocarditis (AM) but only 1 had biopsy evidence of lymphocytic myocarditis (LM); 6 had nonspecific findings suggestive of cardiomyopathy (CM). 17 pts had EMB for unex-
plained heart
cardiac failure
dilatation (CHF):
1 pt
(CD) with had
findings
or without of
LM,
3 had endocardial fibroelastosis (EFE) and 13 had CM. 8 pts without CD had EMB for lifethreatening arrhythmia or syncope: 2 had LM, 5 had CM, and only 1 had a normal biopsy. 4 pts had EMB for CHF without CD: 2 had findings consistent with restrictive cardiomyopathy and 2 with hypertrophic cardiomyopathy. Complications occurred in 2 of 39 pts (5%): pneumothorax 1 pt, and ventricular perfo-
ration
requiring
There
pericardiocentesis
1 pt.
were no deaths. In the clinical setting of AM, unexplained CD, or unexplained life-threatening arrhythmia, EMB may document LM, EFE, or evolving CM. Significant complications can occur with EMB in children and one must be prepared to manage these, particularly ventricular perforation
with
tamponade.
198.5 Journal
710
AAP Program and Abstracts
CARDIAC INVOLVEMENT IMMUNE DEFIFIENCY.
IN CHILDREN
WITH ACQUIRED
Henry J. Issenberg*, Morris Charytan, Arye Rubinstein, Dept. of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY Acquired Immune Deficiency (AIDS) is frequently complicated by cardiac malignancy, such as Kaposi's sarcoma, endocarditis or pulmonary insufficiency secondary to pneumonia. We prospectively performed cardiac evaluations consisting of physical examination, EKG and echocardiogram, in a total of 22 children ranaina in aae from 6 months to 6 years with AIDS In=12 6.8-5.8 yrs, mean = 2.9 yrs) and AIDS Related Complex (ARC) (n=lO 0.5-6.0 yrs, mean = 3.4 yrs). Echocardioaraphic abnormalities were detected frequently in both groups (64%) and consisted of pericardial effusion in 4 (18%), LV dilation with decreased contractility in 10 (45%), and RV dilation or prolonqed RV systolic time intervals in 2 (9%). -EKG abnormalities were varied and frequent (55%), and included voltaae chanaes consistent with ventricular hypert;ophy in 8 and complete riaht bundle branch block in 1. None of the chrldren studied had Kaposi's sarcoma, or veqetations detected. There were no sianificant differences in the cardiac abnormalities observed between the AIDS and ARC qroup. We postulate that these two groups of-children frequently have cardiac abnormalities, primarily affecting their left ventricle that may complicate their clinical course.
ECHOCARDIOGRAPHIC EVALUATION OF MYOCARDIAL FUNCTIONINPEDIATRICAIDSPATIENTS Patricia Sherron*, Arthur S. Pickoff, FAAP, Pedro L. Ferrer, FAAP, Dolores Tamer, FAAP? Gwendolyn B. Scott. University of Miami School of Medicine, Miami, FL Twenty-three patients (pt) ages 4to 48 months (mo) with Acquired Immune Deficiency Sz;rr;ome (AIDS) or AIDS Related Complex underwent nonlnvaslve cardiac evaluHtion. Ten pt (44%) had symptoms of cardiovascular compromise, 8 pt (35%) had lymphoid interstitial neumonitis of >6 mo duration and 5 pt (21% P had no cardiopulmonary manifestations. M-mode and 2 dimensional echocardiograms (echo) were performed in all pt. Follow up echo studies were obtained in 9 pt at 3 month intervals. Seventeen pt, (74%) showed left ventricular (LV) dysfunction. A shortening fraction of ~28% was found in 15 pt; of these, 8 had LV systolic time interval (LVSTI) ratios of >.37 and 6 pt had increased isovo lumic contraction times (ICT) >40 msec (ages ~36 mo) or '47 msec (>36 mo). Moderate pericardial effusion6 were observed in 5 pt; all had LV dvsfunction. Pulmonary-artery hypertension (PHT) defined b right ventricular systolic time interval YRVSTI) ratio >.35 was found . 4 Pt. All had associated I. v i!sfunction. LV dysfunction preceded RVSTI ratio prolongation. One pt (4%) developed isolated findings of PHT without LV dysfunction. GNLY 5 pt (22%) had normal cardiac function by echo. In conclusion, echo abnormalities are common in pediatric AIDS pt. LV dysfunction is the most frequent finding. Evidence of abnormal RV function usually occurs in association with LV dysfunction and follows reoeated pulmonary infections.
American
MAGNEXIC
-CE
COAHCTATION
Heart
IMAGING STUDIES IN OF TWX AORTA
Robert A. Boxer, MD, FAAP*, Michael A. IaCorte, MD, FLAP, Rubin S. Cooper, MD, FLAP, Sharanjeet Singh, MD, FAX', Mitchell~Goldman, i%, Harry L. Stein, MD, Department of Pediatrics, North Shore University Hospital-Cornell University edical College, Manhasset, NY 11030 mated magnetic resonance imaging (MRI) studies were done on 11 children ages 2-16 yrs treated for coarctation (coax) of the aorta transaxial and left P.0). Coronal, sagittal, anterior oblique imaging planes were obtained using a 0.6 l&la super-conducting magnet employing 0.75-l cm thick sections.In-3 pts, MRI was performed only prior to therapy: in 3 pts, MRI was performed both before andafter therapy; and in 5 pts, MRI was performed only after therapy. In all 6 pretherapy studies, the area of the coarc was well delineated. The use of multiple imaging planes gave excellent visualization of the Ao isthmus, descending m, arch vessels and collaterals when present. The 8 pst treatment studies were performed l16.5 mths after treatment; 1 post surgery and 7 pxt balloon angioplasty. In all 8 pts, the MRI demonstrated satisfactory relief of the coarc . In 3 pts post balloon angioplasty, sagittal and/or left anterior obligue views delineated an abnormal area of dilatation in the previous site of ooarc. Angiography was performed in 1 of these pts and confirmed the presence of an aneurysm. In smry, MRI allows accurate localization of the site of the coarc and is an excellent noninvasive modality for serial follow up after treatment.
ENDOMYOCARDIALBIOPSY IN INFANTS AND CHILDREN Ernerio T. Alboliras, MD*, David J. Driscoll, MD, FAAP, Douglas D. Mair, MD, FAAP, Donald J. Hagler, MD, FAAP, James B. Seward, MD, David R. Holmes, Jr., MD, William D. Edwards, MD Mayo Clinic, Rochester, Minnesota
We assessed the utility
and risks
of endo-
myocardial biopsy (EMB) performed at the Mayo Clinic on 39 pediatric patients (pts) (25 males, 14 females) aged 6 mos - 18 yrs. Histologically adequate specimens were obtained in 36 pts (92%). 7 pts had a clinical diagnosis of acute myocarditis (AM) but only 1 had biopsy evidence of lymphocytic myocarditis (LM); 6 had nonspecific findings suggestive of cardiomyopathy (CM). 17 pts had EMB for unex-
plained heart
cardiac failure
dilatation (CHF):
1 pt
(CD) with had
findings
or without of
LM,
3 had endocardial fibroelastosis (EFE) and 13 had CM. 8 pts without CD had EMB for lifethreatening arrhythmia or syncope: 2 had LM, 5 had CM, and only 1 had a normal biopsy. 4 pts had EMB for CHF without CD: 2 had findings consistent with restrictive cardiomyopathy and 2 with hypertrophic cardiomyopathy. Complications occurred in 2 of 39 pts (5%): pneumothorax 1 pt, and ventricular perfo-
ration
requiring
There
pericardiocentesis
1 pt.
were no deaths. In the clinical setting of AM, unexplained CD, or unexplained life-threatening arrhythmia, EMB may document LM, EFE, or evolving CM. Significant complications can occur with EMB in children and one must be prepared to manage these, particularly ventricular perforation
with
tamponade.
198.5 Journal