Author Of 2 Presentations
ACUTE SEVERE MYOCARDITIS WITH EXTENSIVE CARDIAC THROMBUS FORMATION IN A TEENAGE BOY: A THERAPEUTIC CHALLENGE
Abstract
Background
Acute myocarditis is a rare condition in pediatrics, but potentially lethal, that can culminate in cardiac disfunction and, rarely, intracardiac thrombus.
Objectives
Not Applicable
Methods
Not Applicable
Results
We report the case of a 16-year-old teenage male, previously healthy, that was transfered to the Pediatric Intensive Care Unit due to suspicion of acute myocarditis with multiorgan disfunction. Echocardiogram at admission revealed moderate to severe left ventricular (LV) disfunction (ejection fraction of 30-35%) and two hyperechoic masses in the LV suggestive of thrombus, given which he initiated non-fractionated heparin. The cardiac magnetic resonance at day 4 was compatible with acute myocarditis with moderate to severe ventricular disfunction and biventricular thrombus. Of the infectious investigation, the only relevant finding was a positive fecal culture for Campylobacter jejuni; remaining microbiological, immunological, and prothrombotic studies were negative. Despite the treatmentwith ceftriaxone, azithromycin and IV immunoglobulin, there was an increase of the thrombus, with decline of cardiac function and peripheric arterial embolization, which led to surgical thrombectomy on day 13. He was maintained on extracorporeal membrane oxygenation until day 28, when he was subjected to orthotopic cardiac transplant with no complications. Evolution was favorable, with progressive improvement of cardiac function and no recurrence of thrombus.
Conclusion
We present a case of acute myocarditis complicated with intracardiac thrombus and systemic embolization. The approach to these cases should be multifactorial and multidisciplinary and the decision of surgical treatment is difficult. Despite severe cardiac dysfunction and intraoperative risk of embolization, the surgery was successful and should be considered in the absence of improvement with medical treatment.
CHARACTERISTICS OF PATIENTS HOSPITALIZED WITH ACUTE BRONCHIOLITIS IN A PORTUGUESE PEDIATRIC INTENSIVE CARE UNIT
Abstract
Background
Bronchiolitis remains a major cause of respiratory failure, with RSV infection being the most frequent cause.
Objectives
To characterize the cases of acute bronchiolitis admitted to a Pediatric Intensive Care Unit (PICU).
Methods
Retrospective study of patients admitted to our PICU with the diagnosis of acute bronchiolitis, from 1-10-2016 to 30-09-2018.
Results
26 patients were admitted with the diagnosis of bronchiolitis; 16 were males and the median age was 3 months [1-24]. The median duration of hospitalization was 6 days [2-44] and the main cause of hospitalization was acute respiratory failure (24/26). Thirteen patients had comorbidities, the most common being prematurity (7/13) and congenital heart disease (5/13). Fifteen patients required noninvasive ventilation (NIV, mean duration of 4 days) and 10 required invasive mechanical ventilation (IMV, mean duration of 6 days). One patient required extracorporeal membrane oxygenation. The most frequently isolated virus was RSV (15/20), followed by Metapneumovirus (3/20). Seventeen patients had bacterial infection; the most frequent agents were Staphylococcus aureus(11/17) and Haemophilus influenzae(10/17). RSV infection was associated with a median duration of hospitalization of more than 7 days (p <0.05), but not with superior requirement of NIV or IMV. No statistically significant differences were found between the groups of patients with and without comorbidities, regarding the duration of hospitalization and the need for NIV or IMV. No deaths were recorded.
Conclusion
Although NIV is increasingly used in bronquiolitis, 40% of our patients required IMV. We also highlight the fact that half of the children had comorbidities, which is according to the literature.
Presenter of 2 Presentations
ACUTE SEVERE MYOCARDITIS WITH EXTENSIVE CARDIAC THROMBUS FORMATION IN A TEENAGE BOY: A THERAPEUTIC CHALLENGE
Abstract
Background
Acute myocarditis is a rare condition in pediatrics, but potentially lethal, that can culminate in cardiac disfunction and, rarely, intracardiac thrombus.
Objectives
Not Applicable
Methods
Not Applicable
Results
We report the case of a 16-year-old teenage male, previously healthy, that was transfered to the Pediatric Intensive Care Unit due to suspicion of acute myocarditis with multiorgan disfunction. Echocardiogram at admission revealed moderate to severe left ventricular (LV) disfunction (ejection fraction of 30-35%) and two hyperechoic masses in the LV suggestive of thrombus, given which he initiated non-fractionated heparin. The cardiac magnetic resonance at day 4 was compatible with acute myocarditis with moderate to severe ventricular disfunction and biventricular thrombus. Of the infectious investigation, the only relevant finding was a positive fecal culture for Campylobacter jejuni; remaining microbiological, immunological, and prothrombotic studies were negative. Despite the treatmentwith ceftriaxone, azithromycin and IV immunoglobulin, there was an increase of the thrombus, with decline of cardiac function and peripheric arterial embolization, which led to surgical thrombectomy on day 13. He was maintained on extracorporeal membrane oxygenation until day 28, when he was subjected to orthotopic cardiac transplant with no complications. Evolution was favorable, with progressive improvement of cardiac function and no recurrence of thrombus.
Conclusion
We present a case of acute myocarditis complicated with intracardiac thrombus and systemic embolization. The approach to these cases should be multifactorial and multidisciplinary and the decision of surgical treatment is difficult. Despite severe cardiac dysfunction and intraoperative risk of embolization, the surgery was successful and should be considered in the absence of improvement with medical treatment.
CHARACTERISTICS OF PATIENTS HOSPITALIZED WITH ACUTE BRONCHIOLITIS IN A PORTUGUESE PEDIATRIC INTENSIVE CARE UNIT
Abstract
Background
Bronchiolitis remains a major cause of respiratory failure, with RSV infection being the most frequent cause.
Objectives
To characterize the cases of acute bronchiolitis admitted to a Pediatric Intensive Care Unit (PICU).
Methods
Retrospective study of patients admitted to our PICU with the diagnosis of acute bronchiolitis, from 1-10-2016 to 30-09-2018.
Results
26 patients were admitted with the diagnosis of bronchiolitis; 16 were males and the median age was 3 months [1-24]. The median duration of hospitalization was 6 days [2-44] and the main cause of hospitalization was acute respiratory failure (24/26). Thirteen patients had comorbidities, the most common being prematurity (7/13) and congenital heart disease (5/13). Fifteen patients required noninvasive ventilation (NIV, mean duration of 4 days) and 10 required invasive mechanical ventilation (IMV, mean duration of 6 days). One patient required extracorporeal membrane oxygenation. The most frequently isolated virus was RSV (15/20), followed by Metapneumovirus (3/20). Seventeen patients had bacterial infection; the most frequent agents were Staphylococcus aureus(11/17) and Haemophilus influenzae(10/17). RSV infection was associated with a median duration of hospitalization of more than 7 days (p <0.05), but not with superior requirement of NIV or IMV. No statistically significant differences were found between the groups of patients with and without comorbidities, regarding the duration of hospitalization and the need for NIV or IMV. No deaths were recorded.
Conclusion
Although NIV is increasingly used in bronquiolitis, 40% of our patients required IMV. We also highlight the fact that half of the children had comorbidities, which is according to the literature.