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.
EXPERIENCE ON POSTOPERATIVE PAEDIATRIC CARDIAC SURGERY IN A PORTUGUESE PAEDIATRIC INTENSIVE CARE UNIT
Abstract
Background
Advances in cardiac surgery over the last few decades, including corrective operations in early life, have dramatically increased the survival of children, particularly those with congenital heart disease.
Objectives
To describe the evolution of patients undergoing cardiac surgery in a Portuguese Paediatric Intensive Care Unit (PICU).
Methods
Retrospective study through databasis of children admitted in PICU in the postoperative period of cardiac surgery, from January 2017 to August 2018.
Results
There were 91 hospitalizations; one of the patients was hospitalized two times in this period. Of 90 patients, 54,4% were male, mean age was 4,27 years [1 month to 18 years]. In this population, 93,3% had congenital heart disease, the most frequent were ventricular and atrial septal defect and Fallot tetralogy; 42,9% had history of another comorbidities and 20,9% have made other cardiac surgeries in the past. Median time of surgery was 287,5 minutes [45-1083min]. In postoperative period, 64,8% were intubated and 27,5% had non-invasive ventilation, with mean duration of mechanical ventilation of 7,8 days. Vasoactive drugs were needed in 48,4% and pacing device in 15,4%; 2 patients needed cardioversion and other 2 patients needed ECMO support. Complications were seen in 50,5%, the most frequent were respiratory and hematologic, and 8,8% of patients required peritoneal dialysis. Deferred closure of the chest was made in 4,4% and 8,8% were reoperated, with one of this patients undergoing heart transplantation. Mortality rate was 2,2% in 20 months of study.
Conclusion
Children undergoing cardiac surgery constitute a high-risk population, justifying a multidisciplinary, differentiated and integrated approach.