Coarctation of the aorta: echocardiographic diagnosis in a child.
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Biomedical subjects
Publications and source records attributed to B N Agarwala.
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Complete heart block (CHB) in infants and children is usually congenital. Nonsurgical acquired CHB is rare. Occasionally, transient acquired CHB is seen in association with viral myocarditis. We describe here an unusual case of transient CHB in a 12-year-old boy with endomyocardial biopsy-proven myocarditis and evidence of Mycoplasma pneumoniae infection.
This is a case of bacterial endocarditis and dissecting aneurysm of the ascending aorta secondary to group B streptococcal (GBS) septicemia in a one-mouth-old infant girl who presented with meningitis. A large aortic vegetation and a large dissecting aneurysm of the root of the aorta were detected by two-dimensional (2D) echocardiography. Apparently the infant did not have any preexisting cardiac anomaly. She received intravenous ampicillin for six weeks. She also underwent successful surgery for the replacement of the ascending aorta with an aortic homograft. This occurrence reemphasizes the value of 2D echocardiography in detecting vegetations for endocarditis.
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Recent studies have demonstrated immunologic abnormalities in the mothers of infants with congenital complete heart block. The disorder should be suspected when a slow pulse rate is detected before or after birth. The block most often occurs in the AV node. There are several specific indications for pacemaker therapy. Most patients who survive beyond infancy are able to lead relatively normal lives.
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Although cardiac catheterization in children is not without significant risk, it is mandatory before corrective cardiac surgery is undertaken. Not only can the procedure delineate the cardiac anatomy but it also yields information about the direction and amount of shunts, pulmonary vascular resistance and myocardial function. It is used to follow the severity of lesions such as aortic or pulmonic stenosis. Complications include cardiac perforation, renal impairment, neurologic problems and many others.
Paroxysmal supraventricular tachycardia has been noted more frequently in fetuses and newborns since the introduction of monitoring devices. These tachyarrhythmias appear to be well tolerated in the fetus, but in newborns and older infants they may lead to congestive heart failure if allowed to persist for prolonged periods. Wolff-Parkinson-White syndrome is commonly associated with paroxysmal supraventricular tachycardia. The drug of choice in infants is digoxin.
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