[Show abstract][Hide abstract] ABSTRACT: Although the association of repolarization alterations to the development of life-threatening ventricular arrhythmias has received considerable research attention, there is paucity of data regarding what may be considered as normal, especially in children.
To define electrocardiographic (ECG) and vectorcardiographic (VCG) descriptors of ventricular repolarization in healthy school-age children, 12-lead digital ECGs were obtained from 646 children (348 males/298 females, mean age 8.54 ± 1.86 years). All QT intervals were measured manually using the digitally stored ECGs. Orthogonal X, Y, and Z leads were reconstructed from the standard 12-lead ECGs and the maximal amplitudes of the spatial QRS and T vectors were calculated, as well as the spatial QRS-T angle.
The mean heart rate was 95.3 ± 15.8 bpm and the QRS duration was 83.4 ± 9.3 ms. Mean QT interval was 334.1 ± 24.2 ms and the corrected QT interval was 436.5 ± 23.8 ms (Bazzet) and 404.3 ± 19.4 ms (Fridericia). Although the uncorrected maximum and mean QT intervals were significantly higher in boys (P values 0.011 and 0.009, respectively), there was no difference in the rate-corrected QT interval. The spatial QRS and T-vector amplitudes were 1512.0 ± 365.7 μV and 478.8 ± 149.3 μV, respectively. The spatial QRS-T angle was 14.1 ± 8.0 degrees. Although the mean QT interval showed significant increase with age (P = 0.014), all VCG parameters did not show significant variance with age.
A range of ECG and VCG descriptors of ventricular repolarization was determined in a large sample of healthy school-age children to provide a data basis of normal values for future reference.
[Show abstract][Hide abstract] ABSTRACT: P waves > or = 110 ms in adults and > or = 90 ms in children are considered abnormal, signifying interatrial block, particularly in the first case.
To evaluate the prevalence of interatrial block in healthy school-aged children, we obtained 12-lead digital ECGs (Cardioperfect 1.1, CardioControl NV, Delft, The Netherlands) of 664 healthy children (349 males/315 females, age range 6-14 years old). P-wave analysis indices [mean, maximum and minimum (in the 12 leads) P-wave duration, P-wave dispersion, P-wave morphology in the derived orthogonal (X, Y, Z) leads, as well the amplitude of the maximum spatial P-wave vector] were calculated in all study participants.
P-wave descriptor values were: mean P-wave duration 84.9 + or - 9.5 ms, maximum P-wave duration 99.0 + or - 9.8 ms, P dispersion 32.2 + or - 12.5 ms, spatial P amplitude 182.7 + or - 69.0 microV. P-wave morphology distribution in the orthogonal leads were: Type I 478 (72.0%), Type II 178 (26.8%), Type III 1 (0.2%), indeterminate 7 (1%). Maximum P-wave duration was positively correlated to age (P < 0.001) and did not differ between sexes (P = 0.339). Using the 90-ms value as cutoff for P-wave duration, 502 (75.6%) children would be classified as having maximum P-wave duration above reference range. The 95th and the 99th percentiles were in the overall population 117 ms and 125 ms, respectively. P-wave morphology type was not in any way correlated to P-wave duration (P = 0.715).
Abnormal P-wave morphology signifying the presence of interatrial block is very rare in a healthy pediatric population, while widened P waves are quite common, although currently classified as abnormal.
[Show abstract][Hide abstract] ABSTRACT: Coagulopathy is a major contributing factor to bleeding related mortality even after achieving adequate surgical control of the haemorrhage in trauma and surgical patients.
A 65 years old Greek man was admitted in our ICU with critical haemorrhage following renal biopsy. Despite surgical exploration the patient continued to bleed resulting in a vicious cycle of transfusion, coagulopathy and re-bleeding. After all standard management options were exhausted, the patient was given rFVIIa (total dose 4,8 mg). Clinical improvement was noted without adverse thrombotic complications. One month later the same patient was operated on for a suspected retroperitoneal infected collection that it was assumed to be the cause of persistent pyrexia. After abdominal washout, he suffered haemorrhagic shock with postoperative coagulopathy. Standard transfusion therapy was again unsuccessful. The patient was given rFVIIa again resulting in an immediate reduction in coagulopathic haemorrhage accompanied by a significant improvement in laboratory measurements and reduction in blood products requirements.
Published clinical experiences for the use of rFVIIa in trauma patients are limited to small series and case reports. However, in trauma patients, administration of rFVIIa appears to be effective in addition to prompt surgical intervention as an adjunctive haemostatic measure to control life threatening bleeding in appropriately selected patients.
[Show abstract][Hide abstract] ABSTRACT: Coronary arteriovenous fistulas are rare. The right coronary artery (RCA) seems to be the most common site of origin, while the right ventricle, right atrium and the main pulmonary artery are the most common draining chambers. We report on a patient with fistulas in both coronary arteries: one arising from the circumflex artery and draining into the coronary sinus (CS), and a fistulous connection between the proximal aorta and the CS, represented by an enlarged and cirsoid RCA. Despite the factthat the non-invasive diagnosis of coronary fistulas has traditionally been difficult, in this case echocardiography led to the suspicion of the anomaly.
[Show abstract][Hide abstract] ABSTRACT: We present the case of a 28-year-old woman admitted to our department with respiratory distress, profound hypotension, and tenderness in the left upper abdominal quadrant and left calf. Ultrasound examination revealed left lower extremity thrombus as well as a floating thrombus in the right atrium attached to a patent foramen ovale. Spiral computed tomography revealed bilateral pulmonary artery embolization, while an abdominal computed tomographic scan disclosed spleen infarction due to a paradoxical embolism through the patent foramen ovale.