Aneurysms In Children Research Articles

A Rare Case of External Jugular Vein Aneurysm Mimicking Branchial Cyst in a Nigerian Child

Abstract Background: An aneurysm of the external jugular vein is exceptionally rare. Its occurrence in children could present diagnostic challenges due to numerous potential differential diagnoses, including anomalies such as branchial cysts. Objective: This study aims to emphasize the necessity of raising suspicion for jugular venous aneurysms in children with cystic neck masses. Case Summary: We report an 18-month-old boy with a left-sided neck swelling persisting for 10 months. The swelling was cystic and increased in size during straining or crying. A preoperative diagnosis of a branchial cyst was made but was inconsistent with intraoperative findings, where a venous aneurysm was diagnosed. Ligation and excision were performed without sequelae. Conclusion: External jugular venous aneurysms, though rare, should be considered as a potential differential diagnosis in case of lateral neck swellings, especially if they demonstrate compressibility with an increase in size on Valsalva maneuvers. Simple ligation and excision are curative measures.

Microsurgical clipping of large MCA aneurysm in a 2-month-old child.

Cerebral aneurysms in children have a low incidence and accounts for less than 4% of all cerebral aneurysms. These aneurysms have been linked to various factors. Severe headache, seizures, and motor-sensory deficits are common presentations. We describe the case of a 2-month-old male patient who presented with generalized tonic-clonic seizures for 4days. At the hospital, he was stabilized with ventilatory support, sedation, and antiepileptic drugs. A NCCT (Head) showed intraparenchymal hemorrhage in the left fronto-parieto-temporal lobe and subarachnoid hemorrhage. Subsequently a CT angiogram revealed an aneurysm of the left M3 segment of MCA. Successfully, the patient underwent microsurgical clipping of aneurysm and evacuation of hematoma. Pediatric cerebral aneurysms differ from their adult counterparts, mainly in their etiology and evolution. As per literature, aneurysmal clipping and neurological endovascular therapy have shown similar results.

Etiology and prognosis of non-Kawasaki disease induced coronary aneurysms in children: a retrospective case series study

While Kawasaki disease (KD) induced coronary artery aneurysms (KD CAAs) in children are well studied, the features and prognosis of non-KD induced CAAs (non-KD CAAs) in the pediatric population are poorly documented. This case series study is to analyze the etiology and prognosis of non-KD CAAs in children and compare the characteristics of non-KD CAAs and KD CAAs. Non-KD CAA and KD CAA cases at our department from January 2022 to December 2023 were retrospectively collected. Etiologies and prognosis of non-KD CAAs were analyzed. Furthermore, demographic data, biochemical parameters and outcomes between children with Non-KD CAAs and children with KD CAAs were comparatively studied. Fifteen children with non-KD CAAs with a median age of 6 years and 117 children with KD CAAs with a median age of 2.0 years (p = 0.022) were included in this study. The causes of non-KD CAAs include: unknown etiologies (2 cases), coronary artery structural abnormalities (4), Takayasu arteritis (2), virus infection (2), cardiomyopathy (2), aplastic anemia with agranulocytosis (1), ANCA-associated vasculitis (1), and mucopolysaccharidosis (1). In the non-KD CAA group, there were a total of 19 CAAs with 3 being giant, 5 medium, and 11 small; 4 patients had complete CAA regression; an infant with a fistula between the right coronary artery and the coronary sinus complicated with cardiac enlargement died of heart failure. The KD group had significantly higher levels of CRP, white cells counts and ESR with zero mortality. Non-KD CAA cases had a significantly lower regression rate than KD-CAA cases (26.7% vs 66.7%, p = 0.004), and the probability of CAA regression in non-KD patients was 0.341 of that in KD patients (p = 0.006, OR = 0.341, 95% CI: 0.179–0.647).Conclusions: Various etiologies for Non-KD CAAs are identified. Patients with Non-KD CAAs were observed to have lower inflammatory indexes but poorer recovery than patients with KD CAAs. Therapeutic strategies different than those for KD may be needed for non-KD CAAs.What is Known:• Coronary artery aneurysm (CAA) in children is most commonly induced by Kawasaki disease (KD CAA), with a 50 ~ 70% regression rate in 1 to 2 years.• CAA induced by diseases other than KD (non-KD CAA) in children is rare and its prognosis remains largely unknown.What is New:• Most non-KD CAA cases are caused by coronary artery structural malformations.• Non-KD CAA in children has poorer prognosis and lower regression rate compared with KD CAA.• In addition to guideline directed anti-platelet and anti-coagulant therapies, treatments targeting the causal factor are necessary for non-KD CAA.

Determination of Serum Procalcitonin Level in Kawasaki Disease

Background: The most frequent cause of coronary artery aneurysm in children is Kawasaki disease (KD). Recently, limited studies on procalcitonin (PCT) were performed to find a biomarker for the diagnosis or prognosis of children with KD. Objectives: This study aimed to compare serum PCT levels between complete and incomplete KD and testify to the predictive validity of PCT for intravenous immunoglobulin (IVIG) resistance and predicting coronary artery lesions (CALs). Methods: This cross-sectional study was conducted at Namazi hospital in Shiraz, Iran, in 2019. All KD patients admitted to the hospital were included, with parental consent obtained. Kawasaki disease patients were categorized as complete KD (cKD) or incomplete KD (iKD). Two-dimensional echocardiography was performed, and peripheral venous blood was examined for PCT levels and other markers. All patients received IVIG and aspirin as standard treatment. The presence of coronary artery abnormalities (CAAs) was determined based on coronary artery size and morphology. We used Stata software version 14.0 for data analysis. Logistic regression models identified predictive factors for coronary complications. This study determined the optimal PCT cut-off point for predicted coronary complications using receiver operating characteristic (ROC) curve analysis. Approval was obtained from the Research Ethics Committees of Shiraz University of Medical Sciences. Results: Procalcitonin values in 38 children hospitalized with acute KD ranged from 0.2 ng/mL to 10 ng/mL, with a mean of 2.65 ng/m. There was no correlation of PCT with patients’ age or gender, incomplete KD, or IVIG resistance. The serum PCT concentration was higher in patients with CAL (P = 0.009). The best PCT cut-off value for CAL prediction was 2.5 ng/mL (corresponding sensitivity = 81.8% and specificity = 68.7%), considering CAL prevalence as the studied group. Conclusions: Supplementary research is needed to determine the sensitivity and specificity of PCT for the diagnosis and prognosis of KD. Procalcitonin might be of value in predicting which children are at increased risk for CALs to intensify therapy.

Результаты эндоваскулярноголечения множественных дефектов межпредсердной перегородки в сочетании с аневризмой перегородки в детском возрасте

Результаты эндоваскулярноголечения множественных дефектов межпредсердной перегородки в сочетании с аневризмой перегородки в детском возрасте

A Case Report of an Intracranial Giant Aneurysm in a 10-Year-Old Female

Pediatric intracranial aneurysms are rare and differ from aneurysms in adults in terms of location, etiology, natural history and management. This is a case report of giant aneurysm in a 10-year-old patient presenting with symptoms of headache and vomiting. Cerebral catheter angiogram revealed a large aneurysm in the left middle cerebral artery, M1 segment. The patient underwent left pterional craniotomy, clip reconstruction of the patent artery, and aneurysmectomy. Post operatively the patient had an unremarkable course and was discharged improved after 1 week. Cerebral catheter angiogram was performed after 2 months and revealed no residual aneurysm. Intracranial aneurysms in children are rare; 0.5% to 4.6% of intracranial aneurysms occur in patients aged 18 years or younger. Aneurysms occurring in very young children and infants are exceedingly rare. Unlike their adult counterparts, pediatric aneurysms have been reported to exhibit features such as male predominance, a higher incidence in locations such as the internal carotid bifurcation and posterior circulation, and greater numbers of giant aneurysms. By far, pediatric aneurysms present more commonly as subarachnoid hemorrhage, with peaks at ages 2-5 years and in adolescents older than 15 years. However, the rate of subarachnoid hemorrhage in children is far lower than in adults. This may be due to high incidence of giant aneurysms that present as space-occupying lesions rather than hemorrhage. In the Philippines, intracranial aneurysms are more common in adults rather that in children. Moreover, there has been no published data about pediatric intracranial aneurysm. Presented here is a case of a 10-year-old female with left middle cerebral artery (MCA) giant aneurysm. This report discusses the epidemiology, signs and symptoms and management of the pediatric patient with a giant aneurysm. Conclusions: Intracranial aneurysms in children differ from those in adults in location, morphology, etiology, natural history, and management. Giant aneurysms produce neurologic compromise related to mass effect. The most efficacious form of treatment involves complete elimination of this lesion from cerebral circulation. Regardless of whether these aneurysms are treated or observed, children with intracranial aneurysms require follow-up imaging and clinical surveillance, given their expected long-life span during which treated aneurysms could recur or additional aneurysms could arise. Key words: pediatric, giant aneurysm, craniotomy, clip reconstruction, aneurysmectomy

Axillary artery aneurysms in pediatric patients: A narrative review

Objectives Axillary artery aneurysms in children are rare and multifactorial. The presenting clinical picture can range from an incidental discovery to threatening symptoms, including loss of extremity function. With the present study we aim to give a comprehensive review of the existing literature focusing on the etiology and management of this rare but threatening pathology. Method A comprehensive review was made in a multi-staged manner. All identified studies have been categorized based on the type of lesions (true or false aneurysm) and their etiologies. Results The treatments differ from the extension of the lesions and from the etiology. Conclusions Open surgery repair with great saphenous vein is still the best long-term approach, but even endovascular, embolization, or conservative management can be considered.

A clinical case of surgical treatment of a child with aneurysms of the abdominal aorta and aortic bifurcation, superior mesenteric artery and multiple aneurysms of the main arteries

A brief literature review on abdominal aortic aneurysms in children and our own observation of surgical treatment of a 5-year-old child with an aneurysm of the abdominal aorta and aortic bifurcation, an aneurysm of the superior mesenteric artery, and multiple aneurysms of the arteries of the lower extremities has been presented in the paper. Staged replacement of the aortic aneurysm and superior mesenteric artery with synthetic polytetrafluoroethylene prostheses was performed. The features of surgical interventions, difficulties and complications that the authors encountered during the treatment of the child are described.

Self-navigated coronary MR angiography for coronary aneurysm detection in Kawasaki disease at 3T: comparison with conventional diaphragm-navigated coronary MR angiography.

To assess the scan time, image quality, and diagnostic performance of self-navigated coronary MR angiography (SN-CMRA) for coronary aneurysm (CAA) detection in Kawasaki disease (KD) patients and compare it with diaphragm-navigated CMRA (DN-CMRA). SN-CMRA and DN-CMRA were performed on 76 pediatric patients with KD (48 males, 6.75 ± 3.59 years). Thirty-three of whom underwent coronary CT angiography (CCTA)/invasive coronary angiography (ICA). The scan time and qualitative and quantitative image quality assessment were compared between the two sequences. The diagnostic performance for CAA detection by the two approaches using CCTA/ICA as the reference standard was compared on per-patient, per-vessel, and per-segment basis. The scan time of SN-CMRA was significantly shorter than that of DN-CMRA (7.49 ± 2.31 min vs. 10.03 ± 4.47 min, p< 0.001). There was no difference in overall and segmental image quality to reach the clinical diagnostic criteria between the two sequences (all p> 0.05). No significant difference in vessel length of the three main coronary arteries was found between the two approaches (all p> 0.05). Moreover, SN-CMRA showed no difference from DN-CMRA in contrast ratio of blood-myocardium (1.25 (interquartile range [IQR], 1.06 to 1.51) vs. 1.18 (IQR, 0.95 to 1.64), p= 0.706). There was no difference in the diagnostic accuracy of SN-CMRA and DN-CMRA for CAA detection on per-patient, per-vessel, or per-segment basis (all p> 0.05). SN-CMRA at 3T showed reliable diagnostic performance and application value for CAA detection in children with KD. Compared with DN-CMRA, SN-CMRA can simplify the scanning procedure and shorten the scan time, achieving comparable image quality and diagnostic accuracy. Coronary aneurysm in children with Kawasaki disease (KD) can be detected by self-navigated coronary MR angiography (CMRA) non-invasively and without radiation, achieving comparable image quality and diagnostic performance as diaphragm-navigated CMRA while shortening scanning time. It can provide reference for risk stratification and treatment management of KD. • Evaluating the size of coronary aneurysm is important for risk stratification and treatment of Kawasaki disease. • Self-navigated coronary MR angiography (SN-CMRA) shortens scan time and achieves comparable image quality and diagnostic performance compared with diaphragm-navigated coronary MR angiography. • SN-CMRA can evaluate coronary aneurysm non-invasively and without radiation, providing information for risk stratification and treatment.

Intracerebral Aneurysms in the Young: Institutional Series and Review of Literature

ABSTRACT Introduction: Intracranial (IC) aneurysms in the paediatric population are uncommon. The natural history, clinical presentation and clinical outcome of children with IC aneurysms are different from their adult counterparts. We analyse our hospital database for IC aneurysms in children &lt;20 years and present our findings. Materials and Methods: A retrospective review of case records of patients less than 20 years admitted with IC aneurysm was conducted at our institute. Details of clinical presentation, treatment provided and outcome were obtained from the case records. Results: Ten children were admitted with IC aneurysms. The mean age of presentation was 16.5 ± 3.43 years (9–20 years). While 90% were spontaneous in presentation, one case was post-traumatic. Nine patients underwent treatment for their aneurysm in the form of microsurgical clipping. Subarachnoid haemorrhage with intracerebral haemorrhage was the most common mode of presentation. Outcome was good in 80% and poor in 20% of patients. One patient succumbed to the illness before treatment. Conclusion: IC aneurysms in the young are represent a small subset of patients with aneurysms. IC aneurysms in the young represent a small subset of patients with aneurysms predominantly located in the anterior circulation. Micro-surgical treatment provides excellent outcomes in these patients.

EE61 Cost Effectiveness of Treating Ivig-Resistant Kawasaki Disease Children with Second Round IVIG Versus Infliximab

Intravenous immunoglobulin (IVIG) is a known effective treatment to reduce the incidence of coronary artery aneurysms in children with Kawasaki Disease (KD). However, there are IVIG-resistant patients and a lack of clinical trial data to determine the best second round treatment. Using recent effectiveness findings from the KIDCARE study, this research aimed to determine if second round IVIG or infliximab is cost effective in KD patients with persistent or recrudescent fever.

Paediatric subarachnoid haemorrhage and severe vasospasm secondary to traumatic pseudoaneurysm of a fenestrated vertebral artery: a case report and review of the literature

Paediatric intracranial aneurysms are rare entities accounting for less than 5% of all age intracranial aneurysms. Traumatic aneurysms are more common in children and have an association with anatomical variations such as arterial fenestrations. Here, we present a case of a child initially presenting with traumatic subarachnoid haemorrhage who returned to baseline and was discharged home only to return within 2 weeks with diffuse subarachnoid and intraventricular re-haemorrhage. A dissecting aneurysm of a duplicated (fenestrated) V4 vertebral artery segment was identified as a rare cause of rebleeding. We describe a course complicated by severe vasospasm delaying aneurysm detection and treatment. Dissecting aneurysms in children should be considered in all cases of delayed post-traumatic cranial rebleeding, particularly where there is anomalous arterial anatomy.

196 Increased Hemorrhage Risk With Brain AVM-Associated Aneurysms in Children

INTRODUCTION: Brain arteriovenous malformations (AVMs) represent a major cause of intracranial hemorrhage with pediatric patients at greater lifetime risk of rupture compared to their adult counterparts. These AVMs can be associated with aneurysms that are either arterial or intranidal. The significance of AVM-associated aneurysms in the pediatric population remains poorly understood due to their rare nature and spare reporting. METHODS: We reviewed a prospectively maintained database of pediatric brain AVMs from 1998 to 2021 at the University of California, San Francisco. Inclusion criteria included patients with age ≤ 18 at time of presentation with angiographically-proven AVM. RESULTS: Of 231 patients with AVMs, 24 patients harbored 35 arterial aneurysms, and 35 patients harbored 38 intranidal aneurysms. Compared to AVMs without aneurysms with a mean nidus size of 3.02 ± 1.74 cm, AVMs with intranidal aneurysms had a significantly smaller mean nidus size at 2.13 ± 1.12 cm (p = 0.004). AVMs with intranidal aneurysms had a higher proportion of being ruptured on presentation compared to AVMs without aneurysms (94% vs. 59%, p &lt; 0.001). AVMs with intranidal and arterial aneurysms also underwent higher proportions of surgical resection (92% and 80% vs. 59%, p = 0.001) and embolization (37% and 50% vs. 25%, p = 0.022) with higher rates of nidus obliteration (91% and 79% vs. 65%, p = 0.005). In those that were not obliterated, AVMs with intranidal and arterial aneurysms have higher annual hemorrhage risks (10.2% and 7.4% vs. 1.6%) after patient presentation. Patients who underwent a hemorrhage event after presentation had a higher proportion of worsened clinical status compared to presentation (38% vs. 5.6%, p &lt; 0.001). CONCLUSIONS: A higher proportion of AVMs with associated aneurysms present with hemorrhage and are more likely to undergo additional hemorrhage events when incompletely treated compared to AVMs without aneurysms.

Ruptured giant fusiform aneurysm in an infant: Case report and review of the literature.

Background: Intracranial aneurysms are exceedingly rare in neonates, accounting for less than 2% of all relevant cases that occur during the first decade of life. More precisely, intracranial aneurysms in children (less than 18 years old) are rarely been recorded, and their epidemiology is poorly investigated. Details about this pathology in this specific population are lacking. Because of the scarcity of this entity along with the peculiar characteristics of this patient group, the treatment of aneurysms of the cerebral circulation of these patients is challenging. The prevalence of Intracranial aneurysms in children is much lower than in adults· apart from that, several differences exist, centered on their etiology, demographic variables, aneurysm location, aneurysm morphological characteristics, clinical presentation, and outcome in pediatric and adult intracranial aneurysms. We describe the case of aneurysmal subarachnoid hemorrhage and extra-axial hemorrhage in an infant, as well as the review of the relevant current literature. Case description: We report the case of a three months old infant who was admitted to our hospital due to episodes of vomiting, associated with loss of consciousness and an epileptic ictus. An MRI-MRA scan and a digital subtraction angiography were immediately performed, which revealed the presence of a giant fusiform aneurysm near the origin of the right anterior cerebral artery. Because of the location and shape of the aneurysmal sac, the ipsilateral internal carotid artery was totally occluded with detachable coils. At follow-up, the child experienced normal psychomotor development with no motor deficit. Conclusions: Intracranial aneurysms should be considered in the differential diagnosis of infants and neonates who present with acute raised intracranial pressure. Even though rupture of an intracranial aneurysm in this age group is rare, subarachnoid hemorrhage is the most common mode of presentation. Intracranial aneurysms are frequently larger than 10 mm and located on the middle cerebral artery. The treatment could be surgical or endovascular, depending on the characteristics of the aneurysm. Seizures and cranial nerve involvement are the most common presenting features in children. The most commonly encountered sites of origin for such aneurysms are the posterior circulation, along with the internal carotid artery bifurcation. Current literature and case series suggest that there is increased incidence of giant, posttraumatic, and mycotic aneurysms in children. Based on the most recently published data, the treatment of ruptured and unruptured pediatric aneurysms is related with an increased incidence of an uneventful outcome, which reaches 95% in the current series. Pediatric intracranial aneurysms are more commonly encountered in male patients and have a predilection for the terminal ICA bifurcation.

Treatment of thrombosis in KD Patients using tissue plasminogen activator: a single center study

ObjectiveThe most severe complication associated with giant coronary aneurysm in children with Kawasaki disease is ischemic cardiomyopathy (ICM) caused by thrombosis. Addition of tissue plasminogen activator, Alteplase, in the treatment regimen can be an efficient thrombolytic therapy, and therefore can have a significantly positive impact on patients’ quality of life in long term.MethodsTotal four male KD patients with central thromboses in coronary aneurysm were treated in Pediatric Cardiology Department of Shengjing Hospital, China Medical University, from January 2020 to August 2021. These patients received thrombolytic treatments including Alteplase once + Heparin for 1 week followed by continuous oral Warfarin + Aspirin + Clopidogrel.Results4 young male KD patients had coronary aneurysm (CAA) complicated with total 7 occurrences of central thrombosis. These patients were given alteplase and heparin/oral Warfarin + Aspirin + Clopidogrel treatment. 9 days to 2 months later, thromboses were significantly dissolved. The treatment successfully diminished the thrombosis complication.Conclusion1. Pediatric KD patients complicated with coronary aneurysm thrombosis are prone to recurrence of thrombosis. 2. In KD patients complicated with coronary aneurysm thrombosis, treatments described in Method can be used for treating either small thromboses formed less than 1 month with strong echo and convex lumen or large thromboses with mixed strong and weak echo. With these treatments, coronary artery blood flow can be improved or completely recovered. 3. Clinical experiences at our center in treating these KD patients suggest that Alteplase can be considered in thrombolytic treatment beyond the limitation of less than 12 h of thrombosis occurrence.

Coronary Artery Ectasia and Giant Coronary Aneurysms Presenting with Recurrent Acute Coronary Syndrome and Heart Failure

Coronary artery ectasia (CAE) or aneurysm (CAA) is characterized by inappropriate dilatation of the coronary vasculature. While our understanding of CAAs has developed over the last few years, the exact mechanism of Kawasaki disease (KD) and coronary artery complications is unknown. There is a scarcity of data addressing the management and prognosis of patients with CAE. KD is the most common cause of coronary aneurysms in children, whereas atherosclerosis is the most common cause in adulthood, and may present as missed KD. While infection, trauma, vasculitis, KD, cocaine use, and iatrogenic causes form the other etiologies of CAE. Here, we report a young patient who presented with recurrent acute coronary syndromes and heart failure in whom angiography showed severely ectatic coronary arteries with giant CAAs containing a heavy burden of thrombus, diagnosed as probable missed KD, especially with morphological findings from the coronary angiogram.

The Negative Predictive Value of Harada Scoring for Coronary Artery Dilatation or Aneurysm in Children with Kawasaki Disease: A Cross-sectional Study.

Background: The most common cause of coronary artery aneurysms in children is Kawasaki disease (KD). One of the risk ratings used to predict coronary artery aneurysms is the Harada score. This study aims to assess the negative predictive value (NPV) of Harada scoring in children with KD.Methods: This cross-sectional study was conducted in Mashhad (Iran) from January 2014 to December 2017. The Harada score was generated for each patient using demographic, laboratory, and echocardiography data retrieved from their medical records. The patients were divided into typical and atypical cases, and the sensitivity, specificity, positive predictive value (PPV), and NPV were calculated. The Chi square test, independent t test, Mann–Whitney U test, and Fisher exact test were used to analyze the data in SPSS software (version 23.0). P≤0.05 was considered statistically significant.Results: The study involved 168 individuals with a mean age of 29.91±19.52 months, including 103 typical and 65 atypical cases. Regarding cardiac complications, the atypical group had a significantly greater rate of coronary artery tapering (P=0.030). Out of 101 patients with cardiac complications, the Harada score was positive in 57 cases, while it was falsely negative in the remaining 44 patients. The calculated sensitivity, specificity, PPV, and NPV were 56.44%, 53.73%, 64.77%, and 45%, respectively.Conclusion: The findings revealed that the Harada scoring is ineffective in detecting coronary artery aneurysms or dilation in KD patients.

Aneurysms in childhood: literature review and cases description

Introduction: In the aneurysm disease, children aneurysms do not represent a majority of the diagnosis. Associated conditions should be monitored, including aortic coarctation, polycystic kidney disease, fibromuscular dysplasia, tuberous sclerosis, Ehlers-Danlos syndrome, and Marfan syndrome. They can present as congenital, infectious, or traumatic. Case report: We describe a series of five cases of aneurysms in patients ranging from 15 to 17 years of age whose aneurysms were found on examination. In most cases, patients were asymptomatic and did not have predisposing syndromes. Surgery was the treatment of choice in all cases. No patient had a recurrence in the following years of radiographic follow-up. Methodology: This is a literature review and case series analysis with a narrative-descriptive approach. The database for the search was PubMed®, which were used to search for articles with the subject descriptors brain, aneurysms, pediatric and child. Between the descriptors, the boolean operator and was used. Discussion: Aneurysms can be classified by their size and morphology, as well as having a predilection for anterior circulation. The most common symptom observed in our pediatric series of 5 patients was migraine or chronic headache (60%), followed by asymptomatic patients (40%). Three of five patients (60%) in this study were previously hypertensive without other comorbidity, while 40% of the cases were totally healthy. Conclusion: Pediatric intracranial aneurysms are relatively rare diseases, corresponding to 1.6 to 7% of intracranial aneurysms across all age groups. They require accurate and detailed diagnosis, which need to be assessed and managed in a multidisciplinary team.

Risk Factors for Coronary Artery Aneurysm in Children with Kawasaki Disease: A Case-control Study

Coronary artery aneurysms (CAA) are common in children with Kawasaki disease (KD) who have delayed diagnosis. This can increase the high cardiovascular burden and cause acquired heart defects in adulthood. This study aims to investigate the risk factors for CAA in children with KD. An observational retrospective case-control study was carried out in Surabaya Tertiary Hospital. We collected the medical records in the child care installation, Pediatrics ward, from 2016 to 2019. The research participants were pediatric patients who were treated with KD. The exclusion criteria were incomplete medical record data regarding the risk factors studied. The risk factors studied included age, sex, duration of fever, haemoglobin, leukocytes levels, platelets levels, C-reactive protein (CRP), and albumin levels. Twenty-eight medical records of children with KD were collected in this study; only 17 eligible patients were observed. The confirmed CAA was found in 8 patients, while 9 patients were non-CAA aged ranging from 3-124 months. Almost 60% of patients had fever duration &gt; 7 days, and 47.1% of patients had hemoglobin &lt;10 g/dL. Platelets were the only risk factor that had a significant correlation for developing CAA in children with KD, with a p-value of 0.015 at a 95% confidence interval (CI), odds ratio (OR) of 24 (1.785 – 336.227). Almost half of KD patients in this study were at risk for developing CAA; platelet value was a risk factor that we could consider in the administration of aspirin and IVIG therapy, providing the follow-up results and evaluating aneurysm progression or regression after IVIG administration is needed to prevent poor long-term outcomes.

Transcatheter closure of fenestrated atrial septal aneurysm in children: Feasibility and long-term results.

To date, extensive experience in transcatheter closure of fenestrated atrial septal aneurysm (ASA) in the pediatric population is limited. To report on procedural feasibility, efficacy, and long-term outcome, we enrolled all children submitted to an attempt of transcatheter closure of fenestrated ASA at two, large volume, pediatric cardiology units (Naples and Massa, Italy) between April 2000 to May 2020. This retrospective study included 139 patients (median age 9 years [range 2-18]and weight 36 kg [range 10-102]); 19 (13.7%) children were ≤20 kg (range 10-20) and 14 (10.1%) were ≤5 years old. Single perforation was observed in 28 patients (20.1%), while 111 patients (79.9%) had multifenestrated ASA. The median size of the main defect was 15 mm (range 6-34) and 25 patients (18%) had a defect ≥20 mm. The procedural success rate was 99% (95% confidence interval [CI]: 94.9-99.8) using a single device in 75 (69%), two devices in 31 (28%), and three devices in 3 (3%) cases. Early minor adverse events (AEs) occurred in four patients (2.8%). Late minor AEswere recorded in one patient (0.7%) over a median follow-up of 5 years ([range 0-18 years; total 890.2 person-years, and with 30 patients (22%) followed ≥10 years). Neither mortality nor major AEs were recorded. Freedom from AEs was 99.1% at 10-15 years (95% CI: 93.5-99.8%), without any difference according to atrial septum anatomy or patient age and weight. Transcatheter closure of fenestrated ASA is technically feasible and effective in children with excellent long-term outcomes.