Background: Obesity in childhood is strongly associated with elevated arterial blood

Patient: Male, 0Final Diagnosis: Bland-White-Garland syndromeSymptoms: Cardiomegaly, feeding problemsMedication: —Clinical Procedure: Reimplantation of the left coronary artery to the aortaSpecialty: Pediatrics and NeonatologyObjective:Rare diseaseBackground:Bland-White-Garland syndrome (BWGS) is a very rare disease characterized by anomalous origin of the left coronary artery from the pulmonary trunk (ALCAPA). WBGS affects 1 in every 300 000 live births. Children typically present with dyspnea, pallor, and failure to thrive. Without surgical repair, most of these children die during the first months of life.Case Report:This case report describes 3-month-old boy admitted to the hospital because of feeding problems. The boy was born at term, with birth weight 3200 g, and was 10 points in Apgar score. He was breast-fed from birth. From the seventh week of age, his mother observed his increasing difficulties with feeding. Physical examination revealed pale skin, diminished heart sounds, tachycardia, cardiomegaly, and hepatomegaly. Results of urine and blood tests and ultrasonography of the central nervous system and abdomen were normal. The chest radiography showed cardiomegaly and electrocardiogram revealed anterolateral myocardial infarction. On echocardiography, an anomalous left coronary artery arising from the pulmonary artery was found. The life-saving treatment of choice was immediate surgical reimplantation of the left coronary artery to the aorta.Conclusions:Children with congenital heart disease are often prone to malnutrition, but in rare cases failure to thrive and breast-feeding problems can be the first symptoms of life-threatening diseases like myocardial infarction secondary to Bland-White-Garland syndrome (BWGS).

Total anomalous pulmonary venous return (TAPVR) is a rare congenital cyanotic heart disease, in which the lack of connection between all four pulmonary veins and left atrium is present. The interatrial communication allows the oxygenated blood flow to systemic circulation through the left atrium. The authors present a 5-month-old girl with heart failure symptoms. Poor weight gain, feeding difficulties, tachypnoe with use of accessory breathing muscles, hepatomegaly and low oxygen saturation level were observed. Serum concentration of NT-proBNP was elevated. Electrocardiography revealed right atrial and right ventricular enlargement. Chest X-Ray showed cardiomegaly and increased pulmonary vascular markings. The echocardiographic evaluation revealed pulmonary venous drainage to superior vena cava, right-sided heart chambers enlargement, main pulmonary artery dilation and atrial septal defect. Computed tomographic angiography was performed in order to acquire more accurate image of pulmonary veins connection. Supracardiac type of total anomalous pulmonary venous return was diagnosed and cardiosurgical correction was performed. The authors pay attention to the importance of recognizing the clinical symptoms of heart failure in infants by primary care physicians.

Aortic stenosis is a congenital heart disease which may present with different symptomatology and may lead to heart failure in newborn. A case of a 9-days old newborn with a severe aortic stenosis is presented. Due to impaired systolic function of the left ventricle and rapidly increasing symptoms of heart failure (tachypnea, dyspnoea, tachycardia) the neonate required pharmacological treatment (prostaglandin E1 infusion and phosphodiesterase inhibitor c-AMP) and balloon valvuloplasty as a matter of urgency. In chest X-ray the heart silhouette was enlarged, the electrocardiogram showed signs of overload of both ventricles. In echocardiography thickened aortic valves with a pin-hole opening, normal left ventricle size with signs of its hypertrophy and reduced contractility (ejection fraction 45%) and a moderate mitral regurgitation were found. Angiography and balloon valvuloplasty of the aortic valve was performed through puncture of the right femoral artery. After expansion of the balloon at the stenotic valve a very good result of the treatment was achieved – low invasive gradient (22 mm Hg) between the left ventricle and the aorta and a trivial aortic valve regurgitation. The good outcome of the procedure was confirmed and monitored in the next days. The general state of the child improved significantly, systolic function of the left ventricle returned to normal values. Because of a complication after the procedure – a thrombosis in the external iliac artery, a 3-month anti-clotting therapy was performed. No improvement in the patency of the vessel was observed; however, abundant collateral vessels provided the extremity with proper circulation.

Anorexia nervosa is one of the most common eating disorders, third on the list of the most frequent chronic diseases in young population in a number of developed countries. 85% of anorectic patients are young women, 80% develop cardiovascular complications. The most common symptoms are bradycardia and hypotension. ECG may show repolarization abnormalities, QT interval prolongation and low amplitude of QRS complex. In course of the disease left ventricular size, volume and mass show tendency to reduction, however global systolic function of left ventricle stays unchanged. In some patients impaired diastolic function is observed. The pericardial effusion and mitral valve prolapse are other frequently observed cardiovascular complications of anorexia nervosa. The majority of cardiovascular pathologies connected with the disease does not result in clinically significant symptoms. Specific cardiological treatment is usually not necessary, as the changes resolve spontaneously in course of successful treatment of underlying disease. Cardiovascular complications, especially complex ventricular arrhythmia, are after suicide the second most common cause of sudden death in anorexia nervosa. Among risk factors of sudden cardiac death are listed: significant body weight reduction, long duration of the disease, chronic hypokalemia and hypoalbuminemia and QT interval prolongation in ECG. The symptoms of heart failure are most likely to appear not in the acute stage of anorexia, but during the treatment and while returning to normal body weight. Therefore check-up of cardiovascular parameters is essential in patients with anorexia nervosa – both in the acute stage of the disease and during therapy.