Clinical Analysis Of 51 Cases Of Dilated Cardiomyopathy In Children

Objective:To retrospectively analyze 51 cases of dilated cardio- myopathy(DCM)in children in order to improve the understanding of the disease.Methods: Clinical characteristics were analyzed retrospectively in 51 children with DCM in Children's Hospital of Chongqing Medical University from 1985 to 2008.Their clinical characteristics and auxiliary examination results were studied.Then they were separated into 2 groups:patients accompanied with hypertension(HP group)and patients with normal blood pressure(No-HP group),to investigate the clinical characteristics including sex,heart function,heart rate and ultrasonic cardiography(UCG)parameters of two groups.And comparing clinical effect of two regimens:only routine medicines(Digoxin,diuresis and so on ) and routine drugs plusβ-blocker.Results:(1)There were 23 boys and 26 girls among 51 patients, average age(6.69±3.84)years old.In this group,11 cases(21.57%)were infancy,17 cases(33.33%)were pre-school age,18 cases(35.29%)were shool age.The course of disease was(8.57±17.36)months,and the time of hospitalization was(21.53±9.51)days.3 cases had family historys.44 cases (86.27%)were DCM patients with infections,and 33 cases(64.71%)with respiratory infection among them.Antibodise of virus were found in 27 cases(52.94%).There were coxsackie virus antibodise in 18 cases(66.67%). About 35.29%(18 cases)of patients began with respiratory infections. About 92.16%(47 cases)of patients had cardiomegalia and heart failure on admission.The cardinal symptems were anhelation in 38 cases(74.51%), difficulty in breathing while lying down in 14 cases(27.45%),debilitation in 34 cases(66.67%),cardiopalmus in 26 cases(50.98%),hidrosis in cases (25.49%),oliguria in 21 case(41.18%),abdominal distention in 14 cases (27.45%)and anorexia in 38 casese(74.51%).The cardinal physical sign were pale face in 30 cases(58.82%),cyanosis in 21 cases(41.18%), distention of jugular vein in 23 cases (45.10%),positive results of hepatojugular reflux sign in 19 cases(37.25%),rattle of lung in 12 cases(23.53%),cardiomegalia in 50 cases(98.04%),cardiac murmur in 27 cases(52.94%),hepatomegaly in 45 cases(88.24%),shifting dullness in 12 casese(23.53%),puffiness in 22 cases(43.14%).All of heart function of children were aboveⅡgrade.(2)The AST,LDH and HBDH in many cases and CK,CK-MB in some cases were higher than the normal threshold value.In this group,troponin I was abnormal in 7 cases of 27 patients.45 cases had ECG,with heart rate increased in 37 cases(82.22%)and arhythmia in 38 cases(84.44%).In the group,sinus tachycardia in 25 cases(65.79%), atrial ventricular block in 13 cases(25.49%),bundle branch block and intraventricular conduction block in 4 cases(10.53%),premature ventricualr contraction in 5 cases,left ventricular hypertrophy in 10 cases(22.22%), change of ST-T in 37 cases(82.22%),low tension of QRS in 16 cases (35.56%). 47 cases had thoracic roentgenoscopy. There were 47 cases with cardiac dilatation,40 cases(85.11%)with moderate and severe cardiac dilatation among them.Attenuated heart beat was detected in 23 cases(48.94%),pulmonary congestion in 8 cases.49 cases had UCG, RV(15.90±5.65)mm,LVDD(51.65±8.90)mm,LVSD(42.53±23.46)mm,LA (28.94±5.53)mm,EF (37.18±10.71)%,MV(0.93±0.23)m/s among them.The thickness of posterior left ventricle and interventricular septum was thinningzed in 30 cases(61.22%)and the amplitude of motion was degraded in 27 cases(55.10%).Mitral regurgitation was detected in 30 cases(61.22%), tricuspid regurgitation in 19 cases(38.78%),pulmonic regurgitation in 4 cases, aortic regurgitatioin in 1 cases.Debouch of mitral valve was shrinked in 2 cases(4.08%).(3)There were 23 patients(45.10%)with hypertension,all of which were high diastolic pressure.Compared with the No-HP group,sex, heart function,heart rate,RV,LVDD,LVSD,LA and EF of HP group weren't significantly changed(P>0.05).Before treatment,compared with the No-HP group,MV of HP group was significantly increasted(P<0.05).Compared with the No-HP group,mitral regurgitation of HP group was significantly increasted and aggravated(P<0.05).(4)In this group,many patients were treated by inotropic agent,diuretic,ACEI,drugs which preserve cardiac muscle and so on.27 patients were takenβ-blocker based on above treatment.51 cases were divided into 2 groups:patients takenβ-blocker (treatment group)(n=27)and patients no takenβ-blocker(control group) (n=24).Compared with control group,the heart rate,RV,LVDD,LVSD,LA, MV and EF of treatment group weren't significantly changed before treatment(P>0.05).The heart rate,RV,LVDD,LVSD,LA,MV and EF of control group weren't significantly changed after treatment(P>0.05).The heart rate and LA of treatment group were significantly decreased after treatment(P<0.05)and RV,LVDD,LVSD,MV and EF of treatment group weren't significantly changed after treatment(P>0.05).Compared with control group,heart function of treatment group was significantly improved after treatment(P<0.05).Based on takenβ-blocker,compared with the No-HP group,heart function of HP group was significantly improved after treatment(P<0.05),but the heart rate,RV,LVDD,LVSD,LA and EF of HP group weren't significantly changed after treatment(P>0.05).Conclusion:(1)The genetics and virus infection may contribute to the pathogen of DCM in children.(2)DCM in children often occurs in infancy, pre-school age and shool age,with insidious onset and slow progress.Its main clinical manifestation is progressive and chronic congestive heart failure,but there isn't specific at its early stages.Many patients begin with respiratory infections.So,we must pay more attention to cardiac work up,such as ECG,X-ray and UCG at its early stages so as to early diagnosis and promptly therapy.(3)In children with DCM,the myocardial enzymes and troponin I show myocardial damage in some patients,ECG often show many kinds of arhythmias,changes of ST-T,and left ventricular hypertrophy, thoracic roentgenoscopy often show cardiac dilatation,attenuated heart beat and pulmonary congestion,UCG show cardiac dilatation,thin posterior left ventricle and interventricular septum with amplitude of motion degraded, EF decreased,debouch of mitral valve shrinked and many kinds of valvular regurgitation.(4)DCM in children often complicate with hypertension,many of which complicate with high diastolic pressure.It may contribute to a rise in MV and mitral regurgitation.(5)The children with DCM can takeβ-blocker,which may improve heart function,decrease heart rate,reduce chambers of heart.The efficacy ofβ-blocker may be better against DCM with hypertension in children.