[Cardiogenic shock revealing heart disease in infancy and childhood: a Lebanese multicentric study]

Diagnosis, initial workup and immediate prognosis in congenital or acquired heart diseases revealed by cardiogenic shock (CS) in a Lebanese paediatric multicentric study.

During a six-year period (1st January 1999 to 31 December 2004), 56 paediatric patients aged between 0 and 7 years have been admitted to the emergency departments or neonatal and intensive care units in ten different Lebanese hospitals, for high degree of CS suspicion with underlying cardiac disease. All diagnoses were confirmed by echocardiography.

All children were initially in a critical condition with signs of CS. Congenital heart diseases (CHD), specially left obstructive diseases (coarctation of the aorta, critical aortic stenosis, hypoplastic left heart syndrome) were the main etiologies found in newborns, followed by dilated cardiomyopathies in infants and children. Mortality was higher in the following two groups of patients: intubation, no diuresis after the first hour of admission despite therapeutic measures (prostaglandines in newborns, dopamine, dobutamine and furosemide). Beside those pathologies necessitating specific treatment, all the CHD (excluding hypoplastic left heart syndrome, one case of critical aortic coarctation and one case of congenital mitral regurgitation) were transferred to the catheterization laboratory or to surgery in a good hemodynamic condition.

CS remains a notable medical problem observed in the emergency and paediatric intensive care units in Lebanon. Immediate prognosis is related to: immediate recognition of the CS, nature of the cardiopathy and initial response to therapeutic procedures such as rapid improvement of respiratory status and rapid diuresis. Echocardiography is a reliable, quick and non-invasive procedure for initial diagnosis.