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Cardiac evaluation in children with hemangiomas
İlkay Erdoğan1, Faik Sarıalioğlu2
1Department of Pediatric Cardiology, Başkent University Faculty of Medicine, Ankara, Turkey. ilkayoerdogan@hotmail.com.
Insights
Pediatric hemangioma patients treated with propranolol showed no cardiac contraindications or side effects. Pretreatment cardiac evaluations are recommended, as cardiac defects are more common in this population.
Area of Science:
- Pediatric Cardiology
- Dermatology
- Pharmacology
Background:
- Hemangiomas are common pediatric tumors often treated with propranolol.
- Standardized cardiac function evaluation before propranolol treatment is lacking.
- This study addresses the need for pretreatment cardiac assessment in pediatric hemangioma patients.
Purpose of the Study:
- To evaluate cardiac function in pediatric hemangioma patients before propranolol treatment.
- To assess the effects of propranolol on vital signs in these patients.
- To identify potential cardiac contraindications for propranolol therapy.
Main Methods:
- Specialized pediatric oncology and cardiology specialists performed all examinations.
- Cardiac evaluation included comprehensive echocardiography and electrocardiography.
- 146 pediatric patients (4 days to 10 years) were screened between September 2009 and January 2014.
Main Results:
- No patient exhibited cardiac contraindications to propranolol.
- Left ventricle dilatation was observed in only 3 patients.
- 68 patients had abnormal echocardiograms, revealing various cardiac anatomic defects, more common than in the general population.
Conclusions:
- Propranolol can be safely administered to pediatric hemangioma patients, including infants, without significant cardiac side effects.
- Large dermal hemangiomas did not impact ventricular size in the studied pediatric population.
- Routine cardiac screening is advisable for pediatric hemangioma patients prior to propranolol therapy.
Objective:
Hemangiomas are tumors most commonly encountered in pediatric patients, and are frequently treated with propranolol. However, there are currently no standard methods for evaluating cardiac function in patients prior to propranolol treatment. The present study was designed to aid in the evaluation of pretreatment cardiac and effects of propranolol on vital signs in pediatric hemangioma patients.
Methods:
A pediatric oncology specialist and a pediatric cardiology specialist examined all patients prior to initiation of propranolol treatment. All patients were examined by the same 2 physicians. Cardiac evaluation included complete echocardiogram and electrocardiography. From September 2009 to January 2014, 146 patients aged 4 days to 10 years were screened.
Results:
No patient had cardiac contraindication to propranolol. The effect of hemangioma on left ventricle size was examined, but left ventricle dilatation was found in only 3 patients. However, 68 patients had abnormal echocardiogram: 17 had patent foramen ovale, 4 had ventricular septal defect, 9 had atrial septal defect (associated with right heart enlargement), 8 had patent ductus arteriosus, 6 had physiologic pulmonary stenosis, and 1 had an aortic coarctation. No contraindications to propranolol or side effects were observed. However, cardiac anatomic defects were more common in this patient group than in the general population.
Conclusion:
Hemangiomas in infants or children, even in small or premature infants, can be treated with propranolol without significant cardiac side effects. In addition, large dermal hemangiomas were not found to affect ventricular size in pediatric patients.
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