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Kohli U, Desai L, Chowdhury D, Harahsheh AS, Yonts AB, Ansong A, Sabati A, Nguyen HH, Hussain T, Khan D, Parra DA, Su JA, Patel JK, Ronai C, Bohun M, Freij BJ, O'Connor MJ, Rosanno JW, Gupta A, Salavitabar A, Dorfman AL, Hansen J, Frosch O, Profita EL, Maskatia S, Thacker D, Shrivastava S, Harris TH, Feingold B, Berger S, Campbell M, Idriss SF, Das S, Renno MS, Knecht K, Asaki SY, Patel S, Ashwath R, Shih R, Phillips J, Das B, Ramachandran P, Sagiv E, Bhat AH, Johnson JN, Taggart NW, Imundo J, Nakra N, Behere S, Patel A, Aggarwal A, Aljemmali S, Lang S, Batlivala SP, Forsha DE, Conners GP, Shaw J, Smith FC, Pauliks L, Vettukattil J, Shaffer K, Cheang S, Voleti S, Shenoy R, Komarlu R, Ryan SJ, Snyder C, Bansal N, Sharma M, Robinson JA, Arnold SR, Salvatore CM, Kumar M, Fremed MA, Glickstein JS, Perrotta M, Orr W, Rozema T, Thirumoorthi M, Mullett CJ, Ang JY. mRNA Coronavirus Disease 2019 Vaccine-Associated Myopericarditis in Adolescents: A Survey Study. J Pediatr 2022; 243:208-213.e3. [PMID: 34952008 PMCID: PMC8691954 DOI: 10.1016/j.jpeds.2021.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/21/2021] [Accepted: 12/16/2021] [Indexed: 12/29/2022]
Abstract
In this survey study of institutions across the US, marked variability in evaluation, treatment, and follow-up of adolescents 12 through 18 years of age with mRNA coronavirus disease 2019 (COVID-19) vaccine-associated myopericarditis was noted. Only one adolescent with life-threatening complications was reported, with no deaths at any of the participating institutions.
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Affiliation(s)
- Utkarsh Kohli
- Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University School of Medicine and West Virginia University Medicine Children's Hospital, Morgantown, WV.
| | - Lavina Desai
- Children's Hospital of Michigan, Division of Pediatric Infectious Diseases, Department of Pediatrics, Detroit, MI; Central Michigan University, College of Medicine, Mt Pleasant, MI
| | - Devyani Chowdhury
- Cardiology Care for Children, Nemours Children's Hospital, Wilmington, DE
| | - Ashraf S Harahsheh
- Division of Pediatric Cardiology, Department of Pediatrics, Children's National Hospital, Washington, DC; The George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Alexandra B Yonts
- The George Washington University School of Medicine & Health Sciences, Washington, DC; Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's National Hospital, Washington, DC
| | - Annette Ansong
- Division of Pediatric Cardiology, Department of Pediatrics, Children's National Hospital, Washington, DC; The George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Arash Sabati
- Division of Pediatric Cardiology, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
| | - Hoang H Nguyen
- Department of Pediatrics, Children's Medical Center Dallas, UTSW Medical Center, Dallas, TX
| | - Tarique Hussain
- Department of Pediatrics, Children's Medical Center Dallas, UTSW Medical Center, Dallas, TX
| | - Danyal Khan
- Department of Cardiology, Nicklaus Children's Hospital, Miami, FL
| | - David A Parra
- Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Jr Children's Hospital, Vanderbilt University Medical Center, Nashville, TN
| | - Jennifer A Su
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
| | - Jyoti K Patel
- Division of Pediatric Cardiology, Department of Pediatrics, Riley Children's Hospital, Indianapolis, IN
| | - Christina Ronai
- Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health & Science University Doernbecher Children's Hospital, Portland, OR
| | - Monique Bohun
- Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health & Science University Doernbecher Children's Hospital, Portland, OR
| | - Bishara J Freij
- Beaumont Children's Hospital, Royal Oak, MI; Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Matthew J O'Connor
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Joseph W Rosanno
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Aamisha Gupta
- Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital, University of California San Diego, San Diego, CA
| | - Arash Salavitabar
- Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Adam L Dorfman
- Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Jesse Hansen
- Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Olivia Frosch
- Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Elizabeth L Profita
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, CA
| | - Shiraz Maskatia
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, CA
| | - Deepika Thacker
- Division of Pediatric Cardiology, Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE
| | - Shubhika Shrivastava
- Division of Pediatric Cardiology, Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE
| | - Tyler H Harris
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA
| | - Brian Feingold
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA
| | - Stuart Berger
- Division of Pediatric Cardiology, Department of Pediatrics, Lurie Children's Hospital, Chicago, IL
| | - Michael Campbell
- Division of Pediatric Cardiology, Department of Pediatrics, Duke Children's Hospital, Durham, NC
| | - Salim F Idriss
- Division of Pediatric Cardiology, Department of Pediatrics, Duke Children's Hospital, Durham, NC
| | - Srikant Das
- Division of Pediatric Cardiology, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR
| | - Markus S Renno
- Division of Pediatric Cardiology, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR
| | - Ken Knecht
- Division of Pediatric Cardiology, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR
| | - S Yukiko Asaki
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah/Primary Children's Hospital, Salt Lake City, UT
| | - Sunil Patel
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC), Harrisburg, Harrisburg, PA
| | - Ravi Ashwath
- Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA
| | - Renata Shih
- Division of Pediatric Cardiology, Department of Pediatrics, University of Florida, Gainesville, Gainesville, FL
| | - John Phillips
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, VA
| | - Bibhuti Das
- Department of Pediatrics, Children's of Mississippi Heart Center, University of Mississippi Medical Center, Jackson, MS
| | - Preeti Ramachandran
- Division of Pediatric Cardiology, Department of Pediatrics, Kentucky Children's Hospital, Lexington, KY; University of Kentucky College of Medicine, Lexington, KY
| | - Eyal Sagiv
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA
| | - Aarti H Bhat
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA
| | - Jonathan N Johnson
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic Children's Center, Rochester, MN
| | - Nathaniel W Taggart
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic Children's Center, Rochester, MN
| | - Jason Imundo
- Division of Pediatric Cardiology, Department of Pediatric, Penn State Health Children's Hospital, Hershey, PA
| | - Natasha Nakra
- Division of Pediatric Infectious Diseases, Department of Pediatrics, UC Davis Children's Hospital, Sacramento, CA
| | - Shashank Behere
- Division of Pediatric Cardiology, Department of Pediatrics, Oklahoma Children's Hospital, Oklahoma City, OK
| | - Anjlee Patel
- Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University School of Medicine and CAMC Women's and Children's Hospital, Charleston, WV
| | - Avichal Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, Houston, TX
| | - Saif Aljemmali
- Division of Pediatric Cardiology, Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - Sean Lang
- Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Sarosh P Batlivala
- Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Daniel E Forsha
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO
| | - Gregory P Conners
- Division of Pediatric Cardiology and Pediatric Infectious Diseases, Department of Pediatrics, Upstate Golisano Children's Hospital, Syracuse, NY
| | - Jana Shaw
- Division of Pediatric Cardiology and Pediatric Infectious Diseases, Department of Pediatrics, Upstate Golisano Children's Hospital, Syracuse, NY
| | - Frank C Smith
- Division of Pediatric Cardiology and Pediatric Infectious Diseases, Department of Pediatrics, Upstate Golisano Children's Hospital, Syracuse, NY
| | - Linda Pauliks
- Division of Pediatric Cardiology, Department of Pediatrics, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Joseph Vettukattil
- Division of Pediatric Cardiology, Department of Pediatrics, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Kenneth Shaffer
- Division of Pediatric Cardiology, Department of Pediatrics, Dell Children's Medical Center, Austin, TX
| | - Stefanie Cheang
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of New Orleans, New Orleans, LA
| | - Sonia Voleti
- Division of Pediatric Cardiology, Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA
| | - Rajesh Shenoy
- Division of Pediatric Cardiology, Department of Pediatrics, Jack and Lucy Clark Department of Pediatrics at the Icahn School of Medicine at Mount Sinai Children's Hospital, New York, NY
| | - Rukmini Komarlu
- Division of Pediatric Cardiology, Department of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OH
| | - Shea J Ryan
- Division of Pediatric Cardiology, Department of Pediatrics, UNC Children's Hospital, Chapel Hill, NC
| | - Christopher Snyder
- Division of Pediatric Cardiology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Neha Bansal
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY
| | - Madhu Sharma
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY
| | - Jeffrey A Robinson
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, NE
| | - Sandra R Arnold
- Division of Infectious Diseases, Department of Pediatrics, Le Bonheur Children's Hospital, Memphis, TN
| | - Christine M Salvatore
- Division of Infectious Diseases, Department of Pediatrics, Weill Cornell Medical Center, New York, NY
| | - Madan Kumar
- Division of Infectious Diseases, Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, IL
| | - Michael A Fremed
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Julie S Glickstein
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Melissa Perrotta
- Division of Pediatric Cardiology, Department of Pediatrics, Norton Children's Hospital, Louisville, KY
| | - William Orr
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, MO
| | - Tamika Rozema
- Division of Pediatric Cardiology, Department of Pediatrics, Lutheran Hospital, Fort Wayne, IN
| | - Muthayipalayam Thirumoorthi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Ascension St John Hospital, Detroit, MI
| | - Charles J Mullett
- Division of Pediatric Critical Care, Department of Pediatrics, West Virginia University School of Medicine and West Virginia University Medicine Children's Hospital, Morgantown, WV
| | - Jocelyn Y Ang
- Children's Hospital of Michigan, Division of Pediatric Infectious Diseases, Department of Pediatrics, Detroit, MI; Central Michigan University, College of Medicine, Mt Pleasant, MI
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Voleti S, Adelbai M, Hovis I, Colyer J, Burns KM, Lewis EO, Arurang JK, Kikuharu A, Gonzales M, Pedro SJ, Zimmerman M, Krishnan A, Beaton A, Sable C, Dougherty S. Novel handheld ultrasound technology to enhance non-expert screening for rheumatic heart disease in the Republic of Palau: A descriptive study. J Paediatr Child Health 2021; 57:1089-1095. [PMID: 33624369 DOI: 10.1111/jpc.15409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/19/2021] [Accepted: 02/03/2021] [Indexed: 11/26/2022]
Abstract
AIM Non-expert training in rheumatic heart disease (RHD) detection is a valuable strategy in resource-limited settings. Here we present an innovative handheld ultrasound application featuring views of correct probe position, imaging protocol and echocardiographic loops of RHD pathology versus normal, accessible during real-time scanning. METHODS This prospective study was implemented into a pre-existing school health screening programme at an elementary school in Koror, Palau. Six learners with no prior ultrasound experience were taught a simplified screening protocol in which a mitral regurgitation jet ≥1.5 cm and/or presence of aortic insufficiency were considered a positive screen. All consented children underwent echocardiographic screening by experts with standard portable echocardiography. All positive cases and 25% of negative cases were referred for handheld scans by learners. RESULTS A total of 26 (4.1%) children were diagnosed with borderline or definite RHD. Mean sensitivity and specificity compared to expert RHD diagnosis over all learners was 71% (standard deviation (SD) 11.3) and 92% (SD 4.9), respectively. For the three highest scanning learners, mean sensitivity was 88% (SD 4.9) and mean specificity was 90% (SD 5.7). For all definite RHD cases, sensitivity was 100% for all but one learner, who achieved sensitivity of 60%. The novel application was used in 229 of 624 (36%) of all handheld scans and 50 of 112 (45%) of expert-diagnosed positive scans, with protocol and reference features most frequently used. Utilisation of the novel application overall decreased per day of scanning per learner. CONCLUSION Adjunctive handheld ultrasound technology may help ease non-experts into RHD screening.
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Affiliation(s)
- Sonia Voleti
- Division of Pediatric Cardiology, Loma Linda University Children's Hospital, Loma Linda, California, United States
| | - Myra Adelbai
- Division of Internal Medicine, Belau National Hospital and Ministry of Health, Koror, Republic of Palau
| | - Ian Hovis
- Division of Pediatric Cardiology, Children's National Hospital, Washington, DC, United States
| | - Jessica Colyer
- Division of Pediatric Cardiology, Children's National Hospital, Washington, DC, United States
| | - Kristin M Burns
- Division of Pediatric Cardiology, Children's National Hospital, Washington, DC, United States
| | - Elway Olkeriil Lewis
- Division of Internal Medicine, Belau National Hospital and Ministry of Health, Koror, Republic of Palau
| | - Jason Kalei Arurang
- Division of Internal Medicine, Belau National Hospital and Ministry of Health, Koror, Republic of Palau
| | - Allyne Kikuharu
- Division of Internal Medicine, Belau National Hospital and Ministry of Health, Koror, Republic of Palau
| | - Maanne Gonzales
- Division of Internal Medicine, Belau National Hospital and Ministry of Health, Koror, Republic of Palau
| | - Sheila Judy Pedro
- Division of Internal Medicine, Belau National Hospital and Ministry of Health, Koror, Republic of Palau
| | - Meghan Zimmerman
- Division of Pediatric Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Anita Krishnan
- Division of Pediatric Cardiology, Children's National Hospital, Washington, DC, United States
| | - Andrea Beaton
- Division of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Craig Sable
- Division of Pediatric Cardiology, Children's National Hospital, Washington, DC, United States
| | - Scott Dougherty
- Division of Internal Medicine, Belau National Hospital and Ministry of Health, Koror, Republic of Palau
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Voleti S, Okello E, Murali M, Sarnacki R, Majwala A, Ssembatya R, Bakka O, Namisanvu H, Njeri A, Matovu A, DeStigter K, Sable C, Beaton A. The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study. BMC Pregnancy Childbirth 2020; 20:611. [PMID: 33036571 PMCID: PMC7547429 DOI: 10.1186/s12884-020-03189-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/19/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pre-existing maternal cardiac disease is a significant contributor to adverse maternal, fetal, and neonatal outcomes. In 2015-2017, our team conducted the first community-based study of maternal rheumatic heart disease (RHD) in sub-Saharan Africa and identified RHD in 88% of those with pre-existing heart disease. Here we conducted a follow up investigation of women previously identified with RHD, describing clinical and echocardiographic outcomes, identifying barriers to medical adherence and evaluating the personal impact of RHD. METHODS A 2 week prospective follow up was completed at sites in Central and Eastern Uganda. Participants underwent a three-step mixed methods study comprising of 1) direct structured interview targeting clinical history and medication adherence, 2) echocardiogram to evaluate left-sided heart valves, and 3) semi-structured guideline interview to elicit personal impacts of RHD. RESULTS The team evaluated 40 (80%) of the original 51 mothers with RHD at a median post-partum time of 2.5 years after delivery (IQR 0.5). Echocardiographic data showed improvement in nine women with the remaining 31 women showing stable echocardiographic findings. Adherence to Benzathine penicillin G (BPG) prophylaxis was poor, with 70% of patients either poorly adherent or non-adherent. Three major themes emerged from interviews: 1) social determinants of health (World Health Organization, Social determinants of health, 2019) negatively affecting healthcare, 2) RHD diagnosis negatively affecting female societal wellbeing, 3) central role of spouse in medical decision making. CONCLUSIONS Screening echocardiography can identify women with pre-existing rheumatic heart disease during pregnancy, but long-term follow-up in Uganda reveals adherence to medical care following diagnosis, including BPG, is poor. Additionally, mothers diagnosed with RHD may experience unintended consequences such as social stigmatization. As identification of occult RHD is critical to prevent adverse pregnancy outcomes, further research is needed to determine how to best support women who face a new diagnosis of RHD, and to determine the role of screening echocardiography in high-risk settings.
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Affiliation(s)
- Sonia Voleti
- Department of Cardiology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
| | - Emmy Okello
- The Uganda Heart Institute, Ward 1 C, Mulago Hospital Complex, Kampala, Uganda
| | - Meghna Murali
- Department of Cardiology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Rachel Sarnacki
- Department of Cardiology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Albert Majwala
- The Uganda Heart Institute, Ward 1 C, Mulago Hospital Complex, Kampala, Uganda
| | - Renny Ssembatya
- Imaging the World Africa, Naayla-Namugongo Rd, Naayla, Uganda
| | - Olivia Bakka
- Imaging the World Africa, Naayla-Namugongo Rd, Naayla, Uganda
| | | | - Angela Njeri
- Imaging the World Africa, Naayla-Namugongo Rd, Naayla, Uganda
| | | | - Kristen DeStigter
- University of Vermont Medical Center, 111 Colchester Avenue, Burlington, VT, USA
| | - Craig Sable
- Department of Cardiology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Andrea Beaton
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, USA.,The University of Cincinnati School of Medicine, Cincinnati, OH, USA
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