Chest
Volume 96, Issue 2, August 1989, Pages 406-413
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Conduction System in Children with Acquired Immunodeficiency Syndrome

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Six children died of acquired immunodeficiency syndrome (AIDS), four of them females, ages 7 months, 13 months, 2 years 8 months, and 4 years; and two of them males, aged 2½ and 7 years. They were born to IV drug-addicted parents. The conduction system (CS) and the entire heart were studied by serial section. In all cases the heart was hypertrophied and enlarged; one had total thrombotic occlusion of the right coronary artery with extensive infarction of the ventricular septum. Vascular changes also were found in all hearts, involving small arteries, arterioles, and venules. In the arteries, they involved the intima, media, and adventitia, and perivascular areas in a degenerative and inflammatory process. The elastic tissue was especially affected. A nonspecific myocarditis was present in four cases and epicarditis in all. Changes in the summit of the ventricular septum were present in four cases, consisting of increased fibrosis and arteriolosclerosis. The CS changes varied in location, showing either vasculitis, myocarditis, or fragmentation of the bundle with lobulation and fibrosis. The changes in the conduction system were not as severe as the changes in the surrounding myocardium. In one case the ECG was abnormal, showing left hemiblock. This corresponded to the finding of fibrosis, vacuolization of cells, and space formation in the left bundle branch. (Chest 1989; 96.-406–13)

Section snippets

MATERIALS AND METHODS

All six children were diagnosed to have AIDS and treated at Children's Hospital, Newark, NJ, where they died. There were four females and two males, and the ages ranged from seven months to seven years. All children were born to IV drug-addicted mothers and/or fathers, and some of the parents had AIDS and died of this disease. Antibody titers against human immunodeficiency virus (HIV) were measured by an enzyme-linked immunosorbent assay and confirmed by Western blot techniques. Each case

FINDINGS*

The findings in the conduction system and the entire heart are given in Table 2, Table 3.

The term myocarditis, as used in this article, implies an infiltration of mononuclear cells, with or without necrosis of the myocytes. This agrees with the terminology of Roldan et al.19 It does not agree with the terminology of Reilly et al,23 Anderson et al,24 and Baroldi et al,25 who follow Aretz et al31 in calling a condition myocarditis only when, in addition to the infiltration of inflammatory cells,

DISCUSSION

The pathologic findings in the cases of AIDS in adults12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 (with the exception of the heart) are (a) meningitis, (b) encephalitis, (c) pneumonitis, (d) lymphoid depletion, (e) esophagitis, (f) oral pathology, (g) herpes simplex, (h) Kaposi's sarcoma, and (i) malignant lymphoma. The organisms involved in the secondary causation of these entities are Pneumocystis, Toxoplasma, Cytomegalovirus, Cryptococcus, Aspergillus, Nocardia, Candida,

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    Aided by grant HL 30558-06 from the National Institutes of Health, National Heart Lung and Blood Institute, Bethesda, MD.

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