Transcripts
DR. CORNEL:
I think hypertension is the
thing I would worry about most in the long term
for these patients. It's so common and
hypertension is there for a lifetime. If it is
not controlled it will cause cardiac problems.
We really have no idea what has
happened to cardiac muscle in any surviving
patient. I could find no reports of biopsy
being done except one very unusual case from
Toronto. That case showed evidence of a dilated
cardiomyopathy that started late after the
Hemolytic Uremic Syndrome. I don't know what
relevance or meaning that has for other patients
but we cannot rule out the possibility that
there is lasting myocardial injury from
multifocal vascular injury from the TMA.
I would think it highly
surprising if there were not such an injury in
most of these children.
We also do not know if the
verotoxin causes a myocarditis more directly.
There's nothing that I could find in the
literature to help with that.
Even having said that there are
all these concerns the cardiac prognosis for
these children should be very good. But they
all should be followed by cardiologists from time
to time, I think, or at least that somebody
should think about their heart.
A problem with these children as
with many of the complex conditions, including
congenital hearts, is that they get followed by
sub, sub, subspecialists, and nobody looks at the
child. I am sure the nephrologists that are
here are exceptions to that, of course. It is
easy to look at the kidney and say the kidney's
doing great or the brain or the heart or the
left leg or whatever but nobody finds out how
the kid is doing. And I think it's of serious
concern.
