ABSTRACT
O termo disfunção endotelial tem sido usado para descrevervárias alterações fisiopatológicas que ocorrem no endotéliovascular, alterações estas que estão associadas a muitas doenças.Muito enfoque foi dado a essas alterações e sua associação asdoenças cardiovasculares, em especial as coronariopatias. Naúltima década, várias pesquisas correlacionaram a disfunçãoendotelial às cardiopatias congênitas. No Brasil, as cardiopatiascongênitas apresentam elevada prevalência, sendo responsáveispor morbimortalidade importante, principalmente em menoresde 5 anos de idade. Estas cardiopatias congênitas relacionam-sea um perfil de alterações endoteliais próprias, causadas tantopela hipóxia como por situações de hiperfluxo pulmonar. Essasalterações endoteliais predispõem esses pacientes a fenômenostrombóticos, hemorrágicos, inflamatórios, entre outros, cujoreconhecimento é fundamental para a estratificação de riscoe para a terapêutica clínica e/ou cirúrgica. O objetivo dopresente artigo é descrever as alterações na função endotelialque ocorrem nos pacientes com cardiopatias congênitas,submetidos ou não a intervenções cirúrgicas, à luz daliteratura vigente, e também relatar os alvos terapêuticosque se tornaram relevantes na última década devido aoreconhecimento de processos endotélio-dependentes, como éo caso, principalmente, do tratamento da hipertensão pulmonarnos pacientes com cardiopatias congênitas...
The term endothelial dysfunction has been used to referto several pathological conditions, including alteredanticoagulant and anti-inflammatory properties of theendothelium, impaired modulations of vascular growthand dysregulation of vascular remodeling. Most attentionhas been gi ven to the relationship between endothelialdysfunction and coronary disease, but in the past decadethere was an increase interest in investigations relating theassociation between congenitaJ heart diseases and endothelialdysfunction. There is a high prevalence of congenital heartdisease in Brazil, which is responsible for high morbidityand mortality, mainly in under 5-year-old children. Theyare related to a complex profile of endothelial dysfunctionthat lead to thrombotic, hemorrhagic and infiammatoryevents and other alterations related to congenital cyanoticand non-cyanotic heart diseases, in children undergoing tosurgical procedures or not. The purpose of this chapter isto discuss the role played by the endothelial dysfunction inchildren with congenital heart disease and its impact on thesignaling pathways that regulate vasodilation and vascularremodeling, looking for new therapeutic targets, withspecial attention to the advances reached in the treatmentof pulmonary hypertensionDescriptors: congenital heart...
Subject(s)
Humans , Infant , Heart Defects, Congenital/surgery , Heart Defects, Congenital/therapy , Endothelium/physiopathology , Hypertension, Pulmonary/complications , Nitric Oxide/metabolism , Protein CABSTRACT
No período de outubro de 2002 a maio de 2003, 16 pacientes foram submetidos a estudo prospectivo, sendo onze do sexo feminino e cinco masculino, idade média foi de 15,06+- 7,40 meses, portadores de cardiopatia congênita acianogênica com hiperfluxo pulmonar./From October 2002 to May 2003, 16 patients submitted to total repair of congenital heart diseases acianogenic and with high pulmonary flow, mean age of 15 months, were submitted to pre and postoperative computed tomography...
Subject(s)
Humans , Male , Female , Infant , Child , Heart Defects, Congenital/surgery , Extracorporeal Circulation/methods , Positive-Pressure Respiration/methods , Infant , Image Interpretation, Computer-Assisted/methods , Prospective Studies , Tomography, X-Ray Computed/methodsABSTRACT
The Heart Institute of the University of Säo Paulo, Medical School is a referral center for the treatment of congenital heart diseases of neonates and infants. In the recent years, the excellent surgical results obtained in our institution may be in part due to modern anesthetic care and to postoperative care based on well-structured protocols. The purpose of this article is to review unique aspects of neonate cardiovascular physiology, the impact of extracorporeal circulation on postoperative evolution, and the prescription for pharmacological support of acute cardiac dysfunction based on our cardiac unit protocols. The main causes of low cardiac output after surgical correction of heart congenital disease are reviewed, and methods of treatment and support are proposed as derived from the relevant literature and our protocols