ABSTRACT
RESUMO Os gêmeos unidos são formados nos estágios iniciais da gestação. A varidade parapagos dicefálicos costumam apresentar corações fundidos com arco aórtico, transposição de grandes vasos e ausência de baço e situs inversus. Assim, é importante o diagnóstico precoce dessa condição, pois ela se relaciona diretamente com o prognóstico. Nesse relato, tem-se uma paciente primigesta, em que através de Ultrassonografia foi diagnosticada gestação bigemelar imperfeita, havendo divisão incompleta dos embriões ao nível do tórax, sendo percebidas duas cabeças e duas colunas cervicais e torácicas, ligadas a um corpo único, composto por uma pelve, duas pernas e dois braços (parapagos dicefálicos), com movimentação e atividade cardíaca presentes. Diante disso, foi realizada conduta expectante, até que com o aumento do sangramento e cólica a paciente foi até o hospital, onde foi feita macroindução e posterior curetagem pós-abortamento. Assim, com o desenvolvimento da ultrassonografia foi que esse diagnóstico passou a ser possível, facilitando a escolha da via de parto e planejamento cirúrgico. PALAVRAS-CHAVE: Gêmeos, gêmeos unidos, diagnóstico pré-natal
ABSTRACT United twins are formed in the early stages of pregnancy. The dicephalic parapagus variety usually presents fused hearts with aortic arch, transposition of large vessels and absence of spleen and situs inversus. Thus, an early diagnosis of this condition is important, as it is directly related to the prognosis. In this report there is a primigravid patient, in whom an imperfect twin pregnancy was diagnosed through ultrasonography, with incomplete division of the embryos at the level of the thorax, with two heads and two cervical and thoracic columns, connected to a single body, consisting of a pelvis, two legs and two arms (dicephalic parapagus), with movement and cardiac activity present. Therefore, an expectant management was performed, up until the patient went to the hospital with increased bleeding and colic, when labor induction and subsequent post-abortion curettage were performed. Thus, with the development of ultrasonography, this diagnosis became possible, facilitating the choice of the mode of delivery and surgical planning. KEYWORDS: Twins, united twins, prenatal diagnosis
Subject(s)
Humans , Pregnancy , Prenatal Diagnosis , Twins , Twins, ConjoinedABSTRACT
BACKGROUND: The level of Galectin-3 (Gal-3) protein purportedly reflects an ongoing cardiac fibrotic process and has been associated with ventricular remodeling, which is instrumental in the development of heart failure with preserved ejection fraction (HFpEF) syndrome. The aim of this study was to investigate the potential use of Gal-3 in improved characterization of the grades of diastolic dysfunction as defined by echocardiography. METHODS: Seventy HFpEF patients undergoing routine echocardiography were prospectively enrolled in the present monocentric study. Blood samples for measurements of Gal-3 and amino-terminal pro-brain natriuretic peptide (NT-proBNP) were collected within 24 hours pre- or post-echocardiographic examination. The classification of patients into subgroups based on diastolic dysfunction grade permitted detailed statistical analyses of the derived data. RESULTS: The Gal-3 serum levels of all patients corresponded to echocardiographic indices, suggesting HFpEF (E/A, P=0.03 and E/E', P=0.02). Gal-3 was also associated with progressive diastolic dysfunction, and increased levels corresponded to the course of disease (P=0.012). Detailed analyses of ROC curves suggested that Gal-3 levels could discriminate patients with grade III diastolic dysfunction (area under the curve [AUC]=0.770, P=0.005). CONCLUSIONS: Gal-3 demonstrates remarkable effectiveness in the diagnosis of patients suffering from severe grade diastolic dysfunction. Increasing levels of Gal-3 possibly reflect the progressive course of HFpEF, as classified by the echocardiographic grades of diastolic dysfunction.