Estudo das alterações cardíacas em crianças com SIDA em relação à terapêutica com anti-retrovirais. Estudo prospectivo de 47 casos / Study of the cardiac alterations in HIV-infected children consequent to the antiretroviral therapy. Prospective study of 47 cases

OBJECTIVE: Detect of cardiac alterations in children with AIDS and compare their evolution with the administration of only one anti-retroviral and the recent cases who received drugs in combination. METHODS: We prospectively studied 47 children in 3 groups: group 1, 20 cases treated only with zidovudine; group 2, 10 patients treated initially with zidovudine and later with a combination of drugs and in group 3, 17 patients, who receiced two or three since the beginning. In all patients it was done chest X-ray, EKG and echocardiography every 6 months and after death complete pathological study. RESULTS: Among the 45 patients cases 26 (57 percent) were index cases. Malnutrition, diarrhea tachycardia, signs of congestive heart failure, pericardial effusion, abnormal ventricular repolarization and arrhythmias were more frequent in group 1. Echocardiographic abnormalities were present in 10 (50 percent) children of group 1. They were less frequent in the others two groups. In regard to the outcome in group 1, two patients had worsening of sings of cardiomyopaty and 4 died. Cardiac dysfunction in all cases of group 2 and 3 improved with the medication. CONCLUSION:- The children who received combination and their cardiac alterations had more favorable outcome than those who received only one drug

Cardite reumática tratada com altas doses de metilprednisolona venosa (pulsoterapia): resultados em 70 crianças durante 12 anos / Rheumatic carditis treated with high doses of pulsetherapy methylprednisolone: results in 70 children over 12 years

Purpose - To report the result of patients treated with IV methylprednisolone divided into three groups and compare their follow-up during the last 12 years. Methods - Seventy children with active rheumatic carditis (76 episodes) in heart failure Class III and IV (NYHA) were studied. The diagnosis was based on modified Jones' criteria. After rulling out infections and stronglyoidiasis, treatment with IV methylprednisolone bolus was started three times a week until the laboratory tests became negative. Patients were divided into 3 groups, according to the time of hospital admittance: Groups 1,2 and 3, comprising of 40, 18 and 12 children, respectively. Results - Eighteen children in Group 1 (45 per cent) were in their 1st attack: 2 series of pulsetherapy were used in 10 (25 per cent), 3 in 9 (23 per cent) and 4 in 21 (52 per cent). In Group 2, 14 cases (77 per cent) were in their 1st attack: 2 series were used in 7 (39 per cent), 4 in 9 (50 per cent) and 5 in 2 (11 per cent). The echocardiogram showed a flail mitral valve in 12 (66 per cent) of these patients (1 death occurred after mitral valvoplasty). In Group 3,6 patients needed 5 or more series of pulsetherapy and a flail mitral valve was present in 5 (41 per cent). One child underwent mitral valve replacement while still in the active phase, after 8 series of pulsetherapy, and another died. The number of patients who needed 5 or more series was significantly higher in Group 3. Conclusion - There were variations in the presentation and evolution of the cases during these 12 year. The established pulsetherapy protocol continues to be useful to treat severe cases.

Asfixia perinatal e problemas Cardíacos / Perinatal asphyxia and heart problems

Objetivo - Avaliar a gravidade das complicações cardíacas na asfixia neonatal, sua evolução e correlacioná-las com o grau e duração do processo hipóxico. Métodos - Foram estudados 90 bebês nos últimos 7 anos com grau de Apgar = 6 no 5§ min de vida. Pelo protocolo, após o exame físico e os cuidados intensivos, eram submetidos a dosagem do pH arterial, CPK-MB, DHL, glicemia, além da realização de radiografia de tórax, eletrocardiograma (ECG), ecocardiograma, seriados e repetidos a cada semana. Aqueles que faleceram eram levados à necropsia. Resultados - Dos 90, 73 (81 por cento) eram prematuros, 30 (41 por cento) eram apropriados para a idade gestacional (AIG) e 43 (59 por cento) eram pequenos (PIG). Em 21 (23 por cento) casos havia pH arterial < 7,2. Os quadros clínicos mais observados foram: pneumonia em 28 (31 por cento), anemia 24 (26 por cento) e icterícia moderada 12 (5 por cento), entre outros. Ao exames físico observaram-se sopro sistólico em 46 (50 por cento), ictus propulsivo 18 (20 por cento) e ICC em 8 (9 por cento). No ECG, os sinais mais freqüentes foram alterações de repolarização (ST e T) em 44 (49 por cento). No ecocardiograma, observou-se persistência do canal arterial (PCA) em 20 (22 por cento), regurgitação tricúspide em 6 (7 por cento), hipertensão pulmonar em 6 (8 por cento), hipocontratilidade de VE e dilatação de VD em 4 (5 por cento). Dos 23 óbitos, 14 foram estudados e as alterações mais freqüentes foram necrose e de fibras em 8 (68 por cento) casos e em 4 (29 por cento) congestão, vacuolização e perda de estriação. Conclusão - A maioria teve evolução favorável mesmo naqueles que tiveram acidemia importante. Muitas alterações de ECG e ecocardiograma se normalizaram. Daqueles que evoluiram para óbito, as lesões mais graves ocorreram nos que sofreram, por mais tempo, processo anóxico.