Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 162
Filter
1.
Arch. pediatr. Urug ; 92(2): e211, dic. 2021. tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1278304

ABSTRACT

Introducción: las cardiopatías congénitas (CC) son patologías frecuentes en pediatría. Son causa de importante morbimortalidad en la infancia. Son pacientes complejos, que requieren abordaje integral, en equipo interdisciplinario. Objetivos: describir las características epidemiológicas, clínicas y evolutivas de niños portadores de CC asistidos en la Unidad de Cardiología del HP-CHPR durante el año 2015, así como su estado nutricional y los factores que pudieran influir en este. Material y método: estudio descriptivo, retrospectivo, a través de la revisión de historias clínicas de pacientes portadores de CC, hospitalizados en la Unidad de Cardiología del HP-CHPR en 2015. Se describieron características epidemiológicas y clínicas de los pacientes. Resultados: en el período evaluado egresaron 63 pacientes, que representaron una tasa de 6,58/1.000 egresos hospitalarios. Tenían un promedio de edad de 23,8 meses. Un total de 8 pacientes fueron diagnosticados en el período prenatal, 54 presentaban CC no cianóticas. Habían sido sometidos a tratamiento quirúrgico 24 niños, 13 con cirugía correctiva. Se diagnosticó desnutrición en 43%. Esta fue más prevalente en portadores de CC cianótica, de defectos complejos, y de cromosomopatías u otras malformaciones. Conclusión: los niños con CC representaron un pequeño porcentaje de quienes requirieron hospitalización en el HP-CHPR. El porcentaje de desnutrición fue elevado. Este estudio confirma la importante morbimortalidad de los niños pequeños portadores de CC. Es importante reconocer el mayor riesgo de estos pacientes y actuar en forma individualizada y oportuna.


Introduction: congenital heart disease (CHD) is a frequent pathology among children. It may cause significant morbidity and mortality during childhood. These are complex patients, who require a comprehensive approach and an interdisciplinary team. Objective: to describe the epidemiological, clinical and evolutionary characteristics of children with CHD assisted in the Cardiology Department of the Children Hospital-CHPR in 2015. Material and Methods: descriptive, retrospective study, review of clinical records of patients with CHD, hospitalized in the Cardiology Department of the Children's Hospital PRHC in 2015. Epidemiological and clinical characteristics of patients were described. Results: 63 patients were hospitalized during the evaluated period, a total rate of 6.58/1.000 discharges. They had an average age of 23.8 months. Eight patients were diagnosed in the prenatal period, 54 presented non-cyanotic CHD. Twenty-four children had undergone surgical treatment, 13 had had corrective surgery. Malnutrition was diagnosed in 43% and it was more prevalent in cyanotic CHD carriers, complex defects, and chromosomopathies or other malformations. Conclusion: CHD represented a small percentage of the children who required hospitalization at the PH-PRHC. The percentage of malnutrition was high. The study confirmed the significant morbidity and mortality of these patients. It is important to recognize the highest risk of these patients and act in a customized and timely fashion.


Introdução: as cardiopatias congênitas (CC) são patologias comuns em pediatria. Elas são uma causa significativa de morbidade e mortalidade na infância. Os pacientes são complexos e requerem uma abordagem integral e uma equipe interdisciplinar. Objetivos: descrever as características epidemiológicas, clínicas e evolutivas de crianças com CC atendidas na Unidade de Cardiologia do Hospital Pediátrico PHPR durante o ano de 2015, descrever seu estado nutricional e os fatores que poderiam influenciá-lo. Material e métodos: estudo descritivo, retrospectivo, feito por meio da revisão de prontuários de pacientes com CC, internados na Unidade de Cardiologia do HP-CHPR em 2015. Foram descritas as características epidemiológicas e clínicas dos pacientes. Resultados: no período avaliado, 63 pacientes receberam alta hospitalar, representando uma taxa de 6,5/1.000 altas hospitalares. Eles tinham uma idade média de 23,8 meses. Oito pacientes foram diagnosticados no período pré-natal, 54 apresentavam CC não cianótica. 24 crianças tinham sido submetidas a tratamento cirúrgico, 13 tinham recebido cirurgia corretiva. 43% foram diagnosticadas com desnutrição, a qual foi mais prevalente em portadores de CC cianótica, defeitos complexos e malformações cromossômicas ou outras. Conclusão: os CCs representaram um pequeno percentual de crianças que necessitaram de internação no HP-CHPR. O percentual de desnutrição foi alto. Este estudo confirma a morbidade e mortalidade significativas de crianças pequenas com CC. É importante reconhecer o risco aumentado desses pacientes e agir de forma individualizada e oportuna.


Subject(s)
Humans , Male , Female , Pregnancy , Infant , Child, Preschool , Child , Adolescent , Malnutrition/complications , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/epidemiology , Hospitalization , Prenatal Diagnosis , Epidemiology, Descriptive , Retrospective Studies , Malnutrition/diagnosis , Malnutrition/epidemiology , Heart Defects, Congenital/surgery , Heart Defects, Congenital/classification
2.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 13: 717-723, jan.-dez. 2021. ilus, tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1178355

ABSTRACT

Objetivo: Analisar características clínico-epidemiológicas de crianças portadoras de cardiopatia congênita residentes do município de Rio das Ostras referenciadas para unidades especializadas no estado do Rio de Janeiro. Método: Pesquisa descritiva, transversal realizada em duas unidades hospitalares no município do Rio de Janeiro, através da técnica documental retrospectiva por meio de dados nos prontuários. A coleta ocorreu entre setembro de 2018 a fevereiro de 2019. Resultados: Foram analisados 48 prontuários, com maior proporção entre os escolares (33,3%); do sexo masculino (58,3%); Em relação as cardiopatias, verificou-se com maior proporção as acianóticas (62,5%); destacando a comunicação interatrial com (14,6%); seguida da comunicação interventricular (12,5%) e coarctação da aorta (12,5%). Conclusão: A identificação dessas crianças no município de Rio das Ostras e a distribuição destas pelo território nacional são informações imprescindíveis para o planejamento e implementação de programas e políticas públicas que atendam as reais demandas deste segmento populacional


Objetivo: Analizar las características clínicas y epidemiológicas de los niños con cardiopatía congénita que viven en la ciudad de Rio das Ostras remitidos a unidades especializadas en el estado de Río de Janeiro. Método: Investigación descriptiva, transversal realizada en dos hospitales de la ciudad de Río de Janeiro, a través de una técnica documental retrospectiva a través de datos en registros médicos. La recolección se realizó entre septiembre de 2018 y febrero de 2019. Resultados: Se analizaron 48 registros médicos, con una mayor proporción entre los estudiantes (33.3%); hombre (58,3%); Con respecto a la enfermedad cardíaca, hubo una mayor proporción de acianóticos (62.5%); destacando la comunicación interauricular con (14,6%); seguido de comunicación interventricular (12.5%) y coartación aórtica (12.5%). Conclusión: La identificación de estos niños en la ciudad de Rio das Ostras y su distribución en todo el territorio nacional son información esencial para la planificación e implementación de programas y políticas públicas que satisfagan las demandas reales de este segmento de la población


Objective: To analyze the clinical and epidemiological characteristics of children with congenital heart disease living in the city of Rio das Ostras referred to specialized units in the state of Rio de Janeiro. Method: Descriptive, cross-sectional research conducted in two hospitals in the city of Rio de Janeiro, through retrospective documentary technique through data in medical records. The collection took place between September 2018 and February 2019. Results: 48 medical records were analyzed, with a higher proportion among students (33.3%); male (58.3%); Regarding heart disease, there was a greater proportion of acyanotic (62.5%); highlighting interatrial communication with (14.6%); followed by interventricular communication (12.5%) and aortic coarctation (12.5%). Conclusion: The identification of these children in the city of Rio das Ostras and their distribution throughout the national territory are essential information for the planning and implementation of programs and public policies that meet the real demands of this population segment


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Young Adult , Health Policy , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/epidemiology , Aortic Coarctation , Heart Septal Defects, Atrial , Heart Septal Defects, Ventricular
3.
Arq. bras. cardiol ; 114(5): 786-792, maio 2020. tab, graf
Article in Portuguese | LILACS, SES-SP | ID: biblio-1131219

ABSTRACT

Resumo Fundamento O conhecimento sobre a própria doença pode ser importante para o autocuidado em pacientes com vários problemas e abrange a informação sobre o diagnóstico até as implicações clínicas mais importantes. Objetivo Identificar o nível de conhecimento de crianças e adolescentes com cardiopatia congênita (CC) sobre a sua doença, e analisar a relação entre o nível de conhecimento e a prática de atividade física. Métodos Estudo transversal com 335 pacientes com CC, de 8 a 13 anos, acompanhados em um serviço de cardiologia pediátrica de referência no Sul do Brasil. Os pacientes foram entrevistados em relação ao seu conhecimento sobre a CC e foi realizada revisão dos prontuários para obtenção de detalhes sobre a cardiopatia e os procedimentos. Foi utilizado o nível de significância p < 0,05. Resultados Mais de 50% das crianças e adolescentes não sabiam referir o nome de sua doença ou explicá-la. Após OR ajustado (ORaj), mostraram potencial para respostas incorretas ou não saber sua doença os pacientes cianóticos em relação aos acianóticos (ORaj: 2,29; IC95%: 1,76-6,71; p=0,019); crianças com menor nível de escolaridade (ORaj: 2,20; IC95%: 1,81-5,86; p=0,025); e não praticantes de atividade física (ORaj: 1,88; IC95%: 1,09-3,45; p=0,011). Conclusão As crianças e adolescentes cianóticos, com menor nível de escolaridade e que não praticavam de atividade física apresentaram pouco conhecimento sobre a sua doença. Há necessidade do desenvolvimento de estratégias de intervenções educativas para aumento do conhecimento e mudança comportamental na promoção da atividade física, de acordo com a complexidade da CC. (Arq Bras Cardiol. 2020; 114(5):786-792)


Abstract Background Knowledge about the disease itself can be important for self-care in patients with several problems and comprehends information about the diagnosis up to the most important clinical implications. Objective To identify the level of knowledge of children and adolescents with congenital heart disease (CHD) about their illness, and to analyze the association between the level of knowledge and the practice of physical activity. Methods Cross-sectional study with 335 patients with CHD, aged 8 to 13 years, followed at a referral pediatric cardiology service in Southern Brazil. Patients were interviewed regarding their knowledge about CHD and a review of medical records was performed to obtain details on heart disease and procedures. A significance level p<0.05 was used. Results More than 50% of the children and adolescents did not know how to say the name of their disease or explain it. After adjusted OR (AOR), cyanotic patients in comparison to acyanotic ones (AOR: 2.29; 95%CI: 1.76-6.71; p = 0.019); children with lower level of schooling (AOR: 2.20; 95%CI: 1.81-5.86; p = 0.025); and those who did not practice physical activity (AOR: 1.88; 95%CI: 1.09-3.45; p = 0.011) showed potential for incorrect answers or did not know their disease. Conclusion Cyanotic children and adolescents, with a lower level of schooling and who did not practice physical activity, had little knowledge about their disease. It is necessary to develop educational intervention strategies to increase knowledge and change behavior in physical activity promotion, according to the CHD complexity. (Arq Bras Cardiol. 2020; 114(5):786-792)


Subject(s)
Humans , Male , Female , Child , Adolescent , Exercise/physiology , Health Knowledge, Attitudes, Practice , Heart Defects, Congenital/epidemiology , Brazil/epidemiology , Cross-Sectional Studies , Heart Defects, Congenital/diagnosis
4.
Rev. pediatr. electrón ; 16(2): 8-12, ago. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1021332

ABSTRACT

La enfermedad cardíaca congénita se ha asociado con alteraciones del neurodesarrollo. Niños y adolescentes con cardiopatía congénita presentan déficits en distintos dominios neurológicos (motor, cognitivo, lenguaje, rendimiento escolar y habilidades sociales). Históricamente se atribuyeron a una potencial injuria cerebral durante la cirugía cardíaca. Sin embargo, evidencia actual demuestra que RN de término ya presentan anormalidades cerebrales y retraso de la maduración (dismaduración) con alta prevalencia 28% (IC 95%, 18-40%) Entre ellas se reporta ventriculomegalia, agenesia cuerpo calloso, hipoplasia de vermis, hemorragia intraventricular, aumento espacio subaracnoídeo, alteraciones de la sustancia blanca (Leucomalacia periventricular), desarrollo cortical alterado y quistes periventriculares. El mecanismo más estudiado es la interferencia de la cardiopatía con el shunt fisiológico de derecha a izquierda por el foramen ovale, que asegura la llegada de la sangre mejor oxigenada primeramente al cerebro. Se discute el beneficio de potenciales intervenciones prenatales neuroprotectoras y el diagnóstico temprano de cardiopatías congénitas.


Congenital heart disease has been associated with neurodevelopmental disorders. Children and adolescents with congenital heart disease present deficits in different neurological domains (motor, cognitive, language, school performance and social skills). Historically they were attributed to a potential brain injury during cardiac surgery. However, current evidence shows that term newborns already present brain abnormalities and delay of maturation (dysmaturation) with high prevalence 28% (95% CI, 18-40%) Among them is reported ventriculomegaly, Corpus Callosum agenesis, hypoplastic vermis, intraventricular hemorrhage, subarachnoid space enlargement, white matter alterations (periventricular leukomalacia), altered cortical development and periventricular cysts. The most studied mechanism is the interference of heart disease with the physiological shunt from right to left by the foramen ovale, which ensures the arrival of the best oxygenated blood first to the brain. The benefit of potential neuroprotective prenatal interventions and early diagnosis of congenital heart diseases is discussed.


Subject(s)
Humans , Female , Pregnancy , Fetal Diseases , Neurodevelopmental Disorders/etiology , Heart Defects, Congenital/complications , Neurodevelopmental Disorders/epidemiology , Heart Defects, Congenital/epidemiology
5.
Med. infant ; 26(2): 117-122, Junio 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1015212

ABSTRACT

Introducción: Las cardiopatías congénitas representan la segunda causa de mortalidad infantil en menores de un año. Objetivo: Describir la epidemiología, resultados y seguimiento de cardiopatías congénitas críticas (pacientes que requirieron intervención quirúrgica o cateterismo intervencionista antes del año de vida). Resultados: Se incluyeron 316 pacientes operados o intervenidos por cateterismo antes del año de vida con diagnóstico de cardiopatías congénitas, de los cuales el 30,7% eran sindromáticos y solo el 7,7% tuvieron diagnóstico prenatal. Se logró cirugía reparadora en un 86,7% de los casos siendo la CIV la cardiopatía congénita operada más frecuente en menores de un año. Los pacientes quedaron con defectos residuales significativos en un 23,73%, con una tasa de complicaciones de 39,64%. En el seguimiento post-operatorio un 19,62% requirieron reoperación, y un 5,06% cateterismo. Un 15,19% de los pacientes fallecieron. Conclusiones: El Hospital Juan P. Garrahan tiene una población numerosa y heterogénea de pacientes con cardiopatías críticas. Dado que solo un pequeño porcentaje de nuestros pacientes tuvieron diagnóstico prenatal, se debe mejo- rar en este aspecto, ya que el diagnóstico de cardiopatía en el período fetal mejora las posibilidades de sobrevida en el neona- to. Es importante el seguimiento multidisciplinario, coordinado y continuo de estos pacientes, dado que muchos niños operados tienen comorbilidades y lesiones residuales (AU)


Introduction: Congenital heart defects are the second leading cause of infant mortality in children under one year of age. Objective: To describe the epidemiology, results, and follow-up of patients with critical congenital heart defects (patients who required surgical intervention or interventional catheterization before the year of life). Results: 316 patients with congenital heart defects who underwent surgery or catheterization before the life year, of whom 30.7% were syndromic and only 7.7% were diagnosed prenatally. Repair surgery could be performed in 86.7% of cases with SVD being the most commonly operated congenital heart defect in children under one year of age. Of the patients, 23.73% had a significant residual defect with a complication rate of 39.64%. In the post-operative follow-up, 19.62% required reoperation and 5.06% catheterization. Overall, 15.19% of the patients died. Conclusions: The Juan P. Garrahan Hospital has a large and heterogeneous population of patients with critical heart disease. Since only a small percentage of our patients had a prenatal diagnosis, this aspect should be enhanced, as the diagnosis of heart disease in uterus improves the chances of survival of the neonate. Multidisciplinary, coordinated and continuous follow-up of these patients is important, as many children who undergo surgery have comorbidities and residual lesions (AU)


Subject(s)
Humans , Infant, Newborn , Infant , Postoperative Complications , Follow-Up Studies , Critical Illness , Heart Defects, Congenital/surgery , Heart Defects, Congenital/epidemiology , Reoperation , Indicators of Morbidity and Mortality , Retrospective Studies , Ambulatory Care
6.
Med. infant ; 26(2): 99-106, Junio 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1009227

ABSTRACT

Introducción: Las cardiopatías congénitas (CC) son las anomalías congénitas más frecuentes. Representan el 0,8-1,2% de todos los defectos del nacimiento y tienen una prevalencia de alrededor de 5,8 por cada 1000 personas. El Servicio de Cardiología del Hospital Garrahan es un centro de referencia nacional y de países limítrofes donde se realizan 18000 consultas anuales. Los pacientes que concurren por primera vez se atienden en el consultorio de orientación. Objetivo: Describir la epidemiologia y perfil de los pacientes que asisten diariamente al consultorio de orientación de cardiología infantil en un hospital pediátrico de tercer nivel de Buenos Aires. Métodos: Entre septiembre de 2017 y febrero de 2018 se recolectaron los datos de 1000 pacientes atendidos en forma consecutiva en el consultorio de orientación de cardiología. A la totalidad de los pacientes se les realizó anamnesis, examen físico cardiovascular, electrocardiograma, y en los casos en los que se consideró necesario, saturometría, radiografía de tórax y/o ecocardiograma. Las variables a considerar fueron edad, procedencia, presencia o ausencia de cardiopatías congénitas o adquiridas, soplo, cianosis, insuficiencia cardíaca, estado nutricional, síndromes genéticos asociados, métodos diagnósticos e indicaciones terapéuticas implementadas. Se subdividió la población en cinco grupos: Grupo A (pacientes con cardiopatía congénita), Grupo B (cardiopatías operadas), Grupo C (miocardiopatías), Grupo D (arritmias), Grupo E (corazón sano). Resultados: La edad mediana fue 4.86 años (0.03 a 18.9 años). El 64% de los pacientes procedían de la provincia de Buenos Aires. Los motivos de consulta fueron: interconsultas internas 29.5%, derivación por cardiopatía 27.2%, soplo 17.6%, síncope 7%, segunda opinión 5.1%, arritmias 4.8%, precordialgia 3.1%, palpitaciones 2.6%, episodio paroxístico 1.4%, cardiomegalia 0.7%, disnea 0.5%, mal progreso de peso 0.3%. El 10.6% tenían un síndrome genético. Grupo A: 252 pacientes con una edad mediana de 1.9 años. Las cardiopatías acianóticas con hiperflujo pulmonar fueron las más frecuentes (66.66%, 168/252). Grupo B: 51 pacientes, 23.52%(12/51) fueron Fallot reparados en otra institución. Grupo C: 22 pacientes, siendo la miocardiopatía hipertrófica la más frecuente. Grupo D: 47 pacientes, la preexcitación ventricular fue el hallazgo más frecuente (34,04%, 16/47). Grupo E: 628 pacientes, 45.70% (287/628) derivados por pediatras del área ambulatoria, principalmente para valoración de pacientes con enfermedades sistémicas o síndromes genéticos. Conclusión: Los motivos de derivación al consultorio de orientación de cardiología fueron muy diversos. La mayoría de los pacientes provenían de provincia de Buenos Aires. Solamente el 37.2% presentó algún problema cardiológico de base. El 91% de los pacientes que consultaron por soplo, no tuvieron cardiopatía. El grupo correspondiente a los pacientes con cardiopatías no operadas (grupo A) fue el de menor edad (mediana de 1.9 años) y las cardiopatías simples no cianóticas con hiperflujo pulmonar representaron el 66.66% de las cardiopatías. La implementación del ecocardiograma portátil en el consultorio de orientación permitió confirmar el diagnóstico y definir la conducta terapéutica en el 29.4% de los pacientes durante la primer consulta (AU)


Introduction: Congenital heart defects (CHD) are the most common congenital abnormalities. They account for 0.8-1.2% of all birth defects and have a prevalence of around 5.8 per 1000 people. The Department of Cardiology of Garrahan Hospital is a national and bordering-country reference center, receiving 18000 consultations annually. Patients seen for the first time are assessed at the cardiology guidance clinic. Objective: To describe the epidemiology and profile of patients who seen daily at the child cardiology guidance clinic of a third-level pediatric hospital in Buenos Aires. Methods: Between September 2017 and February 2018, data from 1000 patients consecutively seen at the cardiology guidance clinic were collected. All patients underwent anamnesis, cardiovascular physical examination, electrocardiogram and, if considered necessary, pulse oximetry, chest x-ray, and/or echocardiogram. The variables considered were age, place of origin, presence or absence of congenital or acquired heart disease, murmur, cyanosis, heart failure, nutritional status, associated genetic syndromes, diagnostic methods, and treatment. The population was divided into five groups: Group A (patients with congenital heart defects), Group B (operated cardiopathies), Group C (myocardiopathies), Group D (arrhythmias), Group E (healthy heart). Results: Median age was 4.86 years (0.03 to 18.9 years). Overall, 64% of patients came from the province of Buenos Aires. The reasons for consultation were: internal consultations 29.5%, cardiac shunt 27.2%, murmur 17.6%, syncope 7%, second opinion 5.1%, arrhythmias 4.8%, precordialgia 3.1%, palpitations 2.6%, paroxysmal episode 1.4%, cardiomegaly 0.7%, dyspnea 0.5%, 0.3% poor weight gain. A genetic syndrome was identified in 10.6%. Group A: 252 patients with a median age of 1.9 years. Acyanotic congenital heart defect with pulmonary hyperflow was the most common (66.66%, 168/252). Group B: 51 patients, 23.52% (12/51) had tetralogy of Fallot repaired at another institution. Group C: 22 patients, in whom hypertrophic cardiomyopathy was the most common. Group D: 47 patients, in whom ventricular preexcitation was the most common finding (34.04%, 16/47). Group E: 628 patients, 45.70% (287/628) referred by pediatricians from the outpatient clinics, mainly for the assessment of systemic diseases or genetic syndromes. Conclusion: The reasons for referral to the cardiology guidance clinic were varied. Most of the patients came from the province of Buenos Aires. Only 37.2% had an underlying heart disease. Of the patients who consulted because of a murmur, 91% did not suffer from heart disease. The group of patients with congenital heart disease who had not undergone surgery (group A) was the youngest (median 1.9 years) and simple non-cyanotic heart disease with pulmonary hyperflow accounted for 66.66% of heart diseases. The implementation of the portable echocardiography in the guidance clinic confirmed the diagnosis and defined the management in 29.4% of patients during the first consultation (AU)


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Cardiology Service, Hospital/statistics & numerical data , Ambulatory Care/statistics & numerical data , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/genetics , Heart Defects, Congenital/epidemiology , Heart Diseases/diagnosis , Heart Diseases/epidemiology , Referral and Consultation , Prevalence , Retrospective Studies , Heart Murmurs/diagnosis , Heart Murmurs/epidemiology , Observational Study
7.
Rev. cuba. pediatr ; 91(1): e661, ene.-mar. 2019. tab
Article in Spanish | LILACS | ID: biblio-985595

ABSTRACT

RESUMEN Introducción: Las cardiopatías congénitas inciden en 8 x 1 000 recién nacidos vivos en el mundo y en gran medida determinan su mortalidad. Objetivo: Precisar la morbilidad y mortalidad neonatal por cardiopatías congénitas. Métodos: Estudio descriptivo, longitudinal y prospectivo realizado en 97 recién nacidos con estas cardiopatías, diagnósticados en el Servicio de Neonatología del Hospital Dr. Agostinho Neto de Guantánamo durante los años 2015- 2017. Se consideró el análisis segmentario, probable mecanismos que la determinan y tipo de cardiopatía. Resultados: Se identificaron cardiopatías congénitas en el 12,9 por ciento de los recién nacidos; la letalidad fue de 1,0 por ciento. Lo más común fue que se identificaron modos y tipos de conexión auriculoventricular y ventriculoarterial fisiológicos. Las anomalías en la muerte celular (47,3 por ciento) fue el mecanismo genético y molecular más observado. La cardiopatía más frecuente fue la comunicación interventricular (63,9 por ciento). La mayoría de las cardiopatías se clasificaron como: aisladas (95,9 por ciento), de gravedad moderada (92,8 por ciento), acianóticas (93,8 por ciento), no se asociaran a síndromes o enfermedades genéticas (94,9 por ciento) pero sí a malformaciones extracardiacas (94,9 por ciento). Se manifestaron sobre todo por soplo cardiaco (85,6 por ciento). El diagnóstico de 70,1 por ciento de las cardiopatías se realizó en etapa prenatal. Conclusiones: Estas afecciones no constituyen un problema de salud en el servicio de este hospital, pero a pesar de que la mayoría de las cardiopatías congénitas se diagnostican en etapa prenatal, se requiere continuar laborando en función de potenciar más su diagnóstico en esta etapa(AU)


ABSTRACT Introduction: Neonatal congenital cardiopathies have a global incidence of 8 x 1000 live births and it greatly determines their mortality. Objective: To specify the neonatal morbidity and mortality by congenital cardiopathies. Method: Descriptive, longitudinal and prospective study of 97 newborns with these cardiopathies diagnosed in the Neonatolgy Service in ´Dr. Agostinho Neto Hospital, Guantánamo province from 2015 to 2017. It was considered: the segmental analysis, probable mechanisms that determine it and cardiopathy type. Results: Congenital cardiopathies were identified in 12.9 percent of the newborns; the lethality was of 1.0 percent. The most common aspect was the identification of ways and types of aurículo-ventricular and physiologic ventrículo-arterial connection. Anomalies in the cellular death (47.3 percent) were the most frequent genetic and molecular mechanism. The most frequent congenital heart disease was the interventricular communication (63.9 percent). Most of the cardiopathies were classified as: isolated (95.9 percent); of moderate graveness (92.8 percent); acyanotic (93.8 percent); not associated to syndromes or genetic diseases (94.9 percent) but yes to extracardiac malformations (94.9 percent); and they manifested mainly by heart murmur (85.6 percent ). The diagnosis of 70.1 percent of the cardiopathies was carried out in prenatal stage. Conclusions: Congenital cardiopathies don't constitute a health problem in the Neonatology service of the Hospital; but instead that these were mainly diagnosed in the prenatal stage, it is required to continue working in function of boosting their prenatal diagnosis(AU)


Subject(s)
Humans , Male , Female , Infant, Newborn , Heart Defects, Congenital/mortality , Heart Defects, Congenital/epidemiology , Infant, Newborn, Diseases/epidemiology , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studies
8.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(1): 65-72, Jan.-Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-985130

ABSTRACT

ABSTRACT Objective: To evaluate the physical activity level and functional capacity of children and adolescents with congenital heart disease and to describe correlations between functionality, surgical and echocardiographic findings, metabolic and inflammatory profile and differences between acyanotic and cyanotic heart defects. Methods: A cross-sectional study including children and adolescents with congenital heart disease between six and 18 years old that were evaluated with the 6-minute walk test (6MWT) to assess functional capacity. The short version form of the International Physical Activity Questionnaire (IPAQ) was performed to evaluate physical activity levels. Also, echocardiography and blood collection, to evaluate the metabolic (blood glucose, lipids, insulin) and inflammatory markers (C-reactive protein), were assessed. Results: Twenty-five individuals were evaluated. Of them, 14 had acyanotic heart defects and 11 cyanotic heart defects. Mean age was 12.0±3.7 years, and 20 (80%) were male. IPAQ showed that six (24%) individuals were very active, eight (32%) were active, nine (36%) had irregular physical activity, and two (8%) were sedentary. The mean distance walked in the 6MWT, considering all studied individuals, was 464.7±100.4 m, which was 181.4±42.0 m less than the predicted (p=0.005). There was a positive correlation between Z score 6MWT and the number of surgical procedures (r=-0.455; p=0.022). Conclusions: Children and adolescents with congenital heart disease have low functional capacity, but they are not completely sedentary.


RESUMO Objetivo: Avaliar o nível de atividade física e a capacidade funcional de crianças e adolescentes com cardiopatia congênita, além de descrever correlações entre funcionalidade, achados cirúrgicos e ecocardiográficos, perfil metabólico e inflamatório e diferenças entre cardiopatias congênitas acianótica e cianótica. Métodos: Estudo transversal com crianças e adolescentes com cardiopatia congênita entre seis e 18 anos de idade. Foi realizado o teste de caminhada de 6 minutos para avaliar a capacidade funcional, e aplicou-se a versão curta do Questionário Internacional de Atividade Física (IPAQ) para avaliar os níveis de atividade física. Foram feitos também: exame ecocardiográfico, coleta de sangue para avaliação de perfil metabólico e inflamatório (glicemia, triglicerídeos, colesterol total, lipoproteína de alta densidade - HDL-colesterol, lipoproteína de baixa densidade - LDL-colesterol, hemograma completo, proteína C reativa, insulina). Resultados: Foram avaliados 25 indivíduos, dos quais 14 tinham cardiopatia congênita acianótica e 11 cianótica. A média de idade foi de 12,0±3,7 anos, e 20 (80%) eram do sexo masculino. O IPAQ mostrou que seis (24%) indivíduos eram muito ativos, oito (32%) eram ativos, nove (36%) tinham atividade física irregular e dois (8%) eram sedentários. A média de distância percorrida no teste de caminhada dos 6 minutos, considerando todos os indivíduos estudados, foi de 464,7±100,4 m, sendo 181,4±42,0 m menor do que o previsto (p=0,005). Encontrou-se correlação entre o escore Z do teste de caminhada de 6 minutos e o número de procedimentos cirúrgicos realizados (r=-0,455; p=0,022). Conclusões: Crianças e adolescentes com cardiopatia congênita têm baixa capacidade funcional, mas não são completamente sedentários.


Subject(s)
Humans , Male , Female , Child , Adolescent , Exercise , Exercise Tolerance , Sedentary Behavior , Blood Pressure Determination/methods , Blood Pressure Determination/statistics & numerical data , Brazil/epidemiology , Body Mass Index , Cross-Sectional Studies , Walk Test/methods , Walk Test/statistics & numerical data , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/physiopathology , Heart Defects, Congenital/psychology , Heart Defects, Congenital/epidemiology , Heart Rate
9.
Cad. Saúde Pública (Online) ; 35(7): e00186418, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1011713

ABSTRACT

Apesar da redução da mortalidade na infância, as causas ainda são majoritariamente evitáveis, e a sobrevida pode estar condicionada à situação de ameaça à vida ao nascer. Foram estimadas a carga de ameaça à vida ao nascer, de near miss neonatal, e a mortalidade, com ênfase na evitabilidade, e sobrevida na infância, em coortes de nascidos vivos. Estudo de coorte retrospectiva de nascidos vivos residentes no Município do Rio de Janeiro (2012-2016). Os bancos de dados dos Sistemas de Informações sobre Nascidos Vivos e sobre Mortalidade foram relacionados. Critérios pragmáticos foram utilizados para definir ameaça à vida e near miss. Óbitos foram classificados segundo a lista brasileira de causas de mortes evitáveis. Foram estimados indicadores de morbimortalidade e a sobrevida (Kaplan-Meier). Dos 425.505 nascidos vivos, 2,2% apresentaram ameaça à vida ao nascer. As taxas de mortalidade na infância, infantil e neonatal foram, respectivamente: 0,01; 0,06 e 14,97 por mil pessoas-dia. Causas evitáveis, não claramente evitáveis e mal definidas corresponderam, respectivamente, a 61%, 35% e 4% dos óbitos. O risco de morte por causas evitáveis atribuível ao nascimento com ameaça à vida foi de 97,6%. A sobrevida foi menor entre recém-nascidos com ameaça à vida, comparados àqueles sem ameaça à vida. Os critérios pragmáticos de ameaça à vida determinaram o perfil de mortalidade proporcional por causas de morte segundo os três grupos de causas da lista brasileira de causas de mortes evitáveis. Nascer com ameaça à vida define crianças com maior risco de morbimortalidade e põe, em pauta, a discussão sobre a vulnerabilidade e as necessidades de assistência às crianças e do apoio social às suas famílias.


A pesar de la reducción de la mortalidad en la infancia, las causas de fallecimiento todavía son mayoritariamente evitables y la supervivencia puede estar condicionada con la situación de amenaza para la vida al nacer. En este trabajo se estimaron la carga de amenaza para la vida al nacer, el near miss neonatal y la mortalidad, con énfasis en la evitabilidad y supervivencia en la infancia en cohortes de nacidos vivos. Es un estudio de cohorte retrospectivo de nacidos vivos, residentes en el municipio de Río de Janeiro, Brasil (2012-2016). Se relacionaron los bancos de datos de los Sistemas de Información sobre Nacidos Vivos y sobre Mortalidad. Se utilizaron criterios pragmáticos para la definición amenaza para la vida al nacer y near miss. Los óbitos se clasificaron según la lista brasileña de causas de muertes evitables. Se estimaron indicadores de morbimortalidad y supervivencia (Kaplan-Meier). De los 425.505 nacidos vivos, un 2,2% presentaron amenaza para la vida. Las tasas de mortalidad en la infancia, infantil y neonatal fueron, respectivamente: 0,01; 0,06 y 14,97 por 1.000 personas-día. Las causas evitables, no claramente evitables y mal definidas, correspondieron, respectivamente, a un 61%, 35% y 4% de los óbitos. El riesgo de muerte por causas evitables atribuible al nacimiento con amenaza para la vida fue de un 97,6%. La supervivencia fue menor entre recién nacidos con amenaza para la vida, comparados con aquellos sin amenaza para la vida. Los criterios pragmáticos de amenaza para la vida determinaron el perfil de mortalidad proporcional por causas de muerte, según los tres grupos de causas de la lista brasileña de causas de muertes evitables. Nacer con amenaza para la vida define a los niños con un mayor riesgo de morbimortalidad y pone en relevancia la discusión sobre vulnerabilidad y necesidades asistenciales para los niños, así como el apoyo social a sus familias.


Despite the reduction in under-five mortality, the causes are still mostly avoidable, and survival may be compromised by life-threatening conditions at birth. The study estimated the burden of life-threatening conditions at birth, neonatal near miss, and mortality, with an emphasis on avoidable causes, as well as under-five survival in live birth cohorts. This was a retrospective cohort study of live birth in the city of Rio de Janeiro, Brazil (2012-2016). The databases from the Brazilian Information System on Live Births and the Brazilian Mortality Information System were linked. Pragmatic criteria were used to define life-threatening conditions and near miss. Deaths were classified according to the Brazilian list of causes of avoidable deaths. Morbidity and mortality and survival indicators were estimated (Kaplan-Meier). Of the 425,505 live birth , 2.2% presented life-threatening conditions at birth. The under-five, infant and neonatal mortality rates were 0.01, 0.06, and 14.97 per 1,000 person-days, respectively. Avoidable, unclearly avoidable, and ill-defined causes accounted respectively for 61%, 35%, and 4% of the deaths. The risk of death from avoidable causes attributable to life-threatening conditions at birth was 97.6%. Survival was lower in newborns with life-threatening conditions compared to those without life-threatening conditions. The pragmatic criteria for life-threatening conditions determined the profile of proportional mortality by causes of death according to the three groups of causes in the Brazilian list of causes of avoidable deaths. Life-threatening conditions at birth increases the risk of morbidity and mortality in under-five children and raises the discussion on vulnerability and the need for care for these children and social support for their families.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Infant , Child, Preschool , Birth Weight , Survival Analysis , Infant Mortality , Cause of Death , Live Birth/epidemiology , Prenatal Care/statistics & numerical data , Brazil/epidemiology , Retrospective Studies , Gestational Age , Risk Assessment , Near Miss, Healthcare/statistics & numerical data , Heart Defects, Congenital/epidemiology
10.
Gac. méd. espirit ; 20(3): 45-53, set.-dic. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-989845

ABSTRACT

RESUMEN Fundamento: La cardiopatía en el embarazo se considera la primera causa de morbilidad y mortalidad materna de causa no obstétrica. En Cuba el seguimiento materno está priorizado. Objetivo: Describir el comportamiento de las cardiopatías asociadas al embarazo en pacientes que acudieron a la Consulta Provincial de Cardiopatía y Embarazo del Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus de septiembre de 2015 a septiembre de 2016. Metodología: Se realizó un estudio observacional, descriptivo, prospectivo en 119 pacientes que acudieron a la consulta de cardiopatía y embarazo. Resultados: El rango de edad que predominó fue entre 16 y 25 años, las cardiopatías congénitas prevalecieron en un 75 %, siendo las más frecuentes las valvulopatías y dentro de estas el prolapso de la válvula mitral. El 49.6 % de las embarazadas presentaron un soplo como motivo de consulta. El electrocardiograma y el ecocardiograma normal fueron los hallazgos más frecuentes, representando el 56.3 % y el 74.8 % respectivamente. Conclusiones: Se observó baja prevalencia de cardiopatías durante el embarazo con un predominio de las cardiopatías congénitas en sus formas ligeras.


ABSTRACT Background: Heart disease in pregnancy is considered the leading cause of maternal morbidity and mortality due to non-obstetric causes. In Cuba, maternal follow-up is prioritized. Objective: To describe the behavior of heart diseases associated with pregnancy in patients who attended the Provincial Consultation of Heart Disease and Pregnancy at the General Camilo Cienfuegos Provincial Hospital of Sancti Spíritus from September 2015 to September 2016. Methodology: An observational, descriptive and prospective study was conducted in 119 patients who attended the clinic for heart disease and pregnancy. Results: The age range that prevailed was between 16 and 25 years, congenital heart diseases prevailed in 75 %, being the valvulopathies the most frequent ones and within these the prolapse of the mitral valve. 49.6 % of pregnant women presented a murmur as a reason for consulting. The electrocardiogram and the normal echocardiogram were the most frequent findings, representing the 56.3% and 74.8 % respectively. Conclusions: Low prevalence of heart disease was observed during pregnancy with a predominance of congenital heart diseases in its light forms.


Subject(s)
Pregnancy Complications, Cardiovascular , Heart Defects, Congenital/epidemiology
11.
Arq. bras. cardiol ; 111(4): 571-577, Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-973774

ABSTRACT

Abstract Background: Congenital heart defects (CHD), as the most common congenital anomaly, have been reported to be associated with chromosomal abnormalities. Currently, patients with CHD are routinely offered karyotyping and chromosomal microarray (CMA) testing, but the genotype-phenotype relationship has not yet been fully established. Objective: To determine the type and frequency of chromosomal abnormalities in fetuses with CHD and to analyze pregnancy outcomes of fetuses with heart abnormalities caused by different genetic factors. Methods: A total of 362 cases of CHD were enrolled from 2009 to 2016. Detailed ultrasound and laboratory examinations, including karyotyping and CMA, were performed. Outcome was obtained from discharge summaries. Results: Of the 362 fetuses, 220 were found with an isolated CHD, and 142 had CHD with extracardiac anomaly. Among these 362 fetuses, 140 were identified with a genetic cause, including 111 cases with aneuploidy, 10 cases with abnormality of chromosomal structure by karyotyping and 19 cases with pathogenic or likely pathogenic copy-number variations (CNVs) by CMA. The detection rate is close to 38.7%. Only one (identified as trisomy 18 syndrome) in 140 positive cases resulted in perinatal death, with the others being induced. The remaining 222 cases had negative results for both genetic testing and of these cases, 56 resulted in induced labor, and 77 had natural childbirth or caesarean births. The pregnancy outcome of the remaining 89 cases was uncertain. Conclusions: Karyotyping and CMA are effective and accurate prenatal genetic techniques for identifying fetal chromosomal abnormalities associated with cardiac defects, and this can assist clinical doctors to perform appropriate genetic counselling with regard to the etiology and outcome of CHD.


Resumo Fundamento: As cardiopatias congênitas (CCs) são as anomalias congênitas mais comuns, e têm sido associadas a anormalidades cromossômicas. Atualmente, a cariotipagem e a análise cromossômica por microarray (CMA) são oferecidas rotineiramente aos pacientes, mas a relação genótipo-fenótipo ainda não foi totalmente estabelecida. Objetivo: Determinar o tipo e a frequência das anomalias cromossômicas em fetos com CC e analisar os desfechos da gestação de fetos com anormalidades cardíacas causadas por diferentes fatores genéticos. Métodos: No total, foram admitidos 362 casos de CC entre 2009 e 2016. Ultrassonografia e exames laboratoriais detalhados foram realizados, incluindo cariotipagem e CMA. O resultado foi obtido a partir das folhas de epicrise. Resultados: Dos 362 fetos, 220 apresentaram doença coronariana isolada e 142 apresentaram doença coronariana com anomalia extracardíaca. Entre esses 362 fetos, foram identificados 140 com causa genética, incluindo 111 casos com aneuploidia, 10 casos com anormalidade da estrutura cromossômica por cariotipagem e 19 casos com variações no número de cópias (CNVs) patogênicas ou provavelmente patogênicas por CMA. A taxa de detecção é de aproximadamente 38,7%. Apenas um (identificado como síndrome da trissomia do cromossomo 18) em 140 casos positivos resultou em morte perinatal, com as demais sendo induzidas. Os 222 casos restantes tiveram resultados negativos para ambos os testes genéticos e, destes, 56 resultaram em trabalho de parto induzido e 77 tiveram partos naturais ou cesarianas. O desfecho da gravidez dos 89 casos restantes foi incerto. Conclusões: A cariotipagem e a CMA são técnicas genéticas pré-natais eficazes e precisas para a identificação de anomalias cromossômicas fetais associadas a defeitos cardíacos, e isso pode ajudar os médicos a realizar aconselhamento genético adequado com relação à etiologia e ao desfecho das cardiopatias congênitas.


Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy Outcome/genetics , Genetic Testing/methods , Chromosome Aberrations/statistics & numerical data , Heart Defects, Congenital/genetics , Syndrome , China/epidemiology , Ultrasonography, Prenatal/methods , Polymorphism, Single Nucleotide , DNA Copy Number Variations , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/diagnostic imaging , Karyotyping/methods
12.
Rev. medica electron ; 40(5): 1399-1428, set.-oct. 2018. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-978680

ABSTRACT

RESUMEN Introducción: el incremento de las cardiopatías congénitas en los últimos años y la relevancia que ha alcanzado en la provincia de Matanzas como una de las primeras causas de muerte infantil, es un tema que preocupa a los especialistas; sin embargo, la gestión en la búsqueda de nuevos conocimientos en esta área de interés aún no es suficiente. Objetivo: caracterizar la morbimortalidad por cardiopatías congénitas en la provincia de Matanzas en el período comprendido de enero del 2002 a diciembre del 2014. Materiales y métodos: se realizó un estudio descriptivo, transversal cuyo universo de trabajo estuvo conformado por todos los pacientes de edad pediátrica a los cuales se les diagnosticó cardiopatía congénita y fueron atendidos por el servicio de Cardiología del Hospital Pediátrico Docente "Eliseo Noel Caamaño". Se incluyeron todos los niños diagnosticados por ultrasonografía durante el período embriofetal. Resultados: la comunicación interventricular resultó ser la más frecuente. Hubo predominio de cardiopatías en pacientes masculinos y procedencia urbana; siendo diagnosticadas la mayoría en la etapa neonatal. La tasa de prevalencia por año presenta una tendencia creciente, mientras que la de mortalidad resultó decreciente. El Síndrome de Down fue la entidad genética más frecuente asociada con las cardiopatías congénitas al igual que las malformaciones craneofaciales. Conclusiones: estos resultados muestran el verdadero comportamiento de esta entidad en esta provincia (AU).


ABSTRACT Introduction: the increase of congenital heart diseases in recent years and the relevance it has achieved in the province of Matanzas as one of the main causes of infantile death is a matter of concern for specialists; however, management of search for new knowledge in this area of interest is still not enough. Objective: to characterize morbidity and mortality due to congenital heart disease in the province of Matanzas in the period from January 2002 until December 2014. Materials and methods: A descriptive, cross-sectional study was carried out in a universe formed by all the patients of pediatric age, diagnosed with congenital heart disease and treated by the Cardiology service of the Teaching Pediatric Hospital "Eliseo Noel Caamaño". All the children diagnosed by ultrasonography during the embryofetal period were included. Results: intraventricular communication was the most frequent. There it was a general predominance of heart disease in male patients, and from urban origins, most of them diagnosed at the neonatal stage. The prevalence rate per year shows an increasing tendency, while mortality decreased. Down syndrome was the most common genetic entity associated to congenital heart disease as well as craniofacial malformations. Conclusions: these results show the true behavior of this entity in our province (AU).


Subject(s)
Humans , Male , Female , Pediatrics , Heart Defects, Congenital/epidemiology , Patients , Cardiology , Child , Heart Defects, Congenital/classification , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/pathology
13.
Med. infant ; 24(4): 344-360, dic. 2017. tab, ilus
Article in Spanish | LILACS | ID: biblio-878313

ABSTRACT

Celebrando los 30 años del Hospital Garrahan y en el marco de las X Jornadas Interdisciplinarias, damos comienzo al VII Encuentro organizado por el Comité Editorial de la revista Medicina Infantil. Durante estas tres décadas el hospital ha forjado un prestigio que trasciende las fronteras del país. Una parte muy importante de él está basado en su recurso humano. Dentro de las virtudes que podemos destacar de él, es su capacidad de innovar y de ser emprendedores. De gente que genera ideas, que se convierten en proyectos que son llevados adelante y se concretan, con el objetivo de brindar la más alta calidad de atención médica a la población pediátrica del país. Vamos a poder escuchar cinco de estas ideas planteadas por los líderes de los equipos que las han motorizado. Serán la doctora Josefa Rodríguez, Directora Médica Ejecutiva, quien nos hablará sobre las respuestas del hospital a la demanda; y la doctora Susana P. Rodríguez, Directora Asociada de Docencia e Investigación, quien expondrá sobre las nuevas tecnologías para la formación de los recursos humanos. Más tarde será el turno del doctor Roberto Debbag, miembro del Consejo de Administración, y cómo el hospital se extiende más allá de sus propios límites físicos, acortando las distancias. En cuarto término el doctor Mauro Castelli, Vicepresidente de la Fundación Garrahan, nos mostrará un modelo de apoyo para el paciente y su familia: la Casa Garrahan. Por último, será expuesto el Programa Nacional de Cardiopatías Congénitas por su coordinadora, la doctora Alejandra Villa. Luego de estas exposiciones, el panel reactivo podrá hacer preguntas, comentarios y reflexiones, de la misma forma que convoco a quienes quieran hacerlo desde el auditorio. Desde la revista Medicina Infantil, queremos agradecer a cada uno de los expositores y a los prestigiosos profesionales que integran nuestro panel reactivo: Dr. Ginés González García, ex ministro de Salud de la Nación y de la provincia de Buenos Aires, doctora Graciela Reybaud, ex ministra de Salud de la CABA y actual integrante del Consejo de Administración del hospital, y la doctora Diana Fariña, ex jefa del Área de Neonatología del hospital y actualmente a cargo de la Dirección de Maternidad e Infancia del Ministerio de Salud (AU)


Subject(s)
Humans , Health Services Needs and Demand , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/surgery , High Fidelity Simulation Training , Hospitals, Pediatric/organization & administration , National Health Programs/statistics & numerical data , Telemedicine
14.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 27(1): 54-62, jan.-mar. 2017. ilus
Article in Portuguese | LILACS | ID: biblio-836988

ABSTRACT

A Cardiologia vem enfrentando uma série de mudanças na abordagem das cardiopatias estruturais na última década. Com o avanço do tratamento por meio da Cardiologia Intervencionista, novos paradigmas têm sido estabelecidos, sobretudo com criação de comitês médicos para ampla discussão dos casos ­ os Times de Cardiologia ou "Heart Teams". Pacientes muito idosos, frágeis e com comorbidades que tornam a cirurgia convencional proibitiva ou de risco muito alto, passaram a ter novas opções além da otimização do tratamento clínico. A ecocardiografia, outrora focada no diagnóstico, tem cada vez mais participado e mesmo atuado de forma ativa nos procedimentos intervencionistas, o que fez surgir uma nova subespecialidade ­ a Ecocardiografia Intervencionista. Importante desde o momento do diagnóstico e do planejamento da intervenção, a ecocardiografia tem papel de destaque durante o procedimento, possibilitando a visualização dos cateteres e dispositivos de forma simultânea às imagens angiográficas, comprovação imediata do resultado e identificação de eventual complicação. Seu uso é praticamente imperativo em situações de implante de endoprótese valvar aórtica, fechamento de comunicação interatrial ou forame oval e oclusão de apêndice atrial esquerdo. Com a evolução tecnológica dos equipamentos e advento da tecnologia tridimensional, tem sido possível visualizar as estruturas cardíacas de forma antes impossível e muito semelhante à visão do cirurgião cardíaco e, com isso, guiar fechamento de "leaks" periprotéticos e reparos na valva mitral


In the last decade, cardiologists have faced a series of changes in the approach to structural cardiopathies. With the advances in treatment through Interventional Cardiology, new paradigms have been established, such as the creation of medical committees for wider discussion of cases, known as "Heart Teams". Very elderly or frail patients, or those with comorbidities that make conventional surgery prohibitive or high risk, now have new alternatives, as well as optimized clinical treatment. Echocardiography, which was previously focused on diagnosis, now plays a major, and even active role in interventional procedures. This has led to the emergence of a new subspecialty ­ Interventional Echocardiography. From the moment of diagnosis and planning of the intervention, echocardiography plays an important role during the procedure, enabling simultaneous visualization of catheters and devices, and angiographic images, immediate identification of the result, and the detection of any complications. Its use is practically mandatory in aortic valve endoprosthesis implantation, interatrial septal defect or foramen ovale closure, and left atrial appendage occlusion procedures. With the technological evolution of the equipment and the advent of three-dimensional technology, it has become possible to visualize the heart structures in a way that was previously impossible, giving a view that is very similar to that of the heart surgeon, guiding periprosthetic leaks and mitral valve repairs


Subject(s)
Humans , Male , Female , Diagnostic Imaging/methods , Echocardiography/methods , Echocardiography, Three-Dimensional/methods , Heart Defects, Congenital/epidemiology , Aortic Valve/surgery , Prostheses and Implants , Bioprosthesis , Magnetic Resonance Spectroscopy/methods , Tomography, X-Ray Computed/methods , Stents , Morbidity , Catheters , Heart Atria , Mitral Valve/surgery , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/physiopathology
16.
Rev. méd. Chile ; 144(8): 998-1005, ago. 2016. tab
Article in Spanish | LILACS | ID: biblio-830604

ABSTRACT

Background: There is a paucity of information about morbidity and mortality of adolescents with Down syndrome (DS). Aim: To describe morbidity and mortality of a cohort of Chilean adolescents with DS. Material and Methods: Review of electronic clinical records of 67 ambulatory patients with DS aged 10 to 20 years (37 women), seen between the years 2007 and 2014 in outpatient clinics of a University hospital. Results: The mean age at the last consultation was 13 ± 3 years. Ninety-eight percent of patients had a chronic condition: 37.1% where overweight or obese, 58.2% had a congenital heart disease, 11.9% where being evaluated or had the diagnosis of autism and 44.8% had hypothyroidism. Pubertal development was consistent with chronologic age in 93.7% of patients. In three patients puberty had been suppressed. In women, average age of menarche was 12.2 ± 1.1 years. There were no deaths reported. Conclusions: There was a high rate of comorbidities in this group of adolescents with DS, most of them with frequencies comparable to those reported in literature.


Subject(s)
Humans , Male , Female , Child , Adolescent , Young Adult , Down Syndrome/epidemiology , Autistic Disorder/epidemiology , Chile/epidemiology , Chronic Disease , Prevalence , Retrospective Studies , Morbidity , Overweight/epidemiology , Heart Defects, Congenital/epidemiology , Hypothyroidism/epidemiology
17.
Yonsei Medical Journal ; : 306-312, 2016.
Article in English | WPRIM | ID: wpr-147361

ABSTRACT

PURPOSE: We evaluated the hemodynamic statuses of patients after partial closure of atrial septal defects with fenestration due to pulmonary hypertension. MATERIALS AND METHODS: Seventeen adult patients underwent partial atrial septal defect closure and follow-up cardiac catheterization. We analyzed hemodynamic data and clinical parameters before and after closure. RESULTS: The median age at closure was 29 years old. The baseline Qp/Qs was 1.9+/-0.6. The median interval from the operation to the cardiac catheterization was 27 months. The CT ratio decreased from 0.55+/-0.07 to 0.48+/-0.06 (p<0.05). The mean pulmonary arterial pressure decreased from 50.0+/-11.5 mm Hg to 32.5+/-14.4 mm Hg (p<0.05), and the pulmonary resistance index decreased from 9.2+/-3.6 Wood units*m2 to 6.3+/-3.8 Wood units*m2 (p<0.05). Eleven patients (64.7%) continued to exhibit high pulmonary resistance (over 3.0 Wood units*m2) after closure. These patients had significantly higher pulmonary resistance indices and mean pulmonary arterial pressures based on oxygen testing before the partial closures (p<0.05). However, no significant predictors of post-closure pulmonary hypertension were identified. CONCLUSION: Despite improvement in symptoms and hemodynamics after partial closure of an atrial septal defect, pulmonary hypertension should be monitored carefully.


Subject(s)
Adult , Aged , Cardiac Catheterization/adverse effects , Female , Follow-Up Studies , Heart Defects, Congenital/epidemiology , Heart Septal Defects, Atrial/surgery , Hemodynamics/physiology , Humans , Hypertension, Pulmonary/diagnosis , Male , Middle Aged , Oxygen , Postoperative Complications/diagnosis , Retrospective Studies , Treatment Outcome , Young Adult
18.
Rev. chil. obstet. ginecol ; 81(5): 426-432, 2016. tab
Article in Spanish | LILACS | ID: biblio-830154

ABSTRACT

Introducción: La preeclampsia (PE) es un desorden multisistémico complejo causado por una angiogénesis anormal placentaria. La cardiopatía congénita (CC) es uno de los defectos estructurales más comunes en neonatos. Recientemente, diversos estudios han identificado un desequilibrio en los niveles de factores proangiogénicos y antiangiogénicos en sangre umbilical de neonatos con CC similares a los hallados en sangre de mujeres con PE, lo que sugiere una posible asociación. Objetivo: Revisar la evidencia científica disponible sobre la relación entre la PE y el desarrollo de CC en neonatos. Métodos: Se realizó una búsqueda en las bases de datos Scopus y Medline/Pubmed utilizando los términos "pre-eclampsia" y "congenital heart defects", se seleccionaron 4 artículos que relacionaban las variables PE y CC, los cuales fueron revisados a texto completo. Únicamente se encontraron trabajos de tipo observacional analítico (1 estudio de prevalencia, 1 estudio de casos y controles y 2 estudios de cohortes), publicados entre el 2014 y 2016. Resultados: La PE de inicio temprano (<34 semanas) fue el factor de riesgo más importante asociado al desarrollo de CC en neonatos. La severidad de un defecto cardiaco se asocia con la intensidad y el momento de inicio de los desequilibrios en los factores angiogénicos. Conclusión: Encontramos evidencia relevante de la asociación entre PE y CC. La condición hipertensiva y los cambios endoteliales condicionados por ésta, estarían relacionados con el aumento de riesgo para el desarrollo de la CC antes que la exposición a medicamentos antihipertensivos.


Introduction: Preeclampsia (PE) is a complex multisystem disorder caused by an abnormal placental angiogenesis. Congenital heart disease (CHD) is one of the most common structural defects in newborn infants. Recently, several studies have identified an imbalance in the levels of proangiogenic and antiangiogenic factors in umbilical blood of newborn infants with CHD similar to those found in the blood of women with PE, suggesting a possible association. Objective: To review the available scientific evidence about the relationship between the PE and the development of CHD in newborn infants. Method: A search was conducted in Scopus and Medline/PubMed databases using the terms "pre-eclampsia" and "congenital heart defects". Four articles that linked PE and CHD were selected and reviewed in full text. Only analytical observational studies were found (1 prevalence study, 1 case-control study and 2 cohort studies), published between 2014 and 2016. Results: Early onset PE (<34 weeks) was the most important risk factor for the development of CHD in newborn infants. The severity of a heart defect is associated with the intensity and the onset time of imbalances in the angiogenic factors. Conclusion: We found relevant evidence on the possible association between PE and CHD. Hypertensive condition and endothelial changes conditioned by this seem to be linked to increased risk for the development of CHD instead of exposure to antihypertensive drugs.


Subject(s)
Humans , Female , Pregnancy , Fetal Diseases/epidemiology , Heart Defects, Congenital/epidemiology , Pre-Eclampsia/epidemiology , Antihypertensive Agents/therapeutic use , Evidence-Based Medicine , Pre-Eclampsia/drug therapy
19.
Colomb. med ; 46(4): 162-167, Oct.-Dec. 2015. ilus
Article in English | LILACS | ID: lil-774949

ABSTRACT

Objectives: To present descriptive epidemiology of Orofacial Clefts and to determine the association of syndromic forms with antenatal high-risk conditions, preterm birth, and comorbidities among nested-series of cases. Methods: A study of nested-series of cases was conducted. Frequencies of cleft type, associated congenital anomalies, syndromic, non-syndromic and multiple malformation forms, and distribution of Orofacial Clefts according to sex and affected-side were determined. Odds ratios were calculated as measures of association between syndromic forms and antenatal high-risk conditions, preterm birth and comorbidities. A total of three hundred and eleven patients with Orofacial Clefts were assessed in a 12-month period. Results: The most frequent type of Orofacial Clefts was cleft lip and palate, this type of cleft was more frequent in males, whereas cleft palate occurred more often in females. The most common cases occurred as non-syndromic forms. Aarskog-Scott syndrome showed the highest frequency amongst syndromic forms. Hypertensive disorders in pregnancy, developmental dysplasia of the hip, central nervous diseases and respiratory failure showed significant statistical associations (p <0.05) with syndromic forms. Conclusions: These data provide an epidemiological reference of Orofacial Clefts in Colombia. Novel associations between syndromic forms and clinical variables are determined. In order to investigate causality relationships between these variables further studies must be carried out.


Objetivos: Presentar la epidemiología descriptiva en torno a las Fisuras Orofaciales y determinar asociaciones entre Fisuras Orofaciales sindromica y antecedentes antenatales de alto riesgo, parto pretérmino, y comorbilidades en una población Colombiana. Métodos: Se planteó un estudio de serie de casos anidado estratificado. Se calcularon frecuencias en relación al tipo de fisura desde el punto de vista anatómico, anomalías congénitas paralelas, morbilidades y forma clínica. Se analizó la distribución de las Fisuras Orofaciales de acuerdo al género y lateralidad. Se determinaron razones de disparidad entre la forma sindrómica y antecedentes antenatales de alto riesgo, parto pretérmino, y comorbilidades. Se evaluaron trecientos once pacientes que asistieron a la consulta de genética clinica durante un año. Resultados: La Fisura Labio-palatina fue el tipo más frecuente en la muestra evaluada y la más frecuente en hombres. La Fisura Palatina fué la más frecuente en mujeres, la forma clínica más común fue la no sindrómica. En la población sindrómica el Síndrome de Aarskog-Scott mostró la frecuencia más alta. Los trastornos Hipertensivos de Embarazo, la Displasia del Desarrollo de la Cadera, las enfermedades respiratorias y del sistema nervioso central mostraron una asociación estadísticamente significativa con la forma sindrómica. (p <0.05). Conclusiones: Estos datos ofrecen una referencia epidemiológica descriptiva de las Fisuras Orofaciales en Colombia. Las asociaciones encontradas entre los aspectos clínicos estudiados y la forma sindrómica, deben ser investigadas en próximos estudios con el fin de determinar relaciones de causalidad.


Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Cleft Lip/epidemiology , Cleft Palate/epidemiology , Age Distribution , Colombia/epidemiology , Dwarfism/epidemiology , Face/abnormalities , Genetic Diseases, X-Linked/epidemiology , Genitalia, Male/abnormalities , Hand Deformities, Congenital/epidemiology , Heart Defects, Congenital/epidemiology , Sex Distribution , Syndrome
20.
Säo Paulo med. j ; 133(6): 521-524, Nov.-Dec. 2015. tab
Article in English | LILACS | ID: lil-770147

ABSTRACT

ABSTRACT CONTEXT AND OBJECTIVE: Down syndrome is the most common genetic disorder, affecting 1/700 live births. Among the clinical findings, one constant concern is the high prevalence of congenital heart disease. The objective of this study was to determine the prevalence and profile of congenital heart disease among patients attended at a Down syndrome outpatient clinic in southern Brazil between 2005 and 2013. DESIGN AND SETTING : Cross-sectional study conducted in a referral center. METHODS : Data were retrospectively gathered from the medical files of 1,207 patients with Down syndrome, among whom 604 (50.0%) had been diagnosed with congenital heart disease. These data were subjected to descriptive analysis using the Statistica software. RESULTS : Among the 604 patients with congenital heart disease, 338 (55.8%) were male and 269 (44.5%) were female. The most common heart diseases were atrial septal defect in 254 patients (42.1%); total atrioventricular septal defect in 91 (15.1%); atrial septal defect and ventricular septal defect in 88 (14.6%); ventricular septal defect in 77 (12.7%); patent ductus arteriosus in 40 (6.6%); patent foramen ovale in 34 (5.6%) patients; tetralogy of Fallot in 12 (2%); and other diseases in 8 (1.3%). Pulmonary hypertension was present in 57 (9.4%). Out of the total, 150 patients (24.8%) underwent cardiac surgery. CONCLUSION : The high prevalence of congenital heart disease among the patients at the Down syndrome outpatient clinic (50%) was similar to findings from other studies and justifies investigation during the neonatal period, so as to decrease mortality and morbidity.


RESUMO CONTEXTO E OBJETIVO : A síndrome de Down é a anomalia genética mais comum e afeta 1/700 nascidos vivos. Entre os achados clínicos, uma preocupação constante é a alta prevalência de cardiopatia congênita e o objetivo do presente estudo é determinar a prevalência e o perfil de cardiopatia congênita em pacientes atendidos em um ambulatório de síndrome de Down no período de 2005 a 2013 no sul do Brasil. TIPO DE ESTUDO E LOCAL : Estudo transversal conduzido em um centro de referência. MÉTODOS : Foi realizada coleta retrospectiva de dados de 1.207 prontuários de pacientes com síndrome de Down, com 604 (50,0%) diagnosticados com cardiopatia congênita. Os dados foram submetidos a análise descritiva, utilizando-se o programa Statistica. RESULTADOS : Entre os 604 pacientes com cardiopatia congênita, 338 (55,8%) eram do sexo masculino e 269 (44,5%) do feminino. A cardiopatia mais comum foi comunicação interatrial, observada em 254 (42,1%) pacientes, defeito de septo atrioventricular total, em 91 (15,1%), comunicação interatrial em conjunto com comunicação interventricular, em 88 (14,6%), comunicação interventricular, em 77 (12,7%), persistência do canal arterial, em 40 (6,6%), forame oval patente, em 34 (5,6%), tetralogia de Fallot, em 12 (2%) e outras cardiopatias observadas em oito (1,3%) pacientes. Hipertensão pulmonar esteve presente em 57 (9,4%). Do total, 150 (24,8%) pacientes foram submetidos a cirurgia cardíaca. CONCLUSÃO : A elevada prevalência das cardiopatias congênitas nos pacientes do ambulatório da síndrome de Down, de 50%, semelhante à encontrada em outros estudos, justifica a investigação no período neonatal, com diminuição da mortalidade e morbidade.


Subject(s)
Female , Humans , Infant , Infant, Newborn , Male , Down Syndrome/epidemiology , Heart Defects, Congenital/epidemiology , Brazil/epidemiology , Cross-Sectional Studies , Hypertension, Pulmonary/epidemiology , Prevalence , Retrospective Studies , Sex Distribution
SELECTION OF CITATIONS
SEARCH DETAIL