Cardiopatías congénitas, tratamiento quirúrgico y sus complicaciones en población pediátrica del Hospital Vicente Corral Moscoso, 2017 - Agosto 2019 / Congenital heart diseases, surgical treatment and complications in pediatric sample of Hospital Vicente Corral Moscoso, 2017-August 2019.

INTRODUCCIÓN: El corazón es el órgano más comúnmente afectado por anormalidades congénitas, con una incidencia de 0.8 por cada 100 nacidos vivos. Cerca de dos tercios de todos los procedimientos son en la actualidad realizados antes del año de edad, lo que mejora la sobrevida y la calidad de vida. Este estudio busca determinar cuáles son las principales intervenciones quirúrgicas realizadas para tratar las cardiopatías congénitas y sus complicaciones. MATERIALES Y MÉTODOS: Se realizó un estudio observacional, descriptivo de corte transversal; con 70 pacientes pediátricos diagnosticados y tratados quirúrgicamente por cardiopatías congénitas. Los datos fueron tomados de las historias clínicas mediante un formulario. El análisis estadístico se realizó utilizando el programa SPSS versión 15. RESULTADOS: La mediana de la edad fue de 1.1 años, el 60% fueron de sexo femenino. El 90% de las cardiopatías fueron no cianógenas. El diagnóstico más frecuente fue la persistencia del conducto arterioso (58.57%), seguido de la comunicación interventricular (12.86%). Según el tipo de procedimiento el 58.57% se realizaron para cierre de persistencia del conducto arterioso y un 12.86% fueron reparaciones quirúrgicas para cierre de comunicación interventricular. La mediana de estadía en la unidad de cuidados intensivos fue de 4 días y la mediada de estadía en la sala general de 5 días. La principales complicaciones observadas en esta población pediátrica sometida a un procedimiento quirúrgico fueron: la neumonía (11.4%) y la sepsis de origen no especificado (8.6%). CONCLUSIÓN: Los tratamientos para las cardiopatías congénitas se realizaron a edades tempranas (Media =2.5 ± 3.2 años). Más de la mitad de los procedimientos quirúrgicos realizados para cardiopatías quirúrgicas fueron para corregir la persistencia del conducto arterioso y la principal complicación fue la neumonía.

BACKGROUND: The heart is the most commonly affected organ by congenital diseases, with and incidence of 0.8 per 100 newborns. Nearly two thirds of all the surgical procedures are now a days performed before the first year of life, improving survival rate and life quality. This study aims to determine the frequency of the surgical interventions performed to treat congenital heart diseases and its complications. METHODS: An observational, descriptive cross sectional study was carried out; with 70 pediatric patients diagnosed and surgically treated for congenital heart diseases. The data was collected from the patient's medical records using a form. Statistical analysis was performed using SPSS version 15 software. RESULTS: The median age was 1.1 years, 60% of the sample were women. 90% of the heart diseases were non-cyanogenic. The most frequent diagnosis was: persistence of the arterial duct (58.57%), followed by interventricular communication (12.86%). The type of procedures corresponds to the heart disease, thus 58.57% were performed for closure of arterial duct persistence and 12.86% were surgical repairs for closure of interventricular communication. The median stay in the intensive care unit was 4 days and the median stay in general hospitalization room was 5 days. The main complications in this pediatric population undergoing a surgical procedure were: pneumonia (11.4%) and sepsis of unspecified origin (8.6%). CONCLUSION: Treatment for heart diseases were performed at early ages (average age= 2.5±3.2). More than half of the surgical procedures for congenital heart disease were performed to correct the persistence of the ductus arteriosus, the main complication was pneumonia.

Perfil clínico e epidemiológico de usuários submetidos a cateterismo cardíaco num hospital universitário do Rio de Janeiro / Clinical-epidemiological profile of patients undergoing cardiac catheterization procedures at a university hospital in Rio de Janeiro state / Perfil clínico y epidemiológico de los usuarios sometidos a um cateterismo cardíaco en el hospital universitario de Río de Janeiro

Objective: The study's purpose has been to delineate the clinical-epidemiological profile of patients undergoing cardiac catheterization; furthermore, to propose a management technology to create a database with information of epidemiological relevance. Methods: It is a retrospective study with a quantitative approach, which considers the databases and medical records of 1,890 patients who underwent cardiac catheterization at a hemodynamic unit from April 2014 to April 2016. Microsoft Office Excel® software was used to both organize and analyze the data. CAAE No. 55615616.0.0000.5282. Results: The average age was 61.45 years old. The majority of the assisted population is indicated by the National Regulation System (63%) with the following distribution: (52.86%) male and (47.14%) female. It was identified that 79.5% of the users have high blood pressure. It was found that the current strategy for monitoring the assisted users shows information deficiencies

Objetivo: Traçar o perfil clínico-epidemiológico de usuários submetidos ao cateterismo cardíaco; propor uma tecnologia gerencial para criar um banco de dados com informações de interesse epidemiológico. Método: Estudo quantitativo, retrospectivo de bases de dados e prontuários de 1890 usuários submetidos ao procedimento na unidade de hemodinâmica entre abril/2014 e abril/2016. Utilizou-se o software Microsoft Office Excel® para organização e análise dos dados. CAAE:55615616.0.0000.5282 Resultados: A idade média é de 61,45 anos. A maioria da população atendida é encaminhada pelo Sistema de Regulação (63%) e sua distribuição: (52,86%) masculino e (47,14%) feminino. Identificou-se que 79,5% dos usuários são hipertensos. Verificou-se que a atual estratégia para acompanhamento dos usuários atendidos apresenta falhas nas informações. Conclusão: A consulta de enfermagem com a obtenção de informações relevantes e determinantes para as condutas de enfermagem, contribui para a melhoria do Sistema Único de Saúde. Descritores: Cateterismo cardíaco; Enfermagem; Fatores de risco; Hemodinâmica; Perfil epidemiológico

Investigation Route of the Coronary Patient in the Public Health System in Curitiba, São Paulo and in Incor - IMPACT Study / Itinerário de Investigação do Paciente Coronariano do SUS em Curitiba, São Paulo e Incor - Estudo IMPACT

Background: The investigation of stable coronary artery disease (CAD) and its treatment depend on risk stratification for decision-making on the need for cardiac catheterization and revascularization. Objective: To analyze the procedures used in the diagnosis and invasive treatment of patients with CAD, at the Brazilian Unified Health System (SUS) in the cities of Curitiba, São Paulo and at InCor-FMUSP. Methods: Retrospective, descriptive, observational study of the diagnostic and therapeutic itineraries of the Brazilian public health care system patient, between groups submitted or not to prior noninvasive tests to invasive cardiac catheterization. Stress testing, stress echocardiography, perfusion scintigraphy, catheterization and percutaneous or surgical revascularization treatment procedures were quantified and the economic impact of the used strategies. Results: There are significant differences in the assessment of patients with suspected or known CAD in the metropolitan region in the three scenarios. Although functional testing procedures are most often used the direct costs of these procedures differ significantly (6.1% in Curitiba, 20% in São Paulo and 27% in InCor-FMUSP). Costs related to the procedures and invasive treatments represent 59.7% of the direct costs of SUS in São Paulo and 87.2% in Curitiba. In InCor-FMUSP, only 24.3% of patients with stable CAD submitted to CABG underwent a noninvasive test before the procedure. Conclusion: Although noninvasive functional tests are the ones most often requested for the assessment of patients with suspected or known CAD most of the costs are related to invasive procedures/treatments. In most revascularized patients, the documentation of ischemic burden was not performed by SUS. .

Fundamento: A investigação da doença arterial coronariana (DAC) estável e seu tratamento dependem da estratificação de risco para a decisão sobre a necessidade de cateterismo cardíaco e revascularização. Objetivo: Analisar os procedimentos utilizados no diagnóstico e tratamento invasivo dos pacientes com DAC do Sistema Único de Saúde (SUS) nos municípios de Curitiba, São Paulo e no IIncor- FMUSP. Métodos: Estudo retrospectivo, descritivo, observacional dos itinerários diagnósticos e terapêuticos dos pacientes do SUS, entre os grupos submetidos ou não a testes não invasivos prévios ao cateterismo cardíaco invasivo. Foram quantificados os procedimentos de teste ergométrico, ecocardiograma de estresse, cintilografia de perfusão, cateterismo e tratamento com revascularização percutânea ou cirúrgica e o impacto econômico destas estratégias utilizadas. Resultados: Existem diferenças importantes na avaliação do paciente com DAC suspeita ou conhecida nos três cenários. Apesar dos testes funcionais serem os procedimentos mais frequentemente utilizados, os custos diretos referentes a esses procedimentos diferem significativamente (6,1% em Curitiba, 20% em São Paulo e 27% no Incor-FMUSP). Os custos relacionados aos procedimentos e tratamentos invasivos representam 59,7% dos custos diretos do SUS em São Paulo e 87,2% em Curitiba. No Incor-FMUSP, apenas 24,3% dos pacientes com DAC estável submetidos à revascularização foram submetidos a um teste não invasivo antes do procedimento. Conclusão: Apesar dos testes funcionais não invasivos serem os exames mais frequentemente solicitados na avaliação de pacientes com DAC suspeita ou conhecida, a maior parte dos custos está relacionada a procedimento/tratamento ...

Determinants of in-hospital cardiac catheterization in acute coronary syndrome patients in Kuwait

Clinical trials and practice guidelines have established the efficacy of early invasive strategy for high risk acute coronary syndrome [ACS] patients. This analysis was undertaken to detect the predictors of in-hospital cardiac catheterization [prior to hospital discharge] in patients with ACS in Kuwait and to assess if this use of early catheterization was according to published guidelines. We analyzed data from a prospective registry of 2054 consecutive patients admitted to all 7 general hospitals in Kuwait with the diagnosis of ACS over a period of 6 months in 2004. Citizens were more likely to receive in-hospital catheterization than expatriates [52.1% vs 38.6%; odds ratio 1.7; 95% confidence interval [CI], 1.4 to 2.2; p<0.001]. Patients with recurrent ischemia were more likely to undergo in-hospital catheterization than patients without recurrent ischemia [55.9% vs 12.2%; odds ratio 11.2; 95% CI, 8.6 to 14.5; p<0.001]. two coronary artery disease risk factors [hyperlipidemia and positive history] were associated with high rate of in-hospital cardiac catheterization [respectively, odds ratio 1.3; 95% CI, 1.2 to 2; p<0.001 and odds ratio 1.5; 95% CI, 1.3 to 2.3; p<0.001]. Although high risk patients benefit the most from an early invasive strategy after ACS, this strategy was persrvered for those with recurrent ischemia and citizens. Other risk factors were not determinants of in-hospital cardiac catheterization. Thus, there is substantial opportunity to improve the use of this effective therapy in high risk patients

Chronic obstructive pulmonary disease in patients with catheter diagnosed coronary artery disease: prevalence and risk factors

Chronic obstructive pulmonary disease [COPD] and coronary artery disease [CAD] co-morbidity exists at different rates. This co-morbidity affects quality of life and increases mortality. In the developing world the prevalence of CAD is increasing but the prevalence of COPD is unknown. This study was designed to estimate the proportion of patients with CAD who have concomitant COPD and identify factors that may increase the likelihood of COPD in CAD patients. A cross sectional study that included consecutive adults with catheter diagnosed CAD recruited from two cardiac centers. Patients completed a COPD diagnosis validated questionnaire and performed spirometry using an electronic spirometer. COPD was diagnosed if patient score placed him/her in the high likelihood zone of having COPD, or if the FEV1 was less than 80% predicted. Results were compared using chi-square test. Fifty nine patients with CAD were studied. The mean age [SD] was 59 [9.7] years. Of these 59 patients; 27 [44%] had COPD diagnosed by either questionnaire or spirometry. COPD was significantly more among patients with single vessel disease compared with multiple vessel disease [p = 0.01]. There was no difference in the number of smokers among patients with CAD and COPD, and CAD alone [p = 0.29]. The prevalence of COPD increased with increasing age [p=0.003]. In this group of patients with CAD more than two in five have concomitant COPD. The prevalence of COPD increases with age and is more in patients with single vessel disease compared with patients who have multiple vessel disease

Percutaneous transcatheter closure of patent ductus arteriosus using amplatzer duct occluder: first Yemeni experience

Results of transcatheter closure of Patent Ductus Arteriosus [PDA] using Amplatzer duct occluder are excellent and have replaced the conventional surgical closure of the PDA in the majority of the cases. To assess the immediate and short term results of Transcatheter closure of patent ductus Arteriosus < 6.5mm, using the Amplatzer Duct Occluder [ADO] for the first time in Yemen. Seventeen patients [11 females and 6 males] were diagnosed to have Patent Ductus Arteriosus between May 2003 to May 2005. They underwent an attempt of Transcatheter closure of the PDA with ADO. The median age was 5.1 years [range 7 months to 11 years], and weight ranged from 4kg to 30kg [median 5. 6 kg]. A 6F sheath was used for delivery of the ADO. The median PDA diameter at the narrowest segment was 4.1mm [range 2.5 to 6.5mm] and the mean pulmonary/systemic flow ratio [QP/QS] was 1.7:1 [range 1.2:1 to 3:1]. There was immediate and complete closure in 10/17 by angiography results. At 24 hrs, 16/17 patients had complete closure of PDAs on colour Doppler echocardiography. Ten patients out of seventeen have completed the 6 and 12 months follow-up and all had complete closure without any complications. Our initial results show that Amplatzer duct occluder is safe and effective in closing PDA in most patients with a PDA < 6.5mm in diameter

Sobrevida al egreso hospitalario de recién nacidos con cardiopatÝas congÚnitas sometidos a cirugÝa cardiaca o cateterismo intervencionista / Post-discharge survival of newborn infants with congenital cardiopathies undergoing heart surgery or interventional catheterization

OBJECTIVE: To report survival of newborns with congenital heart disease who underwent cardiac surgery during neonatal period. DESIGN: Descriptive, ambispective. SETTING: Neonatal Intensive Care Unit (NICU), Hospital de PediatrÝa, Centro MÚdico Nacional Siglo XXI. PATIENTS: We studied 74 newborns with congenital heart defects who underwent corrective surgery, palliative surgery or interventional techniques and received preoperative and postoperative care in NICU. Premature patients with patent ductus arteriosus were excluded. RESULTS: The following median values were found: birth weight was 2,862 g, gestational age was 39 weeks, onset of symptoms was 1 day, age at surgery was 14.5 days and postoperative hospital stay was 9 days. Most frequent congenital heart defects were single-ventricle, transposition of the great arteries and hypoplastic right heart. Fifty percent of surgeries were corrective, 46 were palliative and 4 were interventional techniques. Global survival was 51, for curative surgery was 43 and for palliative surgery was 58. Only 3 patients underwent interventional cardiology, 2 of them died (survival 33). CONCLUSIONS: Global survival in newborns who underwent cardiac surgery is lower in comparison with other studies. Survival is higher in children with palliative surgery in comparison with those who underwent corrective surgery.

Cateterismo cardiaco en México: Resultados del censo 1996 de Servicios de Cateterismo Cardiaco por la Sociedad Mexicana de Cardiología / Cardiac catheterization in Mexico. Results of the 1996 survey of cardiac catheterization service by the Mexican Society of Cardiology

Se presentan los resultados del censo 1996, realizado por la Sociedad Mexicana de Cardiología, de los servicios de cateterismo cardiaco en la República Mexicana. Existen 52 servicios distribuidos en 16 ciudades de 13 estados y el Distrito Federal. Las ciudades que tienen más de un servicio son las de México con 20, Guadalajara 6 y Monterrey 5. El 96 por ciento de los servicios se encuentran en hospitales, en los que se puede hacer cirugía cardiovascular. Ocho (17 por ciento) tiene programa de entrenamiento en cateterismo cardiaco. Dos (3.8 por ciento) están dedicados específicamente a cateterismo cardiaco pediátrico. Los médicos con privilegios para efectuar cateterismo cardiaco suman 270. La problemática relacionada con la distribución geográfica de servicios, volumen de casos y número de médicos que efectúan cateterismo cardiaco son discutidos.

Cateterismo cardíaco ambulatorial: análise da experiência acumulada em 10 meses / Outpatient Cardiac Catheterization. Analysis of a 10 Month Experience

Objetivo - Identificar pacientes que se prestem à estratégia do cateterismo cardíaco ambulatorial, com base nos aspectos sociais, riscos e complicações, por um período de 24 h. Métodos - Dos 2.126 casos submetidos a ca-teterismo cardíaco, no Instituto Dante Pazzanese de Cardiologia, no período de setembro de 1990 a junho de 1991, excluíramse: a) aqueles com idade superior a 75 anos; b) os com síndromes isquêmicas agudas; c) os com descompensação cardíaca classe IV (NYHA); d) os estudados pela técnica femoral com sistemas introdutores de alto perfil; e) os submetidos à anestesia geral, estudos eletrofisiológicos ou biópsias endomiocárdicas. Após a realização do exame, seguia-se período de observação de 3 h e, na ausência de complicacões, os pacientes re-cebiam alta com orientação de retorno obrigatório no dia seguinte, para reavaliação clínica. As eventuais complicacões deste período foram anotadas. Resultados - Dos 719pacientes elegíveis, 68% eram do sexo masculino, e a idade média era de 55,3 anos. Sessenta e um por cento estavam em classefuncional I da NYHA e a maioria (80,8%) foi estudada pela via braquial. Em 83% dos casos realizou-se a coronariografia, dos quais, 52%exibiam aterosclerose coronária. Quatrocentos e quatorze casos não receberam alta, pela seguintes razões: 217 por término do exame após as 18 h, 111 por razões sócio-econômicas, 23 por recusa do médico assistente, 8 devido à lesão do tronco da coronária esquerda e 55 por complicacões diversas. Todos os 305 pacientes que receberam alta ambulatorial não mostraram qualquer complicação na avaliação clínica do dia seguinte. Conclusão - O cateterismo ambulatorial demonstrou ser seguro em pacientes selecionados, viabilizando grande número de exames, com relativa economia de leitos e outros recursos hospitalares

Purpose - To identify patients suitable for out-patient cardiac catheterization strategy, based on social aspects, risks and complications, for a 24 hour period. Methods - In a series of 2.126 cases submitted to cardiac catheterization at the Instituto Dante Pazzanese de Cardiologia, between September 1990 and June 1991, were excluded: a) those over 75 years of age; b) the acute ischemic syndroms; c) those in NYHA functional class IV; d) patients who used 7 or 8 French femoral angiographtc catheters; e) patients who had undergone general anesthesia, electrophysiological study or endomyocardial biopsy. After the procedure, the patients were observed for a 3 hour period and in the absence of any complication, they were discharged from the hospital, returning the next day for clinical evaluation. If any complication occurred it was registered. Results - In a cohort of 719 eligible patients, 68% were male, with a mean age of 55,3 years. Sixty one per cent were in NYHA functional class I and most of them (80,8%) were studied by the brachial approach. Eigthy-three per cent of the patients were submitted to coronary angiography, with 52% of them having coronary artery disease. Four hundred and fourteen patients were not discharged on the same day: 217 did not have their procedures finish after 6p.m., 111forsocial-economical reasons, 23 because of theirphysician's refuse, 8 because of left main coronary disease, 55 because of any kind of complication. All the 305 patients who were discharged on the same day, did not have shown any complication in the next day evaluation. Conclusion - Outpatient cardiac catheterization is a safe technique in selected patients, making possible the accomplishment of a greater number of procedures improving bed utilization and decreasing hospitalar costs

Estudo epidemiologico de orovalvulopatias submetidas a cateterismo cardíaco: análise do últimos 10 anos da casuística da 6 enfermaria da Santa Casa da Misericórdia do Rio de Janeiro / Epidemiologic study of heart valve diseases submitted at cardiac catheterization

The authors studied 6,627 patients submitted to cardiac catheterization. These, about 825 had orovalvular disease. Orovalvular disease was more frequent in women in reason of three to two for man. The mitral valve lesion was the most frequent, with 53.78 per cent of cases. In men, the most frequent lesion was aortic. In women, the mitral. In most cases, there was only one valve with lesion, with predominance of mitral stenosis and, after, aortic insuficiency. In cases where there was association of lesions, the predominance was of mitro-aortica lesion. About half of patients who have had isolated lesion had too left ventricular disfunction. In these cases, the aortic insufficiency predominated.