Seguimento tardio após correçäo de coarctaçäo da aorta: reintervençäo cirúrgica subsequente / Long-Term Follow-up After Correction of Coarctation of the Aorta. Subsequent Surgical Procedures

PURPOSE--To determine the frequency and main features of subsequent cardiovascular surgery in patients operated on for coarctation of the thoracic aorta. METHODS--One hundred and five patients operated on for coarctation of the aorta with a mean follow-up period of 14 years had their notes analysed. The patients were divided in 4 groups according to age at correction of the coarctation. The incidence of recoarctation repair and other cardiovascular operations were noted. RESULTS--Surgical morbidity was important: 33 per cent . Recoarctation occurred in 14 per cent of the cases, mainly in those who had the coarctation resected during the first year of life. Operation for other cardiovascular defects was necessary in 24.5 per cent of the cases. Among these, correction of left-to-right shunts was done in 50 per cent of the patients who had the coarctation resected in the first year of life. Relief of aortic stenosis was the most frequent procedure (73 per cent ), tends to be more frequent the other is the patient at coarctation repair and more than one procedure may be necessary in some cases. CONCLUSION--Reoperation is frequent in the long term of patients operated on for coarctation of the aorta. The elective coarctation should be repaired after the first year of life hoping to avoid recoarctation. Routine follow-up is advisable for all patients aiming to detect residual left-to-right shunts and left ventricular outflow tract obstruction. Family counseling regarding prognosis after coarctation resection is recommended

Indice nutricional em cardiopatias na infância / Nutritional index in heart diseases in childhood

Estudar incidência e repercussöes de cardiopatias sobre o estado nutricional de crianças. Duzentas crianças, dispostas em 3 grupos: 1) 113 (56,5%) com forma congênita acianótica; 2) 19 (9,5%) com forma congênita cianótica; e 3) 68 (34%) com forma adquirida, que freqüentaram o ambulatório de cardiologia pediátrica do Hospital das Clínicas da Faculdade de Medicina de Ribeiräo Preto da USP de 1987 a 1990. A média etária foi de 5,1 ñ 0,4 anos e 56% eram masculinos. Os diagnósticos mais freqüentes foram comunicaçäo interventricular (51 casos), comunicaçäo interatria (21 casos), valvopatias adquiridas (21 casos), arritmias benignas (20 casos), comprometimento cardíaco secundário a doenças sistêmicas (20 casos) e tetralogia de Fallot (8 casos). A maioria (92%) das crianças era portador de índice nutricional entre os percentis 5 abaixo do percentil 5 e apenas 4 (2%) acima do 95, consideradas obesas. Na comparaçäo entre os valores médios de índice nutricional, observou-se diferença estatisticamente significativa (p < 0,05) para os 3 grupos, o pior para as formas congênitas cianóticas e o melhor para as formas adquiridas. As cardiopatias na infância associam-se a reduçäo do índice nutricional na maioria dos casos

Purpose ­ To study heart disease in childhood aiming to know its incidence and consequences upon the nutritional status. Patients and Methods ­ Two-hundred patients were distributed in three groups: 1)113 (56.5%) with congenital acianotic form; 2) 19 (9.5%) with congenital cianotic form; and 3) 68 (34%) with acquired forms. All of them regularly visiting the ambulatory service of Paediatric cardiology of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da USP from 1987 until 1990. Results ­ The majority (92%) of the children (being 56% male and aging 5.1 ± 0.4 years-old) showed nutritional indexes between 5 and 95 (percentil scale). The overall diagnosis distribution were: 1) ventricular septal defect (51 cases); 2) atrial septal defect (21 cases); 3) valvular diseases (21 cases); 4) arrhythmias (20 cases); 5) cardiac involvement of systemic diseases (20 cases); and 6) tetralogy complex (8 cases). Twelve patients (6%) were underscored (below percentil 5) and only 4 (2%) scored above percentil 95 (obese patients). The comparison of the mean indexes were found statistical different (p < 0.05), being the cianotic congenital forms the worst ones and the acquired forms the best one. Conclusion ­ Heart disease in childhood is associated to nutritional index deficits in the majority of the cases.