RESUMO
Presentamos una revisión de 8 casos de bloqueo atrioventricular (BAV) congénito diagnosticados prenatalmente, controlados en el Centro de Referencia Perinatal Oriente (CERPO) entre 2003-2006. Entre las 8 gestantes portadoras de fetos con BAV encontramos tres casos asociados a malformación cardíaca y cinco casos aislados. Las cardiopatías estructurales corresponden a un caso de síndrome de hipoplasia ventricular izquierdo (SHVI) y dos casos a transposición de grandes arterias corregida (L-TGA). Entre los bloqueos aislados hubo un único caso con estudio serológico positivo para autoanticuerpos maternos anti-Ro y anti-La. Se diagnosticaron seis BAV completos y dos BAV de 2º grado (tipo Mobitz II). Un caso recibió terapia fetal transplacentaria con dexametasona, manteniéndose en bloqueo de 2º grado hasta el parto. Seis de las ocho pacientes fueron derivadas desde otras regiones al CERPO. El resultado perinatal fue satisfactorio, salvo una muerte fetal ocurrida en un BAV completo asociado a SHVI y presencia de hidrops fetal. Todos los casos necesitaron implantación de marcapasos, entre el primer día y hasta los 10 meses de vida. Hubo un caso de mortalidad postneonatal por sepsis, posterior a la corrección quirúrgica de una comunicación interventricular. El seguimiento postnatal fluctúa entre los 3 meses y 1 año 8 meses de vida. Todos los pacientes asisten a control periódico en cardiología infantil, se encuentran en buenas condiciones y sin secuelas.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Gravidez , Recém-Nascido , Lactente , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/terapia , Bloqueio Cardíaco , Cardiopatias Congênitas/complicações , Doenças Autoimunes/complicações , Índice de Apgar , Evolução Clínica , Ecocardiografia , Doenças Fetais , Seguimentos , Hidropisia Fetal , Marca-Passo Artificial , Assistência Perinatal , Prognóstico , Ultrassonografia Pré-NatalRESUMO
Background: Chile has a National Health Services System, formed by 29 Health Services. An efficient resource distribution among this services is crucial for an efficient health care delivery. Aim: To obtain indices from the Chilean Public Health Services, that could improve allocation of resources. Material and methods: Information from the Chilean Public Health Services, corresponding to activities during 2001 budgetary period, was collected. This is the latest complete and official information for the totality of Health Services in the country. Seventeen variables generated or monitored by the Instituto Nacional de Estadísticas (INE), the Ministerio de Salud (MINSAL), the Ministerio de Hacienda, the Ministerio de Planificación y Cooperación (MIDEPLAN) and the Fondo Nacional de Salud (FONASA) were studied. The Main Components Analysis (ACP) was used, obtained from the R correlation matrix. Results: The first two main components were selected, with an accumulated percentage of explained variability of 63.05 percent. The first component is related to the population assigned to each Health Service. This corresponds to the number of people needed to treat in the hospitals of these Services and their answer to this demand, justified by the expenses in which each Health Service incurs. There is an inverse relation of the first component with health indicators, measured by burden of disease and death. The second main component would represent the social and economic characteristics of the population, poor and ery poor populations and public health insurance beneficiaries, to take care of in each Health Service. Conclusions: Health indicators in each Health Service are not considered a priority for resource distribution among Health Services in the country. The transference is done considering the indices contained in the two main components defined.