Mortalidad por cardiopatías congénitas y adquiridas en niños de Villa Clara

RESUMEN Introducción: Las enfermedades cardiovasculares de la infancia constituyen un grupo heterogéneo de afecciones congénitas y adquiridas que representan una causa importante de morbilidad y mortalidad pediátricas. Objetivo: Describir clínica y epidemiológicamente a los pacientes pediátricos fallecidos por enfermedades cardiovasculares entre los años 2005 y 2017. Métodos: Estudio descriptivo transversal retrospectivo en los 117 pacientes pediátricos fallecidos con diagnóstico de enfermedades cardiovasculares en la provincia de Villa Clara, entre los años 2005 y 2017, con predominio del análisis documental como método de investigación. Resultados: Se obtuvo una tasa de mortalidad de 1,6 por cada 1000 nacidos vivos con tendencia a disminuir en el tiempo, con predominio de los fallecidos con piel blanca (70,09 %), y sin diferencias en cuanto al sexo. Fueron más frecuentes las cardiopatías congénitas (75,21 %) como coartación aórtica y transposición de grandes vasos. Entre las cardiopatías adquiridas fue la miocarditis la más frecuente (79,30 %). Se diagnosticaron en la primera semana de vida 48,70 % de los pacientes y recibieron tratamiento médico 63,25 % de los pacientes. Las causas de muerte más frecuentes fueron la propia cardiopatía congénita de base y la disfunción multiorgánica por sepsis en el grupo de las congénitas y en las adquiridas el shock cardiogénico. Conclusiones: Predominaron las cardiopatías congénitas fundamentalmente la coartación aórtica. La mayoría de los pacientes recibieron solo tratamiento médico y las principales causas directas de muerte fueron la propia cardiopatía congénita y la disfunción multiorgánica.

ABSTRACT Introduction: Children cardiovascular diseases constitute a heterogeneous group of congenital and acquired conditions that represent an important cause of pediatric morbidity and mortality. Objective: Describe clinically and epidemiologically pediatric patients who died of cardiovascular diseases between 2005 and 2017. Methods: A retrospective cross-sectional descriptive study was conducted in the 117 pediatric patients who died with a diagnosis of cardiovascular diseases in the Villa Clara province, between 2005 and 2017, with a predominance of documentary analysis as a research method. Results: A mortality rate of 1.6 per 1000 live births was obtained, with a tendency to decrease over time, with a predominance of those who died with white skin (70.09%), and without differences in sex. Congenital heart disease (75.21%) was more frequent, such as aortic coarctation and transposition of large vessels. Among the acquired heart diseases, myocarditis was the most frequent (79.30%). 48.70% of patients were diagnosed in the first week of life and 63.25% of patients received medical treatment. The most frequent causes of death were congenital heart disease itself and multi-organ dysfunction due to sepsis in the congenital group and in those acquired cardiogenic shock. Conclusions: Congenital heart disease predominated, mainly aortic coarctation. Most patients received only medical treatment and the main direct causes of death were congenital heart disease itself and multi-organ dysfunction.

Cardiopatías y embarazo, ¿donde están los límites? / Cardiopathies and pregnancy, where are the limits?

Las pacientes embarazadas que presentan cardiopatías congénitas(CC) o adquiridas(CADQ) con diverso grado de DSVI, algunas con severa HTP, la mayoría sin conocimiento de su enfermedad, sin tratamiento específico y sin información acerca del riesgo, dada la morbi-mortalidad materno-infantil e inestabilidad hemodinámica deben ser derivadas a centros de mayor complejidad. Objetivos: Estratificar los riesgos quepresenta esta población con CC o CADQ durante el pre y posparto; identificar incidencia de morbimortalidadmaterna y fetal en este grupo y evaluar con el equipo tratante la conducta adecuada. Material y Métodos: Encontramos 18 embarazadas portadoras de cardiopatías. Congénitas: 2 con HTP Primaria, CIA,CIV+Ductus, 2 con Persistencia del Conducto Arterioso e HTP, Obstrucción TSVD con EP, VU+EP, 2 con Enfermedad de Ebstein. Adquiridas: EM severa+HTP, Chagas con DSVI, Chagas y marcapaso definitivo, 2 con MH, Miocardio no compactado, IT post-Endocarditis infecciosa, Preeclampsia, Miocardiopatía periparto Resultados: Edad media 30.7años, la peor evolución se asoció a DSVI e HTP. Se realizó cesárea al 77.7%,mortalidad materna:22.2%, fetal:16.7%. Conclusiones: Factores sociales, culturales y económicos, dificultanel diagnóstico precoz de las cardiopatias en embarazadas; la no contracepción y la consulta tardía dificultansu control. La HTP severa y la DSVI marcada juegan un rol crucial en el pronóstico de las madres y del reciénnacido. La preeclampsia además constituye un FR cardiovascular alejado.

Pregnant women with congenital heart disease (CHD) or acquired (CADQ) with varying degrees of LVSD,some with severe pulmonary hypertension, most without knowledge of their disease without specific treatmentand no information about the risk, given the morbidity and maternal mortality -Infant and hemodynamic instability should be referred to centers of greater complexity. Objectives: To stratify the risks to thepopulation CC or CADQ during the pre and postpartum; identify incidence of maternal and fetal morbidity andmortality in this group and the treating team assess appropriate behavior. Material and Methods: We found18 pregnant carriers of heart disease. Congenital: 2 with primary PH, ASD, VSD + Ductus, 2 Ductus and PH,RVOT obstruction PS, VU + PS, 2 with Ebstein disease. Acquired: severe MS + PH, Chagas LVSD, Chagasand permanent pacemaker, 2 HCM, non-compacted myocardium, IT post-infectious endocarditis, Preeclampsia, peripartum cardiomyopa thy Results: Average age 30.7años, the worse outcomes associated with LVSD and PH . 22.2%, fetal: 16.7% to 77.7% cesarean section, maternal mortality was conducted. Conclusions: social, cultural and economic factors hinder early diagnosis of heart disease in pregnant; noncontraception and the late consultation impede the control. The severe LVSD marked HTP and play a crucialrole in the prognosis of mothers and newborn. Preeclampsia also constitutes an away cardiovascular RF.

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.