Ecocardiografía funcional como una herramienta de evaluación dinámica del tratamiento en neonatos críticamente enfermos / Functional echocardiography as a tool for the dynamic treatment evaluation in critically ill neonates

Resumen Introducción: Aún existe controversia sobre la utilidad de la ecocardiografía funcional (EcoFn) en la valoración cardiovascular de neonatos críticamente enfermos. Objetivo: Analizar la utilidad de la EcoFn en la modificación de tratamiento en neonatos ingresados a una Unidad de Cuidados Intensivos Neonatales (UCIN). Material y métodos: Estudio prospectivo en una UCIN durante un año mediante EcoFn realizada por un cardiólogo capacitado en pacientes en sus primeras 72 horas de vida extrauterina, con valoración de la funcionalidad cardiaca y presencia de alteraciones estructurales. Con base en los hallazgos se analizaron las modificaciones al tratamiento. Resultados: 37 neonatos fueron evaluados con EcoFn en dos ocasiones: una diagnóstica y otra de seguimiento. En 11 (29.7%) se encontró daño estructural y funcional, en 9 (24.3%) solo funcional, en 7 (18.9%) solo estructural y en 10 (27%) no se observaron alteraciones. En el 70% se realizó al menos un cambio de tratamiento. Los cambios más frecuentes fueron modificaciones al apoyo ventilatorio (63%), seguido del apoyo aminérgico (19.5%) y modificaciones en el aporte de líquidos (10.8%). En todos los casos los cambios mejoraron las condiciones clínicas de los neonatos. Conclusiones: La EcoFn permitió determinar mejor las condiciones estructurales y hemodinámicas de los pacientes y realizar modificaciones terapéuticas más precisas.

Abstract Introduction: It is still controversy about the usefulness of functional echocardiography (FnEC) in critically ill neonates. Objective: To analyze the usefulness of the FnEC in the treatment decisions in neonates admitted to a Neonatal Intensive Care Unit (NICU). Materials and methods: A year prospective study in a NICU. A trained cardiologist performed a FnEC to 72 h of life patients to evaluate the cardiac function and heart structure. We analyzed the clinical decisions after the findings. Results: 37 neonates underwent two FnEC: at the diagnosis and at follow-up. Eleven patients (29.7%) had structural and functional abnormalities, 9 (24.3%) only functional, 7 (18.9%) only structural, and in the rest, 10 (27%), were normal. Al least one change in the management occurred in 70% of the patients. The main changes were to the ventilatory support (63%), followed by inotropic support (19.5%) and fluid intake (10.8%). In all changes, we observed an improvement in the clinical conditions of the neonates. Conclusions: The FnEC allowed to determinate the cardiovascular structures and hemodynamic conditions of the patients and make a more precise therapeutic modifications.

Avaliação prospectiva do sistema cardiovascular em adolescentes jogadores de futebol / Prospective assessment of the cardiovascular system among teenage soccer players

Avaliar o efeito cardiovascular do treinamento físico em adolescentes jogadores de futebol da categoria infantil de um time profissional da cidade de Salvador. Métodos: Estudo prospectivo realizado durante o período de maio de 2004 a outubro de 2005 em 27 atletas do sexo masculino com a idade variando de 13 a 16 anos e um grupo de 11 adolescentes com prática esportiva a nível escolar. O grupo de atletas foi submetido em duas oportunidades e o grupo controle em uma, á avaliação clínica e a exames complementares como o ECG, Teste ergométrico, Ecocardiograma e a Espirometria. Estatística: a diferença entre as médias foi avaliada com o T de Teste Student para amostra pareadas. Resultados: Quando comparadas as duas avaliações funcionais (Anos 2004 a 2005 dos atletas, detectou-se um aumento significativo do V02 (p<0,009). A comparação entre os dois grupos mostrou um V02 superior nos jogadores (p<0,004). a comparação com os dois ecocardiogramas de 2004 e 2005 feitos nos atletas mostrou um aumento nos diâmetros das câmaras cardíacas (p<0,002), como também na massa ventricular (p<0,007). Já as espessuras musculares das paredes do ventrículo esquerdo não mostram uma diferença significativa (p<0,06). a comparação dos achados ecocardiográficos entre os dois grupos não demonstrou diferença em nenhuma das variáveis estudadas (p<0,4). Conclusão: A comparação das duas avaliações dos atletas mostrou um aumento significativo da superfície corporal, do V02, das câmaras cardíacas e massa ventricular. O estudo realizado com esta amostra sugere que o treinamento físico realizado nos atletas de futebol não causa um aumento significativo da massa ventricular ou das câmaras cardíacas quando comparado com outros esportes.

To evaluate the cardiovascular effect of regular physical training in adolescent football players of infantile category of professional teams of Salvador city. Methods: Prospective study carried from May 2004 to October 2005, in 27 men athletes, age ranging from 13 to 16 years, matched to 11 adolescents with exercise training by school level. The athlete group was evaluated twice and the control once clinical evaluation and the complementary examination as ECG, Ergometric Test, Echocardiogram and Spirometry. Statistics: The difference between averages was a significant of V02 (p<0,009). The comparison between group showed higher V02 in athletes (p<0,004). The comparasion of the two echocardiograms (Years 2004, 2005) in athletes showed an increase in the cardiac chambers diameters (p<0,002), as well as in the ventricular mass (p<0,007). Muscular thicknesses of the left ventricle walls did not show difference (p<0,6). The comparison of echocardiographic findings between groups did not demonstrate difference in none of the studied variables (p<0,4). Conclusion: The comparison of the two evaluations of the thçetes showed a significant increase of the corporal surface, V02, cardiac chambers and ventricular mass. the study suggests that physical training in the soccer athletes do not lead to significant of the ventricular mass or cardiac chambers when compared with other sports.

Cardiovascular findings of Hutchinson-Gilford syndrome: a Doppler and two-dimensional echocardiographic study

Progeria, also known as Hutchinson-Gilford syndrome, is an extremely rare condition originally described by Hutchinson in 1886. Death results from cardiac complications in the majority of cases and usually occurs at an average age of fourteen years. We recently experienced a patient with progeria who died suddenly after symptomatic improvement with conservative treatment. A Doppler and two-dimensional echocardiographic study revealed an enlarged and hypertrophied left ventricle with reduced global systolic function and senile aortic calcific stenosis (peak systolic pressure gradient: 50 mmHg) with a moderate degree of aortic regurgitation. Doppler findings of restrictive hemodynamic suggest severe left ventricular dysfunction due to multiple influences from the aging process, coronary artery and valvular heart disease