Quantificação sistemática das artérias em biópsias pulmonares de pacientes com defeitos cardíacos congênitos e sua contribuição para a indicação e abordagem terapêutica / Systematic Quantification of the Arteries in Lung Biopsies of Patients with Congenital Heart Defects and its Contribution to the Therapeutic Indication / Systematic quantification of the arteries in lung biopsies of patients with congenital heart defects and its contribution to the therapeutic management

RESUMO

PURPOSE: To determine the value of the quantitative analysis of lung biopsies from patients with congenital cardiac defects. METHODS: Fourty nine biopsies were examined, from patients 43 patients increased pulmonary blood flow, 3 with pulmonary atresia and large systemic-to-pulmonary collateral vessels, and 3 with decreased pulmonary flow. The degree of lesion was determined as in Heath-Edwards and of Rabinovitch and col. RESULTS: The Heath and Edwards grade was determined in 41 cases; I in nine; II in 23; III in eight; IV in one; 3 biopsies showed evidence of reduced pulmonary flow and 5 had no signs of vascular disease. The Down patients (7) presented a greater proportion of severe lesions. Quantitative evaluation was obtained in 35 biopsies 11 had grade B and 24 had grade C. Wall atrophy and dilatation of intraacinar arteries were detected in 7 cases, what suggested the existence of obstructive lesions in proximal vessels, even if not sampled. Medical thickness greater than 2 times the normal were observed in pre-acinar arteries from 14 biopsies. CONCLUSION: The morphometric approach allowed us to detect severe lesions which the qualitative analysis alone would not indicate adequately. In the patients presenting decreased pulmonary flow, morphometry made possible to assess if the degree of arterial wall hypertrophy was compatible with a surgery of atrio-pulmonary anastomosis.