Brazilian fetal cardiology guidelines ­ 2019 / Diretriz brasileira de cardiologia fetal ­ 2019

Over the years, Fetal Cardiology have been incorporated into the daily practice of Pediatric Cardiology. What was once restricted to a few fetal heart researchers, has slowly been incorporated into health institutions that deal with congenital heart diseases (CHD). Fetal echocardiography has generated extensive knowledge of the natural and modified history of heart diseases in utero, and normal fetal heart physiology and anatomy. The benefits of fetal diagnosis have become unquestionable over the years. Pioneers in the area succeeded in demystifying the fetal heart examination and proving the importance of screening for cardiac abnormalities during obstetric examinations. Prenatal detection rates have increased, and interest in fetal echocardiography is, thus, no longer merely a diagnostic tool; it has gone on to become a tool of the utmost importance in assisting medical and, progressively, interventional treatment of specific anomalies that occur in fetal life. A vast body of literature currently supports the practice of Fetal Cardiology. In addition to diagnosis, anatomical and functional particularities may be identified in utero, with implications on the delivery planning and pre and postnatal management. Prenatal diagnosis has certainly led to increase the number of babies with complex heart diseases in Pediatric Cardiology hospital beds. Prior to this, children with complex heart diseases did not survive the immediate neonatal period and died in neonatal intensive care units without being diagnosed. Nowadays, these children require increasingly careful and specific management involving Pediatric Cardiology and thus modifying the practice of Neonatal Cardiology. Despite the vast literature pertinent to Fetal Cardiology, due to the restricted number of cases, there is a lack of studies with large populations and randomization processes, being the information based on observational studies and description of small samples or cases reports. However, the accumulated knowledge is already enough to develop scientific statements or guidelines. In April 2014, the American Heart Association (AHA) published the first scientific statement for Fetal Cardiology, encompassing all the practical aspects involved in this area, including screening, diagnosis, medical or interventional therapy, counseling, delivery planning, and neonatal treatment. Considering this extremely thorough and highly useful document, we have accepted the challenge of bringing together professionals dedicated to Fetal Cardiology from different regions of Brazil in order to jointly establish guidelines which are adapted to our reality and which also take into consideration knowledge created in Brazil. We believe that the information brought together in this document will be of great use to professionals who face the challenge of dealing with possible abnormalities that affect the fetal heart in their daily practice. (AU)

Association between Clinical and Doppler Echocardiographic Parameters with Sudden Death in Hemodialysis Patients / Associação entre Parâmetros Clínicos e Ecodopplercardiográficos com Morte Súbita em Pacientes de Hemodiálise

Abstract Background: Sudden cardiac death (SCD) is the leading cause of death in maintenance hemodialysis (HD) patients, but there is little information about underlying risk factors. Objectives: Evaluate the association between clinical and echocardiographic variables with SCD on HD patients. Methods: Retrospective nested case-control study on chronic HD patients who were prospectively followed. The primary endpoint was SCD. Variables were compared by Student t test, Mann-Whitney or Chi-Square, and independent predictors of SCD were evidenced by multivariate logistic regression. Results: We followed 153 patients (50 ± 15 years, 58% men) for 23 ± 14 months and observed 35 deaths, 17 of which were SCD events. When compared to the control group (matched for gender, age, and body mass index) there were no differences regarding time on dialysis, traditional biochemical parameters, blood pressure, smoking, use of cardiovascular protective drugs, ejection fraction, left ventricular dimensions, and diastolic function indices. On the other hand, in the SCD group, we found a higher prevalence of previous heart failure, acute myocardial infarction and diabetes, greater left ventricular mass index, greater left atrial size and lower global myocardial performance. After multivariate logistic regression analysis, diabetes (OR = 2.6; CI = 1.3-7.5; p = 0.023) and left ventricular mass index ≥ 101 g/m2.7 (OR = 1.04; CI = 1.01-1.08; p = 0.028) showed independent association with SCD events. Conclusions: HD patients with diabetes mellitus and left ventricular hypertrophy appear to have the highest risk of SCD. Preventive and therapeutic strategies should be encouraged in addressing these risk factors to minimize the occurrence of SCD in HD patients.

Resumo Fundamento: Morte súbita cardiovascular (MSC) é a principal causa de óbito nos pacientes em hemodiálise (HD) de manutenção, mas há escassa informação sobre os fatores de risco associados. Objetivos: Avaliar a associação entre parâmetros clínicos e ecodopplercardiográficos com MSC em pacientes em HD. Métodos: Estudo retrospectivo de caso-controle aninhado em pacientes em HD prospectivamente acompanhados. O desfecho primário foi MSC. As variáveis foram comparadas por teste t de Student, Mann-Whitney ou qui-quadrado, e preditores independentes foram evidenciados por análise de regressão logística multivariada. Resultados: Foram acompanhados 153 indivíduos (idade 50 ± 15 anos, 58% homens) por 23 ± 14 meses, período em que ocorreram 35 mortes, das quais 17 MSC. Comparados ao grupo controle (pareado para sexo, idade e índice de massa corpórea) não houve diferenças no tempo de tratamento por HD, parâmetros laboratoriais usuais, pressão arterial, tabagismo, uso de drogas cardioprotetoras, fração de ejeção, dimensões do ventrículo esquerdo e índices de função diastólica. Por outro lado, encontrou-se no grupo MSC maior prevalência de insuficiência cardíaca prévia, infarto agudo do miocárdio e diabetes; maior massa ventricular esquerda indexada, tamanho do átrio esquerdo e menor desempenho miocárdico global. Após análise multivariada, diabetes (OR = 2,6; IC = 1,3-7,5; p = 0,023) e massa ventricular esquerda indexada (OR = 1,04; IC = 1,01-1,08; p = 0,028) mostraram associação independente com a ocorrência de MSC. Conclusões: Pacientes em HD com diabetes mellitus e hipertrofia ventricular esquerda parecem ter o maior risco de MSC. Estratégias preventivas e terapêuticas devem ser estimuladas na abordagem desses fatores de risco para diminuir a ocorrência de MSC.

Association between Clinical and Doppler Echocardiographic Parameters with Sudden Death in Hemodialysis Patients.

BACKGROUND: Sudden cardiac death (SCD) is the leading cause of death in maintenance hemodialysis (HD) patients, but there is little information about underlying risk factors. OBJECTIVES: Evaluate the association between clinical and echocardiographic variables with SCD on HD patients. METHODS: Retrospective nested case-control study on chronic HD patients who were prospectively followed. The primary endpoint was SCD. Variables were compared by Student t test, Mann-Whitney or Chi-Square, and independent predictors of SCD were evidenced by multivariate logistic regression. RESULTS: We followed 153 patients (50 ± 15 years, 58% men) for 23 ± 14 months and observed 35 deaths, 17 of which were SCD events. When compared to the control group (matched for gender, age, and body mass index) there were no differences regarding time on dialysis, traditional biochemical parameters, blood pressure, smoking, use of cardiovascular protective drugs, ejection fraction, left ventricular dimensions, and diastolic function indices. On the other hand, in the SCD group, we found a higher prevalence of previous heart failure, acute myocardial infarction and diabetes, greater left ventricular mass index, greater left atrial size and lower global myocardial performance. After multivariate logistic regression analysis, diabetes (OR = 2.6; CI = 1.3-7.5; p = 0.023) and left ventricular mass index ≥ 101 g/m2.7 (OR = 1.04; CI = 1.01-1.08; p = 0.028) showed independent association with SCD events. CONCLUSIONS: HD patients with diabetes mellitus and left ventricular hypertrophy appear to have the highest risk of SCD. Preventive and therapeutic strategies should be encouraged in addressing these risk factors to minimize the occurrence of SCD in HD patients.

[Right atrial aneurysm associated to fetal hydrops: diagnosis through fetal echocardiography]. / Aneurisma do átrio direito associado à hidropisia fetal: diagnóstico por ecocardiografia fetal.

Right atrium aneurysms are entities which are rarely reported in cardiologic practice, especially in intrauterine life, and may be mistaken with pericardial effusion and Ebstein's anomaly. We show a review of the literature and illustrate with a case of prenatal diagnosis of right atrium aneurysm running through with hydropsy signs.

Aneurisma do átrio direito associado à hidropisia fetal: diagnóstico por ecocardiografia fetal / Right atrial aneurysm associated to fetal hydrops: diagnosis through fetal echocardiography

Os aneurismas de átrio direito são entidades raramente relatadas na prática cardiológica, especialmente em vida intra-uterina, e podendo ser confundidos com derrame pericárdico e anomalia de Ebstein da valva tricúspide. Apresentamos revisão da literatura e ilustramos com caso de diagnóstico pré-natal de aneurisma de átrio direito cursando com sinais de hidropisia.

Aneurysm of the right atrial appendage.

Atrial aneurysms involving the free wall or atrial appendage are rare entities in cardiology practice and may be associated with atrial arrhythmias or embolic phenomena. We review the literature and report a case of aneurysm of the right atrial appendage in a young adult, whose diagnosis was established with echocardiography after an episode of paroxysmal atrial flutter.

Aneurisma de aurícula direita / Aneurysm of the right atrial appendage

Atrial aneurysms involving the free wall or atrial appendage are rare entities in cardiology practice and may be associated with atrial arrhythmias or embolic phenomena. We review the literature and report a case of aneurysm of the right atrial appendage in a young adult, whose diagnosis was established with echocardiography after an episode of paroxysmal atrial flutter

Taquicardia supraventricular sustentada associada a hidropsia fetal: diagnostico e evolucao desfavoravel / Sustained supraventricular tachycardia associated with hydrops fetalis: diagnosis and poor evolution

Relata-se um caso de feto com taquicardia supraventricular sustentada, associada a hidropsia. Apos falha em se reverter a taquicardia com a digoxina, optou-se pela amiodarona. Embora esta ultima tenha se mostrado eficaz no controle da taquicardia, o feto nao tolerou o longo periodo em taquiarritmia e evoluiu para o obito