ABSTRACT
BACKGROUND: In countries where organ donation is scarce, mortality in the pediatric heart transplant waiting list is high, and ventricular assist devices (VADs) are therapeutic alternatives in these situations. Berlin Heart EXCOR is currently 1 of the few VADs specific for children. METHODS: This retrospective study includes pediatric patients who underwent Berlin Heart EXCOR placement in a Brazilian hospital between 2012 and 2021. Clinical and laboratory data at the time of VAD implantation and the occurrence of complications and outcomes (success as a bridge to transplant or death) were analyzed. RESULTS: Eight patients, from 8 months to 15 years, were included: 6 with cardiomyopathy and 2 with congenital heart disease. Six were on Intermacs 1 and 2 on Intermacs 2. The most common complications observed were stroke and right ventricular dysfunction. Six were transplanted, and 2 died. Those submitted to transplant had a higher mean weight than those who died, with no statistically significant difference. The underlying disease had no impact on the outcome. The group undergoing transplant had lower brain natriuretic peptide and lactate values, but no laboratory variable showed a statistically significant difference in the outcome. CONCLUSION: A VAD is an invasive treatment with potentially serious adverse effects and is still poorly available in Brazil. However, as a bridge to transplant, it is a useful treatment for children in progressive clinical decline. In this study, we did not observe any clinical or laboratory factor at the time of VAD implantation that implied better outcomes.
Subject(s)
Cardiovascular System , Heart Failure , Heart Transplantation , Heart-Assist Devices , Child , Humans , Heart Failure/surgery , Retrospective Studies , Treatment Outcome , Heart Transplantation/adverse effects , Heart-Assist Devices/adverse effectsABSTRACT
Central Illustration : Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023 Proposal for including strain in the integrated diastolic function assessment algorithm, adapted from Nagueh et al.67 Am: mitral A-wave duration; Ap: reverse pulmonary A-wave duration; DD: diastolic dysfunction; LA: left atrium; LASr: LA strain reserve; LVGLS: left ventricular global longitudinal strain; TI: tricuspid insufficiency. Confirm concentric remodeling with LVGLS. In LVEF, mitral E wave deceleration time < 160 ms and pulmonary S-wave < D-wave are also parameters of increased filling pressure. This algorithm does not apply to patients with atrial fibrillation (AF), mitral annulus calcification, > mild mitral valve disease, left bundle branch block, paced rhythm, prosthetic valves, or severe primary pulmonary hypertension.
Figura Central : Posicionamento do Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia sobre o Uso do Strain Miocárdico na Rotina do Cardiologista 2023 Proposta de inclusão do strain no algoritmo integrado de avaliação da função diastólica, adaptado e traduzido de Nagueh et al. 67 AE: átrio esquerdo; Ap: duração da onda A reversa pulmonar; Am: duração da onda A mitral; DD: disfunção diastólica; FEVEr: fração de ejeção do ventrículo esquerdo reduzida; IT: insuficiência tricúspide; SAEr: strain do AE de reservatório; SLGVE: strain longitudinal global do ventrículo esquerdo. Se remodelamento concêntrico, confirmar com SLGVE. Na presença de FEVEr, tempo de desaceleração da onda E mitral (TDE) < 160 ms e onda S < D pulmonar também são parâmetros de pressão de enchimento aumentada. Esse algoritmo não se aplica a pacientes com fibrilação atrial (FA), calcificação do anel mitral ou valvopatia mitral maior que discreta, bloqueio de ramo esquerdo (BRE), ritmo de marca-passo, próteses valvares ou hipertensão pulmonar (HP) primária grave.
Subject(s)
Atrial Fibrillation , Cardiology , Ventricular Dysfunction, Left , Humans , Echocardiography, Doppler , Brazil , Atrial Fibrillation/diagnostic imaging , Heart Atria/diagnostic imaging , Ventricular Function, LeftSubject(s)
Humans , Child , Adult , Cardiovascular Diseases/diagnostic imaging , COVID-19/physiopathology , COVID-19/transmission , COVID-19/diagnostic imaging , Security Measures , Echocardiography/methods , Surveys and Questionnaires , Physical Contaminants/prevention & control , Echocardiography, Stress/methods , Clinical Trial Protocols as TopicABSTRACT
Se pretende conocer las estrategias de afrontamiento que utilizan los padres de niños con cáncer ante al reto que supone esta enfermedad. Se ha utilizado una metodología de investigación grupal y cualitativa. La muestra la constituyen 14 madres/padres cuyos hijos hace más de dos años que han contraído la enfermedad. Se ha comprobado que los padres utilizan una gran variedad de estrategias. Unas son activas: centrada en el problema (adecuación a la acción y calma, entereza y reflexión); regulación afectiva; búsqueda de información; adquisición de apoyo social, instrumental, informativo y/o emocional; reevaluación o reestructuración cognitiva y pensamiento positivo; y distracción. Otras son pasivas: rumiación, huida/evitación, y aislamiento social. El conocimiento de estas estrategias es de gran utilidad para los profesionales de la educación en la comprensión de las reacciones de los padres, en la comunicación e interrelación con ellos y en la orientación familiar (AU)
It aims to determine the coping strategies used by parents of children with cancer. We used a research methodology, that is both group-based (self-help groups) and qualitative (discourse analysis of participants in group sessions). The sample is composed of 14 parents whose children contracted the disease more than two years before. There is evidence that parents use a variety of strategies to meet the challenge of disease of their children. Some are active: problem solving, adapting to circumstances and calm, courage, reflection, affect regulation, searching for information, seeking and acquiring social support, instrumental, informational and/or emotional, reappraisal or cognitive restructuring, positive thinking, and distraction. Others are passive: rumination, escape/avoidance, and social withdrawal. Knowledge of these strategies is useful to professionals of education to understand the reactions of parents, to communicate and interact with them and for family counseling (AU)
Subject(s)
Humans , Resilience, Psychological , Neoplasms/psychology , Family Relations , Parent-Child Relations , Child Guidance , Social SupportABSTRACT
Actualmente la intervención e investigación en psicooncología pediátrica se dirige hacia la evaluación de las consecuencias de la enfermedad y los efectos secundarios de los tratamientos, y a los factores predictivos tanto de desajustes como de aspectos adaptativos a la enfermedad del paciente y de su familia. Las tasas de curación alcanzadas en la actualidad, nos permiten contar con un número considerable de supervivientes de cáncer infantil, susceptibles de ser evaluados y poder determinar así las secuelas a largo plazo de la enfermedad y sus procedimientos terapéuticos. Además de incrementar considerablemente la supervivencia, también se ha mejorado la calidad de vida de los niños, mediante el tratamiento de soporte que amortigua notablemente los efectos secundarios de los tratamientos y su toxicidad, permitiendo de este modo, junto con la intervención temprana de los equipos multidisciplinares, que el niño mantenga continuidad con sus actividades habituales, aún estando en el periodo de tratamiento. Durante la última década, diversos estudios ponen de manifiesto la ausencia de diferencias significativas entre niños enfermos oncológicos, en relación a la población de niños sanos, en cuanto al funcionamiento psicosocial se refiere. No obstante, los pacientes afectos de tumores cerebrales y leucemias u otros tumores que han recibido quimioterapia intratecal y/o irradiación cráneo-espinal, constituyen un grupo de riesgo que requiere de una evaluación y un tratamiento específico (AU)
Nowadays, intervention and research in pediatric psychooncology is leading towards evaluation of neoplastic disease and treatment consequences, as well as predictive factors of adaptative aspects related to disease and family. High rates of survival in pediatric oncology imply an important number of pediatric cancer survivors, whose psychological and neuropsychological evaluation is crucial to determine long term sequelae. Quality of survival has also improved considerably due to improvements in supportive treatment along years, decreasing acute side effects. This fact as well as early intervention by multidisciplinary teams let the child continue his/her daily activities, even during oncologic treatment. In the last decade, several studies have shown the absence of significative differences between cancer patients and their peers, as far as social functioning is concerned. Nevertheless, patients with brain tumors and leukemias treated with radiotherapy/intrathecal chemotherapy are a risk group that required a specific evaluation and treatment (AU)
Subject(s)
Humans , Male , Female , Child , Central Nervous System Neoplasms/complications , Leukemia/complications , Radiotherapy/adverse effects , Radiation Injuries/rehabilitation , Neuropsychological Tests , Cognition Disorders/rehabilitation , Child Behavior Disorders/rehabilitationABSTRACT
Objetivos: conocer cómo perciben los padres los cambios producidos en las relaciones familiares debidos a un cáncer pediátrico. Método: Se ha utilizado una metodología de investigación grupal (grupos de autoayuda) y cualitativa (análisis del discurso de los participantes en las sesiones grupales). La muestra la constituyen 22 madres/padres cuyos hijos hace más de dos años que han contraído la enfermedad. Las sesiones grupales se realizaron en la sede de ASPANION (Asociación de padres de niños oncológicos de la Comunidad Valenciana) en Valencia. Resultados: Se constata cómo la enfermedad cambia las relaciones: - Con la pareja: redistribución de roles, diferentes formas de reaccionar y de asumir responsabilidades por parte de los padres, dificultades en la comunicación, alteraciones en las relaciones sexuales... - Con los otros hijos y con el niño enfermo. - Con la familia extensa: apoyo, falta de comunicación, y desarrollo de sentimientos inapropiados. También se constatan problemas en el manejo de la enfermedad después de la hospitalización, y en las actividades lúdicas (AU)
Objectives: Understanding how parents perceive the changes that occur in family relations as a result of pediatric cancer. Method: We used a research methodology that is both group-based (self-help groups) and qualitative (discourse analysis of participants in group sessions). The sample is composed of 22 parents whose children contracted the disease more than two years before. Group sessions were held at the headquarters of ASPANION (Association of Parents of Children with Cancer of Valencia) in Valencia. Results: It is argued that the disease changes the relationships between family members: - Foreign partner: redistribution of roles, different ways to react and to take responsibility on the part of parents, difficulty in communication, alterations in sexual relationships, and so on. - Relations with other children and the sick child. - Relations with the extended family: support, lack of communication and development of inappropriate feelings. Problems in the management of the disease after hospitalization and development of recreational activities have also been (AU)
