ABSTRACT
BACKGROUND: Coronary artery evaluation remains after arterial switch operation a clinical challenge. OBJECTIVE: This study aims to correlate anatomical changes diagnosed by cardiac computed tomography (CCT) with physiological alterations on clinical evaluation to diagnose coronary obstruction in late ASO patients. METHODS: This study included 61 consecutive patients with mean age of 9.4 years who underwent ASO. The patients were submitted to echocardiography, electrocardiography, cardiopulmonary exercise test, and cardiac computed tomography to evaluate functional capacity and coronary artery anatomy. RESULTS: Cardiac computed tomography revealed that only 3.3% of the patients had coronary stenosis. These patients were asymptomatic, and no signs of myocardial ischemia were detected by the tests. CONCLUSION: The incidence of coronary abnormalities in late ASO patients was 3.3% in our cohort. There is no clear guideline as to why, when, and how these patients should be screened or what to propose when a coronary obstruction is diagnosed in asymptomatic patients.
FUNDAMENTO: A avaliação da artéria coronária após a cirurgia de Jatene ainda é um desafio clínico. OBJETIVO: Correlacionar alterações anatômicas identificadas por tomografia computadorizada cardíaca (TCC) com alterações fisiológicas detectadas na avaliação clínica para diagnosticar obstrução coronária no pós-operatório tardio de pacientes submetidos à cirurgia de Jatene. MÉTODOS: Este estudo incluiu 61 pacientes consecutivos com idade média de 9,4 anos que foram submetidos à cirurgia de Jatene. Os pacientes realizaram ecocardiografia, eletrocardiografia, teste cardiopulmonar do exercício, e tomografia computadorizada cardíaca para avaliação da capacidade funcional e anatomia da artéria coronária. RESULTADOS: A tomografia computadorizada cardíaca revelou que somente 3,3% dos pacientes apresentaram estenose da artéria coronária. Esses pacientes eram assintomáticos, e não foram detectados sinais de isquemia miocárdicas pelos exames realizados. CONCLUSÃO: A incidência de anormalidades da artéria coronária é de 3,3% no seguimento tardio de nossa coorte de pacientes submetidos à cirurgia de Jatene. Não existe uma diretriz clara sobre o porquê, quando, e como esses pacientes deveriam ser rastreados, ou o que propor quando pacientes assintomáticos forem diagnosticados com obstrução coronária.
Subject(s)
Arterial Switch Operation , Transposition of Great Vessels , Child , Coronary Angiography , Coronary Circulation , Coronary Vessels , HumansABSTRACT
Resumo Fundamento A avaliação da artéria coronária após a cirurgia de Jatene ainda é um desafio clínico. Objetivo Correlacionar alterações anatômicas identificadas por tomografia computadorizada cardíaca (TCC) com alterações fisiológicas detectadas na avaliação clínica para diagnosticar obstrução coronária no pós-operatório tardio de pacientes submetidos à cirurgia de Jatene. Métodos Este estudo incluiu 61 pacientes consecutivos com idade média de 9,4 anos que foram submetidos à cirurgia de Jatene. Os pacientes realizaram ecocardiografia, eletrocardiografia, teste cardiopulmonar do exercício, e tomografia computadorizada cardíaca para avaliação da capacidade funcional e anatomia da artéria coronária. Resultados A tomografia computadorizada cardíaca revelou que somente 3,3% dos pacientes apresentaram estenose da artéria coronária. Esses pacientes eram assintomáticos, e não foram detectados sinais de isquemia miocárdicas pelos exames realizados. Conclusão A incidência de anormalidades da artéria coronária é de 3,3% no seguimento tardio de nossa coorte de pacientes submetidos à cirurgia de Jatene. Não existe uma diretriz clara sobre o porquê, quando, e como esses pacientes deveriam ser rastreados, ou o que propor quando pacientes assintomáticos forem diagnosticados com obstrução coronária.
Abstract Background Coronary artery evaluation remains after arterial switch operation a clinical challenge. Objective This study aims to correlate anatomical changes diagnosed by cardiac computed tomography (CCT) with physiological alterations on clinical evaluation to diagnose coronary obstruction in late ASO patients. Methods This study included 61 consecutive patients with mean age of 9.4 years who underwent ASO. The patients were submitted to echocardiography, electrocardiography, cardiopulmonary exercise test, and cardiac computed tomography to evaluate functional capacity and coronary artery anatomy. Results Cardiac computed tomography revealed that only 3.3% of the patients had coronary stenosis. These patients were asymptomatic, and no signs of myocardial ischemia were detected by the tests. Conclusion The incidence of coronary abnormalities in late ASO patients was 3.3% in our cohort. There is no clear guideline as to why, when, and how these patients should be screened or what to propose when a coronary obstruction is diagnosed in asymptomatic patients.
Subject(s)
Humans , Child , Transposition of Great Vessels , Arterial Switch Operation , Coronary Angiography , Coronary Circulation , Coronary VesselsABSTRACT
BACKGROUND: Acute viral respiratory infections (VRI) are the most common diseases in humans and are associated with high morbidity and mortality in infants and the elderly. Children with congenital heart disease (CHD) are more susceptible to get severe forms of VRI due to their altered lung mechanics, leading to several complications, such as increased hospital stay, longer mechanical ventilation, and higher mortality. This study aimed to identify the frequency of VRI in children with CHD undergoing cardiac surgery, and to compare the major outcomes according to the presence or absence of a VRI. METHODS: This was a longitudinal, observational cohort study. Nasopharyngeal secretion samples were collected pre- and postoperatively for patients undergoing cardiac surgery, from May 2013 to May 2014. Respiratory viruses were detected using CLART Pneumovir®. RESULTS: Forty-eight patients were enrolled. We found a VRI preoperatively in 16 children with CHD before surgery (33.3%), and the frequency of new infections was 8.3% (4 patients). However, in this study, in univariate analyses, the two groups did not differ in any of the studied outcomes. In the multivariate regression models, adjusting for age and STAT category, the presence of a VRI did not show a significant effect on the major outcomes. CONCLUSIONS: In conclusion, VRI was frequent in children undergoing open-heart surgery, but the presence of a VRI did not impact on major outcomes in this cohort.
