Cardiopatías y embarazo, ¿donde están los límites? / Cardiopathies and pregnancy, where are the limits?

Las pacientes embarazadas que presentan cardiopatías congénitas(CC) o adquiridas(CADQ) con diverso grado de DSVI, algunas con severa HTP, la mayoría sin conocimiento de su enfermedad, sin tratamiento específico y sin información acerca del riesgo, dada la morbi-mortalidad materno-infantil e inestabilidad hemodinámica deben ser derivadas a centros de mayor complejidad. Objetivos: Estratificar los riesgos quepresenta esta población con CC o CADQ durante el pre y posparto; identificar incidencia de morbimortalidadmaterna y fetal en este grupo y evaluar con el equipo tratante la conducta adecuada. Material y Métodos: Encontramos 18 embarazadas portadoras de cardiopatías. Congénitas: 2 con HTP Primaria, CIA,CIV+Ductus, 2 con Persistencia del Conducto Arterioso e HTP, Obstrucción TSVD con EP, VU+EP, 2 con Enfermedad de Ebstein. Adquiridas: EM severa+HTP, Chagas con DSVI, Chagas y marcapaso definitivo, 2 con MH, Miocardio no compactado, IT post-Endocarditis infecciosa, Preeclampsia, Miocardiopatía periparto Resultados: Edad media 30.7años, la peor evolución se asoció a DSVI e HTP. Se realizó cesárea al 77.7%,mortalidad materna:22.2%, fetal:16.7%. Conclusiones: Factores sociales, culturales y económicos, dificultanel diagnóstico precoz de las cardiopatias en embarazadas; la no contracepción y la consulta tardía dificultansu control. La HTP severa y la DSVI marcada juegan un rol crucial en el pronóstico de las madres y del reciénnacido. La preeclampsia además constituye un FR cardiovascular alejado.

Pregnant women with congenital heart disease (CHD) or acquired (CADQ) with varying degrees of LVSD,some with severe pulmonary hypertension, most without knowledge of their disease without specific treatmentand no information about the risk, given the morbidity and maternal mortality -Infant and hemodynamic instability should be referred to centers of greater complexity. Objectives: To stratify the risks to thepopulation CC or CADQ during the pre and postpartum; identify incidence of maternal and fetal morbidity andmortality in this group and the treating team assess appropriate behavior. Material and Methods: We found18 pregnant carriers of heart disease. Congenital: 2 with primary PH, ASD, VSD + Ductus, 2 Ductus and PH,RVOT obstruction PS, VU + PS, 2 with Ebstein disease. Acquired: severe MS + PH, Chagas LVSD, Chagasand permanent pacemaker, 2 HCM, non-compacted myocardium, IT post-infectious endocarditis, Preeclampsia, peripartum cardiomyopa thy Results: Average age 30.7años, the worse outcomes associated with LVSD and PH . 22.2%, fetal: 16.7% to 77.7% cesarean section, maternal mortality was conducted. Conclusions: social, cultural and economic factors hinder early diagnosis of heart disease in pregnant; noncontraception and the late consultation impede the control. The severe LVSD marked HTP and play a crucialrole in the prognosis of mothers and newborn. Preeclampsia also constitutes an away cardiovascular RF.

Indice nutricional em cardiopatias na infância / Nutritional index in heart diseases in childhood

Estudar incidência e repercussöes de cardiopatias sobre o estado nutricional de crianças. Duzentas crianças, dispostas em 3 grupos: 1) 113 (56,5%) com forma congênita acianótica; 2) 19 (9,5%) com forma congênita cianótica; e 3) 68 (34%) com forma adquirida, que freqüentaram o ambulatório de cardiologia pediátrica do Hospital das Clínicas da Faculdade de Medicina de Ribeiräo Preto da USP de 1987 a 1990. A média etária foi de 5,1 ñ 0,4 anos e 56% eram masculinos. Os diagnósticos mais freqüentes foram comunicaçäo interventricular (51 casos), comunicaçäo interatria (21 casos), valvopatias adquiridas (21 casos), arritmias benignas (20 casos), comprometimento cardíaco secundário a doenças sistêmicas (20 casos) e tetralogia de Fallot (8 casos). A maioria (92%) das crianças era portador de índice nutricional entre os percentis 5 abaixo do percentil 5 e apenas 4 (2%) acima do 95, consideradas obesas. Na comparaçäo entre os valores médios de índice nutricional, observou-se diferença estatisticamente significativa (p < 0,05) para os 3 grupos, o pior para as formas congênitas cianóticas e o melhor para as formas adquiridas. As cardiopatias na infância associam-se a reduçäo do índice nutricional na maioria dos casos

Purpose ­ To study heart disease in childhood aiming to know its incidence and consequences upon the nutritional status. Patients and Methods ­ Two-hundred patients were distributed in three groups: 1)113 (56.5%) with congenital acianotic form; 2) 19 (9.5%) with congenital cianotic form; and 3) 68 (34%) with acquired forms. All of them regularly visiting the ambulatory service of Paediatric cardiology of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da USP from 1987 until 1990. Results ­ The majority (92%) of the children (being 56% male and aging 5.1 ± 0.4 years-old) showed nutritional indexes between 5 and 95 (percentil scale). The overall diagnosis distribution were: 1) ventricular septal defect (51 cases); 2) atrial septal defect (21 cases); 3) valvular diseases (21 cases); 4) arrhythmias (20 cases); 5) cardiac involvement of systemic diseases (20 cases); and 6) tetralogy complex (8 cases). Twelve patients (6%) were underscored (below percentil 5) and only 4 (2%) scored above percentil 95 (obese patients). The comparison of the mean indexes were found statistical different (p < 0.05), being the cianotic congenital forms the worst ones and the acquired forms the best one. Conclusion ­ Heart disease in childhood is associated to nutritional index deficits in the majority of the cases.