Aortopulmonary window--impact of associated lesions on surgical results.

OBJECTIVES: The aortopulmonary window (APW) is a communication between the pulmonary artery (PA) and the ascending aorta in the presence of two separate semilunar valves. This review describes the natural history of the APW and the impact of associated defects on surgical results in patients treated at our institution. METHODS: Retrospective longitudinal study, based on the review of medical files of patients diagnosed between 1995 and 2005. RESULTS: Of nine patients diagnosed as having APW, six had associated lesions. Seven patients were submitted to surgical treatment with two deaths. One patient was not submitted to surgery due to pulmonary hypertension and another one died before the surgery due to a respiratory infection complication. CONCLUSION: The surgical results are satisfactory when the APW presents as an isolated defect and when surgery is performed early, preventing the development of irreversible arterial pulmonary hypertension (APH). The presence of associated complex congenital heart disease is a bad prognostic factor in our series.

Janela aortopulmonar: impacto das lesões associadas no resultado cirúrgico / Aortopulmonary window: impact of associated lesions on surgical results

OBJETIVOS: A janela aortopulmonar (JAP) é uma comunicação entre a artéria pulmonar (AP) e a aorta ascendente na presença de duas valvas semilunares separadas. Nesta revisão, descrevemos nossa experiência na história natural da JAP e do impacto de lesões associadas nos resultados cirúrgicos de pacientes tratados em nosso serviço. MÉTODOS: Estudo longitudinal retrospectivo, com revisão dos prontuários dos pacientes diagnosticados entre 1995 e 2005. RESULTADOS: Dos 9 pacientes diagnosticados como portadores de JAP, 6 apresentavam cardiopatia associada. Sete pacientes foram submetidos a tratamento cirúrgico, ocorrendo dois óbitos. Um paciente teve a cirurgia contra-indicada pela presença de hipertensão pulmonar, e outro faleceu antes do procedimento cirúrgico por complicação infecciosa respiratória. CONCLUSÃO: Os resultados cirúrgicos são satisfatórios quando a JAP se apresenta como defeito isolado e quando a cirurgia é realizada precocemente, evitando-se o desenvolvimento de hipertensão arterial pulmonar (HAP) irreversível. A presença de cardiopatia congênita complexa associada é fator de pior prognóstico em nossa série de casos.

OBJECTIVES: The aortopulmonary window (APW) is a communication between the pulmonary artery (PA) and the ascending aorta in the presence of two separate semilunar valves. This review describes the natural history of the APW and the impact of associated defects on surgical results in patients treated at our institution. METHODS: Retrospective longitudinal study, based on the review of medical files of patients diagnosed between 1995 and 2005. RESULTS: Of nine patients diagnosed as having APW, six had associated lesions. Seven patients were submitted to surgical treatment with two deaths. One patient was not submitted to surgery due to pulmonary hypertension and another one died before the surgery due to a respiratory infection complication. CONCLUSION: The surgical results are satisfactory when the APW presents as an isolated defect and when surgery is performed early, preventing the development of irreversible arterial pulmonary hypertension (APH). The presence of associated complex congenital heart disease is a bad prognostic factor in our series.

[Attention deficit/hyperactivity disorder prevalence in an inner city elementary school]. / Prevalência do transtorno de déficit de atenção/hiperatividade numa escola pública primária.

OBJECTIVE: To define the prevalence of attention deficit/hyperactivity disorder (ADHD) in a sample school-aged children from a public elementary school. METHOD: The study population was composed of all pupils who attended the first five grades at a public state school. During the first stage, school teachers and parents filled a standardized questionnaire of 18 ADHD symptoms defined at DSM-IV. In the second stage, children who screened positive and their parents were invited for a medical visit at school. After signature of an informed consent, the following procedures were done: DSM-IV symptoms questionnaire, oriented history, physical exam and neurologic exam. ADHD diagnosis was subdivided into three types: predominantly hyperactive (H), predominantly inattentive (ADD), and mixed type ADD + H. RESULTS: Among 403 pupils recruited in the first stage, 108 screened positive. Of these, 101 were assessed. There were 68 boys and 33 girls. Median age was 9 years (Range, 6-15 years; standard deviation, 1.99). ADHD diagnosis was defined for 69 pupils (17.1%), including 27 children (39.1%) with ADD, 26 children (37.7%) with ADD + H, and 16 children (23.2%) with H without ADD. Among children who received a diagnosis of ADHD, 45 (65.2%) were boys and 24 (34.8%) were girls (ratio 1.9:1). CONCLUSION: ADHD prevalence in a sample of 403 school-aged children from a public elementary school was 17.1%.

Prevalência do transtorno de déficit de atençäo/hiperatividade numa escola pública primária / Attention deficit/hyperactivity disorder prevalence in an inner city elementary school

OBJETIVO: Definir a prevalência do transtorno de déficit de atençäo/hiperatividade (TDAH) numa amostra de crianças escolares de uma única escola primária pública. MÉTODO: A populaçäo do estudo foi composta por todos os alunos das classes de alfabetizaçäo à quarta série de uma escola. No primeiro estágio da pesquisa, as professoras e os pais preencheram um questionário padronizado de 18 sintomas definidos no DSM-IV. No segundo estágio, os alunos com triagem positiva foram convidados para um atendimento na escola. Após assinatura de consentimento esclarecido, preencheram-se o questionário de sintomas do DSM-IV, uma anamnese dirigida e um questionário psicossocial concebido para a pesquisa e realizaram-se exames físico e neurológico completos. O diagnóstico de TDAH admitia três subtipos: hiperativo predominante (H), desatento predominante (TDA), ou misto (TDA+ H). RESULTADOS: De 403 alunos avaliados no início, 108 tiveram triagem positiva. Destes, avaliaram-se 101 alunos. Havia 68 meninos e 33 meninas. A idade mediana foi 9 anos (faixa, 6-15 anos; desvio padräo, 1,99). O diagnóstico de TDAH foi definido em 69 alunos (17,1 por cento), incluindo 27 crianças (39,1 por cento) com TDA sem H, 26 crianças (37,7 por cento) com TDA + H e 16 (23,2 por cento) com H sem TDA. Dentre as crianças diagnosticadas, 45 (65,2 por cento) eram meninos e 24 (34,8 por cento) meninas (razäo 1,9:1). CONCLUSÄO: A prevalência de TDAH em 403 crianças escolares de uma escola primária pública foi 17,1 por cento