Impacto clínico e na qualidade de vida em pacientes submetidos ao implante transcateter da valva pulmonar Melody / Clinical impact and quality of life in patients undergoing to transcatheter pulmonary valve implant Melody

INTRODUÇÃO: O Implante transcateter da valva pulmonar (ITVP) é terapia consagrada para o reestabelecimento da via de saída do ventrículo direito (VD) em pacientes com disfunção pulmonar grave. Apesar de promover melhora do VD, pouco se sabe sobre o seu impacto na qualidade de vida (QV). MÉTODOS: Estudo prospectivo e multicêntrico com pacientes submetidos ao ITVP, com enfoque no impacto clínico e na qualidade de vida. Pacientes com disfunção pulmonar grave e submetidos ao ITVP foram incluídos. Dados clínicos, ecocardiográficos (ECO), de teste cardiopulmonar (TCP) e ressonância magnética (RNM) previamente e 1 ano após o ITVP foram comparados (média e desvio-padrão). Da mesma forma, foi avaliada a qualidade de vida através do questionário SF-36 para os maiores de 18 anos e SF-10 para os menores. RESULTADOS: De 17/12/2013 a 31/12/2017 foram incluídos 19 pacientes (11 masculinos). No procedimento tinham média de 21,0±7,1 anos e 56,2±15,7 Kg. O número de cirurgias prévias foi de 2 (1-4) e o tempo desde a última foi 10,6±5,6 anos. Dez pacientes apresentavam estenose pulmonar (53%), 4 insuficiências (21%) e 5 lesões mista (26%). Foi observado sucesso imediato, com queda do gradiente sistólico ao cate de 38,8±22,0 para 9,9±6,8 mmHg e relação das pressões do VD/Aorta de 0,70±0,21 para 0,37±0,07 mmHg (ambos p 0,001). Após 1 ano de seguimento, houve melhora dos índices: Classe funcional de 2 (1-3) para 1 (1-2) (p < 0,001), frequência cardíaca máxima ao TCP de 81,0±7,9 para 85,9±11,4 bpm (p 0,006), volumes diastólico e sistólico finais de VD (VDFVD e VSFVD) à RNM de 109,1±33,3 e 60,8±29,0 ml/m2 para 92,5±29,2 e 47,9±19,9 ml/m2 (p <0,0001 e p 0,004), respectivamente. Além disto, aumento dos VDFVE e VSFVE de 80,0±19,6 e 32,1±10,6 ml/m2 para 87,9±16,2 e 37,7±10,8 ml/m2 (p 0,049 e p 0,035). A análise da QV mostrou melhora somente nos pacientes maiores de 18 anos, com aumento da percepção de saúde física (PCS) de 45,7±8,0 para 52,1±6,3 (p 0,006) e saúde mental (MCS) de 46,1±11,2 para 55,1±8,4 (p 0,008). Neste período, não houve óbitos. Um dos pacientes apresentou endocardite bacteriana 9 meses após o implante e necessitou cirurgia cardíaca para troca valvar, com sucesso, sem complicações. CONCLUSÃO: O ITVP mostrou-se factível, seguro eficaz na primeira experiência brasileira. Após 1 ano de seguimento, houve inquestionável melhora clínica e na qualidade de vida - esta última, somente nos pacientes maiores de idade, provavelmente em virtude do baixo número de incluídos. (AU)

Fetal ductal constriction caused by maternal ingestion of green tea in late pregnancy: an experimental study.

OBJECTIVES: The aim of this study was to test the hypothesis that experimental maternal intake of green tea in late pregnancy causes fetal ductus arteriosus constriction, probably because of prostaglandin inhibition. METHODS AND RESULTS: Twelve fetal lambs (pregnancy > 120 days) were assessed before and after maternal administration of green tea (n = 8) or water (n = 4; controls) as the only source of liquid. After 1 week, echocardiography showed signs of constriction of the ductus arteriosus in all fetuses from mothers ingesting green tea, with increase in mean systolic velocity(from 0.70 ± 0.19 m/s to 0.92 ± 0.15 m/s, 31.4%, p = 0.001) and mean diastolic velocity (0.19 ± 0.05 m/s to 0.31 ± 0.01 m/s, 63.1%, p < 0.001), decrease of pulsatility index (2.2 ± 0.4 to 1.8 ± 0.3, 22.2%, p = 0.003) and increase of mean right ventricular/left ventricular diameter ratio (0.89 ± 0.14 to 1.43 ± 0.23, 60.6%, p < 0.001). In the four control fetuses, there were no significant changes. All lambs exposed to green tea also showed at autopsy dilated and hypertrophic right ventricles, which was not present in control fetuses. Histological analysis showed a significantly larger mean thickness of the medial avascular zone of the ductus arteriosus in fetuses exposed to green tea than in controls (747.6 ± 214.6 µm vs 255.3 ± 97.9 µm, p < 0.001). CONCLUSIONS: This study in fetal lambs shows a cause and effect relationship between experimental maternal exposure of green tea and fetal ductus arteriosus constriction in late pregnancy.

Balloon aortic valvuloplasty for congenital aortic stenosis using the femoral and the carotid artery approach: a 16-year experience from a single center.

OBJECTIVES: The aim of this article is to report a 16-year experience with percutaneous balloon aortic valvuloplasty (BAVP) in newborns and young infants up to 3 months of age in a tertiary care cardiac reference center in a developing country and to determine its value in postponing open heart surgery. BACKGROUND: Congenital aortic stenosis (AS) is a potentially life threatening disorder. BAVP and surgical procedures have similar short and medium-term efficacy. METHODS: Thirty-one consecutive newborns and young infants with critical AS underwent BAVP in our department from 1991 to 2007. Mean patient age at time of the procedure was 22 days (range 2-92 days) and mean weight was 3,310 g (1,840-4,400 g). RESULTS: There was a significant reduction in mean Doppler-derived peak gradient across the aortic valve immediately after the procedure (75.1 ± 22 versus 32.2 ± 13.02, P < 0.001), and this finding was maintained throughout follow-up. Since 2003, when the carotid approach became routine practice, no major vascular complications were observed. Mean time of follow-up was 81 months (5 days-196 months) with only two deaths (7.4%). Only 24% patients required surgical reintervention on the aortic valve during follow-up. Survival free from aortic valve surgery was 80% at 24 months, 66% at 63 months, and 50% at 80 months. CONCLUSION: Percutaneous intervention for relief of critical aortic stenosis in newborns in a tertiary center of a developing country is safe and has excellent short and long-term results comparable to other centers throughout the world.