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1.
Pediatr Cardiol ; 44(4): 816-825, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36905431

RESUMO

Major congenital heart disease (CHD) is associated with impaired neurodevelopment (ND), partly from prenatal insults. In this study we explore associations between 2nd and 3rd trimester umbilical (UA) and middle cerebral artery (MCA) pulsatility index (PI = systolic-diastolic velocities/mean velocity) in fetuses with major CHD and 2-year ND and growth outcomes. Eligible patients included those with a prenatal diagnosis of CHD from 2007 to 2017 without a genetic syndrome who underwent previously defined cardiac surgeries and 2-year biometric and ND assessments in our program. UA and MCA-PI Z-scores at fetal echocardiography were examined for relationships with 2-year Bayley Scales of Infant and Toddler Development and biometric Z-scores. Data from 147 children was analyzed. Second and 3rd trimester fetal echocardiograms were performed at 22.4 ± 3.7 and 34.7 ± 2.9 weeks (mean ± SD), respectively. Multivariable regression analysis showed an inverse relationship between 3rd trimester UA-PI for all CHD and cognitive - 1.98 (- 3.37, - 0.59), motor - 2.57 (- 4.15, - 0.99), and language - 1.67 (- 3.3, - 0.03) (effect size and 95th confidence interval) ND domains (p < 0.05), with the strongest relationships in the single ventricle and hypoplastic left heart syndrome subgroups. No association was found for 2nd trimester UA-PI or any trimester MCA-PI and ND or between UA or MCA-PI and 2-year growth parameters. Increased 3rd trimester UA-PI, reflecting an altered late gestation fetoplacental circulation, relates to worse 2-year ND in all domains.


Assuntos
Cardiopatias Congênitas , Artérias Umbilicais , Feminino , Gravidez , Humanos , Terceiro Trimestre da Gravidez , Artérias Umbilicais/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Diagnóstico Pré-Natal , Segundo Trimestre da Gravidez , Feto , Ultrassonografia Pré-Natal , Idade Gestacional , Fluxo Pulsátil
2.
Physiol Meas ; 34(10): 1319-27, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24021191

RESUMO

Electrical impedance tomography (EIT) can determine ventilation and perfusion relationship. Most of the data obtained so far originates from experimental settings and in healthy subjects. The aim of this study was to demonstrate that EIT measures the perioperative changes in pulmonary blood flow after repair of a ventricular septum defect in children with haemodynamic relevant septal defects undergoing open heart surgery. In a 19 bed intensive care unit in a tertiary children's hospital ventilation and cardiac related impedance changes were measured using EIT before and after surgery in 18 spontaneously breathing patients. The EIT signals were either filtered for ventilation (ΔZV) or for cardiac (ΔZQ) related impedance changes. Impedance signals were then normalized (normΔZV, normΔZQ) for calculation of the global and regional impedance related ventilation perfusion relationship (normΔZV/normΔZQ). We observed a trend towards increased normΔZV in all lung regions, a significantly decreased normΔZQ in the global and anterior, but not the posterior lung region. The normΔZV/normΔZQ was significantly increased in the global and anterior lung region. Our study qualitatively validates our previously published modified EIT filtration technique in the clinical setting of young children with significant left-to-right shunt undergoing corrective open heart surgery, where perioperative assessment of the ventilation perfusion relation is of high clinical relevance.


Assuntos
Coração/fisiopatologia , Ventilação Pulmonar , Cirurgia Torácica , Tomografia , Pré-Escolar , Impedância Elétrica , Feminino , Comunicação Interventricular/fisiopatologia , Comunicação Interventricular/cirurgia , Hemodinâmica , Humanos , Lactente , Masculino , Período Pré-Operatório , Relação Ventilação-Perfusão
3.
Indian J Pediatr ; 77(8): 911-3, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20953914

RESUMO

PHACES syndrome is a neurocutaneous disorder characterized by posterior fossa brain malformations, hemangiomas, cardiac anomalies and coarctation of aorta, eye anomalies ± sternal clefts. All reported cases are sporadic and notably common in females. The underlying cause is unknown. Here is described, one of the twin baby with characteristic features of PHACE syndrome. The presence of large segmental hemangioma, especially on face should prompt the primary care provider to act early, to prevent complications related to facial hemangiomas and other associated anomalies.


Assuntos
Coartação Aórtica/diagnóstico , Doenças em Gêmeos , Anormalidades do Olho/diagnóstico , Hemangioma/diagnóstico , Síndromes Neurocutâneas/diagnóstico , Neoplasias Cutâneas/diagnóstico , Feminino , Humanos , Lactente
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