Assuntos
Cateterismo Cardíaco/métodos , Cardiopatias Congênitas/diagnóstico por imagem , Artéria Pulmonar/anormalidades , Dispositivo para Oclusão Septal , Fístula Vascular/cirurgia , Criança , Angiografia por Tomografia Computadorizada/métodos , Seguimentos , Átrios do Coração/anormalidades , Cardiopatias Congênitas/cirurgia , Humanos , Imageamento Tridimensional/métodos , Masculino , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagemAssuntos
Canal Arterial/diagnóstico por imagem , Ecocardiografia , Comunicação Interatrial/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico por imagem , Trombose/diagnóstico por imagem , Anticoagulantes/uso terapêutico , Canal Arterial/patologia , Feminino , Seguimentos , Humanos , Recém-Nascido , Embolia Pulmonar/tratamento farmacológico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Medição de Risco , Nascimento a Termo , Trombose/tratamento farmacológicoRESUMO
Although exercise stress echocardiography (ESE) is a well-validated technique in adult population, its use in children is quite limited. We aimed to assess the feasibility, the safety and the reproducibility of ESE, using on-line scanning in semi-supine cyclo-ergometer protocol in a large pediatric population. Between July 2008 and January 2013, 42 patients (mean age 14 ± 3) were evaluated with a bicycle ESE performing 50 studies. ESE was successfully performed and well tolerated by all patients. None of the patients presented with adverse effects of stress-induced ischemia. HR was 82 ± 13 at rest, and 153 ± 19.1 during peak exercise. Among 544 views analyzed for grading of image quality, the visualization was optimal in 473 (87 %), suboptimal in 39, and inadequate in 32 (6 %). 37 tests were performed in patients with congenital or acquired coronary abnormality. Regional wall motion abnormalities (RWMA) were revealed in nine cases (24 %). The agreement between the two different observers showed a K index of 0.7276 (95 % CI 0.6497-0.8055) for the image quality and a K index of 0.5125 (95 % CI 0.4782-0.5468) for the RWMA analysis. Among ten patients with hypertrophic cardiomyopathy, we were able to demonstrate the new comparison of significant left ventricular outflow tract gradient (≥30 mmHg) during exercise in three patients (30 %). Bicycle stress echocardiography performed by on-line scanning during exercise is a feasible, safe, and reproducible modality in children. Further data to assess its diagnostic accuracy are, however, needed. Stress echocardiography provides a dynamic assessment of the myocardial structure and function under conditions of physiologic or pharmacologic stress.
Assuntos
Ecocardiografia sob Estresse/métodos , Teste de Esforço/métodos , Coração/anatomia & histologia , Coração/fisiologia , Coração/fisiopatologia , Adolescente , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/fisiopatologia , Criança , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Medição de Risco , Decúbito Dorsal , Função Ventricular Esquerda/fisiologiaRESUMO
AIM: The aim of this study was to evaluate the role of Bishop score, sonographic measurements of uterine cervical length and maternal characteristics, as predictors of spontaneous onset of labor within 24 hours, as well as response to induction in prolonged pregnancies. METHODS: Pregnancies with gestational age over 280 days were followed as outpatient. Patients were included in the study if spontaneous delivery occurred between 286 and 295 days of gestation, or in pregnancies with gestational age of 291-293 days who required labor induction. Data about Bishop score, ultrasonographic cervical characteristics (length, funneling, volume) and maternal features (parity, body mass index and age) registered at the last control immediately before the delivery were retrieved from clinical charts. RESULTS: Data from 195 patients were available. Bishop score and, in particular, ultrasonographic cervical length can predict the spontaneous onset of labor with a positive predictive value (PPV) of 22% and 44%, respectively in 24 hours. On the other hands, in patients requiring labor induction, parity and ultrasonographic cervical length remained the only predictive parameters with a PPV of 39% and 42%, respectively. In term of predictive performance, the value of 30 mm was identified as the best cut-off value for the ultrasonographic cervical length (specificity 59% and sensitivity 69%). CONCLUSION: In prolonged pregnancies, Bishop score and ultrasonographic cervical length were shown to be relevant in the prediction of spontaneous onset of labor, while in patients who required labor induction, ultrasonographic cervical length represented the only clinic parameter predicting the onset of labor.