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Resumen Introducción: El origen aórtico anómalo de las arterias coronarias tiene una prevalencia estimada del 0.02-5.7% y están potencialmente involucradas con complicaciones en su evolución natural o aquellos que requieran procedimientos intervencionistas hemodinámico y/o quirúrgicos. Puede asociarse a muerte súbita o dañarse durante intervenciones sobre el anillo mitral, aórtico, pulmonar o el cierre percutáneo de un defecto septal interauricular. Objetivo: identificar estos pacientes por diferentes técnicas de imágenes como el ecocardiograma Doppler color transtorácico (ETT), angiotomografía o angiografía coronaria. Métodos: Las técnicas de imágenes utilizadas para la detección de anomalías coronarias fueron el ETT, angiotomografía coronaria multicorte o angiografía coronaria convencional de acuerdo con lo universalmente aceptado. Resultados: Estudio prospectivo realizado desde enero del 2020 a junio del 2021. Se identificaron 15 pacientes y en 12/15 la sospecha fue por ETT y en los tres restantes por angiotomografía coronaria. La arteria circunfleja fue la más involucrada en forma aislada o asociada a otra anomalía coronaria (12/15 pacientes) y en los tres casos restantes la coronaria anómala tuvo un trayecto interarterial, siendo las arterias coronarias derecha y la descendente anterior las afectadas. Conclusiones: El subdiagnóstico por ETT de las anomalías de las arterias coronarias puede deberse a la dificultad para su visualización, sobre todo en la población adulta. Su detección es crucial, ya que puede generar muerte súbita asociada a isquemia miocárdica y arritmias graves o complicar procedimientos intervencionistas sobre el septum interauricular o sobre los anillos mitral, pulmonar y/o aórtico.
Abstract Introduction: The anomalous aortic origin of the coronary arteries has an estimated prevalence of 0.02-5.7%. It can be associated with sudden death when it has an interarterial or intramural pathway or be damaged during interventions on the mitral, pulmonary and/or aortic annulus or percutaneous closure of an interatrial septal defect. Objective: To identify these patients by imaging techniques such as transthoracic color Doppler echocardiography (TTE), computed tomography (CT) multislice angiography or coronary angiography. Methods: The imaging techniques used for the detection of coronary anomalies were TTE, multislice coronary angiography or coronary angiography according to what is generally accepted. Results: Fifteen patients were identified; in 12 of them the suspicion was due to TTE and in the remaining 3, CT multislice angiography was diagnostic. The circumflex artery was the coronary artery most involved, associated or not with another coronary anomaly (12/15 patients) and in the other three cases, the anomalous coronary artery had an interarterial course, with the right coronary arteries and the anterior descending coronary arteries being involved. Conclusions: The under diagnosis by TTE of coronary artery abnormalities may be due to the difficulty of visualization that is accentuated with age. Their detection is crucial because they can both, lead to sudden death associated with an intramural and/or interarterial pathway and complicate an interventional procedure on the interatrial septum or within the mitral, pulmonary and/or aortic rings.
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Introduction: The anomalous aortic origin of the coronary arteries has an estimated prevalence of 0.02-5.7%. It can be associated with sudden death when it has an interarterial or intramural pathway or be damaged during interventions on the mitral, pulmonary and/or aortic annulus or percutaneous closure of an interatrial septal defect. Objective: To identify these patients by imaging techniques such as transthoracic color Doppler echocardiography (TTE), computed tomography (CT) multislice angiography or coronary angiography. Methods: The imaging techniques used for the detection of coronary anomalies were TTE, multislice coronary angiography or coronary angiography according to what is generally accepted. Results: Fifteen patients were identified; in 12 of them the suspicion was due to TTE and in the remaining 3, CT multislice angiography was diagnostic. The circumflex artery was the coronary artery most involved, associated or not with another coronary anomaly (12/15 patients) and in the other three cases, the anomalous coronary artery had an interarterial course, with the right coronary arteries and the anterior descending coronary arteries being involved. Conclusions: The under diagnosis by TTE of coronary artery abnormalities may be due to the difficulty of visualization that is accentuated with age. Their detection is crucial because they can both, lead to sudden death associated with an intramural and/or interarterial pathway and complicate an interventional procedure on the interatrial septum or within the mitral, pulmonary and/or aortic rings.
Introducción: El origen aórtico anómalo de las arterias coronarias tiene una prevalencia estimada del 0.02-5.7% y están potencialmente involucradas con complicaciones en su evolución natural o aquellos que requieran procedimientos intervencionistas hemodinámico y/o quirúrgicos. Puede asociarse a muerte súbita o dañarse durante intervenciones sobre el anillo mitral, aórtico, pulmonar o el cierre percutáneo de un defecto septal interauricular. Objetivo: Identificar estos pacientes por diferentes técnicas de imágenes como el ecocardiograma Doppler color transtorácico (ETT), angiotomografía o angiografía coronaria. Métodos: Las técnicas de imágenes utilizadas para la detección de anomalías coronarias fueron el ETT, angiotomografía coronaria multicorte o angiografía coronaria convencional de acuerdo con lo universalmente aceptado. Resultados: Estudio prospectivo realizado desde enero del 2020 a junio del 2021. Se identificaron 15 pacientes y en 12/15 la sospecha fue por ETT y en los tres restantes por angiotomografía coronaria. La arteria circunfleja fue la más involucrada en forma aislada o asociada a otra anomalía coronaria (12/15 pacientes) y en los tres casos restantes la coronaria anómala tuvo un trayecto interarterial, siendo las arterias coronarias derecha y la descendente anterior las afectadas. Conclusiones: El subdiagnóstico por ETT de las anomalías de las arterias coronarias puede deberse a la dificultad para su visualización, sobre todo en la población adulta. Su detección es crucial, ya que puede generar muerte súbita asociada a isquemia miocárdica y arritmias graves o complicar procedimientos intervencionistas sobre el septum interauricular o sobre los anillos mitral, pulmonar y/o aórtico.
Assuntos
Anomalias dos Vasos Coronários , Humanos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/complicações , Aorta , Tomografia Computadorizada por Raios X , Angiografia Coronária/métodos , Morte SúbitaRESUMO
Introducción: La enfermedad de Kawasaki, una vasculitis aguda de origen desconocido, es actualmente la principal causa de cardiopatía adquirida durante la infancia y sus principales secuelas están relacionadas con las arterias coronarias, por lo que el reconocimiento temprano de la probabilidad de daño coronario posibilita el tratamiento oportuno para disminuir su ocurrencia. Objetivos: Determinar la probabilidad de sufrir daño coronario en pacientes con enfermedad de Kawasaki, reconocer los factores de riesgo para el desarrollo de lesión coronaria y la evolución a largo plazo de estos pacientes. Material y métodos: Se diagnosticó enfermedad de Kawasaki en 245 niños (octubre 1988 - diciembre 2013) con edad media de 3,48 años. Las variables analizadas fueron: edad, sexo, criterios clínicos y de laboratorio de enfermedad de Kawasaki, hallazgos ecocardiográficos y evolución a largo plazo. Se calculó el odds ratio para evaluar las diferentes variables analizadas como probables factores de riesgo de enfermedad coronaria. Resultados: Presentaron daño coronario 39 pacientes: 25 varones y 14 mujeres; edad media: 2,05 años. Se identificaron como factores de riesgo la edad < 3 años, la fiebre prolongada = 6 días, la eritrosedimentación > 50 mm/h, la proteína C reactiva > 100 mg/L y el hematocrito < 30%. Trece pacientes mostraron dilatación transitoria de las arterias coronarias, 12 pacientes aneurismas solitarios de tamaño pequeño o mediano, 7 pacientes aneurismas coronarios múltiples, 6 pacientes aneurismas coronarios gigantes y uno infarto agudo de miocardio por lesión obstructiva grave. La mortalidad hospitalaria fue del 4. Conclusiones: La probabilidad de presentar daño coronario en pacientes con enfermedad de Kawasaki fue del 15,91%. Los factores de riesgo para lesión coronaria detectados fueron: edad menor de 3 años, 6 o más días de fiebre, eritrosedimentación > 50 mm/h, proteína C reactiva > 100 mg/L y hematocrito < 30%. En los pacientes con daño coronario residual persistente tratados en forma convencional no hubo eventos adversos durante el seguimiento a mediano y a largo plazos.
Background: Kawasaki disease, a vasculitis of unknown origin, is currently the main cause of acquired heart disease during childhood and its main sequelae are associated with coronary arteries. Therefore, early identification of possible coronary lesions enables adequate treatment to decrease their occurrence. Objectives: The aims of this study were to determine the probability of coronary injury in patients with Kawasaki disease, to identify the risk factors for developing coronary lesions and the long-term outcome of these patients. Methods: A total of 245 children with mean age of 3.48 years were diagnosed with Kawasaki disease between October 1988 and December 2013. Age, sex, clinical and laboratory criteria of Kawasaki disease, echocardiographic findings and long-term outcome were analyzed, and the odds ratio was used to assess their participation as probable risk factors for coronary lesions. Results: Thirty-nine patients presented coronary lesions: 25 male and 14 female patients with mean age of 2.05 years. Risk factors were: age < 3 years; prolonged fever = 6 days, erythrocyte sedimentation rate > 50 mm/hr; C-reactive protein > 100 mg/l and hematocrit < 30%. Thirteen patients showed transient coronary artery dilation, 12 solitary small or medium-sized aneurysms, 7 multiple coronary aneurysms, 6 giant coronary aneurysms and one myocardial infarction by severe obstructive lesion. In-hospital mortality was 4. Conclusions: Risk of coronary artery lesions in patients with Kawasaki disease was 15.91%. Risk factors were age under 3 years, fever lasting more than 6 days, erythrocyte sedimentation rate > 50 mm/hr; C-reactive protein > 100 mg/L and hematocrit < 30%. In patients with persistent residual coronary lesions treated conventionally there were no adverse events in the mid- and long-term follow-up.
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INTRODUCTION AND OBJECTIVES: To evaluate ventricular function using Doppler echocardiography in patients with an atrial septal defect (ASD). METHODS: The study involved 158 children, who were divided into two groups: Group 1 comprised 111 children with an ASD, and Group 2, 47 healthy children. Left ventricular systolic function was evaluated by measuring the ejection fraction, the shortening fraction, and the systolic mitral annular velocity (by tissue Doppler), and right ventricular systolic function, by measuring the systolic tricuspid annular velocity. Left ventricular diastolic function was evaluated by measuring standard transmitral Doppler indices, the color M-mode Doppler flow propagation velocity (Vp), the E/Vp ratio, and early and late diastolic mitral annular velocities at the lateral and septal areas of the mitral annulus (EML, EMS and AML, AML waves, respectively), and right ventricular diastolic function, by using pulsed tissue Doppler to measure early and late diastolic tricuspid annular velocities (ET and AT waves, respectively). RESULTS: There was no significant difference between the two groups in any left ventricular systolic or diastolic function parameter, except that the EML and EMS velocities were smaller in Group 1. Right ventricular systolic function was significantly increased in children with an ASD. The peak ET wave velocity was similar in the two groups but the peak AT wave velocity was significantly greater in children with an ASD. CONCLUSIONS: Systolic and diastolic left ventricular function (i.e., preload-independent indices) were similar in the two groups. Children with an ASD demonstrated an increase in right ventricular systolic function, though diastolic function was unchanged.
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Ecocardiografia Doppler , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/fisiopatologia , Função Ventricular , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos ProspectivosAssuntos
Anormalidades Múltiplas/diagnóstico por imagem , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Artérias Carótidas/anormalidades , Artérias Carótidas/diagnóstico por imagem , Imageamento Tridimensional , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Angiografia/métodos , Humanos , Lactente , MasculinoRESUMO
The aim of this study was to determine risk factors for coronary lesions, the type of heart lesion present, and long-term outcome in Kawasaki disease. We studied 150 children, aged 3 months to 9.5 years, who met the criteria for a diagnosis of Kawasaki disease. Of the 18% who were diagnosed with heart disease, 100% had coronary artery abnormalities, 11.1% had pancarditis, and 3.7%, mitral insufficiency. The coronary abnormalities were classified according severity as follows: diffuse ectasia in 40.7%; a small-to-medium-sized solitary coronary artery aneurysm in 33.3%; numerous small-to-medium-sized aneurysms in 11.1%; giant aneurysms in 11.1%; and coronary artery stenosis in 3.7%. The presence of pancarditis was a predictor of a giant coronary artery aneurysm. Mortality was 3.7%. Coronary aneurysm was the predominant heart lesion. The risk factors for coronary aneurysm in Kawasaki disease included age less than 27 months, fever lasting more than 8 days, erythrocyte sedimentation greater than 70 mm, and pancarditis.