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1.
Scand J Clin Lab Invest ; 78(7-8): 595-600, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30755099

RESUMEN

Oxidative stress seems to be an important link between obesity and cardiovascular disease. The aim of our study was to assess oxidative stress in obese patients stratified according to ambulatory blood pressure status and to determine independent predictors of abnormal left ventricular geometry.A cross-sectional study was conducted. A total of 113 obese participants referred for 24-h ambulatory blood pressure monitoring (ABPM) aged 9-19 years, and 29 healthy controls were enrolled. In addition to anthropometric and biochemical measurements, such as fasting serum levels of glucose, insulin, lipid profile, and oxidative biomarkers, ABPM and echocardiography were performed.According to ABPM results, obese subjects were split in two groups: 57 hypertensive and 56 normotensive. Both hypertensive and normotensive obese participants had higher levels of oxidative stress parameters (pro-oxidative/antioxidative balance and total oxidant status) compared with control group. Levels of superoxide anion (O2-) and sulfhydryl groups were higher in obese hypertensive participants as compared to obese normotensive and control groups. Abnormal left ventricular geometry among obese participants was independently associated with O2- (p = .006) and body mass index z score (p = .020), with no significant impact of gender, while age and systolic blood pressure exhibited interaction term for the outcome.The independent effect of oxidative mechanisms on left ventricular geometry appears to start in childhood. Oxidative stress occurs in obese adolescents prior to the development of sustained hypertension.


Asunto(s)
Hipertensión/complicaciones , Obesidad/complicaciones , Estrés Oxidativo , Remodelación Ventricular , Adolescente , Adulto , Biomarcadores/sangre , Glucemia , Enfermedades Cardiovasculares/patología , Niño , Humanos , Hipertensión/metabolismo , Insulina/sangre , Metabolismo de los Lípidos , Lípidos/sangre
2.
Cardiology ; 134(3): 375-80, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27111550

RESUMEN

A double-chambered right ventricle (DCRV) is an uncommon congenital anomaly: the right ventricle (RV) is divided into two chambers due to the presence of an abnormally located muscular band or anomalous muscle hypertrophy in the subinfundibular part of RV outflow tract, with a variable degree of obstruction. Generally, DCRV is well recognized in childhood and misdiagnosed in adult patients. Transthoracic and/or transesophageal echocardiography are the mx0435;thods of choice for the diagnosis of DCRV. Due to limitations of echocardiography in adult patients, this entity may be missed, particularly if it presents concomitant with other congenital defects, and therefore additional imaging methods such as MRI or cardiac catheterization are required for a definitive diagnosis.


Asunto(s)
Cardiopatías Congénitas/diagnóstico , Defectos del Tabique Interventricular/diagnóstico , Ventrículos Cardíacos/anomalías , Adulto , Femenino , Cardiopatías Congénitas/fisiopatología , Cardiopatías Congénitas/terapia , Defectos del Tabique Interventricular/fisiopatología , Defectos del Tabique Interventricular/terapia , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Adulto Joven
3.
Cardiol Young ; 23(2): 181-8, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22717372

RESUMEN

Malposition of the branch pulmonary arteries is a rare malformation with two forms. In the typical form, pulmonary arteries cross each other as they proceed to their respective lungs. The "lesser form" is characterised by the left pulmonary artery ostium lying directly superior to the ostium of the right pulmonary artery, without crossing of the branch pulmonary arteries. Malposition of the branch pulmonary arteries is often associated with other congenital heart defects and extracardiac anomalies, as well as with 22q11.2 microdeletion. We report three infants with crossed pulmonary arteries and one adolescent with "lesser form" of the malformation. The results suggest that diagnosis of malposition of the branch pulmonary arteries could be challenging if based solely on echocardiography, whereas modern imaging technologies such as contrast computed tomography and magnetic resonance angiography provide reliable establishment of diagnosis. In addition, we performed the first molecular characterisation of the 22q11.2 region among patients with malposition of the branch pulmonary arteries and revealed a 3-megabase deletion in two out of four patients


Asunto(s)
Síndrome de DiGeorge/diagnóstico , Cardiopatías Congénitas/diagnóstico , Arteria Pulmonar/anomalías , Adolescente , Síndrome de DiGeorge/genética , Ecocardiografía Doppler , Femenino , Cardiopatías Congénitas/genética , Humanos , Lactante , Angiografía por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos X
4.
Srp Arh Celok Lek ; 143(9-10): 559-66, 2015.
Artículo en Sr | MEDLINE | ID: mdl-26727863

RESUMEN

INTRODUCTION: Diagnosis of neonatal coarctation of the aorta (CoA) still presents a challenge in routine practice because of absence of reliable morphologic and functional parameters for early detection of this congenital heart defect in newborns. OBJECTIVE: The aim of this study is to identify easy obtainable two-dimensional echocardiographic parameters for detection of the CoA in newborns. METHODS: Echocardiographic evaluation was performed in 30 newborns with CoA and 20 healthy neonates (control group). Measurements of the proximal transverse arch (PTA), distal transverse arch (DTA), isthmus, distance between the left common carotid artery (LCCA) at the origin of the left subclavian artery (LSA), were obtained by two-dimensional echocardiography. Aortic arch hypoplasia was defined using Mouleart, Karl and Mee criteria, and Z-value. Index 1 was calculated as a ratio of DTA and distance between origins LCCA-LSA, Index 2 was calculated as a ratio of the ascending aorta and the distance between LCCA-LSA origins, and Index 3 was calculated as a ratio of PTA and distance between LCCA-LSA origins. RESULTS: Index 1 was significantly lower in patients with CoA in comparison with control group (0.50 vs. 1.39; p≤0.01). A cut-off point at 0.39, for Index 1, showed a sensitivity of 92% and specificity of 99% for the diagnosis of neonatal CoA, while cut off points at 0.69 and 0.44, for Index 2 and Index 3, showed the highest sensitivity and specificity for the diagnosis of CoA in newborns. CONCLUSION: By using these echo indexes, two-dimensional echocardiographic aortic arch measurement becomes a simple, reliable noninvasive method for the evaluation of aortic coarctation in newborns and may lead to earlier diagnosis and subsequent surgical correction.


Asunto(s)
Aorta Torácica/diagnóstico por imagen , Coartación Aórtica/diagnóstico por imagen , Arteria Subclavia/diagnóstico por imagen , Aorta Torácica/anomalías , Ecocardiografía/métodos , Femenino , Cardiopatías Congénitas/diagnóstico por imagen , Humanos , Recién Nacido , Masculino , Sensibilidad y Especificidad
5.
Srp Arh Celok Lek ; 142(3-4): 164-9, 2014.
Artículo en Sr | MEDLINE | ID: mdl-24839770

RESUMEN

INTRODUCTION: Total anomalous pulmonary venous connection (TAPVC) is a rare congenital heart disease and in some variants represents the only true surgical emergency in congenital heart surgery. Basic anatomical characteristic of this anomaly is an abnormal connection of pulmonary veins with systemic venous circulation. Although the results of TAPVC repair in infancy have been markedly improved in recent years, the recurrent pulmonary venous obstruction (RPVO) remains relatively frequent complication of surgical treatment. OBJECTIVE: The aim of this study was a retrospective evaluation of TAPVC repair at a single institution, identifying the risk factors associated with the increased mortality and morbidity. METHODS: Between January 2001 and January 2010, 43 consecutive patients underwent repair of TAPVC at the University Children's Hospital, with median weight of 3.8 kg (1.8-13 kg). Median age at surgery varied from 5 days to 5 years. Distribution of TAPVC types was as follows: supracardiac 19 (44%), cardiac 12(28%), infracardiac 9 (21%), and mixed 3 (7%). Eleven patients (26%) were emergencies due to obstructed drainage. RESULTS: Early mortality was 9.30% (4/43). An average time of followup/survival for 95% interval of confidence was 101.6 +/- 6.7 months. Kaplan-Meier cumulative survival was 83.7 +/- 5.7%. Freedom from reintervention after 10 years was 87.2 +/- 0.5%. The principal reason for reintervention was RPVO. CONCLUSION: Preoperative obstruction is not a risk factor of early mortality and RPVO. Low body mass (below 2.5 kg) is the only identified risk factor of early mortality. Complex morphology of the confluens, particularly in a mixed type of TAPVR, is the main risk factor of RPVO development.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Cardiopatías Congénitas/cirugía , Venas Pulmonares/anomalías , Procedimientos Quirúrgicos Vasculares , Peso Corporal , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Preescolar , Femenino , Cardiopatías Congénitas/epidemiología , Humanos , Lactante , Recién Nacido , Masculino , Morbilidad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Venas Pulmonares/cirugía , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/mortalidad , Procedimientos Quirúrgicos Vasculares/estadística & datos numéricos
6.
Srp Arh Celok Lek ; 142(1-2): 17-22, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24684026

RESUMEN

INTRODUCTION: Balloon valvuloplasty (BVP) is one of the primary therapies for congenital aortic stenosis in children and adolescents. The aim of this interventional procedure is to gain time before possible surgical therapy (aortic valve replacement) until adulthood. OBJECTIVE: The aim of this study was to evaluate the efficacy, safety and mid-term results oftranscatheter BVP in children and adolescent in our Center. METHODS: From 2004 to 2011, 50 patients, aged 18 days to 18 years (mean 6.3 years) underwent BVP. Retrospective analysis of the echocardiographic and hemodynamic parameters were performed before and after procedure, especially peak pressure gradient (PG) across the aortic valve, semiquantification of the aortic regurgitation (AR) after the BVP as well as the left ventricle dimensions and functions. RESULTS: The mean peak PG in the whole group decreased from 74.80 +/- 27.72 mm Hg to 27.86 +/- 3.04 mm Hg (p < 0.001) after BVP. In 39 patients (78%), residual PG was lower than 30 mm Hg just after dilation. At the end of follow-up period, 25 patients (50%) had PG above 50 mm Hg, measured by Doppler technique, and four of them underwent re-dilation. Eight patients (16%) had severe AR. During the follow-up period (12-80 months, mean 51 months), six patients (12%) were referred to cardiac surgeons for aortic valve replacement or Ross procedure. CONCLUSIONS: This retrospective study analyzes our first experience of BVP as primary therapy of the congenital aortic stenosis. The results confirmed that BVP effectively postponed the need for surgery in children and adolescents toward the adulthood.


Asunto(s)
Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Valvuloplastia con Balón/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Adolescente , Estenosis de la Válvula Aórtica/congénito , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Cateterismo , Niño , Preescolar , Femenino , Implantación de Prótesis de Válvulas Cardíacas , Hemodinámica , Humanos , Lactante , Recién Nacido , Masculino , Reoperación , Estudios Retrospectivos , Ultrasonografía
7.
Ann Thorac Surg ; 97(2): 707-10, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24484819

RESUMEN

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) represents one of the most common causes of myocardial ischemia in infants and if left untreated results in a high mortality rate. When ALCAPA coexists with other congenital malformations, particularly those associated with pulmonary hypertension, the initial presentation can be quite confusing and is often misinterpreted. We report an infant with ALCAPA associated with scimitar syndrome and aortic coarctation whose clinical course illustrates the complexities and difficulties of management with a successful outcome.


Asunto(s)
Coartación Aórtica/complicaciones , Anomalías de los Vasos Coronarios/complicaciones , Arteria Pulmonar/anomalías , Síndrome de Cimitarra/complicaciones , Anomalías Múltiples/diagnóstico , Anomalías Múltiples/cirugía , Coartación Aórtica/diagnóstico , Coartación Aórtica/cirugía , Anomalías de los Vasos Coronarios/diagnóstico , Anomalías de los Vasos Coronarios/cirugía , Humanos , Recién Nacido , Arteria Pulmonar/cirugía , Síndrome de Cimitarra/diagnóstico , Síndrome de Cimitarra/cirugía
8.
Srp Arh Celok Lek ; 141(11-12): 803-6, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24502102

RESUMEN

INTRODUCTION: Critical congenital heart diseases (CHD) are mostly duct-dependent and require stable systemic-pulmonary communication. In order to maintain patency of the ductus arteriosus (DA), the first line treatment is Prostaglandin E1 and the second step is the surgical creation of aortic-pulmonary shunt. To reduce surgical risk in neonates with the critical CHD, transcatheter stenting of DA can be performed in selected cases. CASE OUTLINE: A four-month old infant was diagnosed with the pulmonary artery atresia with ventricular septal defect (PAA/VSD). The left pulmonary artery was perfused from DA, and the right lung through three major aortopulmonary collaterals (MAPCAs). A coronary stent was placed in the long and critically stenotic DA, with final arterial duct diameter of 3.5 mm, and significantly increased blood supply to the left lung. After the procedure, the infant's status was improved with regard to arterial oxygen saturation, feeding and weight gain. During the follow-up, one year later, aortography revealed in-stent stenosis. The left pulmonary artery, as well as the branches, was well-developed and the decision was made to proceed with further surgical correction. CONCLUSION: Stenting of DA can be an effective alternative to primary surgical correction in selected patients with duct-dependent CHD.


Asunto(s)
Cateterismo Cardíaco/métodos , Conducto Arterioso Permeable/cirugía , Defectos de los Tabiques Cardíacos/cirugía , Atresia Pulmonar/cirugía , Stents , Femenino , Humanos , Lactante , Resultado del Tratamiento
9.
Srp Arh Celok Lek ; 132 Suppl 1: 9-13, 2004 Oct.
Artículo en Sr | MEDLINE | ID: mdl-15615457

RESUMEN

Cyanotic heart diseases are relatively rare, but they are severe and heterogeneous congenital heart diseases, which require complex surgery. Development of different advanced surgical procedures, such as arterial switch operation (ASO), Fontan and its modifications, Norwood etc. operations, as well as better perioperative care significantly improved survival rate and quality of life of these children. The study group included 308 children treated for cyanotic heart disease in Yugoslavia, in the period January 2000 to July 2004. Some of them (239, 77.6%) were treated at the University Children's Hospital in Belgrade, and others (69, 22.4%) in different institutions abroad. The age of the operated patients varied between 1 day and 19 years (median 12 months). The patients (pts) were divided into four groups, according to the disease and type of the operation. In the whole group of 308 patients treated due to cyanotic heart disease, there were 232 (75.3%) cases with open heart surgery and 76 (24.7%) with closed procedures. The mortality rate was significantly different between disease/operation groups, and age groups. Average mortality rates differed from 11.8% for palliative procedures to 12.5% for complete corrections. Mortality rate and achieved surgical results in treatment of children with cyanotic heart diseases were significantly worse than those published by leading cardiac surgery centers in the world. However, there is a clear tendency in introducing new surgical procedures, lowering the age at which the operation is done and decreasing the mortality rates.


Asunto(s)
Cardiopatías Congénitas/cirugía , Adolescente , Adulto , Procedimientos Quirúrgicos Cardíacos/mortalidad , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Niño , Preescolar , Cardiopatías Congénitas/mortalidad , Humanos , Lactante , Recién Nacido , Tasa de Supervivencia
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