[Infective endocarditis in adolescents. Analysis of risk factors for hospital mortality]. / Endocardite infecciosa em adolescentes. Análise dos fatores de risco de mortalidade intra-hospitalar.

PURPOSE: To study the epidemiological, clinical, therapeutic and evolutive aspects of endocarditis in a group of patients aging 12 to 20 years-old (mean 15.5). METHODS: Thirty-three consecutive patients (14 males, 19 females) admitted with infective endocarditis were retrospectively studied. RESULTS: Infective endocarditis mortality was 42%. Rheumatic heart disease was the predominant underlying condition in 63% of patients. Congenital heart disease (24%) and cardiac prosthesis (12%) were the other affections involved. The majority of patients (78%) were in functional class III and IV, with more deaths than the 22% who were in functional class I and II (p = 0.01). Staphylococcus aureus was the most frequently isolated agent (42% of the positive blood cultures, followed by Staphylococcus viridans, 21%). Multivariate analysis identified total leukocyte count above 10,000/mm3 and functional class, both at admission (p = 0.01 and p = 0.004, respectively), and the occurrence of embolic complications (p = 0.03) as independent predictors of in-hospital mortality. CONCLUSION: Rheumatic heart disease remains, as in adults, the main predisposing factor for infective endocarditis in adolescents, and S. aureus is, like in children, the leading agent. Mortality is high and functional class at hospital admission, embolic complications and leukocytosis are independent predictors of in-hospital mortality.

[Morpho-functional cardiac evaluation in young normotensive children of hypertensive patients. A prospective Doppler-echocardiographic study]. / Avaliação morfo-funcional cardíaca em jovens normotensos, filhos de hipertensos. Estudo Doppler-ecocardiográfico prospectivo.

PURPOSE: Evaluate functional and/or structural cardiac changes in young normotensive subjects with a family history of hypertension. METHODS: Prospective study was performed with 62 normotensive persons, ages 15 to 30 years, divided in 32 children of hypertensive patients (group 1) and 30 children of normotensive persons (group 2) comparable in blood pressure, body surface area, heart rate, age and sex. After clinical examination, all underwent Doppler-echocardiogram to evaluate cardiac structure and left ventricular (LV) systolic and diastolic function. RESULTS: Systolic LV fractional shortening was increased in group 1 when compared with group 2 (38.03 +/- 4.95% and 34.7 +/- 4.48%, respectively--p < 0.01). Mitral deceleration time (DT) ranged from 85 to 160 ms--mean values 116.47 +/- 16.99 ms--in group 1 and from 100 to 220 ms--mean values 126.73 +/- 26.66 ms--in group 2 (p < 0.05). A correlation between LV mass and left atrium (LA) diameter was noted in group 1 (r-0.514, p < 0.01). CONCLUSION: Children of hypertensive patients show increased LV function, similar to what occurs in early hypertension and in borderline hypertension, even when there is no evidence of LV hypertrophy or high blood pressure. Mitral DT (shorten in group 1) was the only diastolic parameter that differed in the groups. The correlation between LV mass and LA dimension suggests that LA size could be related to functional and hemodynamic LV changes.

[Clinical and hemodynamic aspects of non-obstructive coronary lesions. A comparative retrospective study]. / Aspectos clínicos e hemodinâmicos das lesões coronárias não-obstrutivas. Estudo retrospectivo comparativo.

PURPOSE: To study the clinical and hemodynamic aspects of a group of patient presenting non-obstructive coronary lesions. METHODS: We reviewed 963 coronary angiographies performed at a same institution. The 52 patients presenting only stenosis < or = 50% after semi-quantitative measurement composed group I, which was compared with two other groups consisted of 52 patients each: one, with patients presenting univascular lesion > 50% (group II) and the other with normal coronary arteriographies (group III). RESULTS: Mean age was similar in groups I and II (49.4 +/- 6.89 and 51.3 +/- 7.86, p > 0.05) and significantly higher than that of group III (44.8 +/- 6.81, p < 0.05). Risk factors did not discriminate group I (GI) from groups II (GII) and III (GIII). During a follow-up period of 63 months, the number of hospital admissions due to cardiac events and repetitions of coronary arteriography were similar in GI and GII, being significantly less frequent in GIII (p < 0.00001 and 0.001; p < 0.01 and 0.05, respectively). By the end of the follow-up period, though angina and heart failure functional classes had been similar in the three groups, patients in groups I and II were using more medications than those in group III (p < 0.0001 and 0.00001). Mean ejection fractions (%) were lower in GI and GII (67.04 +/- 10.13 and 68.90 +/- 11.32) than in GIII (74.69 +/- 6.40, p < 0.01). Lesions were predominantly proximal in GI when compared with GII (p < 0.05). Length, simmetry, ulceration, thrombus and proximal shoulder showed no difference between GI and GII. CONCLUSION: Patients with non-obstructive coronary lesions were similar to those with univascular lesion > 50% regarding several aspects and were considerably different from those with normal coronary arteries.

[Percutaneous transluminal renal angioplasty in the treatment of renovascular hypertension]. / Angioplastia renal transluminal percutânea no tratamento da hipertensão renovascular.

PURPOSE: To analyze the effect of percutaneous transluminal renal angioplasty (PTRA) in renovascular hypertension. METHODS: Twenty-three patients with renal artery stenosis and arterial hypertension underwent PTRA. There were 11 male and 12 female, 19 to 78 years old (45.8 +/- 17.41). In 20 lesions the diagnosis was atherosclerosis, in 7 fibromuscular dysplasia and in 1 Takayasu arteritis. Three patients underwent bilateral dilatation and 2 patients repeated the procedure due to restenosis. Two patients presented with acute renal failure and severe bilateral renal artery stenosis. RESULTS: There were 21 technical success in 25 procedures. After 20 satisfactory dilatations, clinical success followed in 17 (100% of cases of fibromuscular dysplasia cases and 77% of atherosclerosis. The fall in diastolic arterial pressure after PTRA was statistical significant (p < 0.001). In two cases acute renal failure the renal function became normal after angioplasty. There were 2 complications and no death attributed to PTRA. CONCLUSION: The method was effective and safe in the management of renovascular hypertension during the short-term follow-up. It was possible in two cases of acute renal failure to normalize renal function.

Endocardite infecciosa em adolescentes: análise dos fatores de risco de mortalidade intra-hospitalar / Infective endocarditis in adolescents: analysis of risk factors for in-hospital mortality

OBJETIVO - Estudar os aspectos epidemiológicos, clínicos, terapêuticos e evolutivos da endocardite infecciosa (EI) em grupo de paciente com idade entre 12 e 20 (média de 15,5) anos. MÉTODOS - Foram estudados, retrospectivamente, 33 pacientes consecutivos (14 do sexo masculino e 19 do feminino), admitidos com diagnóstico de EI. RESULTADOS - A mortalidade da EI foi de 42 'por cento'. A cardiopatia reumática predominou como condição predisponente (63 'por cento' dos casos), seguida das cardiopatias congênitas (24 'por cento') e próteses cardíacas (12 'por cento'). A maioria dos pacientes (78 'por cento') encontrava-se na admissão em CF III e IV e apresentava mortalidade significativamente maior do que os que se encontravam na CF I e II (p=0,001). Complicaçöes embólicas foram detectadas em 51 'por cento' e determinaram maior mortalidade (p=0,05). O agente etiológico mais isolado foi o Staphylococcus aureus (em 42 'por cento' das hemoculturas positivas), seguido do Staphylococcus viridans (21 'por cento'). A análise multivariada mostrou que a contagem global de leucócitos acima de 10.000/mmü, e a CF referidos na admissão (p=0,001 e p=0,04), e a ocorrência de embolias (p=0,03) eram preditores independentes de mortalidade intra-hospitalar. CONCLUSÄO - A cardiopatia reumática permanece, semelhante à população adulta, como principal fator predisponente da EI nos adolescentes, tendo como principal agente etiológico o S.aureus, semelhante à população pediátrica. A mortalidade é elevada e representam preditores de mortalidade intra-hospitalar a CF na admissão, a ocorrência da fenômenos embólicos e a leucocitose.

Dispersão do intervalo QTc nos diferentes padröes geométricos e funcionais do ventrículo esquerdo na hipertensão sistêmica / QTc interval dispersion in different geometric and functional patterns of the left ventricle in systemic arterial hypertension

OBJETIVO: Analisar a dispersão do QTc nos diferentes padröes morfológicos e funcionais da hipertensão arterial sistêmica. PACIENTES E MÉTODOS: Foram estudados prospectivamente 162 pacientes portadores de hipertensão arterial sistêmica (HAS), oriundos de uma mesma instituição, e que foram submetidos a eletrocardiograma (ECG) computadorizado com registro sumultâneo das 12 derivaçöes e a ecocardiograma. Os ECGs foram analisados "off-line" por dois observadores independentes com auxílio do programa APEXPOS. Os índices de massa ventricular foram estimados pelo ecocardiograma modo M guiado pelo bidimensional, através da equação de regressão de Devereux. Os pacientes foram divididos em 64 normais (G1), 25 com remodelagem concêntrica (G2), 20 com hipertrofia ventricular (HVE) excêntrica, 43 com HVE concêntrica (G4) e 10 com disfunção sistólica do ventrículo esquerdo (G5). RESULTADO: Houve correlação significativa da dispersão do QTc com o índice de massa do ventrículo esquerdo (r=0,45 e p<0,001). Após ajuste para a idade, fração de ejeção e número de derivaçöes aferidas, a correlação manteve-se significativa (r= 0,37 e p, 0,001). Em relação à análise multivariada em "stepwise", somente a dispersão do QTc e a idade foram preditores independentes de HVE (p< 0,0001 e 0,05). As médias das dispersöes do QTc foram: ... fórmulas ..., com G4 e G5 diferindo significativamente de G1 e G2 pelo teste de Scheffé (p< 0,05). Num modelo de MANOVA, diferenças persistiram entre grupos após inclusão da idade e da fração de ejeção. CONCLUSÄO: A dispersão do QTc difere significativamente entre os diversos padröes geométricos-funcionais do ventrículo esquerdo na hipertensão arterial sistêmica, sendo preditora independente de hipertrofia ventricular esquerda.