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Rev. bras. cir. cardiovasc ; 36(2): 165-171, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1251086


Abstract Introduction: Anemia and blood transfusion are risk factors for morbidity/mortality in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The objective of this study is to analyze the association of blood transfusion with morbidity/mortality in patients undergoing coronary artery bypass grafting (CABG) under CPB in the state of São Paulo, Brazil. Methods: This is a retrospective analysis using the State of São Paulo Registry of Cardiovascular Surgery from November 2013 to August 2014. Blood transfusion was only considered during surgery or within six hours after surgery. Anemia was defined as hematocrit ≤ 37.5%. Patients < 18 years old were excluded. The sample was divided in four groups - Group I (851, no anemia), Group II (200, anemia without blood transfusion), Group III (181, no anemia and transfusion), and Group IV (258, anemia and transfusion). Results: A total of 1,490 patients were included; 639 (42.9%) were anemic and 439 (29.5%) underwent blood transfusion. Group II showed lower composite morbidity (odds ratio [OR] −0.05; confidence interval [CI] −0.27-0.17; P=0.81) than Group III (OR 0.41; CI 0.23-0.59; P=0.018) or Group IV (OR 0.54; CI 0.31-0.77; P=0.016). Group III was at greater risk of mortality (OR 0.73; CI 0.43-1.03; P=0.02) than Group II, which was exposed only to anemia (OR −0.13; CI −0.55-0.29; P=0.75), or Group IV (OR 0.29; CI −0.13-0.71; P=0.539). Conclusion: Anemia in patients undergoing CABG with CPB is bad, but blood transfusion can be worse, increasing at least 50% the risk for mortality and/or morbidity.

Humans , Adolescent , Cardiac Surgical Procedures/adverse effects , Anemia/etiology , Brazil , Coronary Artery Bypass , Retrospective Studies
Rev. bras. cir. cardiovasc ; 35(2): 134-140, 2020. tab, graf
Article in English | LILACS | ID: biblio-1101474


Abstract Objective: To analyze the impact of vacuum-assisted venous drainage (VAVD) on arterial pump flow in a simulated pediatric cardiopulmonary bypass circuit utilizing a centrifugal pump (CP) with an external arterial filter. Methods: The simulation circuit consisted of a Quadrox-I Pediatric oxygenator, a Rotaflow CP (Maquet Cardiopulmonary AG, Rastatt, Germany), and a custom pediatric tubing set primed with Lactated Ringer's solution and packed red blood cells. Venous line pressure, reservoir pressure, and arterial flow were measured with VAVD turned off to record baseline values. Four other conditions were tested with progressively higher vacuum pressures (-20, -40, -60, and -80 mmHg) applied to the baseline cardiotomy pressure. An arterial filter was placed into the circuit and arterial flow was measured with the purge line in both open and closed positions. These trials were repeated at set arterial flow rates of 1500, 2000, and 2500 mL/min. Results: The use of progressively higher vacuum caused a reduction in effective arterial flow from 1490±0.00 to 590±0.00, from 2020±0.01 to 1220±0.00, and from 2490±0.0 to 1830±0.01 mL/min. Effective forward flow decreased with increased levels of VAVD. Conclusion: The use of VAVD reduces arterial flow when a CP is used as the main arterial pump. The reduction in the forward arterial flow increases as the vacuum level increases. The loss of forward flow is further reduced when the arterial filter purge line is kept in the recommended open position. An independent flow probe is essential to monitor pump flow during cardiopulmonary bypass.

Humans , Child , Cardiopulmonary Bypass , Drainage , Equipment Design , Hemodynamics , Models, Cardiovascular
Rev. bras. cir. cardiovasc ; 34(5): 511-516, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042045


Abstract Objective: This study aimed to evaluate Ebstein's anomaly surgical correction and its early and long-term outcomes. Methods: A retrospective analysis of 62 consecutive patients who underwent surgical repair of Ebstein's anomaly in our institution from January 2000 to July 2016. The following long-term outcomes were evaluated: survival, reoperations, tricuspid regurgitation, and postoperative right ventricular dysfunction. Results: Valve repair was performed in 46 (74.2%) patients - 12 of them using the Da Silva cone reconstruction; tricuspid valve replacement was performed in 11 (17.7%) patients; univentricular palliation in one (1.6%) patient; and the one and a half ventricle repair in four (6.5%) patients. The patients' mean age at the time of surgery was 20.5±14.9 years, and 46.8% of them were male. The mean follow-up time was 8.8±6 years. The 30-day mortality rate was 8.06% and the one and 10-year survival rates were 91.9% both. Eleven (17.7%) of the 62 patients required late reoperation due to tricuspid regurgitation, in an average time of 7.1±4.9 years after the first procedure. Conclusion: In our experience, the long-term results of the surgical treatment of Ebstein's anomaly demonstrate an acceptable survival rate and a low incidence of reinterventions.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Tricuspid Valve/surgery , Ebstein Anomaly/surgery , Postoperative Complications/etiology , Reoperation/statistics & numerical data , Time Factors , Tricuspid Valve Insufficiency/etiology , Severity of Illness Index , Retrospective Studies , Treatment Outcome , Ventricular Dysfunction, Right/etiology , Ebstein Anomaly/complications , Ebstein Anomaly/mortality , Kaplan-Meier Estimate , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/mortality
Rev. bras. cir. cardiovasc ; 33(3): 242-249, May-June 2018. tab, graf
Article in English | LILACS | ID: biblio-958407


Abstract Introduction: Donor shortage and organ allocation is the main problem in pediatric heart transplant. Mechanical circulatory support is known to increase waiting list survival, but it is not routinely used in pediatric programs in Latin America. Methods: All patients listed for heart transplant and supported by a mechanical circulatory support between January 2012 and March 2016 were included in this retrospective single-center study. The endpoints were mechanical circulatory support time, complications, heart transplant survival and discharge from the hospital. Results: Twenty-nine patients from our waiting list were assessed. Twelve (45%) patients were initially supported by extracorporeal membrane oxygenation (ECMO) and a centrifugal pump was implanted in 17 (55%) patients. Five patients initially supported by ECMO were bridged to another device. One was bridged to a centrifugal pump and four were bridged to Berlin Heart Excor®. Among the 29 supported patients, 18 (62%) managed to have a heart transplant. Thirty-day survival period after heart transplant was 56% (10 patients). Median support duration was 12 days (interquartile range [IQR] 4 - 26 days) per run and the waiting time for heart transplant was 9.5 days (IQR 2.5-25 days). Acute kidney injury was identified as a mortality predictor (OR=22.6 [CI=1.04-494.6]; P=0.04). Conclusion: Mechanical circulatory support was able to bridge most INTERMACS 1 and 2 pediatric patients to transplant with an acceptable complication rate. Acute renal failure increased mortality after mechanical circulatory support in our experience.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Young Adult , Extracorporeal Membrane Oxygenation/methods , Heart-Assist Devices , Heart Transplantation/methods , Heart Defects, Congenital/surgery , Time Factors , Extracorporeal Membrane Oxygenation/mortality , Multivariate Analysis , Retrospective Studies , Risk Factors , Waiting Lists , Heart Transplantation/mortality , Treatment Outcome , Statistics, Nonparametric , Heart Defects, Congenital/mortality
Rev. bras. cir. cardiovasc ; 33(3): 224-232, May-June 2018. tab, graf
Article in English | LILACS | ID: biblio-958406


Abstract Objective: Hemodilution is a concern in cardiopulmonary bypass (CPB). Using a smaller dual tubing rather than a single larger inner diameter (ID) tubing in the venous limb to decrease prime volume has been a standard practice. The purpose of this study is to evaluate these tubing options. Methods: Four different CPB circuits primed with blood (hematocrit 30%) were investigated. Two setups were used with two circuits for each one. In Setup I, a neonatal oxygenator was connected to dual 3/16" ID venous limbs (Circuit A) or to a single 1/4" ID venous limb (Circuit B); and in Setup II, a pediatric oxygenator was connected to dual 1/4" ID venous limbs (Circuit C) or a single 3/8" ID venous limb (Circuit D). Trials were conducted at arterial flow rates of 500 ml/min up to 1500 ml/min (Setup I) and up to 3000 ml/min (Setup II), at 36°C and 28°C. Results: Circuit B exhibited a higher venous flow rate than Circuit A, and Circuit D exhibited a higher venous flow rate than Circuit C, at both temperatures. Flow resistance was significantly higher in Circuits A and C than in Circuits B (P<0.001) and D (P<0.001), respectively. Conclusion: A single 1/4" venous limb is better than dual 3/16" venous limbs at all flow rates, up to 1500 ml/min. Moreover, a single 3/8" venous limb is better than dual 1/4" venous limbs, up to 3000 ml/min. Our findings strongly suggest a revision of perfusion practice to include single venous limb circuits for CPB.

Humans , Oxygenators/standards , Cardiopulmonary Bypass/instrumentation , Cannula/standards , Pediatrics/instrumentation , Reference Standards , Temperature , Time Factors , Venous Pressure/physiology , Blood Flow Velocity/physiology , Cardiopulmonary Bypass/methods , Reproducibility of Results , Equipment Design , Equipment Safety , Hemodilution , Models, Cardiovascular
ABC., imagem cardiovasc ; 27(4): 229-234, out.-dez. 2014. ilus, tab
Article in Portuguese | LILACS | ID: lil-730116


Fundamento: O Ecocardiograma Transesofágico (ETE) intraoperatório tem sido muito utilizado durante as correções das cardiopatias congênitas; entretanto, em obstruções de vias de saída dos ventrículos, as informações são limitadas. Objetivo: Avaliar a confiabilidade do ETE em detectar gradientes residuais em pacientes com obstruções de vias de saída dos ventrículos. Pacientes e Método: Os gradientes sistólicos após circulação extracorpórea ao ETE de 127 pacientes (idade média de 7 anos), sendo 79 com obstrução direita e 48 com obstrução esquerda, foram comparados ao Ecocardiograma Transtorácico (ETT) após cirurgia. Gradientes maiores que 40 mmHg foram considerados de significância hemodinâmica.Resultados: Nas obstruções esquerdas o ETE mostrou gradientes médios maiores que o ETT (30 mmHg vs 24mmHg; p = 0,014). Os gradientes ao ETE foram menores que 40 mmHg em 75% dos pacientes e houve concordância com o ETT em 97%. Nos demais, o gradiente ao ETE foi maior que 40 mmHg e houve concordância com o ETT em 33%. Nas obstruções direitas o ETE mostrou gradientes médios semelhantes ao ETT (28 mmHg vs 25 mmHg; p = 0,21). Os gradientes ao ETE foram menores que 40 mmHg em 88% dos pacientes e houve concordância com o ETT em 91,5%. Nos demais, o gradiente ao ETE foi maior que 40 mmHg e houve concordância com o ETT em 60%. Conclusão: O ETE mostrou-se útil na detecção de gradientes residuais nas vias de saída dos ventrículos nos pacientes estudados. Entretanto, em gradientes maiores que 40 mmHg, o ETE sugere maior severidade das obstruções, particularmente no lado esquerdo.

Background: Despite the large use of intraoperative Transesophageal Echocardiography (TEE) in congenital heart surgery, limited information is available regarding ventricular outflow tract obstruction. Objective: The aim of this study was to assess the reliability of the post-bypass TEE to detect residual gradients in patients with ventricular outflow obstruction. Patients and Methods: Post-bypass TEE peak systolic gradients of 127 patients (mean age of 7 years), being 79 with right ventricular outflow tract obstruction and 48 with left ventricular outflow tract obstruction, were compared with the postoperative TTE. Postoperative lesions were considered of hemodynamic significance when peak systolic gradient was higher than 40 mmHg. Results: In patients with left ventricular outflow tract obstruction TEE showed mean peak systolic gradients higher than TTE (30 mmHg versus 24 mmHg; p= 0,014). In 75%, TEE gradients were lower than 40 mmHg and agreed with TTE in 97%. In the remaining patients, TEE gradients were higher than 40 mmHg and agree with TTE in 33%. In patients with right ventricular outflow tract obstruction TEE mean gradients agreed with TTE (28 mmHg versus 25 mmHg; p= 0.21). In 88%, TEE gradients were lower than 40 mmHg and agreed with TTE in 91.5%. In the remaining patients, TEE gradients were higher than 40 mmHg and agreed with TTE in 60%.Conclusion: TEE showed to be a reliable technique to detect residual ventricular outflow tract obstructions in the majority of patients. However, when considered gradients higher than 40 mmHg, TEE suggested a greater severity of obstructions, particularly on the left side.

Humans , Male , Female , Child , Heart Defects, Congenital/therapy , Echocardiography , Echocardiography, Transesophageal , Intraoperative Care , Ventricular Outflow Obstruction/surgery , Extracorporeal Circulation , Ventricular Function/physiology , Hemodynamics , Data Interpretation, Statistical , Tetralogy of Fallot
Arq. bras. cardiol ; 103(5): 382-390, 11/2014. tab, graf
Article in English | LILACS | ID: lil-730365


Background: To alert for the diagnosis of the 22q11.2 deletion syndrome (22q11.2DS) in patients with congenital heart disease (CHD). Objective: To describe the main CHDs, as well as phenotypic, metabolic and immunological findings in a series of 60 patients diagnosed with 22q11.2DS. Methods: The study included 60 patients with 22q11.2DS evaluated between 2007 and 2013 (M:F=1.3, age range 14 days to 20 years and 3 months) at a pediatric reference center for primary immunodeficiencies. The diagnosis was established by detection of the 22q11.2 microdeletion using FISH (n = 18) and/or MLPA (n = 42), in association with clinical and laboratory information. Associated CHDs, progression of phenotypic facial features, hypocalcemia and immunological changes were analyzed. Results: CHDs were detected in 77% of the patients and the most frequent type was tetralogy of Fallot (38.3%). Surgical correction of CHD was performed in 34 patients. Craniofacial dysmorphisms were detected in 41 patients: elongated face (60%) and/or elongated nose (53.3%), narrow palpebral fissure (50%), dysplastic, overfolded ears (48.3%), thin lips (41.6%), elongated fingers (38.3%) and short stature (36.6%). Hypocalcemia was detected in 64.2% and decreased parathyroid hormone (PTH) level in 25.9%. Decrease in total lymphocytes, CD4 and CD8 counts were present in 40%, 53.3% and 33.3%, respectively. Hypogammaglobulinemia was detected in one patient and decreased concentrations of immunoglobulin M (IgM) in two other patients. Conclusion: Suspicion for 22q11.2DS should be raised in all patients with CHD associated with hypocalcemia and/or facial dysmorphisms, considering that many of these changes may evolve with age. The 22q11.2 microdeletion should be confirmed by molecular testing in all patients. .

Fundamento: Alertar para o diagnóstico da síndrome da deleção 22q11.2 (SD 22q11.2) em pacientes com cardiopatias congênitas. Objetivo: Descrever as principais cardiopatias, alterações fenotípicas, metabólicas e imunológicas em uma série de 60 pacientes com a SD22q11.2. Métodos: Foram incluídos 60 pacientes com SD22q11.2 avaliados entre 2007 e 2013 (M:F = 1,3; idades entre 14 dias a 20 anos e 3 meses) em um centro pediátrico de referência para imunodeficiências primárias. O diagnóstico foi feito pela detecção da microdeleção 22q11.2 através de FISH (n = 18) e/ou MLPA (n = 42), associados a dados clínicos e laboratoriais. Foram analisadas as cardiopatias, aspectos fenotípicos evolutivos da fácies, a hipocalcemia e alterações imunológicas associadas. Resultados: Cardiopatias congênitas ocorreram em 77% dos casos, sendo que a tetralogia de Fallot ocorreu em 38,3%. Correção cirúrgica da cardiopatia foi realizada em 34 pacientes. Os dismorfismos craniofaciais foram detectados em 41 pacientes: face (60%) e/ou nariz alongados (53,3%), fenda palpebral estreita (50%), orelhas displásicas com hiperdobramento (48,3%), lábios finos (41,6%), dedos alongados (38,3%) e baixa estatura (36,6%). Hipocalcemia foi observada em 64,2% com redução do nível de paratormônio (PTH) em 25,9%. Observou-se número reduzido de linfócitos totais, CD4 e CD8 em 40%, 53,3%, e 33,3%, respectivamente. Detectou-se hipogamaglobulinemia em um paciente e redução das concentrações de imunoglobulina M (IgM) em outros dois pacientes. Conclusão: Deve-se suspeitar da SD22q11.2 em todos os portadores de cardiopatia congênita com hipocalcemia e/ou dismorfismos faciais, ressaltando-se que muitas dessas alterações podem ser evolutivas. ...

Clinics ; 68(4): 531-536, abr. 2013. tab, graf
Article in English | LILACS | ID: lil-674249


OBJECTIVE: To analyze the preoperative plasma antigenic concentration and activity of von Willebrand factor and its main cleaving protease ADAMTS-13 in pediatric patients with cyanotic congenital heart disease undergoing surgical treatment and investigate possible correlations with postoperative bleeding. METHODS: Plasma antigenic concentrations (von Willebrand factor:Ag and ADAMTS-13:Ag) were measured using enzyme-linked immunoassays. Collagen-binding assays were developed to measure biological activities (von Willebrand factor:collagen binding and ADAMTS-13 activity). The multimeric structure of von Willebrand factor was analyzed using Western immunoblotting. Demographic, diagnostic, and general and specific laboratory data and surgery-related variables were subjected to univariate, bivariate, and multivariate analysis for the prediction of postoperative bleeding. RESULTS: Forty-eight patients were enrolled, with ages ranging from 9 months to 7.6 years (median 2.5 years). The plasma concentrations of von Willebrand factor:Ag and ADAMTS-13:Ag were decreased by 65 and 82%, respectively, in the patients compared with the controls (p<0.001). An increased density of low-molecular-weight fractions of von Willebrand factor, which are suggestive of proteolytic degradation (p = 0.0081), was associated with decreased ADAMTS-13 activity, which was likely due to ADAMTS-13 consumption (71% of controls, p = 0.0029) and decreased von Willebrand factor:collagen binding (76% of controls, p = 0.0004). Significant postoperative bleeding occurred in 13 patients. The preoperative ADAMTS-13 activity of <64.6% (mean level for the group), preoperative activated partial thromboplastin time, and the need for cardiopulmonary bypass were characterized as independent risk factors for postoperative bleeding, with respective hazard ratios of 22.35 (95% CI 1.69 to 294.79), 1.096 (95% CI 1.016 to 1.183), and 37.43 (95% ...

Child , Child, Preschool , Female , Humans , Infant , Male , ADAM Proteins/blood , Heart Defects, Congenital/blood , Postoperative Hemorrhage/blood , von Willebrand Factor/analysis , ADAM Proteins/physiology , Analysis of Variance , Blotting, Western , Blood Coagulation/physiology , Enzyme-Linked Immunosorbent Assay , Heart Defects, Congenital/surgery , Predictive Value of Tests , Postoperative Hemorrhage/etiology , Reference Values , Risk Factors , von Willebrand Factor/physiology
Arq. bras. cardiol ; 98(5): 390-397, maio 2012. ilus, tab
Article in Portuguese | LILACS | ID: lil-643641


FUNDAMENTO: O número crescente de crianças com cardiopatias congênitas em evolução demanda maior preparo dos profissionais e das instituições que as manuseiam. OBJETIVO: Descrever o perfil dos pacientes com idade superior a 16 anos com cardiopatia congênita operados e analisar os fatores de risco preditivos de mortalidade hospitalar. MÉTODOS: Mil, quinhentos e vinte pacientes (idade média 27 ± 13 anos) foram operados entre janeiro de 1986 e dezembro de 2010. Foram realizadas análise descritiva do perfil epidemiológico da população estudada e análise dos fatores de risco para mortalidade hospitalar, considerando escore de complexidade, ano em que a cirurgia foi realizada, procedimento realizado pelo cirurgião pediátrico ou não e presença de reoperação. RESULTADOS: Ocorreu um crescimento expressivo no número de casos a partir do ano 2000. A média do escore de complexidade foi 5,4 e os defeitos septais corresponderam a 45% dos casos. A mortalidade geral foi 7,7% e o maior número de procedimentos (973 ou 61,9%) com maior complexidade foi realizado por cirurgiões pediátricos. Complexidade (OR 1,5), reoperação (OR 2,17) e cirurgião pediátrico (OR 0,28) foram fatores de risco independentes que influenciaram a mortalidade. A análise multivariada mostrou que o ano em que a cirurgia foi realizada (OR 1,03), a complexidade (OR 1,44) e o cirurgião pediátrico (OR 0,28) influenciaram no resultado. CONCLUSÃO: Observa-se um número crescente de pacientes com idade superior a 16 anos e que, apesar do grande número de casos simples, os mais complexos foram encaminhados para os cirurgiões pediátricos, que apresentaram menor mortalidade, em especial nos anos mais recentes. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).

BACKGROUND: The increasing number of children with evolving congenital heart diseases demands greater preparation of professionals and institutions that handle them. OBJECTIVE: To describe the profile of patients aged over 16 years with congenital heart disease, who have undergone surgery, and analyze the risk factors that predict hospital mortality. METHOD: One thousand five hundred twenty patients (mean age 27 ± 13 years) were operated between January 1986 and December 2010. We performed a descriptive analysis of the epidemiological profile of the study population and analyzed risk factors for hospital mortality, considering the complexity score, the year in which surgery was performed, the procedure performed or not performed by the pediatric surgeon and reoperation. RESULTS: There was a significant increase in the number of cases from the year 2000. The average complexity score was 5.4 and the septal defects represented 45% of cases. Overall mortality was 7.7% and most procedures (973 or 61.9%) with greater complexity were performed by pediatric surgeons. Complexity (OR 1.5), reoperation (OR 2.17) and pediatric surgeon (OR 0.28) were independent risk factors influencing mortality. Multivariate analysis showed that the year in which the surgery was performed (OR 1.03), the complexity (OR 1.44) and the pediatric surgeon (OR 0.28) influenced the result. CONCLUSION: There is an increasing number of patients aged 16 years which, despite the large number of simple cases, the most complex ones were referred to pediatric surgeons, who had lower mortality, especially in recent years. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).

Adolescent , Adult , Aged , Humans , Middle Aged , Young Adult , Hospital Mortality , Heart Defects, Congenital/surgery , Age Factors , Brazil/epidemiology , Epidemiologic Methods , Heart Defects, Congenital/mortality , Specialties, Surgical , Time Factors , Treatment Outcome
Rev. bras. cardiol. invasiva ; 20(3): 315-323, 2012. ilus, tab
Article in Portuguese | LILACS, SES-SP | ID: lil-656097


INTRODUÇÃO: Estudos comparando os métodos percutâneo e cirúrgico no tratamento da persistência do canal arterial (PCA) são raros na literatura. Nosso objetivo foi realizar análise comparativa entre os dois métodos de tratamento da PCA, enfatizando os aspectos de eficácia e morbidade. MÉTODOS: Estudo observacional com 2 coortes de crianças e adolescentes > 5 kg e < 14 anos, portadores de PCA, tratados durante um projeto de avaliação de incorporação de novas tecnologias ao Sistema Único de Saúde (SUS), realizado em um hospital cardiológico de excelência, em parceria com o Ministério da Saúde do Brasil. Foi feita análise prospectiva no grupo percutâneo entre 2009 e 2011 e retrospectiva no grupo cirúrgico entre 2006 e 2011. RESULTADOS: Foram incluídos 80 pacientes no grupo percutâneo (60% do sexo feminino) e 39 no grupo cirúrgico (51% do sexo feminino; P = 0,37). A mediana de idade e de peso dos grupos percutâneo e cirúrgico foi de 39,4 meses vs. 25,5 meses (P = 0,04) e de 14 kg vs. 11,1 kg (P = 0,052), respectivamente. No grupo percutâneo, 78 pacientes (92%) tinham PCA do tipo A e o diâmetro mínimo do canal à angiografia foi de 2,5 ± 1,2 mm. As próteses mais utilizadas foram Amplatzer®, molas de Gianturco e CeraTM. A técnica cirúrgica mais utilizada foi a clipagem. A taxa de sucesso dos procedimentos foi de 100% nos dois grupos. O grupo cirúrgico apresentou maiores taxas de complicação, incluindo quilotórax, infecções, necessidade de hemoderivados, hipertensão arterial sistêmica e uso de opioides, como também maior necessidade de terapia intensiva. A mediana do tempo de internação foi de 1,3 dia no grupo percutâneo e de 7,9 dias no grupo cirúrgico (P < 0,01). À alta hospitalar, as taxas de oclusão foram semelhantes nos dois grupos (91% no grupo percutâneo e 87% no grupo cirúrgico; P = 0,71). CONCLUSÕES: Em decorrência da menor morbidade, do menor tempo de internação e da igual eficácia, o tratamento percutâneo da PCA deve ser considerado a modalidade terapêutica de escolha para pacientes selecionados.

BACKGROUND: Studies comparing percutaneous and surgical methods for the treatment of the patent ductus arteriosus (PDA) are rare in the literature. This study aimed to perform a comparative analysis between both PDA treatment methods with emphasis on efficacy and morbidity. METHODS: Observational study with 2 cohorts of children and adolescents > 5 kg and < 14 years of age with PDA, treated under a study protocol to assess the incorporation of novel technologies to the Brazilian Public Health System (Unified Health System - SUS) at an excellence hospital, in partnership with the Brazilian Ministry of Health. A prospective analysis was conducted for the percutaneous group from 2009 to 2011 and a retrospective analysis was performed for the surgical group between 2006 and 2011. RESULTS: Eighty patients were included in the percutaneous group (60% female) and 39 patients in the surgical group (51% female; P = 0.37). The median age and weight of the percutaneous and surgical groups was 39.4 months vs 25.5 months (P = 0.04) and 14 kg vs 11.1 kg (P = 0.052), respectively. In the percutaneous group, 78 patients (92%) had type A PDA and the minimal ductal diameter at angiography was 2.5 + 1.2 mm. Amplatzer®, Gianturco coils and CeraTM were the most commonly used devices. Clipping was the most commonly used surgical technique. The success rate of the procedure was 100% in both groups. The surgical group had higher complication rates, including chylothorax, infections, transfusions, systemic arterial hypertension, use of opioids and a greater need for intensive care. The median hospitalization time was 1.3 days in the percutaneous group and 7.9 days in the surgical group (P < 0.01). Upon discharge, occlusion rates were similar in both groups (91% in the percutaneous group and 87% in the surgical group; P = 0.71). CONCLUSIONS: Due to the lower morbidity, the shorter hospitalization time and similar efficacy, percutaneous treatment of the PDA should be considered the modality of choice for selected patients.

Humans , Prostheses and Implants , Heart Defects, Congenital/surgery , Heart Defects, Congenital/complications , Cardiac Catheterization/methods , Cardiac Catheterization , Ductus Arteriosus, Patent/surgery , Ductus Arteriosus, Patent/complications , General Surgery/methods
Rev. Soc. Cardiol. Estado de Säo Paulo ; 21(4): 49-53, out.-dez. 2011. tab, ilus
Article in Portuguese | LILACS | ID: lil-619510


A cardiologia pediátrica vem experimentando inigualável desenvolvimento nos últimos anos. Novas técnicas cirúrgicas e intervencionistas têm propiciado o tratamento neonatal de várias anomalias, cujo prognóstico anteriormente era desfavorável. A cardiologia fetal é parte importante deste crescimento, não apenas pela possibilidade do diagnóstico precoce, como, também, pela abertura de novas opções terapêuticas ainda na vida intrauterina. Esta especialidade tem trazido um novo paciente para dentro do hospital cardiológico, o feto, com todas as suas particularidades, e, em especial, por estar dentro do organismo materno. Por estes motivos, tem sido tendência atual a instituição de uma unidade fetal acoplada ao centro de cardiologia pediátrica, onde procedimentos diagnósticos e terapêuticos podem ser realizados de maneira segura na vida pré-natal e onde o recém-nascido já é trazido ao centro especializado que receberá o tratamento cirúrgico ou intervencionista, desde o momento do parto. Neste artigo, serão discutidas as vantagens e o impacto da unidade fetal na evolução de recém-nascidos portadores de cardiopatias com repercussão hemodinâmica neonatal.

Humans , Heart Defects, Congenital/complications , Heart Defects, Congenital/mortality , Cardiac Catheterization/methods , Cardiac Catheterization , Thoracic Surgery/trends , Echocardiography/methods , Echocardiography
Rev. bras. cardiol. invasiva ; 17(3): 386-397, jul.-set. 2009. ilus, tab
Article in Portuguese | LILACS, SES-SP | ID: lil-535099


Fundamentos: O fechamento perventricular das comunicações interventriculares (CIVs) musculares tornou-se uma altenativa terapêutica atraente em pequenos lactentes com grandes defeitos. Entretanto, a reprodutibilidade desse métodos em vários centros mundiais ainda é uma questão em aberto. Método: Relatamos uma experiência multicêntrica na América do Sul com tal abordagem. No período de julho de 2007 a maio de 2009, nove pacientes não consecutivos (idade e peso médios de 6 meses e 5,5kg, respectivamente) foram submetidos a procedimento no centro cirúgico, sob monitoração da ecocardiográfia transesofágica, utilizando-se dispositivos Amplatzer. Todos os pacientes, com exceção de um, apresentavam insuficiência cardíaca e graus variados de hipertensão pulmonar. Quatro pacientes...

Background: Perventricular closure of muscular ventricular septal defects (VSD) has become an attractive treatment modality for infants. However, its reproducibility worldwide remains to be seen. Methods: We report a multicenter experience in South America. From July, 2007 to May, 2009, nine non-consecutive patients (median age and weight were 6 months and 5.5 kg, respectively) underwent the procedure in the operating room under transesophageal echocardiographic guidance using Amplatzer devices. All patients but one were in congestive heart failure and had pulmonary arterial hypertension. Four patients had coarctation of the aorta and one was submitted to pulmonary artery banding at 6 months of life, which were all repaired at the same session. Eight patients had single defects (six mid-muscular, two apical) measuring 10.3 ± 3.7 mm and one patient had multiple apical defects that required two devices. Results: Ten devices were implanted successfully (median size: 12 mm), and two had to be sutured to the right ventricular wall with a surgical suture. One patient...

Humans , Infant , Prostheses and Implants , Cardiac Catheterization/methods , Cardiac Catheterization , Heart Septal Defects, Ventricular/surgery
Arq. bras. cardiol ; 88(6): e182-e184, jun. 2007. tab
Article in Portuguese | LILACS | ID: lil-456736


A cianose persistente constitui complicação freqüente no pós-operatório da cirurgia de Norwood modificada por Sano. Sua ocorrência pode ser explicada pela obstrução dinâmica da anastomose proximal do conduto sintético, que liga o ventrículo direito ao tronco pulmonar, evidenciada à ecocardiografia. A fim de melhorar a saturação arterial de oxigênio, foi recentemente descrita a utilização de betabloqueador, no período pós-operatório. Neste relato, descrevemos a utilização de propranolol em dois casos de cirurgia de Norwood modificada por Sano, demonstrando diminuição do gradiente no tubo sintético, aumento dos níveis de saturação arterial de oxigênio, diminuição da freqüência cardíaca e aumento da pressão arterial, traduzido em melhora clínica. Concluímos que autilização de betabloqueador nesses casos mostrou-se benéfica.

Persistent cyanosis is a frequent complication in the post-operative period of Sano modification of the Norwood procedure. It may be explained by a dynamic proximal shunt stenosis of the synthetic conduit that links the right ventricle to the pulmonary artery, as detected by echo cardiographic study. The use of beta-blockers in the post-operative period has been recently described in order to improve the arterial oxygen saturation. In this report, we describe the use of propranolol in two patients undergoing Sano modification of the Norwood procedure, in whom a gradient reduction in the synthetic conduit, increase in the levels of arterial oxygen saturation, decrease in heart rate, and increase in blood pressure were observed, thus resulting in clinical improvement. We conclude that the use of beta-blockers in these cases was beneficial.

Humans , Infant, Newborn , Adrenergic beta-Antagonists/therapeutic use , Cardiac Surgical Procedures/adverse effects , Cyanosis/drug therapy , Propranolol/therapeutic use , Blood Pressure/drug effects , Cardiac Surgical Procedures/methods , Cyanosis/etiology , Heart Rate/drug effects , Oxygen Consumption/drug effects , Postoperative Period
Rev. bras. cir. cardiovasc ; 17(1): 1-5, jan.-mar. 2002.
Article in Portuguese | LILACS | ID: lil-314576


Os autores propõem um sistema de nomenclatura para cardiopatias congênitas baseado no princípio da análise segmentar seqüencial. Apresentam a lista curta de diagnósticos e discutem a importância da uniformização dos nomes para facilitar a troca de informações entre instituições...

Humans , Heart Defects, Congenital/classification , Unified Medical Language System/classification , Terminology
Rev. bras. cir. cardiovasc ; 16(4): 321-336, out.-dez. 2001. ilus, tab, graf
Article in Portuguese | LILACS | ID: lil-304840


OBJETIVO: Analisar as características anatômicas, o resultado das técnicas empregadas na correçäo cirúrgica de acordo com o número de procedimentos, assim como a mortalidade em cada grupo da classificaçäo de Barbero-Marcial para atresia pulmonar com comunicaçäo interventricular. CASUíSTICA E MÉTODOS: De janeiro de 1990 a novembro de 1999, 73 pacientes que foram submetidos a estudo cineangiocardiográfico previamente à primeira intervençäo cirúrgica, foram analisados. As características anatômicas das artérias pulmonares e artérias colaterais sistêmico-pulmonares, assim como as técnicas cirúrgicas que propiciaram tratamento paliativo, "paliativo definitivo" e definitivo foram estudadas. As causas de mortalidade também foram descritas. RESULTADOS: Dezenove pacientes apresentavam os segmentos pulmonares supridos por artérias pulmonares (grupo A), 45 por artérias pulmonares e artérias colaterais sistêmico-pulmonares (grupo B) e 9 somente por artérias colaterais sistêmico-pulmonares (grupo C). O grupo A apresentou maior proporçäo de tratamentos definitivos, o grupo B maior proporçäo de paliativos e o grupo C, maior proporçäo de "paliativos definitivos" (p< 0,0001). Näo houve diferença estatística significante de mortalidade entre os grupos (p=0,860), embora a proporçäo de óbitos nos grupos B e C foi mais que o dobro da proporçäo do grupo A. CONCLUSÖES: A classificaçäo de Barbero-Marcial permite estimar a probabilidade de um paciente ser submetido a tratamento paliativo, "paliativo definitivo" ou definitivo, assim como o risco de mortalidade em pacientes portadores de atresia pulmonar com comunicaçäo interventricular

Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Heart Septal Defects, Ventricular , Pulmonary Artery , Pulmonary Atresia , Heart Septal Defects, Ventricular , Pulmonary Artery , Pulmonary Atresia
Rev. bras. cir. cardiovasc ; 15(3): 234-237, jul.-set. 2000.
Article in Portuguese | LILACS | ID: lil-280493


CASUISTICA E METODOS: No período de novembro de 1996 a dezembro de 1997, 15 crianças portadoras de canal arterial (CA), sendo 12 do sexo feminino, com idade média de 2,7 anos, peso médio de 13,9 kg foram submetidas a fechamento do CA por minitoracotomia. O ecodopplercardiograma confirmou o diagnóstico em todos o casos e mostrou o diâmetro do CA entre 2 mm e 10 mm, com média de 4,06 mm. A indicaçäo cirúrgica foi eletiva em todos os casos. A operaçäo consistiu de minitoracotomia esquerda no 4§ espaço intercostal de 2,5 cm a 3,0 cm, seguida de dissecçäo do CA e clipagem do mesmo com 2 clips metálicos. Näo foi utilizada drenagem pleural em nenhum dos casos. RESULTADOS: Todos os pacientes receberam alta em média no 4§ dia de pós-operatório, sem nenhum escape pelo CA ao ecodopplercardiograma. CONCLUSÃO: O fechamento de CA por minitoracotomia é uma alternativa de tratamento que reduz o período de internaçäo, bom efeito cosmético e baixo índice de complicaçöes

Humans , Male , Female , Infant , Child, Preschool , Child , Ductus Arteriosus, Patent/surgery , Thoracotomy , Minimally Invasive Surgical Procedures , Treatment Outcome
Rev. bras. cir. cardiovasc ; 15(2): 173-8, abr.-jun. 2000. graf, tab
Article in Portuguese | LILACS | ID: lil-267959


INTRODUÇÃO: A tromboendarterectomia pulmonar é utilizada como método bem estabelecido para aliviar a hipertensão pulmonar nos casos de tromboembolismo pulmonar crônico. A dificuldade que se apresenta é conciliar o tempo relativamente exíguo de parada circulatória total (PCT) hipotérmica com a completa desobstrução das artérias pulmonares, sob pena de danos neurológicos. CASUÍSTICA E MÉTODOS: No período de março de 1998 a abril de 1999 (13 meses), 8 pacientes, 5 do sexo masculino, 1 de cor negra, com idade variando entre 25 a 56 anos (média 46,2 anos) e com diagnóstico angiográfico de tromboembolismo pulmonar, foram submetidos a tromboendarterectomia pulmonar uni ou bilateral por tromboembolismo pulmonar crônico (TEP). Instalado o circuito extracorpóreo e incisada a artéria pulmonar, procede-se à PCT e, aproximadamente a cada 20 minutos de procedimento, intermitentemente, o fluxo da circulação extracorpórea (CEC) é restabelecido a 14º C por um período de 15 minutos objetivando-se a reperfusão cerebral e corpórea. Sucessivas paradas circulatórias total são realizadas e tantas quanto forem necessárias até a remoção de todos os trombos da artéria pulmonar. RESULTADOS: Não foram registrados óbitos no transoperatório. Um paciente faleceu no 30º dia de pós-operatório (PO) devido a broncopneumonia que evoluiu para sepse. Os 8 pacientes foram submetidos a CEC e PCT hipotérmica, sendo que em 5 (62,5 por cento) foram necessárias 4 PCT e em 3 (37,5 por cento) apenas 3 PCT, com média de 3,6 PCT. O tempo total de CEC variou de 210 a 255 minutos, com média de 225 minutos. O tempo de PCT hipotérmica variou de 58 a 88 minutos, com média de 76,7 minutos e o período de PCT por paciente variou de 18 a 24 minutos, com média de 20,5 minutos. Em todos os pacientes foram realizadas tomografias de crânio, que não revelaram nenhuma alteração anatômica, assim como o exame físico não revelou déficit motor ou rebaixamento do sensório. CONCLUSÃO: Acreditamos ser esta uma técnica promissora, capaz de oferecer tranqüilidade para o cirurgião e segurança para o paciente em termos de proteção do sistema nervoso central.

Humans , Male , Female , Adult , Middle Aged , Cerebrum/physiology , Central Nervous System Diseases/prevention & control , Endarterectomy , Hypothermia, Induced , Heart Arrest, Induced/methods , Pulmonary Embolism/surgery , Time Factors