ABSTRACT
As cardiopatias congênitas são importantes causas de morbimortalidade infantil e, em cerca de 50% dos casos, é necessária a intervenção cirúrgica no primeiro ano de vida. Estima-se alto défice de procedimentos na Região Norte do Brasil.Analisar o tempo de espera para realização de tratamento eletivo cirúrgico e/ou intervencionista de crianças portadoras de cardiopatias congênitas em um centro de referência cardiológico, e fazer considerações sobre as cardiopatias e suas formas de tratamento na referida instituição. Estudo analítico, de caráter transversal do período de janeiro de 2012 a outubro de 2014, de pacientes com idade igual ou inferior a 14 anos diagnosticados com cardiopatias congênitas que estavam na fila de tratamento cardíaco eletivo cirúrgico ou percutâneo. Das 407 crianças que aguardavam por tratamento, a faixa etária mais prevalente foi a de > 2 a 6 anos (34,0%). O tempo médio de espera, em meses, foi 23,1 ± 18,3, com mediana de 19. As cardiopatias mais frequentes foram comunicação interventricular (28,98%), persistência do canal arterial (18,42%) e comunicação interatrial (11,05%). A maioria das crianças (63,4%) não pertencia à região metropolitana. As intervenções percutâneas representaram somente 27,84% do total de cateterismos e 14,85% de todos os tratamentos cardíacos. Cerca de 60% do volume de cirurgias pediátricas ocorreu em crianças sem cadastro prévio no sistema, devido ao caráter de urgência. Grande parte das crianças que aguardam por procedimento cardíaco é procedente de fora da região metropolitana e tem malformações potencialmente tratáveis por cateterismo. É necessário aumentar a capacidade operacional do único centro de referência público do Estado, além de descentralizar o atendimento em alta complexidade cardiológica da região metropolitana
Congenital heart disease is an important cause of morbidity and mortality in childhood, and in 50% of cases, surgery is required in the first year of life. A high deficit of surgical procedures is estimated in Northern Brazil. To analyze the waiting time for elective surgical treatment and/or intervention in children with congenital heart disease in a Cardiology referral center, and to make considerations about heart diseases and forms of treatment in that institution. A cross-sectional study of all patients aged less than 14 years, with a diagnosis of congenital heart disease that were waiting for elective surgical or percutaneous cardiac treatment. Among the 407 children with congenital heart defects, the most prevalent age group was > 2 to 6 years (34.0%). The average waiting time was 23.1 ± 18.3 months, with a median of 19. The most frequent heart disease was ventricular septal defect (28.98%), patent ductus arteriosus (18.42%) and atrial septal defect (11.05%). Most children (63.4%) were not from the metropolitan area. The percutaneous interventions represented only 27.84% of the catheterization procedures and 14,85% of all heart treatments. Approximately 60% of the pediatric surgeries occurred in children who were not previously registered due to urgency cases. Most of the children waiting for a cardiac procedure were not from the metropolitan area and had malformations potentially treatable by catheterization. It is necessary to increase the capacity of the single referral center in the state of Pará, as well as decentralize the high-complexity cardiological care in the metropolitan region
Subject(s)
Humans , Male , Female , Child , Child , Heart Defects, Congenital/surgery , Heart Defects, Congenital/therapy , Waiting Lists , Brazil , Cardiac Care Facilities , Catheterization/methods , Congenital Abnormalities , Cross-Sectional Studies , Data Collection , Elective Surgical Procedures/methods , Endocardial Cushion Defects/therapy , Epidemiology, Descriptive , Heart , Heart Septal Defects, Ventricular/therapy , PrevalenceABSTRACT
Congenital heart disease is an important cause of morbidity and mortality in childhood, and in 50% of cases, surgery is required in the first year of life. A high deficit of surgical procedures is estimated in Northern Brazil. Objective: To analyze the waiting time for elective surgical treatment and/ or intervention in children with congenital heart disease in a Cardiology referral center, and to make considerations about heart diseases and forms of treatment in that institution. Methods: A cross-sectional study of all patients aged less than 14 years, with a diagnosis of congenital heart disease that were waiting for elective surgical or percutaneous cardiac treatment. Results: Among the 407 children with congenital heart defects, the most prevalent age group was > 2 to 6 years (34.0%). The average waiting time was 23.1 ± 18.3 months, with a median of 19. The most frequent heart disease was ventricular septal defect (28.98%), patent ductus arteriosus (18.42%) and atrial septal defect (11.05%). Most children (63.4%) were not from the metropolitan area. The percutaneous interventions represented only 27.84% of the catheterization procedures and 14,85% of all heart treatments. Approximately 60% of the pediatric surgeries occurred in children who were not previously registered due to urgency cases. Conclusion: Most of the children waiting for a cardiac procedure were not from the metropolitan area and had malformations potentially treatable by catheterization. It is necessary to increase the capacity of the single referral center in the state of Pará, as well as decentralize the high-complexity cardiological care in the metropolitan region
As cardiopatias congênitas são importantes causas de morbimortalidade infantil e, em cerca de 50% dos casos, é necessária a intervenção cirúrgica no primeiro ano de vida. Estima-se alto défice de procedimentos na Região Norte do Brasil. Objetivo: Analisar o tempo de espera para realização de tratamento eletivo cirúrgico e/ou intervencionista de crianças portadoras de cardiopatias congênitas em um centro de referência cardiológico, e fazer considerações sobre as cardiopatias e suas formas de tratamento na referida instituição. Método: Estudo analítico, de caráter transversal do período de janeiro de 2012 a outubro de 2014, de pacientes com idade igual ou inferior a 14 anos diagnosticados com cardiopatias congênitas que estavam na fila de tratamento cardíaco eletivo cirúrgico ou percutâneo. Resultados: Das 407 crianças que aguardavam por tratamento, a faixa etária mais prevalente foi a de > 2 a 6 anos (34,0%). O tempo médio de espera, em meses, foi 23,1 ± 18,3, com mediana de 19. As cardiopatias mais frequentes foram comunicação interventricular (28,98%), persistência do canal arterial (18,42%) e comunicação interatrial (11,05%). A maioria das crianças (63,4%) não pertencia à região metropolitana. As intervenções percutâneas representaram somente 27,84% do total de cateterismos e 14,85% de todos os tratamentos cardíacos. Cerca de 60% do volume de cirurgias pediátricas ocorreu em crianças sem cadastro prévio no sistema, devido ao caráter de urgência. Conclusão: Grande parte das crianças que aguardam por procedimento cardíaco é procedente de fora da região metropolitana e tem malformações potencialmente tratáveis por cateterismo. É necessário aumentar a capacidade operacional do único centro de referência público do Estado, além de descentralizar o atendimento em alta complexidade cardiológica da região metropolitana
Subject(s)
Humans , Male , Female , Child , Child , Waiting Lists , Heart Defects, Congenital/surgery , Heart Defects, Congenital/therapy , Congenital Abnormalities , Brazil , Catheterization/methods , Cardiac Care Facilities , Epidemiology, Descriptive , Prevalence , Cross-Sectional Studies , Data Collection , Elective Surgical Procedures/methods , Endocardial Cushion Defects/therapy , Heart , Heart Septal Defects, Ventricular/therapyABSTRACT
Down syndrome with endocardial cushion defect is a challenging diagnosis for parents as well as members of the health care team. Utilizing a framework of relationship-based care, nurses are in a position to positively affect parents' experience by providing education, advocacy, and support from initial diagnosis through discharge. The plan of care is multidisciplinary and focuses on critical developmental needs, such as bonding and feeding. Because Down syndrome is associated with multiple anomalies, anticipatory guidance is needed to assist parents with establishing a health maintenance plan for their child after discharge.
Subject(s)
Down Syndrome/psychology , Endocardial Cushion Defects/nursing , Nurse-Patient Relations , Parents/education , Down Syndrome/nursing , Endocardial Cushion Defects/diagnosis , Endocardial Cushion Defects/therapy , Humans , Parents/psychology , Social SupportABSTRACT
BACKGROUND: The first symptoms of previously undiagnosed congenital heart disease may become apparent during pregnancy. It is important to recognize structural heart lesions since they require additional monitoring during the prenatal, peripartum, and postpartum periods and are associated with increased maternal and fetal morbidity and mortality. CASE: We report a case of a new diagnosis of an endocardial cushion defect in an otherwise healthy woman in her third trimester whose presenting complaint was dyspnea in the left lateral decubitus position. CONCLUSION: We located only one other case report of a congenital heart lesion first diagnosed during pregnancy. While rare, since the signs and symptoms of congenital heart disease may also occur in normal pregnant women, it is important for the clinician to be aware that structural heart lesions are part of the differential diagnosis.
Subject(s)
Endocardial Cushion Defects/diagnosis , Pregnancy Complications, Cardiovascular/diagnosis , Chemoprevention , Diuretics/therapeutic use , Dyspnea/etiology , Echocardiography , Endocardial Cushion Defects/therapy , Female , Furosemide/therapeutic use , Heart Murmurs/diagnosis , Humans , Posture , Pregnancy , Pregnancy Complications, Cardiovascular/therapy , Thromboembolism/prevention & controlABSTRACT
Complete atrioventricular canal (CAVC), also referred to as complete atrioventricular septal defect, is characterised by an ostium primum atrial septal defect, a common atrioventricular valve and a variable deficiency of the ventricular septum inflow. CAVC is an uncommon congenital heart disease, accounting for about 3% of cardiac malformations. Atrioventricular canal occurs in two out of every 10,000 live births. Both sexes are equally affected and a striking association with Down syndrome was found. Depending on the morphology of the superior leaflet of the common atrioventricular valve, 3 types of CAVC have been delineated (type A, B and C, according to Rastelli's classification). CAVC results in a significant interatrial and interventricular systemic-to-pulmonary shunt, thus inducing right ventricular pressure and volume overload and pulmonary hypertension. It becomes symptomatic in infancy due to congestive heart failure and failure to thrive. Diagnosis of CAVC might be suspected from electrocardiographic and chest X-ray findings. Echocardiography confirms it and gives anatomical details. Over time, pulmonary hypertension becomes irreversible, thus precluding the surgical therapy. This is the reason why cardiac catheterisation is not mandatory in infants (less than 6 months) but is indicated in older patients if irreversible pulmonary hypertension is suspected. Medical treatment (digitalis, diuretics, vasodilators) plays a role only as a bridge toward surgery, usually performed between the 3rd and 6th month of life.
Subject(s)
Endocardial Cushion Defects/diagnosis , Diagnosis, Differential , Endocardial Cushion Defects/classification , Endocardial Cushion Defects/complications , Endocardial Cushion Defects/genetics , Endocardial Cushion Defects/therapy , Female , Heart Valve Diseases/congenital , Heart Valve Diseases/diagnosis , Heart Valve Diseases/genetics , Heart Valve Diseases/therapy , Humans , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/prevention & control , Infant , Infant, Newborn , Male , Pregnancy , Prenatal Diagnosis/methods , PrognosisSubject(s)
Heart Defects, Congenital/therapy , Adult , Canada , Cardiac Surgical Procedures , Ductus Arteriosus, Patent/therapy , Endocardial Cushion Defects/therapy , Heart Septal Defects, Atrial/therapy , Heart Septal Defects, Ventricular/therapy , Hospitals, Special , Humans , Referral and ConsultationABSTRACT
A left-to-right shunt lesions exists when blood from the left atrium, left ventricle, or aorta transits to the right atrium or its tributaries, the right ventricle, or the pulmonary artery. This article discusses: the incidence, types, embryology, clinical presentations, physical examinations, electrocardiographic features, chest radiographs, echocardiographic and cardiac catheterization issues, treatment, natural history of atrial septal defects, and outcomes of treatment of atrial septal defects, ventricular septal defects, patent ductus arteriosus, and endocardial cushion defects.
Subject(s)
Ductus Arteriosus, Patent , Endocardial Cushion Defects , Heart Septal Defects , Hemodynamics , Cardiac Catheterization , Child, Preschool , Ductus Arteriosus, Patent/diagnosis , Ductus Arteriosus, Patent/physiopathology , Ductus Arteriosus, Patent/therapy , Echocardiography , Electrocardiography , Endocardial Cushion Defects/diagnosis , Endocardial Cushion Defects/physiopathology , Endocardial Cushion Defects/therapy , Female , Heart Septal Defects/diagnosis , Heart Septal Defects/physiopathology , Heart Septal Defects/therapy , Humans , Incidence , Infant , Infant, Newborn , Male , Medical History Taking , Physical Examination , Treatment OutcomeABSTRACT
A 74-year-old woman with a unilateral left superior vena cava required dual chamber permanent pacing after a radical cardiac operation for an incomplete from of endocardial cushion defect. An active fixation ventricular lead was used to prevent the instability induced by the strange course of the electrode. For atrial pacing, a ventricular passive fixation lead was used. A transvenous dual chamber pacemaker was successfully inserted via a unilateral left superior vena cava.
Subject(s)
Cardiac Pacing, Artificial/methods , Endocardial Cushion Defects/therapy , Vena Cava, Superior/abnormalities , Aged , Cardiac Catheterization , Female , Humans , PhlebographyABSTRACT
Os autores estudaram a resposta e os efeitos adversos da indometacina no tratamento de 10 RN prematuros com patologias graves e persistencia do canal arterial, que receberam indometacina por via oral, 0,2mg/kg. Foi analisada a resposta terapeutica e seus efeitos adversos, sendo constatado fechamento do canal arterial na maioria dos RN (60 por cento), com melhora clínica da insuficiencia cardiaca
Subject(s)
Humans , Male , Female , Adult , Endocardial Cushion Defects/therapy , Indomethacin/adverse effects , Administration, Oral , Indomethacin/therapeutic use , Infant, Premature , Retrospective StudiesABSTRACT
This article focuses on the clinical evaluation of children with cardiovascular diseases associated with Down syndrome. Recent advances in diagnosis and management are discussed and the medical or surgical approach to the patient with severe cardiovascular malformations is presented.
