Nursing Guidelines on Cardiac Surgery and Parents' Anxiety: Randomized Clinical Trial.

OBJECTIVE: The preparation of parents of children who should undergo cardiac surgery requires special treatment such as the explanations about the event. This study aims to compare the effects of standardized nursing guidelines with routine institutional orientation on the anxiety of parents of children undergoing cardiac surgery. METHODS: Randomized clinical trial. The sample consisted of parents of children who underwent cardiac surgery from December 2010 to April 2011. Twenty-two parents were randomized to the intervention group (IG) and received the standard nursing guidelines and 22 participated in the control group (CG) and received the routine guidelines from the institution. Anxiety was assessed by the State-Trait Anxiety Inventory (STAI) applied in the preoperative period, between 12 and 20 hours before surgery and before receiving standard or institutional guidelines and 48 hours after surgery. The analysis of variance (ANOVA) for repeated measures was performed to evaluate the differences between the variations in STAI scores between the groups during the studied period. The level of significance was 0.05. RESULTS: There were no significant differences in baseline anxiety scores between groups with regard to trait anxiety as well as state anxiety: STAI-trait (CG 42.6±4.9 vs. IG 41.4±6.0, P=0.48); STAI-state (CG 42.3±5.7 vs. IG 45.6±8.3, P=0.18). Likewise, the variation in score after 48 hours was similar between groups (STAI-trait P=0.77; STAI-state P=0.61). CONCLUSION: There were no significant differences in the parents' anxiety levels when comparing the two types of guidelines: the standard nursing and the institutional orientation.

Nursing guidelines on cardiac surgery and parents anxiety: randomized clinical trial

Abstract Objective: The preparation of parents of children who should undergo cardiac surgery requires special treatment such as the explanations about the event. This study aims to compare the effects of standardized nursing guidelines with routine institutional orientation on the anxiety of parents of children undergoing cardiac surgery. Methods: Randomized clinical trial. The sample consisted of parents of children who underwent cardiac surgery from December 2010 to April 2011. Twenty-two parents were randomized to the intervention group (IG) and received the standard nursing guidelines and 22 participated in the control group (CG) and received the routine guidelines from the institution. Anxiety was assessed by the State-Trait Anxiety Inventory (STAI) applied in the preoperative period, between 12 and 20 hours before surgery and before receiving standard or institutional guidelines and 48 hours after surgery. The analysis of variance (ANOVA) for repeated measures was performed to evaluate the differences between the variations in STAI scores between the groups during the studied period. The level of significance was 0.05. Results: There were no significant differences in baseline anxiety scores between groups with regard to trait anxiety as well as state anxiety: STAI-trait (CG 42.6±4.9 vs. IG 41.4±6.0, P=0.48); STAI-state (CG 42.3±5.7 vs. IG 45.6±8.3, P=0.18). Likewise, the variation in score after 48 hours was similar between groups (STAI-trait P=0.77; STAI-state P=0.61). Conclusion: There were no significant differences in the parents' anxiety levels when comparing the two types of guidelines: the standard nursing and the institutional orientation.

Incidence of hemorrhagic complications with use of a radial compression device: a cohort study.

OBJECTIVE: To examine the incidence of hemorrhagic complications in patients undergoing radial cardiac catheterization and using a hemostatic device for arterial compression. METHOD: A prospective cohort study conducted with patients undergoing elective cardiac catheterization in two hemodynamic laboratories in southern Brazil. The TR Band® radial compression device was used during 4 hours for hemostasis of the arterial puncture site. Hematomas and minor bleeding were the outcomes evaluated. RESULTS: A total of 244 patients were evaluated. The mean age was 63.5±10.9 years, 61.9% were male, 73.8% had systemic arterial hypertension (SAH) and 42.8% were dyslipidemic. Type I hematoma occurred in 1.2% of patients and minor bleeding in 9% after removal of the device. There was no significant association between hematomas and bleeding, and patients who used oral anticoagulants (p=0.604) and prior use of antiplatelets (p=0.958). CONCLUSION: The use of the hemostatic device for radial artery compression was safe in clinical practice and there was a low incidence of hematomas and minor bleeding after radial coronary angiography.

Independent Predictors of Late Presentation in Patients with ST-Segment Elevation Myocardial Infarction.

BACKGROUND: In patients with acute ST-segment elevation myocardial infarction (STEMI), the time elapsed from symptom onset to receiving medical care is one of the main mortality predictors. OBJECTIVE: To identify independent predictors of late presentation in patients STEMI representative of daily clinical practice. METHODS: All patients admitted with a diagnosis of STEMI in a reference center between December 2009 and November 2014 were evaluated and prospectively followed during hospitalization and for 30 days after discharge. Late presentation was defined as a time interval > 6 hours from chest pain onset until hospital arrival. Multiple logistic regression analysis was used to identify independent predictors of late presentation. Values of p < 0.05 were considered statistically significant. RESULTS: A total of 1,297 patients were included, with a mean age of 60.7 ± 11.6 years, of which 71% were males, 85% Caucasians, 72% had a mean income lower than five minimum wages and 66% had systemic arterial hypertension. The median time of clinical presentation was 3.00 [1.40-5.48] hours, and approximately one-quarter of the patients had a late presentation, with their mortality being significantly higher. The independent predictors of late presentation were Black ethnicity, low income and diabetes mellitus, and a history of previous heart disease was a protective factor. CONCLUSION: Black ethnicity, low income and diabetes mellitus are independent predictors of late presentation in STEMI. The identification of subgroups of patients prone to late presentation may help to stimulate prevention policies for these high-risk individuals.

Independent Predictors of Late Presentation in Patients with ST-Segment Elevation Myocardial Infarction / Preditores de Apresentação Tardia em Pacientes com Infarto Agudo do Miocárdio com Supradesnivelamento do Segmento ST

Abstract Background: In patients with acute ST-segment elevation myocardial infarction (STEMI), the time elapsed from symptom onset to receiving medical care is one of the main mortality predictors. Objective: To identify independent predictors of late presentation in patients STEMI representative of daily clinical practice. Methods: All patients admitted with a diagnosis of STEMI in a reference center between December 2009 and November 2014 were evaluated and prospectively followed during hospitalization and for 30 days after discharge. Late presentation was defined as a time interval > 6 hours from chest pain onset until hospital arrival. Multiple logistic regression analysis was used to identify independent predictors of late presentation. Values of p < 0.05 were considered statistically significant. Results: A total of 1,297 patients were included, with a mean age of 60.7 ± 11.6 years, of which 71% were males, 85% Caucasians, 72% had a mean income lower than five minimum wages and 66% had systemic arterial hypertension. The median time of clinical presentation was 3.00 [1.40-5.48] hours, and approximately one-quarter of the patients had a late presentation, with their mortality being significantly higher. The independent predictors of late presentation were Black ethnicity, low income and diabetes mellitus, and a history of previous heart disease was a protective factor. Conclusion: Black ethnicity, low income and diabetes mellitus are independent predictors of late presentation in STEMI. The identification of subgroups of patients prone to late presentation may help to stimulate prevention policies for these high-risk individuals.

Resumo Fundamento: Em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST), o tempo decorrido desde o início dos sintomas até a busca por atendimento médico é um dos principais preditores de mortalidade. Objetivo: Identificar preditores independentes de apresentação tardia em pacientes com IAMCSST representativos da prática clínica diária. Métodos: Todos os pacientes admitidos com diagnóstico de IAMCSST em um centro de referência, no período de dezembro de 2009 a novembro de 2014, foram avaliados e prospectivamente acompanhados, durante a hospitalização e por 30 dias após a alta. A apresentação tardia foi definida como tempo maior que 6 horas desde o início da dor torácica até a chegada ao hospital. Análise de regressão logística múltipla foi usada para identificar os preditores independentes de apresentação tardia. Foi considerado estatisticamente significativo p < 0,05. Resultados: Foram incluídos 1.297 pacientes, com idade média de 60,7 ± 11,6 anos, 71% do sexo masculino, 85% da raça branca, 72% com renda média menor que cinco salários mínimos e 66% com hipertensão arterial sistêmica. A mediana do tempo de apresentação clínica foi de 3,00 [1,40-5,48] horas, sendo que aproximadamente um quarto dos pacientes apresentou-se tardiamente, e a mortalidade deles foi significativamente maior. Os preditores independentes de apresentação tardia foram raça negra, baixa renda e diabetes melito, e história de doença cardíaca prévia foi fator protetor. Conclusão: Raça negra, baixa renda e diabetes melito são preditores independentes de apresentação tardia no IAMCSST. A identificação de subgrupos de pacientes propensos à apresentação tardia pode auxiliar a estimular políticas de prevenção nestes indivíduos de alto risco.

Incidence of hemorrhagic complications with use of a radial compression device: a cohort study / Incidencia de complicaciones hemorrágicas con el uso de pulsera de compresión radial: estudio de cohorte / Incidência de complicações hemorrágicas com o uso de pulseira de compressão radial: estudo de coorte

ABSTRACT Objective: To examine the incidence of hemorrhagic complications in patients undergoing radial cardiac catheterization and using a hemostatic device for arterial compression. Method: A prospective cohort study conducted with patients undergoing elective cardiac catheterization in two hemodynamic laboratories in southern Brazil. The TR Band® radial compression device was used during 4 hours for hemostasis of the arterial puncture site. Hematomas and minor bleeding were the outcomes evaluated. Results: A total of 244 patients were evaluated. The mean age was 63.5±10.9 years, 61.9% were male, 73.8% had systemic arterial hypertension (SAH) and 42.8% were dyslipidemic. Type I hematoma occurred in 1.2% of patients and minor bleeding in 9% after removal of the device. There was no significant association between hematomas and bleeding, and patients who used oral anticoagulants (p=0.604) and prior use of antiplatelets (p=0.958). Conclusion: The use of the hemostatic device for radial artery compression was safe in clinical practice and there was a low incidence of hematomas and minor bleeding after radial coronary angiography.

RESUMEN Objetivo: Verificar la incidencia de complicaciones hemorrágicas en pacientes sometidos a cateterismo cardiaco radial y con el uso de pulsera hemostática para compresión arterial. Método: Estudio de cohorte prospectivo, conducido con pacientes sometidos a cateterismo cardiaco electivo, en dos laboratorios de hemodinámica en el sur de Brasil. Para la hemostasia del sitio de punción arterial, se utilizó la pulsera de compresión radial TR Band® por 4 horas. Los resultados evaluados fueron hematomas y sangrado menor. Resultados: Fueron evaluados 244 pacientes, con edad media de 63,5±10,9 años, el 61,9% del sexo masculino, el 73,8% con hipertensión arterial sistémica y el 42,8% dislipidémicos. Ocurrió el 1,2% de hematoma tipo I y el 9% de sangrado menor después de la retirada de la pulsera. No hubo asociación significativa entre hematomas y sangrados y los pacientes que hacían uso de anticoagulante oral (p=0,604) y uso previo de antiplaquetario (p=0,958). Conclusión: El uso de la pulsera hemostática para compresión de la arteria radial se mostró segura en la práctica clínica y con reducida incidencia de hematomas y sangrado menor luego de cinecoronariografía por vía radial.

RESUMO Objetivo: Verificar a incidência de complicações hemorrágicas em pacientes submetidos a cateterismo cardíaco radial e com uso de pulseira hemostática para compressão arterial. Método: Estudo de coorte prospectivo, conduzido com pacientes submetidos a cateterismo cardíaco eletivo, em dois laboratórios de hemodinâmica no sul do Brasil. Para a hemostasia do sítio de punção arterial, foi utilizada a pulseira de compressão radial TR Band® por 4 horas. Os desfechos avaliados foram hematomas e sangramento menor. Resultados: Foram avaliados 244 pacientes, com idade média de 63,5±10,9 anos, 61,9% do sexo masculino, 73,8% com hipertensão arterial sistêmica e 42,8% dislipidêmicos. Ocorreram 1,2% de hematoma tipo I e 9% de sangramento menor depois da retirada da pulseira. Não houve associação significativa entre hematomas e sangramentos e os pacientes que faziam uso de anticoagulante oral (p=0,604) e uso prévio de antiplaquetário (p=0,958). Conclusão: O uso da pulseira hemostática para compressão da artéria radial mostrou-se segura na prática clínica e com reduzida incidência de hematomas e sangramento menor após cinecoronariografia por via radial.

Predictors of Mediastinitis Risk after Coronary Artery Bypass Surgery: Applicability of Score in 1. 322 Cases / Preditores de Risco de Mediastinite após Cirurgia de Revascularização do Miocárdio: Aplicabilidade de Score em 1. 322 Casos

Abstract Background: Mediastinitis is a severe surgical complication of low incidence, but high lethality. Scores used in the preoperative period to stratify the risk of postoperative mediastinitis may contribute to improve the results. Objective: To test the applicability of the MagedanzSCORE in predicting the risk factors for mediastinitis in patients undergoing coronary artery bypass grafting at a cardiology reference hospital. Methods: Historical cohort study with adult patients who underwent coronary artery bypass grafting. The analyzed variables were contemplated in the MagedanzSCORE: reoperation, chronic obstructive pulmonary disease (COPD), obesity, class IV unstable angina, polytransfusion therapy, mediastinitis and death as outcome variables. Results: Of the 1.322 patients examined, 56 (4.2%) developed mediastinitis. Of these, 26 (46.4%) were classified as high risk for mediastinitis and 15 (26.8%) at very high risk for mediastinitis. Three of the five variables of the Magendanz Score showed statistically significant differences: reoperation, COPD and obesity. Class IV unstable angina and postoperative polytransfusion were not associated with mediastinitis after coronary artery by-pass grafting. The area under the ROC curve was 0.80 (CI 95% 0.73 - 0.86), indicating the model's satisfactory ability to predict the occurrence of mediastinitis. Conclusion: The tool was useful in the preoperative assessment demonstrating the risk for mediastinitis in this population of intensive care patients. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Resumo Fundamento: A mediastinite é uma complicação cirúrgica grave de baixa incidência, porém com alto poder de letalidade. Escores utilizados no período pré-operatório para estratificar o risco de sua ocorrência podem contribuir para melhorar os resultados. Objetivo: Testar a aplicabilidade do MagedanzSCORE em prever risco de mediastinite em pacientes submetidos à cirurgia de revascularização do miocárdio (CRM) em um hospital de referência em cardiologia. Métodos: Estudo de coorte histórica conduzido com pacientes adultos submetidos à CRM. As variáveis analisadas foram as contempladas no MagedanzSCORE: reintervenção cirúrgica, doença pulmonar obstrutiva crônica (DPOC), obesidade, angina estável classe IV/angina instável, politransfusão sanguínea, mediastinite e óbito como variáveis de desfecho. Resultados: Dentre os 1.322 pacientes analisados, 56 (4,2%) desenvolveram mediastinite. Destes, 26 (46,4%) foram classificados com risco elevado e 15 (26,8%) com risco muito elevado. Três das cinco variáveis do escore apresentaram diferenças estatisticamente significativas: reintervenção cirúrgica, DPOC e obesidade. Angina classe IV/instável e politransfusão (pós-operatória) não apresentaram associação com mediastinite após a CRM. A área sob a curva ROC foi de 0,80 (IC 95% 0,73 - 0,86), demonstrando capacidade satisfatória do modelo em prever a ocorrência de mediastinite. Conclusão: O instrumento mostrou-se útil para auxiliar na avaliação pré-operatória por apontar o risco de mediastinite nesta população de pacientes de cuidados intensivos. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Predictors of Mediastinitis Risk after Coronary Artery Bypass Surgery: Applicability of Score in 1.322 Cases.

BACKGROUND: Mediastinitis is a severe surgical complication of low incidence, but high lethality. Scores used in the preoperative period to stratify the risk of postoperative mediastinitis may contribute to improve the results. OBJECTIVE: To test the applicability of the MagedanzSCORE in predicting the risk factors for mediastinitis in patients undergoing coronary artery bypass grafting at a cardiology reference hospital. METHODS: Historical cohort study with adult patients who underwent coronary artery bypass grafting. The analyzed variables were contemplated in the MagedanzSCORE: reoperation, chronic obstructive pulmonary disease (COPD), obesity, class IV unstable angina, polytransfusion therapy, mediastinitis and death as outcome variables. RESULTS: Of the 1.322 patients examined, 56 (4.2%) developed mediastinitis. Of these, 26 (46.4%) were classified as high risk for mediastinitis and 15 (26.8%) at very high risk for mediastinitis. Three of the five variables of the Magendanz Score showed statistically significant differences: reoperation, COPD and obesity. Class IV unstable angina and postoperative polytransfusion were not associated with mediastinitis after coronary artery by-pass grafting. The area under the ROC curve was 0.80 (CI 95% 0.73 - 0.86), indicating the model's satisfactory ability to predict the occurrence of mediastinitis. CONCLUSION: The tool was useful in the preoperative assessment demonstrating the risk for mediastinitis in this population of intensive care patients. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0).

Desfechos clínicos de pacientes submetidos à cirurgia cardíaca em um hospital do noroeste do Rio Grande do Sul / Resultados clínicos de los pacientes sometidos a cirugía cardíaca en un hospital del noroeste del Rio Grande do Sul / Clinical outcomes of patients undergoing cardiac surgery in a hospital in northwest of Rio Grande do Sul

Objetivo: Analisar os desfechos clínicos dos pacientes submetidos à cirurgiacardíaca em um hospital de alta complexidade. Método: Estudo descritivo, longitudinalhistórico, no qual foram analisados prontuários de pacientes submetidos à cirurgia cardíaca no período de um ano. Resultados: Entre os 137 prontuários analisados, a cirurgia de revascularização do miocárdio foi a mais prevalente 85(62%). A média de tempo de internação na unidade de terapia intensiva foi de 2,93±4,53 dias, e na unidade deinternação clinica/cirúrgica foi de 3,77±3,53 dias. As drogas mais utilizadas foram asvasoativas. As intercorrências mais prevalentes, no período pós-operatório, foram a hipotensão arterial 50(36,6%), sangramento 17(12,4%) e hiperglicemia 10(7,3%). O tempomédio de permanência do dreno de tórax foi de 51h43min, do uso de ventilação mecânicafoi de 16h38min e do tubo orotraqueal foi de 16h48min. Conclusão: Os principais desfechos clínicos no pós-operatório de cirurgia cardíaca relacionam-se com a condição hemodinâmica do paciente.

Aim: To analyze the clinical outcomes of patients undergoing cardiac surgeryin a high complexity hospital. Method: Descriptive historical longitudinal study, in which records of patients undergoing cardiac surgery within the period of one year wereanalyzed. Results: Among the 137 patient records analyzed, CABG surgery was the mostprevalent 85 (62%). The average length of stay in the ICU was 2.93 ± 4.53 days, andclinical / surgical units, was 3.77 ± 3.53 days. The most used drugs were the vasoactiveones. The most prevalent complications in the postoperative period were hypotension 50(36.6%), bleeding 17 (12.4%) and hyperglycemia 10 (7.3%). The average time of the chesttube removal was 51h43min , the use of mechanical ventilation was 16:38min and of theendotracheal tube was 16:48min. Conclusion: The major clinical outcomes in post-cardiacsurgery are related to the hemodynamic status of the patient.

Objetivo: Analizar los resultados clínicos de los pacientes sometidos a cirugíacardiaca en un hospital de alta complejidad. Método: Estudio descriptivo, longitudinalhistórica, que analizó los registros de los pacientes sometidos a cirugía cardíaca entre el período de um ano. Resultados: De los 137 registros de pacientes analizados, cirugía de bypass coronario fue el más prevalente 85 (62%). La duración media de la estancia de la UCI fue de 2,93 ± 4,53 días, y unidades clínicas / quirúrgicos, fue 3,77 ± 3,53 días. Las complicaciones más frecuentes en el postoperatorio fueron hipotensión 50 (36,6%),sangrado 17 (12,4%) y la hiperglucemia 10 (7,3%). La duración promedio de la retirada deltubo torácico fue 51h43min, la ventilación mecánica fue 16h38min y el tubo endotraquealfue 16h48min. Conclusión: Los principales resultados clínicos en cirugía post-cardiacaestán relacionados con el estado hemodinámico del paciente.

Conhecimento do enfermeiro sobre insuficiência cardíaca em hospital geral / Conocimiento del enfermero sobre insuficiencia cardiaca en hospital general / Nurses' knowledge on heart failure in general hospital

Objetivos: verificar entre os enfermeiros de dois hospitais gerais o conhecimento da síndrome de Insuficiência Cardíaca (IC) e os fatores que interferem nas orientações prestadas aos pacientes. Métodos: o conhecimento foi avaliado pelo Questionário de conhecimento para enfermeiros sobre IC (Q-CENIC), composto por 14 questões. Também foram realizados questionamentos relacionados à orientação, limitações para orientação, e auto avaliação sobre conhecimentos da IC. Resultados: foram avaliados 51 enfermeiros, destes 82,4% atingiram o percentual de 70% de acertos. Sintomas de IC avançada e uso de sildenafil foram questões que tiveram percentuais menores de acertos. Mais de 70% (n=40) dos enfermeiros orienta os pacientes sobre IC e autocuidado. O fator que mais interfere Objetivos: verificar entre os enfermeiros de dois hospitais gerais o conhecimento da síndrome de Insuficiência Cardíaca (IC) e os fatores que interferem nas orientações prestadas aos pacientes. Métodos: o conhecimento foi avaliado pelo Questionário de conhecimento para enfermeiros sobre IC (Q-CENIC), composto por 14 questões. Também foram realizados questionamentos relacionados à orientação, limitações para orientação, e auto avaliação sobre conhecimentos da IC. Resultados: foram avaliados 51 enfermeiros, destes 82,4% atingiram o percentual de 70% de acertos. Sintomas de IC avançada e uso de sildenafil foram questões que tiveram percentuais menores de acertos. Mais de 70% (n=40) dos enfermeiros orienta os pacientes sobre IC e autocuidado. O fator que mais interfere nas orientações é a falta de tempo. Conclusão: os resultados indicam que os enfermeiros orientam e apresentaram conhecimento satisfatório sobre o manejo da síndrome de IC. A falta de tempo foi a principal dificuldade para otimização desse processo. falta de tempo foi a principal dificuldade para otimização desse processo.

Objective: to evaluate the knowledge of nurses from two general hospitals on heart failure (HF) syndrome and the factors that interfere with the guidance they provide to patients. Methods: knowledge was assessed by the 14-item Nurses’ Knowledge of Heart Failure (NKHF) questionnaire. Participants were also asked about guidance, guidance limitations, and self-assessment of knowledge on HF. Results: fifty-one nurses were evaluated, 82.4% of which achieved a percentage of 70% of correct answers. Symptoms of advanced HF and use of sildenafil were the items that had the lowest percentages of correct answers. More than 70% (n=40) of nurses provided patients with guidance on HF and self-care. The factor that most interfered with guidance was lack of time. Conclusion: results indicate that nurses advise patients and have satisfactory knowledge on the management of HF syndrome. Lack of time was the main difficulty for optimizing this process.

Objetivos: verificar el conocimiento sobre insuficiencia cardiaca (IC) entre enfermeros de dos hospitales generales y los factores que interfieren en las orientaciones a los pacientes. Métodos: se evaluó el conocimiento mediante el Cuestionario de Conocimiento sobre IC para enfermeros (Q-CENIC), compuesto de 14 preguntas. También se cuestionó sobre la orientación, limitaciones a la orientación, y autoevaluación de conocimientos sobre IC. Resultados: se evaluaron 51 enfermeros, el 82,4% de los cuales llegaron al 70% de aciertos. Síntomas de IC avanzada y uso de sildenafil fueron los tópicos con los menores porcentajes de acierto. Más del 70% (n=40) de los enfermeros orienta a los pacientes sobre IC y autocuidado. El factor que más interfiere en las orientaciones es falta de tiempo. Conclusión: los resultados indican que los enfermeros orientan y presentan conocimiento satisfactorio sobre el manejo de la IC. La falta de tiempo fue la principal dificultad para la optimización del proceso.

Perfil de pacientes com cardiopatia congênita submetidos a procedimentos percutâneos em um centro terciário: análise de 1.002 casos / Profile of patients with congenital heart disease submitted to percutaneous procedures at a tertiary center: analysis of 1.002 cases

INTRODUÇÃO: O diagnóstico precoce e o tratamento dos defeitos cardíacos congênitos têm reconhecido impacto na qualidade de vida dos pacientes. Nosso objetivo foi descrever a população de pacientes com cardiopatias congênitas submetidos a procedimentos diagnósticos ou terapêuticos percutâneos em um centro terciário. MÉTODOS: Análise retrospectiva de 1.002 pacientes submetidos a cateterismo cardíaco no período de 2003 a 2009 no Instituto de Cardiologia do Rio Grande do Sul. Variáveis demográficas, clínicas e do procedimento foram obtidas a partir de um banco de dados institucional e dos prontuários dos pacientes. RESULTADOS: A mediana de idade dos pacientes foi de 33 (0-73) anos e a de peso, de 23 (9,6-52,6) kg. Houve predominância do sexo feminino (52%), de doença acianótica (63,2%) e de diagnóstico realizado no período pós-natal (94,8%). Estenose pulmonar (22,9%), comunicação interatrial (22,5%) e persistência do canal arterial (21,6%) foram os defeitos acianóticos mais comuns, e tetralogia de Fallot foi a doença cianótica mais frequente (15,2%). A maioria dos procedimentos (58,6%) foi terapêutica, incluindo valvuloplastias pulmonares (32,9%), fechamento de comunicações interatriais (20,9%) e fechamento de persistências do canal arterial (15%). Em 19,2% dos pacientes foram observadas complicações, sendo os hematomas inguinais (7,8%) ou a febre (7,6%) as mais frequentes. Ocorreram 3 óbitos (0,3%) relacionados aos procedimentos. CONCLUSÕES: Os resultados deste estudo evidenciaram a predominância de procedimentos terapêuticos em pacientes com cardiopatias congênitas acianóticas, realizados com baixo índice de complicações, em centro terciário de referência.

BACKGROUND: Early diagnosis and treatment of congenital heart defects have a well-known impact on patient´s quality of life. This study aimed to describe the population of patients with congenital heart disease submitted to percutaneous diagnostic or therapeutic procedures at a tertiary referral center. METHODS: Retrospective analysis of 1,002 patients submitted to cardiac catheterization between 2003 and 2009 at Instituto de Cardiologia do Rio Grande do Sul. Clinical, demographic and procedure variables were obtained from an institutional database and patient charts. RESULTS: Median age was 33 (0-73) years and median weight was 23 (9.6-52.6) kg. Patients were predominantly females (52%), with acyanotic heart disease (63.2%) and postnatal diagnosis (94.8%). Pulmonary stenosis (22.9%), atrial septal defect (22.5%) and patent ductus ateriosus (21.6%) were the most common acyanotic heart defects, whereas tetralogy of Fallot was the most frequent cyanotic heart disease (15,2%). Most of the procedures (58,6%) were therapeutic, including pulmonary balloon valvuloplasty (32.9%), atrial septal defect closure (20.9%) and ductus arteriosus closure (15%). Complications were observed in 19.2% of patients, and inguinal hematomas (7.8%) and fever (7.6%) were the most frequent findings. There were 3 procedure-related deaths (0.3%). CONCLUSIONS: The study results demonstrated the prevalence of therapeutic procedures in patients with acyanotic heart disease, performed with a low complication rate at a tertiary referral center.

Dor torácica no infarto agudo do miocárdio entre pacientes diabéticos e não diabéticos / Chest pain in acute myocardial infarction among diabetic and non-diabetic patients / Dolor torácico en el infarto agudo de miocardio entre pacientes diabéticos y no diabéticos

Considerando-se que pacientes diabéticos acometidos de Infarto Agudo do Miocárdio (IAM) podem, ou não, apresentar dor torácica, objetivou-se neste estudo comparar a presença e intensidade de dor torácica no IAM entre pacientes diabéticos e não diabéticos. Realizou-se um estudo transversal, que incluiu pacientes com IAM, idade ≥18 anos, ambos os sexos. Utilizou-se uma escala numérica verbal para avaliar a presença e a intensidade da dor.Foram incluídos 88 pacientes no estudo, dentre os quais 77 (87,5%) não diabéticos e 11 (12,5%) diabéticos. A dor esteve presente em 11 (100%) dos diabéticos e 76 (98,7%) dos não diabéticos. A intensidade da dor nos diabéticos foi de 8,91 versus 8,23 nos não diabéticos. O estudo mostrou semelhança na presença e intensidade da dor torácica entre pacientes diabéticos e não diabéticos acometidos de IAM.

Considering that diabetic patients suffering from Acute Myocardial Infarction (AMI) may or may not have chest pain, this study aimed to compare the presence and intensity of chest pain in AMI between diabetic and non-diabetic patients. We conducted a cross-sectional study that included patients with AMI, aged ≥ 18 years, both sexes. We used a verbal numeric scale for assessing the presence and intensity of pain. The study included 88 patients, of whom 77 (87.5%) non-diabetic patients and 11 (12.5%) diabetics. The pain was present in 11 (100%) of diabetics and in 76 (98.7%) of non-diabetics. The intensity of pain in diabetics was 8.91 versus 8.23 in non-diabetic patients. The study showed similarity in the presence and intensity of chest pain between diabetic and non diabetic patients suffering from AMI.

Teniendo en cuenta que los pacientes diabéticos acometidos de Infarto Agudo del Miocardio (IAM) pueden o no presentar dolor torácico. Este estudio objetivó comparar la presencia e intensidad de dolor torácico en el IAM entre pacientes diabéticos y no-diabéticos. Realizó-se un estudio transversal, que incluyó a pacientes con IAM, ambos sexos, edad ≥18 años. La presencia y la intensidad del dolor fueron evaluadas a través de la escala numérica verbal. Se incluyeron 88 pacientes, de los cuales 77 (87,5%) no-diabéticos y 11 (12,5%) diabéticos. El dolor estuvo presente en 11 (100%) de los diabéticos y en 76 (98,7%) de los no-diabéticos. La intensidad del dolor en los diabéticos fue de 8,91 versus 8,23 en no-diabéticos. El estudio mostró igualdades en la presencia e intensidad del dolor torácico entre pacientes diabéticos y no-diabéticos acometidos de IAM.

Cicatrização da ferida operatória de cirurgia cardíaca com cianocrilato / Healing heart surgery wound using cyanoacrylate

Objetivo: Verificar a evolução da ferida operatória por esternotomia realizada com curativo de cianocrilato, em crianças submetidas à cirurgia cardíaca. Métodos: estudo transversal prospectivo, realizado com crianças no pós-operatório imediato, de ambos os sexos, com idade ≤ 12 anos. A coleta de dados foi realizada através de um instrumento. As variáveis foram: sangramento, hiperemia, hematoma, equimose, secreção na ferida operatória e tempo de circulação extracorpórea. Resultados: Foram incluídos 86 pacientes, com mediana de idade de 17 (7 - 65) meses, 43 (50%) do sexo masculino. A cirurgia mais prevalente foi comunicação interventricular 31 (36%). O tempo de internação na unidade de terapia intensiva foi 8,7 ± 9,7 dias. Os resultados demonstraram que 67 (77%) dos pacientes apresentaram boa evolução da ferida operatória. Conclusão: O curativo com cianocrilato no pós-operatório imediato de cirurgia cardíaca pediátrica contribuiu para uma adequada cicatrização cirúrgica, com redução de riscos de infecções devido a uma menor manipulação da ferida operatória.

Objective: to follow the healing of a sternotomy surgical wound in which cyanoacrylate bandaging was used, in children who underwent heart surgery. Methods: prospective cross-sectional study performed with children during the immediate postoperative period of heart surgery, with the average of 12 and both genders. The data collected were performed using an instrument. The variables were: bleeding, hyperemia, hematoma, ecchymosis, secretion from surgical wound and extracorporeal circulation time. Results: eighty-six patients were included, with median of 17 (7 - 65) months, 43 (50%) male. The most prevalent surgery was interventricular communication 31(36%). The length of stay in the intensive care unit was 8.7 ± 9.7 days. The showed that in 67 (77%) of the patients the surgical wound healed well. Conclusion: the cyanoacrylate bandage during the post-surgery period immediately after pediatric heart surgery achieved adequate surgical healing, with lower risk of infection due to less handling of the surgical wound.

Objetivo: percibir la evolución de la herida operatoria por estereotomía concurativo de cianocrilato, en niños sometidos a cirugía cardiaca. Métodos: estudio transversal prospectivo, con niños en postoperatorio inmediato, de ambos sexos, con edad < 12 años. La recolecta de datos se realizó mediante un instrumento. Las variables fueron:sangramiento, hiperemia, hematoma, equimosis, secreción y tiempo de circulación extracorpórea. Resultados: fueron incluidos 86 pacientes, con edad mediana de 17 (7-65) meses, 43 el (50%) del sexo masculino. La cirugía más prevalente fue comunicación interventricular 31 el (36%). El tiempo de internación en la unidad de terapia intensiva fue 8,7 + 9,7 días. Los resultados comprueban que 67 el (77%) de los pacientes presentaronbuena evolución de la herida operatoria. Conclusión: el curativo con cianocrilato en el postoperatorio inmediato de cirugía cardiaca pediátrica contribuye para una adecuada cicatrización quirúrgica, con reducción de riesgos de infecciones, pues hay unadisminución en la manipulación de la herida operatoria.

Incidence of vascular complications in patients submitted to percutaneous transluminal coronary angioplasty by transradial and transfemoral arterial approach / Incidência de complicações vasculares em pacientes submetidos a angioplastia coronariana transluminal percutânea por via arterial transradial e transfemoral

OBJECTIVE: To describe the vascular complications of transradial and transfemoral artery punctures in patients submitted to percutaneous transluminal coronary angioplasty (PTCA). METHODS: Prospective cohort study including patients submitted to PTCA. An interview was performed and an instrument applied to collect risk factors/predictors of complications. After the procedure, a physical examination was performed, vital signs were measured and the puncture site was assessed. RESULTS: 199 patients were included, age 64±10 years. Complications found for the radial and femoral approach were respectively: ecchymosis (18.29%), (17.14%); bruising (17.66%), (14.27%); urinary retention (2.43%), (25.71%); loss of vessel permeability (8.53%), (0%). CONCLUSION: The complications found were considered minor or secondary, depending on the classification found in literature. A higher rate of vascular complications related to transradial artery punctures compared to the interventions performed by transfemoral approach.

OBJETIVO: Descrever as complicações vasculares relacionadas às punções arteriais transradial e transfemoral, em pacientes submetidos à angioplastia coronariana transluminal percutânea (ACTP). MÉTODOS: Estudo de coorte prospectivo que incluiu pacientes submetidos à ACTP. Foi realizada entrevista e aplicado um instrumento para coleta de fatores risco/preditores de complicações. Após o procedimento foi realizado exame físico, mensuração dos sinais vitais e avaliado o local da punção. RESULTADOS: Foram incluídos 199 pacientes, com idade 64±10 anos, Complicações encontradas para via radial e femoral respectivamente: equimose (18,29%), (17,14%); hematoma (17,66%), (14,27%); retenção urinária (2,43%), (25,71%); perda de permeabilidade do vaso (8,53%), (0%). CONCLUSÃO: As complicações presentes foram consideradas menores ou secundárias conforme classificação literária. Existiu maior incidência de complicações vasculares relacionadas às punções arteriais transradiais quando comparadas às intervenções realizadas pela via transfemural.

OBJETIVO: Describir complicaciones vasculares relacionadas a punciones arteriales transradial y transfemoral en pacientes sometidos a angioplastía coronaria transluminal percutánea (ACTP). MÉTODOS: Se trata de un estudio de cohorte prospectivo realizado con pacientes sometidos a ACTP. Se llevó a cabo una entrevista y aplicó un instrumento para obtener factores de riesgo/predictores. Fue realizado un examen físico, medición de signos vitales y se evaluó el lugar de punción. RESULTADOS: Fueron incluidos 199 pacientes, edad 64±10 años. Las complicaciones encontradas para vía radial y femoral respectivamente, fueron: esquimosis (18,29%), (17,14%); hematoma (17,66%), (14,27%); retención urinaria (2,43%), (25,71%); pérdida de permeabilidad de vaso (8,53%), (0%). CONCLUSIÓN: Las complicaciones fueron consideradas menores o secundarias conforme clasificación literaria. Existe una mayor incidencia de complicaciones vasculares relacionadas a punciones arteriales transradiales que cuando las intervenciones se realizan por vía transfemoral.