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1.
Medicine (Baltimore) ; 99(7): e19163, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049845

RESUMO

RATIONALE: Woven coronary artery is a very rare congenital anomaly which may lead to acute coronary syndrome in previous literatures. At present, there is no consensus on the treatment of this coronary artery abnormality. PATIENT CONCERNS: A 48-year-old male was admitted to the other hospital because of persistent chest pain. The electrocardiogram showed an ST-segment elevation in the v1-v5 lead and the patient was diagnosed with acute anterior myocardial infarction. Coronary angiography revealed 2 lumens in the proximal segment of the left anterior descending artery. Then the patient was transferred to our hospital for further diagnosis and treatment. DIAGNOSES: The patient was diagnosed with acute myocardial infarction and woven coronary. Transthoracic echocardiography showed left ventricular anterior wall segmental motor abnormalities. INTERVENTIONS: Optical coherence tomography (OCT) and fractional flow reserve (FFR) guided percutaneous coronary intervention was performed successfully. OUTCOMES: During the follow-up period of 4 years, the patient remained asymptomatic and no adverse events. LESSONS: Although the significance of blood flow limitation in one of the lumens detected by FFR is unclear, this strategy of OCT and FFR-guided treatment in woven coronary artery combined with acute coronary events still shows its feasibility.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico , Reserva Fracionada de Fluxo Miocárdico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia de Coerência Óptica
2.
Medicine (Baltimore) ; 99(7): e19176, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049849

RESUMO

INTRODUCTION: Single coronary artery is a rare condition characterized by the origin of a coronary that supplies the entire heart from a single coronary ostium. PATIENT CONCERNS: A 45-year-old woman with an altered exercise testing was addressed to a computed tomography coronary angiography (CTCA) to rule out coronary artery disease (CAD). DIAGNOSIS: CTCA examination showed the absence of the right coronary artery (RCA). The left anterior descending artery and the left circumflex artery (LCX) presented regular origin and course and LCX provided the posterior interventricular artery and the posterolateral artery. INTERVENTIONS: As CTCA highlighted the absence of potentially life-threatening features related to coronary anomaly, no surgical treatment was advised. OUTCOMES: The patient was dismissed, kept under pharmacological control and monitored over time. CONCLUSION: CTCA is the first-choice imaging modality in patients with ECG abnormalities properly allowing the differential diagnosis between CAD and congenital heart disease.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Angiografia Coronária , Feminino , Humanos , Pessoa de Meia-Idade
3.
Zhonghua Er Ke Za Zhi ; 58(2): 113-117, 2020 Feb 02.
Artigo em Chinês | MEDLINE | ID: mdl-32102147

RESUMO

Objective: To investigate the clinical features and improve the diagnosis and treatment of anomalous origin of the left coronary artery from the right coronary sinus with an interarterial course (ALCA-R-IAC) between the ascending aorta and main pulmonary artery in children. Methods: A retrospective analysis of the clinical manifestation, laboratory test, radiological feature, treatment and prognosis were conducted in four female children presented with ALCA-R-IAC in Beijing Children's Hospital from November 2015 to June 2018. Results: The four girls with onset age of 7.5-14.7 years were diagnosed with ALCA-R-IAC by CT coronary angiography (CTCA). Four children presented with exercise-induced syncope and clinical manifestations of acute myocardial infarction including 3 patients with acute left heart failure, 1 cardiogenic shock and 1 cardiac arrest. Nervous system involvement was found in one patient. Troponin I increased significantly to 20.65-50.00 µg/L in the four patients. Electrocardiogram (ECG) developed signs of left main coronary artery involvement. Echocardiography revealed reduced left ventricular ejection fraction (LVEF) of 25%-45% in three children and suspected anomalous origin of the left coronary artery in one child. CTCA showed an anomalous left coronary artery originating from the right coronary sinus, which had an interarterial course between the aorta and pulmonary artery leading to a slim left main coronary trunk. Two children underwent unroofing procedure and the other two children in whom physical activities were restricted received conservative managements. During a regular follow-up period of 12-43 months, all the children survived without recurrent symptoms and had good prognosis. Conclusions: ALCA-R-IAC can present as exercise-related syncope and acute myocardial infarction, even sudden death in children and adolescents. CTCA is helpful to clarify the early diagnosis of ALCA-R-IAC. Surgical intervention is the main treatment for ALCA-R-IAC and strenuous physical activities should be avoided.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Ecocardiografia , Adolescente , Criança , Angiografia Coronária , Feminino , Humanos , Estudos Retrospectivos , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
4.
Medicine (Baltimore) ; 99(5): e18981, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000431

RESUMO

RATIONALE: Congenital absence of the right coronary artery with acute myocardial infarction (AMI) is a rare clinical situation that may lead to death. We report a case of successful percutaneous coronary intervention for congenital absence of the right coronary artery with AMI. PATIENT CONCERNS: A 53-year-old woman had a 7-day history of chest discomfort that had worsened over 10 hours. She was diagnosed as having myocardial infarction and was admitted to hospital. DIAGNOSIS: Coronary angiography showed absence of the right coronary artery; the left anterior descending (LAD) branch sent out the right ventricular branch and the posterior descending branch. The LAD branch was occluded and there was diffuse stenosis of the middle right ventricular branch and severe stenosis of the distal circumflex branch. INTERVENTIONS: Percutaneous coronary intervention was performed. One stent was implanted in the LAD branch and another implanted in the right ventricular branch. OUTCOMES: The patient was discharged 3 weeks after surgery. The follow-up showed that the patient was asymptomatic without recurrence. LESSONS: Although absence of the right coronary artery with AMI is a fatal condition, percutaneous coronary intervention remains an effective treatment.


Assuntos
Anomalias dos Vasos Coronários/cirurgia , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Stents
5.
BMC Cardiovasc Disord ; 20(1): 37, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996146

RESUMO

BACKGROUND: The Starr-Edwards ball valve prosthesis was successfully introduced in 1961-62 and largely used for aortic and mitral valve replacement. Even if Starr-Edwards valves have been widely replaced in clinical practice by other mechanical valves, they define a standard concerning long-term durability. CASE PRESENTATION: We describe the case of a 55-year-old man referred to our Department to perform a cardiac computed tomography (CCT), to better evaluate a severe dilation of ascending aorta discovered at echocardiography. The patient had been surgically treated 46 years earlier to correct a supra-cristal type ventricular septal defect. Both mitral and aortic valves were replaced, respectively due to bacterial mitral endocarditis and a fibrous sub-valvular aortic stenosis. In addition, the right coronary artery (RCA) was found to arise from the left coronary sinus. CONCLUSION: We report the longest lasting durability (46 years) of aortic and mitral Starr-Edwards valves successfully implanted in a patient simultaneously carrying a malignant anomalous origin of RCA.


Assuntos
Valva Aórtica/cirurgia , Anomalias dos Vasos Coronários/complicações , Comunicação Interventricular/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Valva Mitral/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico por imagem , Comunicação Interventricular/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Fatores de Tempo , Resultado do Tratamento
7.
Braz J Cardiovasc Surg ; 34(6): 779-782, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31793257

RESUMO

Spontaneous coronary artery dissection (SCAD) is characterized by tear of the inner layer in the coronary artery, creating a false lumen between the inner and central layer. Its infrequent incidence often leads to delay in diagnosis posing challenges in management. There are currently no guidelines for the treatment of this condition. We describe an adult patient who presented with multiple episodes of ventricular fibrillation, in whom cardiac catheterization showed SCAD, treated by off-pump coronary artery bypass.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Doenças Vasculares/congênito , Adulto , Cateterismo Cardíaco , Angiografia Coronária , Vasos Coronários , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/cirurgia
8.
Rev Med Liege ; 74(12): 625-626, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31833270

RESUMO

Congenital coronary artery fistulas are infrequent but sometimes hemodynamically important anomalies depending on their magnitude and the cardiac chamber or vascular site involved. Fistula from left circumflex artery to coronary sinus are potentially curable causes of ischemic heart disease.


Assuntos
Doença da Artéria Coronariana , Anomalias dos Vasos Coronários , Fístula Vascular , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Seio Coronário , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Humanos , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia
9.
Tex Heart Inst J ; 46(3): 189-194, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708701

RESUMO

Patients with anomalous origin of a coronary artery during aortic valve replacement (AVR) are at risk of coronary compromise. Large case series are lacking. In this retrospective study, we review our experience with this condition. From August 2014 through June 2016, 8 adult patients (mean age, 74 ± 17.5 yr; age range, 33-86 yr; 5 men) with anomalous aortic origin of a coronary artery underwent surgical or transcatheter AVR at our institution. Six patients had aortic stenosis; 2 had aortic insufficiency, one of whom had an associated aortic root aneurysm. In 7 patients, the left anomalous coronary artery originated from the right aortic sinus, and in one, the right coronary artery arose from the left cusp. The anatomic course was revealed by means of 3-dimensional computed tomographic angiography. No patient underwent primary aortic reimplantation of the anomalous artery. Two had the artery mobilized from encircling the annulus too closely and then underwent coronary artery bypass grafting. Two high-risk patients underwent transcatheter AVR. After surgical AVR, 2 patients had perioperative myocardial infarction caused by coronary compression, so percutaneous coronary intervention was performed. One patient died of sepsis 3 months after discharge from the hospital. In our patients, AVR sometimes led to severe perioperative complications. Successful AVR depended on 3-dimensional computed tomographic angiographic findings, individual anatomic variations, and appropriate treatment choices.


Assuntos
Valva Aórtica/cirurgia , Anomalias dos Vasos Coronários/diagnóstico , Doenças das Valvas Cardíacas/cirurgia , Substituição da Valva Aórtica Transcateter/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Angiografia Coronária , Ponte de Artéria Coronária/métodos , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/cirurgia , Ecocardiografia Doppler em Cores , Feminino , Seguimentos , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Estudos Retrospectivos , Resultado do Tratamento
10.
Tex Heart Inst J ; 46(3): 222-224, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708709

RESUMO

Low origin of the coronary arteries, defined as an origin less than 10 mm above the functional aortic annulus, is not usually considered to be a notable anomaly because functional impairment is not intrinsic. We describe a case of severe complications after surgical aortic valve replacement in a 59-year-old woman who had symptomatic aortic valve stenosis, low origin of both main coronary arteries, and a hypoplastic aortic annulus less than 19 mm in diameter. The aortic prosthesis had to be implanted above the hypoplastic anatomic annulus. An inferior-wall myocardial infarction, hypotension, right-sided heart failure, and atrial fibrillation developed during the early perioperative period. Coronary angiograms showed occlusion of the right coronary artery ostium and critical stenosis of the left coronary ostium. During reoperation, posterior aortic patch annuloplasty enabled lower reimplantation of the prosthetic aortic valve, jointly with right coronary artery-venous grafting. To prevent potentially severe complications, we recommend that low origin of the coronary arteries be reported before patients undergo surgical aortic valve replacement. If the ostia are not seen when routine coronary angiography is used, computed tomography should be prospectively performed to characterize this anomaly.


Assuntos
Anormalidades Múltiplas , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/anormalidades , Anuloplastia da Valva Cardíaca/métodos , Anomalias dos Vasos Coronários/diagnóstico , Implante de Prótese de Valva Cardíaca/métodos , Complicações Intraoperatórias , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico , Angiografia Coronária , Ponte de Artéria Coronária/métodos , Anomalias dos Vasos Coronários/cirurgia , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade
11.
Tex Heart Inst J ; 46(3): 225-228, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708710

RESUMO

Anomalous origin of the right coronary artery from the pulmonary artery, a rare congenital cardiac defect, is typically not diagnosed during infancy. On the other hand, Turner syndrome is usually diagnosed early, and it is classically associated with bicuspid aortic valve and aortic coarctation. Individuals with Turner syndrome are also at increased risk for coronary artery anomalies. We present a case of anomalous right coronary artery from the pulmonary artery in a week-old neonate who also had Turner syndrome, patent ductus arteriosus, transverse aortic arch hypoplasia, and impaired ventricular function. Prostaglandin therapy through the ductus increased the patient's myocardial perfusion. Four months after corrective surgery, she was doing well. We discuss the reperfusion phenomenon in our patient's case, as well as other considerations in this combination of congenital defects.


Assuntos
Anormalidades Múltiplas , Aorta Torácica/anormalidades , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Artéria Pulmonar/anormalidades , Síndrome de Turner/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Cateterismo Cardíaco , Angiografia por Tomografia Computadorizada , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Ecocardiografia , Feminino , Fluoroscopia , Humanos , Recém-Nascido , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia
12.
Rev Port Cardiol ; 38(8): 609.e1-609.e7, 2019 08.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31694785

RESUMO

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome that typically occurs in relatively young patients without classical cardiovascular risk factors for coronary artery disease. The etiology appears to be multifactorial and optimal management is not clearly established, so the treatment strategy is often selected based on clinical presentation and coronary anatomy. We present two cases of spontaneous coronary artery dissection with different initial approaches, highlighting the importance of a case-by-case assessment.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Tomada de Decisões , Stents , Doenças Vasculares/congênito , Adulto , Angiografia Coronária , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Humanos , Masculino , Ultrassonografia de Intervenção , Doenças Vasculares/diagnóstico , Doenças Vasculares/cirurgia
13.
Methodist Debakey Cardiovasc J ; 15(3): 223-225, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687103

RESUMO

Anomalous origin of the right coronary artery (ARCA) is an extremely rare cardiac pathology. The coronary artery can potentially course between the aorta and the pulmonary artery, putting the patient at risk for sudden cardiac death. Even rarer is an ARCA that arises from the left main coronary artery (LMCA). To our knowledge, this is the first case where an ARCA arising entirely from the LMCA is associated with critical bicuspid aortic valve stenosis.


Assuntos
Estenose da Valva Aórtica/etiologia , Valva Aórtica/anormalidades , Anomalias dos Vasos Coronários/complicações , Doenças das Valvas Cardíacas/complicações , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
15.
Eur. j. anat ; 23(6): 459-463, nov. 2019. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-185089

RESUMO

Situs inversus viscerum (SIV) is a rare congenital anomaly, which is still an intriguing phenomenon to anatomists and physicians alike. A complete SIV is characterized by a left-right transposition and mirror image of all thoraco-abdominal organs and their vasculature. The present report is based on one case with complete SIV, which was observed during the routine educational dissections of cadavers in the authors' Anatomy Department. A transposition of all truncal organs and their vasculature, and several variations of arteries and veins were present. The right branch of the proper hepatic artery was replaced by an artery that emanated from the superior mesenteric artery. The latter also released the inferior mesenteric artery. Additionally, a left accessory renal artery ran anterior to the inferior caval vein and posterior to the ureter to enter the hilum of the left kidney. There was also a variation in the anterior-posterior arrangement of the hilar structures of the left kidney. Additionally, a globally enlarged heart with coronary artery by-passes, a replaced aortic valve and an aortic arch aneurysm was observed. This case report is unique, as it presents a previously unreported co-incidence of SIV and hepatic, intestinal and renal vascular anomalies. It is important for the surgeon to be aware of such variations while planning an abdominal surgery in patients with SIV


No disponible


Assuntos
Humanos , Masculino , Idoso , Situs Inversus , Ductos Biliares Intra-Hepáticos/anormalidades , Trato Gastrointestinal/anormalidades , Rim/anormalidades , Anomalias dos Vasos Coronários , Ductos Biliares Intra-Hepáticos/anatomia & histologia , Trato Gastrointestinal/anatomia & histologia , Rim/anatomia & histologia , Dissecação/métodos , Artérias Mesentéricas/anormalidades , Artérias Mesentéricas/anatomia & histologia , Cadáver , Vasos Coronários/anatomia & histologia
16.
Medicine (Baltimore) ; 98(38): e17212, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567975

RESUMO

RATIONALE: Anomalous Origin of Left Coronary Arteries from the Pulmonary Artery (ALCAPA), also known as Bland-White-Garland (BWG), is a rare form of coronary artery anomaly that is usually discovered in the first few months of life. Only rarely can patients with this anomaly reach adulthood without symptoms. PATIENT CONCERNS: A 28-year-old female was witnessed suddenly collapse with a seizure-like episode by her colleagues at work. DIAGNOSIS AND INTERVENTION: Routine cardiopulmonary resuscitation was performed by emergency medical service technologists. The patient was unable to be revived. Postmortem examination revealed the patient had ALCAPA with a focal chronic ischemic injury of the left ventricle. Moreover, a high take-off of the right coronary artery was also discovered. OUTCOMES: The patient passed away due to ALCAPA. The mechanism of death was cardiac arrhythmia being triggered by myocardial ischemic changes. LESSONS: In the rare cases where ALCAPA manifests in an asymptomatic adult, the mortality rate is very high. This case demonstrates the importance of awareness of such patients living under the tremendous risk of sudden cardiac death.


Assuntos
Anomalias dos Vasos Coronários/patologia , Artéria Pulmonar/anormalidades , Adulto , Arritmias Cardíacas/etiologia , Doenças Assintomáticas , Autopsia , Morte Súbita Cardíaca , Feminino , Humanos
18.
Lakartidningen ; 1162019 Sep 13.
Artigo em Sueco | MEDLINE | ID: mdl-31529421

RESUMO

Spontaneous coronary artery dissection can be caused by a tear in the intima or a bleeding in the wall of a coronary artery. It is a possible cause of acute coronary syndrome and should be suspected in patients with few risk factors for coronary artery disease. The condition is overrepresented in women particularly during the peripartum period. We present a case where a 36-year-old woman, three days after delivering her third child, presented with myocardial infarction with nonobstructive coronary arteries. She later presented again with ST-elevation myocardial infarction and coronary angiography with optical coherence tomography revealed coronary dissection that was treated with percutaneous coronary intervention.


Assuntos
Anomalias dos Vasos Coronários , Doenças Vasculares/congênito , Adulto , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Eletrocardiografia , Feminino , Humanos , Equipe de Assistência ao Paciente , Intervenção Coronária Percutânea , Período Periparto , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/cirurgia , Fatores de Risco , Tomografia de Coerência Óptica , Doenças Vasculares/diagnóstico , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/cirurgia
19.
J Assoc Physicians India ; 67(8): 85-86, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31562729

RESUMO

Congenital coronary anomalies are uncommon with rarest being absent left circumflex artery (LCX) having prevalence of 0.003%. We report a case of a 68 year old male having acute coronary syndrome and left ventricular dysfunction whose coronary angiogram showed an absent LCX with super dominant right coronary artery (RCA). Precise morphological evaluation is needed for best suited management strategy.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico , Idoso , Angiografia Coronária , Humanos , Masculino
20.
Kyobu Geka ; 72(9): 707-711, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31506414

RESUMO

We describe surgical treatment of a coronary artery fistula (CAF) in a neonate. A 5-day-old male neonate was diagnosed with CAF at another hospital and was transferred to our hospital. Transthoracic echocardiography revealed a right coronary artery-to-right ventricle (RV) fistula. Emergency surgery was performed to treat progressive congestive heart failure due to a significant left-to-right shunt through the large CAF. Intraoperatively, we confirmed that the large CAF drained into the inlet of the RV through multiple openings. Intracardiac CAF closure was performed with a bovine pericardial patch. The neonate showed an uneventful postoperative recovery, and postoperative echocardiography revealed a trivial residual shunt with good left ventricular function without increased pulmonary artery pressure.


Assuntos
Doença da Artéria Coronariana , Anomalias dos Vasos Coronários , Fístula , Cardiopatias Congênitas , Animais , Bovinos , Ecocardiografia , Humanos , Recém-Nascido , Masculino
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