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1.
J Cardiovasc Med (Hagerstown) ; 22(1): 9-13, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32740440

RESUMO

: The worldwide response to the current COVID-19 pandemic has been focused on how to prevent the disease and to protect the high-risk patient from a potentially lethal infection. Several consensus and guidelines articles have been published dealing with the cardiac patient with systemic hypertension, heart transplant or heart failure. Very little is known about the patients, both in the pediatric as well as in the adult age, with congenital heart disease. The peculiar physiology of the heart with a native, repaired or palliated congenital heart defect deserves a specialized care. Hereby we describe the early recommendations issued by the Italian Society of Pediatric Cardiology and Congenital Heart Disease and how the network of the congenital cardiac institutions in Italy reacted to the threat of potential wide spread of the infection among this fragile kind of patient.


Assuntos
/prevenção & controle , Cardiologia/organização & administração , Cardiopatias Congênitas/terapia , Adulto , Criança , Transplante de Coração , Humanos , Itália , Guias de Prática Clínica como Assunto , Sociedades Médicas
2.
Cardiovasc Pathol ; 50: 107277, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32882373

RESUMO

Mitral valve is a complex cardiac structure composed of several components to work in synchrony to allow blood flow into left ventricle during diastole and not to allow blood flow into left atrium during systole. Accessory mitral valve tissue (AMVT) was defined as existence of any additional part and parcel of valvular structure which has an attachment to normal mitral valve apparatus in left-sided cardiac chambers. AMVT may present itself in different clinical circumstances ranging from a silent clinical course to thromboembolic events, heart failure, left ventricular outflow tract obstruction, and severe arrhythmia. This article reviews the clinical perspectives of AMVT in terms of symptoms, diagnosis, and treatment, providing a new anatomical classification regarding the location of AMVT. Briefly type I refers to AMVT having attachments on the supra leaflets level, type II refers to attachments on the mitral leaflets, and type III refers to attachment below the mitral leaflets. Increased awareness and widespread use of echocardiographic techniques would increase recognition of AMVT in patients with heart murmurs but otherwise healthy and in those with left ventricular outflow tract obstruction or tissue which causes subaortic stenosis and with unexplained cerebrovascular events.


Assuntos
Cardiopatias Congênitas , Valva Mitral/anormalidades , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/terapia , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Tromboembolia/etiologia , Obstrução do Fluxo Ventricular Externo/etiologia
3.
Asian Cardiovasc Thorac Ann ; 28(8): 520-532, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32878458

RESUMO

Computational fluid dynamics has become an important tool for studying blood flow dynamics. As an in-silico collection of methods, computational fluid dynamics is noninvasive and provides numerical values for the most important parameters of blood flow, such as velocity and pressure that are crucial in hemodynamic studies. In this primer, we briefly explain the basic theory and workflow of the two most commonly applied computational fluid dynamics techniques used in the congenital heart disease literature: the finite element method and the finite volume method. We define important terminology and include specific examples of how using these methods can answer important clinical questions in congenital cardiac surgery planning and perioperative patient management.


Assuntos
Cardiopatias Congênitas/diagnóstico por imagem , Hemodinâmica , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Tomada de Decisão Clínica , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/terapia , Humanos , Hidrodinâmica , Valor Preditivo dos Testes
4.
Pediatr Clin North Am ; 67(5): 963-971, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32888692

RESUMO

There is a growing population of patients living with congenital heart disease (CHD), now with more adults living with CHD than children. Adults with CHD have unique health care needs, requiring a thoughtful approach to cardiac, neurocognitive, mental, and physical health issues. They have increased risk of anxiety, depression, pragmatic language impairment, limited social cognition, worse educational attainment and unemployment, and delayed progression into independent adulthood. As a result, it is important to establish an individualized approach to obtain successful transition and transfer of care from the pediatric to adult health care world in this patient population.


Assuntos
Cardiopatias Congênitas/terapia , Melhoria de Qualidade , Transição para Assistência do Adulto/organização & administração , Adulto , Criança , Progressão da Doença , Humanos
5.
Emerg Med Clin North Am ; 38(4): 819-839, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981620

RESUMO

Pediatric cardiac arrest is a relatively rare but devastating presentation in infants and children. In contrast to adult patients, in whom a primary cardiac dysrhythmia is the most likely cause of cardiac arrest, pediatric patients experience cardiovascular collapse most frequently after an initial respiratory arrest. Aggressive treatment in the precardiac arrest state should be initiated to prevent deterioration and should focus on support of oxygenation, ventilation, and hemodynamics, regardless of the presumed cause. Unfortunately, outcomes for pediatric cardiac arrest, whether in hospital or out of hospital, continue to be poor.


Assuntos
Parada Cardíaca/terapia , Ressuscitação/métodos , Manuseio das Vias Aéreas , Glicemia/análise , Criança , Maus-Tratos Infantis/terapia , Cardioversão Elétrica , Eletroencefalografia , Serviço Hospitalar de Emergência , Epinefrina/uso terapêutico , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/etiologia , Cardiopatias Congênitas/terapia , Frequência Cardíaca , Humanos , Hipotermia/complicações , Hipotermia/terapia , Hipotermia Induzida , Pneumopatias/terapia , Pais , Exame Físico , Envenenamento/terapia , Avaliação de Processos em Cuidados de Saúde , Valores de Referência , Insuficiência Respiratória/terapia , Taxa Respiratória , Ordens quanto à Conduta (Ética Médica) , Sepse/terapia , Choque/etiologia , Choque/terapia , Vasoconstritores/uso terapêutico , Ferimentos e Lesões/terapia
6.
Heart Lung Circ ; 29(9): e217-e221, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32839114

RESUMO

At the time of writing (25 May 2020), there have been nearly 4.4 million infections and 300,000 deaths worldwide related to COVID-19, an infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Australia (currently 6,900 infections and 98 deaths) and New Zealand (1,500 infections and 21 deaths) have thus far been less affected than other regions. Risk factors for more severe disease include older age and pre-existing cardiovascular disease. The purposes of this document from the Paediatric and Congenital Council of the Cardiac Society of Australia and New Zealand (CSANZ) are to: 1) To review the mechanisms for cardiac involvement in COVID-19, specifically as they may impact patients with childhood and adult congenital heart disease (CHD); 2) To review the impact of SARS-CoV-2 infection in the paediatric population; 3) To review available data on the risks related to COVID-19 for childhood heart disease and adult CHD; 4) To provide guidance for childhood heart disease and adult CHD units in our Australasian region to re-organise services during the pandemic, so as to protect a highly specialised workforce and yet continue to provide an essential service; and 5) To review risk reduction strategies for acquiring COVID-19 for patients with childhood heart disease or adult CHD. Eleven (11) recommendations relevant to the care of children with heart disease and adults with CHD to mitigate the impact of COVID-19 are highlighted through the document.


Assuntos
Doenças Cardiovasculares/epidemiologia , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Cardiopatias Congênitas/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Adulto , Fatores Etários , Austrália , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Criança , Infecções por Coronavirus/epidemiologia , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/terapia , Humanos , Controle de Infecções/organização & administração , Masculino , Nova Zelândia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Prevalência , Medição de Risco , Fatores Sexuais , Sociedades Médicas , Análise de Sobrevida , Resultado do Tratamento
7.
Eur J Clin Invest ; 50(10): e13367, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32735699

RESUMO

Producing excellent physician scientists starts with the active discovery of talent and dedication, supported by the strong belief that physician involvement in biomedical research is essential to make fundamental discoveries that improve human health. The revolution of surgical and interventional therapy of structural heart disease has had 'profoundly positive effects on survival and quality of life over the decades. (…) Small increments in clinical improvement will still be possible in the future, but for the most part, the potential for major advancement using these techniques has been exhausted' (Frank Hanley, MD; Stanford). Personalized medicine, rapid genetic diagnostics, RNA and extracellular vesicle biology, epigenetics, gene editing, gene and stem cell-derived therapy are exemplary areas where specialized training for paediatric/congenital cardiology physician scientists will be increasingly needed to further advance the field. About a decade ago, a series in Circulation discussed academic career models and highlighted the major challenges facing the cardiovascular 'clinician scientist' (syn. physician scientist), which have not abated since. To develop the skills and expertise in both clinical congenital cardiology and basic research, the training of fellows must be focused and integrated. The current pandemic COVID-19 puts additional pressure and hurdles on fellows-in-training (FIT) and early career investigators (ECI) who aim to establish, consolidate or expand their own research group. Here, we discuss the major challenges, opportunities and necessary changes for academic institutions to sustain and recruit physician scientists in paediatric/congenital cardiology in the years to come.


Assuntos
Pesquisa Biomédica , Cardiologistas/provisão & distribução , Escolha da Profissão , Cardiopatias Congênitas/terapia , Pediatras/provisão & distribução , Seleção de Pessoal , Pesquisadores/provisão & distribução , Centros Médicos Acadêmicos , Betacoronavirus , Cardiologistas/educação , Cardiologia/educação , Infecções por Coronavirus , Educação de Pós-Graduação em Medicina , Bolsas de Estudo , Humanos , Pandemias , Pediatras/educação , Pediatria/educação , Pneumonia Viral , Pesquisadores/educação
8.
Pediatr Cardiol ; 41(7): 1532-1537, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32813029

RESUMO

In this review, we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our aim is to provide a summary of the latest articles published recently in other journals in our field. The articles address (1) cardiac resynchronization in children with symptomatic ventricular dysfunction and dyssynchrony which seems to result in higher transplant-free survival, (2) outcomes of aortic leaflet reconstruction including Ozaki procedure to repair aortic valve disease in adolescents, (3) meta-analysis for risk factors of ventricular tachycardia and death after repaired tetralogy of Fallot which reiterates the known risk factors and showed that the severity of pulmonary regurgitation is not in itself associated with outcomes although the ventricular response to regurgitation (dilation and dysfunction) is, (4) preschool promotion of healthy life style did not associate with sustained effect when evaluated later in childhood although repeated intervention seems to have a dose-related effect to promote healthy life style, (5) the lack of beneficial effects of angiotensin-converting enzyme inhibitors in the interstage period, and (6) a new phenomenon of acute heart failure and multisystem inflammatory syndrome in children temporarily related to the COVID-19 pandemic.


Assuntos
Cardiopatias/complicações , Cardiopatias/terapia , Adolescente , Betacoronavirus , Terapia de Ressincronização Cardíaca/métodos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criança , Pré-Escolar , Infecções por Coronavirus/complicações , Cardiopatias Congênitas/terapia , Cardiopatias/cirurgia , Insuficiência Cardíaca/complicações , Ventrículos do Coração/fisiopatologia , Humanos , Síndrome do Coração Esquerdo Hipoplásico/tratamento farmacológico , Pandemias , Pneumonia Viral/complicações , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/complicações , Taquicardia Ventricular/complicações , Tetralogia de Fallot/complicações , Tetralogia de Fallot/cirurgia
10.
Cardiol Young ; 30(10): 1405-1408, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32624052

RESUMO

BACKGROUND: Adults with CHD are known to greatly benefit from a prompt access to continuous expert care. On the other hand, coronavirus disease 2019 pandemic has determined a dramatic worldwide reconfiguration of the healthcare systems, with rapid redeployment of resources towards this emergency. Italy was the first Western country affected by a large-scale spread of coronavirus disease 2019. The aim of our study is to analyse the impact of the coronavirus disease 2019 outbreak on in-hospital care of patients with CHD in an Italian tertiary centre. METHODS AND RESULTS: We retrospectively reviewed data on CHD hospital admissions in our centre since 1 March, 2020, when the adoption of a strict infection containment policy throughout the country resulted in limited access of patients to routine hospital care and resources reallocation to the care of infected patients. Comparison with data from the previous year was performed in order to identify any relevant differences attributable to the outbreak. Despite cancellation of all elective procedures, the overall number of urgent hospital admission remained stable throughout the period of study. Patients admitted during the pandemic had greater disease complexity (p = 0.001) with longer length of in-hospital stay (p = 0.01). No adverse events or positive swabs were reported among CHD patients who were admitted to hospital or medical personnel caring for these patients. CONCLUSION: Data from our early experience suggest that coronavirus disease 2019 pandemic did not impact significantly on the provision of urgent care to adult patients with CHD.


Assuntos
Assistência Ambulatorial , Infecções por Coronavirus , Cardiopatias Congênitas , Hospitalização , Controle de Infecções/métodos , Pandemias , Pneumonia Viral , Adulto , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Betacoronavirus , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/terapia , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Inovação Organizacional , Avaliação de Processos e Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Estudos Retrospectivos
11.
Pediatr Cardiol ; 41(6): 1220-1230, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32500288

RESUMO

With increasing survival trends for children and adolescents with congenital heart defects (CHD), there is a growing need to focus on transition from pediatric to adult specialty cardiac care. To better understand parental perspectives on the transition process, a survey was distributed to 451 parents of adolescents with CHD who had recent contact with the healthcare system in Georgia (GA) and New York (NY). Among respondents, 90.7% reported excellent, very good or good health-related quality of life (HRQoL) for their adolescent. While the majority of parents (77.8%) had been told by a provider about their adolescent's need to transition to adult specialty cardiac care, most reported concerns about transitioning to adult care. Parents were most commonly concerned with replacing the strong relationship with pediatric providers (60.7%), locating an appropriate adult provider (48.7%), and accessing adult health insurance coverage (43.6%). These findings may offer insights into transition planning for adolescents with CHD.


Assuntos
Atitude Frente a Saúde , Cardiopatias Congênitas/terapia , Pais/psicologia , Transição para Assistência do Adulto , Adolescente , Adulto , Criança , Feminino , Georgia , Humanos , Seguro Saúde , Masculino , New York , Qualidade de Vida , Inquéritos e Questionários
17.
Heart ; 106(17): 1302-1309, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32522822

RESUMO

Adults with congenital heart disease (ACHD) may be at high risk in the case of COVID-19. Due to the heterogeneity of ACHD and secondary complications, risk profiles are, however, not uniform. This document aims to give an overview of relevant data and outline our pragmatic approach to disease prevention and management. Based on anatomy and additional physiological factors including symptoms, exercise capacity, heart failure, pulmonary hypertension and cyanosis, we propose a pragmatic approach to categorising patients into low-risk, intermediate-risk and high-risk groups. We regard especially patients with complex cyanotic conditions, those with palliated univentricular hearts, heart failure, severe valvular disease or pulmonary hypertension as high-risk patients. To avoid infection, we recommend self-isolation and exemption from work for these cohorts. Infected ACHD patients with low or moderate risk and without signs of deterioration may be remotely followed and cared for at home while in self isolation. High-risk patients or those with signs of respiratory or cardiovascular impairment require admission ideally at a tertiary ACHD centre. Especially patients with complex, cyanotic disease, heart failure and arrhythmias require particular attention. Treatment in patients with cyanotic heart disease should be guided by the relative degree of desaturation compared with baseline and lactate levels rather than absolute oxygen saturation levels. Patients with right heart dilatation or dysfunction are potentially at increased risk of right heart failure as mechanical ventilation and acute respiratory distress syndrome can lead to increase in pulmonary arterial pressures.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus , Cardiopatias Congênitas , Pandemias , Administração dos Cuidados ao Paciente/métodos , Pneumonia Viral , Adulto , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Cardiopatias Congênitas/classificação , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/terapia , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Medição de Risco
18.
Arch Cardiovasc Dis ; 113(8-9): 579-586, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32522436

RESUMO

This paper aims to provide a paediatric cardiac computed tomography angiography expert panel consensus based on the opinions of experts from the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) and the Filiale de cardiologie pédiatrique congénitale (FCPC). This expert panel consensus includes recommendations for indications, patient preparation, computed tomography angiography radiation dose reduction techniques and postprocessing techniques. We think that to realize its full potential and to avoid pitfalls, cardiac computed tomography angiography in children with congenital heart disease requires training and experience. Moreover, paediatric cardiac computed tomography angiography protocols should be standardized to acquire optimal images in this population with the lowest radiation dose possible, to prevent unnecessary radiation exposure. We also provide a suggested structured report and a list of acquisition protocols and technical parameters in relation to specific vendors.


Assuntos
Angiografia por Tomografia Computadorizada/normas , Angiografia Coronária/normas , Vasos Coronários/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Adolescente , Fatores Etários , Criança , Pré-Escolar , Angiografia por Tomografia Computadorizada/efeitos adversos , Consenso , Angiografia Coronária/efeitos adversos , Cardiopatias Congênitas/terapia , Humanos , Lactente , Recém-Nascido , Valor Preditivo dos Testes , Prognóstico , Doses de Radiação , Exposição à Radiação/efeitos adversos , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco
19.
Circ Cardiovasc Interv ; 13(5): e008172, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32408819

RESUMO

BACKGROUND: The C3PO-QI (Congenital Cardiac Catheterization Project on Outcomes - Quality Improvement), a multicenter registry launched in 2015, instituted quality improvement (QI) initiatives to reduce patient radiation exposure. Through regular collaboration, this initiative would allow for harmony among active participants, maximizing efforts and efficiency at achieving radiation best practices. This study sought to report these efforts with a detailed methodology for which institutions can target initiatives, reducing radiation exposure, and increasing patient safety. METHODS: Data were collected prospectively by 8 C3PO-QI institutions between January 1, 2015 and December 31, 2017. Radiation exposure was measured in dose area product per body weight (dose area product/kg; µGy*m2/kg) and reported by expected radiation exposure categories (REC) and institution for 40 published unique procedure types. Targeted interventions addressing selected strategic domains for radiation reduction were implemented in the pediatric catheterization labs of the C3PO-QI institutions. RESULTS: The study consisted of 15 257 unique cases. Median exposure (dose area product/kg) was decreased by 30% for all procedures. Dose area product/kg was reduced in all 3 REC, with the greatest improvement observed in REC I (REC I, -37%; REC II, -23%; REC III, -27%). Although the baseline radiation exposures and exact percent decrease varied across all C3PO-QI sites, each institution demonstrated improvements in radiation dose over time. These improvements occurred with the implementation of institution-specific QI interventions accelerated by participation in the C3PO-QI multicenter collaborative. CONCLUSIONS: Substantial radiation dose reductions can be achieved using targeted QI methodology and interventions. Participation in a multicenter QI collaborative may accelerate improvement across all centers due to enhanced engagement and shared learning between sites.


Assuntos
Cateterismo Cardíaco , Angiografia Coronária , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/terapia , Doses de Radiação , Exposição à Radiação/prevenção & controle , Lesões por Radiação/prevenção & controle , Proteção Radiológica , Adolescente , Adulto , Cateterismo Cardíaco/efeitos adversos , Criança , Pré-Escolar , Angiografia Coronária/efeitos adversos , Bases de Dados Factuais , Feminino , Disparidades em Assistência à Saúde , Humanos , Lactente , Masculino , Segurança do Paciente , Estudos Prospectivos , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Exposição à Radiação/efeitos adversos , Lesões por Radiação/etiologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
20.
BMC Cardiovasc Disord ; 20(1): 227, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32414329

RESUMO

BACKGROUND: As a result of advances in pediatric care and diagnostic testing, there is a growing population of adults with congenital heart disease (ACHD). The purpose of this study was to better define the epidemiology and changes in the trend of hospitalizations for ACHD in Korean society. METHODS: We reviewed outpatient and inpatient data from 2005 to 2017 to identify patient ≥18 years of age admitted for acute care with a congenital heart disease (CHD) diagnosis in the pediatric cardiology division. We tried to analyze changes of hospitalization trend for ACHD. RESULTS: The ratio of outpatients with ACHD increased 286.5%, from 11.1% (1748/15,682) in 2005 to 31.8% (7795/24,532) in 2017. The number of ACHD hospitalizations increased 360.7%, from 8.9% (37/414) in 2005 to 32.1% (226/705) in 2017. The average patient age increased from 24.3 years in 2005 to 27.4 in 2017. The main diagnosis for admission of ACHD is heart failure, arrhythmia and Fontan-related complications. The annual ICU admission percentage was around 5% and mean length of intensive care unit (ICU) stay was 8.4 ± 14.6 days. Mean personal hospital charges by admission of ACHD increased to around two times from 2005 to 2017. (from $2578.1 to $3697.0). Total annual hospital charges by ACHD markedly increased ten times (from $95,389.7 to $831,834.2). CONCLUSIONS: The number of hospital cares for ACHD dramatically increased more than five times from 2005 to 2017. We need preparations for efficient healthcare for adults with CHD such as a multi-dimensional approach, effective communication, and professional training.


Assuntos
Serviço Hospitalar de Cardiologia/tendências , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/terapia , Hospitalização/tendências , Pediatria/tendências , Sobreviventes , Adolescente , Adulto , Serviço Hospitalar de Cardiologia/economia , Feminino , Gastos em Saúde/tendências , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/economia , Preços Hospitalares/tendências , Custos Hospitalares/tendências , Hospitalização/economia , Humanos , Masculino , Pediatria/economia , Estudos Retrospectivos , Seul/epidemiologia , Fatores de Tempo , Adulto Jovem
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