Routine Detection of Atrial Fibrillation/Flutter Predicts a Worse Outcome in a Cohort of Tetralogy of Fallot Patients During 23 Years of Follow-Up.

Atrial flutter/fibrillation (AFL/AF) is a late complication in adults with repaired tetralogy of Fallot (TOF). Its effects on long-term prognosis are not fully understood. We evaluate the impact of AFL/AF in adults with repaired TOF on global mortality and unplanned hospitalizations during follow-up, and the predictors for AFL/AF occurrence. The presence of AFL/FA was analysed in all exams performed during the last 10 years of outpatients follow up in a unicentric cohort of repaired TOF between 1980 and 2003. Two-hundred and six patients were included; at a mean follow-up of 21 ± 8.2 years, there were 5 deaths (19.2%) in the AFL/AF group and 2 (1.1%) in those without arrhythmia (p < 0.001). Patients with AFL/AF where older at the time of the surgical repair (p < 0.001) and had a higher rate of reinterventions (p = 0.003). No differences were observed between the groups regarding the use of a transannular patch, ventriculotomy and previous palliative shunt. QRS duration was longer in patients with AFL/AF (174 ± 33.4) when compared to those without arrhythmia (147 ± 39.6; p < 0.0001). Age at surgery, QRS duration, and tricuspid regurgitation ≥ moderate were independent risk predictors for AFL/AF. In the multivariate analysis, atrial flutter/fibrillation and QRS duration were predictors of death and hospitalization. AFL/AF is associated with an increased risk of death and hospitalization during the follow-up of patients with repaired TOF. Early detection of AFL/AF and their predictors is an essential step in the evaluation of such population.

Transcatheter closure of atrial septal defect with Amplatzer device in children aged less than 10 years old: immediate and late follow-up.

AIMS: To analyze the efficacy and follow-up results of percutaneous closure of Atrial septal defect (ASD) with the Amplatzer septal occluder in children aged <10 years old. METHODS: Between November 1998 and September 2005, 27 patients diagnosed with ASD were treated percutaneously with an Amplatzer septal occluder. The procedure was carried out in the cathlab, under general anesthesia and with both fluoroscopy and transesophageal echocardiography guidance. Basal physical examinations and echocardiograms were performed prior to the procedure and at 30 days, 6, and 12 months of follow-up. Survival free of symptom was estimated by Kaplan-Meier. RESULTS: The mean age, weight, height, body mass index, and corporal surface was: 5.35 +/- 2.11 years, 23.07 +/- 9.43 kg, 110.55 +/- 17.6 cm, 16.77 +/- 2.42 kg/m(2), and 1.24 +/- 2.44 m(2). The prevalence of septal aneurysm was 3.7% and all patients presented single secundum ASD. The mean stretched diameter by fluoroscopy and transesophageal echocardiography were 17.18 +/- 6.75 mm and 16.77 +/- 5.99 mm, and the prostheses sizes were 18.83 +/- 6.98 mm, ranging from 10 to 30 mm. The systolic and diastolic pulmonary pressures were 25.26 +/- 5.97 mm Hg and 13.38 +/- 3.40 mm Hg, respectively. The procedure time was 82.92 +/- 29.14 min and the hospital stay was 2.20 +/- 0.26 days. Clinical and echocardiography follow-ups were performed within 11.59 +/- 4.42 months and all devices were in the correct position with no residual shunt. Right ventricular diameter decreased from 19.38 +/- 5.23mm to 11.38 +/- 11.92 (P 0.001). No major complications or deaths occurred; two patients had a hematoma at the vascular access. CONCLUSION: Secundum atrial septal defect closure can be safely and successfully performed with the Amplatzer septal occluder in children younger than 10 years old.

Entrecruzamento das vias de entrada ventriculres (Criss-Cross Heart) e transposição anatomicamente corrigida das grandes artérias: relato de caso e revisao de literatura / Criss-Cross heart and corrected transposition of great arteries: case report and literature review

Criss-cross heart é uma rara e complexa anomalia congênita que se caracteriza pela rotação da conexão atrioventricular e entrecruzamento dos fluxos de entrada dos ventrículos. É resultado de uma anomalia de rotação embrionária da massa ventricular no seu eixo longo de forma horária ou anti-horária, sem movimentação concomitante dos átrios. O quadro clínico depende das malformações associadas, dimensões da comunicação interventricular, presença ou não de estenose pulmonar, straddling da valva mitral e dimensões das cavidades ventriculares. A presente revisão abordará os critérios ecocardiográficos de criss-cross heart, definindo as questões técnicas do exame, além de relatar um caso de criss-cross com transposição corrigida das grandes artérias.

Corte paracoronal transgástrico transesofágico. Uso e indicaçoes em cardiologia pediátrica / ransesophageal Paracoronal Transgastric View. Indication and Use in Pediatric Cardiology

PURPOSE--To evaluate the contribution and comparative value of paracoronal transgastric view compared with conventional transesophageal examination for morpho-functional assessment of different types of congenital heart disease in a pediatric group. METHODS--Fifteen patients with clinical and echocardiographic diagnosis of congenital heart disease were selected for single plane transesophageal examination. After routine evaluation, the probe was positioned to obtain a paracoronal transgastric view, and images that result from this technique were recorded and compared with those obtained in the conventional way. Eleven procedures were carried out in the cathlab and four in pediatric intensive care unit, under general anesthesia or heavy sedation. The age and weight were 32.0 months and 11.6 kg respectively. No adverse reactions were observed with this method. RESULTS--In comparison with conventional transesophageal study, the paracoronal transgastric view permitted better morpho-functional assessment of the outlets of the right and left ventricles, as well as additional informations about the left pulmonary artery. CONCLUSION--Morphological and hemodynamic informations obtained from paracoronal transgastric view is a safe method which can be used either as an alternative or a complement to conventional examination to assess the outlets of both ventricles, as well as to evaluate the subvalvar, valvar and supravalvar region in different types of congenital heart disease.

Pneumonia por Chlamydia trachomatis: descriçäo de dois casos / Chlamydia trachomatis pneumonia: report of 2 cases

Vários estudos epidemiológicos realizados nos Estados Unidos têm mostrado que as infecçöes por Chlamydia säo freqüentes em mulheres grávidas e que cerca de 1% dos recém-nascidos desenvolvem pneumonia por este agente. Através de testes sorológicos recentemente introduzidos em nosso meio passou a ser possível o diagnóstico destas infecçöes. Descreve-se em dois casos de pneumonia por Chlamydia trachomatis em recém-nascidos, adquiridas na passagem pelo canal do parto. A doença caracterizou-se por disfunçäo respiratória progressiva, associada em algum momento a uma conjuntivite, apresentando ao raio X um infiltrado intersticial difuso com hiperexpansäo pulmonar. Eosinofilia esteve presente em ambos os casos. O tratamento com eritromicina seguiu-se de rápida regressäo do quadro clínico e radiológico

Resposta metabólica ao trauma / Metabolic response to trauma

Através deste trabalho de revisäo da literatura, objetiva-se sistematizar e caracterizar as diversas fases da convalescença pós-trauma, enfatizando as respostas do paciente cirúrgico e correlacionando-as com as manifestaçöes clínicas, bem como identificar os fatores que podem interferir na mesma

Nódulo solitário de pulmäo / Solitary pulmonary nodule

Os aspectos clínicos, radiológicos e histopatológicos de 29 pacientes portadores de nódulo solitário de pulmäo, submetidos a toracotomia, foram analisados retrospectivamente. Em 22 casos o exame histopatológico mostrou a presença de lesäo neoplásica, dos quais dezenove eram malignos e três benignos. Nos demais sete casos, cinco eram tuberculomas, um antrascose e um lipoma