RESUMEN
OBJECTIVE: Percutaneous balloon valvulotomy (PBV) is the procedure of choice for the treatment of valvular pulmonary stenosis (PS) with similar results comparable to surgical valvotomy but less invasive. METHODS AND RESULTS: Twenty-seven consecutive patients with PS being evaluated for PBV were enrolled in the study. Peak instantaneous transvalvular gradient, right ventricle (RV) diameter, mean atrial pressures, RV systolic pressure (RVSP), pro-brain natriuretic peptide (proBNP) levels significantly decreased immediately after PBV. Regarding heart rate variability (HRV) parameters, mean HR (heart rate), LF (low frequency) day and night, LF/HF day and night significantly decreased and standard deviation of all NN intervals (SDNN), root mean square of successive differences (RMSSD), P number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50), HF (High frequency) day and night significantly increased 1 day after PBV and these changes were shown to be preserved at the first month. The increase in SDNN was correlated with the decrease in right atrial pressure (RAP) (r =-0.5, P = 0.04); the increase in standard deviation of the 5-minute mean RR intervals (SDANN) was correlated with the decrease in proBNP (r =-0.4, P = 0.03). CONCLUSIONS: Sympathetic overactivity and increased proBNP levels were associated with the symptomatic status of patients with PS. Associated with a decrease in atrial pressures and proBNP levels, PBV yielded a decrease in adrenergic overactivity in the patients with PS.
Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Cateterismo/métodos , Electrocardiografía , Estenosis de la Válvula Pulmonar/terapia , Adolescente , Adulto , Enfermedades del Sistema Nervioso Autónomo/etiología , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Niño , Estudios de Cohortes , Ecocardiografía Transesofágica , Femenino , Estudios de Seguimiento , Pruebas de Función Cardíaca , Frecuencia Cardíaca/fisiología , Humanos , Modelos Logísticos , Masculino , Estenosis de la Válvula Pulmonar/complicaciones , Estenosis de la Válvula Pulmonar/diagnóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Sistema Nervioso Simpático/fisiopatología , Resultado del TratamientoRESUMEN
Malnutrition is a widespread disorder in children, and ultrasonography is the method of choice to estimate kidney dimensions. Previously, kidney sizes had been studied in healthy newborns and in pediatric patients; however, kidney sizes were not investigated sufficiently in malnourished children. The study group consisted of 74 children with energy malnutrition (marasmus), and the control group consisted of 47 healthy children. Kidney sizes were mesaured by the same radiologist using ultrasonography. The mean age of the marasmic group was 29.6 +/- 14.0 months. Malnourished children had significantly lower kidney length and renal volume but higher relative kidney volume (cm3/body weight) compared with controls (P < 0.05). The mean length and volume of left kidney were higher than those of right kidney in both marasmic and control groups (P < 0.05). The strongest positive correlations were found between body height and kidney length, depth and volume in marasmic group. Regression analysis revealed that height and age of marasmic children had a significant effect on kidney volume; however, only body height had an effect on kidney length. In conclusion, malnourished children had smaller kidney sizes, and body height was the main determinant of their kidney length and volume. The potential long-term detrimental consequences of poor renal growth in malnutrition need to be investigated.