RESUMO
Transient cardiac constriction is an unusual complication of purulent pericarditis. It should be suspected in the presence of clinical and haemodynamic deterioration when signs of activity have abated. Features of cardiac constriction were observed in a 4-year-old boy 2 weeks after surgical drainage. The patient was managed conservatively without surgery and the outcome was good. Follow up 2 years later showed a healthy boy with a normal cardiological examination.
Assuntos
Infecções por Haemophilus/complicações , Haemophilus influenzae , Derrame Pericárdico/complicações , Pericardite Constritiva/etiologia , Pericardite/complicações , Doença Aguda , Pré-Escolar , Ecocardiografia , Infecções por Haemophilus/diagnóstico por imagem , Infecções por Haemophilus/microbiologia , Haemophilus influenzae/isolamento & purificação , Humanos , Masculino , Derrame Pericárdico/microbiologia , Pericardite/diagnóstico por imagem , Pericardite/microbiologia , Pericardite Constritiva/diagnóstico por imagemRESUMO
The mechanisms responsible for long-term hypertension in children after successful repair of coarctation of the aorta have not yet been determined. We measured plasma renin activity and aldosterone, adrenalin, and noradrenalin concentrations both under basal conditions and in response to standing and treadmill exercise in 24 normal normotensive children, 16 normotensive postcoarctectomy children, eight hypertensive postcoarctectomy children, and seven children with essential hypertension. Exercise-induced changes in plasma renin activity, aldosterone, adrenalin, and noradrenalin were comparable in the four groups in spite of a significantly greater increase in systolic blood pressure in the children with hypertension. In response to standing, the plasma concentration of noradrenalin increased significantly in normotensive but not in hypertensive children. Hyperresponse of blood pressure to exercise in hypertensive postcoarctectomy children and children with essential hypertension is not related to abnormalities in the sympathetic nervous system or the angiotensin-aldosterone axis. Hypertension could be related to primary baroreceptor alterations, to structural changes in the arterial wall, or both. Twenty percent of normotensive postcoarctectomy children had a blood pressure hyperresponse to exercise and an abnormal noradrenalin response to standing similar to that seen in the hypertensive children. Follow-up of children after coarctectomy may elucidate whether these two abnormalities are indicators of an increased risk of developing long-term recurrent hypertension.
Assuntos
Coartação Aórtica/cirurgia , Hipertensão/etiologia , Complicações Pós-Operatórias , Aldosterona/sangue , Pressão Sanguínea , Criança , Feminino , Frequência Cardíaca , Humanos , Hipertensão/sangue , Hipertensão/fisiopatologia , Masculino , Norepinefrina/sangue , Esforço Físico , Postura , Renina/sangue , Fatores de TempoRESUMO
We have studied 44 patients with classical tricuspid atresia who underwent radical surgery between 1971 and 1985. Bypassing of the incomplete and rudimentary right ventricle was performed, in anterior fashion, in 17 patients operated on from 1971 to 1980. Subsequently, from 1980 to 1985, we used a technique of posterior retroaortic atriopulmonary anastomosis. This was undertaken in 27 patients. We have now compared the results in the two groups. Hospital and late mortality was 23.5 and 17.6% in those undergoing an anterior anastomosis, while it was 7.4 and 3.7% in those having a retroaortic connexion. When we compared the results in survivors, according to a previously designed clinical assessment score, we found that 41.1% of those undergoing the anterior approach were in excellent clinical status in comparison to 85.1% of those having a posterior anastomosis. The actuarial survival curve at 6 years showed 88.8% survival (70% confidence limit 44-77) for the posterior approach and 64.7% for the anterior. On the basis of our findings we felt able to remove from consideration as risk factors three of the features initially identified by Choussat and his colleagues. We conclude that better immediate and late results are obtained with the posterior retroaortic approach. We also found that those patients with excellent long-term outcome had postoperative right atrial pressures less than 14 mm Hg. Late arrhythmias were associated with increased right atrial pressures and were a relevant risk factor in both groups.
Assuntos
Ventrículos do Coração/anormalidades , Valva Tricúspide/anormalidades , Adolescente , Arritmias Cardíacas/etiologia , Criança , Pré-Escolar , Cianose/etiologia , Seguimentos , Átrios do Coração/cirurgia , Hemodinâmica , Hepatomegalia/etiologia , Humanos , Métodos , Derrame Pleural/etiologia , Complicações Pós-Operatórias/mortalidade , Artéria Pulmonar/cirurgia , ReoperaçãoRESUMO
A general review of the main problems found in the management of inoperable heart anomalies is made by the author. He determines the reasons why a heart disease cannot be corrected by surgery, the complications found in such cases, the cautiousness that must be taken and the psychological aspect of these problems in relationship with the family and the patient.