RESUMO
The recognition of tricuspid valve involvement in presence of rheumatic mitral valve disease is important when surgery is contemplated. At the National Institute of Cardiology in Mexico City, we studied 57 patients with preoperative echocardiogram and catheterisation on whom the tricuspid valve (TV) was explored during surgical repair of mitral valve disease. TV was normal in 17 patients (group I), 28 had functional tricuspid insufficiency (group II) and 12 had rheumatic involvement (group III). Surgical treatment over TV was required in 22 (20 annuloplasty, 1 comissurotomy and 1 homograft valve replacement). We found pure mitral stenosis in 15, mitral stenosis and regurgitation in 36 and 6 with pure mitral insufficiency; the surgical repair over the mitral valve consisted in: 4 comissurotomies and 53 prosthetic valve replacement. At catheterisation, no significant pressure differences were found among the groups (right atrium, end diastolic of right ventricle, systolic pulmonary artery and capillary wedge). Echocardiogram showed E-F slope velocity diminished in group III (P less than 0.01), a diastolic anterior motion of septal leaflet of TV was found in 22 patients. No significant differences in the right ventricle measurements were found. In 7 patients a systolic anterior motion of interventricular septum was observed, all had mitral stenosis, 6 from group II and 1 from group III. We conclude that: echocardiogram study is a useful tool for the evaluation of TV involvement in patients with rheumatic mitral valve disease.
Assuntos
Ecocardiografia , Insuficiência da Valva Mitral/fisiopatologia , Estenose da Valva Mitral/fisiopatologia , Cardiopatia Reumática/fisiopatologia , Valva Tricúspide/fisiopatologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The most common cardiac defect in Turner syndrome has been described previously as coarctation of the aorta. We have evaluated 35 consecutive patients with Turner syndrome by clinical examination and by M-mode and two-dimensional echocardiography. Twelve patients (34%) had isolated, nonstenotic bicuspid aortic valve. A high correlation (82%) existed between the presence of a systolic ejection click and echocardiographic evidence of a bicuspid aortic valve. These data indicate that bicuspid aortic valve may be the most common cardiac anomaly in Turner syndrome.
Assuntos
Valva Aórtica/anormalidades , Ecocardiografia , Síndrome de Turner/complicações , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , LactenteRESUMO
The cardiovascular effects of dopamine were evaluated in 14 severely asphyxiated neonates. After a period of stabilization, either dopamine 2.5 micrograms/kg/minute or placebo was infused in a randomized double-blind protocol. In seven dopamine-treated infants, echocardiographically determined shortening fraction and mean velocity of circumferential fiber shortening increased when compared to preinfusion values (P less than 0.05). There was no significant change in these echo indices of cardiac function in the placebo-treated group. Systolic blood pressure rose in the dopamine group when compared to predopamine infusion values and to the postinfusion values of the placebo group (P less than 0.001 and 0.025, respectively). Diastolic blood pressure increased to a small degree in the dopamine group. There was no significant change in heart rate or echocardiographically measured systolic time intervals. Low doses of dopamine increase cardiac performance and raise systolic blood pressure in the severely asphyxiated neonate.
Assuntos
Asfixia Neonatal/tratamento farmacológico , Sistema Cardiovascular/efeitos dos fármacos , Dopamina/farmacologia , Hemodinâmica/efeitos dos fármacos , Asfixia Neonatal/fisiopatologia , Pressão Sanguínea/efeitos dos fármacos , Ensaios Clínicos como Assunto , Dopamina/uso terapêutico , Método Duplo-Cego , Frequência Cardíaca/efeitos dos fármacos , Humanos , Recém-Nascido , Placebos , Sístole/efeitos dos fármacosRESUMO
The course and complications of fifty-two infants with patent ductus arteriosus requiring closure were assessed prospectively. Twenty-six infants with a PDA received indomethacin for pharmacologic closure of the PDA, and 26 underwent ligation. The current study analyzes and compares the longitudinal follow-up with respect to somatic growth, neurologic function, psychomotor and mental development, and renal, ophthalmologic, and audiologic function in 21 infants in each group who entered the follow-up. No selective morbidity was attributable to PDA closure with indomethacin when compared to surgically treated infants.
Assuntos
Permeabilidade do Canal Arterial/terapia , Indometacina/uso terapêutico , Desenvolvimento Infantil , Permeabilidade do Canal Arterial/tratamento farmacológico , Permeabilidade do Canal Arterial/cirurgia , Seguimentos , Crescimento/efeitos dos fármacos , Nível de Saúde , Humanos , Indometacina/efeitos adversos , Lactente , Recém-Nascido , Ligadura , Exame Neurológico , Cooperação do Paciente , Complicações Pós-Operatórias , Estudos Prospectivos , Transtornos da Visão/etiologiaRESUMO
This report summarizes a consecutive experience with 59 preterm infants with clinical, radiographic, and echocardiographic findings of a large patent ductus arteriosus. Thirty-five infants who met defined criteria received indomethacin, and 24 infants underwent PDA ligation. Analysis of the clinical course of these infants revealed no selective indomethacin morbidity and suggests that infants undergoing ligation require more prolonged ventilator therapy with increased exposure to FiO2 greater than or equal to 0.3. Mortality rates between ligated and pharmacologically treated groups were similar. This study documents that inhibition of prostaglandin synthesis to constrict and close the PDA in the premature infant is an effective alternative to operative closure.
Assuntos
Permeabilidade do Canal Arterial/terapia , Indometacina/uso terapêutico , Permeabilidade do Canal Arterial/tratamento farmacológico , Permeabilidade do Canal Arterial/cirurgia , Humanos , Recém-Nascido , Ligadura , Síndrome do Desconforto Respiratório do Recém-Nascido/complicações , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Ventiladores MecânicosRESUMO
Thirty-one infants with clinical and radiographic evidence of a large left-to-right shunt across a patent ductus arteriosus underwent echocardiographic study to determine the magnitude of shunting. Seven patients were found to have a normal-left atrial dimensions and a normal left atrial/aortic root dimension at the time when physical and roentgenographic findings of a large PDA were most pronounced. In contrast, left ventricular end diastolic dimensions were excessive in these infants. After ductal closure (four, surgery; two, indomethacin, one, spontaneous) the left ventricular end diastolic dimension fell to the normal range. Optimal echocardiographic accuracy in infants with PDA should combine analysis of both atrial and ventricular dimensions; the former, used alone, may be misleading.