RESUMO
INTRODUCTION: The optimal management of a patent ductus arteriosus in a population of preterm infants is controversial. Traditionally, when the patent ductus arteriosus does not close either with conservative treatment or in response to pharmacological therapy, the only option is surgical closure. However, transcatheter occlusion might provide a therapeutic alternative. METHODS: We searched PubMed, Embase, and Cochrane databases for non-randomised and randomised controlled trials that compared transcatheter percutaneous closure of patent ductus arteriosus with surgical ligation in low-birth-weight preterm infants (<2,500 g). A random-effects model was used for outcomes with high heterogeneity. RESULTS: We included twelve studies comprising 4,668 low-birth-weight preterm infants, of whom 966 (20.7%) were in the transcatheter percutaneous closure group, and 3,702 (79.3%) patients were included in the surgical group. All-cause mortality (OR 0.28; 95% confidence interval 0.18-0.423; p < 0.00001; I2 = 0%) and haemodynamic instability (OR 0.10; 95% confidence interval 0.05-0.21; p < 0.001; I2 = 14%) were significantly lower in the transcatheter percutaneous closure group. There was no significant difference between transcatheter and surgical patent ductus arteriosus closure for the outcomes of bronchopulmonary dysplasia (0.93; 95% confidence interval 0.46-1.87; p = 0.83; I2 = 0%) and major complications (OR 0.76; 95% confidence interval 0.34-1.69; p = 0.51; I2 = 43%). CONCLUSION: These findings suggest that transcatheter patent ductus arteriosus closure in preterm infants under 2,500 g is a safe and effective alternative to surgical treatment. There was a substantial reduction in all-cause mortality and haemodynamic instability with transcatheter intervention compared to surgical closure.
Assuntos
Cateterismo Cardíaco , Permeabilidade do Canal Arterial , Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro , Humanos , Recém-Nascido , Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Permeabilidade do Canal Arterial/cirurgia , LigaduraRESUMO
OBJECTIVE: Cardiopulmonary bypass is associated with ischemia-reperfusion injury to multiple organs. We aimed to evaluate whether remote ischemic preconditioning performed the day before surgery for congenital heart disease with cardiopulmonary bypass attenuates the postoperative inflammatory response and myocardial dysfunction. METHODS: This was a prospective, randomized, single-blind, controlled trial. Children allocated to remote ischemic preconditioning underwent 4 periods of 5 minutes of lower limb ischemia by a blood pressure cuff intercalated with 5 minutes of reperfusion. Blood samples were collected 4, 12, 24, and 48 hours after cardiopulmonary bypass to evaluate nuclear factor kappa B activation in leukocytes by quantification of mRNA of I kappa B alpha by real-time quantitative polymerase chain reaction and for interleukin-8 and 10 plasma concentration measurements by enzyme-linked immunosorbent assay. Myocardial dysfunction was assessed by N-terminal pro-B-type natriuretic peptide and cardiac troponin I plasma concentrations, measured by chemiluminescence, and clinical parameters of low cardiac output syndrome. RESULTS: Twelve children were allocated to remote ischemic preconditioning, and 10 children were allocated to the control group. Demographic data and Risk Adjustment for Congenital Heart Surgery 1 classification were comparable in both groups. Remote ischemic preconditioning group had lower postoperative values of N-terminal pro-B-type natriuretic peptide, but cardiac troponin I levels were not significantly different between groups. Interleukin-8 and 10 concentrations and I kappa B alpha gene expression were similar in both groups. Postoperative morbidity was similar in both groups; there were no postoperative deaths in either group. CONCLUSIONS: Late remote ischemic preconditioning did not provide clinically relevant cardioprotection to children undergoing cardiopulmonary bypass.
Assuntos
Ponte Cardiopulmonar , Cardiopatias Congênitas/sangue , Cardiopatias Congênitas/cirurgia , Precondicionamento Isquêmico , Feminino , Cardiopatias Congênitas/fisiopatologia , Humanos , Lactente , Interleucina-10/sangue , Interleucina-8/sangue , Perna (Membro)/irrigação sanguínea , Modelos Lineares , Masculino , NF-kappa B/sangue , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Estudos Prospectivos , Método Simples-Cego , Estatísticas não Paramétricas , Resultado do Tratamento , Troponina I/sangueRESUMO
Three-years-old boy presenting with a subvalvar aortic stenosis without a precise definition by echocardiography, where the surgical approach revealed an accessory mitral leaflet.
Assuntos
Estenose Aórtica Subvalvar/cirurgia , Valva Mitral/anormalidades , Estenose Aórtica Subvalvar/diagnóstico por imagem , Pré-Escolar , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Resultado do Tratamento , UltrassonografiaRESUMO
O presente trabalho avaliou o uso de tabaco (incluindo uso nocivo - F17.1 e dependência - F17.2) entre a população de rua de Juiz de Fora, MG. Baseou-se em levantamento no banco de dados construído a partir de pesquisa anterior que apurou a prevalência de transtornos mentais entre a população de rua da cidade. Foram analisados 79, com idade de 18 anos ou mais e tempo mínimo de exposição à rua de 12 meses, sendo encontrados 58 que apresentavam um dos diagnósticos acima (73,4%). Esse subgrupo, composto pelos considerados casos, foi então comparado com o restante da amostra. Buscou-se características demográficas, biográficas e clínicas que os distinguisse. A prevalência de tabagismo encontrada é semelhante àquelas de estudos internacionais anteriores, porém bem acima do índice para a população geral adulta no Brasil (41% na região Sudeste). Também foi encontrada uma forte associação entre tabagismo e alcoolismo (p = 0,00002), sendo que 54 dos fumantes (83,1%) também eram usuários de bebidas alcoólicas. Os dados apontam a gravidade do problema e indicam a necessidade urgente de esforços integrados da sociedade voltados para a prevenção e combate ao tabagismo, diminuindo sua prevalência e a morbimortalidade associada a esse hábito.