Assuntos
Cardiopatias/diagnóstico por imagem , Sopros Cardíacos/etiologia , Fístula Vascular/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Anomalias dos Vasos Coronários/diagnóstico por imagem , Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
El origen anómalo de la arteria coronaria derecha de la arteria pulmonar es una entidad rara con una incidencia del 0,002 % y potencialmente grave, que puede causar muerte súbita. El diagnóstico frecuentemente es incidental, secundario a evaluaciones por soplos cardíacos a diferencia del origen anómalo de la arteria coronaria izquierda de la arteria pulmonar, reconocido por presentar isquemia miocárdica e insuficiencia cardíaca. Se reporta el caso de una niña de 6 meses evaluada por un soplo y derivada por sospecha de fístula coronaria. La evaluación mediante ecocardiograma doppler color, cateterismo cardíaco y angiotomografía mostró la presencia de una comunicación interauricular ostium secundum pequeña y origen anómalo de la arteria coronaria derecha de la arteria pulmonar. A los 11 meses, se realizó una cirugía de reimplante de la arteria coronaria derecha en la arteria aorta y el cierre de la comunicación interauricular.
The anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare entity that has an incidence of 0.002 % and can potentially cause sudden death. Unlike to the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), usually presented with myocardial ischemia and heart failure; the diagnosis of ARCAPA is often incidental during evaluation of a heart murmur. We report a case of a 6 months old female patient referred to us with a cardiac murmur and a suspicion of coronary fistula. For a proper diagnostic assessment an echocardiogram, a computed tomography angiography and a cardiac catheterization were requested. A small ostium secundum-type atrial septal defect (ASD) and an ARCAPA were revealed. At 11 months old, the patient was scheduled for corrective cardiovascular surgery. The aim of this report is to describe a low incidence and potentially fatal disease.
Assuntos
Humanos , Feminino , Lactente , Sopros Cardíacos/etiologia , Síndrome de Bland-White-Garland/diagnóstico , Comunicação Interatrial/diagnóstico , Ecocardiografia/métodos , Cateterismo Cardíaco/métodos , Vasos Coronários/patologia , Vasos Coronários/diagnóstico por imagem , Síndrome de Bland-White-Garland/cirurgia , Síndrome de Bland-White-Garland/fisiopatologia , Fístula/diagnóstico , Angiografia por Tomografia Computadorizada/métodos , Comunicação Interatrial/cirurgiaRESUMO
The anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare entity that has an incidence of 0.002 % and can potentially cause sudden death. Unlike to the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), usually presented with myocardial ischemia and heart failure; the diagnosis of ARCAPA is often incidental during evaluation of a heart murmur. We report a case of a 6 months old female patient referred to us with a cardiac murmur and a suspicion of coronary fistula. For a proper diagnostic assessment an echocardiogram, a computed tomography angiography and a cardiac catheterization were requested. A small ostium secundum-type atrial septal defect (ASD) and an ARCAPA were revealed. At 11 months old, the patient was scheduled for corrective cardiovascular surgery. The aim of this report is to describe a low incidence and potentially fatal disease.
El origen anómalo de la arteria coronaria derecha de la arteria pulmonar es una entidad rara con una incidencia del 0,002 % y potencialmente grave, que puede causar muerte súbita. El diagnóstico frecuentemente es incidental, secundario a evaluaciones por soplos cardíacos a diferencia del origen anómalo de la arteria coronaria izquierda de la arteria pulmonar, reconocido por presentar isquemia miocárdica e insuficiencia cardíaca. Se reporta el caso de una niña de 6 meses evaluada por un soplo y derivada por sospecha de fístula coronaria. La evaluación mediante ecocardiograma doppler color, cateterismo cardíaco y angiotomografía mostró la presencia de una comunicación interauricular ostium secundum pequeña y origen anómalo de la arteria coronaria derecha de la arteria pulmonar. A los 11 meses, se realizó una cirugía de reimplante de la arteria coronaria derecha en la arteria aorta y el cierre de la comunicación interauricular.
Assuntos
Síndrome de Bland-White-Garland/diagnóstico , Sopros Cardíacos/etiologia , Comunicação Interatrial/diagnóstico , Síndrome de Bland-White-Garland/fisiopatologia , Síndrome de Bland-White-Garland/cirurgia , Cateterismo Cardíaco/métodos , Angiografia por Tomografia Computadorizada/métodos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Ecocardiografia/métodos , Feminino , Fístula/diagnóstico , Comunicação Interatrial/cirurgia , Humanos , LactenteRESUMO
Alterations in cardiac energy metabolism play a key role in the pathogenesis of diabetic cardiomyopathy. Hypercholesterolemia associated with bioenergetic impairment and oxidative stress has not been well characterized in the cardiac function under glycemic control deficiency conditions. This work aimed to determine the cardioprotective effects of quercetin (QUE) against the damage induced by a high-cholesterol (HC) diet in hyperglycemic rats, addressing intracellular antioxidant mechanisms and bioenergetics. Quercetin reduced HC-induced alterations in the lipid profile and glycemia in rats. In addition, QUE attenuated cardiac diastolic dysfunction (increased E:A ratio), prevented cardiac cholesterol accumulation, and reduced the increase in HC-induced myocyte density. Moreover, QUE reduced HC-induced oxidative stress by preventing the decrease in GSH/GSSG ratio, Nrf2 nuclear translocation, HO-1 expression, and antioxidant enzymatic activity. Quercetin also counteracted HC-induced bioenergetic impairment, preventing a reduction in ATP levels and alterations in PGC-1α, UCP2, and PPARγ expression. In conclusion, the mechanisms that support the cardioprotective effect of QUE in rats with HC might be mediated by the upregulation of antioxidant mechanisms and improved bioenergetics on the heart. Targeting bioenergetics with QUE can be used as a pharmacological approach to modulate structural and functional changes of the heart under hypercholesterolemic and hyperglycemic conditions.
Assuntos
Dieta/efeitos adversos , Sopros Cardíacos/prevenção & controle , Hipercolesterolemia/tratamento farmacológico , Quercetina/farmacologia , Animais , Colesterol/administração & dosagem , Metabolismo Energético , Sopros Cardíacos/tratamento farmacológico , Sopros Cardíacos/etiologia , Hipercolesterolemia/patologia , Hiperglicemia/etiologia , Hiperglicemia/fisiopatologia , Masculino , Estresse Oxidativo , Distribuição Aleatória , Ratos , Ratos WistarRESUMO
BACKGROUND: The small ventricular septal defect (VSD) usually presents good clinical evolution, even at long-term follow-up. OBJECTIVE: To verify the clinical evolution of patients with small VSD in order to determine the continuation or not of the expectant conduct, considering the low operative risk, which results in a more liberal indication for surgery. METHODS: From October 1976 to December 2007, 187 cases of small VSD (diameter < 3 mm at the echocardiogram) were evaluated and 155 of them were assessed at long-term follow-up. Time of the clinical manifestation of the murmur and evolution aspects such as the spontaneous closure of the defect (group I)--64 cases, persistence of the initial size (group II--74 cases and decrease in the size of the defect (group III)--17 cases, in addition to clinical complications, were studied. RESULTS: The clinical manifestation of the murmur occurred, in the majority of cases, during the first month of life, corresponding to 48 (75%), 54 (72.9%) and 12 (70.5%) patients, in the three groups, respectively and after the first year of life in 11 (5.8%) patients. Spontaneous closure occurred in the first year of life in 48 cases (75%), mean of 7.6 months and from 1 to 5.5 years in 15 patients (23.4%), with a maximum follow-up of 18 years. The persistence of the defect until 40 years of age was observed. The decrease in the size of the defect occurred on a mean of 15 months, followed for up to 9 years. The probability of VSD closure by the actuarial curve was 34.38% in 1 year and 49.89% in 5 years. There were no clinical complications. CONCLUSION: A favorable evolution of the small VSD at long-term follow-up does not require surgical intervention, with concerns regarding the strict antibiotic prophylaxis.
Assuntos
Comunicação Interventricular/complicações , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Seguimentos , Sopros Cardíacos/epidemiologia , Sopros Cardíacos/etiologia , Sopros Cardíacos/patologia , Comunicação Interventricular/epidemiologia , Comunicação Interventricular/patologia , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Remissão Espontânea , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
FUNDAMENTO: A comunicação interventricular (CIV) pequena apresenta geralmente boa evolução clínica, mesmo em longo prazo. OBJETIVO: Verificar evolução clínica de pacientes com CIV pequena, a fim de determinar continuidade ou não da conduta expectante, em vista do baixo risco operatório, o que ocasiona maior liberalidade da indicação cirúrgica. MÉTODOS: No período de outubro de 1976 a dezembro de 2007, foram examinados 187 casos com CIV pequena (diâmetro menor que 3 mm pelo ecocardiograma) e seguidos 155 deles em longo prazo. Estudaram-se a época de exteriorização do sopro e aspectos evolutivos como fechamento espontâneo do defeito (grupo I) - 64 casos, continuidade do tamanho inicial (grupo II) - 74 casos e diminuição do mesmo (grupo III) -17 casos, além de intercorrências clínicas. RESULTADOS: A exteriorização do sopro ocorreu na maioria no primeiro mês de vida, correspondendo a 48 (75 por cento), 54 (72,9 por cento) e 12 (70,5 por cento) pacientes, nos três grupos respectivos, e acima do primeiro ano em 11 (5,8 por cento) pacientes. Fechamento espontâneo ocorreu no primeiro ano em 48 casos (75 por cento), média de 7,6 m e de 1 a 5,5 anos em 15 pacientes (23,4 por cento), em acompanhamento máximo de 18 anos. Verificou-se continuidade do defeito até 40 anos. A diminuição do defeito ocorreu em média de 15 meses, seguidos até 9 anos. Probabilidade de fechamento da CIV, pela curva actuarial, foi de 34,38 por cento em 1 ano e de 49,89 por cento em 5 anos. Não houve intercorrências clínicas. CONCLUSÃO: Evolução favorável da CIV pequena em longo prazo dispensa intervenção operatória, com preocupação da profilaxia antibiótica rigorosa.
BACKGROUND: The small ventricular septal defect (VSD) usually presents good clinical evolution, even at long-term follow-up. OBJECTIVE: To verify the clinical evolution of patients with small VSD in order to determine the continuation or not of the expectant conduct, considering the low operative risk, which results in a more liberal indication for surgery. METHODS: From October 1976 to December 2007, 187 cases of small VSD (diameter < 3 mm at the echocardiogram) were evaluated and 155 of them were assessed at long-term follow-up. Time of the clinical manifestation of the murmur and evolution aspects such as the spontaneous closure of the defect (group I) - 64 cases, persistence of the initial size (group II - 74 cases and decrease in the size of the defect (group III) - 17 cases, in addition to clinical complications, were studied. RESULTS: The clinical manifestation of the murmur occurred, in the majority of cases, during the first month of life, corresponding to 48 (75 percent), 54 (72.9 percent) and 12 (70.5 percent) patients, in the three groups, respectively and after the first year of life in 11 (5.8 percent) patients. Spontaneous closure occurred in the first year of life in 48 cases (75 percent), mean of 7.6 months and from 1 to 5.5 years in 15 patients (23.4 percent), with a maximum follow-up of 18 years. The persistence of the defect until 40 years of age was observed. The decrease in the size of the defect occurred on a mean of 15 months, followed for up to 9 years. The probability of VSD closure by the actuarial curve was 34.38 percent in 1 year and 49.89 percent in 5 years. There were no clinical complications. CONLCUSION: A favorable evolution of the small VSD at long-term follow-up does not require surgical intervention, with concerns regarding the strict antibiotic prophylaxis.
FUNDAMENTO: La comunicación interventricular (CIV) pequeña presenta generalmente buena evolución clínica, aun a largo plazo. OBJETIVO: Verificar la evolución clínica de pacientes con CIV pequeña, a fin de determinar continuidad o no de la conducta expectante, en vista del bajo riesgo operatorio, resultando una mayor liberalidad de la indicación quirúrgica. MÉTODOS: En el período de octubre de 1976 a diciembre de 2007, se examinaron 187 casos con CIV pequeña (diámetro menor que 3 mm por el ecocardiograma) y se siguieron a 155 de ellos a largo plazo. Se estudiaron la época de exteriorización del soplo y los aspectos evolutivos, como cierre espontáneo del defecto (grupo I): 64 casos; continuidad del tamaño inicial (grupo II): 74 casos; y disminución del mismo (grupo III):17 casos; además de intercurrencias clínicas. RESULTADOS: En la mayoría de los casos, la exteriorización del soplo tuvo lugar en el primer mes de vida, correspondiendo a 48 (75 por ciento), 54 (72,9 por ciento) y 12 (70,5 por ciento) pacientes, en los tres grupos respectivos, y después del primer año en 11 (5,8 por ciento) pacientes. Cierre espontáneo ocurrió en el primer año en 48 casos (75 por ciento), promedio de 7,6 m y de 1 a 5,5 años en 15 pacientes (23,4 por ciento), en seguimiento máximo de 18 años. Se verificó continuidad del defecto hasta 40 años. La disminución del defecto ocurrió en promedio de 15 meses, seguidos hasta 9 años. Probabilidad de cierre de la CIV, por la curva actuarial, fue de un 34,38 por ciento en 1 año y de un 49,89 por ciento en 5 años. No hubo intercurrencias clínicas. CONCLUSIÓN: Evolución favorable de la CIV pequeña a largo plazo dispensa intervención operatoria, con preocupación de la profilaxis antibiótica rigurosa.
Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Adulto Jovem , Comunicação Interventricular/complicações , Brasil/epidemiologia , Seguimentos , Sopros Cardíacos/epidemiologia , Sopros Cardíacos/etiologia , Sopros Cardíacos/patologia , Comunicação Interventricular/epidemiologia , Comunicação Interventricular/patologia , Estimativa de Kaplan-Meier , Remissão Espontânea , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
We report a preterm infant with 30 weeks of gestation, that received broad spectrum antimicrobials during the first days of life. At nine days of life, the infant appeared with abdominal distension and hematochezia. A systolic murmur with changing auscultatory features also appeared. An echocardiography showed an atrial vegetation. A yeast, that was identified as the emergent pathogen Saccharomyces cerevisiae appeared in two blood cultures. Treatment with amphotericin B was started, the dose was adjusted calculating the minimal inhibitory concentration of amphotericin B, and measuring plasma levels of the antimicrobial. Therefore the minimal effective dose was prescribed, avoiding its deleterious effects. After 14 days of antifungal therapy, a new echocardiography showed a reduction in the size of the atrial vegetation. At 35 days, it disappeared and amphotericin B was discontinued. On the outpatient follow up, the infant has shown a normal growth and a normal cardiac auscultation
Assuntos
Humanos , Masculino , Recém-Nascido , Saccharomyces cerevisiae , Endocardite Bacteriana , Recém-Nascido Prematuro , Anfotericina B , Sopros Cardíacos/etiologiaRESUMO
A 7-year-old male was referred for evaluation of a heart murmur heard on routine check-up. Transthoracic echocardiogram revealed the presence of a fenestrated atrial septal defect (ASD) in a dextrocardia with total situs inversus ( mirror image ). Two Amplatzer Septal Occluders (Cook Incorporated, Bloomington, Indiana) were used to successfully occlude the ASDs with no residual shunt.
Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/instrumentação , Dextrocardia/complicações , Comunicação Interatrial/complicações , Comunicação Interatrial/cirurgia , Situs Inversus/complicações , Procedimentos Cirúrgicos Cardíacos/métodos , Criança , Ecocardiografia , Equipamentos e Provisões , Sopros Cardíacos/diagnóstico por imagem , Sopros Cardíacos/etiologia , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Resultado do TratamentoRESUMO
Rvisión de 14 casos de tumores cardiacos y pericárdicos en niños diagnosticados desde 1985 hasta 1999, en el Servicio de Cardiovascular del Hospital Luis Calvo Mackenna. Objetivo: evaluar el tipo de tumor, forma de presentación y pronóstico. El diagnóstico es mediante la ecocardiografía. Los tumores fueron rabdomiomas en 71 por ciento, mixoma, lipoma, teratoma quístico y sarcoma de Ewing. Edad de presentación: período antenatal en 3 pacientes y hasta 15 años; 50 por ciento en menores de 3 meses. Los síntomas má frecuentes fueron soplos cardiacos y arritmias. La mayoría de los rabdomiomas eran múltiples, ubicados en las distintas cavidades cardiacas. Un tercio de ellos se asoció con esclerosis tuberosa. El pronóstico dependió del tipo de tumor y de su ubicación. Fallecieron dos pacientes, un niño con sarcoma de Ewing y otro con rabdomioma intramural con foco arritmogénico ventricular
Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Lactente , Pré-Escolar , Adolescente , Neoplasias Cardíacas , Pericárdio/patologia , Rabdomioma , Arritmias Cardíacas/etiologia , Neoplasias Cardíacas/complicações , Estatísticas Hospitalares , Prognóstico , Rabdomioma/complicações , Sopros Cardíacos/etiologia , Esclerose Tuberosa/etiologia , Ultrassonografia Pré-NatalRESUMO
OBJECTIVE: To determine the accuracy of expert examination for pulmonary stenosis (PS) among children with murmur. STUDY DESIGN: Five hundred twenty-one consecutive, previously unevaluated, pediatric patients were enrolled. The investigators prospectively recorded their diagnosis and level of confidence, categorizing any PS suspected as mild or severe. After echocardiography, PS was categorized by severity with peak systolic flow velocity. Receiver operating characteristic curves described accuracy of clinical examination. RESULTS: Sixty-two patients had PS (mild, 29; moderate, 27; and severe, 6). Receiver operator characteristic curve areas were: total, 0.834 +/- 0.033; mild, 0.862 +/- 0.044; and moderate to severe, 0.809 +/- 0.046 (P =.20). Specific difficulties in discrimination of PS from small ventricular septal defect, aortic valve disease, atrial septal defect, and innocent murmur were identified. All cases of severe PS in which PS was suspected were thought possibly severe. CONCLUSIONS: Although expert clinical examination is highly accurate for distinguishing PS from non-PS cardiac murmurs in pediatric patients, it is imperfect.
Assuntos
Sopros Cardíacos/etiologia , Estenose da Valva Pulmonar/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Diagnóstico Diferencial , Ecocardiografia , Reações Falso-Positivas , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Estenose da Valva Pulmonar/classificação , Estenose da Valva Pulmonar/complicações , Curva ROC , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
A 16-year-old male, ORIF non-union of (R) medial epicondlye. He had no significant past medical history and his physical exam was essentially negative. He sustained the initial injury playing basketball. He was monitored with standard ASA monitors and induced width 1mg Midazolam 100macro grams Fentanyl and 250 mg Sodium Penthol. Endotracheal intubation was performed under relaxation using 50 mg Atracrium. Anesthesia was maintained with nitrous oxide, oxygen and Isoflourane changing to Desflurane at the end of the procedure, when he extubated and transferred to PACU where vital signs were stable but he had a harsh pan systolic murmur. On discharge from PACU, he was admitted and a Pediatric Cardiology consultation was requested. At 10:00p.m., six hours post-op the murmur was no longer heardand he remained asymptomatic. Our differential diagnosis was MVP IHSS and flow murmurs(AU)
Assuntos
Humanos , Masculino , Adolescente , Sopros Cardíacos/etiologia , Anestesia Geral/efeitos adversosRESUMO
OBJECTIVE: To compare the efficacy of injections of 1.2 million units of benzathine penicillin G given every 3 weeks versus every 4 weeks for secondary prevention of rheumatic fever, based on the long-term outcome of patients receiving such prophylaxis. METHODS: A total of 249 consecutive patients with rheumatic fever, randomly assigned to either a 3-week or a 4-week regimen, were examined every 3 to 6 months, and followed for 794 and 775 patient-years, respectively. RESULTS: Compliance with each regimen was comparable: 83 (66.9%) of 124 patients in the 3-week group versus 92 (73.6%) of 125 patients in the 4-week group stayed in the program (p > 0.05). Streptococcal infections occurred less frequently in those receiving the 3-week regimen: 7.5 versus 12.6 per 100 patient-years (p < 0.01). Prophylaxis failed in 2 patients receiving the 3-week regimen and in 10 receiving the 4-week regimen (0.25 and 1.29 per 100 patient-years respectively; p = 0.015). Serum penicillin levels were adequate (> or = 0.02 micrograms/ml) in 100 (56%) of 179 samples obtained 21 days after penicillin injection in the 3-week regimen, and in 51 (33%) of 155 samples obtained 28 days after injection in the 4-week regimen (p < 0.01). Of 71 patients with mitral regurgitation in the 3-week regimen, 47 (66%) no longer had the murmur; of 87 patients in the 4-week regimen, 40 (46%) no longer had the murmur (p < 0.05). CONCLUSIONS: This 12-year controlled study indicates that the outcome of patients with rheumatic fever is better with a 3-week than with a 4-week penicillin prophylaxis regimen. Greater emphasis and more widespread use of the 3-week regimen should be recommended.
Assuntos
Penicilina G Benzatina/uso terapêutico , Febre Reumática/prevenção & controle , Cardiopatia Reumática/prevenção & controle , Adolescente , Adulto , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/epidemiologia , Insuficiência da Valva Aórtica/prevenção & controle , Criança , Pré-Escolar , Esquema de Medicação , Feminino , Seguimentos , Sopros Cardíacos/epidemiologia , Sopros Cardíacos/etiologia , Sopros Cardíacos/prevenção & controle , Humanos , Masculino , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/epidemiologia , Insuficiência da Valva Mitral/prevenção & controle , Cooperação do Paciente , Penicilina G Benzatina/sangue , Estudos Prospectivos , Recidiva , Indução de Remissão , Febre Reumática/complicações , Febre Reumática/epidemiologia , Cardiopatia Reumática/complicações , Cardiopatia Reumática/epidemiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
We studied five patients with acquired ventricular septal defect during the course of an infective endocarditis. All patients were male and had a previous aortic valve disease associated with an aortic ring abscess. Clinical examination was useful for the diagnosis of 4 cases, emphasizing the following findings: systolic murmur and/or left paraesternal thrill and right-heart failure. Incidence of congestive heart failure was 60%, while 40% of all patients died during the in-hospital course. No specific etiologic agent was detected. Therefore, acquired ventricular septal defect should be suspected in patients with infective endocarditis of the aortic valve that evolve with a systolic murmur and/or paraesternal thrill and right-heart failure. Immediate surgical treatment is mandatory in these cases.