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Pinheiro PDS, Azevedo VMP, Rocha G. Predicting Factors of Surgical Mortality in Children and Adolescents Undergoing Correction of Tetralogy of Fallot. International Journal of Cardiovascular Sciences 2022. [DOI: 10.36660/ijcs.20200394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Quintella EF, Ferreira E, Azevedo VMP, Araujo DV, Sant'Anna FM, Amorim B, Albuquerque DCD. Clinical Outcomes and Cost-Effectiveness Analysis of FFR Compared with Angiography in Multivessel Disease Patient. Arq Bras Cardiol 2018; 112:40-47. [PMID: 30570071 PMCID: PMC6317625 DOI: 10.5935/abc.20180262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/23/2018] [Indexed: 11/20/2022] Open
Abstract
Background In multivessel disease patients with moderate stenosis, fractional flow
reserve (FFR) allows the analysis of the lesions and guides treatment, and
could contribute to the cost-effectiveness (CE) of non-pharmacological
stents (NPS). Objectives To evaluate CE and clinical impact of FFR-guided versus angiography-guided
angioplasty (ANGIO) in multivessel patients using NPS. Methods Multivessel disease patients were prospectively randomized to FFR or ANGIO
groups during a 5 year-period and followed for < 12 months. Outcomes
measures were major adverse cardiac events (MACE), restenosis and CE. Results We studied 69 patients, 47 (68.1%) men, aged 62.0 ± 9.0 years, 34
(49.2%) in FFR group and 53 (50.7%) in ANGIO group, with stable angina or
acute coronary syndrome. In FFR, there were 26 patients with biarterial
disease (76.5%) and 8 (23.5%) with triarterial disease, and in ANGIO, 24
(68.6%) with biarterial and 11 (31.4%) with triarterial disease. Twelve
MACEs were observed - 3 deaths: 2 (5.8%) in FFR and 1 (2.8%) in ANGIO, 9
(13.0%) angina: 4(11.7%) in FFR and 5(14.2%) in ANGIO, 6 restenosis: 2(5.8%)
in FFR and 4 (11.4%) in ANGIO. Angiography detected 87(53.0%) lesions in
FFR, 39(23.7%) with PCI and 48(29.3%) with medical treatment; and 77 (47.0%)
lesions in ANGIO, all treated with angioplasty. Thirty-nine (33.3%) stents
were registered in FFR (0.45 ± 0.50 stents/lesion) and 78 (1.05
± 0.22 stents/lesion) in ANGIO (p = 0.0001), 51.4% greater in ANGIO
than FFR. CE analysis revealed a cost of BRL 5,045.97 BRL 5,430.60 in ANGIO
and FFR, respectively. The difference of effectiveness was of 1.82%. Conclusion FFR reduced the number of lesions treated and stents, and the need for
target-lesion revascularization, with a CE comparable with that of
angiography.
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Affiliation(s)
- Edgard Freitas Quintella
- Hospital Universitário Pedro Ernesto - Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil.,Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro, RJ - Brazil
| | - Esmeralci Ferreira
- Hospital Universitário Pedro Ernesto - Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil
| | - Vitor Manuel Pereira Azevedo
- Cardiology Department. Hospital Clínico Universitario, INCLIVA. Universitat de València, Valencia - Spain.,Instituto Nacional de Cardiologia Laranjeiras (INCL), Rio de Janeiro, RJ - Brazil
| | - Denizar V Araujo
- Hospital Universitário Pedro Ernesto - Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil
| | - Fernando Mendes Sant'Anna
- Hospital Universitário Pedro Ernesto - Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil
| | - Bernardo Amorim
- Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro, RJ - Brazil
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Kaufman R, Azevedo VMP, Sá RMGD, Geller M, Xavier RMDA, Chaves RBM, Castier MB. Epidemiological Characteristics and Mortality Predictors in Patients Over 70 Years
Submitted to Coronary Artery Bypass Grafting. International Journal of Cardiovascular Sciences 2018. [DOI: 10.5935/2359-4802.20180020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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de Aquino Xavier RM, Azevedo VMP, Godoy PH, Migowski A, Ribeiro ALP, Chaves RBM, Correia MG, de Aquino Xavier C, de Aquino Hashimoto L, Weksler C, Silva NASE. Medium-term outcomes of 78,808 patients after heart valve surgery in a middle-income country: a nationwide population-based study. BMC Cardiovasc Disord 2017; 17:302. [PMID: 29284400 PMCID: PMC5745641 DOI: 10.1186/s12872-017-0725-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/28/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Heart valve surgery outcomes are unknown in middle-income countries and thus cannot be used in health system decision making processes. This study estimated in-hospital mortality and medium and long-term survival. METHODS This was a retrospective study of 78,806 patients who underwent heart valve surgery between 2001 and 2007 in Brazil. Two national databases were used, the Hospital Information System and the Mortality Information System. Kaplan-Meier survival analysis and log-rank tests were performed. Maximum and median follow-up was 7.7 and 2.8 years, respectively (0.002-7.707). RESULTS Valve replacement accounted for 69.1% of procedures performed. Mitral stenosis, the most common valve injury, represented 38.9% of the total. In 94.7% of mitral stenosis patients, aetiology was rheumatic heart disease. In-hospital mortality was 7.6% and was higher for women, for patients who had undergone concomitant coronary artery bypass grafting (CABG) and for the elderly. Overall survival was 69.9% at the end of follow-up. Survival was worst among elderly, male and concomitant CABG patients (P<0.001). CONCLUSIONS Rheumatic heart disease is still a major public health problem in Brazil. In-hospital mortality and global survival rates of patients who have undergone heart valve surgery were less satisfactory than those reported in high-income countries. The findings of this study can contribute to guiding decision making processes in middle-income countries similar to Brazil and others concerned with improving the quality of care.
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Affiliation(s)
- Regina Maria de Aquino Xavier
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil.
| | - Vitor Manuel Pereira Azevedo
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil
| | | | - Arn Migowski
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil
| | - Antonio Luiz Pinho Ribeiro
- University Hospital and School of Medicine - Universidade Federal de Minas Gerais (UFMG), Minas Gerais, Brazil
| | - Rogério Brant Martins Chaves
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil
| | - Marcelo Goulart Correia
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil
| | - Carolina de Aquino Xavier
- University Hospital and School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Clara Weksler
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil
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Costa RLD, Lamas CDC, Azevedo VMP, Cardoso EMDSC, Duarte LP, Weksler C. Impact of Pulmonary Hypertension on Surgical Mortality and 3-Year Survival After Aortic Valve Replacement. International Journal of Cardiovascular Sciences 2016. [DOI: 10.5935/2359-4802.20160010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Migowski A, Ribeiro AL, Carvalho MS, Azevedo VMP, Chaves RBM, Hashimoto LDA, Xavier CDA, Xavier RMDA. Seven years of use of implantable cardioverter-defibrillator therapies: a nationwide population-based assessment of their effectiveness in real clinical settings. BMC Cardiovasc Disord 2015; 15:22. [PMID: 25888219 PMCID: PMC4364497 DOI: 10.1186/s12872-015-0016-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background The efficacy of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) therapy has already been established in clinical trials but their effectiveness in several clinical settings remains undetermined. This study aimed to assess the effectiveness of ICD and CRT-D therapies within the Brazilian National Health System (SUS). Methods All patients who underwent ICD or CRT-D implantation within the SUS from 2001 to 2007 were included in the study. We compared estimated Kaplan-Meier survival curves using the Peto’s test. Prognostic factors were selected using Cox’s models. Results There were included 3,295 patients in the ICD group and 681 patients in the CRT-D group. Cardiac causes accounted for 79% of all deaths in both groups and Chagas’ heart disease accounted for 31% of these deaths. In the CRT-D group, survival significantly decreased around the fourth year of follow-up, with a decrease from 59.5% to 38.3% in 5.5 months. Transvenous implantation technique was used in 62% of CRT-D patients. In-hospital case-fatality rates were higher in those undergoing surgical implantation (5.3%) than those undergoing transvenous implantation (1.6%) (p = 0.02). Conclusions The results show that short-term, medium-term and long-term effectiveness of ICD therapy appears to be similar to that evidenced in clinical trials. In the CRT-D group, in-hospital case-fatality and 30-day case-fatality were higher than those reported in other studies. Surgical epicardial implantation technique was performed in this group at a higher frequency than that reported in the literature and was associated with poorer short-term prognosis.
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Affiliation(s)
- Arn Migowski
- Instituto Nacional de Cardiologia - INC (National Institute of Cardiology, Ministry of Health), Coordenação de Ensino e Pesquisa, Divisão de Saúde Coletiva, rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil.
| | - Antonio Luiz Ribeiro
- University Hospital and School of Medicine, Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil.
| | | | - Vitor Manuel Pereira Azevedo
- Instituto Nacional de Cardiologia - INC (National Institute of Cardiology, Ministry of Health), Coordenação de Ensino e Pesquisa, Divisão de Saúde Coletiva, rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil.
| | - Rogério Brant Martins Chaves
- Instituto Nacional de Cardiologia - INC (National Institute of Cardiology, Ministry of Health), Coordenação de Ensino e Pesquisa, Divisão de Saúde Coletiva, rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil.
| | | | | | - Regina Maria de Aquino Xavier
- Instituto Nacional de Cardiologia - INC (National Institute of Cardiology, Ministry of Health), Coordenação de Ensino e Pesquisa, Divisão de Saúde Coletiva, rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil.
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Fernandes PV, Castro MMD, Fuchs A, Machado MCDR, Oliveira FDD, Silva LB, Rosa LF, Azevedo VMP, Geller M, Kaufman R. Predictive Value of the Framingham Risk Score in Identifying High Cardiovascular Risk. International Journal of Cardiovascular Sciences 2015. [DOI: 10.5935/2359-4802.20150002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kaufman R, Azevedo VMP, Xavier RMDA, Geller M, Chaves RBM, Castier MB. Evolution of Heart Failure-related Hospital Admissions and Mortality Rates: a 12-Year Analysis. International Journal of Cardiovascular Sciences 2015. [DOI: 10.5935/2359-4802.20150040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pimentel ELC, Azevedo VMP, Castro RDAL, Reis LC, De Lorenzo A. Caries experience in young children with congenital heart disease in a developing country. Braz Oral Res 2013; 27:103-8. [PMID: 23538422 DOI: 10.1590/s1806-83242013000100016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 01/12/2013] [Indexed: 01/10/2023] Open
Abstract
Oral care is frequently suboptimal in children from developing countries, especially those suffering from severe systemic diseases. The aim of the present study was to analyze the oral epidemiological profile of 3-to-5-year-old children with congenital heart disease. Dental and medical records of children evaluated at the Dental Service of the National Institute of Cardiology, Rio de Janeiro, Brazil, were reviewed. Caries experience was reported using the dmft index. Negative behavior towards dental management was recorded. The sample consisted of 144 children aged 4.41 ± 0.95 years. The mean dmft value was 5.4 ± 4.9, and 80.5% had at least one caries lesion. Dmft index was greater in the presence of cyanotic cardiac disease and in children with negative behavior. An increase in the "missing" component of the dmft index was also found in children using medicine on a daily basis. A higher caries experience was associated with children whose fathers had only an elementary education. In conclusion, children with congenital heart disease had high levels of caries experience at a young age. Cyanosis, negative behavior, daily use of medicine, one-parent family and the educational level of fathers seem to influence caries experience in children with congenital cardiac disease.
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Ferreira E, Araújo DV, Azevedo VMP, Rodrigues CV, Ferreira A, Junqueira CDL, Amino JGDC, Farias ML, Farias Neto A, de Albuquerque DC. Analysis of the cost-effectiveness of drug-eluting and bare-metal stents in coronary disease. Arq Bras Cardiol 2011; 94:286-92, 306-12. [PMID: 20730255 DOI: 10.1590/s0066-782x2010000300005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 08/07/2009] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a scarcity of cost-effectiveness analyses in the national literature comparing drug-eluting stents (DES) with bare-metal stents (BMS), at late follow-up. OBJECTIVE To estimate the Incremental Cost-Effectiveness Ratio (ICER) between DES and BMS in uniarterial coronariopathy. METHODS 217 patients (130 DES and 87 BMS), with 48 months of follow-up (mean = 26 months) were assessed. PRIMARY OUTCOME cost per prevented restenosis, with effectiveness being defined as the decrease in major events. The analytical model of decision was based on the study by Polanczyk et al. The direct costs were those used directly in the interventions. RESULTS The sample was homogenous for age and sex. The DES was more used in diabetic patients: 59 (45.4%) vs 16 (18.4%)(p<0.0001) and with a history of coronary artery disease (CAD): 53 (40.7%) vs 13 (14.9%)(p<0.0001). The BMS was more used in simple lesions, but with worse ventricular function. The DES were implanted preferentially in proximal lesions: (p=0.0428) and the BMS in the mid-third (p=0.0001). Event-free survival: DES = 118 (90.8%) vs BMS=74 (85.0%) (p=0.19); Angina: DES=9 (6.9%) vs BMS=9 (10.3%) (NS): Clinical restenosis: DES=3 (2.3%) vs BMS=10 (10.3%) (p=0.0253). Cardiac deaths: 2 (1.5%) in DES and 3 (3.5%) in BMS (NS). COSTS the tree of decision was modeled based on restenosis. The net benefit for the DES needed an increment of R$7,238.16. The ICER was R$131,647.84 per prevented restenosis (above the WHO threshold). CONCLUSIONS The DES was used in more complex lesions. The clinical results were similar. The restenosis rate was higher in the BMS group. The DES was a non-cost-effective strategy.
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Migowski A, Chaves RBM, Coeli CM, Ribeiro ALP, Tura BR, Kuschnir MCC, Azevedo VMP, Floriano DB, Magalhães CAM, Pinheiro MCCM, Xavier RMDA. Acurácia do relacionamento probabilístico na avaliação da alta complexidade em cardiologia. Rev Saude Publica 2011; 45:269-75. [DOI: 10.1590/s0034-89102011005000012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 08/25/2010] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a viabilidade de estratégia de relacionamento probabilístico de bases de dados na identificação de óbitos de pacientes submetidos a procedimentos de alta complexidade em cardiologia. MÉTODOS: O custo de processamento foi estimado com base em 1.672 registros de pacientes submetidos à cirurgia de revascularização do miocárdio, relacionados com todos os registros de óbito no Brasil em 2005. A acurácia do relacionamento baseou-se em linkage probabilístico entre 99 registros de autorização de internação hospitalar de pacientes submetidos a cirurgias cardíacas em instituto de referência em cardiologia, com status vital conhecido, e todos os registros de óbito do estado do Rio de Janeiro em 2005. O linkage foi realizado em quatro etapas: padronização das bases, blocagem, pareamento e classificação dos pares. Utilizou-se a blocagem em cinco passos, com chaves de blocagem com combinação de variáveis como soundex do primeiro e último nome, sexo e ano de nascimento. As variáveis utilizadas no pareamento foram "nome completo", com a utilização da distância de Levenshtein, e "data de nascimento". RESULTADOS: O segundo e o quinto passos de blocagem tiveram os maiores números de pares formados e os maiores tempos de processamento para o pareamento. O quarto passo demandou menor custo de processamento. No estudo de acurácia, após os cinco passos de blocagem, a sensibilidade do linkage foi de 90,6% e a especificidade foi de 100%. CONCLUSÕES: A estratégia de relacionamento probabilístico utilizada apresenta boa acurácia e poderá ser utilizada em estudos sobre a efetividade dos procedimentos de alta complexidade e alto custo em cardiologia.
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Santos MA, Azevedo VMP, Cunha MOMD. [Critical left ventricular volume in aortic stenosis in first year of life: its importance in patients selection candidates to univentricular surgical correction pos-valvotomy]. Arq Bras Cardiol 2005; 85:186-90. [PMID: 16200265 DOI: 10.1590/s0066-782x2005001600007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Analysis of critical end diastolic left ventricular volume (EDLVV), defined as the lowest acceptable volume to keep cardiac output, in the selection of patients with post-valvotomy aortic stenosis, candidates to univentricular correction. METHODS A retrospective study in 21 patients with aortic stenosis, during the first year of life, and 232 patients compiled from literature. Values of end diastolic volume (EDLVV), from 20 to 60 ml/m2 were determined as normal. The EDLVV of deceased patients was compared to that from survival patients. A correlation between the age and EDLVV was carried out at the time of valvotomy, between the groups. Finally, the critical EDLVV through the theoretical relationship between the EDLVV and heart rate for different ejection fractions and designated cardiac indexes (CI): 2,000 and 2,500 20-60 ml/min/m2 was determined. RESULTS For EDLVV values < 20 ml/m2 and > 60 ml/m2, there was statistical significance between deceased and survival patients (p < 0.0001). However, in the range between 20 and 60 ml/m2, that significance was lower (p = 0.0309). A greater incidence of death took place among those who showed it in the first week of life. For a CI of 2,500 ml/min/m2 and a heart rate (HR) of 140 bpm, critical EDLVV will be 26 ml/m2 if left ventricular ejection fraction (LVEF) is 0.70, and 44.5 ml/m2, if LVFE is 0.40. CONCLUSION The analysis of critical end diastolic left ventricular volume (EDLVV) can add another parameter in the indication of univentricular correction in patients with post-valvotomy aortic stenosis, during the first year of life.
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Abstract
OBJECTIVE To identify the types of pulmonary vascular blood supply in tetralogy of Fallot with pulmonary atresia by use of hemodynamic study. METHODS Fifty-six patients with tetralogy of Fallot and pulmonary atresia, and ages ranging from 20 days to 4 years, underwent cineangiocardiographic study with contrast medium injections in the following vascular structures: 1) wedged pulmonary vein; 2) aortopulmonary collaterals; 3) thoracic aorta; and 4) ductus arteriosus or systemic-pulmonary shunt. RESULTS In the 56 patients studied, pulmonary blood was supplied as follows: in 15, by aortopulmonary collaterals; in 36, only by the ductus arteriosus; and in 5, by the ductus arteriosus and aortopulmonary collaterals. The patients were classified into 6 types depending on the type of pulmonary vascular perfusion and the presence or absence of vascular structures that compose the pulmonary circulation in tetralogy of Fallot with pulmonary atresia. CONCLUSION This type of approach enables the obtainment of information necessary for the correct clinicosurgical management of patients, due to the great complexity and extreme variability of the pulmonary blood supply in tetralogy of Fallot with pulmonary atresia.
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Santos MA, Azevedo VMP. Anomalous origin of a pulmonary artery from the ascending aorta: surgical repair resolving pulmonary arterial hypertension. Arq Bras Cardiol 2005; 83:503-7; 498-502. [PMID: 15654447 DOI: 10.1590/s0066-782x2004001800008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To emphasize the diagnostic possibility of the anomalous origin of one pulmonary artery from the ascending aorta in infants with clinically refractory heart failure and no intracardiac structural defect. METHODS Retrospective study of 4 infants with refractory heart failure undergoing 2-dimensional echocardiographic study with subcostal, suprasternal, and parasternal views, and hemodynamic and angiocardiographic study in the anteroposterior projection. RESULTS Three of the 4 infants had their right pulmonary artery originating from the ascending aorta as their major diagnosis. In the fourth patient, the left pulmonary artery originated from the ascending aorta in association with a large interventricular septal defect. The pressure level in both pulmonary arteries in all infants was that of the systemic level. All patients underwent surgery, which consisted of translocation of the anomalous pulmonary artery from the aorta. Neither immediate nor late cardiac deaths occurred. CONCLUSION Once the diagnosis of anomalous origin of the pulmonary artery from the ascending aorta in the isolated form is established, the surgical correction should be immediately performed, not only because of the risk of developing pulmonary vascular disease, but also because of the excellent surgical results currently obtained.
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MESH Headings
- Aorta/abnormalities
- Aorta/surgery
- Cardiac Output, Low/diagnosis
- Cardiac Output, Low/etiology
- Cardiac Output, Low/surgery
- Female
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/surgery
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/surgery
- Infant
- Lung Diseases, Obstructive/diagnosis
- Lung Diseases, Obstructive/surgery
- Male
- Pulmonary Artery/abnormalities
- Pulmonary Artery/surgery
- Retrospective Studies
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Abstract
OBJECTIVE To determine the morphological and functional changes in the right ventricle in pulmonary atresia with intact ventricular septum (PAIVS) for assessing the candidates for the different therapeutic procedures currently available. METHODS Thirty-one patients underwent cineangiocardiographic study with axial projections. Their ages ranged from 1 to 50 days (x = 9.6), and 28 of them were studied during the first month of life. The statistical analysis comprised the following: chi-square test, Kruskal-Wallis test for the mean and standard deviation, multiple regression, and the 95% confidence interval (95%CI) was calculated. The significance level adopted was alpha < or =0.05. RESULTS The patients were divided into 3 groups according to the angiographic morphology of the right ventricle (RV): group A -- tripartite RV (n=16); group B -- bipartite RV (n=9); and group C -- unipartite RV (n=6). The diameter of the tricuspid valve was 10.28 +/- 2.67 mm (A); 7.82 +/- 3.41 (B); and 5.27 +/- 0.57 (C) (P=0.0005). Pulmonary atresia was of the valvular type in all group A patients and of the infundibular type in all group C patients (P<0.0001). Coronary-cavitary connections were rare (2/16) in group A patients, but occurred in all group C patients (P=0.0006), with retrograde opacity of the aorta (flow from the RV to the aorta) in 2 group A patients and in all group C patients (P=0.0003). Three patients (2 in group C and 1 in group A) had right-ventricular-dependent coronary circulation. Isolated moderate/severe tricuspid regurgitation showed a tendency towards being more frequent in group A (P=0.0525). The angle of the ductus arteriosus with the descending aorta was as follows: 104.06 +/- 8.98 in group A; 79.17 +/- 33.08 in group B; and 39.0 +/- 6.52 in group C (P=0.0016). The correlation between the diameter of the tricuspid valve and the angle of the ductus arteriosus with the descending aorta was 0.6568 (P=0.0002). CONCLUSION Because of the heterogeneity of the morphology of the RV in patients with pulmonary atresia with intact ventricular septum, knowledge about all these data is required for selecting candidates for the different therapeutic procedures.
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Azevedo VMP, Albanesi Filho FM, Santos MA, Castier MB, Tura BR. Como o ecocardiograma pode ser útil em predizer a morte em crianças com cardiomiopatia dilatada idiopática? Arq Bras Cardiol 2004; 82:505-14. [PMID: 15257368 DOI: 10.1590/s0066-782x2004000600003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the echocardiographic predicting factors of death in children with idiopathic dilated cardiomyopathy. METHODS A retrospective study of 148 children with idiopathic dilated cardiomyopathy diagnosed between September 1979 and March 2003 was carried out. The inclusion criteria were as follows: heart failure and a reduction in contractility on the echocardiogram in the absence of congenital or secondary heart disease. Four hundred and seventy examinations during a period of 244.8 months of evolution were analyzed. The following parameters were assessed: left atrial dimension (LAD); left atrium/aorta ratio (LAD/Ao); left ventricular systolic (LVSD) and diastolic (LVDD) dimensions; left ventricular mass (LVmass); right ventricular dimension (RVD); left ventricular ejection fraction (LVEF); left ventricular shortening fraction (% SH); severity of the insufficiency of the atrioventricular and pulmonary valves; and right ventricular systolic (RVSP) and diastolic (RVDP) pressures. The significance level adopted was alpha < 0.05. RESULTS The mean age was 2.37 years, and 35 patients died (23.7%--95 CI = 17.1% to 31.2%). The analysis of variance showed the following: LAD (p<0.0001); LAD/Ao (p<0.0001); LVSD (p=0.0061); LVDD (p=0.0086); LVmass (p<0.0001); LVEF (p=0.0074); %SH (p=0.0072); and RVD (p<0.0001). Worsening of mitral (MI) (p=0.0113) and tricuspid (TI) insufficiencies (p=0.0044) were markers of death, and the presence of MI, TI, and moderate/severe pulmonary insufficiency were deleterious to survival. The Cox proportional hazards regression model showed the following independent predictors of death: LAD/Ao (p=0.0487); LVEF (<0.0001); and the presence of moderate/severe MI (p=0.0419). CONCLUSION Patients with a progressive increase in LAD/Ao, a reduction in LVEF, and progressive worsening of MI, regardless of the clinical treatment, should be considered for early heart transplantation.
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Abstract
OBJECTIVE To analyze our experience with percutaneous aortic balloon valvuloplasty in newborn infants with aortic stenosis, emphasizing the extraordinary importance of myocardial perfusion. METHODS Over a 10-year-period, 21 neonates underwent percutaneous aortic balloon valvuloplasty. Age ranged from 2 to 27 days, weight ranged from 2.2 to 4.1 kg and 19 were males. All patients presented with congestive heart failure that could not be treated clinically. The onset of symptoms in the first week of life occurred in 9 patients considered as having critical aortic stenosis. Severe aortic stenosis occurred in 12 patients with the onset of symptoms in the second week of life. RESULTS Mortality reached 100% in the patients with critical aortic stenosis. The procedure was considered effective in the 12 patients with severe aortic stenosis. Vascular complications included the loss of pulse in 12 patients and rupture of the femoral artery in 2 patients. Cardiac complications included acute aortic regurgitation in 2 patients and myocardial perforation in one. In an 8.2+/-1.3-year follow-up, 5 of the 12 patients died (2 patients due to septicemia and 3 patients due to congestive heart failure). Five of the other 7 patients underwent a new procedure and 2 required surgery. CONCLUSION Percutaneous aortic valvuloplasty in neonates is not an effective procedure in the 1st week of life, because at this age the common presentation is cardiogenic shock. It is possible that, in those patients with critical aortic stenosis, dilation of the aortic valve during fetal life may change the prognosis of its clinical outcome.
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