RESUMO
La coartación de aorta (CoAo) es una cardiopatía congénita caracterizada por un estrechamiento de la aorta descendente distal al origen de la arteria subclavia izquierda, lo que determina una obstrucción al flujo sanguíneo. Es imperativo realizar un diagnóstico precoz y tratamiento oportuno para evitar complicaciones y la muerte en algunos casos. Se describen las características clínicas y anatómicas, así como el tratamiento y la evolución en niños menores de 15 años asistidos en un hospital pediátrico de referencia de Uruguay.
Coarctation of the aorta (CoAo) is a congenital heart disease characterized by a narrowing of the descending aorta distal to the origin of the left subclavian artery, which determines an obstruction to blood flow. It is imperative to make an early diagnosis and timely treatment to avoid complications and death in some cases. The clinical and anatomical characteristics are described, as well as the treatment and evolution in children under 15 years of age attended in a reference pediatric hospital in Uruguay.
A coarctação da aorta (CoAo) é uma doença cardíaca congênita caracterizada por estreitamento da aorta descendente distal à origem da artéria subclávia esquerda, o que determina uma obstrução ao fluxo sanguíneo. É imperativo fazer um diagnóstico precoce e tratamento oportuno para evitar complicações e morte em alguns casos. São descritas as características clínicas e anatômicas, bem como o tratamento e a evolução em crianças menores de 15 anos atendidas em um hospital pediátrico de referência no Uruguai.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Coartação Aórtica/diagnóstico , Coartação Aórtica/cirurgia , Coartação Aórtica/mortalidade , Estudos Retrospectivos , Distribuição por Idade e SexoRESUMO
BACKGROUND: Left-sided cardiac obstructions represent 15% of congenital heart disease (CHD). The treatment in adults is surgical; however, balloon dilation by interventional catheterization can alleviate the symptoms in pediatric patients to allow them to reach the target height. The aim was to determine the survival and the factors associated with reintervention in patients with CHD with left-sided obstruction treated with balloon angioplasty. METHODS: A cohort study was conducted in patients aged 4 to 17 years with left-sided heart obstruction (valvular stenosis [VS], supravalvular aortic stenosis [SAS], coarctation of the aorta [CA]) successfully treated with balloon angioplasty. The follow-up was of 10 years and the outcome variable was the restenosis with reintervention criteria. Pediatric stage at the time of the procedure, nutritional status, residual gradient, and presence of genetic syndromes were considered prognostic variables. For statistical analysis, measures of central tendency and dispersion were used. Chi squared was employed in qualitative variables and Kruskal-Wallis in quantitative variables. RESULTS: We had a total of 110 patients: 40% had CA, 35% VS, and 25% SAS. 39% required reintervention: 80% in SAS, 35% in CA, and 14% in VS. CONCLUSION: The intervention balloon is a stopgap measure that allows patients with left-sided obstructions to reach the target height.
Introducción: las obstrucciones izquierdas representan 15% de las cardiopatías congénitas (CC). El tratamiento en la edad adulta es quirúrgico; no obstante, la dilatación con balón puede paliar los síntomas en edad pediátrica para permitir que alcancen la talla diana. El objetivo fue determinar la sobrevida y los factores asociados a la reintervención en enfermos con CC con obstrucción izquierda tratados con plastía con balón. Métodos: se realizó un estudio de cohorte en pacientes entre 4 y 17 años con cardiopatías de obstrucción izquierda (estenosis valvular, supravalvular y coartación aórtica) tratados con angioplastía con balón exitosa. El seguimiento fue de 10 años y la variable de desenlace fue la reestenosis con criterios para reintervención. Se consideraron variables pronósticas la etapa pediátrica al momento del procedimiento, el estado nutricional, el gradiente residual y la presencia de síndromes genéticos. Se usaron medidas de tendencia central y dispersión. Se usó chi cuadrada en variables cualitativas y Kruskal-Wallis en variables cuantitativas. Resultados: fueron 110 pacientes; 40% presentó coartación aórtica, 35% estenosis valvular y 25% estenosis supravalvular aórtica. El 39% requirió reintervención y la frecuencia fue la siguiente: 80% en estenosis supravalvular, 35% en coartación aórtica y 14% en estenosis valvular aórtica. Conclusión: la intervención con balón es una medida paliativa que permite a los enfermos con obstrucciones izquierdas alcanzar la talla diana.
Assuntos
Angioplastia com Balão , Coartação Aórtica/terapia , Estenose da Valva Aórtica/terapia , Adolescente , Coartação Aórtica/mortalidade , Estenose Aórtica Supravalvular/congênito , Estenose Aórtica Supravalvular/mortalidade , Estenose Aórtica Supravalvular/terapia , Estenose da Valva Aórtica/congênito , Estenose da Valva Aórtica/mortalidade , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Recidiva , Resultado do TratamentoRESUMO
O precondicionamento isquêmico é o mais poderoso método experimental de proteção celular e pode ser aplicado em cirurgias que ocasionem isquemia tecidual como na correção de coarctação da aorta. Objetivo: Avaliar os resultados clínicos, inflamatórios e infecciosos de crianças submetidas à cirurgia de coarctação da aorta com ou sem uso de precondicionamento isquêmico por pinçamento da aorta torácica. Como desfechos primários foram avaliados os Eventos Adversos Principais (EAP) e o óbito em até 30 dias. Método: Foram analisados retrospectivamente os dados clínicos de 104 pacientes submetidos consecutivamente a cirurgia de coarctação da aorta entre dezembro de 2007 e dezembro de 2012 no Instituto Nacional de Cardiologia, Centro Pediátrico da Lagoa e Hospital Prontobaby na cidade do Rio de Janeiro. Foram constituídos dois grupos, G PRE: 27 pacientes submetidos ao precondicionamento e G CONT: 77 pacientes de controle. Resultados: Houve predomínio do sexo masculino, 62,5 por cento, a média de peso foi de 4,04±3,07 kg e 11,53 por cento tinham peso < 2,5kg. A média de idade foi de 3,82±2, com mediana de 1,04 meses. A cirurgia foi realizada em caráter de emergência em 81,48 por cento no G PRE (p<0,001) e o Basic e o Comprehensive Aristotle Score foram maiores no G CONT (p<0,001). A bandagem da artéria pulmonar foi realizada em 37,9 por cento do G PRE contra 9,09 por cento do G CONT e 81,48 por cento do G PRE tiveram anastomose estendida no arco aórtico (p<0,001). As complicações aconteceram em 66,23 por cento no G CONT e em 22,22% no G PRE (p<0,001)...
Ischemic preconditioning is the most powerful experimental method for cellprotection and can be applied in surgeries which result in tissue ischemia as correction ofcoarctation of the aorta.Objective: To evaluate the clinical, inflammatory and infectious in children undergoingsurgery for aortic coarctation with and without ischemic preconditioning. As primaryoutcomes will be Major Adverse Events (MAE) and death within 30 days.Methods: We retrospectively evaluated the clinical data of 104 consecutive patientsundergoing surgery for aortic coarctation between December 2007 and December 2012 at theInstituto Nacional de Cardiologia, Centro Pediátrico da Lagoa e Hospital Prontobaby in thecity of Rio de Janeiro. Two groups were composed, G PRE: 27 patients underwentpreconditioning and G CONT: 77 control patients.Results: Male gender were 62.5 percent, the mean weight was 4.04±3.07 kg and 11.53 percent hadweight <2.5 kg. The mean age was 3.82 ± 2.05 with a median of 1.04 months. The G PREhad 81.48% of emergency surgeries (p <0.001) and Basic and Comprehensive Aristotle scorewere higher in G PRE (p <0.001). Pulmonary artery banding was performed in 37.9 percent of GPRE and in 9.09 percent of G CONT and 81.48 percent of G PRE had extended aortic arch anastomosis(p <0.001)...
Assuntos
Pré-Escolar , Anormalidades Congênitas , Coartação Aórtica/mortalidade , Doenças Cardiovasculares/cirurgia , Precondicionamento Isquêmico , Anestesia Balanceada/métodos , ToracotomiaRESUMO
OBJECTIVES: Evaluate long-term evolution of patients submitted to surgery for coarctation of the aorta. Compare event free survival in younger vs older patients at the time of surgical correction. METHODS: We reviewed the clinical records of patients operated for coarctation of the aorta from January 1 1980 to December 31 1994. The mean follow-up ranged from 9 to 23 years (mean 10.9 y). Final events registered were recoarctation, death, systemic hypertension, endocarditis, stroke, aneurisms. RESULTS: Two hundred and sixteen patients were found with mean age 13 +/- 12 y male gender was most frequent (61%). Recoarctation was found in 13 patients (6.02%), persistent hypertension in 14.1%. Event free survival at 10 years was 86.2%. In patients less than 10 y was 89% vs 80.2% in older patients. Hypertension free survival in patients less than 10 y was 98.3% vs 80.1% in older patients (p < 0.001). CONCLUSIONS: Our data confirms that surgical treatment for coarctation of the aorta is associated with low morbidity and mortality at long-term with reduced rate of recoarctation (7%). Early correction (< 10 y) is associated with a better long term survival. Hypertension and use of pharmacologic treatment are reduced after surgery and persist in the long-term evolution.
Assuntos
Coartação Aórtica/cirurgia , Adolescente , Adulto , Coartação Aórtica/mortalidade , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de TempoRESUMO
OBJECTIVES: Evaluate long-term evolution of patients submitted to surgery for coarctation of the aorta. Compare event free survival in younger vs older patients at the time of surgical correction. METHODS: We reviewed the clinical records of patients operated for coarctation of the aorta from January 1 1980 to December 31 1994. The mean follow-up ranged from 9 to 23 years (mean 10.9 y). Final events registered were recoarctation, death, systemic hypertension, endocarditis, stroke, aneurisms. RESULTS: Two hundred and sixteen patients were found with mean age 13 +/- 12 y male gender was most frequent (61%). Recoarctation was found in 13 patients (6.02%), persistent hypertension in 14.1%. Event free survival at 10 years was 86.2%. In patients less than 10 y was 89% vs 80.2% in older patients. Hypertension free survival in patients less than 10 y was 98.3% vs 80.1% in older patients (p < 0.001). CONCLUSIONS: Our data confirms that surgical treatment for coarctation of the aorta is associated with low morbidity and mortality at long-term with reduced rate of recoarctation (7%). Early correction (< 10 y) is associated with a better long term survival. Hypertension and use of pharmacologic treatment are reduced after surgery and persist in the long-term evolution.
Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Coartação Aórtica , Coartação Aórtica/mortalidade , Seguimentos , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de TempoRESUMO
BACKGROUND: The left ventricular outflow tract (LVOT) malformations aortic valve stenosis (AVS), coarctation of the aorta (CoA), and hypoplastic left heart syndrome (HLHS) contribute significantly to infant mortality due to birth defects. Previous epidemiology data showed rate differences between male and female and white and black ethnic groups. The Texas Birth Defects Registry, an active surveillance program, enables study in a large, diverse population including Hispanics. METHODS: Records of children up to 1 year old with AVS, CoA, and HLHS born in Texas from 1999 to 2001, were collected from the registry. Those including additional heart defects or a chromosomal anomaly were excluded. Multivariate analysis included: infant sex; United States-Mexico border county residence; and maternal age, race/ethnicity, birthplace, and education. RESULTS: There were 910 cases among 1.08 million live births, of which 499 met inclusion criteria. Multivariate modeling of all LVOT malformations combined demonstrated lower prevalence rate ratios (PRRs) for black males (0.26) and Hispanic males (0.70). Similar results were found for CoA but not AVS or HLHS. Higher PRRs were noted for increased maternal age for LVOT (1.3 for 24-34 years; 1.7 for >34 years), AVS, and HLHS, but not CoA, and higher PRRs across all diagnoses for males (LVOT PRR, 2.4) were noted. CoA PRRs were higher in border county vs. non-border county residents (PRR, 2.1). Maternal education and birthplace were not significant factors. CONCLUSIONS: There are rate differences for males among all 3 ethnic groups. Sex and ethnic differences suggest genetic etiologies, where the ethnic differences could be used to find susceptibility loci with mapping by admixture linkage disequilibrium. Increased CoA rates along the U.S.-Mexico border suggest environmental causes that will require further monitoring.
Assuntos
Coartação Aórtica/epidemiologia , Estenose da Valva Aórtica/epidemiologia , Síndrome do Coração Esquerdo Hipoplásico/epidemiologia , Coartação Aórtica/etnologia , Coartação Aórtica/mortalidade , Estenose da Valva Aórtica/etnologia , Estenose da Valva Aórtica/mortalidade , Feminino , Humanos , Síndrome do Coração Esquerdo Hipoplásico/etnologia , Síndrome do Coração Esquerdo Hipoplásico/mortalidade , Lactente , Recém-Nascido , Masculino , Idade Materna , México , Análise Multivariada , Gravidez , Prevalência , Grupos Raciais , Fatores Sexuais , Texas , Obstrução do Fluxo Ventricular Externo/congênito , Obstrução do Fluxo Ventricular Externo/epidemiologiaRESUMO
OBJECTIVE: A review of experience with techniques of correction used, in the last 20 years, in children younger than one year old. METHODS: In the period from 1978 to 1998, 148 patients (pt) with coarctation of the aorta (CoAo), under one year of age, with or without associated intracardiac defects, were submitted to surgery. Median age 50 days, 92 female pt (62.1%). The average weight was 4,367 +/- 1,897 gr. The average follow-up was 1,152 +/- 1,462 days. The population was divided in 3 groups: Group I, isolated CoAo: 74 pt (50%); Group II, CoAo and interventricular communication (IVC): 41 pt (27.7%) and Group III, CoAo with complex intracardiac malformations: 33 pt (22.3%). RESULTS: The total mortality was of 43 patients (29%). In patients younger than 30 days, the mortality was 53%, p=0.009, DR=4.5, between 31 and 90 days, 14.7%, p=0.69, and over 91 days, 15%, p=0.004. The probability of actuarial survival of the whole population was 67% at 5 and 10 years. Thirty-six patients (24.3%) had recoarctation, from which 18 patients (50%) were younger than 30 days, DR=6.35. The incidence of recoarctation was with Waldhausen technique in 4 patients (10%) and with the classic termino-terminal technique in 19 patients (26%) p=0.03, and isthmusplastic operation in 6 patients (37.5%). The patients younger than 30 days showed a relative risk for recoarctation de DR=6.35. The probability of actuarial survival, free of coarctation repair, at 5 and 10 years was of 69% with Waldhausen's technique and 63% with the classic termino-terminal technique. CONCLUSION: Patients younger than 30 days showed increased mortality and recoarctation risk. Waldhausen's technique in patients older than 30 days showed effective. The classic termino-terminal technique did not show to be a good option in all age ranges, being imperative to carry out more radical technical variations, such as the extended termino-terminal.
Assuntos
Coartação Aórtica/mortalidade , Coartação Aórtica/cirurgia , Brasil/epidemiologia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias , Taxa de Sobrevida , Resultado do TratamentoRESUMO
OBJETIVO: Revisão da experiência com diversas técnicas de correcão empregadas, nos últimos 20 anos, em criancas menores de um ano de idade. MÉTODOS: No período de 1978 a 1998, foram operados 148 pacientes (pc) consecutivos com coartacão de aorta (CoAo) com até um ano de idade, com ou sem defeitos intracardíacos associados. A idade apresentou mediana de 50 dias, 92 pc do sexo feminino (62,1 por cento). O peso foi de 4.367n1.897 gramas. O seguimento foi em média de 1.152n1.462 dias. A populacão foi dividida em 3 grupos: Grupo I, CoAo isolada: 74 pc (50 por cento); Grupo II, CoAo e comunicacão interventricular (CIV): 41 pacientes (27,7 por cento) e Grupo III, CoAo com malformacões complexas: 33 pc (22,3 por cento). RESULTADOS: Mortalidade total foi 43 pc (29 por cento): com menos de 30 dias, foi 53 por cento, p=0,009, OR=4,5, entre 31 e 90 dias, foi 14,7 por cento, p=0,69, e acima de 91 dias, 15 por cento, p=0,004. A probabilidade de sobrevida atuarial de toda a populacão foi de 67 por cento aos 5 e 10 anos. Trinta e seis pacientes (24,3 por cento) recoartaram, dos quais 18 pacientes (50 por cento) tinham menos de 30 dias, OR=6,35. A incidência de recoartacão foi com a técnica de Waldhausen em 4 pacientes (10 por cento) e com a término-terminal clássica em 19 pacientes (26 por cento) p=0.03, e a istmoplastia em 6 pacientes (37,5 por cento). A probabilidade de sobrevida atuarial livre de recoartacão aos 5 e 10 anos foi de 69 por cento com a técnica de Waldhausen e 63 por cento com a técnica término-terminal clássica. CONCLUSAO: Pacientes com menos de 30 dias apresentaram risco aumentado de mortalidade e recoartacão. A técnica de Waldhausen em pacientes com mais de 30 dias mostrou-se efetiva. A técnica término-terminal clássica mostrou não ser uma boa opcão em todas as faixas etárias, sendo imperativo executar variantes técnicas como término-terminal estendida.