Carlos Henrique De Marchi

Atrioventricular septal defect with intact septal structures presenting as left atrioventricular valvar insufficiency

We describe the findings in a six-year-old girl who presented with signs of left atrioventricular valvar insufficiency. The echocardiogram showed a common atrioventricular junction, intact atrial and ventricular septal structures. At surgery, the left-sided atrioventricular valve was found to be tri-foliate, and corrected by valvoplasty. To the best of our knowledge, this is the first case of atrioventricular septal defect with common atrioventricular junction and intact septal structures diagnosed during life.

Should the Bidirectional Glenn Operation be performed with or without cardiopulmonary bypass

OBJECTIVE: To compare patients who underwent the Bidirectional Glenn Operation with and without cardiopulmonary bypass (CPB), analyzing the characteristics and confirming if there is superiority of either of the employed techniques. METHOD: Between January 2002 and January 2004, 16 patients with complex heart defects were submitted to this operative technique. The mean age of the patients was 19 months and 14 were female. The patients were divided into two groups: Group A with seven patients (using CPB) and group B with 9 patients (without the use of CPB). Gender, age, mean pulmonary artery pressure (MPAP), CPB time, aortic clamping time, venoatrial shunt, previous operations, time in intensive care unit (ICU), total hospitalization time and immediate complications were all compared between the two groups. RESULTS: The median MPAP was 13 mmHg. In group A the CPB time was 91 ± 47 minutes (57-195 minutes), myocardial ischemia was 25 ± 33 minutes (0-80 minutes). Of these four patients required intracardiac procedures or enlargement of the pulmonary branches and in three, CPB assistance as ventilatory support was needed. In group B the venoatrial shunt was 21 ± 10 minutes (0-39 minutes). The time to extubation was 9 ± 13 hours with a median of 3 hours (1-43 hours). The ICU stay was 8 ± 12 days with a median of 5 days (1-50 days). Hospitalization was 12 ± 12 days with a median of 7 days (0-50 days). Five patients had been submitted to surgeries previously. Two, one patient from each group, died (12.5%). No neurological complications, pleural or pericardial effusions were observed. No significant differences were evidenced between the two groups in respect to all the variables studied. CONCLUSION: In spite of the relatively small cohort, this study suggests that the bidirectional Glenn operation can be performed with or without CPB giving similar results in respect to morbidity and mortality. Thus, the operation without CPB can be safely employed when the anatomic findings are appropriate and there is no severe hypoxia.

Monitoração ecocardiográfica da atriosseptostomia com balão

OBJECTIVEnTo assess balloon atrial septostomy monitored with echocardiography.nnnMETHODSnFrom August 1997 to January 2004, 31 infants with congenital heart diseases indicated for balloon atrial septostomy underwent the procedure with exclusive echocardiographic monitoring. Success was defined as the obtainment of an atrial septal defect diameter > 4 mm and ample mobility of its margins.nnnRESULTSnThe male sex predominated (83.9%). The median age was 5 days (1-150), and the median weight was 3,300 g (1,800-7,500). Transposition of the great arteries occurred in 80.6% of the patients, tricuspid valve atresia in 12.9%, total anomalous pulmonary venous drainage in 3.2%, and pulmonary atresia with intact septum in 3.2%. The procedure was successful in all patients. The size of the atrial septal defect increased from 1.8 +/- 0.8 mm to 5.8 +/- 1.3 mm (P < 0.0001) and oxygen arterial saturation from 64.5 +/- 18.9% to 85.1 +/- 9.2% (P < 0.0001). The following complications occurred: 3 balloon ruptures, one lesion of the right femoral vein, one supraventricular tachycardia, and one atrial flutter.nnnCONCLUSIONnBalloon atrial septostomy monitored with echocardiography is a safe and effective procedure. It may be performed at bedside, avoiding transporting of the patient, identifies the catheter location, reduces the occurrence of severe complications, and assesses the immediate result of the procedure.

Double Aortic Arch Associated with Pulmonary Atresia with Ventricular Septal Defect

week, second day of life, 2.7 kg, male, referred to our service after presenting respiratory distress associated with cyanosis. Upon physical examination presented at a regular general condition, eupneic in use of an oxygen mask with saturation around 97%. Presence of systolic murmur 4+/6+ predominantly at the lower left sternal border. Clear lung sounds. No abdomen findings. Present and symmetrical peripheral pulses.

Evolution of weight and height of children with congenital heart disease undergoing surgical treatment

Objective To evaluate the height and weight development of children with congenital heart disease undergoing surgery with the goal of determining when they reach the threshold of normal development and whether there are differences between patients with developmental pattern below the level of normality preoperatively (z-score<-2 for the analyzed parameter) in comparison to the total group of cardiac patients. Methods We prospectively followed up 27 children undergoing operation into five time periods: preoperatively and at four subsequent outpatient appointments: 1st month, 3rd month, 6th month and 12th month after hospital discharge. The anthropometric parameters used were median z-score (MZ), weight (WAZ), height (HAZ), subscapular skinfold (SSFAZ), upper arm circumference (UAC) and triceps skinfold (TSFAZ). The evolution assessment of the parameters was performed by analysis of variance and comparison with the general normal population from unpaired t test, both in the total group of cardiac patients, and in subgroups with preoperative parameters below the normal level (Zm<-2). Results In the total group there was no significant evolution of MZ of all parameters. WAZ was statistically lower than the normal population until the 1st month of follow-up (P=0.028); HAZ only preoperatively (P=0.044), SSFAZ in the first month (P=0.015) and at 12th month (P=0.038), UAC and TSFAZ were always statistically equal to the general population. In patients whose development was below the level of normality, there were important variation of WAZ (P=0.002), HAZ (P=0.001) and UAC (P=0.031) after the operation, and the WAZ was lower than the normal population until the 3rd month (P=0.015); HAZ and UAC, until the first month (P=0.024 and P=0.039 respectively), SSFAZ, up to the 12th month (P=0.005), the TSFAZ only preoperatively (P=0.011). Conclusion The operation promoted the return to normalcy for those with heart disease in general within up to three months, but for the group of patients below normal developmental pattern of the return occurred within 12 months.

Surgical correction of the anomalous origin of right pulmonary artery of aorta

Artigo recebido em 5 de agosto de 2010 Artigo aprovado em 9 de setembro de 2010 CARACTERIZAÇÃO DO PACIENTE Criança com 20 dias, 2,9 kg, sexo feminino, com dispneia em repouso desde o nascimento. O eletrocardiograma indicava importante sobrecarga ventricular direita, a radiografia de tórax, aumento de área cardíaca, e o ecocardiograma definiu o diagnóstico de artéria pulmonar direita (APD) com origem na face lateral esquerda da aorta ascendente a 5,8 mm do plano valvar aórtico, com a origem medindo 5mm e a porção distal, 7 mm. Havia também uma comunicação interatrial ostium secundum de 1,8 mm, insuficiência valvar tricúspide moderada e hipertensão arterial pulmonar importante. A tomografia computadorizada de múltiplos detectores confirmou os achados do ecocardiograma. A correção cirúrgica consistiu na secção total da aorta ascendente, restando um flap de tecido desta para anastomose direta da origem da APD na parede lateral direita do tronco pulmonar. A aorta foi reconstruída com anastomose direta entre as porções proximal e distal. Todas as anastomoses foram realizadas com fios de polidioxanona, com intuito de permitir o crescimento dos tecidos. O tempo de circulação extracorpórea (CEC) foi de 90 minutos e de isquemia miocárdica, 27 minutos, à temperatura mínima de 26oC [1].

Tratamento ambulatorial da endocardite bacteriana estreptocócica

Bacterial endocarditis is a severe infectious disease. of which treatment is traditionally carried out in hospitalized patients through intravenous medication. The possibility of at-home or ambulatory treatment. for stringently selected cases. is attractive from the social as well as from the economic point of view. We report 6 patients with a diagnosis of bacterial endocarditis caused by Streptococcus. treated partially or completely on an outpatient basis. All of them evolved without complications and presented complete resolution of the infection.Bacterial endocarditis is a severe infectious disease. of which treatment is traditionally carried out in hospitalized patients through intravenous medication. The possibility of at-home or ambulatory treatment. for stringently selected cases. is attractive from the social as well as from the economic point of view. We report 6 patients with a diagnosis of bacterial endocarditis caused by Streptococcus. treated partially or completely on an outpatient basis. All of them evolved without complications and presented complete resolution of the infection.

Atrioventricular septal defect with tetralogy of Fallot in patient with Down's syndrome

CLINICAL DATAFemale infant; born on term with 2.6 kg, normal delivery.Mother; fourth pregnancy, denied the use of medicationduring pregnancy. Presented respiratory discomfort at birth,evolving with neonatal infection and use of antibiotictherapy for 29 days.At two months, she was referred to our Service forevaluation with use of digoxin, furosemide and captopril.After confirming the diagnostic, the therapy with betablocking agents was started with scheduled clinical follow-ups every three months, due to the absence of cardiac failure.At two years-old, there was an aggravation of thesymptoms and hypoxemic crisis, resulting in the child’sreferral to surgical treatment.The physical examination presented satisfactory generalconditions, cyanotic ++/4+, normotensive and withadequate weight and growth. The normal positioned

Case 8/2007: partial anomalous pulmonary venous connection into the right atrium with absence of interatrial communication

Correspondence address: Ulisses Alexandre Croti Hospital de Base – FAMERP – Avenida Brigadeiro Faria Lima, 5544. CEP 15090-000 – Sao Jose do Rio Preto – SP Fone (Fax): 17 3201 5025 / 3222 6450 / 9772 6560 E-mail address: uacroti@uol.com.br Ulisses Alexandre CROTI1, Domingo Marcolino BRAILE1, Sirio HASSEM SOBRINHO1, Carlos Henrique DE MARCHI1 Rev Bras Cir Cardiovasc 2007; 22(4): 513-514 CLINICAL SURGICAL CORRELATION

Disfunção sinusal em paciente com isomerismo atrial esquerdo

We report the case of an asymptomatic six-year-old child with left atrial isomerism and sinus venosus atrial septal defect. The physical examination revealed several periods of bradycardia. During a 24-hour electrocardiographic monitoring the patient presented a significant sinus node dysfunction with sinus pauses of up to 2.4 seconds. A permanent pacemaker was implanted, with a satisfactory outcome.