Lilian Beani

Avaliação tomográfica pulmonar tardia em prematuros com displasia broncopulmonar e persistência de canal arterial

OBJECTIVE: To assess through high-resolution computed tomography the pulmonary parenchyma of children prematurely born with both very low birth weight and patent ductus arteriosus submitted to medical or surgical treatment that developed bronchopulmonary dysplasia. METHODS: Between December 2006 and January 2007, 14 children prematurely born with a weight less than 1500g with bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) were submitted to high-resolution computed tomography (HRCT). All of them underwent surgical closure of the canal divided into two groups: A - medical (n=6) and B - surgical (n=8). The pool of patients comprised 9 baby boys and 5 girls who were 36.5±4.3 month-old. The HRCT were analyzed by two independent observers and quantified in each patient. The statistical analyses were assessed using the Mann-Whitney test, and p<0.05 was considered statistically significant. RESULTS: Three patients presented normal tomographies, being two of A group and one of B. In A, the most frequent finding was multifocal ground-glass opacity. In B, multifocal ground-glass opacity, atelectasis, and low attenuation areas with relatively decreased number and caliber of vessels were prevalent (62.5%). There was a statistically significant difference between both groups, with B having higher averages in the intubation times, use of oxygen, and admission. However, as to the number of injuries found on HRCT there was no statistically significant difference (p=0.0787). CONCLUSION: The lately use of HRCT have shown no significant difference between both medical and surgical treatment aiming at to occlude the PDA in pulmonary parenchyma injuries of premature with PDA that developed bronchopulmonary dysplasia.

Tomografia computadorizada na avaliação tardia do tratamento cirúrgico da conexão anômala total de veias pulmonares

OBJECTIVE To evaluate if the findings of multislice computed tomography (MSCT) are associated with clinical and laboratory tests routinely used in the late follow-up of children undergoing surgical treatment of total anomalous pulmonary venous connection (TAPVC). METHODS From January 2002 to December 2007, 12 patients operated due to CATVP were evaluated with history, physical examination, chest X-ray, electrocardiogram, echocardiography and MSCT. Specific changes observed in each one of these tests were identified and compared with MSCT qualitative findings. RESULTS Eleven patients were in functional class I (NYHA), three had nonspecific murmurs, and three were below the 15th percentile of weight and height. Two had pulmonary field abnormalities and three had a slight increase of the cardiac area in the X-ray examination. In the electrocardiogram, one patient had right ventricular overload and one had junctional rhythm. All echocardiograms were within the normal range, except for one patient with stenosis between the superior vena cava and right atrium. MSCT was completely normal in four patients, three had compression of the pulmonary veins and four had significant caliber reduction, which correlated with the other findings. Thus, MSCT showed a sensitivity of 87.5%, specificity of 0.75%, positive predictive value of 87.5%, negative predictive value of 75% and accuracy of 83.3% to demonstrate anatomic changes compared to changes in the physical examination or other additional tests. CONCLUSION MSTC may provide valuable information and complement the diagnosis of possible anatomical and functional changes in the late follow-up of patients undergoing surgical repair of TAPVC.

Caso 3/2007 - Coarctação de aorta: aortoplastia com interposição da artéria subclávia esquerda (Técnica de Teles Mendonça)

CLINICAL DATA The case of a 47-day-old white male weighing 3695 g is reported. The child was prescribed furosemide, digoxin and captopril and referred to our service with a diagnosis of severe congenital heart disease. Since birth, he became tired during breastfeeding that evolved with tachydyspnea leading to hospitalization in the intensive care unit with a diagnosis of bronchopneumonia requiring mechanical ventilation. He was in a moderate general state, ruddy, hydrated and intubated. His thorax was symmetrical with ictus cordis palpable at the 4th left intercostal space. His heart rhythm was regular with two normal sounds and an ejective murmur +/6+ at the left sternal edge. Pulmonary auscultation identified bilateral coarse crackles. The abdomen was rounded; the liver was 4 cm from the right costal edge and there were fluid sounds. The pulses of the lower limbs were diminished; the arterial pressures of the arms were 130 x 50 mmHg and of the legs 40 x 20 mmHg. Oximetry of the pulse of the upper limbs was 90%.

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.

The use of decellularized homograft monocuspid in the treatment of truncus arterious by Barbero Marcial technique

1. Pediatrics Cardiac Surgery Service - Hospital de Base, State MedicalSchool of Sao Jose do Rio Preto - FAMERPCorrespondence: Ulisses Alexandre CrotiHospital de Base – FAMERP – Avenida Brigadeiro Faria Lima, 5544.CEP 15090-000 – Sao Jose do Rio Preto – Sao PauloPhone (Fax): 17 – 3201-5025 / 3222-6450 / 9772-6560.E-mail address: uacroti@uol.com.br

Children's HeartLink homenageia Brasil nos Estados Unidos da América

The partnership between the American Foundation Children’s HeartLink (CHL) and the Department of Cardiology and Pediatric Cardiovascular Surgery, Hospital de Base (FUNFARME) School of Medicine Regional Sao Jose do Rio Preto (FAMERP) continues to evolve and bearing fruit [1]. In 2011, there were two visits with teams consisting of surgeons, anesthetists, physiotherapists, nurses and members of the CHL, with several operations, conduct discussions and integration of teams, directly reflected in a change of vision and local behavior. A third specific nursing and physical therapy visit also had very positive impact on our team. At each visit, integration reflects a visible growth! Alongside this integration, the service continued to advance in the share of global database based on RACHS risk score, called Quality Improvement Collaborative International Congenital Heart Surgery (IQIC team), led by Dr. Kathy Jenkins, of the Boston Children’s Hospital, Harvard Medical School [1,2]. The IQIC team has given classes monthly via the Internet to our team of Sao Jose do Rio Preto, during the years 2010 and 2011. These lessons have been translated and adapted to our reality by Professor Adilia Maria Pires Sciarra by pediatric cardiovascular surgeon Ulisses Alexandre Croti and nurse Sirley da Silva Pacheco, being given by our nurses to nursing technicians and the support staff of the Service. Dr. Kathy Jenkins signed the permission to use the copyright for teaching materials, allowing that all of these classes were used in Brazil and thus we could transmit them not only to our staff but also have them available to other centers interested (Figure 1). The foundation CHL, responsible for all this help in our environment is maintained by money from some events, donations from individuals and companies, for example, the Medtronic Foundation (http:// www.childrensheartlink.org). In this context, in 2011 we were invited to visit the Mayo Clinic Foundation, Rochester, MN, USA, under the care of Dr. Joseph A. Dearani, and the Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN, USA, with Dr. David Overman, both services entirely focused on the treatment of congenital heart disease. Those were days of much learning and opportunity to observe how these teams work, each with its own characteristics, but both with a concern that caught our attention: they wanted us to understand the importance of focusing on the patient first, as main reason for our work. They have made clear that for this to become feasible, it is first necessary human resources, highly trained people,

Aneurysm of the left atrium in a child with patent ductus arteriosus and mitral valve prolapse

CLINICAL DATA Infant 9 months, 6.5 kg, female with history of dyspnea during feeding and poor weight gain. Born at term weighing 3.2 kg. In the first month, was diagnosed with congenital heart disease with increased pulmonary hemodynamic, being the child sent from her hometown for surgical treatment. Physical examination showed malnutrition with weight below the percentile 3 for age, tachydyspneic, acyanotic and pale. Hyperdynamic precordium with apical impulse deviated to the left and chest bulging to the left. Continuous murmur 3 + / 6 +, with multiple clicks in the left infraclavicular region. Liver 3 cm from the right costal margin. Large and palpable peripheral pulses in all four limbs.

Ampliação da neopulmonar tardiamente à operação de Jatene

Article received on August 9th, 2010 Article accepted on September 5th, 2010 CLINICAL DATA 7-year-old female child, 19 kg, height of 116 cm and asymptomatic. Full-term baby with a diagnosis of transposition of the great arteries underwent Jatene’s operation with Lecompte maneuver, at the first week of life. In the immediate postoperative period, presented endocarditis due to Candida glabrata, which was treated medically. In outpatient treatment it was noted an increase in gradient between the right ventricle and neopulmonary in routine echocardiographic examinations. With 7 years of evolution, further surgery was indicated, although the patient did not use drugs. The physical examination was completely normal except for a systolic ejection murmur at the left sternal border of +4 / 6+.

Enlargement of the neopulmonary after Jatene's operation

Article received on August 9th, 2010 Article accepted on September 5th, 2010 CLINICAL DATA 7-year-old female child, 19 kg, height of 116 cm and asymptomatic. Full-term baby with a diagnosis of transposition of the great arteries underwent Jatene’s operation with Lecompte maneuver, at the first week of life. In the immediate postoperative period, presented endocarditis due to Candida glabrata, which was treated medically. In outpatient treatment it was noted an increase in gradient between the right ventricle and neopulmonary in routine echocardiographic examinations. With 7 years of evolution, further surgery was indicated, although the patient did not use drugs. The physical examination was completely normal except for a systolic ejection murmur at the left sternal border of +4 / 6+.

Case 1/2007: juxtaposition of atrial appendix at left side on great arteries transposition

DADOS CLÍNICOS Criança de 7 anos, sexo feminino, negra, procedente de Alagoas. Desde o nascimento sabidamente com cardiopatia cianogênica, porém sem tratamento cirúrgico ou farmacológico prévio. Encaminhada ao nosso Serviço para conduta, apresentava-se com cianose importante em repouso, dificuldade de caminhar e dispnéia aos mínimos esforços. REG, corada, hidratada, eupneica, cianótica 3+/4. Tórax com deformidade, impulsão sistólica de ventrículo direito, ritmo cardíaco regular em dois tempos, segunda bulha única e hiperfonética em bordo esternal esquerdo médio, com sopro sistólico ejetivo +3/6+ em bordo esternal esquerdo médio alto. Ausculta pulmonar normal. Abdome normal. Pressões arteriais e pulsos normais nos quatro membros, estes com baqueteamento digital. Saturação periférica de 62%.