Sírio Hassem Sobrinho

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.

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.

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.

Cardioversor desfibrilador implantável em criança com miocárdio não-compactado isolado

CLINICAL DATA9-year-old male child, 25 kg, from Barretos, Sao Paulo.Full-term patient presenting cardiorespiratory arrest (CRA)without defined cause and remained for 30 days in IntensiveCare Unit (ICU). At 11 months presented episode of fainting,followed by cyanosis and CRA. He had undergonecardioversion due to ventricular fibrillation (sic). At thetime, corticoid and digitalis were used, and the patientevolved well until the last two months, when presentednew fainting episode at rest, requiring cardiac massage andnew cardioversion to revert this presentation. Amiodarone,spironolactone, aspirin and suspension of digitalis wereadministered. After about 10 episodes of syncope andfainting, the child was referred to the ICU of our Service.On physical examination the patient was in good generalcondition, afebrile, acyanotic and eupneic. Precordiumunchanged, regular heart rhythm, with normal and rhythmicsounds. Pulmonary auscultation was normal. Flaccidabdomen, liver at 2 cm from the right costal margin, spleennot palpable and presence of bowel sounds. Goodperipheral perfusion, without edema, palpable andsymmetrical pulses in all limbs, without motor sequels withonly mild mental retardation, resulting from the CRA at thetime of parturition (sic).ELECTROCARDIOGRAMSinus rhythm, heart beat of 88 bpm, SÂP 0°, SÂQRS -30°, PR interval 0.24s. First-degree AV block, atrial and leftventricular overload, and left branch block.RADIOGRAMVisceral

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.

Ambulatory treatment of streptococcal bacterial endocarditis

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.

Tratamiento clínico de la endocarditis 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.

Surgical repair of rheumatic mitral valve disease with Gregori-Braile's Ring

1. Servico de Cirurgia Cardiovascular Pediatrica de Sao Jose do RioPreto – Hospital de Base – Faculdade de Medicina de Sao Jose doRio Preto, SP, Brasil.Endereco para correspondencia: Ulisses Alexandre CrotiHospital de Base – FAMERP – Avenida Brigadeiro Faria Lima, 5544.CEP 15090-000 – Sao Jose do Rio Preto – SP - BrasilFone (Fax): 17 – 3201-5025 / 3222-6450E-mail: uacroti@uol.com.br