The benefits of intraoperative transesophageal echocardiography (TEE) during cardiac surgery are well documented. Intraoperative TEE accurately confirms and in many cases refines delineation of congenital heart lesions, can be used as a means for establishing an intraoperative technical surgical score, and offers a low incidence of intraoperative complications. It seemed likely that the rate of perioperative complications in children would be congruent with the current available data in adults. After Institutional Review Board approval, a retrospective chart review of patients at Boston Children's Hospital who underwent the TEE procedure between May 2012 and December 2014 was conducted. The final study sample consisted of 129 patient charts. Adverse events related to TEE were documented and defined as follows: 1) those potentially attributable to TEE and 2) those with a high likelihood of being related to TEE; defined as dysphagia, esophageal perforation, gastrointestinal bleeding, and throat discomfort/pain. Of the 129 total cases, there was only one case reporting an intraoperative adverse event with a high likelihood of being related to TEE. This incidence rate of 0.77% is consistent with the literature existing on adult and pediatric TEE safety studies. Literature on postoperative adverse events related to intraoperative TEE use in pediatric patients was limited to the incidence of dysphagia. The sample included no incidence of dysphagia and the review enumerated six postoperative adverse events (4.65%) of which had a high likelihood of being related to TEE. Three of these events were classified as major and three were classified as minor. Major postoperative events included blood draining from nasogastric/orogastric tubes and blood tinged secretions suctioned from the endotracheal tube. Minor events were patient reported as sore throat and voice hoarseness. It was concluded that TEE use is not associated with an increased risk of adverse events in pediatric patients if performed according to institutional procedure and recommendations. Intraoperative TEE offers immediate assessment of the adequacy of surgical repair and presence of residual lesions. This information can be used to generate a surgical technical performance score. The ability to detect and correct residual lesions with information provided by intraoperative TEE allows the surgeon to improve technical performance thereby reducing postoperative morbidity.

We report our experience with asymptomatic valvar aortic stenosis diagnosed during infancy. During the period between November 1, 1986 and October 31, 1992 a total of 13 infants were diagnosed with asymptomatic aortic stenosis, 5 of whom showed rapid progression over the first 2 years of life. Two of these asymptomatic infants had severe aortic stenosis by 2 months of age, requiring intervention. We agree that aortic stenosis is a progressive lesion even in mild cases, but we emphasize the need for close clinical and echocardiographic follow-up of these asymptomatic children during infancy to prevent congestive heart failure and sudden death.

Orientador: Regina Kiomi Takahira / Resumo: A miocardiopatia hipertrófica é a doença cardíaca mais observada em gatos da raça Maine Coon e está diretamente relacionada à presença de uma mutação (A31P) que ocorre no gene da proteína C miosina ligante (MYBPC3). A doença pode provocar em determinados pacientes quadros secundários graves como o tromboembolismo arterial (TEA). O objetivo do presente trabalho foi avaliar gatos da raça Maine Coon não portadores da mutação A31P no gene MYBPC3 (G1) e portadores da mutação A31P no gene MYBPC3 (G2), por meio do perfil tromboelastométrico. Foram selecionados no estudo 15 gatos pertencentes ao grupo G1 e 15 gatos G2, previamente avaliados para A31P-MYBPC3, tendo como critério de inclusão a presença ou não da mutação e higidez clínica e laboratorial para hemograma e provas de bioquímicas séricas. A coleta das amostras ocorreu em momento único após avaliação ecocardiográfica. A análise estatística foi realizada por meio de análise descritiva dos dados seguida da comparação dos grupos ao nível de 5 % de significância. No presente estudo o perfil pela tromboelastometria (TEM) não identificou diferenças quando comparados os grupos G1 e G2, portanto os animais não demonstraram variações de coagulabilidade. A concentração sérica de albumina foi significativamente menor no G2, mas se manteve dentro dos intervalos de referência para a espécie. No ecocardiograma foi observada alteração no volume diastólico final no G2, indicando a presença de possível disfunção diastólica. O G2 também aprese... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Hypertrophic cardiomyopathy is the most observed heart disease in Maine Coon cats and is directly related to the presence of a mutation (A31P) occurring in the myosin binding protein C (MYBPC3) gene. The disease can cause serious side effects such as arterial thromboembolism (ATE) in certain patients. The objective of the present study was to evaluate the thromboelastometric profile in cats Maine Coon breed without mutation A31P on MYBPC3 gene (G1) and mutation carrier (G2). Thirty cats previously evaluated for A31P-MYBPC3 were divided into G1 and G2 groups (n=15). The inclusion criteria were the presence or absence of mutation and clinical data, blood counts and serum biochemistry within reference intervals. The samples were taken at a single moment after an echocardiographic evaluation. Statistical analysis was performed through descriptive data analysis followed by comparison of groups at the 5% level of significance. In the present study, the profile by thromboelastometry (TEM) did not identify differences when comparing groups G1 and G2, and the animals showed no coagulability variations. Serum albumin concentration was significantly lower in the mutation carrier group (G2), but it remained within the reference intervals for the species. On the echocardiogram, a change in final diastolic volume was observed in the carrier group, indicating that the carrier animals should be evaluated to previous identification of possible diastolic dysfunction. The carrier group also pre... (Complete abstract click electronic access below) / Doutor

Objectives: To describe utilization of specialised prenatal care by high-risk survivors and evaluate echocardiogram use in echocardiogram-need survivors, as per survivorship guideline recommendations. Methods: Retrospective population-based matched survivor:control study utilizing Ontario health administrative data. Survivors were classified as high-risk/low-risk for obstetrical outcomes, and as echocardiogram-need (yes/no) for echocardiogram outcomes. Associations were tested using logistic regression. Results: 11% (n=363) of 3,204 pregnant survivors were classified as high-risk. Over 90% received specialized prenatal care. Living in a rural area was associated with lower use. (AOR 0.51; 95% CI 0.44-0.59). Since 2003, 32% (560/1,737) of survivors had an echocardiogram-need. Only 14% (77/560) had ≥1 echocardiogram, this was not associated with rurality nor neighbourhood income quintile. Conclusions: Although the majority of high-risk survivors receive specialized prenatal care, geographic inequality in care persists. Despite survivorship guidelines, >85% of echocardiogram-need pregnant survivors do not have an echocardiogram performed; future work should address this gap in care.

Objectives: To describe utilization of specialised prenatal care by high-risk survivors and evaluate echocardiogram use in echocardiogram-need survivors, as per survivorship guideline recommendations. Methods: Retrospective population-based matched survivor:control study utilizing Ontario health administrative data. Survivors were classified as high-risk/low-risk for obstetrical outcomes, and as echocardiogram-need (yes/no) for echocardiogram outcomes. Associations were tested using logistic regression. Results: 11% (n=363) of 3,204 pregnant survivors were classified as high-risk. Over 90% received specialized prenatal care. Living in a rural area was associated with lower use. (AOR 0.51; 95% CI 0.44-0.59). Since 2003, 32% (560/1,737) of survivors had an echocardiogram-need. Only 14% (77/560) had ≥1 echocardiogram, this was not associated with rurality nor neighbourhood income quintile. Conclusions: Although the majority of high-risk survivors receive specialized prenatal care, geographic inequality in care persists. Despite survivorship guidelines, >85% of echocardiogram-need pregnant survivors do not have an echocardiogram performed; future work should address this gap in care.

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2016-07-21T18:56:02Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO - HIPERTROFIA CARDÍACA EM ATLETAS DE FUTEBOL.pdf: 1232873 bytes, checksum: ba768f7a453ba087bc8e123924b2c931 (MD5) / Made available in DSpace on 2016-07-21T18:56:02Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO - HIPERTROFIA CARDÍACA EM ATLETAS DE FUTEBOL.pdf: 1232873 bytes, checksum: ba768f7a453ba087bc8e123924b2c931 (MD5) Previous issue date: 2016-03-01 / As atividades desenvolvidas no treinamento para o futebol profissional são propícias para sobrecarregar o sistema cardiovascular. As modificações fisiológicas no padrão fenotípico cardíaco, experimentadas em atletas, são reconhecidas popularmente como “coração do atleta”. Na população feminina, este padrão é pouco conhecido pela escassez de trabalhos com grupos de indivíduos desta modalidade e gênero, e as comparações destes padrões adaptativos morfológicos e funcionais cardíacos entre os gêneros são desconhecidas no futebol. Métodos: essa dissertação foi dividida em seis capítulos. No primeiro capítulo, Apresentação, contextualizamos o nível crescente de exigência nos treinamentos para a prática de futebol profissional em ambos os gêneros caracterizando essa prática esportiva como de potencial para sobrecarregar o sistema cardiovascular. Realizamos uma revisão abrangente da literatura dividindo-a em: A hipertrofia ventricular esquerda e o “coração do atleta”; Indução de respostas adaptativas do sistema cardiovascular; A análise ecocardiográfica e A miocardiopatia hipertrófica. O segundo capítulo, descreve, dentre os Objetivos gerais, a comparação das respostas adaptativas cardíacas de jogadores de futebol profissional entre os gêneros masculino e feminino. São apresentados também os objetivos específicos do trabalho. O terceiro capítulo engloba as Hipóteses que norteiam a pesquisa. O quarto capítulo, intitulado Materiais e Métodos, descreve o desenho da pesquisa realizada, em corte transversal, no laboratório de ecocardiografia do Hospital Dom Helder Camara/IMIP-PE, com atletas profissionais de futebol e não-atletas voluntários de ambos os gêneros. Avaliamos medidas antropométricas e variáveis ecocardiográficas da morfologia e função cardíaca. Este capítulo descreve também como a análise estatística foi realizada. O quinto capítulo Resultados, é apresentado em forma de Artigo original, intitulado “Comparing the magnitude of cardiac hypertrophy between genders in professional soccer players” onde demonstramos que os atletas de ambos os gêneros apresentaram aumento significativo do átrio esquerdo (MA: 1,88±0,12 x MN:1,68±0,43 e FA: 1,88±0,20 x FN:1,79±0,18 cm/m2), do índice de massa ventricular esquerda (MA: 121,65±20,23 x MN:99,84±13,80 e FA: 91,77±22,05 x FN:72,28±10,46 g/m2), diâmetro diastólico final do ventrículo esquerdo (MA: 2,81±0,26 x MN:2,55±0,66 e FA: 2,86±0,25 x FN:2,74±0,22 cm/m2), da espessura do septo interventricular (MA: 0,45±0,04 x MN:0,40±0,11 e FA: 0,47±0,06 x FN:0,41±0,04 cm/m2) e da parede posterior do ventrículo esquerdo (MA: 0,43±0,04 x MN:0,39±0,10 e FA: 0,44±0,06 x FN:0,39±0,04 cm/m2) em relação aos controles (p<o,o5). No sexto capítulo, Considerações finais, concluímos que os atletas de futebol experimentam um fenômeno adaptativo caracterizado por um padrão de remodelamento das câmaras cardíacas esquerdas semelhante em ambos os gêneros, representado por aumento tanto do diâmetro do átrio quanto do ventrículo esquerdo, o qual apresenta um padrão próprio e balanceado de hipertrofia, com componentes concêntrico e excêntrico, e esta adaptação se faz com a mesma magnitude entre os gêneros. O conhecimento desse padrão de alteração pode ser útil no diagnóstico diferencial entre patologias cardíacas. / The activities developed in training for professional soccer are conducive to overload the cardiovascular system. The physiological changes in cardiac phenotypic standard, experienced in athletes, are recognized popularly as "athlete's heart". In the female population, this pattern is less known due to few studies with this type and gender of individuals, and comparisons of these morphological and functional cardiac adaptive patterns between genders are unknown. Methods: this dissertation was divided into six chapters. In the first chapter, Presentation, we contextualize the growing level of demand in training for the practice of professional soccer in both genders characterizing this sports practice as potential to overload the cardiovascular system. In the second chapter we conducted a comprehensive review of the literature dividing it into: Left ventricular hypertrophy and "athlete's heart"; Induction of adaptive responses cardovascular system; Echocardiographic analysis and the Hypertrophic cardiomyopathy. The second chapter describes, among the General objectives, the comparison of cardiac adaptive responses of professional soccer players among males and females. Also presents the Specific objectives of the work. The third chapter includes the Hypothesis that guide the search, The fourth chapter, entitled Materials and Methods, describes the design of the survey, conducted in cross-section in the echocardiography laboratory of the Dom Helder Camara Hospital/IMIP-PE, with professional athletes soccer and volunteers non-athletes of both genders. We evaluated anthropometric measurements and echocardiographic variable morphology and cardiac function. This chapter also describes the statistical analysis performed. The fith chapter, Results, presented in the form of original article, entitled "Comparing the magnitude of cardiac hypertrophy between genders in professional soccer players" where demonstrated that athletes of both genders showed significant enlargement of the left atrium (MA: 1.88 ± 0.12 vs MN: 1.68 ± 0.43 and FA: 1.88 ± 0.20 vs. FN: 1.79 ± 0.18 cm/m2), the left ventricular mass index (MA: 121.65 ± 20.23 vs. MN: 99.84 ± 13.80 and FA: 91.77 ± 22.05 vs. FN: 72.28 ± 10.46 cm/m2), end-diastolic diameter of the left ventricle (MA: 2.81 ± 0.26 vs MN: 2.55 ± 0.66 and FA: 2.86 ± 0.25 vs FN: 2.74 ± 0 22 cm/m2), the septal thickness (MA: 0.45 ± 0.04 vs MN: 0.40 ± 0.11 and FA: 0.47 ± 0.06 vs FN: 0.41 ± 0.04 cm/m2) and posterior wall thickness of the left ventricle (MA: 0.43 ± 0.04 vs. MN: 0.39 ± 0.10 and FA: 0.44 ± 0.06 vs FN: 0.39 ± 0.04 cm/m2). compared to controls (p <o,o5). In the sixth chapter, Final considerations, we conclude that the soccer players experience an adaptive phenomenon characterized by a remodeling pattern of the left cardiac chambers similar in both genders, represented by increase in both the atrium diameters as the left ventricle, which shows an own pattern and balanced hypertrophy with concentric and eccentric components, and this adaptation is made with the same magnitude between genders. Knowing this pattern of change can be useful in the differential diagnosis of cardiac pathologies.

A 67-year-old male patient received a coronary artery bypass graft. Less than 2 months afterward, he presented with recurrent exacerbations of congestive heart failure. His response to a standard treatment regimen for heart failure was partly successful, but a few days after discharge he was readmitted for worsening dyspnea and edema. Doppler echocardiography suggested the hemodynamics of constrictive pericarditis. Magnetic resonance imaging showed thickened pericardium with exudates in the pericardial space. Cardiac catheterization confirmed the diagnosis, showing equalization of diastolic pressures of the left and right ventricles. The patient underwent subtotal pericardiectomy with resolution of the pericardial disease, but he died from respiratory insufficiency.

No description available.

O +dP/dt e o dP/dt são considerados índices ecocardiográficos de avaliação da função sistólica e diastólica, respectivamente, menos influenciados pela pré e pós-carga do que os índices calculados na fase de ejeção. O objetivo desse estudo foi determinar se o dP/dt não-invasivo se correlaciona com os índices ecocardiográficos sistólicos e diastólicos e se pode ser usado para identificar animais com e sem remodelamento, aqueles com e sem ICC e avaliar a gravidade da DVCM. Esta pesquisa constituiu um estudo clínico observacional prospectivo transversal, realizada em cães com DVCM. Comparou-se o +dP/dt e o dP/dt entre grupos divididos quanto à presença de remodelamento e presença ou não de ICC; para a comparação do dP/dt em relação à função diastólica do VE, os cães foram distribuídos de acordo com o padrão diastólico. Os cães foram submetidos ao exame ecodopplercardiográfico para mensuração do +dP/dt, -dP/dt e dos demais índices ecocardiográficos. Foram inclusos ao todo 57 cães com DVCM, em estágios B1 (n=13), B2 (n=18) e C+D (n=26). Comparando-se o +dP/dt nos três grupos divididos de acordo com à presença de remodelamento, com ou sem ICC, o grupo C+D (2142 mmHg/s, P25-P75 = 2023-2456) apresentou +dP/dt significativamente mais baixo que o grupo B1 (2865 mmHg/s, P25-P75 = 2383-3308) e B2 (2721 mmHg/s, P25-P75 = 2241-3186) (P = 0,0023). O mesmo foi observado para o dP/dt, quando comparado o grupo C+D ao grupo B1 (968,5 mmHg/s ± 266,8 e 1198 mmHg/s ± 165,7; P= 0,0115). Quando o dP/dt foi comparado entre os grupos com ICC e sem ICC, o grupo com ICC apresentou valores menores tanto do +dP/dt (2142 mmHg/s, P25-P75 = 2023-2456; 2858 mmHg/s, P25-P75 = 2299-3241; P = 0,0007) como do dP/dt (968,5 ± 266,8 mmHg/s e 1155 mmHg/s ± 199,0; P = 0,0041). Quanto à função diastólica, o grupo com padrão restritivo (769,7 mmHg/s ± 124,1) apresentou valores menores do -dP/dt quando comparados aos grupos sem disfunção diastólica (1132 mmHg ± 204,0), alteração de relaxamento (1229 mmHg ±186,9) e padrão pseudonormal (1107 mmHg ±223,4) (P&lt; 0,0001). Utilizando-se +dP/dt&lt;1800 mmHg/s como ponto de corte, houve duas vezes mais chance do cão com DVCM ter ICC do que não ter. Considerando-se como ponto de corte um -dP/dt&lt;800mmHg/s, a chance de ter ICC é oito vezes maior do que não ter e a chance de ter padrão diastólico restritivo é oito vezes maior do que não ter. Conclui-se que o +dP/dt e o dP/dt não-invasivos podem contribuir, respectivamente, para a avaliação da função sistólica e diastólica. / Noninvasive +dP/dt and dP/dt derived from mitral regurgitant jet are considered echocardiographic indexes for assessment of systolic and diastolic function respectively, that have less preload and afterload dependence than the ejection phase indexes. This study aimed to determine whether non-invasive dP/dt correlates with other systolic and diastolic echocardiographic indexes, and if they can be used to identify dogs with and without remodeling, with or without congestive heart failure (CHF) and for evaluation of chronic mitral valve disease (CMVD) severity. An observational prospective cross-sectional clinical study was undertaken including dogs with CMVD. Dogs were distributed in groups regarding the presence of remodeling and heart failure,to evaluate +dP/dt and dP/dt, and distributed according the diastolic pattern to compare dP/dt regarding diastolic function. Echocardiographic exam was obtained for conventional indexes and to measure +dP/dt and -dP/dt. Fifty seven dogs diagnosed with CMVD and classified according to the stages [B1 (n=13), B2 (n=18), C+D (n=26)] were included. In the comparison among the three groups regarding the presence of remodeling and CHF, group C+D (2142 mmHg/s, P25-P75 = 2023-2456) had +dP/dt significantly lower than B1 (2865 mmHg/s, P25-P75 = 2383-3308) and B2 (2721 mmHg/s, P25-P75 = 2241-3186) (P = 0.0023). Group C+D also had lower dP/dt, compared to B1 (968.5 mmHg/s ± 266.8 and 1198 mmHg/s ± 165.7; P= 0.0115). Group of dogs with CHF compared to those without CHF, showed lower +dP/dt (2142 mmHg/s, P25-P75 = 2023-2456; 2858 mmHg/s, P25-P75 = 2299-3241; P = 0.0007) as well as dP/dt (968.5 ± 266.8 mmHg/s e 1155 mmHg/s ± 199.0; P=0.0041). Regarding diastolic function, -dP/dt was lower for the restrictive pattern group (769.7 mmHg/s ± 124.1) compared to those without diastolic disfunction, (1132 mmHg ± 204.0), relaxation abnormality (1229 mmHg ±186.9) and pseudonormal pattern (1107 mmHg ±223.4) (P&lt; 0.0001). Considering +dP/dt&lt1800 mmHg/s as cutoff value, there is twice the chance for the dog with CMVD to have CHF than not to have. With a -dP/dt&lt;800mmHg/s as a cut off value, the chance of having CHF is eigth times higher than not having it. It is concluded that non-invasive doppler derived +dP/dt and dP/dt may contribute respectively, for systolic and diastolic assessment of dogs with CMVD.

O átrio esquerdo (AE) pode aumentar de tamanho e massa por sobrecarga de pressão e volume em várias doenças cardíacas, a exemplo da degeneração da valva mitral. O tamanho do AE é de especial interesse na avaliação da gravidade da doença, uma vez que o grau de aumento será um dos parâmetros para a instituição da terapia. A ecocardiografia é o método padrão para a avaliação não invasiva do paciente cardiopata e sempre inclui a mensuração do tamanho do AE. O modo-M convencional tem sido usado para tal avaliação, contudo, o mesmo tem suas limitações, devido à dificuldade em incluir a porção mais ampla do AE, resultando em um diâmetro e índice AE:AO subestimados. No modo bidimensional o AE pode ser mensurado em sua maior amplitude, resultando em uma medida mais acurada. Assim sendo, o objetivo deste estudo foi comparar os dois métodos, utilizando-se de 40 cães adultos sadios, com idade variando de 1,5 a 7 anos. No modo-M, o AE e a aorta (AO) foram medidos conforme normas da American Society of Echocardiography, no corte longitudinal para-esternal direito, e no modo bidimensional realizaram-se medidas lineares em pontos específicos e em momentos estabelecidos do ciclo cardíaco, no corte transverso para-esternal direito. Estabeleceu-se um índice para cada método, dividindo-se o diâmetro do AE com a AO. Observou-se que a diferença de diâmetro do AE no modo bidimensional (AEB) e do AE no modo-M foi estatisticamente significante (p < 0,001). O mesmo ocorreu com o índice AEB:AOB quando comparado ao índice AEM:AOM, sendo que a média do AEB:AOB = 1,379±0,130; I.C. 95%= 1,337-1,422 e a média do AEM:AOM = 1,067±0,064, I.C. 95%= 1,046-1,088. Observou-se correlação alta entre as medidas do AE, nos dois modos, com superfície de área corpórea e peso (coeficiente de correlação = 0,882-0,896). Ocorreu correlação alta também entre as medidas de AE dos sexos masculino e feminino, pelos dois métodos (p=0,003 e coeficiente de correlação = 0,725-0,732). Com relação aos índices, não houve correlação entre os mesmos e a superfície de área e o peso, podendo-se dizer que são, portanto, índices independentes de peso. O modo bidimensional oferece a possibilidade de aferição do AE em sua maior amplitude, superando assim o modo-M convencional. / The left atrium (LA) can become enlarged in size and mass attributable to both pressure and volume overload in various cardiac diseases, an example is the mitral valve degeneration. The size of LA is of special interest for clinical assessment of severity of the disease, once the degree of enlargement will be one of the parameters for therapy institution. The echocardiography is the standard method of noninvasive evaluation of the cardiac patient and often involves the LA size. The M-mode has been used to this evaluation, however it has inherent limitations, due to the difficulty in including the largest portion of the LA, underestimating the LA diameter and LA:AO index. In the two-dimensional (2D) mode, the LA can be measured at its largest portion and it is likely to be more accurate. The purpose of this study was to compare both methods, using 40 healthy adult dogs, and ages between 1,5 and 7 years old. In the M-mode, the LA and the aorta (AO) was measured according to the guidelines from the American Society of Echocardiography, using a right long-axis view and in the 2D-mode, linear measurements were made at specific time and points of the cardiac cycle, using a right short-axis view. LA:AO ratios were established for each method. The difference between the LA diameter in the 2D-mode (LAB) and in the M-mode (LAM) was significant (p < 0,001). The same has occured with the LAB:AOB index when it was compared with the LAM:AOM ratio. The LAB:AOB index was 1,379±0,130; C.I. 95%= 1,337-1,422 and the LAM:AOM index was 1,067±0,064, C.I. 95%= 1,046-1,088. It was observed high association between LA measurements, in both methods, with body weight and body surface area (correlation coefficient = 0,882-0,896) and also a high correlation between the LA in female and male, in both methods (p=0,003 e correlation coefficient = 0,725-0,732). There was no association between both indices with body weight and body surface area, which provides a body weight - independent measurement of LA size. The 2D - mode offers more accurate LA measurement , so it overcomes the M- mode.