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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
121

Is Maternal Headache a Risk Factor for Congenital Heart Disease?

Erdenebileg, Ariuntsatsral Ariunaa 20 July 2009 (has links)
Congenital Heart Disease (CHD) is one of the most common birth defects. It is the single most modifiable cause of infant mortality under one year of age. Therefore, the causes of CHD have been extensively researched in the past but the etiology remains largely unknown. Environmental risks, particularly maternal risk factors for congenital cardiac malformation have been evaluated in the original BWIS previously. However, in this research we examined one of the additional risk factors. We sought to determine whether maternal headache during six months prior to conception and throughout gestation until birth is a risk factor for CHD in the BWIS dataset. Among 3274 singleton cases and 3519 controls, a maternal report of headache was found to be associated with a nearly 20% increase in the risk of a congenital heart defect (OR= 1.2 p=0.001). Moreover, any medications use for headache 1-6 months prior to conception increased the risk of abnormal cardiac development by 1.3 fold (OR = 1.3, p=0.0004). Aspirin or aspirin containing analgesics were found to increase the risk for CHD at the defined risk period. According to subgroup analysis, aspirin or aspirin containing analgesics and acetaminophen or acetaminophen containing analgesics were found to be the risk factor for CTD i.e. Conotruncal defects. Furthermore, aspirin or aspirin containing analgesics increased the risk for PVSD i.e. Peri-membranous Ventricular Defect in offspring when the mother uses these drugs 1-6 months prior to conception. Additionally, the risk for CVD i.e. critical valve disease were found to be increased when women were exposed to aspirin or aspirin containing analgesics during third trimester after pregnancy. In conclusion, maternal headache increased the risk for CHD by 20% and the use of headache medications specifically pain relievers during 1-6 months prior to conception modulated type of defect was observed.
122

In Vitro Fluid Dynamics of Stereolithographic Single Ventricle Congenital Heart Defects From In Vivo Magnetic Resonance Imaging

Kitajima, Hiroumi D. 20 July 2007 (has links)
Background: Single ventricle congenital heart defects with cyanotic mixing between systemic and pulmonary circulations afflict 2 per 1000 live births. Following the atriopulmonary connection proposed by Fontan and Baudet in 1971, the present procedure is the total cavopulmonary connection (TCPC), where the superior vena cava (SVC) and inferior vena cava (IVC) are sutured to the left pulmonary artery (LPA) and right pulmonary artery (RPA). However, surgeon preference dictates the implementation of the extra-cardiac and intra-atrial varieties of the TCPC. Overall efficiency and hemodynamic advantage of the competing methodologies have not been determined. Hypothesis: It is hypothesized that an understanding of the experimental fluid dynamic differences between various Fontan surgical methodologies in the TCPC allows for power loss evaluation toward improved surgical planning and design. Methods: Toward such analysis, a previously developed data processing methodology is applied to create an anatomic database of single ventricle patients from in vivo magnetic resonance imaging (MRI) to examine the gamut of TCPC anatomies. From stereolithographic models of representative cases, pressure and flow data are used to quantify control volume power loss to measure overall efficiency. particle image velocimetry (PIV) is employed to detail flow structures in the vasculature. Results are validated with dye injection flow visualization and 3-D phase contrast magnetic resonance imaging (PC-MRI) velocimetry, highlighting flow phenomena that cannot be captured with in vivo MRI due to prohibitively long scanning times. Preliminary results illustrate the variation of control volume power loss over several TCPC anatomies with varying flow conditions, the application of PIV, and validation approaches with 3-D PC-MRI velocimetry. Data from control volume power loss evaluation demonstrate a correlation with TCPC anatomy, providing added clinical knowledge of optimal TCPC design. Findings from PIV and 3-D PC-MRI velocimetry reveal a means for quantitatively comparing flow structure. Dye injection flow visualization offers qualitative insight into limitations of the selected velocimetry techniques.
123

Efficacité de deux méthodes d’enseignement d’hygiène orale chez les enfants atteints de cardiopathies

Dubois Lebel, Andrée-Maude 02 1900 (has links)
Le brossage des dents, la mastication des aliments et toutes autres activités orales quotidiennes peuvent provoquer une bactériémie transitoire. Cette bactériémie transitoire a le potentiel de causer une endocardite infectieuse en présence de certains facteurs de risque. Les cardiopathies congénitales chez les enfants font partie de ces facteurs de risque. Le contrôle de la plaque dentaire et une bonne santé buccodentaire permettent de réduire le risque d’endocardite infectieuse. Les objectifs du présent projet de recherche visent à évaluer les connaissances des parents d’enfants atteints de cardiopathies congénitales sur l’endocardite infectieuse et son lien avec la santé buccodentaire et de connaître les habitudes d’hygiène orale personnelles et professionnelles adoptées par les enfants atteints de cardiopathies congénitales. Le projet de recherche vise également à évaluer l’efficacité de deux méthodes d’enseignement d’hygiène orale chez les enfants atteints de cardiopathies congénitales. La procédure expérimentale implique que tous les parents ou gardiens légaux d’enfants atteints de cardiopathies congénitales, âgés entre 6 et 12 ans qui visitent le service de cardiologie du CHU Sainte-Justine sont sollicités à participer au projet de recherche. Un formulaire d’information et de consentement ainsi qu’un questionnaire sont remis aux parents. Le questionnaire vise à évaluer la connaissance des parents d’enfants atteints de cardiopathies congénitales sur ce qu’est l’endocardite infectieuse et son lien avec la santé buccodentaire ainsi que de connaître les habitudes d’hygiène orale personnelles et professionnelles des enfants atteints de cardiopathies congénitales. L’examen clinique nécessaire au projet de recherche implique le prélèvement d’un indice de plaque Quigley & Hein, Turesky modifié avant et après que l’enfant participant au projet de recherche ait appliqué les instructions d’hygiène orale reçues. L’enfant est assigné à l’une des deux méthodes d’instructions d’hygiène orale avec l’aide d’une table de randomisation. La méthode d’instructions d’hygiène orale du groupe 1 correspond à des instructions transmises par le cardiologue tandis que la méthode d’instructions d’hygiène orale du groupe 2 correspond aux instructions transmises par l’intermédiaire d’un document audio visuel. Des analyses chi-carré et des tests de T pairé ainsi que des analyses de variance univariée (one-way ANOVA) et des analyses de corrélation de Pearson entre le questionnaire et les données cliniques ont été effectuées pour analyser les données recueillies. Les résultats démontrent que les parents d’enfants « à risque élevé » d’effet adverse d’une endocardite infectieuse ne connaissent pas davantage le risque d’endocardite infectieuse d’origine buccodentaire que les parents d’enfants « de moindre risque » (p=0,104). Les résultats démontrent toutefois que les parents d’enfants atteints de cardiopathies congénitales qui connaissent le risque d’endocardite infectieuse et son lien avec la santé buccodentaire adhèrent à des comportements dans le but de maintenir une bonne santé buccodentaire chez leur enfant. Les résultats qui proviennent de l’examen clinique démontrent que l’application des instructions d’hygiène orale faites par le cardiologue et par l’intermédiaire d’un document audio visuel permettent d’observer une différence statistiquement significative (p=0,000) au niveau du contrôle de la plaque dans chacun de ces groupes. Toutefois, aucune différence statistiquement significative (p=0,668) n’a pu être démontrée entre les deux méthodes d’instructions d’hygiène orale. Les parents qui connaissent le lien entre la santé buccodentaire et le risque d’endocardite infectieuse pour leur enfant atteint de cardiopathie congénitale adoptent un comportement pour optimiser la santé buccodentaire de leur enfant. Les instructions d’hygiène orale par l’intermédiaire d’un document audio visuel sont équivalentes aux instructions d’hygiène orale prodiguées par le cardiologue. / Tooth brushing and food chewing are among the oral activities that can cause transient bacteremia. A transient bacteremia can initiate infective endocarditis in patients at risk. Risk factors for infective endocarditis in children include most congenital heart diseases and it has been shown that effective plaque control and good oral hygiene can reduce the risk for infective endocarditis initiated by bacteria of oral origin. The present research objectives were drawn up to evaluate the level of knowledge of parents of children with congenital heart disease on infective endocarditis and its relation to oral health. Our other research objective was to probe the oral hygiene habits of children with congenital heart disease. The efficacy of two oral hygiene instructional methods in children with congenital heart disease was also evaluated. The experimental procedure meant the involvement of all the parents of children with congenital heart disease, between 6 and 12 years old who were visiting the department of cardiology at the CHU Sainte-Justine. They were solicited to participate in the research project and were given an information and consent form. All parents who agreed to participate were given the questionnaire that was used to evaluate the knowledge of parents of children with congenital heart disease on infective endocarditis and its association with oral health. The questionnaire also aimed to know the personal and professional oral hygiene habits of children with congenital heart disease. A clinical exam performed on each child cited the Quigley & Hein, Turesky modified plaque index before and after the utilization of the assigned oral hygiene instructions. Each child was assigned to one of the two oral hygiene instruction groups through a randomization table. The method of oral hygiene instructions of group 1 corresponded to the instructions given by the cardiologist and the method of oral hygiene instructions of group 2 corresponded the to instructions given by an audio visual presentation. Paired T-test and Chi-square analyses, as well as one-way ANOVA analysis and Pearson’s correlation analysis were produced to evaluate the data. The results demonstrated that the knowledge of the association between oral health and infective endocarditis was not superior in parents of children with higher risk of adverse effect from infective endocarditis than in parents of children with a lesser risk (p=0,104). Interestingly enough, parents of children with a congenital heart disease that are knowledgeable about the association will adopt preventive behaviors in order to promote their child’s oral heath and reduce their risk for infective endocarditis. The clinical exam also demonstrated that both oral hygiene instructions methods were effective for plaque control (p=0,000) but no significant statistical difference was found between the two methods (p=0,668). The parents of children with congenital heart disease that are aware of the association between oral health and infective endocarditis demonstrated preventive oral health behaviors to promote oral health in comparison with the parents who lacked the knowledge. The oral hygiene instructions methods given by way of the audio visual presentation was not superior to those given by the cardiologist.
124

Unga vuxnas upplevelser av att leva med medfött hjärtfel / Young adult´s experiences of living with congenital heart disease

Olsson, Annie, Hurtig, Nathalie January 2016 (has links)
Background: Approximately 1000 children with a congenital heart disease are born in Sweden each year. Congenital heart diseases include malformations of the heart which comprise various anatomical differences. Progresses in diagnostics and treatment of the cardiac diseases have contributed to the survival of these young adults which makes a new and growing group of patients. Aim: The aim of this study was to describe young adults' between the ages of 13-40 experiences of living with congenital heart disease. Method: A literature study based on qualitative studies from Cinahl and PubMed was performed. Ten articles were analyzed by content analysis. Results: The results of the study present two main categories "accept one's heart disease" and "challenge to accept one's heart disease" with a total of ten subcategories. Conclusion: Individuals with congenital heart disease may experience their situation in various ways and they may or may not have accepted their congenital heart disease. Some individuals feel that the disease contributes to personal strength, while others are living with a constant presence of anxiety over the fact that life can change for the worse at any time.
125

Coarctation of the aorta : register and imaging studies

Rinnström, Daniel January 2016 (has links)
Background Coarctation of the aorta (CoA) constitutes 5-8 % of all congenital heart disease (CHD) and is associated with long-term complications such as hypertension (HTN) and left ventricular hypertrophy (LVH). Factors associated with HTN, LVH, and diffuse myocardial fibrosis, are not yet fully explored in this population. Methods Papers I-III: The Swedish national register of congenital heart disease (SWEDCON) was used to identify adult patients with repaired CoA. Paper IV: Data on 2,424 adult patients with CHD was extracted from SWEDCON and compared to controls (n = 4,605) regarding height, weight and body mass index (BMI). Paper V: Adults with CoA (n = 21, age 28.5 (19.1-65.1) years, 33.3 % female) referred for CMR were investigated with T1 mapping to determine left ventricular extracellular volume fraction (ECV). Results Papers I-II: Out of 653 patients, 344 (52.7 %) had HTN. In a multivariable model, age (years) (OR 1.07, CI 1.05-1.10), sex (male) (OR 3.35, CI 1.98-5.68) and BMI (kg/m2) (OR 1.09, CI 1.03-1.16) were associated with having HTN, and so was systolic arm-leg blood pressure (BP) gradient where an association was found at the ranges (10, 20] mmHg (OR 3.58, CI 1.70-7.55) and > 20 mmHg (OR 11.38, CI 4.03-32.11), in comparison to the range [0, 10] mmHg. When investigating 243 patients with diagnosed HTN, 127 (52.3 %) had elevated BP (≥ 140/90 mmHg). Age (years) (OR 1.03, CI 1.01-1.06) was associated with elevated BP, and so was systolic arm-leg BP gradient in the ranges (10, 20] mmHg (OR 4.92, CI 1.76-13.79), and > 20 mmHg (OR 9.93, CI 2.99-33.02), in comparison to the reference interval [0, 10] mmHg. Patients with elevated BP had more classes of anti-hypertensive medication classes prescribed (1.9 vs 1.5, p = 0.003). Paper III: Out of 506 patients, 114 (22.5 %) were found to have LVH. Systolic BP (mmHg) (OR 1.02, CI 1.01-1.04), aortic valve disease, (OR 2.17, CI 1.33–3.53), age (years) (OR 1.03, CI 1.01–1.05), and HTN (OR 3.02, CI 1.81-5.02), were associated with LVH, while sex (female) (OR 0.41, CI 0.24-0.72) was negatively associated with LVH. Paper IV: There was no difference in height, weight, or BMI between patients with CoA (n = 414) and the reference population. Paper V: In the population of 21 patients, an increased left ventricular myocardial ECV was found in 6 cases (28.6 %). Of the patients with increased ECV, 5/6 (83.3 %) were female (p = 0.002). Patients with increased ECV did not otherwise differ from the rest of the study population. iv Conclusions In adults with repaired CoA, HTN and LVH were common, and many patients with HTN had elevated BP despite treatment. The potentially modifiable factors BMI and systolic arm-leg BP gradient were associated with HTN, and the gradient was also associated with elevated BP among patients with diagnosed HTN. The gradient’s significance remained even within what the current guidelines consider acceptable ranges. Potentially modifiable factors associated with LVH were systolic BP and aortic valve disease. We found no general difference in height, weight, or BMI between patients with CoA and the reference population. While LVH was more common among men, increased myocardial ECV was more common among women.
126

Recruitment, single ventricular palliation, and complex biventricular repair for patients with Hypoplastic Left Heart Syndrome

Wu, Vivian 18 June 2019 (has links)
BACKGROUND: Hypoplastic Left Heart Syndrome is a congenital birth defect that is defined by underdevelopment of the left heart during pregnancy. This is especially dangerous as the left heart holds the systemic flow of blood- the oxygenated blood. Not enough oxygen throughout the whole body causes cyanosis, which symptoms include bluish discoloration of the skin or mucous membrane due to low oxygen saturation. Single Ventricle Palliation followed by Biventricular Conversion is the most common surgical procedural pathway to correct this defect. The goal is to convert from a single ventricle circulation during single ventricle palliation to biventricular circulation via biventricular conversion, which is the normal heart anatomy. Single Ventricle Pallation consists of three stages: Stage 1 Norwood Procedure, Bidirectional Glenn, and Fontan. Biventricular Conversion can be performed after any of the three stages. In addition, further compromise of the left ventricle includes other factors such as a thickening of fibroblast-like cells on the endocardial layer called endocardial fibroelastosis. Therefore, additional surgical procedures, also known as recruitment procedures, combat these problems. It is critical to find a correlation between a specific procedure and post surgery success in left ventricle growth and function for these patients. OBJECTIVES: Patients with Hypoplastic Left Heart Syndrome at Boston Children’s Hospital have undergone single ventricle palliation with some patients proceeding to biventricular conversion. This study aimed to study the palliation stages individually and recruitment procedures (specifically endocardial fibroelastosis resection) on the effect of left ventricle growth. METHODS: Patients with Hypoplastic Left Heart Syndrome were studied retrospectively (before 2014) and prospectively (after 2014 until December 1, 2018). Single Ventricle Palliation and Biventricular Conversion were analyzed via descriptional analysis with evidence of left ventricular growth measured by left ventricular end diastolic volume and respective z-scores. Z-scores were used to standardize end diastolic volume values across variability in age, weight, and height. RESULTS: A total of 55 patients underwent single ventricle palliation and 39 ended with biventricular circulation via biventricular conversion. Overall, there was a 9.29 ml increase in end diastolic volume between Bidirectional Glenn and Fontan and a 0.795 increase in end diastolic volume z-score between Fontan and Biventricular Conversion. Next, those who did not have recruitment procedures experienced a 135.6%, 48.8%, and 0% growth at Stage 1, Bidirectional Glenn, and Fontan, respectively, before directly proceeding to biventricular conversion. Those with recruitment experienced a 44.5%, 90.4%, and 83.0% growth at Stage 1, Bidirectional Glenn, and Fontan, respectively, before directly proceeding to biventricular conversion. Finally, there was a 50.2% and 62.3% in left ventricular growth at Bidirectional Glenn and Fontan, respectively, after endocardial fibroelastosis resection compared to only a 6.9% growth at Stage 1. CONCLUSION: Bidirectional Glenn was the most effective palliation stage for left ventricular growth. Recruitment in patients at this stage was associated with growth that exceeds those who did not have recruitment. This stage also best demonstrates the ability and success of growing a small ventricle to be adequate for biventricular conversion. Left ventricular growth at Fontan circulation holds promising results that are a point of interest for more studies. Endocardial Fibroelastosis resection is more effective on left ventricular growth at Bidirectional Glenn and Fontan compared to Stage 1.
127

Cartilha de orientações para famílias de crianças com cardiopatias congênitas / Booklet of guidelines for familys of children with congenital heart diseases

Missiaggia, Lara Perez Sucena 20 October 2016 (has links)
Trata-se de pesquisa metodológica, tipo validação, que realizou a tradução da cartilha \"A volta para casa depois da cirurgia cardíaca infantil\" para o português (versão Brasil). O processo de validação da cartilha abrangeu três etapas: 1) Tradução da cartilha do idioma espanhol para o português (Brasil); 2) Comitê de Especialistas; 3) Retrotradução. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo. Ressalta-se que todos os princípios éticos relacionados a pesquisas envolvendo seres humanos foram respeitados. Após tradução da cartilha para o português (versão Brasil), o material foi avaliado por um comitê de especialistas, composto em sua maioria por enfermeiros, com idade entre 30 a 39 anos e tempo de formação de cinco a nove anos. As sugestões deste grupo de profissionais, que objetivaram a melhor compreensão dos leitores e a clareza das informações, foram incorporadas à tradução mediante a obtenção de aceitação de 80% dos avaliadores do item contendo a modificação realizada. Após duas rodadas, atingida essa porcentagem, realizou-se a retrotradução e foram enviadas a versão final em português e a versão retrotraduzida à Organização que desenvolveu a cartilha na Espanha, para fins de aprovação. A maioria dos temas abordados pela cartilha encontra-se relatada na literatura como aspectos essenciais no processo de alta hospitalar da criança, o que demonstra o grande potencial deste material para auxiliar os pais e até mesmo as próprias crianças. Como contribuição para a enfermagem, tem-se que a distribuição da cartilha \"A volta a casa após a cirurgia cardíaca da criança\" pode tornar esse momento mais fácil e menos sofrido para as famílias, sobretudo ao cuidador. Uma vez que a educação de pacientes e familiares é um dos papeis do enfermeiro, que deve empoderá-los para um cuidado mais qualificado, a cartilha se fará uma aliada para esse recomeço, após a alta hospitalar / This is a methodological research, characterized as validation, which held a handbook translation from Spanish to Portuguese - The return to home after the child\'s heart surgery (Brazilian version). The validation process was based on three stages: 1) Translation of the handbook from Spanish to Portuguese (Brazil); 2) Expert Committee; 3) Back-translation. The Ethics Research Committee of Ribeirão Preto School of Nursing, University of São Paulo, approved the research. All ethical principles related to research involving human beings were respected. Translation was performed to Portuguese (Brazilian version), and it was evaluated by an expert committee composed mostly of nurses, aged 30 to 39 years and with work experience of five to nine years. Their suggestions were related to a better understanding of readers and the clarity of the information. These suggestions were added into the translation handbook when they achieved 80% of the experts evaluation acceptance for the item in which the change was made. After two rounds of the expert committee evaluation and reached that percentage of acceptance, a back-translation was performed and sent to the Organization who developed the original handbook in Spain as well as a Portuguese final version. The back translation was approved by the Organization in Spain. Most of the issues addressed by the handbook are highlighted in the literature as essential in the hospital child discharge process. The fact of addressing issues so important, shows how the handbook has the potential to assist parents and even children. As a contribution to nursing field, the handbook \"The return home after the child\'s heart surgery\" can make this time easier, less tortuous and lighter for the families, especially for the caregiver. Considering that, one of the nurses\' roles, is the education of patients and their families in order to empower them for a more skilled care, the handbook will be an important source of information for the child and the family in return home
128

Alterações seqüenciais da deformação miocárdica longitudinal e radial (strain/strain rate) e das velocidades do Doppler tecidual pulsado em neonatos normais / Sequential changes of longitudinal and radial deformation (strain/strain rate) and pulsed wave tissue Doppler in normal neonates

Pena, José Luiz Barros 20 January 2006 (has links)
Introdução: O Doppler tecidual (DT) surgiu como uma técnica ecocardiográfica para registro das velocidades do miocárdio e evoluiu para a determinação da deformação miocárdica regional com medida do strain rate (SR) e strain longitudinal e radial unidimensionais. Nosso objetivo foi determinar padrões de normalidade em neonatos e analisar seqüencialmente esses índices em períodos de alta e baixa resistência vascular pulmonar. Casuística e Método: Selecionaram-se 55 crianças com idade média de 20,14 ± 14,0 horas, constituindo o Grupo I (G I). Um segundo exame foi realizado em 30 crianças que retornaram após 31,9 ± 2,9 dias de vida, constituindo o Grupo II (G II). As velocidades do DT pulsado foram obtidas em cortes transversais (R) e longitudinais (L) do ventrículo esquerdo (VE) em posições apical 4 e 2 câmaras e no VD (paredes livre e inferior). Foram medidas velocidades sistólicas (onda Sm), diastólica inicial (Em), diastólica final (Am) de pico e a relação Em/Am. Pelo menos três ciclos cardíacos consecutivos com taxa de quadros/s superior a 300 foram digitalmente obtidos nos cortes mencionados e analisados posteriormente utilizando programa específico para medida das curvas de SR/strain e seus componentes sistólico, diastólico inicial e final. Resultados: As velocidades demonstraram gradiente bem definido com redução progressiva na direção base-ápice do coração. As velocidades do VD foram superiores às do VE quando comparadas com as medidas nas paredes septal (S), anterior (A) e lateral (L). No GI verificamos diferença significativa entre as medidas do SR/strain sistólicos do segmento basal da parede S em relação à apical (-1,90 ± 0,61, - 25,90 ± 4,90 vs -1,66 ± 0,25, - 24,23 ± 3,08), p=0,04 e p=0,02 e do segmento médio em relação ao apical (p=0,01 e 0,02). A avaliação regional do VD demonstrou strain sistólico maior no segmento médio em relação ao basal (-33,20 ± 6,34 vs -28,38 ± 4,90, p=0,00) e em relação ao segmento apical (-33,20 ± 6,34 vs -31,95 ± 5,06, p=0,021). Os valores absolutos de SR/strain e todos os seus componentes foram maiores na direção R quando comparados com a L (SR sistólico 2,99 ± 0,78 s-1 vs (-)1,90 ± 0,60 s-1 strain sistólico 49,72% ± 12,86% vs (-) 25,86% ± 4,83 p=0,00). Quando comparamos os GI e GII verificamos redução do strain sistólico do VE na direção R e L nas paredes S, L e A em todos os segmentos. O SR sistólico reduziu apenas na porção basal da parede L (-1,91 ± 0,46 s-1 vs - 1,71 ± 0,33 s-1, p=0,02). O VD apresentou no GII aumento significativo do strain sistólico e diastólico inicial em todos os segmentos e paredes. O SR sistólico também apresentou aumento dos valores nos segmentos basal e médio de sua parede livre e na parede inferior. A correlação entre a onda Sm e SR/strain sistólicos não foi significativa. Conclusão: Os índices regionais de deformação miocárdica constituem técnica clínica reproduzível em neonatos e podem monitorar alterações seqüenciais fisiológicas da circulação neonatal precoce e tardia. São mais robustos que as velocidades na quantificação da função regional. / Background: Color Doppler myocardial imaging (CDMI) has emerged as an echocardiographic technique for determining myocardial velocities and has been further developed to allow the determination of one-dimension regional longitudinal and radial strain rate (SR)and strain. Our goal was to determine normal values in neonates and sequentially analyse these indices in periods of high and low pulmonary vascular resistance. Study population and methods: Fifty-five term newborns with mean age of 20.14 ± 14.0 hours were selected to be part of Group I (GI). A second echo study was performed on 30 children that had returned with 31.9 ± 2.9 days after birth, being Group II (GII). Pulsed wave Doppler tissue velocities (PWDTV) were obtained in short axis (R) and longitudinal (L) axis of the left ventricle (LV) in apical 4 and 2 chamber view and in 4 and 2 chamber of the right ventricle (RV), including RV free lateral and inferior walls. Peak systolic (Sm), peak early diastolic (Em) and peak late diastolic (Am) motion velocities and Em/Am ratio were measured. At least three consecutive cardiac cycles with frame rate more than 300 fps were stored in digital format from the mentioned views for offline analysis by using dedicated software for measuring peak systolic and peak early and late diastolic SR/strain. Results: PWTDV have shown a well-defined gradient with progressive peak reduction from base to apex. RV velocities were higher than those of the LV whem compared to septal (S), anterior (A) and lateral (L) walls. In GI there was a significant difference between systolic SR/strain measurement of basal S segment in relation to apical (-1.90 ± 0.61, -25.90 ± 4.90 vs -1.66 ± 0.25, - 24.23 ± 3.08), p=0.04 e p=0.02 and from the mid in relation to the apical segment (p=0.01 e 0.02). Regional RV longitudinal function showed that systolic strain recorded from the mid segment was significantly higher than that recorded from the basal segment (-33.20 ± 6.34 vs -28.38 ± 4.90, p=0.00) and that from the apical segment (-33.20 ± 6.34 vs ?31.95 ± 5.06, p=0.021). The absolute and all components of SR/strain were significantly higher in R direction when compared to the L ones (systolic SR 2.99 ± 0.78 s-1 vs (-)1.90 ± 0.60 s-1 systolic strain 49.72% ± 12.86% vs (-)25.86% ± 4.83 p=0.00). When comparing data from GI and GII, we noticed reduction of LV systolic strain in the second group for both R and L, in all segments of S, L and A walls. Systolic SR showed reduction of the values in GII only in the basal segment of the L wall (-1.91 ± 0.46 s-1 vs ?1.71 ± 0.33s-1, p=0.02). Regional RV function showed systolic and early diastolic strain significantly higher in all segments of wall in GII. Systolic SR also showed higher values in the basal and mid segments of RV free lateral and inferior wall in GII when comparing to GI. The correlation between peak systolic velocity Sm and peak systolic SR/strain was not significant. Conclusion: Regional myocardial deformation indices are reproducible clinical techniques in neonates and can monitor physiological sequential circulatory changes of the early and late neonatal period. They are more robust than velocities in the quantification of the regional myocardial function.
129

Analyse der Autopsiefälle mit kongenitalem Vitium im Kindersektionsgut der Charité von 1952 bis 1996

Rinne, Katy 01 August 2000 (has links)
ANALYSE VON 1.990 AUTOPSIEFÄLLEN MIT ANGEBORENEM HERZFEHLER IM KINDERSEKTIONSGUT DER CHARITÈ VON 1952 BIS 1996 Die vorliegende Arbeit basiert auf dem retrospektiven Studium der Befunde aller Kinder unter 16 Jahren, der Totgeburten und Schwangerschaftsbeendigungen, die von 1952 bis 1996 an der Charité, Medizinische Fakultät der Humboldt-Universität zu Berlin, autopsiert wurden. Alle Berichte, in denen ein angeborener Herzfehler vorlag, wurden eingesehen. Die Zielstellung bestand darin, Veränderungen und Trends in der Häufigkeit der kongenitalen Vitien, im Sterbealter, im klinischen Verlauf (operative oder interventionelle Therapie) und in den Todesursachen, zum einen in Abhängigkeit von der Art des Herzfehlers und des weiteren vom Zeitabschnitt innerhalb der 45 Jahre, zu untersuchen. Die genannten Aspekte wurden in einer dafür erstellten Datenbank erfaßt. Insgesamt fanden sich unter den 11.261 Sektionen 1.990 Fälle mit einem angeborenen Herzfehler, dies entspricht einer Häufigkeit von 17,7%. Diese Gruppe setzte sich zusammen aus 1.774 Lebendgeborenen, 138 Totgeburten und 78 Schwangerschaftsbeendigungen. 76,7% aller Kinder verstarben im Säuglingsalter. In der zeitlichen Betrachtung variierte die Altersstruktur deutlich, beeinflußt von der Entwicklung der Interventionskardiologie und Kinderherzchirurgie an der Charité. Von den 1.774 Lebendgeborenen hatten 699 Kinder (39,4%) eine invasive Therapie (chirurgisch/ katheterinterventionell) erhalten. Innerhalb der 45 Jahre zeigte sich ein signifikanter Anstieg im Anteil der operierten Kinder. Deren Häufigkeit wiederum war deutlich abhängig vom zugrundeliegenden Herzfehler. In der detaillierten Analyse der operativen Therapie stellte sich die Wandlung der Herzchirurgie von den extrakardialen Palliationsoperationen als Ersteingriff zu den heutigen Korrekturoperationen und komplexen Palliationen dar. Von allen operierten Kindern verstarben 631 (90,3%) perioperativ. Bei den Todesursachen im natürlichen Verlauf lag in 41,6% eine dekompensierte chronische Herzinsuffizienz vor, in 26,8% eine Komplikation des Herzfehlers (thrombembolische Ereignisse, hypoxische Hirnschädigung, Endokarditis). 10% der Kinder wiesen letale extrakardiale Fehlbildungen auf. In 21,6% der Fälle stand die Todesursache nicht im Zusammenhang mit dem Herzfehler. Zusammenfassend ließ sich in dieser Arbeit klar demonstrieren, wie sehr sich die Fortschritte in der Diagnostik und Therapie der angeborenen Herzfehler auf die Befunde in einem Sektionsgut auswirken. Ausgehend davon kann deren kritische Einschätzung zur Qualitätssicherung der klinischen Entwicklungen beitragen. / ANALYSIS OF 1.990 AUTOPSY CASES WITH CONGENITAL HEART DISEASE AT THE CHARITÈ-HOSPITAL BETWEEN 1952 TO 1996 In a retrospective review we have examined the reports of all children under the age of 16 years, stillbirth and terminated pregnancies that underwent a post-mortem at the Charité Hospital between 1952 to 1996. Specifically we were interested in the cases with congenital heart malformations. We wanted to find out about changes in the frequency of congenital heart disease, the age of these patients, their clinical history (kind of interventional or surgical therapy) and the cause of death depending on the kind of cardiac defect and the time over the period of 45 years. All criterias were registered in a database and analysed for statistical significance. In the series of 11.261 autopsies we found 1.990 cases with a congenital heart malformation (medium frequency of 17,7%). The group consists of 1.774 liveborn children, 138 stillbirths and 78 cases of abortion. 76,7% of all liveborn children died within the first year. Depending on time this age differed significantly according to the innovations in cardiac surgery and interventional procedures. Of all 1.774 liveborn cases 699 children (39,4%) had an invasive (surgical/interventional) procedure. Over the time period there was a significant increase in the percentage of operated children. Their frequency again was clearly depending on the kind of cardiac defect. In the detailed analysis of the kind of therapy we could show the development of cardiac surgery from palliative extracardiac procedures at the beginning to corrective and more complex palliations nowadays. 631 (90,3%) of all operated children died perioperatively whereas the others died from left heart failure in 41,6%, in 26,8% a serious complication of the cardiac defect (arterial embolism, cerebral hypoxia, endocarditis) was the cause, in 10,0% a lethal extracardiac congenital malformation was present and in 21,6% the cause of death was not related to the cardiac defect. From the results of the study we could conclude that the criterias in a post-mortem series depend enormously on the present clinical situation concerning the kind cardiac defect and the kind of therapy according to the development of cardiac surgery and interventional procedures. There are further current studies necessary in order to evaluate recent clinical questions using autopsy results.
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Associação entre complexidade das cardiopatias congênitas e o período pós operatório sob ventilação mecânica invasiva

Santos Junior, Daniel dos 17 August 2017 (has links)
Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-10-31T16:39:22Z No. of bitstreams: 1 danielSantosJunior_dissert.pdf: 3226623 bytes, checksum: 477c93c04c202181bf3ce038329c2637 (MD5) / Made available in DSpace on 2018-10-31T16:39:22Z (GMT). No. of bitstreams: 1 danielSantosJunior_dissert.pdf: 3226623 bytes, checksum: 477c93c04c202181bf3ce038329c2637 (MD5) Previous issue date: 2017-08-17 / Congenital heart diseases are presented as a group of conditions that account for a great number of deaths. Pointed out this complexity, several studies are focused on understanding how these can best treated by surgical procedures that could be less harmful to the patient. Invasive mechanical ventilation is one of the major supporting at the time of performing such procedures, but this could be one of the greatest complications at the time of the patient´s evolution in the ICU environment, since the moment of its withdrawal depends on many factors. Objective: The aim of this study was to evaluate whether the time required for a safety extubation following the surgical procedure would be associated to the complexity of the preoperative cardiopathy. Methodology: A total of 352 medical records of patients from a three-year period who had undergone surgery and maintained in the ICU were investigated . They were divided into two groups: neonates and non-neonates. To perform the statistical tests, six groups were created for evaluation among them, according to the degree of complexity. Rachs-1 Cardio-Surgical Risk assessment was taken into account to observe each patient´s degree of complexity. Results: Non-Neonates: Discrete male predominance in the period. When we compared the mortality according to the increase in the complexity, we could observe a statistically significant difference in four of the six evaluated groups, as well as the intubation time length , which was higher as the complexity of heart diseases increased. Regarding the estimative lines of intubation time, the best correlation was the polynomial with a 0.84-correlation coefficient, which could be feasible at the moment to evaluate intubation time. Neonates: Predominance of male sex. There was no significant difference in relation to mortality according to Rachs-1, as well as the intubation length of time. Thus, there was no statistically significant difference between the samples; this demonstrated that there was no increase in time length as the complexity increased. CONCLUSION: After assessing data and comparing them with the ones from the literature, we could conclude that the time length of patients´ intubation in the postoperative period of cardiac surgery is directly related to the complexity of the heart failure to be corrected; except in newborns from this evaluated group. The extubation time length behaved polynomially, and could be feasible to predict the patient´s extubation. Regarding the deaths, there is a relationship with a higher number according to the increase of the complexity of the heart failures, but no relationship was observed according to the case of the newborns. / As Cardiopatias Congênitas apresentam-se como um grupo de afecções que respondem por um grande número de óbitos. Levando-se em consideração esta complexidade, várias são as pesquisas com foco no entendimento de como estas cardiopatias podem ser mais bem tratadas, a partir de procedimentos cirúrgicos que se apresentam menos lesivos ao paciente. Um dos maiores aliados no momento da realização de procedimentos de grande porte como tal, é a ventilação mecânica invasiva. No entanto, este auxílio pode ser um dos maiores complicadores no momento da evolução do paciente no ambiente de UTI, pois o momento da sua retirada depende de muitos fatores. OBJETIVO: O objetivo deste trabalho foi avaliar se o tempo necessário para a realização da extubação com segurança do paciente, após a realização do procedimento cirúrgico, estaria ligado à complexidade da cardiopatia pré-operatória. METODOLOGIA: Foram investigados prontuários de 379 pacientes de um período de três anos, os quais passaram por cirurgia e estiveram na UTI. Foram divididos em dois grupos: neonatos e não neonatos. Para a realização dos testes estatísticos foram gerados seis grupos para avaliação entre eles, de acordo com o grau de complexidade. Levou-se em consideração a avaliação de Risco Cárdio-Cirúrgico Rachs-1 para constatação do grau de complexidade de cada paciente RESULTADOS: Não Neonatos: Discreta predominância do sexo masculino no período. Quando comparamos a mortalidade de acordo com o aumento da complexidade, pudemos observar diferença estatisticamente significante em quatro dos seis grupos, bem como, o tempo de intubação, que foi maior conforme o aumento da complexidade das cardiopatias. Com relação às linhas de estimativa de tempo de intubação, observou-se que a melhor correlação foi a polinomial com coeficiente de correlação de 0,84, podendo ser útil no momento da avaliação de tempo de intubação. Neonatos: Predomínio do sexo masculino. Não houve diferença significante com relação à mortalidade de acordo com o Rachs-1, bem como o tempo de intubação. Assim, sem diferença estatística considerável entre as amostras, o que demonstrou não haver aumento de tempo de acordo com o aumento da complexidade. CONCLUSÃO: Após a avaliação dos dados e confrontá-los com dados da literatura, concluiu-se que o tempo de intubação em pacientes no pós-operatório de cirurgia cardíaca está diretamente ligado à complexidade da cardiopatia a ser corrigida; exceto em pacientes recém-nascidos no grupo avaliado. O tempo até a extubação comportou-se de forma polinomial, podendo ser útil na predição para uma possível extubação do paciente. Com relação aos óbitos observamos que existe associação com o maior número de acordo com o aumento da complexidade das cardiopatias, porém, mais uma vez, no caso dos recém-nascidos não foi observada relação.

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