RESUMENAntecedentes: En Chile las malformaciones congénitas son la primera causa de mortalidad neonatal precoz, siendo las cardiopatías congénitas su principal factor. La incorporación de la ecocardiografía prenatal es de gran ayuda en su pesquisa precoz. Objetivos: Evaluar la ecocardiografía prenatal como prueba diagnóstica y su concordancia con la ecocardiografía posnatal. Métodos: Se analizaron embarazadas derivadas al Hospital de Niños Dr. Roberto del Río entre abril 2004 y abril 2008, por sospecha de cardiopatías congé-nitas con posterior control neonatal. Resultados: Se evaluaron 188 embarazadas tanto con diagnóstico de cardiopatía congénita como con ecocardiografía normal. La edad gestacional promedio de derivación fue de 32 semanas, siendo la principal causa la sospecha de cardiopatía congénita en el examen obstétrico de rutina. Como prueba diagnóstica se obtuvo una sensibilidad de 100% y especificidad de 40% con una moderada concordancia entre ésta y el examen postnatal. Como prueba diagnóstica la ecocardiografía prenatal, se obtuvo una sensibilidad de 100% y especificidad de 89% del examen, al ser evaluada como cardiopatías en general, con una muy buena concordancia entre ésta y el examen postnatal. Discusión: Existe una tardía derivación y diagnóstico prenatal de las cardiopatías congénitas a nivel nacional, siendo importante capacitar aún más a los obstetras que realizan este tamizaje. La ecocardiografía prenatal realizada en nuestro centro por cardiólogos es una confiable herramienta diagnóstica con una muy buena concordancia con la ecocardiografía posnatal.PALABRAS CLAVES: Cardiopatía congénita, ecocardiografía prenatal, prueba diagnóstica, índice kappa SUMMARYBackground: In Chile, congenital malformations are the first cause of early neonatal mortality, the congenital heart defects its the main factor. The incorporation of antenatal echocardiography is very helpful in your research early. Objectives: To evaluate prenatal echocardiography as a diagnosis test and their concordance with postnatal echocardiography. Methods: We analyzed pregnancy who were derived to the Hospital de Niños Dr. Roberto del Rio, between April 2004 and April 2008, where studied because suspicion of having congenital heart defects with subsequent neonatal control. Results: 188 pregnancy were evaluated either with a diagnosis of congenital heart defect or with normal echocardiography. The mean gestational age of derivation was 32 weeks, the main causes the suspicion of congenital heart defect on routine obstetric examination. When being studied as diagnosis test it was obtained a sensitivity of 100% and a specificity of 40% with a moderate concordance between both echocardiographies. When analyzing with the diagnosis test prenatal echocardiography, it was obtained a sensitivity of 100% and a specificity of 89% of the review,
The clinical, phonocardiographic, hemodynamic and angiocaidiographic findings in 8 children with aplastic pulmonary valve are presented. All had a ventricular septal defect and in 6 there was aiso an infundibular pulmonic stenosis. Clinically, the most striking feature was late, low frecuency diastolic murmur of crecendo decrescendo quality and maximal intensity in the second and third left intercostal space, asociated with single, normal intensity second sound and, radiologically, abnormal parahiliar shadows, specially on the right side, or aneurysmatic dilatation of the pulmonary artery trunk. The angiocardiographic work-up usually showed aneurysmatic dilatation of the pulmonary artery trunk or his main branches and sudden peripheric reduction of their lumen. These findings are not seen in any other heart disease. The ethiology and results of surgical treatment of this abnormality are analized.
Echocardiographic identification of patent ductus arteriosusContrast echocardiography (CE) was carried out in 16 newborns less than 72 hours of life weighing under 2.000 g, by inyecting 5% dextrose in water through an umbilical artery catheter, with simultaneus echocardiographic register of the pulmonary artery (PA). An X ray contrast aortography was made afterwards. According to the intensity of the echos obtained from PA, CE was classified in grade I (weak echos) and grade II (dense echos). The size of PDA as seen in the aortography was classified depending on the ratio of to descending aortic diameter: ratios greater than 0.5 indicated large ductus, ratios less than 0.5 indicated small ductus. The aortographic-echocardiographic correlation was excelent: 11 cases with aortographic PDA had positive CE: 8 aortographic large PDA with CE grade II and 3 aortographic small PDA with CE grade I. This CE technique is easy to obtain and credible to detect PDA in prematures, allowing an early medical or surgical treatment. (
The clinical and hemodynamic data in 80 children with Ostium Secundum atrial septal defect (OS-ASD) were analyzed. Sixty one of them weie followed after surgical repair during a period of one month to six years. It must be emphasized that OS-ASD rarely causes significant symptoms in childhood and that it is infrecuently diagnosed in the first years of life. Nevertheless the clinical features of OS-ASD are typical allowing an appropriate diagnosis and even an estimate of the magnitude of the shunt. In contrast with the experience in adults the surgical treatment of children with OS-ASD is safe and with low morbidity (0%mortality and 4,9%morbidity in our serie). For that reason it is very important to make an early diagnosis and surgical repair.La Comunicacion Interauricular tipo Ostium Secundum (CIA-OS) constituye alrededor del 15% de las cardiopati'as congenitas en el nino, siendo despues de la Comunicacion interventricular la mas frecuente. El defecto permite un cortocircuito de izquierda a derecha entre las auriculas cuya direction y magnitud dependen del tamano del defecto y de la resistencia al flujo sanguineo hacia los respectivos ventrfculos; normalmente el ventn'culo izquierdo crea una mayor resistencia al llenado diastolico desde la auricula que el ventn'culo derecho, mas delgado y distensible. Es asi como en la CIA-OS el flujo pulmonar es 2 a 3 veces mayor que el sistemico siendo esto tolerado durante anos sin gran dificultad. Hacia la cuarta decada de la vida, sin embargo, se cpmplica frecuentemente con hipertension pulmonar, trastornos del ritmo e insuficiencia cardiaca, determinando con ello una significativa menor sobrevida 1 -2-3-4-5-6-7 La correction quirurgica de la CIA-OS es efectiva y con baja morbimortalidad si se realiza en nihos. De ahi la importancia de diagnostics y tratamiento precoces, aun en sujetos asintomaticos.El objeto de esta revision fue mostrar la forma de presentation, evolution natural y post-operatoria de la CIA-OS en nuestro medio.For constituir embriologica, ch'nica y hemodinamicamente una entidad diferente optamos por excluir las Comunicaciones Interauriculares tipo Ostium Primum. MATERIAL Y METODODe 156 fichas clinicas de pacientes portadores de CIA-OS controlados en la Unidad de CardioUnidad de Cardiologi'a, Hospital Roberto del Rio. Trabajo de incorporacion a la Sociedad Chilena de Pediatn'a. logia del Hospital Roberto del Rio se seleccionaron 80 por contener information completa. En ellas se efectuo un analisis retrospectivo ch'nico, auscultatorio-fonocardiografico y hemodinamico. Los niveles de signification estadistica se realizaron segiin la distribucion de Students.El seguimiento ch'nico de los niuos operados fluctuo entre 1 mes y 6 aiios. Todos los pacientes estan vivos. RESULTADOS
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