Objective To identify clinical and echocardiographic indicators of the necessity for early
surgical closure of patent ductus arteriosus in preterm neonates. Methods The prospective study was conducted at the Neonatal Unit of Hospital Municipal
Odilon Behrens between 2006 and 2010. The study population comprised 115 preterm
neonates diagnosed with patent ductus arteriosus in the first week after birth, of
whom 55 (group S) were submitted to clinical and or surgical closure and 60 (group
NS) received non-surgical treatment. The parameters analyzed were birth weight,
diameter of the ductus arteriosus (DAD), left atrial-to-aortic root diameter ratio
(LA:Ao), the quotient of DAD2 and birth weight (mm2/kg), and
ductal shunting. Results The study population comprised 58 males and 57 females. The average birth weight
of group S (924 ± 224.3 g) was significantly (P=0.049) lower than
that of group NS (1012.3 ± 242.8 g). The probability of the preterm neonates being
submitted to surgical closure was 62.1% (P=0.006) when the
DAD2/birth weight index was > 5 mm2/kg, 72.2%
(P=0.001) when the LA:Ao ratio was > 1.5, and 61.2% when
ductal shunting was high (P=0.025). Conclusion The parameters DAD2/birth weight index > 5 mm2/kg, LA:Ao
ratio > 1.5 and high ductal shunting were statistically significant indicators
(P<0.05) of the need for surgical closure of patent ductus
arteriosus in low birth weight preterm neonates. Moreover, when an LA:Ao ratio
> 1.5 was associated with the occurrence of shock, the probability of surgical
closure increased to 78.4%.
The authors describe a case of Takayasu's arteritis in a child of only 3 years of age, emphasizing the rarity of this disease in this age group. The child was admitted to the emergency room in a post-convulsive state after a tonic-clonic seizure. After a detailed clinical examination, extensive diagnostic tests, and observation of the clinical evolution, the diagnosis was Takayasu's disease with severe cardiac and arterial involvement. The report warns pediatricians and cardiologists to awareness of the possibility of this disease in very small infants, in countries where it is underdiagnosed.
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