Cardiopatia congênita no recém-nascido: da solicitação do pediatra à avaliação do cardiologista

Abstract

SummaryObjective: To analyze the importance of symptoms as a reason for referral to pediatric cardiologists in the diagnosis of congenital heart diseases (CHD) in the newborn (NB).Methods: Prospective study on live NB referred for cardiac evaluation, with performance of electrocardiogram, chest radiography and echocardiography. Cardiology consultation was requested by means of a multiple-choice form including signs and symptoms suggestive of CHD. Patent ductus arteriosus (PDA) without clinical and/or hemodynamic consequences was not considered a heart disease.Results: From 1999 to 2002, 358 out of 3716 NB were studied, and 49 cases of CHD and 128 of PDA were found. The prevalence of CHD was 13.2:1000 NB. The main reason for referral to the cardiologist was heart murmur in 256 (72%) NB, of which 39 (15%) had CHD, and in 91% of the 128 cases of PDA. In 14 (4%) NB, the reason for referral was cyanosis, and eight of these patients (57%) had a CHD. Heart failure was the reason for referral in 37 (10%) NB, of whom 17 (46%) had CHD. Arrhythmia, associated congenital malformations, or chromosome disorders were the reasons for referral in 14% of the cases. Conclusion:The main reason for referral was detection of a heart murmur on cardiac auscultation. Although cyanosis and heart failure were uncommon reasons for referral, their presence indicated a high probability of the diagnosis of heart disease. Pediatric screening plays a key role in this diagnosis. (Arq Bras Cardiol 2007; 89(1) : 6-10)

Perfil clínico-hospitalar de crianças com cardiopatia congênita

“…Nas cardiopatias CIA e PCA, enquanto os dados literários mensuravam entre 5 e 10% de ocorrência, os valores coletados apontaram 29,87 e 25,97%, respectivamente, números muito acima do esperado. Dentro da média histórica, foram constatadas a EP (11,69%) e a Transposição de Grandes Artérias (TGA) (3,9%) com pequenas variações, porém próximas aos valores de referência de 8-12% para a EP e de 5% para transposição de grandes artérias 14,18 . As malformações EA e CoA apresentaram percentuais bem abaixo da referência literária, com 8-12% e 8-10%, respectivamente, registrando dois casos do primeiro (2,6%) e apenas um do segundo (1,3%) 12,14,18 .…”

“…Dentro da média histórica, foram constatadas a EP (11,69%) e a Transposição de Grandes Artérias (TGA) (3,9%) com pequenas variações, porém próximas aos valores de referência de 8-12% para a EP e de 5% para transposição de grandes artérias 14,18 . As malformações EA e CoA apresentaram percentuais bem abaixo da referência literária, com 8-12% e 8-10%, respectivamente, registrando dois casos do primeiro (2,6%) e apenas um do segundo (1,3%) 12,14,18 . Outro diagnóstico surpreendente foi a frequência do DSAV, com valor superior a dez vezes (10,39%) ao registrado historicamente, que não chega a atingir 1% dos casos.…”

Malformações cardíacas congênitas em necropsias pediátricas: características, associações e prevalência

“…In Brazil, the prevalence of these defects varies between 5.5:1000-13.2:1000 live births 6,8,[11][12][13][14][15] . Since 2001, the congenital abnormalities are the second cause of mortality in children younger than one year in our country, according to the Mortality Information System of the Ministry of Health, being responsible for 11.2% of these deaths, with 39.4% of all children's deaths due to malformation being ascribed to cardiovascular defects in 1997 16 .…”

“…In all studies that have been published, not only in Brazil 7,12,[15][16][17] but also in other countries 20,21 , one can observe the high prevalence of congenital cardiac malformations in live births and stillbirths, with the most frequent congenital defects being the interventricular and interatrial communications 13 and the patent ductus arteriosus 21 . These congenital cardiac defects, Aortic arch hypoplasia which affect mostly children from the neonatal age 22 or even infants, are the most prevalent ones regardless of the population and the methodology used 14 , in agreement with the results of the present study.…”

“…These abnormalities appear as the main cause of death in childhood in the first-world countries. With improvements in the diagnosis and treatment, the mortality due to congenital cardiopathies has decreased considerably in the last years, thus increasing the prevalence of congenital cardiac malformations, which has a devastating socioeconomic and emotional impact, requiring more efforts regarding prevention measures.In Brazil, the prevalence of these defects varies between 5.5:1000-13.2:1000 live births 6,8,[11][12][13][14][15] . Since 2001, the congenital abnormalities are the second cause of mortality in children younger than one year in our country, according to the Mortality Information System of the Ministry of Health, being responsible for 11.2% of these deaths, with 39.4% of all children's deaths due to malformation being ascribed to cardiovascular defects in 1997 16 .…”