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Ana Carriço

Publications and source records attributed to Ana Carriço.

9 recordsLinked to original sources
PubMed2005

Exercise testing in pediatric cardiology.

Exercise testing in pediatric patients differs in many aspects from the tests performed in adults. Diseases that are associated with myocardial ischemia are very rare in children. Their cardiovascular response to exercise presents different characteristics, particularly maximal heart rate and blood pressure response, which are essential in interpreting hemodynamic data. The main indications for exercise testing in children are evaluation of exercise capacity and identification of exercise-induced arrhythmias. There are many testing protocols, but the Bruce protocol is widely used in many pediatric cardiac centers. In this article the authors describe the main indications for exercise testing in children with congenital heart disease, the contraindications for exercise testing and the indications for terminating an exercise test.

Blood Pressure↗
PubMed2004

Balloon pulmonary valvotomy performed in the first year of life.

OBJECTIVE: Evaluation of the global results after percutaneous pulmonary valvotomy with a balloon catheter performed in the first year of life. METHODS: We assessed retrospectively the data of 27 patients with pulmonary stenosis who underwent balloon valvotomy in the first 12 months of life, from January 1994 to July 2002. The following data were evaluated: gender, age at diagnosis, clinical presentation, echocardiographic features, other cardiac anomalies, age at balloon valvotomy, diameter of pulmonary annulus, initial and final pressure gradient across the valve, complications and follow-up. We used the median and the Wilcoxon test. For other variables we present the mean and standard deviation. RESULTS: Fourteen patients (52%) were female. We had two prenatal diagnoses. Age at diagnosis ranged between one and 60 days (median: 28.0). With regard to clinical presentation, one (4%) had isolated cyanosis, seven (28%) a systolic murmur and 17 (68%) both cyanosis and a systolic murmur. Associated malformations included: ventricular septal defect--two, dilatation of left pulmonary artery--one, supravalvar stenosis--one, and subvalvular membrane--one. The pulmonary annulus ranged between 4.5 and 11 mm (mean: 8.3 +/- 1.8). The procedure was performed in 23 patients aged 2 to 357 days (median: 60), 43.5% of cases in the first 28 days of life. Balloon diameter ranged from six to 14 mm (mean: 10.7 +/- 2.3). The median value of right ventricular peak systolic pressure before dilatation was 115 mmHg (variation: 60-212) and decreased to 48 mmHg (variation: 20-120) (p < 0.001). Significant infundibular stenosis was documented in five cases and propranolol was initiated after the procedure. In four cases the procedure was abandoned before dilatation. The follow-up period ranged from 0 to 101 months (mean: 40.1 +/- 32.1). The maximum instantaneous gradient between the right ventricle and the pulmonary artery ranged between 0 and 95 mmHg (mean: 23.7 +/- 19.5), and was more than 40 mmHg in 13% of the cases. CONCLUSIONS: Percutaneous pulmonary valvotomy with a balloon catheter performed in the first year of life is effective in relieving obstruction of the right ventricular outflow tract. The success rate was 78% (21 of 27 patients).

Catheterization↗
PubMed2004

How important is a cardiac echogenic focus in a routine fetal examination?

UNLABELLED: Intracardiac echogenic foci are very frequent findings during routine fetal ultrasound examination and sometimes a reason for referral of patients for fetal echocardiography. OBJECTIVE: To assess the incidence of echogenic intracardiac foci in a mixed population of fetuses at high and low risk for congenital heart defects, and to determine whether the association between echogenic foci and congenital heart disease is stronger than in the general fetal population. DESIGN: Retrospective evaluation of clinical files at two fetal cardiology referral centers, during the last two years. All cases that had at least one echogenic focus were selected for our study. Maternal age, gestational age, reason for referral, location and number of echogenic foci, chromosomal abnormalities and cardiac defects were analyzed. As previous studies suggest increased risk of trisomy associated with echogenic foci and considering that congenital heart defects are more frequent in fetuses with trisomy 21, we excluded all fetuses with aneuploidy from our study. RESULTS: Thus, 753 clinical files were reviewed, of which 61 (8.1%) had a fetus with at least one echogenic focus. Mean maternal age was 29.0 years (minimum--19 years, maximum--43 years). Mean gestational age at the time of the examination was 23.4 weeks (minimum--19 weeks, maximum--31 weeks). In 48.0% the reason for referral for fetal echocardiography was the existence of echogenic foci previously seen during a routine maternal examination. Increased nuchal translucency in 13.0% of pregnant women, maternal age in 10.0%, family history of congenital heart defects in 8.4%, suspicion of cardiac malformation in the obstetric scan in 4.2%, twinning in 4.0%, history of miscarriage in 2.1% and maternal pathology in 10.3% were other referral reasons. In 53 cases a single echogenic focus was found, 44 of them inside the left ventricle and 9 in the right ventricle. Multiple echogenic foci were found in the different heart chambers in the eight remaining cases. Fifty-six fetuses had a structurally normal heart and in five (8.1%) a cardiac defect was found. CONCLUSION: Echogenic foci are commonly seen inside heart chambers during routine fetal heart scanning, the left ventricle being the most frequent location. Although they probably represent a normal variant of papillary muscle development their presence should be interpreted as a possible risk for congenital heart defects.

Adult↗
PubMed2003

Patients with aortic coarctation operated during the first year of life, different surgical techniques and prognostic factors--21 years of experience.

UNLABELLED: The authors reviewed the clinical files of all patients with coarctation of the aorta (CoAo) operated during the first year of life, in a tertiary center, in order to assess the outcome of different surgical techniques and prognostic factors. MATERIAL AND METHODS: The study included all patients operated from 1 June 1980 to 1 June 2001. They were divided into three groups according to diagnosis: Group I--isolated CoAo (with or without persistent ductus arteriosus (PDA), group II--CoAo plus ventricular septal defect (VSD), and group III--CoAo associated with complex heart defects. The surgical techniques were divided into four groups: Group A--resection of the CoAo with end-to-end anastomosis, group B--Waldhausen technique (subclavian flap), group C--enlargement of the aorta with a patch, and group D--Waldhausen technique plus resection of the CoAo with end-to-end anastomosis. Several parameters were analyzed: sex, age at surgery, other surgical procedures during surgery, reoperation, mortality and outcome (good result, recoarctation). RESULTS: 156 patients were operated during the study period (84.5% of them since 1989). 61.5% were male. Surgery was performed between 3 and 336 days of life. 60.9% patients were included in group I, 32.7% in group II and 6.4% in group III. 25.0% of the patients had group A surgery, 60.2% group B surgery, 7.0% group C surgery and 7.7% group D surgery. The PDA was sectioned in 48.0% of the patients. It was necessary to perform banding of the pulmonary artery, during the first surgery, in 19.9% of cases. 18.6% needed a second operation to close the VSD and for debanding or repair of associated defects. Total mortality was 19.2%. Mortality rate per groups was: Group I--15.8%, group II--21.5%, group III--30.0%, group A--18.0%, group B--19.1%, group C--27.2% and group D--16.7%. In 7.6% of the patients recoarctation was found during follow-up. 40% of the patients are doing well with no medication and minor or no residual defects. 29.4% were lost to follow-up. CONCLUSIONS: Total mortality has decreased over the years with the highest mortality found in Group C and Group III. The best results were achieved in patients with isolated CoAo. Long-term results were generally good with few recoarctations and a good quality of life.

Aortic Coarctation↗