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Biomedical subjects

J A Granzotti

Publications and source records attributed to J A Granzotti.

17 recordsLinked to original sources
PubMed2000

Congenital atresia of the ostium of the left coronary artery. Diagnostic difficulty and successful surgical revascularization in two patients.

We report two cases of congenital atresia of the ostium of the left coronary artery. Case 1: a six-month-old infant presenting with serious cardiac insufficiency. A noninvasive diagnosis of dilated myocardiopathy was established and the clinical picture was pharmacologically compensated. When the patient was nine months of age, a hemodynamic study was performed that revealed congenital atresia of the ostium of the left coronary artery; the infant immediately underwent a successful anastomosis of the internal mammary artery with the left coronary artery. Case 2: an eleven-year-old asymptomatic boy with a history of heart murmur from the age of six months on, was referred for surgery with a diagnosis of anomalous origin of the left coronary artery from pulmonary trunk. A definitive diagnosis of atresia of the left coronary ostium was only established during surgery. Successful surgical revascularization with the left internal mammary artery, and left ventricular aneurysmectomy were performed.

Child↗
PubMed1999

Cardiologic evaluation of children with suspected heart disease: experience of a public outpatient clinic in Brazil.

CONTEXT: During initial evaluation of children on an outpatient basis, the index of suspected heart disease may be high, particularly if we consider that innocent murmur occurs in about 50% of the pediatric population. This is the most common cause of referral to the pediatric cardiologist. OBJECTIVE: To report on the experience of a public outpatient clinic in the southeastern region of Brazil. DESIGN: Retrospective analysis of all patients submitted to cardiologic evaluation within a 39 month period. SETTING: Public pediatric cardiology outpatient clinic. PARTICIPANTS: 2675 consecutive children aged</=15 years referred from the local and regional basic health units due to suspected heart disease. MAIN MEASUREMENTS: Reason for referral, diagnostic investigation, final diagnosis based on the reason for referral, therapeutic procedures. RESULTS: The main reasons for referral were: murmur (70%), precordial pain (9%), suspicion of arrhythmia (9%) and breathlessness (5%). Of the total number, 695 cases (26%) did not complete the investigation and were not included in the analysis. A final diagnosis was obtained based on the reason for referral and the main conclusions were: l) a high incidence of normality was found: murmur (83%), pain (98%), arrhythmia (97%) and breathless (94%); 2) heart disease was unlikely, based on other referral reasons; 3) 14% of the children were considered abnormal and 1% needed therapeutical procedures. CONCLUSIONS: The establishment of a pediatric cardiology outpatient clinic within the public health service in the region seems to be justifiable, due to the high current demand. The low global incidence of heart disease, with a high prevalence of children with innocent murmur, discloses the need for a specific training program in cardiology for pediatricians.

Ambulatory Care Facilities↗
PubMed1999

Anomalous origin of the left coronary artery from the pulmonary trunk. Clinical features and midterm results after surgical treatment.

OBJECTIVE: To report the authors' experience with the anomalous origin of the left coronary artery (AOLCA) from the pulmonary trunk, emphasizing preoperative data, surgical aspects and midterm results of the follow-up. METHODS: Retrospective analysis of 11 patients operated upon at the Royal Brompton Hospital from October, 84 to April, 97. RESULTS: Nine infants had heart failure (HF) and two other children presented with dyspnea and chest pain. All had ECG changes. The echocardio-gram identified the anomalous origin of the coronary artery in 7 (64%) patients and hemodynamic studies were performed in 7 patients. All infants were operated upon between the 2nd and 10th month of life. Six patients were treated with aortic reimplantation of the left coronary artery, whereas five were operated upon according to the Takeuchi technique. All patients are alive, with clear improvement of the ECG changes and ventricular function, as evaluated by echocardiography. Two patients operated upon according to the Takeuchi technique required additional surgery due to severe supravalvular pulmonary stenosis. CONCLUSION: AOLCA is a rare disease. Most patients show early signs of severe HF associated with ECG findings. Surgical therapy must be instituted early in the disease, preferentially through aortic implantation of the anomalous coronary artery, with a high possibility of success. Shortly after surgery, clinical and ECG improvement, as well as normalization of left ventricular function, should be expected.

Adolescent↗
PubMed1997

[Quality of life after surgical correction of the aorta coarctation. Retrospective analysis of a group of patients with long-term follow-up].

PURPOSE: To report on the long-term results after operation for coarctation of the aorta. METHODS: One hundred and four patients were studied, divided in four groups (G1, G2, G3 and G4), according to age at operation. Data analysed: reoperation, persistent hypertension, residual lesions, left ventricular function and ability index. RESULTS: Reoperation was frequent, mainly in G1 (60%) and G4 (29%). Resting hypertension occurred predominantly in cases operated on after the 10th year of life: 28% (G3) and 29% (G4). Exercise hypertension was found in cases operated on after the 20th year. Residual lesions were frequent: 97%, 98%, 83% and 65% (G1 to G4). Individual functional limitation was uncommon. The ability index was normal in the great majority of the patients (94%). CONCLUSION: Reoperation is frequent, particularly for recoarctation and aortic stenosis. Rest and/or exercise hypertension is common and related to delayed surgery. Aortic residual lesions are frequent. Physical limitation is uncommon. Postoperative follow-up is essential in order to detect late complications, which, usually, do not limit the individual patient.

Adolescent↗
PubMed1996

[Massive pulmonary arteriovenous fistula. A rare, potentially curable cause of hypoxia in the newborn].

The case of a six-day-old neonate admitted in an emergency situation because of dyspnea and increasing cyanosis is reported. Despite abnormal opacification on the chest X-ray and left ventricular overload on the electrocardiogram and echocardiogram, features compatible with the disease, the diagnosis of massive pulmonary arteriovenous fistula affecting the whole left superior lobe, was made possible only after necroscopic examination.

Arteriovenous Fistula↗
PubMed1996

[Neonatal heart failure and Marfan syndrome].

We report the case of a neonate admitted to the hospital in the 4th day of life in severe heart failure due to aortic and mitral regurgitation with a largely dilated aortic root. The associated skeletal features involving the superior and inferior limbs as well as the thorax, and joint hypermobility, allowed the clinical diagnosis of Marfan syndrome. Despite favorable initial response to medical therapy, sudden deterioration led to death two weeks after birth. Typical necroscopic findings were confirmed and the case is considered the most severe clinical manifestation possible to be found in this syndrome.

Fatal Outcome↗
PubMed1995

[Management of children with heart murmurs. Diagnostic importance of noninvasive complementary tests].

PURPOSE: To determine the benefits of noninvasive tests in the characterization of heart disease in children referred due to heart murmur. METHODS: Two hundred and thirty three consecutive children were fully examined with the aid of the electrocardiograma (ECG), chest X-ray and echocardiogram (ECHO). The patients were divided in 2 groups according to the initial diagnosis of innocent murmur (n = 23) and pathological murmur (n = 210). A comparison was made between the initial and final diagnosis after the noninvasive tests. Statistical analysis was employed through the qui-square test. RESULTS: The initial diagnosis did not change after ECG. The chest X-ray induced the diagnosis of idiopathic dilatation of the main pulmonary artery in one case and of cardiomyopathy in 8 cases, confirmed in only one. After ECHO, the initial diagnosis of innocent murmur was maintained in 70% of the cases, while 30% had some form of heart disease. In 80% of the pathologic murmur group, the diagnosis did not change after ECHO, while 20% were considered as having an innocent murmur. In the 2 groups together, the concordance index between initial and final diagnosis after ECHO reached 90%. Statistically, a non-significant difference was found between the 2 groups. CONCLUSION: Careful clinical examination is mandatory in the initial evaluation of children with heart murmur. ECG and chest X-ray does not change the initial clinical diagnosis. After ECHO, the diagnosis changing was low (10%), as long as clinical mistakes are eliminated. The initial diagnosis of innocent murmur excludes the necessity of noninvasive tests with a small possibility of error. EKG, chest X-ray and ECHO should be reserved to cases with obvious or persistent suspicious heart disease after clinical examination.

Adolescent↗
PubMed1993

[Delayed follow-up after aortic coarctation correction. Subsequent surgical reoperation].

PURPOSE: To determine the frequency and main features of subsequent cardiovascular surgery in patients operated on for coarctation of the thoracic aorta. METHODS: One hundred and five patients operated on for coarctation of the aorta with a mean follow-up period of 14 years had their notes analysed. The patients were divided in 4 groups according to age at correction of the coarctation. The incidence of recoarctation repair and other cardiovascular operations were noted. RESULTS: Surgical morbidity was important: 33%. Recoarctation occurred in 14% of the cases, mainly in those who had the coarctation resected during the first year of life. Operation for other cardiovascular defects was necessary in 24.5% of the cases. Among these, correction of left-to-right shunts was done in 50% of the patients who had the coarctation resected in the first year of life. Relief of aortic stenosis was the most frequent procedure (73%), tends to be more frequent the other is the patient at coarctation repair and more than one procedure may be necessary in some cases. CONCLUSION: Reoperation is frequent in the long term of patients operated on for coarctation of the aorta. The elective coarctation should be repaired after the first year of life hoping to avoid recoarctation. Routine follow-up is advisable for all patients aiming to detect residual left-to-right shunts and left ventricular outflow tract obstruction. Family counseling regarding prognosis after coarctation resection is recommended.

Adolescent↗
PubMed1993

[Aortic coarctation associated with a large aneurysm].

The case of a symptomatic 16-year-old girl, referred with the diagnosis of coarctation of the aorta is presented. Aortography showed a severe coarctation and a huge aneurysm distal to the coarctation. Successful operation was performed with resection of the coarctation and aneurysm and interposition of a tube of bovine pericardium for the anastomosis. Two months after the operation the blood pressure was normal and a 10 mm/Hg gradient was detected by doppler-echocardiography.

Adolescent↗
PubMed1990

[Nutritional index in heart diseases in childhood].

PURPOSE: To study heart disease in childhood aiming to know its incidence and consequences upon the nutritional status. PATIENTS AND METHODS: Two-hundred patients were distributed in three groups: 1) 113 (56.5%) with congenital acyanotic form; 2) 19 (9.5%) with congenital cyanotic form and 3) 68 (34%) with acquired forms. All of them regularly visiting the ambulatory service of Paediatric cardiology of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da USP from 1987 until 1990. RESULTS: The majority (92%) of the children (being 56% male and aging 5.1 +/- 0.4 years-old) showed nutritional indexes between 5 and 95 (percentile scale). The overall diagnosis distribution were: 1) ventricular septal defect (51 cases); 2) atrial septal defect (21 cases); 3) valvular diseases (21 cases); 4) arrhythmias (20 cases); 5) cardiac involvement of systemic diseases (20 cases); and 6) tetralogy complex (8 cases). Twelve patients (6%) were underscored (below percentile 5) and only 4 (2%) scored above percentile 95 (obese patients). The comparison of the mean indexes were found statistical different (p less than 0.05), being the cyanotic congenital forms the worst ones and the acquired forms the best one. CONCLUSION: Heart disease in childhood is associated to nutritional index deficits in the majority of the cases.

Body Height↗
PubMedDate not supplied

[Congenital rubella syndrome and the occurrence of congenital heart disease].

Aiming to document the incidence and type of associated congenital heart disease, 20 children affected with the congenital rubella syndrome have been evaluated during a 5 year period, starting 1988. Congenital heart disease was detected in 45% of the cases. Persistent ductus arteriosus was the most frequent finding, followed by ventricular and atrial septal defects. Hearing disturbances occurred in 83% of the 12 cases studied. Ophthalmic lesions appeared in 69% of the 13 cases analysed, congenital cataracts being the most frequent one. An association of 66% was found between ophthalmic and heart lesions. Regarding the nutritional index, 70% of the cases were situated between the 25th and 50th percentile. The relevant incidence of congenital defects and the documentation of an important number of cases in a short period of time point out to a significant prevalence of the syndrome with imperative need improve the vaccination programs.

English Abstract↗
PubMedDate not supplied

[Incidence of heart defects in Down syndrome].

Eighty-six patients with Down Syndrome were studied with the main purpose of quantifying the incidence of congenital heart defects and the risk of occurrence according to the mothers age. Thirty-eight patients had the cariotypes determined, 35 of them having trissomy of chromosome 21 and translocation in 3 cases. Congenital heart disease was found in 44 (51%) of the patients, the most common one being ventricular septal defect. An important incidence of Fallot's tetralogy was also found (20%). These 86 children were submitted to 41 surgical procedures, most of them on the cardiovascular system. The maternal mean age was 33 -/+ 8.6 years and the estimated risk of Down Syndrome was 1/590, a lower value than the one reported in other studies.

English Abstract↗
PubMedDate not supplied

[Cardiac evaluation in children with suspected heart disease. Preliminary results in 2000 patients].

Two thousand consecutive children have been evaluated for suspected heart disease in a 27-month period. The main reasons for referral were: murmur (70%), precordial pain (9.5%), suspicion of arrhythmia (8.5%) and breathless (5%). Five hundred and six (25%) cases did not complete the investigation and the results were not computed. A final diagnosis was obtained based on the reason for referral and the main conclusions were: 1) a high incidence of normality was found: murmur (83%), pain (98%), arrhythmia (97%) and breathless (94%); 2) heart disease is unlikely when other referral reasons were analyzed; 3) 14% of the children were considered abnormal and the necessity of therapeutic procedures was 0.8%. A pediatric cardiology outpatient clinic in a public setting seems to be justifiable in the region, due to the high current demand.

English Abstract↗