Critério de relação ecocardiográfica. Um novo método para a indicação da valvotomia mitral com cateter-balão
Pulse Therapy (High Dosis of Intravenous Methyl-Prednisolone) in Children with Rheumatic Carditis. Prospective Study of 40 Episodes
Arq. bras. cardiol; 60 (6), 1993
Publication year: 1993
PURPOSE--To find out new subjects that could be useful to select patients between 9 and 12 points, according to Block's Criteria, to mitral balloon valvotomy. METHODS--One hundred and forty patients underwent mitral balloon valvotomy. Among them, 29 (21) had between 9 and 12 points.
These patients were divided into two groups:
group A-patients with mitral valve area > or = 1.5cm2, immediately after balloon valvotomy and in the follow-up period; group B-patients with mitral valve area < 1.5cm2 immediately after or during the follow-up period, patients with severe mitral regurgitation after the procedure and patients who died in the follow-up period. All patients were analyzed by echocardiographic relation criteria (ERC): calcification + subvalvar disease/thickness + mobility. Each one was quantified from 1 to 4 points according to the degree of valvular disease. RESULTS--Group A was composed of 17 (51) and group B 12 (41) patients. The variables age, sex, previous mitral commissurotomy and atrial fibrillation did not show difference between groups. In group A mitral valve area (cm2) increased from 1.15 +/- 0.25 to 1.97 +/- 0.26 (p < 0.00001) keeping stable during the follow-up period. In group B percutaneous mitral balloon valvotomy resulted in an increase from 1.26 +/- 0.19 to 1.77 +/- 0.16 (p < 0.00001), however, there was an important decrease in the follow-up period to 1.34 +/- 0.15 (p < 0.00001). The ERC showed that all group A patients had a relation < 1. However, in group B, 10 patients (83), the relation was > or = 1, and in only 2 patients (17) was < 1 (p < 0.00001). CONCLUSION--The group of patients between 9 and 12 points in the Block's criteria is heterogenic, therefore, each case might be evaluated individually and the echocardiographic relation criteria should be used in order to select these patients to the procedure.
Objetivo - Diminuir o prazo de uso de corticoterapia na cardite reumática, mantendo o paciente internado e avaliar o tempo para negativação das provas de atividade da doença.
Métodos - Foram tratados 36 pacientes entre 6 e 17 anos (40 episódios) com metilprednisolona venosa (1g/dia) em séries de três dias semanais. O número de
séries variou de duas a quatro, dependendo da gravidade. Todos os pacientes preenchiam os critérios de Jones para diagnóstico de febre reumática. Todos foram submetidos a erradicação estreptocócica, PPD, tratamento de verminoses e dos focos dentários antes da
corticoterapia. Resultados - Todos os pacientes melhoraram da insuficiência cardíaca na época da alta. Em 6 casos ocorreram intercorrências durante a pulsoterapia, mas foram
controladas rapidamente. Foram realizadas duas séries em 10 pacientes, três em 9 e quatro em 21 episódios. Oito foram encaminhados para troca de válvula. O tempo de
negativação das provas de atividade reumática e da alta hospitalarioi 41,2±13,3 dias.
Conclusão - O esquema utilizado encurtou o tempo total de uso dos corticosteróides, podendo assim manter o paciente internado e eliminando-se a interrupção do tratamento da cardite. Não ocorreu diferença significativa quanto ao prazo de negativação das provas de atividade reumática entre o esquema clássico oral e a
pulsoterapia