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Publications (22)8.88 Total impact

  • G Nogueira, A J Macedo, S Kaku
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 07/2000; 19(6):741-3. · 0.53 Impact Factor
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    ABSTRACT: Abnormalities of cardiovascular structure and function have been described among children with human immunodeficiency virus (HIV). In order to evaluate their occurrence and clinical predictors, 32 children infected with HIV, aged three months to 13 years (mean age = 3.11 +/- 3.51 years) were studied. Perinatal transmission was identified in 90% of the children. Twenty-two patients (pts) (69%) had symptoms, nine being moderately symptomatic and eight severely symptomatic. Fourteen pts had immunological disturbances and eight of them were severely immunosuppressed. Twenty-eight pts (88%) had HIV-1 infection and 6 recent Ebstein-Barr virus coinfection. Nineteen were on zidovudine and 14 on intravenous immunoglobulin treatment. Nineteen cardiovascular abnormalities were found in 15 pts (47%): 11 cases of pulmonary hypertension by echocardiographic criteria (eight of them had interstitial lung infiltrates seen on chest X-ray) and four cases of left ventricular dysfunction requiring anticongestive therapy. Other abnormalities were: patent ductus arteriosus, septal hypertrophy, mitral valve prolapse and pericardial effusion (one case each). Surface ECG displayed right ventricular hypertrophy in four pts, left ventricular hypertrophy in one patient and unspecific ST-T wave changes in two pts. Fourteen pts (44%) had sinus tachycardia with mean heart rate above the 95th percentile on 24-hour Holter monitoring. CONCLUSIONS: Cardiovascular abnormalities are frequent among children with HIV-1 infection in late stages; pulmonary hypertension is the most frequently found cardiovascular anomaly and seems to be related to either chronic or recurrent respiratory disease; cardiological follow-up is recommended for HIV-infected children.
    Acta médica portuguesa 01/1999; 11(12):1051-7. · 0.28 Impact Factor
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    ABSTRACT: The mortality rate is high and prognosis is worse among new-borns with prenatal diagnosis of heart malformation, mainly due to factors such as its association with other malformations, and a range of more severe diseases probably resulting from the predominance of the obstetric use of the four chamber view. In this study we retrospectively assessed the range of cardiopathies diagnosed by foetal echocardiography and their evolution, compared with previous years. From January 1994 to December 1995, 1173 foetal echocardiograms were performed at a gestation age of 24 weeks. Sixty-one foetuses (5.2%) had cardiac anomalies, structural in 56 and arrhythmia in 5. The risks and indications were maternal in 37%, foetal in 31%, familial in 17% and environmental in 15%. Three were false negatives (VSD:2; truncus arteriosus: 1). Five died in utero, and 18 were assessed after birth with a mean gestational age of 37 weeks and birth weight of 3 Kg, a caesarean section was performed in 9. All but one were born in central hospitals. Six children were operated on. Two children died, one after surgery. Compared with the four previous years of activity, indication due to foetal risk rose from 6 to 31%, the number of cases diagnosed with heart disease increased from 14 to 30 per year, and the mortality decreased from 59 to 11%. Despite this, we still observe that the vast majority of new-borns who are hospitalised due to a severe heart disease had no prenatal diagnosis, indicating the need to continue our educational policy in this field.
    Acta médica portuguesa 08/1998; 11(7):655-8. · 0.28 Impact Factor
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    ABSTRACT: Cardiac hydatid cyst is a rare disease, especially in children. An 11-year-old boy with a previous anaphylactic reaction and episodes of abdominal pain was admitted for workup of an acquired long systolic murmur. Echocardiographic investigation disclosed a tumor of the right ventricular anterior wall, with multiple loculations. Magnetic resonance imaging characterized it as a multilobular tumor with cyst formation and disclosed another cyst in the right pulmonary artery. With a positive ELISA reaction the child was admitted for surgery with the diagnosis of cardiac and pulmonary hydatid cysts. Cardiac surgery was performed with good results, followed by medical treatment with albendazole.
    Pediatric Cardiology 01/1997; 18(3):226-8. DOI:10.1007/s002469900158 · 1.55 Impact Factor
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    ABSTRACT: A retrospective study was made of 6 children, with nonsurgical-related acute myocardial infarction (AMI), between January 1987 and December 1994. The ratio for gender was 1 and mean age at AMI was 49 days, 4 cases being associated with congenital heart disease (Fallot's tetralogy, truncus arteriosus and DiGeorge syndrome, one case each, and anomalous origin of left coronary artery, 2 cases). Kawasaki disease and coronary embolisation from thrombosis of the renal vein occurred in the other 2 cases respectively. All developed congestive cardiac failure and cardiomegaly. In the ECG pathologic q waves with more than 35 msec occurred in all, and QT prolongation occurred in 3. Five children (83%) all with AMI in the anterior and lateral wall of the left ventricle died, death being related with cardiac mechanical failure and not with arrhythmias.
    Acta médica portuguesa 01/1996; 9(10-12):341-6. · 0.28 Impact Factor
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    ABSTRACT: In order to make an actual perspective about prenatal diagnosis of congenital heart disease in the area of influence of our department, a prospective study including 948 fetus and 185 newborn was done, 348 fetus and 20 newborn evaluated during 1993 (group I) and the remaining during 1994 (group II). In both groups indications for fetal echocardiography were mainly maternal (18%) and familiar (14%) factors, but occurrence of CHD were respectively 2% and 0% for them. Fetal factors for echocardiography account for 7%, namely arrhythmias (7%) and obstetric suspicion of CHD (6%), but occurrence of CHD was respectively 13% and 32% for group I and 36% and 48% for group II. In the newborn with serious CHD, risk factors could be identified in 30% in group I and 36% in group II, being respectively 15% and 7% referred for fetal echocardiography. It is concluded that although a rise in the number of fetus evaluated and a better obstetric accuracy have occurred, the rate of prenatal diagnosis of CHD is still very low, pointing to necessity of continuing our actual policy of teaching and spreading this area, specially in the primary health care units.
    Acta médica portuguesa 01/1996; 9(2-3):91-6. · 0.28 Impact Factor
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    ABSTRACT: Four children, three males and one female, aged 1.5 months to 11 years, with restrictive cardiomyopathy are described. One had patent ductus arteriosus in association. Hepatomegaly, abnormal second heart sound and signs of pulmonary venous congestion in chest X-ray were the most consistent clinical findings. Diagnosis was based on echocardiographic findings, cardiac catheterization data and results of pathology. The most frequent echocardiographic sign was the enlargement of both atria but with the ventricles within normal size and normal systolic function. Abnormalities in second phase of the ventricular filling were recorded in 2D-echo Doppler and cardiac catheterization, where a dip and plateau morphology of ventricular tracings was recorded. Metabolic studies performed in two children were normal, and any child had hypereosinophilia. Two children died, one was lost for follow-up and another is asymptomatic. Remarks on medical and surgical management are made.
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 06/1995; 14(5):401-8, 361. · 0.53 Impact Factor
  • A J Macedo, M Ferreira, M Lima
    Acta médica portuguesa 03/1995; 8(2):69-72. · 0.28 Impact Factor
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    ABSTRACT: In a 4 1/2 year period fetal, echocardiographic studies were performed on 1600 fetuses. In 55 with arrhythmia, 44 had supraventricular ectopic beats, resolved in all, and none had heart disease. Sustained arrhythmias occurred in 11 fetuses. Atrial flutter was present in 3 all with heart disease (Ebstein disease, right atrial tumour and WPW diagnosed after birth). Another 3 fetuses had supraventricular tachycardia (SVT), all with a normal heart. In the bradycardia group, 2 had complete heart block (CHB) associated with AVSD; 2 sinus bradycardia and one had non conducted atrial ectopic beats. Digoxin was the first choice drug for tachyarrhythmia therapy; association with Verapamil, Flecainide, Quinidine and Procainamide was used in 4 of the 6. One fetus with CHB received Orciprenaline with no results. Atrial flutter resolved or improved; in SVT 2 fetuses converted to sinus rhythm and one died in utero. All fetuses with CHB died in cardiac failure. Mortality was 27% (3 cases) in utero and global 36%. In our experience most fetal arrhythmias (90%) were transitory ectopic beats or non lasting bradycardia in normal heart and did not trigger other kinds of arrhythmias. In sustained arrhythmias, heart failure and heart disease had a negative effect on prognosis.
    Acta médica portuguesa 03/1995; 8(2):73-9. · 0.28 Impact Factor
  • A J Macedo, M Ferreira, M Lima
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    ABSTRACT: After concluding a local teaching program to obstetric echographists about prenatal diagnosis of congenital heart disease (CHD), we compared 2 periods of activity in fetal echocardiography, that before, lasting 3 and one half years (G.I) and the other 6 months after (G.II). During the second period 20 newborn consecutively admitted with CHD (G.III) were also studied. Teaching program protocol for the 10 district hospitals visited is described. The results show a rise from 25 to 58 foetus per month observed, comparing the two periods, being 4 and 7% respectively those referred with suspicion of CHD, and 54 and 33% the obstetric accuracy. Total incidence of CHD was 4,2%, 41 in G.I and 6 in G.II. Types of CHD, treatment and evolution are described, being the mortality 68 and 50% respectively. Of the 20 newborn from G.III, 90% had no prenatal diagnosis of CHD, being 30% high risk pregnancies. Mortality in this group was 20%, 50% in the newborn from high risk pregnancies; eight newborns were operated on without mortality, 5 to aortic coarctation and 2 with arterial switch for transposition. It is concluded the necessity of continuing teaching programs so that prenatal diagnosis of CHD may improve and the care of the newborn may so be anticipated and ameliorated.
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 12/1994; 13(11):823-31, 807. · 0.53 Impact Factor
  • C Cotrim, A J Macedo, J Duarte, M Lima
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    ABSTRACT: In order to evaluate the contribution of echocardiography (echo) in the first episode of rheumatic fever, 18 children (mean age: 8.5 +/- 2.9 years) observed between 1987 and 1992 have been retrospectively studied. In 11 of them the echo has been done in the first month after the initial episode. By M-Mode echo the most constant finding was a high left atrium: aorta ratio in all cases with clinical carditis. By 2D-echo, hyperechogenicity of mitral valve leaflets and subvalvular apparatus was a common finding, three patients having mitral valve prolapse, one with dilatation of the mitral ring and the other with leaflets not able to coapt. Doppler-echo displayed in 17 patients mitral valve regurgitation, and in three aortic regurgitation. In three children the diagnosis of carditis was made by echo in the absence of murmur. During follow-up mitral valve regurgitation disappeared in four children. The authors conclude that early echo is very important in all children suspected to have rheumatic fever, specially because mitral valve regurgitation can be demonstrated by color flow mapping even in the absence of cardiac murmur.
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 01/1994; 13(7-8):581-6, 563. · 0.53 Impact Factor
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    ABSTRACT: During the last three years (July 89 to July 92), 875 fetal echocardiographic studies were performed, at a mean gestational age of 26 +/- 6.5 weeks (12 to 40 weeks), with the following main referral indications: family history of congenital heart disease 23%; advanced maternal age 13%; fetal arrhythmia 10%; amniotic fluid abnormalities 8%; fetal malformations 7%; diabetes 6%; four chamber view changes 4%. There were 15 twin pregnancies, two of them thoracopagus. The referral patterns with higher percentage of cardiac pathology were: abnormal four chamber view 56%; fetal chromosomal anomalies 50%; omphalocele 33%; twin pregnancy 33%; IUGR 29%; arrhythmias 20%. The referral patterns with lower percentage of cardiac pathology were: congenital heart disease in the family 0.2%; maternal risk 2%; amniotic fluid volume alterations 2%. The diagnosis of congenital heart disease was made in 37 fetus (4.2%), with the following most frequent: 9 cases with the atrioventricular septal defect, 5 cases with ventricular septal defect, 5 cases with hypoplastic left heart syndrome and 5 cases with tricuspid valve abnormalities. From a total of 78 referred fetal arrhythmias, 25 were confirmed, 20 being ectopic beats without structural heart disease, 3 with tachycardia, and 2 with bradycardia. One newborn with tachycardia and Ebstein's disease died, and the fetus with AV block and left atrial isomerism died in utero. The treatment and follow up of the remaining cases with heart disease are described. The whole mortality in the cases with heart pathology was 65%.(ABSTRACT TRUNCATED AT 250 WORDS)
    Acta médica portuguesa 12/1993; 6 Suppl 1:I9-13. · 0.28 Impact Factor
  • A J Macedo, M Ferreira, F Sampayo
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    ABSTRACT: The bases for prenatal diagnosis of congenital heart disease are presented, in the line of a comprehensive program undertaken by paediatric cardiology and obstetrics. This program is designed to improve the screening of fetal heart diseases by obstetric echographists, particularly those working at peripheral high risk clinics. It includes the visit of paediatric cardiologists to district hospitals for joint meetings with local physicians, going over theoretical aspects, case presentation and four chamber view with outflow tract demonstrations using local ultrasound equipment. Referring protocols, handouts and support media exchange are contemplated. Support texts on the program divulged, on etiology of congenital heart disease, on abnormal fetal echocardiography and on fetal dysrhythmias are presented here in. The need for an organized national effort to increase the prenatal diagnosis of congenital heart disease is emphasized as well as the need to centralize some aspects related to diagnosis and treatment in order to improve the care of newborns with congenital heart disease.
    Acta médica portuguesa 12/1993; 6 Suppl 1:I15-21. · 0.28 Impact Factor
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    ABSTRACT: Four cases of cor triatriatum in children aged from 4 days to 12 months are described. In one case isolated classical form of the disease occurred, and in the other it was associated respectively to ventricular septal defect, anomalous pulmonary venous connexion and persistence of left superior venae cava. One child had successful surgical correction, two died before surgery could be attempted and one waits operation. Relevant clinical and investigational data are described and the role of echocardiography as an excellent diagnostic tool is stressed. We conclude that isolated form of cor triatriatum can simulate primary lung disease and when associated to other cardiac anomalies it has an earlier diagnosis due to early referral. Surgical results and prognosis depend not only on associated anomalies but also on early diagnosis.
    Acta médica portuguesa 04/1992; 5(3):149-51. · 0.28 Impact Factor
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    ABSTRACT: To determine the influence of echocardiography in the preoperative diagnosis of heart diseases in children. Retrospective study. Hospitalized children admitted in Departments of Pediatric Cardiology and Cardiothoracic Surgery. Children of both sexes, aged from neonate to 14 years old, with heart disease who underwent cardiac surgery. From January 1989 to July 1990, 220 consecutive cardiac surgeries were performed in children with heart disease. The initial diagnosis was based on data from clinical examination, electrocardiogram, thorax X-Ray and echocardiogram (M-mode, 2D, conventional and colour Doppler). Patients were separated in three groups according to their ages: newborn infants less than 28 days old; infants less than 12 months old; children more than 1 year old and less than 14 years old. Patients were separated according to the investigations used further for preoperative diagnosis: whether they had or not cardiac catheterization performed prior to surgery. From 220 surgical interventions performed, 124 were "open heart" surgeries (9 neonates, 28 infants and 87 children) and the remaining had "closed heart" operations (14 neonates, 37 infants and 45 children). Preoperative diagnosis was mainly dependent on echocardiography, dispensing catheterization in 90 cardiac interventions. The diagnosis was confirmed at surgery or at autopsy. There were 9 deaths, 3 of which occurred in patients not submitted to cardiac catheterization. Echocardiography is a reliable method for investigation and establishment of the preoperative diagnosis of heart diseases in children. Its use may further reduce the need for diagnostic catheterization in children, particularly in risk groups.
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 02/1992; 11(1):37-43. · 0.53 Impact Factor
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    ABSTRACT: In order to correlate gross morphological features with pulmonary and coronary vasculature changes in hypoplastic left heart syndrome (HLHS) 15 heart-lung necropsy specimens from neonates were analysed. Histology of left atrium wall, lung vessels with pulmonary arteriolar disease morphometric grading, study of intra and extra pulmonary wall veins and coronary arteries were recorded. Classic HLHS was observed in 11, and DORV with mitral atresia in 4, the foramen ovale (FO) being the only left atrium outflow tract in all. All specimens had increased % of thickness and muscular extension of arterioles and increased wall thickness of pulmonary veins, but severer arteriolar and venous changes with left atrium fibrosis were noticed in 8 specimens with either closed FO (3 cases) or mean FO diameter (d) of 5 mm when compared with specimens with mean FOd of 9 mm. Coronary arteries histology disclosed in 4 of 8 specimens with opened but hypoplastic mitral valve, intima proliferative changes with lumen narrowing, not observed in 7 specimens with mitral valve atresia. We concluded that in HLHS closed or restrictive FO and permeable mitral valve may predispose neonates to respiratory complications, right ventricle abnormal function and arrhythmias, specially after cardiac surgery.
    Acta médica portuguesa 01/1991; 4(5):253-6. · 0.28 Impact Factor
  • A Macedo, A Paixão, M Lima, F Sampayo
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    ABSTRACT: A case of atrial septal defect in association with dilated cardiomyopathy is presented. Evolutive features are mainly assessed by echocardiography. On initial presentation the findings on physical examination pointed to the diagnosis of atrial septal defect with severe congestive heart failure. In addition to the demonstration of the congenital heart disease, echocardiography showed very dilated right atrial and ventricular cavities and later appearance of right atrium intracavitary thrombi. Left cavities were initially normal but, after surgical repair of the atrial septal defect, they rapidly increased. Endomyocardial biopsy confirmed the diagnosis of cardiomyopathy, which clinically seemed to only affect the right ventricle, but actually shown to be a diffuse myocardial disease.
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 01/1991; 10(7-8):581-5. · 0.53 Impact Factor
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    ABSTRACT: Three children with Candida Parapsilosis endocarditis after total surgical correction for Tetralogy of Fallot, are reported. Blood cultures became negative in one child with amphotericin-B and in the other two with Ketoconazole, before reoperation for septal patch replacement. Oral therapy with Ketoconazole continued for a total of 24 months, and during a mean follow-up of 36 months no side effects or reinfection occurred. Medical and surgical conjoined therapy, with surgical timing decided on clinical and laboratorial grounds, were important for good results and cure.
    Acta médica portuguesa 01/1991; 4(6):301-4. · 0.28 Impact Factor
  • C Marques, A Macedo, M Lima
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    ABSTRACT: Evaluation of coronary anomalies in children with Kawasaki disease (KD) by two-dimensional echocardiography. Outpatient and Laboratory of Echocardiography in the Pediatric Cardiology Department of Santa Marta Hospital. Forty four children (M/F = 1.7/1) with a mean age of 2 years and 8 months (range from 2 months to 8 years) underwent Outpatient and serial echocardiographic study from July 1984 to December 1988. Coronary artery anomalies were demonstrated in 13 (52%) of 44 children; 11 (25%) had uniform dilatation and 12 (27%) had aneurysms. These anomalies were never observed before the first week of illness. During a mean follow-up of 8.4 months, we have observed normalization of coronary arteries lumen, in 10 (43.4%) of the 23 cases. The anomalies remained in 13 (56.6%). Coronary artery anomalies are a frequent complication of KD. In about 50% of patients, coronary artery anomalies remained in a mean follow-up of 8 months. Two-dimensional echocardiography is a good method to study coronary anomalies in KD.
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 06/1990; 9(5):435-40. · 0.53 Impact Factor
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    ABSTRACT: The case rate of children observed with rheumatic carditis or rheumatic heart disease during two consecutive periods of nine years are compared. The first was from October 1969 to September 1978, with previously published data, and the present study from October 1978 to September 1987. During the second period there were 38 cases, 26 of which had the first attack in Portugal, with isolated carditis in 18 (69%), associated with polyarthritis in 5 (20%) and associated with chorea in 3 (11%). Isolated mitral insufficiency was the most frequent valve lesion (80%) and 84% of the children were in NYHA class I and II when first seen. Eighteen children were followed during an average of 2.7 years and there was good compliance of secondary prevention in 78% of them with improvement of the valve lesion. The 12 cases referred from the african countries of portuguese language were more severe, and studied separately. Comparing with the first 9 years period, the case rate of rheumatic carditis, per year decreased from 12.5 to 2.3, the mortality was reduced and the clinical presentation was different, with earlier detection, milder forms and better compliance to secondary prevention.
    Acta médica portuguesa 01/1989; 2(3):127-31. · 0.28 Impact Factor