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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2022.tde-17012023-173559
Document
Author
Full name
Fabricio Marcondes Camargo
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2022
Supervisor
Committee
Brizot, Maria de Lourdes (President)
Francisco, Rossana Pulcineli Vieira
Guerra, Vitor Coimbra
Leal, Gabriela Nunes
Title in Portuguese
Resultados perinatais e seguimento em longo prazo de tumores cardíacos fetais: estudo de coorte histórica de 30 anos
Keywords in Portuguese
Diagnóstico pré-natal
Ecocardiografia fetal
Rabdomioma
Seguimento tardio
Tumor cardíaco
Abstract in Portuguese
Objetivo: Avaliar a morbidade e mortalidade perinatal e em longo prazo em fetos com diagnóstico de rabdomioma cardíaco. Como objetivo secundário, avaliar os fatores que influenciaram os resultados perinatais e pós-natais. Método: Estudo retrospectivo e descritivo envolvendo 74 gestantes com diagnóstico ecocardiográfico fetal de tumor cardíaco acompanhadas em dois serviços de referência em Ecocardiografia Fetal, no período de maio de 1991 a novembro de 2021. Foi realizada análise descritiva dos dados por meio de frequências absolutas (n) e relativas (%), mediana e intervalos interquartis. Para avaliar a associação entre as características ecocardiográficas e as manifestações clínicas com os resultados perinatais e pós-natais, foi aplicado o teste Exato de Fisher. O cálculo da sobrevida global (SG) foi realizado pelo método de Kaplan-Meier e a comparação de curvas, pelo teste de log-rank. O tempo de seguimento calculado em meses foi definido a partir da data de alta do hospital à data do status atual (vivo/censura ou óbito). O nível de significância considerado foi de 5% (p<0,05). Resultados: O rabdomioma é o tipo mais frequente (85%) de tumor cardíaco; apresenta alta morbidade (79,3%) e mortalidade geral relevante (17,4%): óbitos fetais em 4,7%, óbitos neonatais em 7,9% e óbitos tardios em 4,8%. Foi possível obter seguimento tardio de 84,1% dos casos. A maioria (95,5%) necessitou de internação em unidade de terapia intensiva e 90,9% receberam alta hospitalar. A presença de hidropisia fetal foi preditiva de óbito (p<0,001). Não houve associação entre os desfechos e as características ecocardiográficas do tumor, como tamanho e número. A esclerose tuberosa esteve presente em 72,7% dos casos válidos de rabdomioma. Conclusão: A presença de hidropisia fetal teve impacto na mortalidade, sendo fator importante para aconselhamento e estabelecimento de prognóstico. A maioria dos óbitos ocorre antes da alta hospitalar
Title in English
Perinatal outcomes and late follow-up of fetal cardiac tumors: a 30-year historical cohort study
Keywords in English
Fetal echocardiography
Heart neoplasms
Late follow-up
Prenatal diagnosis
Rhabdomyoma
Abstract in English
Objective: To evaluate perinatal and long-term morbidity and mortality in fetuses diagnosed with cardiac rhabdomyoma. As a secondary objective, the factors that influenced the perinatal and postnatal outcomes were evaluated. Method: Retrospective cohort study involving 74 pregnant women with fetal echocardiographic diagnosis of cardiac tumor followed in two reference services in Fetal Echocardiography, from May 1991 to November 2021. Descriptive analysis of the data was performed using absolute (n) and relative (%), median and interquartile intervals frequencies. To evaluate the association between echocardiographic characteristics and clinical manifestations with perinatal and postnatal outcomes, fisher's exact test was applied. The calculation of overall survival (SG) was performed by the Kaplan- Meier method and the comparison of curves by the log-rank test. The follow-up time calculated in months was defined from the date of discharge from the hospital to the date of the status (live/censorship or death). The significance level considered was 5% (p<0.05). Results: Rhabdomyoma is the most frequent type (85%) of cardiac tumor; it presents high morbidity (79.3%) and relevant general mortality (17.4%): fetal deaths in 4.7%, neonatal deaths in 7.9% and late deaths in 4.8%. It was possible to obtain late follow-up of 84.1% of the cases. The majority (95.5%) required hospitalization in an intensive care unit and 90.9% were discharged from the hospital. The presence of fetal hydrops was predictive of death (p<0.001). There was no association between the outcomes and echocardiographic characteristics of the tumor, such as size and number. Tuberous sclerosis was present in 72.7% of valid cases of rhabdomyoma. Conclusion: The presence of fetal hydrops had an impact on mortality, being an important factor for counseling and prognostic establishment. Most deaths occur before hospital discharge
 
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Publishing Date
2023-01-18
 
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