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Brazilian Journal of Cardiovascular Surgery

Print version ISSN 0102-7638

Rev Bras Cir Cardiovasc vol.7 no.4 São José do Rio Preto Oct./Dec. 1992

http://dx.doi.org/10.1590/S0102-76381992000400004 

ARTIGOS ORIGINAIS

 

O papel da biopsia pulmonar na indicação cirúrgica de cardiopatias congénitas

 

The role of lung biopsy in the decision-making process for congenital heart disease

 

 

Solange Bordignon; Marizele E. Molon; Renato A. K. Kalil; Fernando A. Lucchese; Paulo R. Prates; João Ricardo M. Sant'Anna; Ivo A. Nesralla

Do Instituto de Cardiologia do Rio Grande do Sul

Endereço para separatas

 

 


RESUMO

Objetivando relacionar o aspecto morfológico dos vasos pulmonares com os dados clínicos para auxiliar na decisão da cirurgia de cardiopatias congênitas com hipertensão pulmonar severa, em casos previamente avaliados por critérios clínicos, angiográficos e/ou hemodinâmicos, foram realizadas, de 1980 a 1991, no Instituto de Cardiologia do Rio Grande do Sul, 49 biópsias pulmonares. As idades dos pacientes variaram de 5m a 28a6m (média = 7a7m) e os diagnósticos foram: CIV (16), PCA (3), CIVe ESubAo (1), PCA e CIV (2), PCA e Cl A (1) DSAV (7), DSAV incompl. e PCA (1), PCA e CoAo (1), Inter Arco Ao com PCA e CIV e/ou ESupraM e Anel SubAo (2), DVSVD com CIV e/ou PCA (6), DVSVE e EP (1), ATe ESubP. (1), TGV (1), TGV corrigida e CIV (1) e truncus arteriosus (5). Houve 3 (6,1 %) óbitos no pós-operatório da biopsia. Baseado na classificação de Heath-Edwards, foram para correção cirúrgica 11 pacientes com cardiopatias simples (CIV, PCA, DSAV), cuja mortalidade foi 36,4%. Dez pacientes com cardiopatias complexas (DVSVD, DVSVE, TGV, truncus, inter arco Ao) foram para cirurgia, com mortalidade de 30%. A evolução pós-operatória tardia foi favorável em 13 (62%) pacientes. Conclui-se que a biopsia pulmonar pode ser útil na indicação cirúrgica das cardiopatias congênitas com hipertensão pulmonar severa e, por envolver riscos, sua utilização deve ser criteriosa. E valiosa para os pacientes que apresentam dúvidas quanto ao grau de doença vascular pulmonar ou quanto à natureza das lesões e o estudo clínico e hemodinâmico não são esclarecedores, ou mesmo quando apontarem para a contra-indicação cirúrgica.

Descritores: biopsia pulmonar; hipertensão arterial pulmonar.


ABSTRACT

Open lung biopsy has been performed in patients with congenital heart disease and severe pulmonary hypertension in order to complement the decision-making process for surgical correction. All patients had clinical, hemodynamic and angiographic evaluation previously and would not be surgical candidates by conventional criteria. The 49 patients were studied from 198 0 to 1991 at the Instituto de Cardiologia do Rio Grande do Sul, Brazil. Age range was 5m to 28y6m (mean=7y7m). The diagnoses were: VSD (16); PDA (3); VSD and SubAortic Stenosis (1); PDA and VSD (2); PDA and ASD (1); AVSD (7); Incomplete AVSV and PDA (1); PDA and ACo (1); AAI with PDA and VSD (2); DORV with VSD and or PDA (6); DOLV with PS (1); TA (1), TGA (1); Corrected TGA with VSD (1) and Truncus Arteriosus (5). There were 3 hospitalar deaths after the biopsy procedure (6.1%). When the pulmonary vascular lesions were classified as Heath-Edwards class III or less, surgical correction was performed. There were 21 patients, 11 simple defects (PDA; VSD; AVSD) with 4 deaths (36.4%) and 10 complex heart defects with 3 deaths (30%) . One patient with VSD had persistent evolutive pulmonary hypertension. The remaining 13 had benefited from the correction. In conclusion, lung biopsy may be useful for the surgical decision in congenital heart disease with severe pulmonary hypertension. As a surgical procedure with the involved risks, it must be selectively indicated. Most patients with vascular lesions below class III (H-E), despite other methods of evaluation would benefit from the corrective procedure.

Descriptors: hypertension, pulmonary; lung biopsy.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

AGRADECIMENTO

Agradecemos à Dra. Lígia Coutinho e à Dra. Marinêz Barra Rossi, pela realização dos exames anatomopatológicos.

 

REFERÊNCIAS BIBLIOGRÁFICAS

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2 HEATH, D. & EDWARDS, J. E. - The pathology of hypertensive pulmonary vascular disease: a description of six grades of structural changes in the pulmonary arteries with special reference to congenital cardiac septal defects. Circulation, 18: 533-547, 1958.         [ Links ]

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6 HAWORTH, S. G.; RADLEY-SMITH, R.; YACOUB, M. - Lung biopsy findings in transposition of the great arteries with ventricular septal defect: potentially reverseble pulmonary vascular disease is not always synonymous with operability. J. Am. College Cardiol., 9: 327-333, 1987.         [ Links ]

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12 WAGENVOORT, C. A.; NAUTA, J.; VAN DER SCHAAR, P. J.; WEEDA, H. W. K; WAGENVOORT, N. - Effect of flow and pressure on pulmonary vessels: semi quantitative study based on lung biopsies. Circulation, 25: 1028-1037, 1967.         [ Links ]

13 WILSON, N. J.; SEAR, M. D.; TAYLOR, G. P.; LE-BLANC, J. E.; SANDOR, G. G. S. - The clinical valve and risks of lung biopsy in children with congenital heart disease. J. Thorac. Cardiovasc. Surg., 99: 460-468, 1990.         [ Links ]

14 YAMAKI, S.; MOHRI, H.; HANEDA, K.; ENDO, M.; AKIMOTO, H. - Indications for surgery based on lung biopsy in cases of ventricular septal defect and/or patent ductus arteriosus with severe pulmonary hypertension. Chest, 96: 31-39, 1989.         [ Links ]

 

 

Endereço para separatas:
Solange Bordignon
Instituto de Cardiologia, Unidade de Pesquisa
Av. Princesa Izabel, 395
90620 Porto Alegre, RS, Brasil

 

 

Trabalho realizado no Instituto de Cardiologia do Rio Grande do Sul. Fundação Universitária de Cardiologia. Porto Alegre, RS, Brasil.
Apresentado ao 19º Congresso Nacional de Cirurgia Cardíaca. São Paulo, SP, 7 a 9 de maio, 1992.

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