Publications by authors named "Andreia Francisco"

7 Publications

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Kawasaki Disease: Predictors of Resistance to Intravenous Immunoglobulin and Cardiac Complications.

Arq Bras Cardiol 2021 Mar;116(3):485-491

Centro Hospitalar e Universitário de Coimbra EPE - Cardiologia Pediátrica, Coimbra - Portugal.

Background: Kawasaki disease (KD) is the leading cause of acquired cardiac disease in children, in developed countries.

Objectives: To identify predictive factors for resistance to intravenous immunoglobulin (IVIG), calculate the effectiveness of Japanese predictive models and characterize cardiac complications.

Methods: Retrospective analysis of KD cases admitted in a Portuguese paediatric hospital between january 2006 and july 2018. ROC curves were used to determine predictive factors for resistance and the multivariate logistic regression analysis was used to develop the predictive model. A significance level of 5% was used.

Results: 48 patients with a median age of 36 months were included. The IVIG resistance was 21%. Echocardiographic anomalies were noted in 46%, with coronary involvement in 25% of the sample population. As predictive variable of resistance, the C-reactive protein (CRP) presented an AUC ROC = 0.789, optimal cut-off value 15.1 mg/dL, sensitivity (Sn) 77.8% and specificity (Sp) 78.9%. The erythrocyte sedimentation rate (ESR) presented an AUC ROC = 0.781, optimal cut-off value 90.5 mm/h, Sn 66.7% and Sp 85.7%. The model with the two variables showed p = 0.042 and AUC ROC = 0.790. Predictive strength of Japanese models were: Kobayashi (Sn 63.6%, Sp 77.3%), Egami (Sn 66.7%, Sp 73.1%), Sano (Sn 28.6%, Sp 94.1%).

Conclusion: CRP and ESR are independent variables that were related to IVIG resistance, with optimal cut-off points of 15.1 mg/dL and 90.5 mm/h, respectively. About half of the patients had some form of cardiac involvement. The Japanese models appeared to be inadequate in our population. (Arq Bras Cardiol. 2021; 116(3):485-491).
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http://dx.doi.org/10.36660/abc.20190758DOI Listing
March 2021

PATENT DUCTUS ARTERIOSUS CLOSURE: EXPERIENCE FROM A TERTIARY REFERRAL CENTER.

Rev Paul Pediatr 2020 27;39:e2020013. Epub 2020 Nov 27.

Universitário de Coimbra, Coimbra, Portugal.

Objective: To characterize the number and methods of closure of Persistent Ductus Arteriosus (PDA) over a span of 16 years in a third level maternity hospital.

Methods: Retrospective study of neonates born between January 2003 and Deccember 2018, who underwent ductus arteriosus closure by pharmacological, surgical and/or transcatheter methods. Gestational age, birth weight, number and methods of closures per year were evaluated. The success rate of the pharmacologic method was calculated, as well as the mortality rate. The association between mortality and birthweight, treatment used and treatment failure was explored.

Results: There were 47,198 births, 5,156 were preterm, 325 presented PDA and 106 were eligible for closure (median gestational age - 27 weeks, birthweight <1000 g - 61%). Frequency of PDA closure decreased during the study period, especially starting in 2010. Success rate with pharmacologic treatment was 62% after the first cycle and 74% after the second. After drug failure, 12 underwent surgical ligation and two underwent transcatheter closure. Exclusive surgical ligation was indicated in four infants. Ibuprofen replaced indomethacin in 2010, and acetaminophen was used in three infants. Among the 106 infants, hospital mortality was 12% and it was associated with birthweight <1000 g (13/65 <1000 vs. 0/41 >1000 g; p=0.002) and with failure in the first pharmacologic treatment cycle (13/27 with failure, vs. 0/75 without failure; p<0.001).

Conclusions: The national consensus published in 2010 for the diagnosis and treatment of PDA in preterm infants led to a decrease in the indication for closure. Pharmacological closure was the method of choice, followed by surgical ligation. Birthweight <1000 g and first cycle of pharmacologic treatment failure were associated with higher mortality.
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http://dx.doi.org/10.1590/1984-0462/2021/39/2020013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695124PMC
November 2020

A case of double-outlet left ventricle, malposition of the great arteries, and superior-inferior ventricular arrangement.

Cardiol Young 2020 Aug 27;30(8):1173-1174. Epub 2020 Jul 27.

Department of Paediatric Cardiology, Referral Centre for Congenital Cardiac Defects, CHUC, Coimbra, Portugal.

Superior-inferior ventricular arrangement with double-outlet left ventricle and malposition of the great arteries is an extremely rare congenital cardiac anomaly. The authors present the case of an infant who presented with cyanosis and respiratory distress. To the best of our knowledge, this is the first case reported.
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http://dx.doi.org/10.1017/S104795112000222XDOI Listing
August 2020

Infant heart tumour.

Rev Port Cardiol 2018 Jan 26;37(1):93-94. Epub 2017 Dec 26.

Hospital Pediátrico de Coimbra, Serviço de Cardiologia Pediátrica, Coimbra, Portugal.

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http://dx.doi.org/10.1016/j.repc.2017.02.019DOI Listing
January 2018

Juxtaposed right atrial appendage in complex Transposition of the Great Arteries.

Rev Port Cardiol 2015 Jan 10;34(1):79-80. Epub 2015 Jan 10.

Cardiovascular MRI Department, Kings College, London, UK; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St. Thomas NHS Foundation Trust, London, UK.

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http://dx.doi.org/10.1016/j.repc.2014.08.015DOI Listing
January 2015

Mitral valve lipomatous hamartoma: a rare entity.

Cardiol Young 2014 Oct 18;24(5):923-5. Epub 2013 Sep 18.

3Department of Pediatric Cardiology,Hospital de Santa Cruz,Centro Hospitalar de Lisboa Ocidental,Portugal.

Lipomatous hamartoma of cardiac valves is a very rare entity, with only three reported cases in children. We describe the case of a 9-year-old girl with a mass in the mitral valve, which was detected in an echocardiogram performed for heart murmur investigation. At surgery, a white round-shaped tumour was removed and histopathological examination revealed a lipomatous hamartoma.
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http://dx.doi.org/10.1017/S1047951113001388DOI Listing
October 2014

Giant coronary artery aneurysms in Kawasaki disease: the cost of a missed diagnosis.

Cardiol Young 2013 Aug;23(4):608-9

Department of Cardiology, Hospital de Santarém, Santarem, Portugal.

Giant coronary aneurysms secondary to Kawasaki disease are rare, but a very severe complication. Delayed diagnosis and appropriate treatment of the disease is a well-known risk factor for coronary aneurysms.
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http://dx.doi.org/10.1017/S1047951112002338DOI Listing
August 2013