Publications by authors named "Eduardo Castela"

27 Publications

  • Page 1 of 1

How to develop a sustainable telemedicine service? A Pediatric Telecardiology Service 20 years on - an exploratory study.

BMC Health Serv Res 2019 Sep 23;19(1):681. Epub 2019 Sep 23.

Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisboa, Portugal.

Background: Telemedicine services are promoting more access to healthcare. Portugal was an early adopter of telemedicine to overcome both its geological barriers and the shortage of healthcare professionals. The Pediatric Cardiology Service (PCS) at Coimbra University Hospital Centre (CHUC) has been using telemedicine to increase access and coverage since 1998. Their Pediatric Telecardiology Service has been daily connecting CHUC with 13 other Portuguese national hospitals, and regularly connecting with Portuguese-speaking African countries, through a teleconsultation platform.

Methods: This study aims at exploring the Pediatric Telecardiology Service's evolution, through a comprehensive assessment of the PCS's development, evolution and impact in public health, to better understand the critical factors for implementation and sustainability of telemedicine, in the context of healthcare services digitalization. A case study was performed, with cost-benefit, critical factors and organizational culture assessment. Finally, the Kingdon's framework helped to understand the implementation and scale-up process and the role of policy-making.

Results: With the total of 32,685 out-patient teleconsultations, growing steadily from 1998 to 2016, the Pediatric Telecardiology Service has reached national and international recognition, being a pioneer and an active promotor of telemedicine. This telemedicine service has saved significant resources, about 1.1 million euros for the health system (e.g. in administrative and logistic costs) and approximately 419 euros per patient (considering an average of 1777 patients per year). PCS presents a dominant "Clan" culture. The Momentum's critical factors for telemedicine service implementation enabled us to understand how barriers were overcome (e.g. political forces). Willingness, perseverance and teamwork, allied with partnership with key stakeholders, were the foundation for professionals' engagement and service networking development. Its positive results, new regulations and the increasing support from the hospital board, set up a window of opportunity to establish a sustainable telemedicine service.

Conclusion: The Pediatric Telecardiology Service enables real-time communication and the sharing of clinical information, overcoming many barriers (from geographical ones to shortage of healthcare professionals), improving access to specialized care both in Portugal and Africa. Motivation and teamwork, and perseverance, were key for the Pediatric Telecardiology Service to tackle the window of opportunity which created conditions for sustainability.
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http://dx.doi.org/10.1186/s12913-019-4511-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6757431PMC
September 2019

Importance of ambulatory blood pressure monitoring in the diagnosis and prognosis of pediatric hypertension.

Rev Port Cardiol 2018 09 2;37(9):783-789. Epub 2018 Jun 2.

Serviço de Cardiologia Pediátrica, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

The prevalence of high blood pressure (BP) at pediatric age has increased progressively, one of the causes of which is obesity. However, the dominant etiology in this age group is renal and/or cardiovascular pathology. Ambulatory blood pressure monitoring (ABPM) is the method of choice for the diagnosis of hypertension, especially in children at high cardiovascular risk. Its use is limited to children from five years of age. Choosing appropriate cuff size is key to obtaining correct blood pressure. The main indication for ABPM is to confirm the diagnosis of hypertension. It also allows the diagnosis of white coat hypertension (which may represent an intermediate stage between the normotensive phase and hypertension), or masked hypertension, associated with progression to sustained hypertension and left ventricular hypertrophy (LVH). Children with isolated nocturnal hypertension should be considered as having masked hypertension. BP load is defined as the percentage of valid measurements above the 95th percentile for age, gender, and height. Values above 25-30% are pathological and those above 50% are predictive of LVH. ABPM correlates with target organ damage, particularly LVH and renal damage. It is useful in the differentiation of secondary hypertension, since these children show higher BP load and less nocturnal dipping, and confirmation of response to therapy. Thus ABPM allows the diagnosis and classification of hypertension, provides cardiovascular prognostic information and identifies patients with intermediate phenotypes of hypertension.
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http://dx.doi.org/10.1016/j.repc.2017.09.026DOI Listing
September 2018

Unusual cause of left ventricular dysfunction in a child.

Rev Port Cardiol 2019 02 21;38(2):159.e1-159.e5. Epub 2018 May 21.

Centro de Cirurgia Cardiotorácica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery is a rare congenital heart disease and a cause of myocardial ischemia during childhood. Most undiagnosed cases die in the first year of life as an extensive collateral network is essential for survival. The diagnosis requires a high index of clinical suspicion. The authors present the case of an 8-year-old black asymptomatic child referred from Cape Verde Island in order to clarify left ventricular dilatation and dysfunction with systo-diastolic turbulent flows observed at the interventricular septum. At the age of 3 months, she was diagnosed with heart failure, in the context of showing dilated cardiomyopathy. She was managed and clinically improved with anticongestive therapy, which she was still taking at the time of admission to our Center. The echocardiogram findings suggested Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery and the diagnosis was confirmed by computerized angiotomography and cardiac catheterization. The patient was successfully submitted to direct implantation of the left coronary artery into the aorta, allowing the creation of a double coronary perfusion system. This case illustrates an unusual presentation of a rare pathology that survived without a diagnosis after the first year of life. It also reinforces the importance of multimodality image screening in these cases.
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http://dx.doi.org/10.1016/j.repc.2017.07.017DOI Listing
February 2019

Abdominal pain of cardiovascular origin.

Rev Port Cardiol 2018 May 26;37(5):449.e1-449.e4. Epub 2018 Apr 26.

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

Infective endocarditis is a microbial infection of the endocardium and it is rare in the pediatric population. In children, congenital heart disease is one of the most important risk factors for developing infective endocarditis and can involve other structures in addition to cardiac valves. The prognosis is generally better than in other forms of endocarditis, although the average mortality rate in the pediatric population is 15-25%. Clinical manifestations can mimic other diseases such as meningitis and collagen-vascular disease or vasculitis. Therefore, a high degree of suspicion is required to make an early diagnosis. Gram-positive bacteria, specifically alpha-hemolytic streptococci, Staphylococcus aureus and coagulase-negative staphylococci, are the most commonly involved bacteria. Diagnosis is based on the modified Duke criteria, which rely mostly on clinical assessment, echocardiography and blood cultures. Antibacterial treatment should ideally be targeted. However, if no specific bacteria have been identified, patients should promptly be treated empirically with multiple drug regimens based on local resistance and the most common etiologies. The authors describe a case of a seven-year-old girl with classic clinical signs of endocarditis, with a clinical twist.
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http://dx.doi.org/10.1016/j.repc.2017.06.023DOI Listing
May 2018

Rare forms of pediatric congenital right ventricular fistulae.

Rev Port Cardiol 2018 May 21;37(5):453-454. Epub 2018 Apr 21.

Serviço de Cardiologia Pediátrica, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

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http://dx.doi.org/10.1016/j.repc.2017.01.015DOI Listing
May 2018

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

[Premature Atherosclerosis in HIV-Infected Pediatric Patients: Literature Review and Clinical Approach].

Acta Med Port 2017 Oct 31;30(10):742-749. Epub 2017 Oct 31.

Laboratório de Fisiologia. Instituto de Imagem Biomédica e Ciências da Vida (IBILI). Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal.

Human immunodeficiency virus infected children and adolescents are a pediatric group with increased risk of premature cardiovascular disease. The virus itself, the antiretroviral therapy and the lifestyle establish a complex interplay of factors that promotes an accelerated atherosclerosis. This process is probably mediated by dyslipidaemia, dysregulation of glucose metabolism, lipodystrophy, inflammation, endothelial dysfunction and a prothrombotic state. The clinical approach to this population in terms of cardiovascular prevention is mainly based on efficient treatment of the infection, reduction of the modifiable risk factors and promotion of lifestyle changes.
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http://dx.doi.org/10.20344/amp.8726DOI Listing
October 2017

Incidental finding in a newborn with respiratory distress.

Einstein (Sao Paulo) 2017 Jul-Sep;15(3):378-379. Epub 2017 Jun 12.

Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

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http://dx.doi.org/10.1590/S1679-45082017AI4001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5823058PMC
May 2018

[Coimbra Telemedicine Service Improves Access to Pediatric Cardiology in Cape Verde].

Authors:
Eduardo Castela

Acta Med Port 2017 04 28;30(4):253-254. Epub 2017 Apr 28.

Serviço de Cardiologia Pediátrica. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.; Presidente. Associação Portuguesa de Telemedicina. Ordem dos Médicos. Coimbra. Portugal.; Promotor Interno de Telesaúde. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.

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http://dx.doi.org/10.20344/amp.9034DOI Listing
April 2017

Total anomalous pulmonary venous return.

Rev Port Cardiol 2016 Apr 16;35(4):243-4. Epub 2016 Mar 16.

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

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http://dx.doi.org/10.1016/j.repc.2015.10.009DOI Listing
April 2016

Circulating endothelial progenitor cells in obese children and adolescents.

J Pediatr (Rio J) 2015 Nov-Dec;91(6):560-6. Epub 2015 Aug 29.

Laboratório de Fisiologia, Instituto de Imagem Biomédica e Ciências da Vida, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal.

Objective: This study aimed to investigate the relationship between circulating endothelial progenitor cell count and endothelial activation in a pediatric population with obesity.

Methods: Observational and transversal study, including 120 children and adolescents with primary obesity of both sexes, aged 6-17 years, who were recruited at this Cardiovascular Risk Clinic. The control group was made up of 41 children and adolescents with normal body mass index. The variables analyzed were: age, gender, body mass index, systolic and diastolic blood pressure, high-sensitivity C-reactive protein, lipid profile, leptin, adiponectin, homeostasis model assessment-insulin resistance, monocyte chemoattractant protein-1, E-selectin, asymmetric dimethylarginine and circulating progenitor endothelial cell count.

Results: Insulin resistance was correlated to asymmetric dimethylarginine (ρ=0.340; p=0.003), which was directly, but weakly correlated to E-selectin (ρ=0.252; p=0.046). High sensitivity C-reactive protein was not found to be correlated to markers of endothelial activation. Systolic blood pressure was directly correlated to body mass index (ρ=0.471; p<0.001) and the homeostasis model assessment-insulin resistance (ρ=0.230; p=0.012), and inversely correlated to adiponectin (ρ=-0.331; p<0.001) and high-density lipoprotein cholesterol (ρ=-0.319; p<0.001). Circulating endothelial progenitor cell count was directly, but weakly correlated, to body mass index (r=0.211; p=0.016), leptin (ρ=0.245; p=0.006), triglyceride levels (r=0.241; p=0.031), and E-selectin (ρ=0.297; p=0.004).

Conclusion: Circulating endothelial progenitor cell count is elevated in obese children and adolescents with evidence of endothelial activation, suggesting that, during infancy, endothelial repairing mechanisms are present in the context of endothelial activation.
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http://dx.doi.org/10.1016/j.jped.2015.01.011DOI Listing
July 2016

Childhood adiposity: being male is a potential cardiovascular risk factor.

Eur J Pediatr 2016 Jan 31;175(1):63-9. Epub 2015 Jul 31.

Laboratório de Fisiologia, Instituto Biomédico de Investigação de Luz e Imagem (IBILI) da Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal.

Unlabelled: As the earliest atherosclerotic lesions begin during childhood, our aim was to correlate gender-related adiposity to classical cardiovascular risk factors in a group of children.An observational and transversal analysis was carried out in a cohort consisting of 161 children of both sexes, aged 6 to 17 years of age. Waist circumference was correlated to leptin, high-sensitivity C-reactive protein, systolic and diastolic blood pressure, plasma lipids, homeostasis model assessment-insulin resistance, and the left ventricular mass index. After adjusting for age, waist circumference in boys, compared to girls, correlated more strongly and directly to systolic (r = 0.538; p < 0.001) and diastolic blood pressure (ρ = 0.401; p < 0.01), ApoB/ApoA ratio (ρ = 0.515; p < 0.01), high-density lipoprotein cholesterol (r = -0.441; p < 0.001), low-density lipoprotein cholesterol (ρ = 0.280; p < 0.01), triglycerides (ρ = 0.420; p < 0.001), homeostasis model assessment-insulin resistance (ρ = 0.463; p < 0.001), and the left ventricular mass index (ρ = 0.286; p < 0.01). A similar pattern was observed regarding the correlations between leptin, high-sensitivity C-reactive protein, and the above parameters (except between high-sensitivity C-reactive protein and diastolic blood pressure), and also, particularly in boys.

Conclusion: Although increased childhood adiposity is related to a more adverse metabolic and clinical profile in both genders, males appear to have a potentially greater cardiovascular risk.

What Is Known: Obesity is characterized by a chronic low-grade inflammatory process.

What Is New: Increased adiposity is related to a more pronounced pro-inflammatory response in boys. Childhood male adiposity is a potentially greater cardiovascular risk factor. Arterial hypertension, insulin resistance, and dyslipidemia is more strongly correlated to waist circumference in boys.
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http://dx.doi.org/10.1007/s00431-015-2599-0DOI Listing
January 2016

[Obesity: Paradigm of Endothelial Dysfunction in Paediatric Age Groups].

Acta Med Port 2015 Mar-Apr;28(2):233-9. Epub 2015 May 29.

Laboratório de Fisiologia. Instituto de Imagem Biomédica e Ciências da Vida (IBILI). Faculdade de Medicina da Universidade de Coimbra. Coimbra. Portugal.

Introduction: Obesity is considered a global epidemic with important public health issues as it is an independent risk factor in the development of cardiovascular disorders.

Material And Methods: Approximately 10% of the worldâÄôs paediatric population has excess weight or obesity and 40% of these will be obese adults. Obesity is characterized by a chronic, low grade, pro-inflammatory process that ultimately results in endothelial dysfunction, the trigger lesion leading to adult cardiovascular disease. This leads to an imbalance in the synthesis of mediators that normally regulate vascular homeostasis, particularly nitric oxide bioavailability, favoring a pro-atherosclerotic status, the hallmark of cardiovascular disorders.

Results: These changes begin early in childhood and anatomopathological studies in children with excess weight or obesity have shown endothelial changes that represent the precursors of the atherosclerotic lesion.

Discussion: Endothelial dysfunction is the earliest manifestation of the atherosclerotic lesion. It is evident in obese children and, as such, it potentially contributes towards cardiovascular disease in the adult.

Conclusion: Although the clinical impact of these changes rarely manifest themselves in infancy, the presence of related biomarkers as well as vascular morphological changes can, at this early stage, be found and assessed.
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May 2017

Insulin resistance, dyslipidemia and cardiovascular changes in a group of obese children.

Arq Bras Cardiol 2015 Apr 23;104(4):266-73. Epub 2015 Jan 23.

Instituto Biomédico de Investigação da Luz e Imagem, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal.

Introduction: Obesity-related comorbidities are present in young obese children, providing a platform for early adult cardiovascular disorders.

Objectives: To compare and correlate markers of adiposity to metabolic disturbances, vascular and cardiac morphology in a European pediatric obese cohort.

Methods: We carried out an observational and transversal analysis in a cohort consisting of 121 obese children of both sexes, between the ages of 6 and 17 years. The control group consisted of 40 children with normal body mass index within the same age range. Markers of adiposity, plasma lipids and lipoproteins, homeostasis model assessment-insulin resistance, common carotid artery intima-media thickness and left ventricular diameters were analyzed.

Results: There were statistically significant differences between the control and obese groups for the variables analyzed, all higher in the obese group, except for age, high-density lipoprotein cholesterol and adiponectin, higher in the control group. In the obese group, body mass index was directly correlated to left ventricular mass (r=0.542; p=0.001), the homeostasis model assessment-insulin resistance (r=0.378; p=<0.001) and mean common carotid artery intima-media thickness (r=0.378; p=<0.001). In that same group, insulin resistance was present in 38.1%, 12.5% had a combined dyslipidemic pattern, and eccentric hypertrophy was the most common left ventricular geometric pattern.

Conclusions: These results suggest that these markers may be used in clinical practice to stratify cardiovascular risk, as well as to assess the impact of weight control programs.
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http://dx.doi.org/10.5935/abc.20140206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415862PMC
April 2015

Pro-inflammatory triggers in childhood obesity: correlation between leptin, adiponectin and high-sensitivity C-reactive protein in a group of obese Portuguese children.

Rev Port Cardiol 2014 Nov 11;33(11):691-7. Epub 2014 Nov 11.

Laboratório de Fisiologia, Instituto de Imagem Biomédica e Ciências da Vida, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal.

Introduction: Pediatric obesity is increasingly prevalent in the Portuguese population. Adipocyte dysfunction results in the expression of pro-inflammatory mediators that are responsible for the low-grade inflammatory process that characterizes obesity.

Objectives: The aim of this study was to investigate the relationship between markers of adiposity, inflammation and adipokines in a Portuguese obese pediatric population.

Methods: One hundred and twenty children of both sexes, aged 6-17 years, were included in this study. The control group consisted of 41 healthy normal-weight children. The variables analyzed were age, gender, body mass index, waist circumference, fat mass percentage, high-sensitivity C-reactive protein (hs-CRP), leptin and adiponectin.

Results: There were significant differences between controls and obese children for all parameters analyzed. In the obese group, after controlling for age and gender, hs-CRP (p=0.041), adiponectin (p=0.019) and leptin (p<0.001) still showed significant statistical differences. A direct correlation was found between hs-CRP, leptin, body mass index and waist circumference, the strongest being with leptin (r=0.568; p<0.001). This trend remained statistically significant, regardless of gender or pubertal age.

Conclusions: Considering the role of leptin, adiponectin and hs-CRP in the genesis of endothelial dysfunction, they may be used in clinical practice for risk stratification, as well as in the assessment of weight control programs.
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http://dx.doi.org/10.1016/j.repc.2014.04.004DOI Listing
November 2014

Giant major aortopulmonary collateral artery: a rare cause of heart murmur in newborns.

Rev Port Cardiol 2014 Jul-Aug;33(7-8):483-5. Epub 2014 Jul 31.

Serviço de Cardiologia, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

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http://dx.doi.org/10.1016/j.repc.2014.02.002DOI Listing
July 2016

[Infective endocarditis as a form of late presentation of congenital heart disease].

Rev Port Cardiol 2013 Feb 22;32(2):145-8. Epub 2013 Jan 22.

Serviço de Cardiologia Pediátrica, Hospital Pediátrico Carmona da Mota, Coimbra, Portugal.

A diagnosis of congenital heart disease is usually established at an early age, so infective endocarditis is a rare form of presentation. The authors describe the case of a male adolescent with a week-long history of intermittent fever and unquantified weight loss. Physical examination detected pansystolic and diastolic murmurs, and an associated precordial thrill. Laboratory tests showed evidence of an active infection. Etiological investigation revealed a perimembranous ventricular septal defect, aortic regurgitation, and aortic and mitral valve vegetations. A diagnosis of mitral-aortic infective endocarditis was made and he was started on intravenous antibiotics and anticongestive therapy. After initial clinical improvement, he developed symptoms and signs of congestive heart failure. Repeat echocardiography showed an extensive mitral-aortic paravalvular abscess. The antibiotics were changed and anticongestive therapy was intensified, and he subsequently underwent surgery. The outcome has been generally favorable, and at present he is asymptomatic under anticongestive therapy.
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http://dx.doi.org/10.1016/j.repc.2012.05.023DOI Listing
February 2013

Algorithm versus physicians variability evaluation in the cardiac chambers extraction.

IEEE Trans Inf Technol Biomed 2012 Sep 19;16(5):835-41. Epub 2012 Jun 19.

School of Technology and Management, Polytechnic Institute of Portalegre, Portalegre, Portugal.

Congenital heart diseases are present in eight of every 1000 newborns. The diagnosis of those pathologies usually depends on the available imaging methods. A correct diagnosis requires a detailed observation of the heart chambers, wall motions, valves function, and quantitative evaluation of the cavity volumes. For that goal numerous automatic algorithms have been proposed to segment the echocardiographic images. In this paper, the authors evaluate the performance of a level set algorithm based on the phase symmetry approach and on a new logarithmic-based stopping function to extract the heart cavity contours simultaneously, and in a fully automatic way. The extracted cardiac borders are then statistically compared with the ones manually sketched by four physicians on a set of 240 cavities. Nonparametric statistical tests are conducted on the data using several figures of merit, in order to study the inter- and intraobserver variabilities among the four physicians and the level set algorithm, concerning to the extracted contours. The results show there is a great concordance about all the used similarity indexes. A higher interobserver variability was found among the physicians than the variability obtained when the algorithm versus physician performance is compared. The statistical analysis suggests the proposed algorithm produces results similar to the ones provided by the physicians.
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http://dx.doi.org/10.1109/TITB.2012.2201949DOI Listing
September 2012

[Asymptomatic cardiac tumor in a child: an incidental diagnosis].

Rev Port Cardiol 2011 Oct;30(10):795-7

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

Cardiac tumors in the pediatric population are rare, their incidence range between 0.001% and 0.003%. They are mostly benign, rhabdomyomas the most common type, followed by fibromas. The clinical features are being usually nonspecific and depend on the size and location of the tumor within the heart. We report the case of a previously healthy four-year-old boy referred for flu-like symptoms. A respiratory infection was suspected and a chest X-ray showed an increased cardiothoracic index. An echocardiogram revealed a single large heterogeneous mass in the left ventricle emerging from the lateral wall. Despite its size, the mass did not obstruct the left ventricular outflow tract or affect mitral valve function. Cardiac magnetic resonance imaging showed a large mass whose imaging features were suggestive of a fibroma. He became symptomatic during follow-up and was referred for surgical excision of the mass. Histological study confirmed a fibroma. At present the patient remains asymptomatic.
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http://dx.doi.org/10.1016/S0870-2551(11)70028-2DOI Listing
October 2011

Left ventricular noncompaction: analysis of a pediatric population.

Rev Port Cardiol 2011 Mar;30(3):295-311

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

Introduction: Left ventricular noncompaction (LVNC) is a rare and potentially progressive cardiomyopathy, characterized by the persistence of multiple trabeculations and deep intratrabecular recesses in the ventricular myocardium. Although two-dimensional and color Doppler echocardiography are the most useful diagnostic modalities, cardiac magnetic resonance imaging has proved to have high sensitivity and specificity in the diagnosis of this anomaly.

Objective: To characterize the clinical and imaging features of LVNC in a pediatric population and to assess their evolution.

Methods And Results: We performed a retrospective chart review of five pediatric patients with LVNC, followed at Coimbra Pediatric Hospital between January 1999 and December 2007. Median age at presentation was five months (ranging from one day to 13 years), and they were mainly male (1.5:1). Two of the children had a family history of sudden death. In one case the clinical presentation was cardiac arrest due to ventricular fibrillation and in three others, congestive cardiac failure. None of the five cases had associated congenital cardiac anomalies. Involvement of the ventricular apical region was found in all cases. Four children additionally had ventricular dysfunction which improved with diuretic and vasodilator therapy. Mean follow-up was 34 months, ranging from six months to seven years. In one case a change in the morphological phenotype was noted, from a dilated to a hypertrophic form. In this case and in the child's father a mutation in the MYBPC3 gene was identified, which is associated with hypertrophic cardiomyopathy. No thromboembolic phenomena or deaths occurred during the study period.

Conclusion: In the pediatric population, congestive cardiac failure is the most common clinical presentation of LVNC, which can coexist with other cardiomyopathies, particularly dilated and hypertrophic forms. The sample presented in this analysis is statistically non-significant due to its limited size and the authors highlight the need for larger prospective studies in the pediatric population in order to clarify this disease and its diagnostic criteria.
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March 2011

Phase symmetry approach applied to children heart chambers segmentation: a comparative study.

IEEE Trans Biomed Eng 2011 Aug 21;58(8). Epub 2011 Apr 21.

Segmentation of echocardiographic images presents a great challenge because these images contain strong speckle noise and artifacts. Besides, most ultrasound segmentation methods are semi-automatic, requiring initial contour to be manually identified in the images. In this work, we propose an algorithm based on the phase symmetry approach and level set evolution, in order to extract simultaneously all heart cavities in a fully automatic way. The level set evolution uses a new logarithmic based stopping function, which demonstrates to perform well in the boundary extraction. We compared our method with other level set approaches, the watershed technique, and the manual segmentation made by two physicians. The experimental work was based on echocardiography images of children. Similarity metrics, namely Pratt Function, Pixel Mean Error, and Similarity Angle have been used for the performance evaluation of the different methods. The results indicate that our method has a performance at least 4% superior to the other methods able to segment the four chambers. Even for the two worst boundary extraction cases (right ventricle and left atrium) the performance of the proposed method still is better than the other techniques.
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http://dx.doi.org/10.1109/TBME.2011.2144982DOI Listing
August 2011

Superior sternal cleft, supraumbilical midline raphe and haemangiomas in a baby girl with an ostium secundum ASD.

Clin Dysmorphol 2011 Apr;20(2):95-7

Department of Pediatric Cardiology, Hospital Pediátrico de Coimbra - CHC, EPE, Coimbra, Portugal.

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http://dx.doi.org/10.1097/MCD.0b013e3283435199DOI Listing
April 2011

Coronary and systemic aneurysms in an infant with Kawasaki disease.

Pediatr Cardiol 2009 May 14;30(4):568-9. Epub 2009 Apr 14.

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

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http://dx.doi.org/10.1007/s00246-009-9429-yDOI Listing
May 2009

Transposition of the great arteries.

Orphanet J Rare Dis 2008 Oct 13;3:27. Epub 2008 Oct 13.

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

Transposition of the great arteries (TGA), also referred to as complete transposition, is a congenital cardiac malformation characterised by atrioventricular concordance and ventriculoarterial (VA) discordance. The incidence is estimated at 1 in 3,500-5,000 live births, with a male-to-female ratio 1.5 to 3.2:1. In 50% of cases, the VA discordance is an isolated finding. In 10% of cases, TGA is associated with noncardiac malformations. The association with other cardiac malformations such as ventricular septal defect (VSD) and left ventricular outflow tract obstruction is frequent and dictates timing and clinical presentation, which consists of cyanosis with or without congestive heart failure. The onset and severity depend on anatomical and functional variants that influence the degree of mixing between the two circulations. If no obstructive lesions are present and there is a large VSD, cyanosis may go undetected and only be perceived during episodes of crying or agitation. In these cases, signs of congestive heart failure prevail. The exact aetiology remains unknown. Some associated risk factors (gestational diabetes mellitus, maternal exposure to rodenticides and herbicides, maternal use of antiepileptic drugs) have been postulated. Mutations in growth differentiation factor-1 gene, the thyroid hormone receptor-associated protein-2 gene and the gene encoding the cryptic protein have been shown implicated in discordant VA connections, but they explain only a small minority of TGA cases.The diagnosis is confirmed by echocardiography, which also provides the morphological details required for future surgical management. Prenatal diagnosis by foetal echocardiography is possible and desirable, as it may improve the early neonatal management and reduce morbidity and mortality. Differential diagnosis includes other causes of central neonatal cyanosis. Palliative treatment with prostaglandin E1 and balloon atrial septostomy are usually required soon after birth. Surgical correction is performed at a later stage. Usually, the Jatene arterial switch operation is the procedure of choice. Whenever this operation is not feasible, adequate alternative surgical approach should be implemented. With the advent of newer and improved surgical techniques and post operative intensive care, the long-term survival is approximately 90% at 15 years of age. However, the exercise performance, cognitive function and quality of life may be impaired.
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http://dx.doi.org/10.1186/1750-1172-3-27DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2577629PMC
October 2008

Innocent heart murmurs.

Rev Port Cardiol 2008 Jun;27(6):815-31

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

Innocent heart murmur is a frequent auscultatory finding in children. The diagnosis is essentially clinical, without need for further investigation. However, excluding heart disease can be a difficult task. This review article describes some features of medical history and physical examination that help in this differentiation. The role of diagnostic tests is also examined.
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June 2008

A rare case of aortic atresia.

Rev Port Cardiol 2008 Mar;27(3):415-8

Serviço de Cardiologia do Hospital de Santarém, Santarém, Portugal.

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March 2008

Five years of teleconsultation: experience of the Cardiology Department of Coimbra Pediatric Hospital.

Rev Port Cardiol 2005 Jun;24(6):835-40

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

Background: Telemedicine is an excellent tool to expand specialized medical care, providing better access for patients and lowering costs for their families. The objective of this work was to evaluate the reliability of teleconsultation in pediatric cardiology, with similar results to traditional consultation. It can be a useful tool to upgrade technical skills among the staff involved and to improve the quality of life of patients and families.

Methods: The authors present their 5 years' experience of pediatric cardiology teleconsultation involving Coimbra Central Pediatric Hospital and district hospitals in the central region of Portugal. During this period 1761 consultations, involving 1056 patients, were given with a pre-established weekly schedule for each hospital and joint online reports were produced, with data confidentiality assured.

Results: Cardiac murmur was the most common reason for consultation (73%). No heart disease was diagnosed in 49% of the patients. Among septal defects, accounting for 43%, ventricular septal defect was the most frequent (20%). Only 10% of all patients had to be seen in the Pediatric Hospital Cardiology Department. Six emergency consultations were requested.

Conclusions: Pediatric cardiology teleconsultation is a reliable procedure using the Medigraf platform, with a similar error rate to consultations by traditional methods. The costs are lower, especially for the families, who do not have to travel far from home or take time off work. The waiting time for a consultation is shorter and therapeutic decisions are faster. A pediatric cardiologist can cover a larger geographic area and the cooperative work during sessions is useful for exchanging knowledge and experiences.
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June 2005