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Ventricular septal defect in children and adolescents in Angola: Experience of a tertiary center
Comunicação interventricular em crianças e adolescentes em Angola: Experiência de um centro terciário
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CHD: congenital heart defect; VSD: ventricular septal defect.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Ventricular septal defect (VSD) is the most common congenital heart defect (CHD), affecting approximately 2–6/1000 live births.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> VSD results from a malfunction of cardiac development, possibly including a failure in the alignment or in the fusion of the atrioventricular cushions during the formation of the interventricular septum.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The defects can be classified according to their location. Perimembranous defects are located in the membranous portion of the interventricular septum and muscular defects are located in the muscular portion of the trabecular septum or at its margins.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Perimembranous defect is more common, occurring in 70–80% of cases.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> VSDs can present in isolation or coexisting with other CHDs.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In Africa VSD is also the most common CHD in childhood.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–9</span></a> In Angola, little is known of the prevalence of VSD, largely because few studies have been conducted.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The authors of this study aim to characterize VSD in children and adolescents based on echocardiographic records from the pediatric cardiology service of the largest pediatric care center in Angola over a period of one year, from April 2010 to March 2011.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">The David Bernardino Pediatric Hospital is the largest pediatric cardiology and care center in Angola. It is a tertiary teaching and postgraduate hospital with 300 beds in 11 departments. The cardiology service has an echocardiography laboratory with teleconsultation links to the pediatric cardiology department of Coimbra Hospital in Portugal. Around the country many pediatrics patients have been referred to the hospital for assessment. Consecutive echocardiographic reports of 1267 patients over a period of one year (from April 2010 to March 2011) were retrospectively reviewed. Repeat scans were not included. All children and adolescents aged 0–18 years with a diagnosis of VSD with or without associated CHD were included. The diagnosis of VSD was made by clinical examination and confirmed by transthoracic echocardiography performed by three cardiologists of the institution. The echocardiogram was performed on a Medison SA 8000 system, using an F24AC transducer.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The sample was divided into two groups, Group 1, isolated VSD; and Group 2, VSD associated with other CHDs.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The variables studied were age (months), gender, type of VSD, other CHDs and associated genetic syndromes. The data were presented as absolute and relative frequencies.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Descriptive statistics was used to determine mean, mode and standard deviation. The software used was Epi Info version 3.5.2.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">Over a period of a year (April 2010–March 2011), 490 CHDs were diagnosed in children and adolescents (0–18 years of age), of which 283 (57.7%) were VSDs. <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> shows the division of the sample into groups: Group 1, isolated VSD (140; 49%); and Group 2, VSD associated with other CHDs (143; 51%). In Group 1, the mean age at diagnosis was 29 months (SD 36 months). The most frequent age (mode) at diagnosis was 24 months. There was no predominance of gender (ratio 1:1). The most common type of VSD was perimembranous (127; 91%) with 13 cases of muscular VSD (9%). In this group, five children (3.6%) had pulmonary hypertension. In Group 2, 113 (79%) had one, 27 (19%) had two and three (2%) had three other CHD associated with VSD (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). In this group, 24 (17%) had VSD associated with a genetic syndrome; of these, 23 (96%) had trisomy 21 and one (4%) had Noonan syndrome (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). In Group 2, 50 (35%) of VSDs were associated with patent ductus arteriosus, 24 (16.8%) with pulmonary stenosis, eight (8.4%) with ostium primum atrial septal defect and seven (7.7%) with ostium secundum atrial septal defect (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">In the present study the incidence of CHDs was higher than is found in the literature, probably due to the fact that this center receives children and adolescents from all over the country. VSD was the most common CHD, as it is worldwide.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–13</span></a> The prevalence of VSDs found in this study was also high compared to published reports.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–14</span></a> More than half of VSDs were associated with other CHDs, which contrasts with the results of some authors.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,12</span></a> This difference may be explained by the exclusion of patients with conotruncal anomalies, atrioventricular septal defect and single ventricle. On the other hand, our results were similar to those of a study at Hospital Infantil Pequeno Principe in Brazil.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> In cases of isolated VSD there was no gender predominance (ratio of 1:1), contrasting with the results of a study conducted in Enugu, Nigeria in which there was a predominance of males. The authors claimed this was due to Nigerian sociocultural practices.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The age range of patients at diagnosis was wide (between six days and 18 years), which reflects the lack of a screening program and hence early diagnosis. Most VSDs were diagnosed at the age of 24 months (mode), which places Angola within the typical range of most developing countries.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a> This result contrasts with those reported by other authors, who emphasize the need for diagnosis in the first year of life.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,12,13</span></a> Delay in diagnosis is directly proportional to a worse prognosis. Generally it is in the first year of life that the clinical manifestations of heart disease with left-to-right shunting appear, as in VSD, due to decreased pulmonary vascular resistance after birth and increased systemic resistance and right ventricular compliance, which causes the left-to-right shunt, leading to pulmonary hypertension and delay in development. The most frequent type of VSD in the isolated VSD group was perimembranous, which coincides with the results of other authors,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,14</span></a> but differs from those in a study at Cathay General Hospital (Taiwan) in which the authors found that 65% of VSDs were muscular.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> This may be an Asian characteristic. The percentage of association of VSD with other CHDs observed in this study is generally similar to the results of Glen et al.,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> although the association of VSD with two or three other CHDs was twice as common as in the literature. Regarding the type of CHD most commonly associated with VSD, our results differed from those of another study<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> in which the most frequent associated CHD was pulmonary infundibular pulmonary stenosis, followed by aortic valve prolapse, pulmonary valve stenosis, ostium secundum atrial septal defect, patent ductus arteriosus and coarctation of the aorta. However, they resemble those of another African study (in Nigeria).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> As in our series, in another study trisomy 21 was the most frequent genetic syndrome (3.5%).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0045" class="elsevierStylePara elsevierViewall">The study demonstrated that VSD is the most common CHD in childhood. Delayed diagnosis is associated with worse prognosis. When VSD is detected we consider a detailed Doppler echocardiographic examination is required to exclude other CHDs associated with the VSD.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical disclosures</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Protection of human and animal subjects</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Confidentiality of data</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Right to privacy and informed consent</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:2 [ "identificador" => "xres379272" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction and Objective" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec358122" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres379271" "titulo" => array:5 [ 0 => "Resumo" 1 => "Introdução e objectivo" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusões" ] ] 3 => array:2 [ "identificador" => "xpalclavsec358123" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:3 [ "identificador" => "sec0030" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "xack99550" "titulo" => "Acknowledgments" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-02-17" "fechaAceptado" => "2014-03-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec358122" "palabras" => array:3 [ 0 => "Congenital heart disease" 1 => "Ventricular septal defect" 2 => "Echocardiography" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec358123" "palabras" => array:3 [ 0 => "Cardiopatia congenital" 1 => "Comunicação interventricular" 2 => "Ecocardiografia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This is the first study in Angola with the aim of characterizing ventricular septal defect (VSD) among children and adolescents.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study based on echocardiographic records of the largest pediatric cardiology center in Angola included all children and adolescents (0 to 18 years old) with VSD between April 2010 and March 2011. The diagnosis was made by transthoracic and Doppler echocardiography with a Medison SA 8000 system. The sample was divided into two groups: Group 1, isolated VSD; and Group 2, VSD associated with other congenital heart defects (CHDs). Age, gender, type of VSD, associated CHDs and genetic syndromes were assessed.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 490 CHDs were diagnosed, of which 283 were VSDs. In Group 1 (140, 49%) the mean age was 29±36 months. The most frequent age (mode) at diagnosis was 24 months. There was no predominance of gender (ratio 1:1). The majority (127, 91%) had perimembranous VSD. In Group 2 (143, 51%) 113 patients (79%) had one, 27 patients (19%) had two and three patients (2%) had three other CHDs. Trisomy 21 was the most common genetic syndrome (23, 96%).</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The study shows that VSD is the most common CHD in childhood, the diagnosis is made late and almost half of VSDs are associated with other CHDs.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introdução e objectivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Esta é a primeira pesquisa em Angola com o objetivo de caracterizar a comunicação interventricular entre crianças e adolescentes.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal, com base nos registos ecocardigráficos do maior Hospital de Cardiologia Pediátrica em Angola (abril de 2010 para março de 2011). Todas as crianças e adolescentes (0 a 18 anos de idade) com comunicação interventricular foram incluídas. O diagnóstico foi feito por ecocardiografia transtorácica e Doppler com a máquina de Medison SA 8000. A amostra foi dividida em dois grupos: Grupo I – comunicação interventricular isolada e Grupo II – comunicação interventricular associada a outras cardiopatias congénitas. A Idade, o sexo, o tipo de defeito do septo, principais cardiopatias congénitas associadas e as síndromes genéticas foram avaliados.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Houve 490 cardiopatias congénitas diagnosticadas, das quais 283 foram comunicação interventricular. No Grupo I (140, 49%) a idade média foi de 29<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>36 meses. A idade mais frequente (moda) ao diagnóstico foi de 24 meses. Não houve predomínio quanto ao género (1: 1). Neste grupo a maioria tinha comunicação interventricular perimembranosa (127, 91%). No Grupo II (143, 51%) 113 pacientes (79%) tinham uma, 27 (19%) tinham duas e três (2%) tinham três outras cardiopatias congénitas associadas a comunicação interventricular. A Trissomia do cromossomo 21 foi a síndrome genética mais comum (24, 96%).</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusões</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">O estudo mostra que comunicação interventricular é a cardiopatia congénita mais comum em crianças pré-escolares.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1074 "Ancho" => 1253 "Tamanyo" => 58947 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of the sample according to whether ventricular septal defect was associated with other congenital heart defects. CHD: congenital heart defect; VSD: ventricular septal defect.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CHD: congenital heart defect.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Number of other associated CHDs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">One \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">113 (79) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Two \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (19) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Three \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">143 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab577228.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Associated congenital heart defects in patients with ventricular septal defect.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Genetic syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Trisomy 21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (96) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Noonan syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab577229.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Types of genetic syndrome associated with ventricular septal defect in Group 2.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">AS: aortic stenosis; CAVD: common atrioventricular canal defect; CHD: congenital heart defect; CoA: coarctation of the aorta; DORV: double outlet right ventricle; OPASD: ostium primum atrial septal defect; OSASD: ostium secundum atrial septal defect; PA: pulmonary atresia; PDA: patent ductus arteriosus; PS: pulmonary stenosis; TA: tricuspid atresia; TGV: transposition of the great vessels; TOF: tetralogy of Fallot.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Type of CHD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PDA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 (35) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (16.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OSASD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (8.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OPASD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (7.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OSASD + PDA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (5.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OPASD + PDA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (4.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TGV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CoA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PDA + DORV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CAVD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DORV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PCA + PS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DORV + OSASD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TOF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Truncus arteriosus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PDA + TGV + PS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TGV + OPASD + PDA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OPASD + PDA + PS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PE + TA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OPASD + TGV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PS + DORV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PS + AS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OPASD + PDA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">143 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab577230.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Prevalence of other congenital heart defects in patients with ventricular septal defect.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital heart disease among 815,569 children born between 1980 and 1990 and their 15 year survival: a prospective Bohemia survival study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. 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| 2024 Abril | 48 | 37 | 85 |
| 2024 Maro | 42 | 35 | 77 |
| 2024 Fevereiro | 66 | 44 | 110 |
| 2024 Janeiro | 23 | 18 | 41 |
| 2023 Dezembro | 46 | 28 | 74 |
| 2023 Novembro | 39 | 28 | 67 |
| 2023 Outubro | 31 | 17 | 48 |
| 2023 Setembro | 32 | 22 | 54 |
| 2023 Agosto | 38 | 24 | 62 |
| 2023 Julho | 30 | 10 | 40 |
| 2023 Junho | 36 | 13 | 49 |
| 2023 Maio | 40 | 26 | 66 |
| 2023 Abril | 23 | 5 | 28 |
| 2023 Maro | 40 | 19 | 59 |
| 2023 Fevereiro | 34 | 19 | 53 |
| 2023 Janeiro | 40 | 21 | 61 |
| 2022 Dezembro | 38 | 26 | 64 |
| 2022 Novembro | 47 | 28 | 75 |
| 2022 Outubro | 48 | 22 | 70 |
| 2022 Setembro | 45 | 37 | 82 |
| 2022 Agosto | 45 | 42 | 87 |
| 2022 Julho | 54 | 41 | 95 |
| 2022 Junho | 29 | 27 | 56 |
| 2022 Maio | 33 | 39 | 72 |
| 2022 Abril | 54 | 43 | 97 |
| 2022 Maro | 48 | 39 | 87 |
| 2022 Fevereiro | 26 | 34 | 60 |
| 2022 Janeiro | 39 | 39 | 78 |
| 2021 Dezembro | 33 | 40 | 73 |
| 2021 Novembro | 78 | 33 | 111 |
| 2021 Outubro | 39 | 37 | 76 |
| 2021 Setembro | 31 | 28 | 59 |
| 2021 Agosto | 44 | 29 | 73 |
| 2021 Julho | 39 | 27 | 66 |
| 2021 Junho | 42 | 22 | 64 |
| 2021 Maio | 39 | 38 | 77 |
| 2021 Abril | 51 | 20 | 71 |
| 2021 Maro | 65 | 21 | 86 |
| 2021 Fevereiro | 73 | 21 | 94 |
| 2021 Janeiro | 29 | 16 | 45 |
| 2020 Dezembro | 42 | 15 | 57 |
| 2020 Novembro | 43 | 13 | 56 |
| 2020 Outubro | 34 | 12 | 46 |
| 2020 Setembro | 69 | 13 | 82 |
| 2020 Agosto | 33 | 7 | 40 |
| 2020 Julho | 52 | 7 | 59 |
| 2020 Junho | 37 | 11 | 48 |
| 2020 Maio | 55 | 6 | 61 |
| 2020 Abril | 65 | 17 | 82 |
| 2020 Maro | 41 | 13 | 54 |
| 2020 Fevereiro | 68 | 25 | 93 |
| 2020 Janeiro | 45 | 16 | 61 |
| 2019 Dezembro | 47 | 20 | 67 |
| 2019 Novembro | 55 | 10 | 65 |
| 2019 Outubro | 50 | 8 | 58 |
| 2019 Setembro | 72 | 12 | 84 |
| 2019 Agosto | 63 | 13 | 76 |
| 2019 Julho | 64 | 9 | 73 |
| 2019 Junho | 59 | 10 | 69 |
| 2019 Maio | 62 | 11 | 73 |
| 2019 Abril | 46 | 25 | 71 |
| 2019 Maro | 103 | 15 | 118 |
| 2019 Fevereiro | 88 | 14 | 102 |
| 2019 Janeiro | 93 | 18 | 111 |
| 2018 Dezembro | 139 | 15 | 154 |
| 2018 Novembro | 205 | 11 | 216 |
| 2018 Outubro | 247 | 18 | 265 |
| 2018 Setembro | 70 | 9 | 79 |
| 2018 Agosto | 28 | 11 | 39 |
| 2018 Julho | 36 | 6 | 42 |
| 2018 Junho | 52 | 7 | 59 |
| 2018 Maio | 50 | 10 | 60 |
| 2018 Abril | 51 | 5 | 56 |
| 2018 Maro | 61 | 11 | 72 |
| 2018 Fevereiro | 37 | 3 | 40 |
| 2018 Janeiro | 19 | 6 | 25 |
| 2017 Dezembro | 67 | 9 | 76 |
| 2017 Novembro | 35 | 10 | 45 |
| 2017 Outubro | 32 | 9 | 41 |
| 2017 Setembro | 30 | 5 | 35 |
| 2017 Agosto | 39 | 4 | 43 |
| 2017 Julho | 40 | 10 | 50 |
| 2017 Junho | 53 | 21 | 74 |
| 2017 Maio | 35 | 13 | 48 |
| 2017 Abril | 26 | 6 | 32 |
| 2017 Maro | 23 | 38 | 61 |
| 2017 Fevereiro | 21 | 6 | 27 |
| 2017 Janeiro | 29 | 6 | 35 |
| 2016 Dezembro | 31 | 6 | 37 |
| 2016 Novembro | 25 | 5 | 30 |
| 2016 Outubro | 23 | 1 | 24 |
| 2016 Setembro | 11 | 8 | 19 |
| 2016 Agosto | 5 | 3 | 8 |
| 2016 Julho | 4 | 2 | 6 |
| 2016 Junho | 22 | 4 | 26 |
| 2016 Maio | 1 | 4 | 5 |
| 2016 Abril | 34 | 2 | 36 |
| 2016 Maro | 58 | 18 | 76 |
| 2016 Fevereiro | 83 | 31 | 114 |
| 2016 Janeiro | 48 | 7 | 55 |
| 2015 Dezembro | 47 | 12 | 59 |
| 2015 Novembro | 55 | 11 | 66 |
| 2015 Outubro | 68 | 10 | 78 |
| 2015 Setembro | 55 | 18 | 73 |
| 2015 Agosto | 62 | 15 | 77 |
| 2015 Julho | 53 | 8 | 61 |
| 2015 Junho | 41 | 2 | 43 |
| 2015 Maio | 52 | 6 | 58 |
| 2015 Abril | 43 | 11 | 54 |
| 2015 Maro | 46 | 6 | 52 |
| 2015 Fevereiro | 32 | 12 | 44 |
| 2015 Janeiro | 43 | 15 | 58 |
| 2014 Dezembro | 36 | 18 | 54 |
| 2014 Novembro | 104 | 64 | 168 |
| 2014 Outubro | 15 | 13 | 28 |
Mostrar tudo
