[RHEUMATOLOGY IN PEDIATRIC CARDIOLOGY FROM FETAL STAGE TO ADULTHOOD. THE ROLE OF FETAL ECHOCARDIOGRAPHY]

Autor: Ivan Malčić
Rok vydání: 2018
Předmět:
Zdroj: Reumatizam
Volume 63
Issue suppl.1
ISSN: 0374-1338
2459-6159
Popis: Iako su se pedijatrijska kardiologija i reumatologija unatrag deset godina i u našim uvjetima formalno razdvojile, među njima su ostale snažne poveznice. One se više ne očituju samo u reumatskoj vrućici već i u drugim reumatološkim entitetima: sistemskom eritemskom lupusu, antifosfolipidnom sindromu, sistemskoj sklerodermiji, Kawasakijevoj bolesti, nodoznom poliarteritisu, nekim oblicima granulomatoznog vaskulitisa. Posebno se osvrćemo na pojavu kompletnoga kongenitalnog atrioventrikularnog bloka (CCAVB) u trudnica koje zbog sistemskih bolesti vezivnog tkiva imaju osobita ANA-protutijela (anti-SSA/Ro i/ili anti-SSB/La), ali i vjerojatnost da istovjetno upalno zbivanje u srcu bude razlogom razvoja restrikcijske kardiomiopatije pridružene CCAVC-u. Iako je time reumatologija već odavno ušla u ranu fetalnu dob, postoje i neki problemi koji se odnose na embrionalno razdoblje (utjecaj odnosa metotreksata i folne kiseline na embrionalni razvoj srca) i na kasno fetalno razdoblje (zbog odnosa antiprostaglandinskih antifl ogistika na prematurno zatvaranje Botallova duktusa). U radu se posebno osvrćemo na najtežu komplikaciju u fetalnom razdoblju koja se zove neonatalni lupusni sindrom. Time se ostvaruje višestruka veza između kardiologije i reumatologije svih dobnih skupina, od embrionalne i fetalne do odrasle dobi. Upravo i jest cilj ovoga rada prikazati neke važne poveznice i na taj način aktualizirati novu suradnju pedijatrijske kardiologije s reumatologijom od fetalne do odrasle dobi.
Even though in the last ten years pediatric cardiology and rheumatology have formally separated in Croatia as well, strong links still remain between them. Th ey are no longer manifested through rheumatic fever, but through other rheumatic entities: systemic lupus erythematosus, antiphospholipid syndrome, systemic scleroderma, Kawasaki disease, polyarteritis nodosa, and some forms of granulomatous vasculitis. We take special note of the occurrence of complete congenital atrioventricular block (CCAVB) in pregnant women who, due to systemic connective tissue diseases, develop distinctive ANA antibodies (anti-SSA/Ro and/or anti SSB/La), but who are also likely to have the same infl ammation within the heart, leading to the development of restricted cardiomyopathy associated with CCAVC. Although rheumatology has thus been involved with early fetal age for some time now, there are also some issues relating to the embryonal stage (the association between methotrexate/folic acid and heart development in embryos), as well as to the late fetal stage (antiprostaglandin anti-infl ammatory agent impact on premature ductus arteriosus closure). We gave special attention to the neonatal lupus syndrome, the most serious complication in the fetal period. Th us the multiple association between cardiology and rheumatology in all age groups, from the embryonal and fetal stage to adulthood, is being realized. Th e aim of this paper is to present some important links and thus further emphasize the new cooperation between pediatric cardiology and rheumatology from fetal stage to adulthood.
Databáze: OpenAIRE
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