Reference intervals for the echocardiographic measurements of the right heart in children and adolescents: a systematic review

BACKGROUND: Transthoracic echocardiography is the primary imaging modality for the diagnosis of right ventricular (RV) involvement in congenital and acquired heart diseases. There is increasing recognition of the contribution of RV dysfunction in heart diseases affecting children and adolescents, but there is insufficient information on reference intervals for the echocardiographic measurements of the right heart in children and adolescents that represent all the continental populations of the world.OBJECTIVE:The aim of this systematic review was to collate, from published studies, normative data for echocardiographic evaluation of the right heart in children and adolescents, and to identify gaps in knowledge in this field especially with respect to sub-Saharan Africans. METHODS: We performed a systematic literature search to identify studies of reference intervals for right heart measurements as determined by transthoracic echocardiography in healthy children and adolescents of school-going age. Articles were retrieved from electronic databases with a combination of search terms from the earliest date available until May 2013. RESULTS: Reference data were available for a broad range of variables. Fifty one studies out of 3096 publications were included. The sample sizes of the reference populations ranged from 13 to 2036 with ages varying from 5 to 21 years. We identified areas lacking sufficient reference data. These included reference data for determining right atrial size, tricuspid valve area, RV dimensions and areas, the RV % fractional area change, pulmonary artery pressure gradients and the right-sided haemodynamics, including the inferior vena cava dimensions and collapsibility. There were no data for sub-Saharan African children and adolescents. CONCLUSION: Reliable reference data are lacking for important echocardiographic measurements of the RV in children and adolescents, especially for sub-Saharan Africans

Considerações teóricas sobre a relação entre respiração oral e disfonia Theoretical considerations on the relationship between mouth breathing and dysphonia

Sabe-se que a respiração oral pode ocasionar diversas alterações ósseas, posturais, musculares e funcionais, como também, alterações na qualidade e/ou comportamento vocal. Estas alterações podem comprometer a comunicação oral, na qual a voz não consegue desempenhar seu papel básico de transmissão da mensagem verbal e emocional do indivíduo. O indivíduo com respiração oral pode apresentar ressonância nasalizada e a voz pode apresentar alterações no traço de sonoridade, hiper ou hiponasal, ou rouca. A partir de pesquisa nas bases de dados LILACS, SciELO, livros, revistas especializadas sobre o tema, buscamos fazer uma revisão na literatura sobre a relação entre respiração oral e disfonia, analisando a influência das alterações causadas pela respiração oral na qualidade e/ou comportamento vocal. No entanto, foi possível observar que a respiração oral promove uma série de alterações estruturais significativas que refletem nas funções estomatognáticas, interferindo também na fonação. Contudo, poucos autores relatam a possível correlação entre esses dois parâmetros (respiração oral e disfonia).<br>It is known that mouth breathing can lead to several bone, postural, muscular and functional alterations, and also changes on vocal quality and/or vocal behavior. These alterations can compromise oral communication, in which the voice cannot perform its basic role on the transmission of an individual's verbal and emotional message. Individuals with mouth breathing can present hiper or hiponasal resonance, changes on voicing features and hoarseness. From researches on LILACS and SciELO databases, books and specialized magazines about the subject, it was carried a literature review about the relationship between mouth breathing and dysphonia, analyzing the influence of alterations caused by mouth breathing on vocal quality and/or vocal behavior. It was possible observe that mouth breathing promotes several significant structural alterations, which reflect on stomatognathic functions and on phonation. However, few authors report the possible correlation between mouth breathing and dysphonia