Carlos Mortera

Use of angioembolization as an effective technique for the management of pediatric solid tumors

PURPOSE In oncology practice, angioembolization has been reported for tumor reduction before surgery, treatment of life-threatening conditions, and for palliative care. Nevertheless, the overall experience with angioembolization for the treatment of tumors is limited. We report our experience in 7 nonvascular solid pediatric tumors. MATERIALS AND METHODS A retrospective review was carried out of medical records from pediatric patients (0-18 years) with solid nonvascular tumors who underwent angioembolization in the last 5 years at our institution. RESULTS Seven patients underwent embolization: 2 neuroblastomas, 1 metastatic paraganglioma, 1 hepatoblastoma, 1 myofibroblastic tumor, 1 osteosarcoma, and 1 undifferentiated sarcoma. The reason for angioembolization was preparation for surgery (3), treatment of a life-threatening event (1), or palliative care (3). Each case is presented and discussed. The outcome was subsequent complete surgical resection in 3 cases, tumor vanished in 1 case, symptom control was achieved in 1, and the other 2 patients improved their survival and quality of life, however, died of disease progression. CONCLUSIONS Tumor angioembolization may enter the treatment algorithm for selected patients who have to face difficult or unwarranted surgical procedures or have diseases where conventional therapies have failed.

Reversed end‐diastolic umbilical flow in a first‐trimester fetus with congenital heart disease

Reversed end‐diastolic umbilical artery velocities and a reduced chorionic sac were first seen at 10 weeks in a pregnancy subsequently showing a normal male karyotype on chorionic villi. Four weeks later Doppler studies demonstrated normal umbilical artery waveforms. At 20 weeks, ultrasound examination of the fetus revealed a mild pericardic effusion, hypoplastic right heart with hypertrophic myocardium and a single umbilical artery, suggesting pulmonary atresia. After neonatal death, pathological studies confirmed pulmonary atresia. This case suggests that reversed end‐diastolic umbilical flow in the first trimester may identify a subgroup of fetuses with a lethal abnormality (heart defect, severe intra‐uterine retardation, aneuploidy or others). Copyright

Complex Aortic Coarctation and PHACE Syndrome

In PHACE syndrome, the acronym PHACE stands for the association of posterior fossa malformations, cervicofacial hemangiomas, arterial anomalies, coarctation and eye anomalies. We report our findings in four patients with this syndrome, in whom it was characterized by complex aortic coarctation that required not only preoperative echocardiographic investigation, but also the use of techniques such as magnetic resonance imaging and angiography. Surgical treatment was also complex. Prognosis in this condition depends primarily on cardiovascular and cerebral artery complications associated with the syndrome.

Valvulotomía pulmonar percutánea mediante radiofrecuencia en la atresia pulmonar con septo interventricular íntegro

La valvulotomia pulmonar percutanea en pacientes con atresia pulmonar y septo interventricular integro permite el desarrollo del ventriculo derecho y la posibilidad de una hemodinamica biventricular. La valvulotomia percutanea constituye hoy dia una alternativa valida a la cirugia. Mediante el uso de cateteres de ablacion con radiofrecuencia disponibles actualmente en el mercado para el tratamiento de las arritmias puede ser llevada a cabo la perforacion valvular de forma segura y eficaz. Describimos el caso de una valvulotomia pulmonar percutanea mediante radiofrecuencia en un neonato con atresia pulmonar a los 15 dias de vida.

Coartación aórtica compleja y síndrome de PHACE

La asociacion de malformaciones de la fosa posterior, hemangiomas cervicofaciales y vasculares, coartacion y alteraciones oculares es conocida con el acronimo PHACE. Presentamos un analisis de 4 casos de este sindrome, caracterizados por coartacion aortica compleja que necesita no solo estudio ecocardiografico preoperatorio, sino ademas tecnicas como resonancia magnetica y angiografia. El tratamiento quirurgico es tambien complejo. El pronostico esta dado por las complicaciones cardiovasculares y arteriales cerebrales propias del sindrome.

Origen aórtico de arteria pulmonar izquierda en neonato con tetralogía de Fallot

Presentamos el caso de un neonato con diagnostico prenatal de tetralogia de Fallot. Durante la segunda semana de vida presento dificultad respiratoria; en la radiografia de torax se observo un aumento del ventriculo derecho con edema pulmonar. La ecocardiografia mostro los hallazgos de la tetralogia de Fallot. En el cateterismo cardiaco se encontro ademas un origen anomalo de la arteria pulmonar izquierda desde la aorta ascendente. A los 23 dias se realizo cirugia correctora con anastomosis directa sin utilizar interposicion de conducto. Fue dado de alta hospitalaria 10 dias despues. Revisamos la literatura medica de esta rara entidad, en sus hallazgos epidemiologicos, fisiopatologicos, clinicos, diagnosticos y quirurgicos.

Radiofrequency Catheter Ablation of an Incessant Supraventricular Tachycardia in a Premature Neonate

BRUGADA, J., et al.: Radiofrequency Catheter Ablation of an Incessant Supraventricular Tachycardia in a Premature Neonate. A 32‐week, premature neonate with incessant supraventricular tachycardia and hemodynamic compromise who failed to respond to antenatal and postnatal antiarrhythmic therapy underwent successful radiofrequency catheter ablation (RCA) of a concealed left free‐wall accessory pathway when the infant was 4‐days‐old and weighed only 1,840 grams. At follow‐up performed 60 days after the procedure, the infant remained free of any drug, in sinus rhythm, and in normal hemodynamic condition.

Percutaneous Treatment of Atrial Septal Defects, Muscular Ventricular Septal Defects and Patent Ductus Arteriosus in Infants Under One Year of Age

Amplatzer devices are used for the percutaneous closure of ostium secundum atrial septal defects, muscular ventricular septal defects and patent ductus arteriosus. However, very little experience has been gained in using these devices in infants under 1 year of age. Between January 2001 and January 2008, 22 symptomatic infants aged under 1 year underwent percutaneous treatment: three had an ostium secundum atrial septal defect, 15 had patent ductus arteriosus, and four had a muscular ventricular septal defect. All the procedures were completed successfully. No immediate or medium-term complications were observed. Closure of these types of defect using an Amplatzer device in infants under 1 year of age, who would otherwise require surgery, is a safe and effective procedure.

Balloon Angioplasty in a 1200-Gram Premature Infant with Critical Aortic Coarctation

closure of the patent arterial duct using the flipper coil in a premature infant weighing 1,400 g: A case report. Neonatal aortic coarctation is a serious condition. It is characterized by signs of heart failure and cardiogenic shock. We report the case of a premature twin, born at the gestational age of 32 weeks, with intrauterine growth retardation, referred to our hospital at the age of 17 days with severe heart failure. Echocardiography revealed severe left ventricular dysfunction (Figure 1A); the dimensions of left ventricle in M mode were 19 mm and 13 mm in diastole and systole, respectively. The aortic arch showed severe coarctation (Figure 1B), with a gradient of 40 mmHg diastolic extension (Figure 1C). Treatment was begun with prostaglandin E1, diuretics and inotropic agents. He also required mechanical ventilation. When he was 24 days old and weighed 1200 g, angioplasty was performed using the Seldinger technique, involving a 3-F introducer in the left carotid artery (Figure 2A). The aortic arch, the region of the coarctation and descending aorta measured 3.5 mm, 1.5 mm, and 5 mm in diameter, respectively. A 4 mm × 20 mm Tyshak Mini ® balloon catheter (NuMED, Hopkinton, NY, USA) (Figure 2B) was utilized. Following angioplasty, the coarcted segment increased in diameter to 4 mm (Figure 2C). The initial gradient of 35 mmHg disappeared completely. The fluoroscopy time was 7 minutes. After the procedure, the administration of prostaglandins and inotropic agents was discontinued. Starting at 30 days of life, a progressive aortic recoarctation was observed, although it was well tolerated clinically. At the age of 61 days, with a body weight of 2200 grams, the infant underwent a second angioplasty procedure with access via the right femoral artery. The angiography revealed severe recoarctation (Figures 2D and 2E); in addition,

Aortic Origin of the Left Pulmonary Artery in an Infant with Fallot's Tetralogy

We report the case of a male neonate who had a prenatal diagnosis of Fallots tetralogy. He presented with respiratory distress during the second week of life. Chest x-ray showed an enlarged right ventricle and pulmonary edema. Echocardiography demonstrated characteristic features of Fallots tetralogy. However, cardiac catheterization disclosed that, in this case of Fallots tetralogy, the left pulmonary artery had an anomalous origin in the ascending aorta. At 23 days of age, the patient underwent total surgical correction of the defects, during which a direct anastomosis was employed without conduit placement. 10 days later, he was discharged. We present the results of a literature review of the epidemiological, physiopathological, clinical, diagnostic, and surgical characteristics of this rare condition.