Felipe Heusser

Atenolol versus propranolol for the treatment of infantile hemangiomas: A randomized controlled study

BACKGROUND Infantile hemangiomas have a dramatic response to propranolol, a nonselective beta-blocker. However, this treatment is not risk-free and many patients are excluded because of respiratory comorbidities. Atenolol is a cardioselective beta-blocker that may have fewer adverse events. OBJECTIVE We sought to evaluate the effectiveness of atenolol against propranolol in a noninferiority trial. METHODS In all, 23 patients met the inclusion criteria and were randomized to receive either atenolol or propranolol. Thirteen patients were treated with atenolol and 10 with propranolol. Follow-up was made at baseline, 2 weeks, 4 weeks, and then monthly for 6 months. RESULTS Patients treated with atenolol had a complete response of 53.8% and 60% with propranolol, respectively. These results were nonsignificant (P = .68). Relevant adverse events were not reported. LIMITATIONS The reduced number of patients could have influenced our results. CONCLUSION Atenolol appears to be as effective as propranolol. We did not find significant differences between these results or any adverse events.

Cardiovascular magnetic resonance findings in a pediatric population with isolated left ventricular non-compaction

BackgroundIsolated Left Ventricular Non-compaction (LVNC) is an uncommon disorder characterized by the presence of increased trabeculations and deep intertrabecular recesses. In adults, it has been found that Ejection Fraction (EF) decreases significantly as non-compaction severity increases. In children however, there are a few data describing the relation between anatomical characteristics of LVNC and ventricular function. We aimed to find correlations between morphological features and ventricular performance in children and young adolescents with LVNC using Cardiovascular Magnetic Resonance (CMR).Methods15 children with LVNC (10 males, mean age 9.7 y.o., range 0.6 - 17 y.o.), underwent a CMR scan. Different morphological measures such as the Compacted Myocardial Mass (CMM), Non-Compaction (NC) to the Compaction (C) distance ratio, Compacted Myocardial Area (CMA) and Non-Compacted Myocardial Area (NCMA), distribution of NC, and the assessment of ventricular wall motion abnormalities were performed to investigate correlations with ventricular performance. EF was considered normal over 53%.ResultsThe distribution of non-compaction in children was similar to published adult data with a predilection for apical, mid-inferior and mid-lateral segments. Five patients had systolic dysfunction with decreased EF. The number of affected segments was the strongest predictor of systolic dysfunction, all five patients had greater than 9 affected segments. Basal segments were less commonly affected but they were affected only in these five severe cases.ConclusionThe segmental pattern of involvement of non-compaction in children is similar to that seen in adults. Systolic dysfunction in children is closely related to the number of affected segments.

New Surgical Approach to Device Closure of Multiple Apical Ventricular Septal Defects

We present an alternative technique for closing multiple ventricular septal defects difficult to access during surgery. A guidewire is advanced through the right ventricular free wall and through the main apical defect to the left ventricle, and this approach is used to place an Amplatzer device to occlude the ventricular septal defects. The procedure is performed in the beating heart, under intraoperative transesophageal echocardiographic guidance, and without extracorporeal circulation. It appears to be a simple and reproducible procedure with excellent short-term results.

Cierre perventricular de la comunicación interventricular múltiple con dispositivo Amplatzer

Se presenta una tecnica alternativa para el cierre de la comunicacion interventricular de dificil acceso quirurgico. Con el corazon latiendo y sin necesidad de circulacion extracorporea, se punciona el ventriculo derecho y se avanza una guia de alambre hasta el ventriculo izquierdo a traves del defecto apical principal; esto permite colocar un dispositivo Amplatzer que ocluye completamente los defectos. El procedimiento se realiza con vision ecocardiografica transesofagica, es simple y con excelentes resultados a corto plazo.

Síndrome de hipoplasia de corazón izquierdo: experiencia de 10 años de un programa de etapificación quirúrgica

UNLABELLED Hypoplastic left heart syndrome (HLHS) is a lethal congenital heart disease in 95% of non-treated patients. Surgical staging is the main form of treatment, consisting of a 3-stage approach, beginning with the Norwood operation. Long term survival of treated patients is unknown in our country. OBJECTIVES 1) To review our experience in the management of all patients seen with HLHS between January 2000 and June 2012. 2) Identify risk factors for mortality. PATIENTS AND METHOD Retrospective analysis of a single institution experience with a cohort of patients with HLHS. Clinical, surgical, and follow-up records were reviewed. RESULTS Of the 76 patients with HLHS, 9 had a restrictive atrial septal defect (ASD), and 8 had an ascending aorta ≤2mm. Of the 65 out of 76 patients that were treated, 77% had a Norwood operation with pulmonary blood flow supplied by a right ventricle to pulmonary artery conduit, 17% had a Norwood with a Blalock-Taussig shunt, and 6% other surgical procedure. Surgical mortality at the first stage was 23%, and for Norwood operation 21.3%. For the period between 2000-2005, surgical mortality at the first stage was 36%, and between 2005-2010, 15% (P=.05). Actuarial survival was 64% at one year, and 57% at 5years. Using a multivariate analysis, a restrictive ASD and a diminutive aorta were high risk factors for mortality. CONCLUSIONS Our immediate and long term outcome for staged surgical management of HLHS is similar to that reported by large centres. There is an improvement in surgical mortality in the second half of our experience. Risk factors for mortality are also identified.

TRATAMIENTO ENDOVASCULAR DE LA COARTACIÓN AÓRTICA NATIVA Y RECURRENTE EN PACIENTES MAYORES DE 4 AÑOS: RESULTADOS Y COMPLICACIONES

Se revisaron los registros clinicos de los pacientes mayores de 4 anos intervenidos por una CoAo nativa o recoartacion en el Hospital Clinico de la Univer -sidad Catolica entre los anos 2007 y 2012. Se realizaron estadisticas descriptivas y se utilizo el test de Wilcoxon signed rank, con una p <0,05.

Resultados inmediatos y alejados del switch arterial en pacientes con dextrotransposición de grandes arterias: experiencia de 20 años.

Estudio retrospectivo de pacientes sometidos a switch arterial entre mayo de 1992 y noviembre de 2012. Se comparo periodo 1 (1992 a 2002) con periodo 2 (2003 a 2012). Se de-finio D-TGA simple aquella sin lesiones asociadas y D-TGA compleja aquella con asociacion de comunica-cion interventricular o coartacion aortica.

Cierre percutáneo de pseudoaneurisma post-operatorio de aorta ascendente con dispositivo Amplatzer

Los pseudoaneurismas de la aorta ascendente, que se desarrollan en los puntos de sutura de anastomosis entre el injerto de Dacron y la aorta, son infrecuentes, pero potencialmente fatales, y usualmente necesitan manejo quirurgico definitivo.Existen reportes de casos en los que se emplearon tec-nicas percutaneas en pacientes con riesgo quirurgico alto. Aqui presentamos el caso de un pseudoaneurisma aortico reparado exitosamente con el cierre percutaneo con un dispositivo Amplatzer para comunicacion inter-ventricular.

Cierre de leak periprotésico mitral con Amplatzer Vascular Plug III, vía transapical y toracotomía mínima

La dehiscencia parcial de una valvula cardiaca prote-sica, produciendo una fuga perivalvular (FPV), es una complicacion que puede ocurrir en el seguimiento ale-jado de los pacientes sometidos a reemplazo valvular. Es clinicamente significativa en 2 a 5% de los casos, en los que produce insuficiencia importante o hemolisis. La etiologia corresponde a una perdida de continuidad de las suturas, ya sea por la tecnica empleada, por en-docarditis o por calcificacion anular.

Cierre percutáneo de orejuela izquierda para prevención de fenómenos embólicos en fibrilación auricular: experiencia preliminar

ResumenIntroduccion: Dentro de las complicaciones mas importantes de la fibrilacion auricular (FA) se encuentra el accidente vascular encefalico embolico (AVE), siendo la terapia anticoagulante oral (TACO) la principal herramienta para su prevencion. Cerca de un 20% de los pacientes con FA presentan condiciones clinicas que impiden su uso. Como la orejuela izquierda (OI) ha sido identificada como el principal sitio de formacion de trombos en la FA no valvular, se ha postulado que su oclusion podria disminuir la incidencia de eventos embolicos en este tipo de pacientes. Con este objetivo se han desarrollado multiples tecnicas, tanto quirurgicas como dispositivos percutaneos para el cierre de esta estructura. En esta publicacion se presenta la experiencia del cierre percutaneo de la OI en tres pacientes, con el uso del dispositivo Amplatzer Cardiac Plug (ACP). Metodos: Los tres pacientes tenian alto riesgo embolico y contraindicacion para uso de TACO. El procedimiento se realizo en el laboratorio de hemodinamia, bajo guia radioscopica y ecocardiografica, con anestesia