Ferran Gran

Embarazo y cardiopatías congénitas

Introduccion y objetivos Desde la creacion de las Unidades de Cardiopatias Congenitas (CC) del Adulto y las Unidades Obstetricas de Alto Riesgo Cardiologico, ha habido creciente interes por la evolucion hemodinamica y obstetrica de embarazadas con CC. Metodos Estudio descriptivo retrospectivo de 56 mujeres con CC y media de edad de 25 (18-40) anos, que iniciaron 84 gestaciones entre enero de 1992 y agosto de 2006. Se las distribuyo en 3 grupos de riesgo gestacional: A, bajo; B, moderado y C, alto. Resultados Las incidencias de complicaciones durante la gestacion fueron del 1,6, el 15 y el 20%, y durante el puerperio, el 2, el 23 y el 50%; la mortalidad materna fue 0, del 7,6 y del 25% de los grupos A, B y C respectivamente. Nacieron 69 ninos y las tasas de prematuridad fueron del 11, el 15 y el 100% respectivamente. Los factores de riesgo principales fueron: la hipertension pulmonar (HTP), la cianosis, la arritmia, la obstruccion del tracto de salida del ventriculo izquierdo, el ventriculo derecho (VD) dilatado, el VD sistemico necesidad de y la anticoagulacion. La HTP fue el factor mas importante asociado a morbimortalidad maternofetal. Conclusiones La estratificacion por riesgo en las gestantes con CC ofrece informacion pronostica que permite adecuar la atencion de equipos multidisciplinarios para conseguir resultados exitosos.

Embolización percutánea de fístulas vasculares con el tapón vascular de Amplatzer o coils

Introduccion y objetivos Hay gran variedad de fistulas vasculares que son remitidas a los laboratorios de cateterismo cardiaco para su diagnostico y oclusion percutanea. Existe tambien una amplia gama de dispositivos utilizables en su tratamiento percutaneo. El objetivo es evaluar la utilidad, las dificultades, las complicaciones y los resultados en el tratamiento percutaneo de las fistulas vasculares mediante el uso de coils de liberacion controlada o tapones vasculares de Amplatzer. Metodos Revision retrospectiva de las embolizaciones percutaneas realizadas desde enero de 2004 a junio de 2008. Resultados Se embolizaron 51 fistulas vasculares en 30 pacientes con edades entre 6 dias y 28 anos (media, 8,4 anos), con buen resultado. Diagnosticos: 27 colaterales venosas en 16 pacientes con Glenn; 4 fistulas quirurgicas (Blalock-Taussig); 11 fistulas arteriovenosas pulmonares en 3 pacientes; 2 arterias colaterales aortopulmonares en 2 pacientes; 1 colateral venosa en 1 paciente con Fontan previo; 1 arteria aortopulmonar en un sindrome de cimitarra; 1 fistula arteriovenosa coronaria; 3 fistulas arteriovenosas sistemicas en 1 recien nacido, y una fistula entre auricula izquierda y vena cava superior tras la cirugia de un retorno venoso pulmonar anomalo. En el tratamiento percutaneo de estas lesiones se emplearon 34 tapones vasculares y 19 coils. Conclusiones Las fistulas vasculares pueden ser ocluidas percutaneamente con buen resultado. Los coils permiten el cierre de fistulas de menor diametro y los tapones vasculares estan indicados en las mas amplias. Ambos dispositivos alcanzan una alta eficacia oclusora y no se han observado especiales dificultades ni complicaciones significativas.

Percutaneous embolization of vascular fistulas using coils or Amplatzer vascular plugs.

INTRODUCTION AND OBJECTIVES A great variety of different types of vascular fistula are referred to cardiac catheterization laboratories for diagnosis and percutaneous occlusion. In addition, a wide range of devices is available for treating them percutaneously. The objectives of this study were to assess the usefulness and difficulty of treating vascular fistulas percutaneously using controlled-release coils or Amplatzer vascular plugs and to report on the complications and overall outcomes observed with these two devices. METHODS Retrospective review of percutaneous embolizations performed from January 2004 through June 2008. RESULTS In total, 51 vascular fistulas in 30 patients aged from 6 days to 28 years (mean, 8.4 years) underwent successful embolization. The underlying diagnoses were: 27 venous collaterals in 16 patients after the Glenn procedure, four surgical (i.e. Blalock-Taussig) fistulas, 11 pulmonary arteriovenous fistulas in three patients, two aortopulmonary collateral arteries in two patients, one venous collateral in a patient who underwent the Fontan procedure, one aortopulmonary artery fistula in a patient with Scimitar syndrome, one coronary arteriovenous fistula, three systemic arteriovenous fistulas in a newborn, and one fistula from the left atrium to the superior vena cava after the repair of anomalous pulmonary venous return. The lesions were treated percutaneously using 34 vascular plugs and 19 coils. CONCLUSIONS Vascular fistulas can be occluded percutaneously with good RESULTS Small fistulas can be closed using coils, while vascular plugs are preferable for large lesions. Both devices are highly effective as occluders and no particular difficulty or significant complication was observed.

Fibrosis endomiocárdica tropical e hipertensión pulmonar secundaria a esquistosomiasis

An 11-year-old black girl from Equatorial Guinea was admitted to our hospital to investigate fatigue, hepatomegaly, and ascites. Echocardiography showed severe left atrial dilation, normal systolic function, and severe dilation of the right chambers. The pulmonary pressure, estimated by the tricuspid regurgitation, was 100 mmHg. A hemodynamic study was performed and confirmed systemic pulmonary pressure with pulmonary resistance of 23 UW/m, which did not change with oxygen and nitric oxide therapy. Additional testing showed a normal hemogram and positive stool culture for Schistosoma intercalatum and S. haematobium. The diagnosis was restrictive cardiomyopathy and pulmonary hypertension due to schistosomiasis. Medical treatment was started with antiparasitic therapy, diuretics, and systemic and pulmonary vasodilators, but there was no apparent response. During the evolution of her condition, the patient presented an episode of left hemiparesis secondary to cerebral thromboembolism during an episode of atrial fibrillation. Four years after the diagnosis, she underwent successful cardiopulmonary transplantation. The figures show a macroscopic section of the ventricle at the level of the papillary muscles in which the ventricular endocardium has a pearly appearance, corresponding to endomyocardial fibrosis (EMF) (Fig. 1), a microscopy view with Masson trichrome stain showing an area of acellular fibrosis (Fig. 2), and a section of the right atrium (Fig. 3). Rev Esp Cardiol. 2011;64(8):713

Prueba de esfuerzo con función cardiopulmonar en niños operados de cardiopatía congénita. Recomendaciones de ejercicio físico en el ámbito escolar

INTRODUCTION AND OBJECTIVES To analyze and discover if stress testing with exhaled gases in children who have had congenital heart surgery is useful so we could make physical exercise recommendations according to heart disease, type of surgery performed, present hemodynamic state and level of exercise practiced. METHODS Prospective study of 108 children, who performed stress testing with exhaled gases, electrocardiogram monitoring and blood pressure. A questionnaire was used to obtain variables concerning heart disease, surgery, present functional condition and level of exercise practiced. Exercise recommendations were given after stress testing, and after a year 35 patients answered a questionnaire. RESULTS There were significant differences between lesion severity and heart rate at rest and during effort, systolic pressure at rest and during effort, oxygen uptake, oxygen pulse, carbon dioxide production and test duration. A relationship was observed between level of weekly exercise and greater oxygen uptake and test duration, but this was not observed with the underlying heart disease. We observed that best performance occurred with fast repairing for 59 children with cyanotic heart disease. Increased exercise level was recommended for 48 children. CONCLUSIONS The cardiopulmonary function study allows us to examine the physical performance of children who have had congenital heart surgery and provides us with important data so that we can recommend better physical exercise planning.

Percutaneus double stent atrial septostomy

Graded balloon septostomy, bladed atrial septostomy, fenestrated Amplatzer devices and stent placement have been reported to obtain stable interatrial communications. We expose our favorable experience creating an interatrial septal defect, by the use of two stents concentrically placed. We think it can be a procedure to be taken into account whenever a wide interauricular septal orifice must be achieved.

Pulmonary Interstitial Glycogenosis A Reversible Underlying Condition Associated With D-Transposition of the Great Arteries and Severe Persistent Pulmonary Hypertension

Transposition of the great arteries with intact ventricular septum and persistent pulmonary hypertension (TGA-IVS PPHN) is a rare association with a poor prognosis. We report the case of a term newborn with TGA-IVS PPHN successfully managed with perioperative extracorporeal membrane oxygenation (ECMO) and aggressive pulmonary vasodilation therapy that underwent successful arterial switch procedure. A lung biopsy obtained during the surgical procedure showed pulmonary interstitial glycogenosis, a reversible condition. Concerns over left ventricle deconditioning after ECMO could be minimized with appropriate management and monitoring of the ductus arteriosus and appropriate timing of surgery.

Immunosuppressive Therapy and Interferon-1β in Acute Myocarditis.

Acute myocarditis is an inflammatory disease of the myocardium with a variable presentation and clinical course. Although the symptoms spontaneously resolve in between 50% and 60% of patients, 20% to 40% die or require heart transplantation. Most patients with a favorable course improve during the first 2 to 4 weeks. A worse clinical course has been associated with the presence of ventricular dysfunction. From July 2008 to March 2016, 32 infants and children (016 years) with acute myocarditis were admitted to our center. Of these, 53% (17 of 32) had a left ventricular ejection fraction (LVEF)

Prevention of Opioid Withdrawal Syndrome After Pediatric Heart Transplantation: Usefulness of Dexmedetomidine

obesity, and physical inactivity. After decades of efforts to call attention to the disease burden attributable to cardiovascular risk factors, these findings represent an important step toward their complete and critical description. This epidemiological evidence should be expected to direct the debates on the new challenges for maintaining and promoting cardiovascular health in the coming years, as well as specific actions that enable the application of multidisciplinary approaches to the prevention and management of the risk factors and their associated comorbidities. Given the complexity of this issue and the fact that the interactions among the determinants of health vary from one context to another, progress in the attempts to control cardiovascular risk factors will require sustained efforts on a regional, national, and international scale.

Interrupted aortic arch

Interrupted aortic arch is a congenital malformation characterized by a complete separation between the ascending aorta and the descending aorta. In type B interrupted aortic arch, the most common form of the condition, the separation is produced between the left carotid and subclavian arteries and is associated with an interventricular communication. The descending aorta is supplied by the pulmonary artery through a patent ductus arteriosus. We present the case of an 8-year-old boy with type B interrupted aortic arch. The physical examination was remarkable for a single, strong second heart sound, secondary to pulmonary hypertension, and asymmetric pulses, which were stronger in the right arm and both carotids than in the other limbs. The patient also presented differential cyanosis with clubbed fingers of the left hand and toes of both feet. Angiographic reconstructions of images obtained with a 64-slice multidetector computed tomography unit, IMAGE IN CARDIOLOGY