Javier Mayol

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.

Neonatal Ross–Konno operation and endocardial fibroelastosis resection after foetal percutaneous aortic valve balloon valvuloplasty: a complex approach to rescue the left heart

We report a case of a patient who presented with aortic stenosis and a borderline left ventricle during foetal life. A balloon aortic valve valvuloplasty was performed in uterus, and in the postnatal period for relief of the left ventricular outflow tract obstruction followed by a Ross-Konno procedure with fibroelastosis resection. These successful interventions allowed left ventricular growth and the conversion to a biventricular circulation after a single-stage surgery.

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.

Tratamiento quirúrgico del origen anómalo de la arteria pulmonar izquierda

We report our experience with the surgical treatment of anomalous origin of the left pulmonary artery in eight children between 2004 and 2009. The congenital heart disease most frequently associated with this condition was patent ductus arteriosus. Surgery was carried out with extracorporeal circulation in five children, and without, in three. The anomalous pulmonary artery was divided and translocated to the main pulmonary artery. One patient died soon after surgery because of hemodynamic instability and another died later because of respiratory complications. The other patients progressed satisfactorily during follow-up: the reimplanted artery remained patent in all cases and respiratory symptoms improved. However, one patient required endoscopic treatment.

Treatment of complex coarctation of aorta with hypoplastic transverse aortic arch using left carotid artery flap

Coarctation of aorta associated with severe hypoplastic aortic arch and ductus arteriosus dependent, often combined with complex cardiac malformations, should be looked upon as bordering of hypoplastic left heart syndrome. The crucial and first objective is the adequate reconstruction of aortic arch, continuing with the repair of cardiac malformations. The surgical treatment making resection of the coarctation segment combined with left carotid flap plasty is a surgical alternative, useful in patients with this complex anatomic variant.

Percutaneous Closure of Ventricular Septal Defect With an Amplatzer Device

We present a series of 4 patients in whom a ventricular septal defect (VSD) was closed with an Amplatzer muscular VSD device during cardiac catheterization. In one patient with type I truncus arteriosus and subarterial VSD, closure of a wide apical defect was done to allow further surgical correction while avoiding left ventricular ventriculotomy. The second patient had congenitally corrected transposition of the great arteries with complete A-V block and a pacemaker implanted from birth. Our intention was unload the systemic anatomical right ventricle. The third patient had had 3 heart surgeries to correct a double outlet right ventricle. She had a residual ventricular septal defect which was large enough to cause heart failure. The last patient had an isolated muscular ventricular septal defect. Percutaneous closure was successful in all patients, and there were no complications. Percutaneous closure of the defect may be used as a primary procedure, before surgery, or as a complementary procedure after surgery.

Palliative switch: a surgical decision after hybrid procedure.

The first-stage palliation of newborns with single-ventricle anatomy and transposed great arteries can be very challenging when associated with systemic ventricular outflow obstruction and aortic arch obstruction. Often, the initial intervention is a stage I Norwood procedure. We present the case of a newborn with double inlet left ventricle, discordant ventriculoarterial connection with restrictive ventricular foramen, and severe aortic arch obstruction. A hybrid procedure was performed initially as a means of addressing hemodynamic instability. Three months later, a palliative arterial switch procedure was performed as an alternative to the combined Norwood-Glenn procedure. Palliative arterial switch combined with arch reconstruction can be an effective surgical option in these complex, challenging patients.

Mixoma gigante auricular derecho en un paciente pediátrico

Nina de 11 anos, con clinica de astenia, fiebre y cefalea recurrente de dos meses de evolucion, anemia macrocitica hipocroma y soplo cardiaco sistolo-diastolico. La ecocardiografia transtoracica confirmo masa auricular derecha de 6 cm de diametro, superficie lisa, adherido al tabique interauricular por un pediculo corto. tras la reseccion se reconstruyo el tabique con parche de pericardio heterologo. El diagnostico anatomopatologico fue mixoma auricular, infrecuente en ninos. Los tumores benignos observados en la poblacion pediatrica son los rabdomiomas, fibro-mas y mixomas. La cirugia tiene excelentes resultados inmediatos y a largo plazo, con una tasa de recidiva inferior al 3%.

Transposición de grandes arterias asociado a drenaje venoso anómalo parcial: reparación «uno y medio»

Presentamos el caso de un lactante de 8 meses con una cardiopatia congenita compleja consistente en transposicion de grandes arterias y retorno venoso anomalo parcial de venas pulmonares superior y media derecha a vena cava superior. La clinica consistia en fallo cardiaco congestivo, desnutricion y cianosis importante. El diagnostico se establecio en la intervencion. Se realizo correccion fisiologica de las dos cardiopatias con buen resultado y con resolucion de la sintomatologia.