Joaquim Bartrons

Ductus Arteriosus Patency With Stenting in Critical Pulmonary Stenosis and Pulmonary Atresia With Intact Interventricular Septum

We report our experience with stenting of the ductus arteriosus in three neonates. Two patients had pulmonary atresia with an intact interventricular septum and one had critical pulmonary stenosis. Radiofrequency ablation was used to open the atretic pulmonary valve in two patients. In all three patients implanting a stent avoided the need for surgical creation of a Blalock-Taussig shunt. In two patients the procedure was scheduled as elective surgery, and in one it was done as an emergency procedure. Ductus arteriosus stenting is an alternative to palliative cardiac surgery.

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.

Permeabilidad del conducto arterioso con stent en la estenosis pulmonar crítica y atresia pulmonar con septo interventricular intacto

Presentamos la implantacion de stent en el conducto arterioso neonatal en 3 ninos, 2 de ellos con atresia pulmonar y septo interventricular intacto, el tercero con estenosis pulmonar critica. En los ninos con atresia pulmonar, la apertura valvular se consiguio mediante radiofrecuencia. En los 3 casos, la implantacion del stent evito la fistula de Blalock-Taussig. En 2 de ellos se hizo de manera electiva y en 1 de manera urgente. La implantacion de stent ductal es una alternativa a la cirugia cardiaca paliativa

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.

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.

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.

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.

Defibrillation threshold decrease with the supradiaphragmatic extracardiac implantable cardioverter-defibrillator implantation technique

Despite advances in implantable cardioverter-defibrillator (ICD) technology, the optimal ICD implantation technique for pediatric patients has not yet been established. One increasingly used option is totally extracardiac implantation. However, concern exists about the high defibrillation threshold (DFT) at the moment of implantation or during follow-up. We report the case of a 3-year-old boy with repetitive syncopal idiopathic ventricular tachycardia episodes treated with ICD implantation using the extracardiac technique. Changing device position from abdominal to a supradiaphragmatic, solved unsafe elevated discharge impedance and DFT during follow-up.

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.