Juan Calderón Colmenero

Protein S100Β: a potential biomarker that correlates with clinical neurological variables in pediatric patients with congenital heart disease?

S100Β belongs to the calmodulin family and is an EF-hand protein discovered by Moore in 1966 as a fraction of the brain in a 100% sulphur solution. S100Β is a universal animal protein and probably functions as a neural growth factor.1,2 Congenital heart diseases are the most frequent malformations in the paediatric population, with a prevalence of 6 to 8 cases per 1000 live births.3 Advances in diagnosis and surgical techniques have allowed many patients to reach adulthood, but the risk of central nervous system damage continues to be one of the most feared morbidities in cardiovascular surgery.4,5 but only 8 per 1000 new-borns have a congenital heart disease3,5-11 and that are at the postoperative period on a long term basis,3,5,7,10-15 The first diagnostic approach for neurological disorders is made by means of a clinical neurological examination and history. Ideally, such as computed tomography, PET/CT (CRANIAL) and SPECT. These studies cannot be performed immediately in the new-born or infant period due to haemodynamic instability, ventilator-dependent patients, unavailability or increased costs. In addition to these factors, the studies can lead to quantifying neurological damage as a whole to predict clinical outcome. Infrastructure and expertise also require major medical facilities; therefore, a biological maker could facilitate the task by selecting candidates to the complete functional imaging tests, neurophysiological protocols, and 3D anatomical imaging with the correct biomarker or biomarkers for a proper triage before referral to level III of medical attention. A biomarker is therefore needed not only to detect brain damage but also to predict the clinical brain metabolic outcome. The S100Β protein, which was identified in the brain, is produced by astrocytes in physiological conditions in children with congenital heart disease16 and in different clinical scenarios, such as cranial trauma, cerebral ischaemia, neurodegenerative disorders, chronic inflammatory cerebral disease, cardiac arrest, and cardiopulmonary bypass.7,8,10-14,17-26 The aim of this study is to determine any correlation between S100Β protein serum concentration levels and clinical neurological abnormal variables or risk factors at the pre-operative period in paediatric patients with congenital heart disease.

Anomalous origin of pulmonary branches from the ascending aorta. A report of five cases and review of the literature

The anomalous origin of pulmonary branches is a rare entity where, either the right or the left pulmonary arteries arise from the ascending aorta and where the aortic and pulmonary valves are separated. Clinical manifestations usually appear in the infant or, more rarely, in the newborn and include respiratory distress or congestive heart failure due to increased pulmonary resistance.The survival rate in an Indian series was 94% with the death of one patient from Fallot tetralogy. We have treated five patients with this congenital heart disease in 20 years; the survival rate was of 80% and in all survival cases, the systolic pressure was significantly decreased. The current treatment of choice, consisting of the anatomical correction with translocation of the right pulmonary artery to the pulmonary trunk, was first performed by Kirkpatrick in 1961.The aim of this paper is to show the Mexican experience in the diagnosis and treatment of the anomalous origin of pulmonary branches from the ascending aorta. Conclusion Early surgery with timely correction of this congenital heart disease improves the prognosis and survival rate of patients, with a reduction in pulmonary hypertension.<Learning objective: This article reports a series of cases of anomalous origin of the pulmonary branches from the ascending aorta. This is a rare congenital anomaly of difficult clinical diagnosis that is often accompanied by other associated anomalies. The diagnosis is based on image studies such as computed tomography and echocardiography and the hemodynamic evaluation is essential to determine a surgical procedure. The surgical treatment consists of the anatomists of the pulmonary branch to the pulmonary trunk.>.