Luis García-Guereta

Alteraciones de la función tiroidea en niños con cardiopatía congénita tras la realización de cateterismo con contrastes yodados

Introduccion y objetivos Los contrastes iodados pueden bloquear la sintesis de hormonas tiroideas. Nuestros objetivos fueron estudiar la incidencia de alteraciones tiroideas poscateterismo en ninos con cardiopatia congenita, y analizar los factores predisponentes al desarrollo de hipotiroidismo postangiografia y evaluar la duracion de este. Pacientes y metodos Entre febrero de 1993 y abril de 1997 se analizaron los niveles de tirotropina (TSH) y tiroxina libre (FT4) previos al cateterismo y en las dos semanas siguientes a este, en 99 ninos cardiopatas menores de tres anos. En aquellos que presentaron elevacion de la TSH postangiografia se repitieron semanalmente las determinaciones hasta observar su normalizacion, o hasta que se indico tratamiento sustitutivo. Tanto los datos de los pacientes (edad, exposicion previa a contrastes, cardiopatia, malformaciones asociadas, insuficiencia renal, gravedad, tratamiento, etc.) como los datos del cateterismo (cantidad y tipo de contraste, etc.) se sometieron al analisis univariante. Resultados En la primera semana poscateterismo se observo elevacion de la cifra media de TSH y disminucion de la cifra media de FT4, ambas significativas (p 10 mUI/ml), mantenido mas de tres semanas en 6 casos. La presencia de sindromes polimalformativos fue el factor de riesgo mas claramente asociado tanto al desarrollo de hipotiroidismo postangiografia (p Conclusiones En los pacientes portadores de sindromes polimalformativos deberia realizarse un control de funcion tiroidea tras la realizacion de angiocardiografia con contrastes iodados.

Aberrant left pulmonary artery with tracheal stenosis without vascular sling

SummaryWe report a case of abnormal origin of the left pulmoanry artery from the right pulmonary artery, associated with tracheal stenosis but with no vascular sling. This is the first such case, to our knowledge, without vascular sling.

Cateterismo intervencionista tras cirugía tipo Norwood

Introduccion y objetivos Analisis retrospectivo de las indicaciones, los resultados y las complicaciones del cateterismo terapeutico en pacientes tras cirugia tipo Norwood. Metodos Entre febrero de 1993 y diciembre de 2006 se realizaron 25 procedimientos intervencionistas en 14 pacientes con cirugia tipo Norwood, previo al Glenn o Fontan. Resultados En 7 de los 14 pacientes se realizaron 9 angioplastias de recoartacion (2 presentaron nuevamente reestenosis tras la primera angioplastia). En 3 pacientes con Norwood clasico se encontro inicialmente o evolutivamente desconexion de arteria pulmonar izquierda; 7 pacientes precisaron 10 angioplastias de arterias pulmonares; 3 pacientes precisaron embolizaciones: de colaterales venosas (nxa0=xa01, con coils), de vena cava superior izquierda (nxa0=xa01, con oclusor Amplatzer para ductus) y de fistula Blalock-Taussig izquierdo (nxa0=xa01, con oclusor Amplatzer para ductus). En 2 casos se realizo angioplastia del Glenn y en otro, fibrinolisis de trombosis de vena cava superior y arteria pulmonar. Otros hallazgos, sobre los que no se realizaron tecnicas intervencionistas, fueron: estenosis de troncos supraaorticos (nxa0=xa06), estenosis en las arterias femorales (nxa0=xa02), trombosis venosa femoral (nxa0=xa05) o de vena subclavia (nxa0=xa01). Como complicaciones se registraron: isquemia arterial (nxa0=xa02), parada cardiaca o bradicardia (nxa0=xa04) y bloqueo auriculoventricular transitorio (nxa0=xa01). Conclusiones Tras la cirugia tipo Norwood debe realizarse una valoracion angiohemodinamica precoz para detectar y tratar estenosis de arterias pulmonares y/o del arco aortico. Aunque la angioplastia de la recoartacion puede ser efectiva, la reestenosis es frecuente. La tecnica de Sano evita la desconexion de la arteria pulmonary izquierda, pero no el desarrollo de estenosis de arterias pulmonares. Tras el estadio II, debe estudiarse si hay colaterales venovenosas, pues estas con frecuencia precisan embolizacion. El cateterismo terapeutico en estos pacientes comporta una incidencia de complicaciones mayor que en otros grupos de pacientes.

Real vision of a vascular ring

Aortic arch abnormalities are a cause of respiratory disorders in children, including dyspnoea, stridor, recurrent respiratory tract infections, and asthma. On the other hand, adults develop more dysphagia (lusoria).nnWe report a Caucasian 13-year-old girl complaining only of a 6-month history of cough, occasional dyspnoea and sibilances. She was on bronchodilator and …

Hypoplasia of the Abdominal Aorta and Hypomelanosis of Ito “Pseudo–Cauda Equina” Imaging

A 4-year-old girl with hypomelanosis of Ito (HI) was referred to the cardiologist for an absence of pulses in the lower extremities. Medical history included hydrocephalus treated with ventriculoperitoneal shunt and congenital glaucoma. She always remained asymptomatic. Physical examination showed upper-body hypertrophy and a repeatedly measured systolic pressure difference between the upper and lower extremities of 35 mm …A 4-year-old girl with hypomelanosis of Ito (HI) was referred to the cardiologist for an absence of pulses in the lower extremities. Medical history included hydrocephalus treated with ventriculoperitoneal shunt and congenital glaucoma. She always remained asymptomatic. Physical examination showed upper-body hypertrophy and a repeatedly measured systolic pressure difference between the upper and lower extremities of 35 mm …

Interventional catheterization after the Norwood procedure

INTRODUCTION AND OBJECTIVESnTo carry out a retrospective analysis of the indications for, and the results and complications of interventional catheterization after the Norwood procedure.nnnMETHODSnBetween February 1993 and December 2006, 25 interventional catheterizations were performed in 14 patients who had undergone the Norwood procedure, prior to the Glenn or Fontan procedure.nnnRESULTSnNine angioplasties were carried out for recoarctation in seven of the 14 patients (2 patients developed restenosis after their first angioplasty). Detachment of the left pulmonary artery occurred either immediately or during follow-up in 3 patients who underwent the classical Norwood procedure. Overall, 10 pulmonary artery angioplasties were required in 7 patients. Three patients needed embolization: one of venous collaterals (using coils), one of the left superior vena cava (using an Amplatzer duct occluder), and one of a left Blalock-Taussig shunt (using an Amplatzer duct occluder). Two patients required a cavopulmonary (Glenn) anastomosis, and another underwent fibrinolysis for thrombosis of the superior vena cava and pulmonary artery. Other findings, which were not treated percutaneously, included: stenosis of the supra-aortic trunk (n=6), femoral artery stenosis (n=2), femoral vein thrombosis (n=5), and subclavian vein thrombosis (n=1). The following complications were recorded: arterial ischemia (n=2), cardiac arrest or bradycardia (n=4), and transient atrioventricular block (n=1).nnnCONCLUSIONSnFollowing stage I of the Norwood procedure, the angiographic and hemodynamic assessments needed for the diagnosis and treatment of pulmonary artery or aortic arch stenosis must be carried out promptly. Although treating recoarctation by angioplasty can be effective, restenosis frequently occurs. With the Sano procedure, detachment of the left pulmonary artery, but not pulmonary artery stenosis, can be avoided. After stage II, the presence of venovenous collaterals must be ruled out, because they frequently require embolization. In these patients, interventional catheterization is associated with a higher incidence of complications than in other groups.

Galactomannan Detection as a Tool for the Diagnosis and Management of Cardiac Aspergillosis in 2 Immunocompetent Patients

Serum galactomannan antigen detection was used for the diagnosis and follow-up of cardiac aspergillosis after surgery in 2 nonneutropenic patients. The galactomannan index, developed in response to surgical and antifungal therapies, could prove to be a valuable method for the diagnosis and follow-up of fungal infections in such patients.

Images in Cardiovascular Medicine. Hypoplasia of the abdominal aorta and hypomelanosis of ito: "pseudo-cauda equina" imaging.

A 4-year-old girl with hypomelanosis of Ito (HI) was referred to the cardiologist for an absence of pulses in the lower extremities. Medical history included hydrocephalus treated with ventriculoperitoneal shunt and congenital glaucoma. She always remained asymptomatic. Physical examination showed upper-body hypertrophy and a repeatedly measured systolic pressure difference between the upper and lower extremities of 35 mm …A 4-year-old girl with hypomelanosis of Ito (HI) was referred to the cardiologist for an absence of pulses in the lower extremities. Medical history included hydrocephalus treated with ventriculoperitoneal shunt and congenital glaucoma. She always remained asymptomatic. Physical examination showed upper-body hypertrophy and a repeatedly measured systolic pressure difference between the upper and lower extremities of 35 mm …

Hypoplasia of the Abdominal Aorta and Hypomelanosis of Ito

A 4-year-old girl with hypomelanosis of Ito (HI) was referred to the cardiologist for an absence of pulses in the lower extremities. Medical history included hydrocephalus treated with ventriculoperitoneal shunt and congenital glaucoma. She always remained asymptomatic. Physical examination showed upper-body hypertrophy and a repeatedly measured systolic pressure difference between the upper and lower extremities of 35 mm …A 4-year-old girl with hypomelanosis of Ito (HI) was referred to the cardiologist for an absence of pulses in the lower extremities. Medical history included hydrocephalus treated with ventriculoperitoneal shunt and congenital glaucoma. She always remained asymptomatic. Physical examination showed upper-body hypertrophy and a repeatedly measured systolic pressure difference between the upper and lower extremities of 35 mm …