Margarita Burgueros

Multiple organ involvement in perinatal asphyxia

OBJECTIVES (1) To evaluate the frequency and spectrum of severity of multisystem dysfunction after perinatal asphyxia and (2) to analyze the relationship between the clinical and biochemical markers of perinatal asphyxia and multiorgan involvement. STUDY DESIGN Seventy-two consecutive term newborn infants with perinatal asphyxia were studied prospectively. Systematic neurologic, renal, pulmonary, cardiac, and gastrointestinal evaluations were performed. Involvement of each organ was classified as moderate or severe. RESULTS Involvement of one or more organs occurred in 82% of the infants; the central nervous system (CNS) was most frequently involved (72%). Severe CNS injury (7 infants) always occurred with involvement of other organs, although moderate CNS involvement was isolated in 14 infants. Renal involvement occurred in 42%, pulmonary in 26%, cardiac in 29%, and gastrointestinal in 29% of the infants; 15% neonates had renal failure and 19% had respiratory failure. The Apgar scores at 1 and 5 minutes were the only perinatal factors related to the number of organs involved and the severity of involvement; the Apgar score at 5 minutes had the stronger independent association. No relationship or organ dysfunction was found with the umbilical cord arterial blood pH, meconium-stained amniotic fluid, umbilical cord abnormalities, presentation, or type of delivery. CONCLUSIONS Our findings indicate that the Apgar score at 5 minutes, in infants who have other criteria for asphyxia, is the perinatal marker that may best identify infants at risk of organ dysfunction.

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.

Management of Patent Ductus Arteriosus in Preterm Babies

There is a higher incidence of delayed closure of the patent ductus arteriosus in premature babies with respiratory distress syndrome. From July, 1975, to December, 1977, 57 small, preterm infants with patent ductus arteriosus were diagnosed at our neonatal intensive care unit. From July, 1975, until September, 1976 (first period), 23 patients were diagnosed, and 11 underwent surgical ligation of a patent ductus arteriosus. There were 3 early deaths. From October, 1976, until December, 1977, out of a total of 34 patients with diagnosed patent ductus, 18 were treated with indomethacin, and only 3 required ligation. Our present policy for patent ductus arteriosus with respiratory distress syndrome in the premature baby is to initiate early treatment with indomethacin. If this treatment fails and the infants status deteriorates, we perform early surgical ligation of the ductus in order to minimize the time on mechanical ventilation and lessen the chances of the development of bronchopulmonary dysplasia.

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 OBJECTIVES To carry out a retrospective analysis of the indications for, and the results and complications of interventional catheterization after the Norwood procedure. METHODS Between 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. RESULTS Nine 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). CONCLUSIONS Following 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.

Cardiac Tamponade After a Systemic–Pulmonary Shunt Complicated by Serous Leakage

A newborn baby with complex congenital heart disease had severe persistent pericardial effusion after a systemic-pulmonary shunt. Pericardiocentesis and pericardiotomy could not stop pericardial leakage. At reoperation, topical application of a fibrin glue resulted in resolution of the leak and avoided replacement of the graft.

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 …