María Grippo

Aortopulmonary Fistula After an Arterial Switch Operation

Aortopulmonary fistula has been documented in adult patients with acute aortic dissection, atherosclerotic disease, and other comorbidities. However, until now we believe this was not previously reported as a complication after the arterial switch operation in a patient with transposition of the great arteries. We report the case of a 3-month-old boy who underwent an arterial switch operation as a neonate. After balloon dilation to relieve a postoperative supravalvular pulmonary stenosis, he presented with severe congestive heart failure due to an undiagnosed but previously present fistula between the ascending aorta and the main pulmonary artery. He underwent successful surgical repair and recovered uneventfully.

Acrocomia Aculeata as an Unreported Cause of Tricuspid Regurgitation

Penetrating chest trauma can produce a wide range of lesions to cardiac structures. Some patients develop signs and symptoms of residual sequelae. We describe the case of an 11-year-old boy with severe tricuspid regurgitation caused by the thorn of a palm tree. A De Vega annuloplasty of the tricuspid valve and a bidirectional Glenn procedure were successfully performed 7 years after the episode. This case illustrates the importance of a thorough investigation of possible valvular heart disease in patients who suffered from chest trauma.

Usefulness of Adenosine Testing in the Differential Diagnosis Between Fasciculoventricular Pathways and Wolff-Parkinson-White-type Ventricular Preexcitation

Introduccion: El diagnostico de preexcitacion ventricular tipo Wolff-Parkinson-White generalmente es sencillo a partir del electrocardiograma. No obstante, en los pacientes con manifestaciones electrocardiograficas minimas o sutiles, la confirmacion diagnostica y la diferenciacion con otras formas de preexcitacion, como las fibras fasciculoventriculares, plantea dificultades. La prueba de adenosina se presenta como una herramienta util para tal fin. Objetivo: Describir nuestra experiencia con el uso de adenosina en el diagnostico diferencial de pacientes con minima preexcitacion ventricular. Material y metodos: De 313 pacientes consecutivos con diagnostico de Wolff-Parkinson-White, se analizaron 28 pacientes con preexcitacion minima en el electrocardiograma que puso en duda el diagnostico. Resultados: La prueba de adenosina permitio descartar Wolff-Parkinson-White en 26 pacientes al documentarse bloqueo auriculoventricular de primer, segundo y/o tercer grado transitorio, sin cambios en el patron de activacion ventricular. En 20 pacientes se realizo estudio electrofisiologico, que confirmo la presencia de vias accesorias fasciculoventriculares en 16 casos. Conclusion: Ante la sospecha de Wolff-Parkinson-White, la prueba de adenosina resulto eficaz y segura para establecer o descartar el diagnostico.