Montserrat Bret

Factores de riesgo asociados a la cirugía del adulto con cardiopatía congénita: 22 años de experiencia. ¿Quién debe intervenirlos?

OBJECTIVE To assess the association between mortality in surgery of congenital heart disease in adults, and factors related to patients and operations. METHOD Descriptive study of operations performed by specialized surgeons in congenital heart surgery (238), adult acquired surgery (117), and specialty residents (108). The association of mortality with surgical risk and complexity, specialization of surgeon, cardiopulmonary by-pass and aortic cross clamping was assessed fitting logistic regression models. RESULTS A total of 463 operations were included (442 with cardiopulmonary by-pass) in the study performed between 1991 and 2012. Median age at surgery: 34; 52.8% were women. First surgery: 295, reoperation: 168. Median score of Aristotle was 6.8, with significantly higher complexity since 2001, after restructuring the Unit. Overall hospital mortality was 3.9%. Mortality was significantly associated to number of previous surgeries (OR: 5.02; 95%CI: 1.44-17.52), operations by acquired heart disease surgeons (OR: 3.53; 95%CI: 1.14-10.98), higher Aristotle (OR: 1,64; 95%CI: 1.18-2.29), and high cardiopulmonary by-pass time (OR: 1.13; 95%CI: 1.07-1.19). CONCLUSIONS Surgery of congenital heart disease in adults has been performed with low mortality. High complexity interventions, prolonged cardiopulmonary by-pass times and multiple reoperations were associated to higher mortality. Participation of cardiac surgeons specialized in congenital heart disease is associated with better outcomes.

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 …

Infective Endocarditis of Unusual Location Following Surgical Correction of a Complex Congenital Heart Disease

A 40‐year‐old woman from Ecuador diagnosed with a complex congenital heart disease was admitted complaining of fever chills, night sweats, and productive cough 6 months after surgical correction of the anomalies. An echocardiography showed vegetations located on the interatrial pericardium patch. To the best of our knowledge, this is the first reported case of postoperative infective endocarditis on this location. Copyright

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 …

Complex Coarctation and Anomalous Right Subclavian Artery

We report the case of a 30-day-old infant referred to our hospital with a diagnosis of anomalous right subclavian artery (ARSA) and suspected coarctation of the aorta based on echocardiographic findings. Prenatal ultrasound screening had detected the ARSA and the patient remained asymptomatic from birth with adequate weight gain. Physical examination revealed a systolic murmur, palpable pulses with no difference between upper and lower extremities, and absence of alterations on blood pressure registration. Electrocardiogram and chest radiography were normal. Transthoracic echocardiography showed mild hypertrophy of the left ventricle not affecting the ejection fraction, a bicuspid aortic valve, and dilatation of the ascending aorta. A continuous wave Doppler examination from the suprasternal notch showed a peak systolic pressure gradient in the descending aorta of 60 mmHg with diastolic run-off indicating a severe obstruction at the classical site of a coarctation. Both subclavian arteries had a different origin than usual. Computed tomography (CT) confirmed the ARSA and coarctation of the aorta and demonstrated that subclavian arteries arose distal to the coarctation (Figure 1 and Figure 2), explaining the normal blood pressure in both arms. Because of the severity of the disease, the patient underwent cardiac surgery after diagnosis (reparation of the aortic arch and reimplantation of both subclavian arteries). Figure 1. Figure 2.

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 …