Patricia Frangini S

Operación de Fontan: resultados inmediatos y a mediano plazo con anastomosis cavopulmonar total

Background: During the last five years, 65 patients with univentricular heart have been treated surgically in our institution, according to a protocol of staged operations that have been previously reported. Aim: To evaluate the early and mid-term outcome of those patients that have completed their staging protocol by means of a Fontan procedure. Patients and Methods: Between April 1996 and June 2001, 23 patients (age 16 to 223 months) underwent a Fontan procedure, 15 with an intracardiac lateral tunnel technique and 8 with an extracardiac conduit. A retrospective review of their clinical, surgical, echocardiographic, angiographic and hemodynamic data was performed, trying to identify risk factors for both mortality and functional capacity (FC). Follow up was complete in all survivors. Results: Three patients died early after surgery (13.04%). Excessive pulmonary blood flow was a risk factor for early death (p= 0.03). One patient died at 14 months. Follow up was 29.9 months (1-63). For those who survived the operation, five years survival was 93.3%. The majority of patients are in FC I or II, with no related risk factors. Conclusions: Our current results are comparable with those of larger series. Patients reach good FC and mid-term survival, irrespective of type of single ventricle or the surgical strategy (Rev Med Chile 2002; 130: 1217-26).

Implante de marcapaso definitivo en pacientes con vena cava superior izquierda persistente y ausencia de vena cava superior derecha: Caso clínico

Persistent left superior vena cava and absent right superior venacava is an uncommon anatomical association. This is a challenging situation for permanentpacemaker implantation. We report three patients with this anomaly and a permanentpacemaker successfully implanted through the left superior vena cava and coronary sinus,without acute or chronic complications (Rev Med Chile 2006; 134: 767-71).(

Cirugía paliativa mediante operación de Norwood en distintas formas de corazón univentricular: resultados quirúrgicos inmediatos

: Norwood procedure is used as the first stage in thepalliative treatment of the hypoplastic heart syndrome and can be used, with some technicalmodifications, in other forms of univentricular heart with aortic stenosis or hypoplasia. Thesepatients have a high mortality (50%), derived from the procedure itself and from their abnor-mal physiological status.

Mixoma auricular izquierdo recurrente en niño de 2 años

Primary cardiac tumors are uncommon in pediatric patients. We report a two year-old boy, who presented a recurrent left atrial myxoma. He was referred for cardiologic evaluation because of cardiomegaly on a chest X-ray. An echocardiography showed a big left atrial tumor attached to the atrial septum. The tumor was uneventfully removed and the pathological examination confirmed a myxoma. He remained asymptomatic and during a follow up echocardiography two years later, a recurrent tumor was noted. He was successfully operated again, remaining free of a new recurrence after 3 years of follow up.

Seguimiento en fase aguda de catéteres electrodos de estimulación endocavitaria permanente: Comparación de tres modelos

, los cuales fueron comercializados enChile a partir de febrero de 2002, marzo de 2000 yagosto 2002, respectivamente. Estos modelos decateteres electrodos se utilizan rutinariamente enlos implantes realizados en nuestro laboratorio ylas especificaciones tecnicas de cada uno de ellosse detallan en la Tabla 1.El objetivo de este trabajo es comparar losresultados del implante y los parametros deestimulacion en fase aguda de los tres modelos decateteres electrodos utilizados en los pacientessometidos a implante de marcapaso o desfibrila-dor en el Laboratorio de Electrofisiologia Cardiacadel Hospital Clinico de la Pontificia UniversidadCatolica de Chile.M

Fulguración con radiofrecuencia de taquicardia ventricular después de corrección quirúrgica de Tetralogía de Fallot: Caso Clínico

Ventricular tachycardia is one of the most feared complications after surgical repair of Tetralogy of Fallot and it is associated with sudden death. We report a 26 years old female with a history of surgical repair of Tetralogy of Fallot at age of 4 year-old, who developed sustained ventricular tachycardia despite antiarrhythmic drugs. She was successfully treated with radiofrequency catheter ablation. Radiofrequency catheter ablation is a valid treatment for these patients.

Síndrome de Twiddler: una causa infrecuente de disfunción de marcapaso definitivo. Caso clínico

We report a 26 year old patient who had a single chamber pacemaker implantation one year before. During a routine pre-operative evaluation, pacemaker dysfunction was demonstrated due to sensing and pacing failure, associated to left pectoral muscle rhythmic contraction. Chest X-ray confirmed Twiddler syndrome, in which twisting or rotation of the device inside the pocket results in lead dislodgement and device malfunction.

Flutter auricular: Resultados inmediatos y alejados de la fulguración con radiofrecuencia del istmo cavo-tricuspídeo

Of all the patients treated, five died and fivewere lost from follow up, thus 76 patients (mean age 56 years, 58 males) were contacted forreassessment. At the moment of the procedure, 51% had an underlying cardiac disease and25% had high blood pressure. All referred palpitations, 25% had dyspnea, 84% were receivingantiarrhythmic drugs and 33% were on oral anticoagulants. Flutter was paroxystic in 83%and chronic in 17%. Fulguration was successful in all patients; one patient presented a highgrade atrioventricular block as a complication of the procedure. At reassessment, 82% ofpatients were in sinus rhythm, 16% had atrial fibrillation and 2%, an atypical flutter.

Terapia de resincronización cardiaca en paciente con vena cava superior izquierda persistente: Caso clínico

Persistent left superior vena cava is the most common venous congenital malformation and is usually asymptomatic. Its presence could increase the difficulty for transvenous lead implantation. We report a 71-year-old woman with an idiopathic dilated cardiomyopathy, atrial fibrillation and heart failure that required biventricular resynchronization therapy. During the placement of the device a persistent left superior vena cava was detected. The device was placed without problems and the patient had a satisfactory postoperative evolution.

Estimulación ventricular derecha multisitio en insuficiencia cardíaca refractaria a tratamiento con resincronización biventricular

The prevalence of congestive heart failure has increased in the world. Despite advances in pharmacological treatment, some patients have progression of the disease and deterioration of their functional class. In this group of patients cardiac resynchronization therapy has been accepted as a treatment option. However, some patients are non-responders to cardiac resynchronization, and others who respond favorably, will experience reappearance of their symptoms. For these patients, multisite stimulation with the implant of a second electrode in the right ventricle has been published as a new option. We report a 76 year-old woman with a dilated cardiomyopathy, who was treated with resynchronization therapy with good clinical response during two years, but symptoms of congestive heart failure reappeared and her functional class deteriorated to NYHA class IV. She was successfully treated with right ventricular multisite stimulation, with a reduction of symptoms that has lasted during the two months of follow up after the procedure.