Follow-up of a simple method for aortic valve reconstruction with fixed pericardium in children.

In 2013, we published a simple method for aortic valve reconstruction in children using fixed pericardium in this journal. This was not expected to be a durable solution but a temporizing measure in the absence of other solutions, in order to buy time for growth that would allow subsequent prosthetic valve insertion. As such, this was implemented in 3 patients with excellent immediate results, as reported in our original publication. We are now writing to provide longer term information. In 2 cases, a newborn and a 12-year-old boy, the valve calcified heavily at 4 years' follow-up. By then, the valvar annulus had grown sufficiently to accept a prosthetic valve in both cases. In these 2 cases, the material used for valve reconstruction was autologous pericardium fixed in 0.6% gluteraldehyde. In the third patient, a 3-year-old girl, the valve failed by dehiscence of the suture line 6 months following surgery. In this case, fixed bovine pericardium had been used, which is more rigid than autologous pericardium, thus possibly explaining the dehiscence. However, the pericardial patch was not calcified. Thus, the described method lived up to our expectation of buying time for growth for later insertion of a prosthetic valve in 2 of the 3 cases.

[Postsurgical pseudoaneurysm of the right ventricular outflow tract]. / Seudoaneurisma posquirúrgico del tracto de salida ventricular derecho.

Cardiac pseudoaneurysm, a sealed rupture of the heart, is potentially fatal if not repaired surgically. The incidence in children is low, and it has been described in connection with surgery involving the right ventricular outflow tract. We describe a case diagnosed 20 months after complete repair of Tetralogy of Fallot with a single coronary artery. The diagnosis was made with two-dimensional echocardiography and confirmed with right ventriculography. The pseudoaneurysm was corrected by emergency surgery without complications. We emphasize the importance of a high index of suspicion of this entity in these patients, who are often asymptomatic.

[Aortopulmonary window: clinical assessment and surgical results]. / Ventana aortopulmonar: valoración clínica y resultados quirúrgicos.

INTRODUCTION AND OBJECTIVES: Aortopulmonary septal defect is an uncommon congenital cardiac anomaly. To date, approximately 300 cases have been reported. We present our experience, emphasizing the importance of early correction to avoid irreversible pulmonary hypertension. PATIENTS AND METHOD: Between 1979 and 2000, seven patients underwent surgical repair of this heart defect in our hospital. Two had type I (proximal), 4 had type II (distal) and 1 had type III (complete). Complex associated cardiac anomalies were present in 4 cases: type A interruption of the aortic arch in 2 cases, hypoplastic aortic arch in 1 and transposition of great arteries with ventricular septal defect in 1. Four cases (57%) were diagnosed by echocardiography. In all patients diagnoses were confirmed by cardiac catheterization. Patient records were reviewed retrospectively, with special attention to clinical, echocardiographic and hemodynamic data as well as surgical characteristics. RESULTS: No intraoperative deaths occurred. The patient with associated transposition of great arteries died 22 days after surgery as a result of severe pulmonary hypertension. The remaining patients are asymptomatic without treatment after a mean follow-up period of 69 months. CONCLUSIONS: Even though aortopulmonary septal defect is a rare anomaly, it should be considered whenever the course of complex congenital heart disease includes early cardiac failure and pulmonary hypertension. Repair before 6 months will prevent irreversible damage of pulmonary vessels.

Implante percutáneo de válvula pulmonar Melody por vía transhepática en paciente de ocho años / Percutaneous pulmonary Melody valve implantation through the transhepatic route in an 8-year-old patient

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Right atrial thrombosis and pulmonary embolism after atrial septal defect repair.

A 3-year-old boy underwent surgical closure of a large ostium secundum atrial septal defect. This was complicated with extensive right atrial thrombus formation and pulmonary thromboembolism immediately following surgery. He was managed with emergency surgical thromboembolectomy and anticoagulation. However, new thrombus was formed again immediately. This prompted us to add thrombolysis to his treatment, but with no effect. He died on the fifth postoperative day. A postmortem study confirmed extensive thromboembolism.

Utilidad de la angiografía rotacional 3D en el diagnóstico de origen anómalo de arteria coronaria izquierda en tronco pulmonar / Use of 3D-rotational angiography in the diagnosis of the anomalous origin of the left coronary artery in the pulmonary artery

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[Update on pediatric cardiology and congenital heart disease]. / Actualización en cardiología pediátrica y cardiopatías congénitas.

The fields of pediatric cardiology and congenital heart disease have experienced considerable progress in the last few years, with advances in new diagnostic and therapeutic techniques that can be applied at all stages of life from the fetus to the adult. This article reviews scientific publications in a number of areas that appeared between August 2007 and September 2008. In developed countries, congenital heart disease is becoming increasingly prevalent in nonpediatric patients, including pregnant women. Actions aimed at preventing coronary heart disease must be started early in infancy and should involve the promotion of a healthy diet and lifestyle. Recent developments in echocardiography include the introduction of three-dimensional echocardiography and of new techniques such as two-dimensional speckle tracking imaging, which can be used for both anatomical and functional investigations in patients with complex heart disease, including a univentricular heart. Progress has also occurred in fetal cardiology, with new data on prognosis and prognostic factors and developments in intrauterine interventions, though indications for these interventions have still to be established. Heart transplantation has become a routine procedure, supplemented in some cases by circulatory support devices. In catheter interventions, new devices have become available for the closure of atrial or ventricular septal defects and patent ductus arteriosus as well as for percutaneous pulmonary valve implantation. Surgery is also advancing, in some cases with hybrid techniques, particularly for the treatment of hypoplastic left heart syndrome. The article ends with a review of publications on cardiomyopathy, myocarditis and the treatment of bacterial endocarditis.

Actualización en cardiología pediátrica y cardiopatías congénitas / Update on pediatric cardiology and congenital heart disease

En el campo de la cardiología pediátrica y las cardiopatías congénitas, hemos progresado en los últimos años con avances en nuevas técnicas diagnósticas y terapias aplicadas del feto al adulto. Revisamos la literatura relacionada con diversos campos desde agosto de2007 a septiembre de 2008. Las cardiopatías congénitas después de la edad pediátrica cada vez son más prevalentes en los países desarrollados, incluso en gestantes con estos trastornos. La prevención de la enfermedad coronaria debe iniciarse precozmente desde la infancia, y ha de incluir la promoción de una dieta sana y un estilo de vida saludable. Entre los avances en ecocardiografía están la aplicación de la ecocardiografía tridimensional y las nuevas técnicas como la 2D speckle tracking imagen para realizar estudios tanto anatómicos como funcionales en cardiopatías complejas como los corazones un ventriculares. La cardiología fetal ha progresado con nuevos datos y factores pronósticos y en las intervenciones intrauterinas, aunque las indicaciones deben ser consolidadas. El trasplante cardiaco se ha convertido en una terapia habitual, asociada en algunos casos a dispositivos de soporte circulatorio. En intervencionismo se dispone de nuevos dispositivos para cierre de comunicaciones interauriculares, interventriculares y ductus, así como válvulas pulmonares de implantación percutánea. La cirugía está avanzando, en algunos casos combinada con técnicas híbridas, sobre todo en el manejo de la hipoplasia de cavidades izquierdas. Finalmente, revisamos las miocardiopatías, la miocarditis y la profilaxis de la endocarditis bacteriana (AU)

The fields of pediatric cardiology and congenital heart disease have experienced considerable progress in the last few years, with advances in new diagnostic and therapeutic techniques that can be applied at all stages of life from the fetus to the adult. This article reviews scientific publications in a number of areas that appeared between August 2007 and September 2008. In developed countries, congenital heart disease is becoming increasingly prevalent in no pediatric patients, including pregnant women. Actions aimed at preventing coronary heart disease must be started early in infancy and should involve the promotion of a healthy diet and lifestyle. Recent developments in echocardiography include the introduction of three-dimensional echocardiography and of new techniques such as two-dimensional speckle tracking imaging, which can be used for both anatomical and functional investigations in patients with complex heart disease, including a univentricular heart. Progress has also occurred in fetal cardiology, with new data on prognosis and prognostic factors and developments in intrauterine interventions, though indications for these interventions have still to be established. Heart transplantation has become a routine procedure, supplemented in some cases by circulatory support devices. In catheter interventions, new devices have become available for the closure of atrial or ventricular septal defects and patent ductus arteriosus as well as for percutaneous pulmonary valve implantation. Surgery is also advancing, in some cases with hybrid techniques, particularly for the treatment of hypoplastic left heart syndrome. The article ends with are view of publications on cardiomyopathy, myocarditis and the treatment of bacterial endocarditis (AU)

Seudoaneurisma posquirúrgico del tracto de salida ventricular derecho / Postsurgical pseudoaneurysm of the right ventricular outflow tract

El seudoaneurisma cardíaco es una rotura cardíaca contenida, potencialmente letal si no se corrige. Su incidencia en niños es muy rara y ha sido descrita en relación con la cirugía del tracto de salida ventricular derecho. Presentamos un caso diagnosticado 20 meses después de la reparación completa de una tetralogía de Fallot con arteria coronaria única. Los hallazgos ecocardiográficos fueron confirmados en la ventriculografía derecha y el seudoaneurisma corregido urgentemente sin complicaciones. Queremos resaltar la trascendencia del diagnóstico de sospecha en enfermos con frecuencia asintomáticos

Cardiac pseudoaneurysm, a sealed rupture of the heart, is potentially fatal if not repaired surgically. The incidence in children is low, and it has been described in connection with surgery involving the right ventricular out flow tract. We describe a case diagnosed 20 months after complete repair of Tetralogy of Fallot with a single coronary artery. The diagnosis was made with two-dimensional echocardiography and confirmed with right ventriculography. The pseudo-aneurysm was corrected by emergency surgery without complications. We emphasize the importance of a high index of suspicion of this entity in these patients, who are often asymptomatic

Ventana aortopulmonar: valoración clínica y resultados quirúrgicos / Aortopulmonary window: clinical assessment and surgical results

Introducción y objetivos. El defecto del septo aortopulmonar es una cardiopatía congénita rara. Hasta el momento se han publicado alrededor de 300 casos. Presentamos nuestra casuística, resaltando la importancia de su corrección precoz para evitar el desarrollo de enfermedad vascular pulmonar irreversible. Pacientes y método. Entre 1979 y 2000, 7 pacientes fueron intervenidos de dicha cardiopatía en nuestro centro. Dos pacientes presentaron el tipo I (proximal), cuatro el tipo II (distal) y uno el tipo III (defecto completo del septo aortopulmonar). En 4 casos (57 por ciento) se asociaron anomalías complejas: interrupción del istmo aórtico tipo A (n = 2), hipoplasia del istmo aórtico (n = 1) y transposición de los grandes vasos con comunicación intraventricular. El diagnóstico se realizó mediante ecocardiografía en 4 casos (57 por ciento) y en todos fue confirmado mediante estudio hemodinámico. Realizamos un estudio retrospectivo de sus historias clínicas, con especial atención a los datos clínicos, del diagnóstico ecocardiográfico y hemodinámico, así como a los aspectos quirúrgicos. Resultados. No hubo ningún fallecimiento durante la intervención quirúrgica. El enfermo portador de transposición de los grandes vasos con comunicación interventricular falleció 22 días después a causa de hipertensión pulmonar severa. Tras un seguimiento medio de 69 meses, los enfermos restantes se encuentran asintomáticos sin medicación. Conclusiones. A pesar de su rareza, se debe pensar en esta entidad ante toda cardiopatía compleja que curse con insuficiencia cardíaca e hipertensión pulmonar precoces. La corrección antes de los 6 meses evitará el desarrollo de enfermedad vascular pulmonar irreversible (AU)