[Percutaneous closure of atrial septal defect with the Amplatz device: initial result and mid-term follow-up]. / Cierre percutáneo de la comunicación interauricular mediante dispositivo de Amplatz: resultado inicial y seguimiento a medio plazo.

OBJECTIVES: Percutaneous device occlusion of atrial septal defects (ASD) is, although with some limitations, an alternative to surgical closure. The aim of this study was to evaluate the efficacy and safety of percutaneous ASD closure using the Amplatz device. PATIENTS AND METHODS: From October 1999 to March 2000, 25 children underwent transcatheter closure of ASD at a mean +/- SD age of 8.7 +/- 3.1 years (range 3-15 years) and a mean weight of 31.8 +/- 16.7 kg (range 11-84 kg). Device selection was based on the stretched diameter of the ASD using the PTA OS balloon. The device was implanted under ultrasonographic and radiological guidance. All patients showed signs of volume-overload of the right ventricle. The ASD was single (n = 21), with two separate holes (n = 2), or cribiform (n = 2). RESULTS: The median +/- SD size of the device used was 21.7 +/- 5.4 mm (range 15-36 mm). In twenty-two patients (88%) the device was successfully implanted. A repeat echocardiogram was performed the next day before discharge. Two patients underwent surgery after deployment of the device due to mitral valve dysfunction (n = 1) or residual leak (n = 1). In a patient with a two-hole ASD, another device was percutaneously withdrawn, while still attached to the delivery cable due to incomplete occlusion. CONCLUSION: a) Transcatheter occlusion with the Amplatzer device is an effective treatment for ostium secundum atrial septal defects; b) the low complication rate and the short hospitalization period makes this procedure the treatment of choice in these patients, and c) ASD which are too large, cribiform or with deficient rims may require a different approach.

[Technical innovations in total extracardiac cavo-pulmonary connection in Fontan-type operation. An experimental study and first 2 operated clinical cases with excellent immediate results]. / Innovaciones técnicas de la conexión cavo-pulmonar total extracardíaca en la cirugía tipo Fontan. Estudio experimental y dos primeros casos clínicos operados con excelentes resultados inmediatos.

INTRODUCTION: Three technical modalities are presented with total extracardiac cava-pulmonary connection, with bidirectional Glenn, as coverage of this type of extracardiac connection for all types of cardiopathies suitable for Fontan type correction. METHODS: Development of an experimental protocol for the perfecting of the three technical variants tested: "Tunnel from inferior cava to right pulmonary artery by means of right atrial wall and vascularized pericardium", "Tunnel from inferior cava to the trunk of the pulmonary artery with or without pulmonary valve with P.T.F.E. hemiconduit" and "Tunnel from inferior cava to the pulmonary graft as a artery with P.T.F.E. graft as a hemiconduit". RESULTS: The first two clinical cases operated on using the third technical variant are presented. Both cases evolved during immediate postoperative period with a very favourable hemodynamic response, with pressures at conduit and P.A. level of 10-12 mmHg, normal cardiac output and sinus rhythm. The later clinical evolution in both cases is very satisfactory. The five cases published by Laschinger with this same technique showed a very favourable evolution during the immediate postoperative period and later. CONCLUSION: The technical facility of its performance, the slight traumatism of this surgery, the important technical advantages with respect to the total cava-pulmonary intraauricular connection and the good initial hemodynamic results make us consider the total extracardiac cava-pulmonary connection as an important contribution in this type of surgery. It is clear that time and greater clinical experience with this type of connection is required for the correct evaluation of all and each one of the numerous theoretical advantages shown and in order to detect possible disadvantages.

[Adenosine triphosphate (ATP) in the management of paroxysmal supraventricular tachycardia: experience in the neonatal period]. / Manejo del adenosín trifosfato (ATP) en la taquicardia paroxística supraventricular: experiencia en el período neonatal.

INTRODUCTION AND OBJECTIVE: The management of supraventricular tachycardia (SVT) in infants is somewhat controversial since numerous methods of treatment are effective. Regardless of the treatment chosen, it is important to quickly stop the tachycardia in neonates with SVT because they may suddenly become hemodynamically unstable. METHODS: Seventeen episodes of SVT treated with intravenous ATP are studied in 3 newborns (two were preterm infants: 30 and 34 weeks of pregnancy). Ages at presentation ranged from 2 to 27 days. RESULTS: ATP is effective in all episodes of SVT, with a mean intravenous doses between 0.10 and 0.50 mg/kg/dose. All patients showed short sinus arrest after ATP. No adverse side effects or hemodynamics changes occurred after ATP administration. CONCLUSIONS: ATP is a safe and reliable antiarrhythmic in neonatal period, including prematurity. We reviewed the experience in ATP management of SVT, mainly in pediatric population.

[Vascular rings of aortic origin: the surgical experience in 43 cases]. / Anillos vasculares de origen aórtico: experiencia quirúrgica en 43 casos.

INTRODUCTION AND OBJECTIVES: Aortic vascular rings can produce compression and obstruction in the airway and/or esophagus early surgical treatment in the first days or months of life. The reported incidence range between 0.3-0.6% with an 0.5% in our series. The following is a retrospective analysis with clinical, radiological and angiocardiographic study of the patients operated on in our service with the diagnosis of aortic vascular ring focused on the surgical results. METHODS: A total of 43 children with ages ranging between 21 days and 10 years (mean age 17 months) underwent surgical treatment for aortic vascular ring, during the period between january 68 and january 94. Clinically, 74% had stridor, 27.4% gastroesophageal reflux, 34% pulmonary infection, 14% respiratory insufficiency with mechanical ventilation, 12% heart failure, 9% dysphagia, 2% crisis of bronchospasm and 2% tracheomalacia that require tracheotomy prior to surgical correction. Diagnosis was made by esophagogram 86% of the cases. Aortography as the late diagnosis method or for election to surgical approach was made in 85% of the cases. In 42% were double aortic arch, 32% anomalous right subclavian artery and 25% right aortic arch with left ductal ligamentum. RESULTS: Reoperation was performed in 4 cases. Two early (1 case for hemorrhage, 1 case for phrenic paralysis requiring diaphragmatic plication), and two late reoperations (1 aortopexy, 1 tracheal termino-terminal anastomosis) at 2 and 13 months respectively. Hospital mortality was 1 case (2%) with 1 additional late death (2%). Follow-up was performed in the remaining 39 cases with a mean of 11 years (ranging between 1 and 25 years. Thirty seven of 41 patients alive asymptomatic (90%). CONCLUSIONS: Due to a low mortality rate (2.3%) not related with the age of the patient at the moment of the surgical procedure based in our experience, we conclude that it is very important to perform both, early diagnosis and surgical treatment in order to avoid the potential residual lesion on the airway caused by tracheo-broncho malacia, in order to avoid the deleterious effect on the results both at early and later follow-up.

[Surgery of symptomatic interauricular communication in the first year of life]. / Cirugía de la comunicación interauricular sintomática en el primer año de la vida.

Symptomatic atrial septal defect (ASD) is rare in infancy and even more is symptomatic ASD requiring surgery at that age (13.7% and 3.7% respectively in our series). Our experience on surgery for symptomatic ASD in infancy with 6 cases out of 161 consecutive ASD surgically corrected during an experience of 17 years is presented. Ages ranged between 5 and 11 months (9.5 +/- 2.5 months) and weight between 4 and 6.400 kg (5.3 +/- 0.8 kg). In all cardiomegally was present with cardiothoracic ratio between 0.6 and 0.7 in 4 and over 0.7 in the remainder two cases. Isolated ASD was present in 3 cases, associated partial anomalous pulmonary venous drainage ein 3 and additional ventricular septal defect in one. Mortality was present in one case due to hypoplasia of the left ventricular cavity. Follow up ranged between 30 and 156 months with a cumulative follow up of 442 months, mean 88.4 +/- 50.8 months/patient. Clinically all are asymptomatic without medication. Clinical and hemodynamic data file, surgery complications and possible risk factors for development symptomatology in the ASD in infancy are widely commented.

Experimental evaluation of atriopulmonary anastomosis in the presence of high pulmonary resistance.

We studied pulmonary resistance as a surgical criterion for atriopulmonary shunt. We created a model of experimental pulmonary hypertension by establishing a systemic-pulmonary shunt in 11 dogs. Two to 3 months after the shunt operation, total pulmonary resistance was calculated before (7.24 +/- 1.54 U . m2) and after (3.50 +/- 1.54 U . m2) ligation of the shunt. An atriopulmonary anastomosis technique was then performed and the hemodynamic status of the dogs during the first 2 postoperative hours was evaluated. Pathologic study of the lungs disclosed no arterial lesions. From our experimental work, we conclude that the surgical criterion for establishing the indication for this operation should be pulmonary resistance, which is conditioned by the state of the intrapulmonary vessels. We propose a procedure for determining real pulmonary resistance in the course of preoperative catheterization.

Extraatrial interatrial duct and reestablishment of aortopulmonary communication by enlarging the aortic arch. Experimental development of two surgical techniques for hypoplastic left heart syndrome palliation without extracorporeal circulation.

A new surgical procedure is presented for palliation of hypoplastic left heart syndrome. The first palliative technique consists of creation of an extraatrial interatrial duct and the second, reestablishment of the aortopulmonary communication by enlarging the aortic arch with a "conduit patch". Both procedures avoid having to clamp small systemic vessels and pulmonary veins and extracorporeal circulation is not needed. Extraatrial interatrial ducts were created in 10 dogs and the effectiveness of the procedure was evaluated. Reestablishment of the aorto-pulmonary communication and enlargement of the aortic arch was done in 7 specimens from patients with hypoplastic left heart syndrome who had died in the first hours of life and in 8 dogs. The surgical procedures, their advantages and the results obtained are described.