ABSTRACT
Heart transplant (HT) remains the best therapeutic option for patients with advanced heart failure (HF). The allocation criteria aim to guarantee equitable access to HT and prioritize patients with a worse clinical status. To review the HT allocation criteria, the Heart Failure Association of the Spanish Society of Cardiology (HFA-SEC), the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) and the National Transplant Organization (ONT), organized a consensus conference involving adult and pediatric cardiologists, adult and pediatric cardiac surgeons, transplant coordinators from all over Spain, and physicians and nurses from the ONT. The aims of the consensus conference were as follows: a) to analyze the organization and management of patients with advanced HF and cardiogenic shock in Spain; b) to critically review heart allocation and priority criteria in other transplant organizations; c) to analyze the outcomes of patients listed and transplanted before and after the modification of the heart allocation criteria in 2017; and d) to propose new heart allocation criteria in Spain after an analysis of the available evidence and multidisciplinary discussion. In this article, by the HFA-SEC, SECCE and the ONT we present the results of the analysis performed in the consensus conference and the rationale for the new heart allocation criteria in Spain.
Subject(s)
Heart Failure , Heart Transplantation , Adult , Humans , Child , Spain/epidemiology , Heart Failure/surgery , Consensus , Shock, CardiogenicABSTRACT
Coronary artery fistulas have been described in patients after heart transplantation more often than in the normal population. We reviewed our centre's database between 2008 and 2020. Thirty patients had coronary angiography and 13 showed non-cameral coronary artery fistulas in their first coronary angiography. Distribution, degree and evolution of the fistulas and characteristics of transplant procedure, patient and immunosuppressive treatments were analysed.
Subject(s)
Coronary Artery Disease , Coronary Vessel Anomalies , Fistula , Heart Transplantation , Child , Coronary Angiography , Coronary Artery Disease/diagnosis , Coronary Artery Disease/etiology , Coronary Vessel Anomalies/diagnostic imaging , Heart Transplantation/adverse effects , HumansABSTRACT
OBJETIVO: Determinar la frecuencia de taquicardia paroxística supraventricular (TPSV) como motivo de traslado interhospitalario en la edad pediátrica, describir la forma de presentación clínica, evolución y tratamiento, y factores de riesgo de presentar compromiso hemodinámico y proponer un protocolo de manejo específico para el transporte. MÉTODO: Estudio retrospectivo observacional de los pacientes atendidos en el Sistema de Emergencias Médicas Pediátricas (SEM-P) del Hospital Vall d'Hebron entre enero 2005 y junio 2017. RESULTADOS: De un total de 7.348 traslados, 67 fueron pacientes con TPSV (0,9%). Edad mediana de 57 días de vida (2h a 18 años). Catorce pacientes (20,9%), presentaban signos de compromiso hemodinámico en el momento del diagnóstico. La edad ≤1 año fue el único factor de riesgo independiente para presentar compromiso hemodinámico al diagnóstico con un OR de 10,2 (IC 95%: 1,2-89,9; p: 0,004). La mayoría de pacientes revirtieron con las intervenciones del hospital emisor, exceptuando la intubación y la cardioversión eléctrica, realizadas más frecuentemente por el equipo de trasporte (ET). El tiempo mediano de estabilización fue de 35min (9-169), con un tiempo mediano de traslado de 30min (9-165). CONCLUSIONES: El transporte de pacientes pediátricos con TPSV es poco frecuente, pero puede requerir un manejo altamente especializado. La edad ≤1 año es el único factor de riesgo independiente para presentar compromiso hemodinámico. La coordinación entre el equipo del hospital emisor y el ET es de gran importancia para un buen resultado asistencial
AIMS: The aim of this study is to establish the incidence of supraventricular tachycardia (SVT) as a main reason for between-hospital transfer in children, as well as to describe the clinical presentation, prognosis and treatment, risk factors presenting with haemodynamic compromise, and to propose a specific management protocol for the transport. METHODS: A retrospective observational study was conducted on all patients with supraventricular tachycardia transferred by the Hospital Vall d'Hebron Sistema de Emergencias Médicas Pediátricas (SEM-P) between January 2005 and June 2017. RESULTS: During the study period, 67 (0.9%) patients (out of a total number of 7348 transfers) suffered from SVT. The median age was 57 days (2 hours-18 years old). There was clinical evidence of cardiogenic shock on admission in 14 (20.9%) patients. Age ≤ 1 year was the only independent risk factor associated with presenting with cardiogenic shock on admission, with an OR of 10.2 (95% CI: 1.2-89.9; P=.004). The majority of patients could be treated appropriately by the local hospital team, except for oral intubation and cardioversion that were performed mainly by the transport team on arrival at the local hospital. Median stabilisation time was 35minutes (9-169), and median total transport time was 30minutes (9-165). CONCLUSIONS: Only 0.9% of transport cases are due to SVT, but this can be highly demanding as patients can be critically ill. Age ≤ 1 year was the only independent risk factor associated with presenting with cardiogenic shock on admission. Coordination between the local and the transport teams is crucial for a good clinical outcome
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Tachycardia, Paroxysmal/diagnosis , Tachycardia, Paroxysmal/therapy , Patient Transfer/methods , Patient Transfer/standards , Retrospective Studies , Pediatric Emergency Medicine/standards , Electric Countershock , Risk FactorsABSTRACT
Flecainide is a class IC antiarrhythmic indicated for ventricular and supraventricular arrhythmias in pediatric patients without structural heart disease. Flecainide has a narrow therapeutic window and proarrhythmic effect even in therapeutic doses and could lead to a life-threatening intoxication. Dosage errors, accidental intakes, and drug or food interactions, especially with dairy products, can be the cause of the intoxication. We report three consecutive cases of flecainide intoxication in children with supraventricular tachycardia (SVT) in our hospital from 2017 to 2019. Two cases had complete and spontaneous normalization of electrocardiogram (ECG) after flecainide removal. However, admission to the intensive care was required due to a sustained ventricular tachycardia in one case. Flecainide intoxication can be a life-threatening complication in patients with SVT. We believe all children should have close monitoring with serial ECG and plasma levels of flecainide during the 48-72 h after initiation of treatment, and consider hospitalization for patients <1 year of age.
ABSTRACT
AIMS: The aim of this study is to establish the incidence of supraventricular tachycardia (SVT) as a main reason for between-hospital transfer in children, as well as to describe the clinical presentation, prognosis and treatment, risk factors presenting with haemodynamic compromise, and to propose a specific management protocol for the transport. METHODS: A retrospective observational study was conducted on all patients with supraventricular tachycardia transferred by the Hospital Vall d'Hebron Sistema de Emergencias Médicas Pediátricas (SEM-P) between January 2005 and June 2017. RESULTS: During the study period, 67 (0.9%) patients (out of a total number of 7348 transfers) suffered from SVT. The median age was 57 days (2 hours-18 years old). There was clinical evidence of cardiogenic shock on admission in 14 (20.9%) patients. Age ≤ 1 year was the only independent risk factor associated with presenting with cardiogenic shock on admission, with an OR of 10.2 (95% CI: 1.2-89.9; P=.004). The majority of patients could be treated appropriately by the local hospital team, except for oral intubation and cardioversion that were performed mainly by the transport team on arrival at the local hospital. Median stabilisation time was 35minutes (9-169), and median total transport time was 30minutes (9-165). CONCLUSIONS: Only 0.9% of transport cases are due to SVT, but this can be highly demanding as patients can be critically ill. Age ≤ 1 year was the only independent risk factor associated with presenting with cardiogenic shock on admission. Coordination between the local and the transport teams is crucial for a good clinical outcome.
Subject(s)
Patient Transfer/statistics & numerical data , Tachycardia, Supraventricular/therapy , Transportation of Patients/methods , Adolescent , Child , Child, Preschool , Clinical Protocols , Female , Humans , Infant , Infant, Newborn , Logistic Models , Male , Patient Transfer/methods , Prognosis , Retrospective Studies , Risk Factors , Tachycardia, Supraventricular/diagnosis , Tachycardia, Supraventricular/etiology , Transportation of Patients/statistics & numerical dataABSTRACT
AIMS: The aim of this study is to establish the incidence of supraventricular tachycardia (SVT) as a main reason for between-hospital transfer in children, as well as to describe the clinical presentation, prognosis and treatment, risk factors presenting with haemodynamic compromise, and to propose a specific management protocol for the transport. METHODS: A retrospective observational study was conducted on all patients with supraventricular tachycardia transferred by the Hospital Vall d'Hebron Sistema de Emergencias Médicas Pediátricas (SEM-P) between January 2005 and June 2017. RESULTS: During the study period, 67 (0.9%) patients (out of a total number of 7348 transfers) suffered from SVT. The median age was 57 days (2â¯h-18 years old). There was clinical evidence of cardiogenic shock on admission in 14 (20.9%) patients. Age ≤1 year was the only independent risk factor associated with presenting with cardiogenic shock on admission, with an OR of 10.2 (95% CI: 1.2-89.9; pâ¯=â¯0.004). The majority of patients could be treated appropriately by the local hospital team, except for oral intubation and cardioversion that were performed mainly by the transport team on arrival at the local hospital. Median stabilisation time was 35â¯min (9-169), and median total transport time was 30â¯min (9-165). CONCLUSIONS: Only 0.9% of transport cases are due to SVT, but this can be highly demanding as patients can be critically ill. Age ≤1 year was the only independent risk factor associated with presenting with cardiogenic shock on admission. Coordination between the local and the transport teams is crucial for a good clinical outcome.
Subject(s)
Anti-Arrhythmia Agents , Tachycardia, Supraventricular , Adolescent , Anti-Arrhythmia Agents/therapeutic use , Child , Child, Preschool , Electric Countershock , Hospitals , Humans , Infant , Infant, Newborn , Patient Transfer , Retrospective Studies , Tachycardia, Supraventricular/epidemiology , Tachycardia, Supraventricular/therapyABSTRACT
No disponible
Subject(s)
Humans , Child , Sudden Infant Death/etiology , Death, Sudden, Cardiac/etiology , Death, Sudden/etiology , Genetic Predisposition to Disease/epidemiology , Heart Defects, Congenital/epidemiology , Autopsy/standardsABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Marfan Syndrome/epidemiology , Loeys-Dietz Syndrome/epidemiology , Indicators of Morbidity and Mortality , Sinus of Valsalva/physiopathology , Genetic Diseases, InbornSubject(s)
Adrenergic beta-Antagonists/therapeutic use , Angiotensin Receptor Antagonists/therapeutic use , Aortic Aneurysm, Thoracic/etiology , Early Diagnosis , Loeys-Dietz Syndrome/complications , Marfan Syndrome/complications , Patient Care Team , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/prevention & control , Child , Disease Management , Female , Genetic Testing/methods , Humans , Loeys-Dietz Syndrome/diagnosis , Loeys-Dietz Syndrome/therapy , Male , Marfan Syndrome/diagnosis , Marfan Syndrome/therapy , PrognosisABSTRACT
Introducción y objetivos: La dilatación de la aorta ascendente asociada a válvula aórtica bicúspide es una causa mayor de morbimortalidad en adultos. El objetivo principal fue reconocer la afectación aórtica en niños, así como sus características y factores de riesgo. Métodos: Se realizaron retrospectivamente las mediciones aórticas de todos los pacientes pediátricos con válvula aórtica bicúspide seguidos en un hospital pediátrico terciario entre 1997 y 2015. Se excluyeron los pacientes con síndromes asociados a dilatación aórtica (n=17). Resultados: Se incluyeron 206 pacientes, de los cuales el 67,9% eran varones. El patrón de apertura más común fue horizontal: 137 (66,7%). La mitad de los pacientes (101) tenía historia de coartación aórtica, 46 de ellos (22,3%) con estenosis aórtica≥moderada y 13 (6%) con insuficiencia aórtica≥moderada. El seguimiento medio fue de 6,1 (4,9) años; el diagnóstico de dilatación aórtica se realizó durante el primer año de seguimiento. La progresión de la dilatación de la aorta ascendente se documentó en el 17,1%, y en el 2,5% en la raíz aórtica. Más de un tercio (80/206) presentó dilatación aórtica (z-score>2). La afectación exclusiva de la aorta ascendente se produjo en 70/80 pacientes, con preservación de la raíz aórtica. En el análisis multivariado, los pacientes con dilatación de la aorta ascendente se asociaron a ausencia de coartación (p=0,001) y patrón de apertura vertical (p=0,007). Conclusiones: Está justificado el seguimiento en los pacientes pediátricos con válvula aórtica bicúspide debido a la frecuente asociación con disfunción valvular y/o dilatación aórtica (AU)
Introduction and objectives: Dilatation of the ascending aorta associated with bicuspid aortic valve is a major cause of morbidity and mortality in adults. The main objective was to recognize the aortic involvement in children, its characteristics and risk factors. Methods: Aortic measures of all pediatric patients with bicuspid aortic valve followed in a tertiary pediatric hospital between 1997 and 2015 were retrospectively taken. Patients with syndromes associated with aortic dilatation were excluded (n=17). Results: Two hundred and six patients were included, 67.9% males. The commonest opening pattern was horizontal: 137 (66.7%). Half of the patients (101) had a history of surgical aortic coarctation, 46 (22.3%) had≥moderate aortic valve stenosis and 13 (6%) had≥moderate aortic insufficiency. Mean follow-up time was 6.1 (4.9) years; diagnosis of aortic dilatation was made during the first year of follow-up. Progression of the dilatation of the ascending aorta was noted in 17.1%, and of the aortic root in 2.5%. More than one-third (80/206) had aortic dilatation (z-score>2). The ascending aorta was exclusively affected in 70/80 patients, with sparing of the aortic root. In the multivariate analysis, patients with dilatation of the ascending aorta were associated with absence of coarctation (P=.001) and vertical opening pattern (P=.007). Conclusions: Pediatric patients with bicuspid aortic valve warrant medical follow-up for the frequent association with valve impairment and/or dilatation of the ascending aorta (AU)
Subject(s)
Humans , Aortic Valve/diagnostic imaging , Aortic Valve/pathology , Risk Factors , Aortic Aneurysm/complications , Aortic Coarctation/physiopathology , Sinus of Valsalva/diagnostic imaging , Retrospective Studies , Multivariate Analysis , Heart Diseases/congenital , Heart Diseases/complicationsABSTRACT
INTRODUCTION AND OBJECTIVES: Dilatation of the ascending aorta associated with bicuspid aortic valve is a major cause of morbidity and mortality in adults. The main objective was to recognize the aortic involvement in children, its characteristics and risk factors. METHODS: Aortic measures of all pediatric patients with bicuspid aortic valve followed in a tertiary pediatric hospital between 1997 and 2015 were retrospectively taken. Patients with syndromes associated with aortic dilatation were excluded (n=17). RESULTS: Two hundred and six patients were included, 67.9% males. The commonest opening pattern was horizontal: 137 (66.7%). Half of the patients (101) had a history of surgical aortic coarctation, 46 (22.3%) had≥moderate aortic valve stenosis and 13 (6%) had≥moderate aortic insufficiency. Mean follow-up time was 6.1 (4.9) years; diagnosis of aortic dilatation was made during the first year of follow-up. Progression of the dilatation of the ascending aorta was noted in 17.1%, and of the aortic root in 2.5%. More than one-third (80/206) had aortic dilatation (z-score>2). The ascending aorta was exclusively affected in 70/80 patients, with sparing of the aortic root. In the multivariate analysis, patients with dilatation of the ascending aorta were associated with absence of coarctation (P=.001) and vertical opening pattern (P=.007). CONCLUSIONS: Pediatric patients with bicuspid aortic valve warrant medical follow-up for the frequent association with valve impairment and/or dilatation of the ascending aorta.
