ABSTRACT
Introducción y objetivos: La exposición a radiación ionizante en los procedimientos de ablación conlleva riesgos para la salud, sobre todo en pacientes pediátricos. Nuestro objetivo es comparar la seguridad y la eficacia de la ablación guiada por un sistema de navegación intracardiaca no fluoroscópica (SNINF) con las de la ablación guiada exclusivamente por fluoroscopia en pacientes pediátricos. Métodos: Se analizaron los resultados de la ablación con catéter en pacientes pediátricos con vías accesorias de riesgo o taquicardias supraventriculares remitidos a nuestro centro en un periodo de 6 años. Se compararon los procedimientos guiados solo por fluoroscopia (grupo A) y los guiados por SNINF (grupo B). Resultados: Se analizaron 120 procedimientos de ablación en 110 pacientes (edad, 11±3,2 años; el 70% varones), 62 procedimientos en el grupo A y 58 en el grupo B. No se encontraron diferencias significativas entre ambos grupos en éxito del procedimiento (el 95% del grupo A y el 93,5% del grupo B; p=0,53), complicaciones (el 1,7 frente al 1,6%; p=0,23) y recurrencia (el 7,3 frente al 6,9%; p=0,61). Sin embargo, el tiempo de fluoroscopia (mediana, 1,1 frente a 12 min; p<0,0005) y el tiempo de ablación (mediana, 96,5 frente a 133,5 s; p=0,03) fueron menores en el grupo B. La presencia de cardiopatía se comportó como un predictor independiente de recurrencia (p=0,03). Conclusiones: El SNINF para guiar los procedimientos de ablación en pacientes pediátricos reduce el tiempo de exposición a la radiación ionizante. Su empleo generalizado en las ablaciones pediátricas podría reducir el riesgo atribuido a la radiación (AU)
Introduction and objectives: Ionizing radiation exposure in catheter ablation procedures carries health risks, especially in pediatric patients. Our aim was to compare the safety and efficacy of catheter ablation guided by a nonfluoroscopic intracardiac navigation system (NFINS) with those of an exclusively fluoroscopy-guided approach in pediatric patients. Methods: We analyzed catheter ablation results in pediatric patients with high-risk accessory pathways or supraventricular tachycardia referred to our center during a 6-year period. We compared fluoroscopy-guided procedures (group A) with NFINS guided procedures (group B). Results: We analyzed 120 catheter ablation procedures in 110 pediatric patients (11±3.2 years, 70% male); there were 62 procedures in group A and 58 in group B. We found no significant differences between the 2 groups in procedure success (95% group A vs 93.5% group B; P=.53), complications (1.7% vs 1.6%; P=.23), or recurrences (7.3% vs 6.9%; P = .61). However, fluoroscopy time (median 1.1minutes vs 12minutes; P <.0005) and ablation time (median 96.5seconds vs 133.5seconds; P=.03) were lower in group B. The presence of structural heart disease was independently associated with recurrence (P=.03). Conclusions: The use of NFINS to guide catheter ablation procedures in pediatric patients reduces radiation exposure time. Its widespread use in pediatric ablations could decrease the risk of ionizing radiation (AU)
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Catheter Ablation/methods , Fluoroscopy , Tachycardia/therapy , Tachycardia, Supraventricular/therapy , Treatment Outcome , Retrospective Studies , Follow-Up StudiesABSTRACT
OBJECTIVE: The aim of this study is to review the current management and outcomes of fetal bradycardia in 9 Spanish centers. METHODS: Retrospective multicenter study: analysis of all fetuses with bradycardia diagnosed between January 2008 and September 2010. Underlying mechanisms of fetal bradyarrhythmias were studied with echocardiography. RESULTS: A total of 37 cases were registered: 3 sinus bradycardia, 15 blocked atrial bigeminy, and 19 high grade atrioventricular blocks. Sinus bradycardia: 3 cases (100%) were associated with serious diseases. Blocked atrial bigeminy had an excellent outcome, except for one case with post-natal tachyarrhythmia. Of the atrioventricular blocks, 16% were related to congenital heart defects with isomerism, 63% related to the presence of maternal SSA/Ro antibodies, and 21% had unclear etiology. Overall mortality was 20% (37%, if terminations of pregnancy are taken into account). Risk factors for mortality were congenital heart disease, hydrops and/or ventricular dysfunction. Management strategies differed among centers. Steroids were administrated in 73% of immune-mediated atrioventricular blocks, including the only immune-mediated IInd grade block. More than half (58%) of atrioventricular blocks had a pacemaker implanted in a follow-up of 18 months. CONCLUSIONS: Sustained fetal bradycardia requires a comprehensive study in all cases, including those with sinus bradycardia. Blocked atrial bigeminy has a good prognosis, but tachyarrhythmias may develop. Heart block has significant mortality and morbidity rates, and its management is still highly controversial.
Subject(s)
Bradycardia/diagnosis , Bradycardia/therapy , Fetal Diseases/diagnosis , Fetal Diseases/therapy , Cross-Sectional Studies , Female , Humans , Infant, Newborn , Pregnancy , Retrospective Studies , SpainABSTRACT
La cianosis diferencial-término que indica una mejor oxigenación de la parte superior del cuerpo (preductal) respecto a la inferior (posductal)-es un hallazgo bien conocido en pediatría, y su causa más frecuente es la hipertensión pulmonar persistente del recién nacido. Por otro lado, hay casos excepcionales en los que se registra una cianosis diferencial inversa y la parte superior del cuerpo está peor oxigenada que la inferior. En este trabajo presentamos 2 casos clínicos con dicho hallazgo: un recién nacido con transposición de grandes vasos con hipertensión pulmonar y otro con drenaje venoso pulmonar anómalo total supracardiaco. Se revisa la bibliografía y se explica la fisiopatología de la cianosis diferencial inversa, demostrándose que es patognomónica de una cardiopatía congénita severa. Concluimos que la medición simultánea de la saturación en el territorio preductal y posductal mediante pulsioximetría debería ser siempre parte integrante de la valoración del recién nacido cianótico(AU)
Differential cyanosis -better oxygenation of the upper (preductal) part of the body with respect to the lower (postductal) part- is a well-known condition in pediatrics, being persistent pulmonary hypertension of the newborn its most common cause. On the other hand, reversed differential cyanosis (RDC) -upper body less oxygenated than the inferior- is a rare condition. This report describes two newborns presenting RDC: a case with transposition of the great arteries with pulmonary hypertension and a case with supracardiac total anomalous pulmonary vein connection. We review the existing literature and discuss its physiopathological bases, demonstrating that this condition is pathognomonic of severe congenital cardiopathy. Therefore, simultaneous preductal and postductal oxygen saturation should be always documented as part of the evaluation of the cyanotic newborn(AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Cyanosis/complications , Cyanosis/diagnosis , Heart Defects, Congenital/complications , Heart Defects, Congenital/diagnosis , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/diagnosis , Cyanosis/physiopathology , Cyanosis , Hypertension, Pulmonary/physiopathology , Hypertension, Pulmonary , Echocardiography/standards , Echocardiography , Gestational AgeABSTRACT
OBJECTIVE: The purpose of this study was to assess the knowledge that parents of children with congenital cardiac disease have about bacterial endocarditis (EB) and its prophylaxis (PEB). PATIENTS AND METHODS: To this end, an elusive questionnaire was prepared and offered to one hundred parents of children who needed PEB. The group was classified according to the age of the children, the cultural level of the parents an the event of a dental or if another septic focus was known in the past. Likewise, the parents' knowledge of their child's disease was analyzed. RESULTS: Of the results obtained, it stood-out that the parents appeared well informed about their child's illness, but their information was insufficient in relationship to EB and PEB. Of those tested, 85% defined the child's heart disease, while only 14% did so for EB. Likewise, only 67.7% of the children who underwent an intervention for a septic focus performed PEB correctly. The knowledge of this theme are in relationship to the family's cultural formation. CONCLUSIONS: We emphasize the need to reinforce the information about PEB that the cardiologists, pediatricians and general physicians give to the families in order to prevent the morbidity and mortality caused by EB.
