Perventricular device closure of congenital muscular ventricular septal defects.

Muscular ventricular septal defects (MVSDs) account for approximately 20% of all congenital ventricular septal defects. Large defects in infants result in early heart failure, failure to thrive and pulmonary hypertension. Although percutaneous closure of MVSDs has been employed safely and effectively in children, adolescents and adults, its application in the small infant (weight <6 kg) carries a higher risk for complications including arrhythmias, hemodynamic compromise, cardiac perforation, tamponade and death. Perventricular closure of such defects, introduced by Amin and coworkers in the late 1990s, has become an attractive treatment modality for these small and high-risk patients. Experience worldwide has shown that the procedure is feasible, reproducible, safe and effective. In this article, the authors review the indications, the step-by-step technique and the results of perventricular closure of MVSDs using the AMPLATZER mVSD device (AGA Medical, MN, USA).

The role of Doppler echocardiography in the diagnosis, follow-up, and management of ventricular septal defects.

The defects of the ventricular septum have received special attention from investigators working in echocardiography. The method showed an incomparable capability to identify all the morphological features of the defects. The increasing improvement in definition of transducers associated with conventional and color Doppler contributed significantly to the reliability to detect most of the defects. The great majority of associated lesions can be easily identified and serial examinations allow prediction of which defect may become smaller or even close spontaneously as well as which have acquired deleterious changes in the heart. Several authors have shown very good statistical correlations between echocardiographic indices and hemodynamic parameters in patients with this type of defect. Doppler echocardiography has become an invaluable tool in the diagnosis and follow-up of ventricular septal defect reducing the need for cardiac catheterization and helping management of these patients.

Ruptura del septum interventricular postinfarto miocardico / Rupture of interventricular septum post-myocardial infarction

Se informan los resultados de la intervencion quirurgica tardia en doce casos de ruptura postinfarto del septum interventricular. En promedio los pacientes fueron intervenidos despues de doce dias de producida la ruptura. Se presentaron dos muertes: una debida a sindrome de bajo gasto cardiaco y otra secundaria un accidente cerebrovascular ppostoperatorio. El manejo inicial se practico con inotropicos, vasodilatadores, diureticos y balon de contrapulsacion intraaortico. E lprocedimiento quirurgico incluyo parche con suturas reforzadas de teflon,aneurismectomia e injertos aortocoronarios cuando fueron necesarios. Se discute la fisiopatologia de la entidad y los resultados obtenidos con intervencion temprana y tardia.

[Single ventricle. New embryological-anatomical classification. I. Pathology and physiology]. / Ventriculo único. Nueva clasificación embriológico-anatómica I. Patología y fisiología

The different nomenclatures which have been given to this malformation are discussed, defining the single ventrical as a single ventricular chamber without an interventricular septum and generally with two well defined atrioventricular orfices, although in some cases there is only one mitral-tricuspid ring. Twelve cases of single ventricle, proven by necropsic study, were examined. A new embriological-anatomical classification was proposed based on the location of the outflow tract (concordant or discordant in relation to the situs viscerae of which it is a part) and the troncoconal morphology (crossed great vessels, transposition of the great arteries, and truncus arteriosus), presenting some examples of these malformations. The pathological characteristics of the malformation in each of the established groups is described, as well as the physiopathology in the most frequent varieties. The defects associated with single ventricle are studied.