Endocardial substrate of ventricular tachycardia in an adult patient with congenitally corrected transposition of great arteries without surgical repair.

Congenitally corrected transposition of the great arteries (CCTGA) is a rare congenital heart disease which may present sudden cardiac death presumably due to malignant ventricular tachycardia (VT). In patients with congenital heart disease, knowledge of arrhythmogenic substrate is crucial for planning an ablation procedure. We present the first description of the arrhythmogenic endocardial substrate of a non-iatrogenic scar-related VT in a patient with CCTGA.

Incidencia de la exposición a los rayos X en cirugías de columna / Incidence of X-rays exposure in spinal surgeries

Introducción: El control radioscópico intraoperatorio es una práctica cada vez más frecuente, que no está libre de eventos adversos para el personal de la salud. Objetivos: Conocer la tasa de uso de radioscopia en la cirugía vertebral, reconocer las medidas de control, evaluar la asimilación del cirujano a los elementos de protección y analizar los eventos adversos en estos profesionales. Materiales y Métodos: Se envió, por correo electrónico, a cirujanos espinales, una encuesta de 17 preguntas de opciones múltiples. Resultados: Se recibieron 55 encuestas. El 87% se dedicaba a la columna, en más del 60% de sus prácticas. El arco en C es el método más utilizado para el control final, en forma pulsátil. Solo el 31% controla el tiempo real. El delantal plomado de una pieza es el método más utilizado, pero se desconoce cuándo se debe reemplazar. La mitad utiliza más de un elemento. Siete casos de trastornos visuales, 5 patologías tiroideas, 3 dermatitis y 2 casos de infertilidad. Tres cirujanos fueron operados por nódulos tiroideos, cataratas o neoplasia. Conclusiones: El control radioscópico intraoperatorio es una práctica frecuente en la cirugía espinal. El delantal plomado de una pieza es el método más utilizado y, muchas veces, se lo combina, pero se desconoce cuándo se deben renovar los plomados. Uno de cada tres cirujanos presentaron las patologías evaluadas y 3, cirugías relacionadas. Así queda en evidencia la protección y el control escasos que existen en los cirujanos especialistas, acompañados de una falta de protocolización que deja a la deriva este control. Nivel de Evidencia: IV

Background: Intraoperative radiographic control (IRC) is an increasingly common practice, but it causes certain adverse events for healthcare providers. Objectives: To measure the use of fluoroscopy in spinal surgery, recognize control measures, evaluate assimilation of protection elements by surgeons, and analyze adverse events for spinal surgeons. Materials and Methods: A survey of 17 multiple-choice questions was e-mailed to spinal surgeons. Results: 55 surveys were answered. More than 60% of surgeons were spinal surgeons. The C-arm is the most widely used machine for final control by pulsating X-rays. Real-time controls are carried out in 31% of cases. One-piece leaded aprons are the most commonly used method, but it is unknown when they should be replaced. Half of the respondents uses more than one protection element. There were seven cases of vision changes, 5 of thyroid disorders, 3 of dermatitis, and 2 of infertility. Three surgeons required surgery for thyroid nodules, cataracts or neoplasm. Conclusions: IRC is a common practice in spinal surgery. One-piece leaded aprons are the most commonly used method and they are often combined with other elements, but it is not known when aprons must be replaced. One in 3 surgeons suffered from the studied conditions, and there were 3 related surgeries. Lack of adequate protection and control is a reality for specialist surgeons, together with a lack of protocols, making this an unregulated issue. Level of Evidence: IV

Transaortic Fallot repair in a grown-up patient: advantages in a situs inversus setting.

We present the case studies of two adult patients with tetralogy of Fallot who were scheduled for surgery. After addressing the right ventricular outflow tract obstruction, the aorta was opened and the ventricular septal defect was approached in a straightforward manner as it was located just under the overriding aortic valve. The second patient presented with was a situs inversus, dextroapex Fallot. In this setting, the aortic approach simplified the repair expeditiously. After 2 years, both patients are in New York Heart Association class I, with no residual ventricular septal defect, no aortic regurgitation, and complete relief of right ventricular outflow tract obstruction.