Diagnóstico prenatal de las cardiopatías congénitas / Prenatal diagnosis of congenital heart diseases

El desarrollo de la ecocardiografía fetal en los últimos años ha convertido a esta técnica en la principal modalidad para el diagnóstico y abordaje prenatal de la patología cardiaca fetal. El ecocardiograma nos permite diagnosticar la existencia de problemas estructurales, además de inferir e! mecanismo e!ectrofisiológico de las arritmia s fetales, así como la necesidad de iniciar el tratamiento médico en caso de ser este necesario. En esta monografía se presentan los resultados acaecidos en nuestro centro en los últimos 11 años. Se realizaron en la Sección de Cardiología Pediátrica de nuestro centro 6.246 ecocardiografías fetales. La edad materna fue 31 +/- 5 años y la edad gestacional en e! momento de la prueba de imagen de 24 +/- 5 semanas. Se detectaron un total 317 cardiopatías congénitas lo que representa un 5,07% de todas las exploraciones. Las cardiopatías congénitas diagnostícadas más frecuentementediagnosticadas fueron la comunicación interventricular ICIV) en un 31,5% de los casos, seguida de la tetralogía de Fallot en un 13,8% de los casos y de! síndrome de corazón izquierdo hipoplásico con un 13,5% de los casos. En conclusión la ecocardiografía fetal permite e! diagnóstico preciso de la mayor parte de las cardiopatías congénitas permitiendo realizar un diagnóstico preciso, establecer el pronóstico y preparar la estrategia adecuada (AU)

The development of the fetal echocardiography in recent years has con verted this technique in the main modality for prenatal diagnosis and approach of fetal heart disease. The echocardiogram allows us to diagnose the existence of structural problems and to deduce the e!ectrophysiological mechanism of fetal arrhythmias as well as the need to initiate medical treatment if necessary. The results occurring in our center in the last 11 years in are presented in this monograph. A total of 6246 fetal echocardiographies were performed in the pediatric cardiology section of our center. Maternal age was 31 +/- 5 years and gestational age at the time of the imaging test was 24 +/- 5 weeks. A total of 317 congenital heart diseases were detected, this representing 5.07% of all the studies. The congenital Heart diseases most frequently diagnosed were interventricular communication in 31.5% of the cases followed by Fallot's Tetralogy in 13.8% of the cases and hypoplastic left heart syndrome accounting for 13.5% of the cases. In conclusion, fetal echocardiography permits the precise diagnosis of most of the congenital heart diseases, making it possible to perform an exact diagnosis, establish the prognosis and prepare the adequate strategy (AU)

Atrioseptostomía de Rashkind con catéter cutting balloon / No disponible

No disponible

Ectopia cordis torácica no asociada a cardiopatía / Thoracic ectopia cordis

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Hipertensión pulmonar primaria: tratamiento con iloprost inhalado / Primary pulmonary hypertension: Treatment with atypical presentation

No disponible

[Actuarial follow-up after percutaneous mitral valvulotomy. Incidence and event-predicting factors]. / Seguimiento actuarial tras valvulotomía mitral percutánea. Incidencia y factores predictores de eventos.

INTRODUCTION: The goal of this study is to analyse the follow-up of patients who underwent percutaneous mitral valvuloplasty and the predicting factors of event-free survival. METHODS: We analysed 220 consecutive valvuloplasty performed between 1988 and 1996 in order to establish the incidence of events (death, restenosis, mitral valve surgery, New York Heart Association class IV, new valvuloplasty or systemic embolia) and the baseline and postprocedural characteristics predicting events, during a mean follow-up of 42 months (range 1-96 months). RESULTS: Overall survival was 94.7%, and event-free survival was 59.2% at 96 months. We analyzed the baseline characteristics in order to predict the mid-term outcome (actuarial survival Kaplan-Meier method) that atrial fibrillation (p < 0.01), age > or = 56 years (p < 0.005), and echocardiographic score > or = 9 (p < 0.005) were baseline characteristics related to adverse events in follow up. An index based on the number of adverse factors in the baseline characteristics provided a significant difference in concerning the number of follow up to even-free between the group without baseline adverse characteristics and the group with two (p = 0.008, OR = 4.5), or three adverse characteristics (p = 0.005, OR 6.4). Among the postprocedural characteristics, while patients with mitral valve area after valvuloplasty > or = 1.5 cm2 had an event-free survival of 72.9% at 96 months, those with postprocedural mitral valve area < 1.5 cm2 had an event-free survival of 10.5% (log-rank test p < 0.0001). CONCLUSIONS: Mid-term event-free survival after percutaneous mitral balloon valvuloplasty can be predicted by baseline and postprocedural characteristics. Age > or = 56, echocardiographic score > or = 9 and atrial fibrillation are baseline factors related with adverse events. Patients with 0 or 1 baseline adverse factors do not have significant differences concerning mid-term outcome while, those with 2, and above all, 3 adverse baseline characteristics have a poorer event-free survival. Mitral valve area > or = 1.5 cm2 is the only postprocedural independent predictor of event-free survival.

[The imaging diagnosis of pericardial agenesis]. / Diagnóstico de imagen de la agenesia de pericardio.

Pericardial agenesis is a rare anomaly, difficult to diagnose. Its evolution is usually benign. However, on rare occasions, partial defects have been the cause of sudden death. Therefore, surgical treatment has sometimes been indicated, even though in the cases were asymptomatic. We report the case of a 50 year-old woman with partial pericardial agenesis and herniation of left atrial appendage trough. The defect was discovered by a routine chest x-ray and treated in a conservative way. Current diagnostic and therapeutic techniques are reviewed.

[Transesophageal echocardiography follow-up of patients operated on using the Bono-Bentall technique in aneurysms or dissection of the ascending aorta]. / Seguimiento con ecocardiografía transesofágica de pacientes intervenidos con técnica de Bono-Bentall por aneurisma o disección de la aorta ascendente.

INTRODUCTION: Increasingly patients are surviving after reconstructive surgery of the ascending aorta. These patients require follow-up to detect postoperative prognostic markers, such as persistence of the flow in a false lumen, intimal rupture, or graft complications. We conducted a study with transthoracic and transesophageal echocardiography in order to detect residual abnormalities and establish the usefulness of this technique in a group of patients after Bono-Bentall surgery for ascending aorta pathology. PATIENTS AND METHODS: Twelve patients were studied with transthoracic and transesophageal echocardiography, four after surgery for annulo-aortic ectasia with severe aortic insufficiency and eight for type A aortic dissection. The Bono-Bentall surgical procedure was used in all the patients with Cabrol's modification being added in three. RESULTS: Seven of the eight (87%) patients with aortic dissection had residual abnormalities: five persistence of the distal dissection, one pseudo-aneurysm, and one peritubular haematoma. A residual lesion (pseudo-aneurysm) was found in just one of the four patients (25%) who underwent surgery for annulo-aortic ectasia. The ejection fraction was normal in those patients who had been operated on for aortic dissection and depressed in those who had annulo-aortic ectasia (60 +/- 9 vs 40 +/- 10; p = 0.005). CONCLUSIONS: In patients undergoing surgery with the Bono-Bentall procedure there is a high incidence of residual aortic abnormalities, especially when the operation is for aortic dissection. Transesophageal echocardiography is an ideal diagnostic method for the detection and follow up of residual abnormalities after ascending aorta surgery. We believe this technique should be included in the periodic follow up of these patients.