Seguimiento a muy largo plazo de pacientes sometidos a cierre de defectos septales interauriculares / Long-term outcomes after percutaneous atrial septal deffects closure

No disponible

Valve-Sparing Tetralogy of Fallot Repair With Intraoperative Dilation of the Pulmonary Valve. Mid-Term Results.

Deleterious long-term effects of chronic pulmonary regurgitation after repair of tetralogy of Fallot have become evident during the last decades. Subsequently, some groups have developed strategies to spare the pulmonary valve function at the time of repair with good early results. However, mid-term outcomes are scarce in the literature and in some cases controversial. The aim of our study is to report our results mid-term with valve-sparing repair of tetralogy of Fallot. We retrospectively reviewed patients undergoing tetralogy of Fallot repair and having preservation of the pulmonary valve with intraoperative dilation at our institution. From June 2009 through June 2017, 42 patients underwent valve-sparing tetralogy of Fallot repair. Median age and weight at surgery were 5.2 months and 7.2 kg. Median preoperative pulmonary valve diameters and Z scores by echocardiography were 6.4 mm (range 4.5-11 mm) and -2.3 (range -1.3 to -4.5). No patient died in our series. For a median follow-up of 45 months, the pulmonary valve has grown by Z score (P < 0.0001) as well as the pulmonary trunk (P= 0.00216). Significant pulmonary regurgitation has developed in 9 patients (21.4%). No patient has required reintervention/reoperation for recurrent right ventricular outflow tract obstruction. Patients with tetralogy of Fallot who had valve-sparing repair with intraoperative dilation of the pulmonary valve show good early and mid-term results with respect to right ventricular outflow tract obstruction. The pulmonary valve annulus and the pulmonary trunk grow through follow-up. Progressive development of significant pulmonary regurgitation is seen in more than 20% of patients. Long-term data with this approach and comparison with a population of patients undergoing a transannular patch repair are required to establish the real utility of this approach.

¿Cuál es la dosis óptima de clopidogrel en pacientes pediátricos? / What is the optimal dose of clopidogrel in pediatric patients?

Introducción: El objetivo de este estudio fue recopilar datos retrospectivos sobre la prescripción de clopidogrel y describir las condiciones de uso en la población pediátrica de un hospital de referencia de nivel terciario y evaluarlas con base en la evidencia disponible. Pacientes y métodos: Estudio observacional, descriptivo y retrospectivo realizado entre marzo de 2010 y marzo de 2017. Los criterios de inclusión fueron: 100% de los pacientes menores de 18 años que fueron dados de alta de nuestro hospital con clopidogrel como tratamiento domiciliario en el período de estudio. Se recogieron los siguientes datos: datos demográficos, diagnóstico, indicación de clopidogrel, fecha de inicio y de finalización del tratamiento, presencia o ausencia de tratamiento concomitante con ácido acetilsalicílico u otros antiagregantes plaquetarios o anticoagulantes, tratamiento concomitante con inhibidores de la bomba de protones, efectividad y efectos adversos. Resultados: Un total de 11 pacientes se incluyeron en el estudio (45% hombres). La edad promedio fue de 3,1 años (rango: 1 mes-8 años). La dosis recomendada de clopidogrel fue de 0,2 mg/kg/día en todos los individuos, recibiendo tratamiento concomitante con ácido acetilsalicílico 10/11 pacientes para optimizar la terapia antiplaquetaria. Ningún niño recibió tratamiento concomitante con anticoagulantes y solo uno de ellos recibió tratamiento con inhibidores de la bomba de protones. No se observaron trastornos hemorrágicos u otros efectos adversos asociados con clopidogrel. Conclusión: Según nuestra experiencia, la dosis de clopidogrel de 0,2 mg/kg/día demostró ser una estrategia segura y efectiva, independientemente de la edad del paciente. La buena tolerancia observada podría estar asociada con el ajuste de la dosis óptima para lograr la agregación plaquetaria sin aumentar el riesgo de efectos adversos

Introduction: The aim of this study was to collect retrospective data on the prescription of clopidogrel, describe the conditions of its use in the paediatric population of a tertiary referral hospital, and evaluate its use based on the current scientific evidence. Patients and methods: We conducted a retrospective, observational and descriptive study between March 2010 and March 2017. We included all patients under the age of 18 who were discharged from our hospital for home treatment with clopidogrel within the study period. We collected data on the following: demographic data, diagnosis, indication for clopidogrel, start and end date of treatment, presence or absence of concomitant treatment with acetylsalicylic acid or other antiplatelet or anticoagulant drugs, concomitant treatment with proton pump inhibitors, effectiveness, and adverse effects. Results: The study included a total of 11 patients (45% male). The mean age was 3.1 years (range, 1 month-8 years). The prescribed dose of clopidogrel was 0.2 mg/kg/day in all patients, and 10/11 patients received concomitant treatment with acetylsalicylic acid with the purpose of optimising antiplatelet therapy. None of the children received concomitant treatment with anticoagulants, and only one of them received treatment with a proton pump inhibitor. We did not find evidence of haemorrhagic complications or other adverse effects associated with clopidogrel. Conclusion: Based on our experience, a clopidogrel dose of 0.2 mg/kg/day is a safe and effective treatment, regardless of the patient's age. The good tolerance observed in our study could be related to the adjustment of the optimal dose with the aim of achieving platelet aggregation without increasing the risk of adverse effects

[What is the optimal dose of clopidogrel in pediatric patients?] / ¿Cuál es la dosis óptima de clopidogrel en pacientes pediátricos?

INTRODUCTION: The aim of this study was to collect retrospective data on the prescription of clopidogrel, describe the conditions of its use in the paediatric population of a tertiary referral hospital, and evaluate its use based on the current scientific evidence. PATIENTS AND METHODS: We conducted a retrospective, observational and descriptive study between March 2010 and March 2017. We included all patients under the age of 18 who were discharged from our hospital for home treatment with clopidogrel within the study period. We collected data on the following: demographic data, diagnosis, indication for clopidogrel, start and end date of treatment, presence or absence of concomitant treatment with acetylsalicylic acid or other antiplatelet or anticoagulant drugs, concomitant treatment with proton pump inhibitors, effectiveness, and adverse effects. RESULTS: The study included a total of 11 patients (45% male). The mean age was 3.1 years (range, 1 month-8 years). The prescribed dose of clopidogrel was 0.2mg/kg/day in all patients, and 10/11 patients received concomitant treatment with acetylsalicylic acid with the purpose of optimising antiplatelet therapy. None of the children received concomitant treatment with anticoagulants, and only one of them received treatment with a proton pump inhibitor. We did not find evidence of haemorrhagic complications or other adverse effects associated with clopidogrel. CONCLUSION: Based on our experience, a clopidogrel dose of 0.2mg/kg/day is a safe and effective treatment, regardless of the patient's age. The good tolerance observed in our study could be related to the adjustment of the optimal dose with the aim of achieving platelet aggregation without increasing the risk of adverse effects.

Comentarios de la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas sobre las recomendaciones de la Sociedad Española de Neonatología relativas al cribado de cardiopatías congénitas críticas en el periodo neonatal / Comments by the Spanish Society for Paediatric Cardiology and Congenital Heart diseases on the recommendations by the Spanish Neonatology Society as regards screening for critical congenital heart diseases in the neonatal period

No disponible

¿Cor triatriatum dexter en la edad adulta? / Cor triatriatum dexter in adults?

No disponible

No disponible

Cierre percutáneo del ductus arterioso persistente en el neonato prematuro / Percutaneous closure of patent ductus arteriosus in preterm infants

No disponible

No disponible

Configuración «en cobra» del dispositivo Amplatzer de cierre de la comunicación interauricular: ¿se puede evitar? / Cobra-like deformation of amplatzer devices used for closing atrial septal defects: can it be avoided?

No disponible

No disponible

[Update on pediatric cardiology and congenital heart disease]. / Actualización en cardiología pediátrica y cardiopatías congénitas.

The fields of pediatric cardiology and congenital heart disease have experienced considerable progress in the last few years, with advances in new diagnostic and therapeutic techniques that can be applied at all stages of life from the fetus to the adult. This article reviews scientific publications in a number of areas that appeared between August 2007 and September 2008. In developed countries, congenital heart disease is becoming increasingly prevalent in nonpediatric patients, including pregnant women. Actions aimed at preventing coronary heart disease must be started early in infancy and should involve the promotion of a healthy diet and lifestyle. Recent developments in echocardiography include the introduction of three-dimensional echocardiography and of new techniques such as two-dimensional speckle tracking imaging, which can be used for both anatomical and functional investigations in patients with complex heart disease, including a univentricular heart. Progress has also occurred in fetal cardiology, with new data on prognosis and prognostic factors and developments in intrauterine interventions, though indications for these interventions have still to be established. Heart transplantation has become a routine procedure, supplemented in some cases by circulatory support devices. In catheter interventions, new devices have become available for the closure of atrial or ventricular septal defects and patent ductus arteriosus as well as for percutaneous pulmonary valve implantation. Surgery is also advancing, in some cases with hybrid techniques, particularly for the treatment of hypoplastic left heart syndrome. The article ends with a review of publications on cardiomyopathy, myocarditis and the treatment of bacterial endocarditis.

Absence of cardiovascular effects on young adults exposed in utero to ritodrine: a long-term follow-up.

OBJECTIVE: To determine, using echocardiographs, if young adults exposed in uterus to Ritodrine have long-term cardiovascular effects. STUDY DESIGN: Retrospective follow-up study. Young adults between the ages of 22- and 26-years-old. Young adults (n=19) exposed in uterus to Ritodrine and age-matched controls (n=27) were studied by means of transthoracic echocardiography. All participants were born following full-term pregnancies. Subgroups of those subjects exposed to the highest dose of Ritodrine and for the longest period of time were established. A multivariate descriptive statistical analysis of the values obtained using transthoracic echocardiography was performed. Echocardiography measurements in M-mode included intraventricular septum and posterior wall thickness, systolic and diastolic diameter of the left ventricle, septum/wall quotient, left ventricle mass and short and ejection fractions. Doppler pressed: E and A peaks in the mitral valve and isovolumetric relaxation time were determined. RESULTS: The mass, posterior wall, systolic diameter and the diastolic diameter of the left ventricle were slightly, but not significantly, higher in the Ritodrine group. The E/A peak and the isovolumetric relaxation time were similar in both groups. A negative correlation between the left ventricle mass index and the total Ritodrine dose (r=-0.67; p=0.051) was found; this disappeared in the subgroups exposed to higher doses and for longer times. CONCLUSIONS: The variables studied using echocardiography showed that in uterus exposure to Ritodrine do not have long-term effects on cardiac functionality in young adults.