Spinal surgery in the univentricular heart--is it viable?

INTRODUCTION: The management of patients with Fontan physiology who undergo scoliosis surgery is difficult. The purpose of this article was to describe our experience in the management of patients with Fontan circulation undergoing spinal surgery for correction of scoliosis. MATERIALS AND METHODS: This was a retrospective study including patients with Fontan physiology who underwent spinal orthopaedic surgery. Anaesthetic management, post-operative complications, paediatric intensive care unit and total hospital stay, and the need for blood transfusions were analysed. RESULTS: We identified eight children with Fontan physiology who had undergone spinal surgery from 2000 to 2010. All patients were receiving cardiac medications at the time of spinal surgery. The mean age at surgery was 14.8 years (range 12-21). In all, three patients needed inotropic support with dopamine (3, 5, and 8 µg/kg/min), which was started during surgery. During the immediate post-operative period, one patient died because of hypovolaemic shock caused by massive bleeding and dysrythmia. Mean blood loss during the post-operative period was 22.2 cc/kg (7.8-44.6). Surgical drainages were maintained for a mean time of 3 days (range 1-7). The mean hospital stay was 9.2 days (range 6-19). Pleural effusions developed in two patients. On follow-up, one patient presented with thoracic pseudarthrosis and another with a serohaematoma of the surgical wound. CONCLUSIONS: Spinal surgery in patients with Fontan circulation is a high-risk operation. These patients must be managed by a specialised team.

Miocarditis aguda fulminante: a propósito de dos casos / Acute fulminant myocarditis: based on two cases

La miocarditis es un proceso inflamatorio del músculo cardíaco. Afecta a cualquier grupo de edad. La mayoría de los casos son subclínicos, aunque puede manifestarse como una insuficiencia cardiaca crónica o fulminante. La inflamación es habitualmente consecuencia de un proceso infeccioso, aunque existen formas idiopáticas o autoinmunes. La mayoría de los virus patógenos para el hombre pueden producir miocarditis, siendo lo más frecuentes los enterovirus y los adenovirus. Se desconoce si el origen de la gravedad de la lesión es producido por el virus o por la respuesta inflamatoria postinfecciosa o por una combinación de ambos factores. Presentamos dos casos que presentaron una miocarditis aguda con una evolución fatal fulminante. En ninguno se pudo identificar el agente etiológico (AU)

Myocarditis is an inflammatory process of cardiac muscle. It affects equally all the age groups. Most of the cases are subclinical even though it can present as chronic or fatal heart failure. Inflammation is usually a consequence of an infectious process although idiopacthic and inmunitary cases have also been described. The majority of human virus can cause myocarditis, among them enterovirus and adenovirus are the most common. It is not known whether the virus causes the severity of the process itself, the post-infectious inflammatory response or a combination of both factors. We present two cases of acute myocarditis with a fatal outcome. We were unable to identify the pathogenic agent in neither of them (AU)

Relación de la enfermedad mínima residual postinducción con el pronóstico a largo plazo en la leucemia linfoblástica aguda en la edad pediátrica / Relationship of the post-induction residual disease with long term prognosis in acute lymphoblastic leukemia in the pediatric age

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