[Frequency and risk factors associated with malnutrition in children with congenital cardiopathy]. / Frecuencia y factores de riesgo asociados a desnutrición de niños con cardiopatía congénita.

OBJECTIVES: To assess the frequency and risk factors of malnutrition among children with congenital heart disease (CHD). MATERIAL AND METHODS: Between August 1997 and May 1998, a cross-sectional survey was conducted among 244 children, at the congenital heart disease ward of the Cardiology Hospital, National Medical Center "Siglo XXI", Mexican Institute of Social Security, in Mexico City. Study subjects were male and female children younger than 17 years, diagnosed with CHD and without any other congenital malformation. Weight/Age (W/A), Height/Age (H/A) and Weight/Height (W/H) were used to measure nutritional status; Z scores greater than -2 was the case definition of malnutrition. Risk factors investigated were age, sex, perinatal history, dietary factors and nutritional supplementation, socioeconomic status, and family composition and functionality. Four CHD groups were studied: acyanotic with and without pulmonary hypertension (APH, AWPH) and, cyanotic with and without pulmonary hypertension (CPH, CWPH). Statistical analysis consisted of the chi-squared, Mann Whitney's U, and Kruskal-Wallis tests. Confounding variables were controlled for with a logistic regression model; odds ratios (OR) and 95% confidence intervals (95%CI) were calculated. RESULTS: APH was the most frequent CHD (62.7%), followed by CWPH (15.6%), AWPH (11.5%), and CPH (10.2%). Malnutrition was identified in 40.9% children with the W/A index, in 24.6% with the H/A index; and in 31.1% with the W/H index. Infants and the CPH group had the worst nutritional status. Risk factors associated with malnutrition were: having a cyanotic CHD (OR 2.54; 95%CI, 0.98-6.58), lack of nutritional supplementation (OR 2.38; 95%CI, 1.06-5.34), and a greater number of family members (OR, 1.42; 95%CI, 0.99-2.05). Older children were more likely to be well-nourished (OR 0.92; 95%CI, 0.89-0.96). CONCLUSIONS: Malnutrition is frequent among children with CHD; it is more common in younger children and in those with cyanotic CHD. Educational programs directed to the families of these children are needed to prevent and decrease the frequency of malnutrition. The English version of this paper is available at: http://www.insp.mx/salud/index.html

[Percutaneous treatment of multiple heart defects]. / Tratamiento por vía percutánea de múltiples defectos cardiacos.

We describe our experience in 6 cases with multiple congenital heart defects treated by percutaneous intervention. Their age ranged from 2.3 to 10 years (mean 6.1), with follow-up from 1 to 84 months (mean 28.8). Two cases had coarctation of the aorta (AC) and persistent ductus arteriosus (PDA). Two patients had pulmonary valve stenosis (PVS) and PDA, one case with aortic stenosis (AE) and PDA and one case with AC, mitral stenosis and subaortic stenosis (Shone's Syndrome). Ductus arteriosus was occluded in all patients with Gianturco coils or Rashkind occluder. The valvular gradient post balloon decreased in cases with AC from 46 to 9 mmHg, with PVS from 110 to 10 mmHg and with AE from 40 to 14 mmHg. In a 8 year old boy with Shone's syndrome, we performed angioplasty of aortic coarctation, mitral valvuloplasty with Inoue catheter. He was referred to surgery for subaortic repair stenosis. All are asymptomatic at follow-up. In conclusion; percutaneous intervention is possible in patients with multiple congenital heart defects.

[A papillary fibroelastoma of the left ventricule in the presence of a mitral valve prosthesis. A case report and review of the literature]. / Fibroelastoma papilar del ventrículo izquierdo en presencia de prótesis valvular mitral. Reporte de un caso y revisión de la literatura.

Papillary fibroelastoma is a rare, benign cardiac tumor. Before echocardiogram came into existence, it was diagnosed only by necropsy or incidentally at surgery. This kind of tumor may appear on the endocardial surface or in any of the valves. Although it is usually small in size, it is associated to embolic phenomena, thoracic pain and sudden death. This report presents the first case of papillary fibroelastoma in the presence of a mechanical valvular prosthesis in mitral position. In a patient 55 years old, presenting inactive rheumatic heart disease. The tumor was detected by means of transthoracic and transesophageal echocardiogram.

[Stents in aortic coarctation. Immediate results]. / Stents en coartación aórtica. Resultados inmediatos.

From September 1996 to March 1997 we implanted stents Palmaz (P-308 Johnson & Johnson) in six patients with aortic coarctation. Age ranged from 13 to 30 years (mean = 20), 3 female and 3 male. We implanted the stent without predilation. Balloon diameter was 12 mm in two cases and 15 mm in four cases for complete expansion we used 14 to 20 mm balloon diameter in five instances and in one case we used a dual balloon 15 + 15 mm. The gradient pre-stent ranged from 30 to 65 mmHg (mean = 44) and decreased to 0 mmHg in five cases and in one patient the residual gradient was 4 mmHg. Systolic aortic pressure pre-stent was 135 mmHg and decreased to 117 mmHg. There were no significant complications. In conclusion, we have demonstrated the feasibility of balloon-expandable stent implantation as a method of alleviation the obstruction in coarctation of the aorta in this group of patients. It is an excellent alternative to surgical treatment and it is better than balloon angioplasty that results in marked improvement in the angiographic appearance of the thoracic aorta. It eliminates the gradient, has minimum morbidity and no mortality, no aneurysm formation. Late restenosis and possible aneurysm formation remains an unlikely complication in view of the ample luminal diameter and the high velocity of flow.

[Transcatheter closure of ductus arteriosus with coils. Immediate results. Initial experience in Mexico]. / Cierre transcateterismo del conducto arterioso mediante espirales (coils). Resultados inmediatos. Experiencia inicial en México.

From March to May 1996 we performed transcatheter closure of patent ductus arteriosus with spring coils in 4 patients. Age ranged from 5 month to 11 years (mean 4.3 years). One of them had two previous Rashkind occluders with persistant shunt and other case had pulmonary valve stenosis, in this case we performed pulmonary valvuloplasty and after that closure of ductus arteriosus. Mean pulmonary arterial pressure was 10 to 38 mmHg (mean 18), QP/QS was 1.2 to 5.0 (mean 3.2). Immediate total occlusion occurred in two cases and the other had trivial shunt by doppler echocardiography. No complications were detected. In conclusion we believe that this device is another no surgical alternative to treat persistant ductus arteriosus. It is effective, it has a low cost, and all the patients are candidates. The procedure carries minimum risk and has no mortality.

[Cor triatriatum. Diagnostic and surgical experience]. / Cor triatriatum. Experiencia diagnóstica y quirúrgica.

Five cases with cor triatriatum were diagnosed in less than a two years period. There were 4 females and one male. The mean age was 3.6 years. Three patients were operated on successfully. One patient died shortly after cardiac catheterization in acute pulmonary edema, another case is waiting for surgery with mild obstruction. We do not have a complete explanation for this high incidence of cor triatriatum. The utility of Echo Doppler color in diagnosis is highlighted. A literature review is made.

Diagnosis of Berry syndrome in an infant by two-dimensional and color Doppler echocardiography.

A 6-month-old male infant with coexistent type B interrupted aortic arch, distal aortopulmonary window, and anomalous origin of the right pulmonary artery arising from the ascending aorta was diagnosed by two-dimensional echocardiography, color Doppler, and cardiac catheterization. Review of the available literature reveals this patient to be the fourteenth reported case of this unusual association of cardiovascular defects.

[Kawasaki disease: the echocardiographic diagnosis of coronary aneurysms. A report of 2 cases]. / Enfermedad de Kawasaki: diagnóstico ecocardiográfico de los aneurismas coronarios. Informe de dos casos.

We report two infants with Kawasaki disease and coronary aneurysms diagnosed by echocardiography. First case, a one year old male with abnormalities of left coronary artery, developed a myocardial infarction and died three weeks later. Second case a two months old male with aneurysm in the right coronary artery who doing well three months after the diagnosis was made. Echocardiography is the primary tool for evaluation and follow up of coronary abnormalities.

[Understanding and diagnosis of complex congenital cardiopathies. II]. / Comprensión y diagnóstico de las cardiopatías congénitas complejas. II.

Once the rules for understanding of complex congenital heart disease were reviewed in part I, the purpose in this second part is show how the clinical diagnosis is made. The first requirement is to separate patients into two groups: neonates and infants. A critical route based on five clue data: patient's age, presence or absence of cyanosis, presence or absence of myocardial failure, pulmonary blood flow estimated on x chest film, and presence of either right or left ventricular hypertrophy or both in ECG, is matched. This approach is helpful to reduce possibilities to diagnosis in congenital heart disease.

[Understanding and diagnosis of complex cardiopathies. I]. / Comprensión y diagnóstico de las cardiopatías complejas. I.

Even pediatricians and cardiologists the complex congenital heart disease is considered to be difficult chapter. The purpose of this review is to show that complex congenital heart disease is not difficult to understand it two avenues are followed: First, a detailed explanation of the methodology used for the segmental analysis is given; all possible segmental combinations are reviewed. Second, 5 basic rules for this analysis are proposed: symmetry of the first segment, a discordant intersegmentary connection, two discordant intersegmentary connections, absence or hypoplasia of one the elements of the ventricular or arterial segment and both components of the arterial segment join one instead of the two ventricles. If these concepts are mastered, the basis for a correct diagnosis and suitable treatment are established.

[Tricuspid atresia. Clinical course in 120 children]. / Atresia tricuspídea. Curso clínico en 120 niños.

We describe the clinical course of 120 children with tricuspid atresia (TA) attended in the Hospital de Cardiología y Neumología, "Dr. Luis Méndez", del Centro Médico Nacional. There were 61 males and 59 females. The age of presentation was in 79 newborn babies, seventeen between one and six months old, 20 between six and 24 months old, and four with two or more years old. The clinical picture was hypoxic spells in 89% and congestive heart failure in the others. The chest film showed cardiomegaly in 85%, with diminished pulmonary flow in 48%, increased flow in 27.5%, and normal in 9%. The electrocardiogram with superior left axis deviation in 94%, right atrial hypertrophy in 58%, left atrial hypertrophy in 47.5% and left ventricular hypertrophy in 96%. TA was classified as type I in 103 children, type Ic in 70, Ib in 27 and Ia in six, and type II in seventeen children, with eight IIc, six IIb and three IIa. In 44 the management was medical, 63 underwent systemic-pulmonary anastomosis, 37 of them with Blalock-Taussig shunt and Fontan procedure in thirteen children. There were 21 deaths. This survey is compared with the literature and from this point we make management recommendations.