Two- and three-dimensional echocardiographic unroofed coronary sinus.

We present the 2-dimensional findings and 3-dimensional reconstruction of images from an 18-year-old patient with unroofed coronary sinus, persistent left superior vena cava, a common atrium with levoisomerism, ventricular septal defect, and double-outlet right ventricle. The left superior vena cava showed continuity with the floor of the coronary sinus. Diagnosis of the constellation of anomalies established by transesophageal reconstruction clarified the continuity of the coronary sinus with left superior vena cava and atrial wall.

[The nutritional status of the child with congenital cardiopathy]. / Estado nutricio del niño con cardiopatía congénita.

OBJECTIVE: To know the frequency and type of nutritional alterations of children with congenital heart disease. MATERIAL AND METHODS: Sixty six children with congenital heart disease were studied. MEASUREMENTS were: weight, size, mid arm circumference, tricipital and subscapular skinfold thickness. Blood samples for white blood cells count, and albumin were taken and urine was collected for determination of creatinine. Muscular and fat areas of the arm and creatinine/height index were calculated. In order to compare the children with both cyanotic and non-cyanotic types of heart diseases chi 2 test or Fisher's exact test, ware used. RESULTS: 41 girls and 25 boys, 42 with acyanotic and 24 cyanotic heart disease. 50 children were malnourished (26 compensated, 23 non-compensated and one acute); 16 were normal. 85% of the children presented diminished muscular area and 97% diminished fatty area. The creatinine/height index was diminished in 94% of the cases. No significant differences were demonstrated between both groups. CONCLUSION: chronic malnutrition in children with congenital heart disease is frequent. Most of the cases with malnutrition are compensated. This poor nutritional status is at the expense of fatty and muscular tissues.

[Oral enalapril in patients with symptomatic ventricular septal defects]. / Enalapril oral en pacientes con comunicación interventricular sintomáticos.

Experimental and clinical studies have demonstrated that the inhibitors of angiotensin-converting enzyme may reduce the left-to-right shunt over a ventricular septal defect (VSD). The objective of the study is to evaluate the effects of enalapril on short and medium follow-up in patients with symptomatic VSD and Qp/Qs ratio > 1.5 and compare the results with conventional anti-congestive treatment in children. Twenty-four patients with ages from 3 months to 8 years were studied, dividing them in 3 groups of 8 patients each. Group I received treatment with enalapril, group II with furosemide an digoxin, and group III was treated with a combination of the three medicaments. Patients were evaluated after one, three and six months. Evaluation considered clinical signs of congestive failure, weight, heart rate, blood pressure, cardiothoracic index, and with echocardiography the dimensions of the cardiac chambers, size of the VSD and hemodynamic parameters as Qp/Qs, pulmonary artery pressure (PAP), systolic pressure gradient over the VSD, EF and SF. Statistic analysis was done for each group and was compared the three groups. The results demonstrated significant weight gain (p > 0.05) in the three groups. A decrease in heart rate, Qp/Qs and PAP was observed in group III, however without statistic significance. No side effects were observed. The use of enalapril in combination with furosemide and digoxin may have beneficial effects in patients with symptomatic VSD, awaiting surgery.

[Interatrial aneurysm as a cause of supraventricular arrhythmia in a newborn infant]. / Aneurisma interatrial como causa de arritmias supraventriculares en el neonato.

Atrial septal aneurysm is a rare malformation that may occur as an isolated abnormality or in association with various cardiac defects or with connective tissue disease. The reported incidence in adults is 0.2% and in children 4.9% which suggests spontaneous regression with advancing age. Atrial septal aneurysm may be complicated by thromboembolism, valvular obstruction or arrhythmias. Supraventricular arrhythmias have been reported in as much as 16% of the cases, most commonly paroxysmal supraventricular tachycardia, supraventricular extrasystoles and atrial flutter. The relationship between the arrhythmias and the atrial septal aneurysm is still controversial. Two cases of atrial septal aneurysm in neonates are described, who presented with arrhythmias: supraventricular extrasystoles with aberrant conduction and atrial flutter with variable conduction, respectively. One of them required treatment with various anti-arrhythmia agents. During follow-up the arrhythmias remitted with spontaneous involution of the aneurysm. In the presence of the supraventricular arrhythmias in neonates, atrial septal aneurysm needs to be ruled out as a potential cause.