Monochorionic Twin Discordance for Horseshoe Lung and Tricuspid Atresia.

Background: The horseshoe lung is a congenital malformation in which the bases of the right and the left lung are fused. Case report: We describe a monochorionic twin gestation with malformation discordance. The abnormal twin had a horseshoe lung with hypoplasia of the right lung, tricuspid atresia, cleft lip, and a pelvic right kidney. Conclusion: The discordance of anomalies in this monochorionic twin suggests that a postzygotic mutation, epigenetic change, or environmental factors may be responsible for these malformations.

Myocardial Injury Biomarkers in Newborns with Congenital Heart Disease.

BACKGROUND: Troponin I, myoglobin, and creatine kinase-MB mass (CK-MB) are biomarkers of cardiomyocyte injury widely used in the management of adult patients. The role of these biomarkers in newborns is still not established. The purpose of this study was to evaluate the value of cardiac injury biomarkers in newborns with congenital heart disease. METHODS: From August 2012 to January 2014, 34 newborns with a prenatal diagnosis of congenital heart disease were admitted consecutively to a neonatal intensive care unit. As controls, 20 healthy newborns were recruited. Plasma levels of cardiac biomarkers (troponin I, myoglobin, and CK-MB) were evaluated, and echocardiography was performed to evaluate cardiac function on D 1. Patients were followed during the first 28 days of life and, according to outcome, categorized as surgical or conservative treatment group. RESULTS: Median (P25-75) levels of CK-MB were higher in patients who underwent cardiac surgery in the neonatal period [7.35 (4.90-13.40) ng/mL] than in patients who were discharged home without surgery [4.2 (2.60-5.90) ng/mL; p = 0.032]. A CK-MB cutoff of ≥ 4.6 ng/mL showed sensitivity of 87.5% and specificity of 63.6%. Troponin I and myoglobin levels were not significantly different between conservative and surgical treatment groups. CK-MB levels correlated with the tissue Doppler image of the mitral valve lateral annulus peak early/late diastolic velocity ratio (ρ = -0.480, p = 0.018). CONCLUSION: CK-MB levels during the first hours of life were higher in newborns that needed neonatal cardiac surgery, and these levels may be an indicator of myocardial diastolic function.

Aspergillus endocarditis in a paediatric patient after a cardiac surgery, associated with septic pulmonary embolism and pulmonary hypertension.

We report a rare case of pulmonary prosthetic valve endocarditis due to Aspergillus fumigatus, associated with septic pulmonary embolism and secondary pulmonary hypertension, in a 4-year-old boy with surgically corrected tetralogy of Fallot. The diagnosis and treatment of Aspergillus endocarditis remains highly challenging. The best therapeutic option for chronic thromboembolic pulmonary hypertension due to an infectious thromboembolic event is highly debatable and the results are poor.

[Therapeutic options for portal hypertensive biliopathy: case series and literature review]. / Opciones terapéuticas de la biliopatía por hipertensión portal: serie de casos y revisión de la bibliografía.

BACKGROUND: Portal hypertensive biliopathy is an underdiagnosed condition because only some patients have symptoms. The major clinical manifestations include cholestasis and cholangitis. The aim of this study is to present a series of cases evaluated, treated and followed at a tertiary-care public institution. CLINICAL CASE: Four patients with portal hypertensive biliopathy were exposed to different therapeutic approaches focused on the management of portal hypertension and biliary decompression. They were followed for ~5 years. Three cases achieved a favorable outcome with symptom remission, but one patient died while attempting dilatation of the bile duct. Finally, we carried out a literature review about actual portal hypertensive biliopathy therapeutics. CONCLUSIONS: There is currently no consensus on the optimal treatment for this condition. The goal is to decompress the biliary tree. Each case should be individually evaluated to choose the best treatment option.

Antecedentes: la biliopatía por hipertensión portal es poco diagnosticada debido a que sólo algunos pacientes experimentan síntomas. Las manifestaciones clínicas más importantes son la colestasis y la colangitis. Objetivo: comunicar una serie de casos evaluados, tratados y seguidos en una institución pública de tercer nivel. Casos clínicos: cuatro pacientes con biliopatía por hipertensión portal se expusieron a diferentes métodos para tratar la hipertensión portal y la descompresión de la vía biliar. Se realizó seguimiento durante casi cinco años. Tres casos mostraron adecuada evolución, con remisión de los síntomas; un paciente falleció al intentar dilatarle la vía biliar. Finalmente, se revisa la bibliografía en relación con la terapéutica de la biliopatía por hipertensión portal. Conclusiones: no existe consenso para el tratamiento óptimo de este padecimiento, aunque el objetivo es descomprimir la vía biliar; cada caso plantea particularidades que guían el tratamiento.

Cardiac findings in routine fetal autopsies: more than meets the eye?

OBJECTIVE: The main objective of this study was to evaluate the spectrum of cardiac anomalies found in routinely performed fetal autopsies and to establish the correlation between prenatal and postmortem diagnosis. STUDY DESIGN: A retrospective study of fetal autopsies was performed. Cases with cardiac anomalies were analyzed. Seven main categories were established and each case was assigned to a single group. Cardiac defects were also classified as isolated or with associated anomalies. In the cases with prenatal diagnosis, we performed a correlation between prenatal and postmortem findings. RESULTS: Abnormal cardiac findings were identified in 99 fetuses (13.6%). The two most common categories were septal defects and complex anomalies, each occurring in 21 fetuses (21.2%). Sixty-seven (67.7%) had associated anomalies. Septal anomalies were more frequent in cases with associated anomalies (p=0.012). Prenatal diagnosis had been performed in 50 cases. There was complete agreement between prenatal and postmortem diagnosis in 36 cases (72%), and major agreement with additional information in ten (20%). When the echocardiogram was not performed by a specialist, the number of cases classified with complete disagreement was higher (33.3% vs 2.4%) (p=0.002). CONCLUSION: The high prevalence of cardiac defects in lost pregnancies, some of them lacking prenatal diagnosis, highlights the importance of examining the heart in all cases.

Prenatal diagnosis of congenital complete heart block.

Congenital complete heart block (CHB) is a conduction defect with an incidence in the general population of 1/15,000 to 1/22,000 live births. It is frequently associated with structural heart defects or maternal autoimmune disease. We describe a case of CHB associated with maternal systemic lupus erythematosus and review our previous cases and experience of CHB.

[Feeling sick and its relationship with anxiety and depression at a primary care emergency service]. / Mareo y su relación con la ansiedad y la depresión en un servicio de urgencias de atención primaria.

OBJECTIVE: To study whether patients who consult because of feeling sick present more often with anxiety and depression disorders than the other patients using a rural emergency primary care service. DESIGN: Transversal descriptive study with paired control group. A questionnaire with clinical and social-demographic questions and the Goldberg Anxiety-Depression Scale (GADS) were administered, with uni- and bi-variate statistical analysis (P< .05). SETTING: Intensive Care and Emergency Unit, Baena, Córdoba, Spain. PARTICIPANTS: Sample of 166 patients aged between 15 and 65; 83 in the study group (SG = feeling sick) and 83 in the control group (CG = not feeling sick). MAIN RESULTS: The SG was positive on the GADS in 80.7% of cases, against the CG with 54.2% (P< .0001). Anxiety sub-scale: 61.4% positive in SG and 42.2% in CG (P=.013). Depression sub-scale: 73.5% positive in SG and 47% in CG (P< .0001); 89.1% of women gave positive in the SG, against 64.3% of men (P=.007). Patients feeling sick who had consulted in the previous month (P=.039) and with a psychiatric history (P=.017) also showed a higher percentage of psychiatric disorders than those who did not feel sick. CONCLUSIONS: Patients feeling sick as their main symptom have higher prevalence of anxiety and depression than other patients at a rural PC emergency service. Being a woman, having a psychiatric history and having consulted in the previous month are related with these disorders.

Mareo y su relación con la ansiedad y la depresión en un servicio de urgencias de atención primaria / Feeling sick and its relationship with anxiety and depression at a primary care emergency service

Objetivo. Estudiar si los pacientes que consultan por mareo presentan con mayor frecuencia trastornos de ansiedad y depresión que el resto de los pacientes usuarios de un servicio de urgencias de atención primaria (SUAP) rural. Diseño. Estudio descriptivo, transversal, con grupo control emparejado. Se administró un cuestionario con preguntas clínicas y sociodemográficas y la Escala de Ansiedad-Depresión de Goldberg (EADG). Análisis estadístico unibivariable (p < 0,05). Emplazamiento. Dispositivo de Cuidados Críticos y Urgencias de Baena (Córdoba). Participantes. Muestra de 166 pacientes de 15-65 años; 83 pacientes en el grupo de estudio (GE, con mareo) y 83 pacientes en grupo control (GC, sin mareo). Resultados principales. El 80,7% del GE dio positivo en la EADG frente al 54,2% del GC (p < 0,0001). Subescala de ansiedad: positiva en el 61,4% del GE y el 42,2% del GC (p = 0,013). Subescala de depresión: positiva en el 73,5% del GE y el 47% del GC (p < 0,0001). El 89,1% de las mujeres dio positivo en el GE frente al 64,3% de los varones (p = 0,007); los pacientes con mareo que habían consultado en el último mes (p = 0,039) y con antecedentes psiquiátricos (p = 0,017) también mostraron un porcentaje mayor de trastornos psiquiátricos que los que no presentaban mareo. Conclusiones. Los pacientes con mareo como síntoma principal tienen una mayor prevalencia de ansiedad y depresión que el resto de los pacientes usuarios de un SUAP. Ser mujer, tener antecedentes psiquiátricos y haber consultado en el último mes se relaciona con estos trastornos

Objective. To study whether patients who consult because of feeling sick present more often with anxiety and depression disorders than the other patients using a rural emergency primary care service. Design. Transversal descriptive study with paired control group. A questionnaire with clinical and social-demographic questions and the Goldberg Anxiety-Depression Scale (GADS) were administered, with uni- and bi-variate statistical analysis (P<.05). Setting. Intensive Care and Emergency Unit, Baena, Córdoba, Spain. Participants. Sample of 166 patients aged between 15 and 65; 83 in the study group (SG = feeling sick) and 83 in the control group (CG = not feeling sick). Main results. The SG was positive on the GADS in 80.7% of cases, against the CG with 54.2% (P<.0001). Anxiety sub-scale: 61.4% positive in SG and 42.2% in CG (P=.013). Depression sub-scale: 73.5% positive in SG and 47% in CG (P<.0001); 89.1% of women gave positive in the SG, against 64.3% of men (P=.007). Patients feeling sick who had consulted in the previous month (P=.039) and with a psychiatric history (P=.017) also showed a higher percentage of psychiatric disorders than those who did not feel sick. Conclusions. Patients feeling sick as their main symptom have higher prevalence of anxiety and depression than other patients at a rural PC emergency service. Being a woman, having a psychiatric history and having consulted in the previous month are related with these disorders

Patients with aortic coarctation operated during the first year of life, different surgical techniques and prognostic factors--21 years of experience.

UNLABELLED: The authors reviewed the clinical files of all patients with coarctation of the aorta (CoAo) operated during the first year of life, in a tertiary center, in order to assess the outcome of different surgical techniques and prognostic factors. MATERIAL AND METHODS: The study included all patients operated from 1 June 1980 to 1 June 2001. They were divided into three groups according to diagnosis: Group I--isolated CoAo (with or without persistent ductus arteriosus (PDA), group II--CoAo plus ventricular septal defect (VSD), and group III--CoAo associated with complex heart defects. The surgical techniques were divided into four groups: Group A--resection of the CoAo with end-to-end anastomosis, group B--Waldhausen technique (subclavian flap), group C--enlargement of the aorta with a patch, and group D--Waldhausen technique plus resection of the CoAo with end-to-end anastomosis. Several parameters were analyzed: sex, age at surgery, other surgical procedures during surgery, reoperation, mortality and outcome (good result, recoarctation). RESULTS: 156 patients were operated during the study period (84.5% of them since 1989). 61.5% were male. Surgery was performed between 3 and 336 days of life. 60.9% patients were included in group I, 32.7% in group II and 6.4% in group III. 25.0% of the patients had group A surgery, 60.2% group B surgery, 7.0% group C surgery and 7.7% group D surgery. The PDA was sectioned in 48.0% of the patients. It was necessary to perform banding of the pulmonary artery, during the first surgery, in 19.9% of cases. 18.6% needed a second operation to close the VSD and for debanding or repair of associated defects. Total mortality was 19.2%. Mortality rate per groups was: Group I--15.8%, group II--21.5%, group III--30.0%, group A--18.0%, group B--19.1%, group C--27.2% and group D--16.7%. In 7.6% of the patients recoarctation was found during follow-up. 40% of the patients are doing well with no medication and minor or no residual defects. 29.4% were lost to follow-up. CONCLUSIONS: Total mortality has decreased over the years with the highest mortality found in Group C and Group III. The best results were achieved in patients with isolated CoAo. Long-term results were generally good with few recoarctations and a good quality of life.