[High-frequency oscillatory ventilation. A single-center study]. / Nuestra experiencia con la ventilación de alta frecuencia oscilatoria.

INTRODUCTION: High-frequency oscillatory ventilation is a safe and effective means of delivering mechanical ventilatory support. OBJECTIVE: To evaluate the safety and effectiveness of high-frequency oscillatory ventilation in pediatric patients with acute respiratory failure. PATIENTS AND METHOD: From August 2003 to July 2005, we performed a prospective observational study of 11 children older than 1 month who underwent high-frequency oscillatory ventilation. Pediatric risk of mortality scores (PRISM), Murray lung-injury scores and air leak scores were recorded at baseline before ventilation. The following variables were studied: ventilatory settings (FiO2 and mean airway pressure), gasometric (PaO2, SaO2, PaCO2, pHa, PaO2/FiO2 ratio) and hemodynamic parameters (Partm, PVC), and the oxygenation index. RESULTS: The overall survival rate was 82 %. Significant increases were found in PaO2 (p < 0.05), SaO2 (p < 0.05) and the PaO2/FiO2 ratio (p < 0.05), while mean airway pressure (p < 0.001), oxygenation index (p < 0.001), and FiO2 (p < 0.001) significantly decreased over time. CONCLUSIONS: High-frequency oscillatory ventilation significantly improved oxygenation in children with acute hypoxemic respiratory failure.

Nuestra experiencia con la ventilación de alta frecuencia oscilatoria / High-frequency oscillatory ventilation. A single-center study

Introducción La ventilación de alta frecuencia oscilatoria es una terapéutica válida, que utiliza una estrategia protectora pulmonar. Objetivo Evaluar la utilidad de esta técnica en niños con insuficiencia respiratoria aguda. Pacientes y método Entre agosto de 2003 y julio de 2005 realizamos un estudio prospectivo y observacional de 11 niños mayores de un mes tratados con ventilación de alta frecuencia oscilatoria. Se hizo una valoración de la gravedad, con la escala Pediatric Risk of Mortality (PRISM); del daño pulmonar, con la de Murray, y de la gravedad del barotrauma, con la de escape aéreo. Se estudiaron las siguientes variables: del respirador (fracción inspiratoria de oxígeno [FiO2], presión media en la vía aérea), gasométricas (presión parcial arterial de oxígeno [PaO2], saturación arterial de oxígeno [SaO2], presión parcial arterial de dióxido de carbono [PaCO2], pH arterial [pHa], relación PaO2/FiO2), índice de oxigenación, y hemodinámicas (presión arterial media [PAM], presión venosa central [PVC]). Resultados La supervivencia global fue del 82 %. Nosotros hemos encontrado modificaciones consistentes en un incremento de la PaO2 (p < 0,05), SaO2 (p < 0,05), y relación PaO2/ FiO2 (p < 0,05); así como un descenso de la presión media en la vía aérea (p < 0,001), del índice de oxigenación (p < 0,001) y de la FiO2 (p < 0,001). Conclusiones La ventilación de alta frecuencia oscilatoria ha mejorado la oxigenación en niños con fallo respiratorio agudo hipoxémico

Introduction High-frequency oscillatory ventilation is a safe and effective means of delivering mechanical ventilatory support. Objective To evaluate the safety and effectiveness of high-frequency oscillatory ventilation in pediatric patients with acute respiratory failure. Patients and method From August 2003 to July 2005, we performed a prospective observational study of 11 children older than 1 month who underwent high-frequency oscillatory ventilation. Pediatric risk of mortality scores (PRISM), Murray lung-injury scores and air leak scores were recorded at baseline before ventilation. The following variables were studied: ventilatory settings (FiO2 and mean airway pressure), gasometric (PaO2, SaO2, PaCO2, pHa, PaO2/FiO2 ratio) and hemodynamic parameters (Partm, PVC), and the oxygenation index. Results The overall survival rate was 82 %. Significant increases were found in PaO2 (p < 0.05), SaO2 (p < 0.05) and the PaO2/FiO2 ratio (p < 0.05), while mean airway pressure (p < 0.001), oxygenation index (p < 0.001), and FiO2 (p < 0.001) significantly decreased over time. Conclusions High-frequency oscillatory ventilation significantly improved oxygenation in children with acute hypoxemic respiratory failure

Efecto secundario grave tras la administración de adenosina en un niño / Severe side effect following adenosine administration in a child

La adenosina es el fármaco de elección en el tratamiento de las taquiarritmias supraventriculares del niño. Presentamos un caso de bloqueo aurículo-ventricular mantenido, que precisó maniobras de reanimación cardiopulmonar, tras la administración de adenosina intravenosa en un niño con taquicardia supraventricular. Ocasionalmente, la adenosina puede presentar efectos secundarios muy graves. Por este motivo, su administración debe realizarse en una unidad con capacidad para tratar de forma inmediata esos posibles efectos indeseables (AU)

Manejo actual de las taquiarritmias supraventriculares en la infancia / Current management of supraventricular tachyarrhythmias in children

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[The surgical treatment of critical aortic stenosis in a child by the Ross-Konno technic]. / Tratamiento quirúrgico de la estenosis aórtica crítica en el niño mediante la técnica de Ross-Konno.

A twenty-nine-day old male infant suffering from critical aortic stenosis underwent aortic valvotomy by cardiopulmonary bypass. At three years of age the aortic stenosis recurred and the child underwent a balloon aortic valvuloplasty, but developed severe aortic insufficiency after the procedure. The critical condition of the patient made aortic valve replacement mandatory. The surgical technique consisted of aortoventriculoplasty with infundibular and valve pulmonary autograft for substituting the aortic root (Ross-Konno technique). As for as we know this is the first report on the Ross-Konno procedure in Spanish journals.

[Anatomic correction of transposition of great vessels with entire interventricular septum. Initial results]. / Corrección anatómica de la transposición de las grandes arterias con septo interventricular íntegro. Resultados iniciales.

INTRODUCTION: Optimal management for patients with simple transposition of great arteries is currently the arterial switch operation. We review our initial experience to evaluate the results. METHOD: From 1988 to 1993, 21 children with simple transposition of the great arteries underwent arterial switch operation. Mean age at surgery was 10.5 +/- 5.6 days, excluding two cases with two-stage arterial switch and one with late diagnosis. Patent ductus arteriosus was present in 12 cases, and a small ventricular septal defect in two. The coronary artery pattern was unusual in 9 cases. Balloon atrial septostomy was performed in 19 cases, seven of them using two-dimensional echocardiography. It was considered no necessary in the remaining two, with a large ductus arteriosus. RESULTS: Total circulatory arrest was used in 13 patients (mean time 29.7 +/- 22.6 min). Three patients died in the early postoperative period (14.3%) in a refractory cardiac failure, one of them secondary to myocardial necrosis. The coronary artery pattern was unusual in two of died patients. All patients but three were in sinus rythm. Mean age at follow-up was 21 months (follow-up range 2 months to 5 years). Seventeen of surviving patients are in a functional state grade I and one in grade II of NYHA. There haven't been late deaths. CONCLUSION: These results compared with the ones of atrial switch operation, have encouraged to us to use the arterial switch operation in all children with simple transposition of the great arteries. Increasing experience will likely lead to improve our results.

[The hypoplastic left heart syndrome. Initiation of a therapeutic program]. / Síndrome del corazón izquierdo hipoplásico. Iniciación de un programa terapéutico.

The hypoplastic left heart syndrome is a very severe congenital heart disease dependent on patency of ductus arteriosus in the newborn. The survival after neonatal period, without surgical treatment, is exceptional. Nowadays, there are basically two types of therapeutic procedures: Palliation with the Norwood operation and/or cardiac transplantation. Both methods have showed advantages and disadvantages; at present, there is not consensus of them. In our hospital, we have recently begun a medical-surgical therapeutic program for the management of neonates with hypoplastic left heart syndrome. Because of this, we report our little experience. We have treated three children in the last year: The first of them dead in the operating room; the second was exitus due to a sepsis two months after surgery, and the third, who is three-month-old now, remained well and was discharged to home.

[An evaluation of surgical correction in tetralogy of Fallot. A study of 101 cases]. / Evaluación de la corrección quirúrgica en la tetralogía de Fallot. Un estudio de 101 casos.

INTRODUCTION: The optimal management of infants with tetralogy of Fallot continues to evolve. We review our series to evaluate the results. PATIENTS AND METHODS: From 1979 to 1992, 101 children with tetralogy of Fallot without pulmonary atresia, were operated on. Infundibular and valvar stenosis were present in 59 cases (58.4%), distal stenosis in 24 (23.7%) and trunk and/or branches hypoplasia in 14 (13.9%). Until 1985, symptomatic infants underwent palliative surgical techniques. Since then, we prefer early repair as elective treatment in all cases, using palliative techniques only in symptomatic infants with inadequate anatomy. Palliative techniques were used in 35 children (34.6%), mean age at surgery was 6.7 +/- 6.7 months; corrective surgery, after palliative technique, in 23 children (22.8%), mean age at surgery was 36.0 +/- 12.9 months and primary correction in 66 children (65.3%), mean age at surgery was 30.7 +/- 20.8 months. For 45 patients (44.6%) the right ventricular outflow tract obstruction was relieved by a transannular patch. RESULTS: Post-repair right ventricular-left ventricular pressure ratio is a usefull index to predict the short and long-term evolution of this cardiopathy. Thus, values were significantly smaller in children without postoperative cardiac failure (0.51 +/- 0.10 vs 0.59 +/- 0.15; p < 0.01), in the survivors (0.53 +/- 0.12 vs 0.72 +/- 0.13; p < 0.001) and in those with better functional status in the follow-up (0.52 +/- 0.12 vs 0.66 +/- 0.13; p < 0.001). Whole mortality was 13% for two-stage correction and 7.6% for primary correction. From 1985 mortality has reduced at 6.7 and 2.3% respectively. The follow-up was completed in 78 children with corrective surgery (96%), with a mean of 43.4 +/- 32.6 months. There were three later deaths. Actuarial survival at six years is 86%. CONCLUSION: We have proved that the optimal treatment in infants with tetralogy of Fallot and suitable size pulmonary vascular tree is the early primary repair. The pressure relation between both ventricles post-repair is a useful index for the outcome.

[Evaluation of the surgical correction in complete atrioventricular channels]. / Evaluación de la corrección quirúrgica en los canales auriculoventriculares completos.

We review our experience of surgical correction in atrioventricular canals between 1979 and 1991. 81 patients, ranging in ages from 5 to 109 months (with an average of 33 months) and weight from 4 to 25 kg (with an average of 9 kg), underwent primary repair. Another cardiac anomalies associated were ruled out, except patency of the arterial ductus. 33 patients (46%) presented the complete form of atrioventricular canals, 27 (33%) the partial form and 17 (21%) the transitional form. 55 patients (68%) of the sample had Down's syndrome. Regarding the cases with the complete form they were frequently associated to Down's syndrome. Thus, 89% of the cases of complete form had Down's syndrome. All operations for complete form cases used a two-patch technique and physiological reconstruction of the left atrioventricular valve. No patient underwent pulmonary artery banding or was discharged from surgery correction due to pulmonary pressure or resistance. The average age of the children with complete form was 19.5 months (11 months from 1986). The main hemodynamic parameters were mean pulmonary arterial pressure of 57 +/- 12 mmHg, pulmonary-systemic pressure relation of 0.87 +/- 0.12 and total pulmonary resistance of 6.3 +/- 4.0 U/m2. The hospital mortality was 32% in the complete form, comparable to samples of similar characteristics. We related this mortality with the hemodynamic profile at the time of surgical correction, compatible with pulmonary vascular obstructive disease, with the elevated percentage of Down's syndrome and with the delay in the surgical operation age.

[Anomalous origin of left coronary artery in pulmonary artery]. / Origen anómalo de la arteria coronaria izquierda en la arteria pulmonar.

We report 2 infants aged 6 months and one year with an anomalous left coronary artery origin treated surgically at our centre with direct aortic reimplantation of the anomalous coronary. Evolution has been satisfactory, with a great improvement of ventricular function. The mitral incompetence and congestive heart failure have disappeared and myocardic perfusion electrocardiographic patterns were corrected. Because of the unfavorable natural course of the disease and the improvement in techniques of coronary revascularization in infants we recommend an early surgical treatment as soon as it be diagnosed. We consider that the most adequate surgical treatment is the direct aortic reimplantation of the anomalous coronary artery.

[Percutaneous transluminal pulmonary valvuloplasty. Results in 34 cases]. / Valvuloplastia transluminal percutánea pulmonar. Resultados en 34 pacientes.

Percutaneous transluminal valvuloplasty with catheter-balloon were performed in thirty-four patients with pulmonary valve stenosis, aged 2 to 11 years (mean = 4.8 +/- 2.4 years). It was a slight stenosis in 24 cases (70.5%) and severe in 10 cases (29.5%). In three of them it was a dysplastic valve. We achieved good results, since right ventricle systolic pressure, decreased from mean = 67 +/- 18 mmHg to mean = 23 +/- 12 mmHg (p less than 0.0001). In the three cases with dysplastic valve, results were rather poor. Procedure was well stood-up and there were no serious complication. We conclude that at the present time valvuloplasty its the elective treatment in pulmonary stenosis in childhood except in cases with dysplastic valve.