[Surgery repair of aortic coarctation in infancy]. / Reparación quirúrgica de coartación aórtica en lactantes menores.

OBJECTIVE: The study's purpose is to present our experience with surgical correction of aortic coarctation in infants, at short and medium term, particularly morbidity and mortality. METHOD: This is a retrospective observational and descriptive trial. We included all infant patients undergoing surgical correction of AC. All data were obtained from the clinical database of the hospital. RESULTS: We included 20 patients with AC. The surgical technique was extended coarctectomy in 19 patients and, in one patient, a subclavian artery flap was performed. In all patients, the average time of aortic clamping was 18min. The residual gradient measured by echocardiography was in average of 12.2mmHg. One patient died of sepsis secondary to pneumonia. The main cause of immediate postoperative morbidity was systemic hypertension in seven patients, nosocomial infection in four patients with development of sepsis, one patient had to be reoperated due to high gradient. One patient had cholestatic syndrome. Eighteen patients required a transfusion at some time during their hospital stay. Average in-hospital stay was of 12 days. CONCLUSION: The aortic coarctation surgery has had favorable results so far and we can conclude that the program has been successful. The surgical technique has shown low mortality and complications and midterm follow-up shows low rate of recoarctation.

Reparación quirúrgica de coartación aórtica en lactantes menores / Surgery repair of aortic coarctation in infancy

Objetivo: Conocer la experiencia con la corrección quirúrgica de coartación aórtica en niños menores de 6 meses de edad, incluidos los neonatos, a corto y mediano plazo, haciendo énfasis en la morbimortalidad. Método: Estudio retrospectivo, observacional y descriptivo. Incluidos los pacientes menores de 6 meses de edad sometidos a corrección quirúrgica de coartación aórtica. Datos obtenidos de la revisión de expedientes electrónicos. Resultados: Se incluyeron 20 pacientes con coartación aórtica. La técnica quirúrgica empleada fue coartectomía ampliada en 19 pacientes y en uno se realizó colgajo de arteria subclavia. El tiempo promedio de pinzamiento aórtico fue de 18min. El gradiente posquirúrgico promedio determinado por ecocardiografía fue de 12.2 mmHg. Un paciente falleció por sepsis secundaria a foco neumónico. La principal morbilidad posquirúrgica inmediata fue la hipertensión arterial sistémica en 7 pacientes, infección intrahospitalaria en 4 pacientes, con desarrollo de sepsis, un paciente se reoperó por gradiente alto. Un paciente presentó síndrome colestásico. Dieciocho pacientes requirieron transfusión en algún momento de su estancia intrahospitalaria. Y el tiempo promedio de estancia intrahospitalaria fue 12 días. Conclusión: La coartectomía ampliada ha tenido resultados favorables, la técnica quirúrgica empleada ha mostrado baja mortalidad y complicaciones relacionadas con la técnica, y el seguimiento muestra bajo índice de recoartación.

Objective: The study's purpose is to present our experience with surgical correction of aortic coarctation in infants, at short and medium term, particularly morbidity and mortality. Method: This is a retrospective observational and descriptive trial. We included all infant Infancy; patients undergoing surgical correction of AC. All data were obtained from the clinical database of the hospital. Results: We included 20 patients with AC. The surgical technique was extended coarctectomy in 19 patients and, in one patient, a subclavian artery flap was performed. In all patients, the average time of aortic clamping was 18 min. The residual gradient measured by echocardiography was in average of 12.2 mmHg. One patient died of sepsis secondary to pneumonia. The main cause of immediate postoperative morbidity was systemic hypertension in seven patients, nosocomial infection in four patients with development of sepsis, one patient had to be reoperated due to high gradient. One patient had cholestatic syndrome. Eighteen patients required a transfusion at some time during their hospital stay. Average in-hospital stay was of 12 days. Conclusion: The aortic coarctation surgery has had favorable results so far and we can conclude that the program has been successful. The surgical technique has shown low mortality and complications and midterm follow-up shows low rate of recoarctation.

Cor triatriatum sinistrum: estrategia diagnóstica y terapéutica / Cor triatriatum a rare congenital cardiac malformation of diagnostic difficulty

Introducción. El cor triatriatum sinistrum es una membrana fibromuscular anómala en aurícula izquierda que la divide en 2 cavidades, con grados variables de obstrucción. Material y métodos. Estudio retrospectivo, longitudinal y descriptivo, que muestra 10 pacientes tratados en el Hospital Infantil de México Federico Gómez en 26 años, diagnosticados con ecocardiografía. Resultados. En ningún caso fue necesario realizar estudios adicionales ya que la ecocardiografía fue definitiva en el diagnóstico. La media de edad fue 16.9 meses; distribución por sexos 1:1. Dos pacientes murieron. El seguimiento a largo plazo promedió 46.8 meses en los 8 pacientes restantes. Conclusión. La ecocardiografía fue diagnóstica e identificó anomalías cardiacas congénitas asociadas. El abordaje por atriotomía derecha permitió una excelente exposición, la resección de la membrana obstructiva y la resolución de defectos asociados, demostrando ser la medida terapéutica definitiva. Esta es la serie pediátrica más grande reportada en nuestro país a la fecha.

Introduction. We define cor triatriatum sinistrum as an anomalous fibromuscular membrane in the left atrium which divides it into 2 cavities with variable degrees of obstruction. Material and methods. In this retrospective, longitudinal and descriptive study we show a series of ten patients treated at the Hospital Infantil de Mexico in a 26 year-experience diagnosed by echocardiography. Results. No additional studies were necessary. Median age was 16.9 months; sex distribution was 1:1, registering mortality in 2 patients (20%). Long-term follow-up in 8 remaining patients had a mean of 46.8 months. Echocardiography is diagnostic and identifies associated congenital cardiac anomalies; right atriotomy approach provides excellent exposure and allows resection of the obstructive membrane. It also allows resolution of associated defects and is the preferential approach. Conclusion. This is the largest pediatric series reported to date in our country.