Síndrome de la válvula pulmonar ausente. Evolución, tratamiento y factores asociados a muerte / Absent pulmonary valve syndrome. Evaluation, surgical treatment and risk factors

From 1991 to 2003 were studied 33 cases with absent pulmonary valve syndrome (AVPS): 66% were female, with a medium age of 1.5 years old and 11 kg of weight. Twenty seven cases (82%) were associated to Tetralogy of Fallot. Fourteen patients (5 younger than 1 year old) had corrective surgery. After the surgery, one patient required ballon pulmonary valvuloplasty for pulmonary stenosis; another one required surgery for changing the pulmonary prothesis one and five years after the first surgery. The rest of the patients did not present important problems. The five year survival was 95.4% in patients older than 6 months and 30.1% in younger patients (p = 0.000). As factors associated to mortality were the age younger than six months old (p = 0.003) and mechanical ventilation (p = 0.001) in our population. We suggest to delay the surgery in this group of patients because no survival were seen with or without the surgery. In older children with symptoms, the surgery also must be delayed in order to avoid more interventions for changing the pulmonary prothesis.

Métodos de estratificación de riesgo en la cirugía de cardiopatías congénitas / Method for risk adjustment for surgery for congenital heart disease

In the last decades, systems have been developed to measure more efficiently and objectively the medical services offered to the community. For this purpose, patients are grouped according to their pathology to facilitate comparison of functionality, costs, and quality among groups. For congenital heart diseases and their surgical treatment we have methods to establish risk stratification (RACHS-1 and Aristotle), which have allowed us to predict the surgical results taking account the congenital heart disease, the kind of repair, as well as factors, such as weight, age, and associated anomalies. We believe that both systems complement each other and that they constitute a first step for Mexico to have a reliable database to allow making comparisons among results of the different health institutes. The purpose is to affect the institutional and national health policies and to assess an instrument that might serve for comparison with foreign specialized centers.