ABSTRACT
Resumen: Introducción: La evaluación ecocardiográfica de pacientes post-trasplante cardiaco pediátrico es una herramienta útil. Sin embargo, aún es necesario definir un protocolo óptimo de seguimiento. Obje tivo: Caracterizar los resultados de la aplicación de un protocolo de evaluación ecocardiográfica fun cional en pacientes en control post-trasplante cardiaco pediátrico ortotópico. Pacientes y Método: Posterior al trasplante cardiaco pediátrico se realizó una ecocardiografía con un protocolo funcional que incluyó strain longitudinal global. Se evaluaron además los datos de la biopsia endomiocárdica y del estudio hemodinámico contemporáneos. Resultados: De un total de 9 pacientes sólo 1 presentó disfunción sistólica de ventrículo izquierdo según parámetros clásicos, pero casi la totalidad presentó un strain longitudinal global alterado. No se observaron episodios de rechazo moderado o severo en estos pacientes. Todos los pacientes presentaban disfunción sistólica ventricular derecha. No se ob servó correlación entre estos parámetros y la presión de arteria pulmonar. Conclusiones: Se observó disfunción sistólica biventricular subclínica en la mayoría de los pacientes de esta serie. No hubo aso ciación con episodios de rechazo o con hipertensión pulmonar, lo que podría estar en relación con la ausencia de episodios de rechazo moderado o severo en la biopsia contemporánea y con el reducido tamaño muestral. Sólo el seguimiento a largo plazo de estos pacientes permitirá definir la relevancia clínica de los hallazgos descritos.
Abstract: Introduction: The echocardiographic evaluation of patients after heart transplantation is a useful tool. However, it is still necessary to define an optimal follow-up protocol. Objective: To describe the results of the application of a functional echocardiographic protocol in patients being followed after pediatric heart transplantation. Patients and Method: Alls patients being followed at our institution after pediatric heart transplantation underwent an echocardiographic examination with a functional protocol that included global longitudinal strain. Contemporaneous endomyocardial biopsy results and hemodynamic data were recorded. Results: 9 patients were evaluated with our echocardiographic functional protocol. Of these patients, only 1 showed systolic left ventricular dysfunction according to classic parameters. However, almost all patients had an abnormal global longitudinal strain. Right ventricular systolic dysfunction was observed in all patients. No epidodes of moderate to severe rejectiom were recorded. No correlation was observed between these parameters and pulmonary artery pressure. Conclusions: Subclinical biventricular systolic dysfunction was observed in the majority of the patients in this study. No association with rejection episodes or pulmonary hypertension was observed, which may be related to the absence of moderate or severe rejection episodes during the study period, and to the small sample size. Long term follow-up of these patients may better define the clinical relevance of our findings.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Postoperative Care/methods , Postoperative Complications/diagnostic imaging , Echocardiography, Doppler/methods , Heart Transplantation , Aftercare/methods , Ventricular Dysfunction, Right/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Postoperative Care/standards , Echocardiography, Doppler/standards , Pilot Projects , Clinical Protocols , Prospective Studies , Follow-Up Studies , Aftercare/standards , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Left/etiologySubject(s)
Humans , Cardiovascular Diseases , Coronary Aneurysm , Mucocutaneous Lymph Node Syndrome/diagnosis , Clinical Evolution , Diagnosis, Differential , Follow-Up Studies , Immunoglobulins , Prognosis , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/etiology , Mucocutaneous Lymph Node Syndrome/drug therapyABSTRACT
La reanimación cardiopulmonar del recién nacido presenta desafíos diferentes a la reanimación del adulto o del niño mayor, especialmente por los dramáticos cambios fisiológicos que ocurren al momento de nacer. En los últimos años se han desarrollado guías universales basadas en evidencia para una adecuada reanimación. El presente artículo es una revisión y resumen de dichas recomendaciones
Subject(s)
Humans , Male , Female , Infant, Newborn , Asphyxia Neonatorum , Cardiopulmonary Resuscitation/methods , Apnea , Asphyxia Neonatorum , Epinephrine , Flumazenil , Naloxone , Respiration, Artificial/methods , Sodium BicarbonateABSTRACT
We describe the morphologic variability and fetal diagnosis in pulmonary atresi with intact ventricular septum, within a chilean peadiatric cardiovacular center. An uncommon disease, that shows considerable morphologic heterogeneity, and with no local reports about this topic. We studied a consecutive series of 28 cases, in a five year period (1997-2002), at the Luis Calvo Mackenna Cardiovascular center. Morphologic feactures of each case were evaluated by direct review of the echocardiograms, angiocardiograms and from surgical reports. Among 28 infants, atresia was membranous in 82 per cent and muscular in 18 per cent. Right ventricle was bipartite in 30 per cent, unipartite in 6 per cent and tripartite in 64 per cent of cases. Coronary arterial abnormalities were identified in 36 per cent, and right ventricular dependent coronary circulation in 7,1 per cent. Median tricuspid annulus valvar size was -3. Fetal diagnosis was made in six of the 28 cases (21,4). In all of these prenatally diagnosed patients arrengements were made in order for the delivery to be fullfilled near by a cardiovascular center. This study shows data about the morphologic diversity and efforts on early fetal diagnose made in our country, in order asses this uncommon diseases