Pregnancy in teenagers with heart disease / Embarazo en pacientes adolescentes con cardiopatía

Abstract The prevalence of pregnancy in adolescent women is high in Mexico and represents a public health problem. The pregnant teenager with heart disease has a high probability of complications during pregnancy and the delivery, which carries a risk of death of both the mother and the product. In many cases the pregnancy should have been avoided, planned or interrupted, however the majority at this age is vulnerable and although certain cases must be interrupted by their high risk of maternal-fetal death, prevention and legal aspects should be considered. In some cases the woman wants a pregnancy although her health condition does not allow it, but there are options of adoption or recourse to a surrogate belly. In response to this growing social problem, the National Cardiology Institute Ignacio Chávez and National Institute of Perinatology, with the coordination of Ministry of Health in Mexico, started a pregnancy prevention module within a clinic of follow-up of cardiopathy and pregnancy. This review raises the global problem in our country that occupies the first place in pregnancies in adolescents, with more than 400,000 pregnancies a year and the form of immediate response in a multidisciplinary way.

Resumen La prevalencia de embarazo en mujeres adolescentes es muy alta en México, y representa un problema de salud pública. La adolescente embarazada con cardiopatía tiene altas posibilidades de complicaciones durante el embarazo y su resolución, lo que pone en riesgo la vida tanto de la madre como del producto. En muchos casos el embarazo debió ser evitado, planeado o interrumpido, sin embargo la mayoría a esta edad es vulnerable y si bien ciertos casos deben ser interrumpidos por su alto riesgo de muerte materno-fetal, es fundamental considerar la prevención y los aspectos legales. En algunos casos la mujer desea un embarazo aunque su condición de salud no se lo permite, pero existen opciones de adopción o recurrir a un vientre subrogado. Atendiendo este problema social cada vez más creciente, el Instituto Nacional de Cardiología Ignacio Chávez, en coordinación con la Comisión Coordinadora de la Secretaría de Salud y el Instituto Nacional de Perinatología, echaron a andar un módulo de prevención de embarazo dentro de una clínica de seguimiento de cardiopatía y embarazo. Esta revisión plantea el problema global en nuestro país, que ocupa el primer lugar en embarazos en adolescentes, con más de 400 mil embarazos al año y la forma de dar respuesta inmediata de manera multidisciplinaria.

Cierre percutáneo de la comunicación interauricular con el dispositivo Amplatzer®: 15 años de experiencia / Percutaneous closure of atrial septal defects with the Amplatzer® device: 15 years of experience

Introducción: El cierre percutáneo de la comunicación interauricular es una alternativa al tratamiento quirúrgico. Objetivos: Comunicar los resultados del cierre percutáneo de la comunicación interauricular con el dispositivo Amplatzer®. Método: Se incluyeron los pacientes sometidos a hemodinamia de septiembre de 1997 a diciembre de 2011. Resultados: Se procedió al cierre del defecto en 721 pacientes y en 85 no se cerró por considerarse no apto anatómicamente. El diámetro expandido del defecto fue de 23 ± 6.7 mm (límites, 5-42). Todos los dispositivos se colocaron con éxito. En 15 casos (2.1%) se cambió el dispositivo por considerarse inestable y en 6 (0.8%) se presentó embolización en las primeras 24 h, 4 fueron rescatados y recolocados (éxito final con intención de tratamiento 719/806-89.2%). El control inmediato mostró oclusión completa en 247 pacientes (34.3%), fuga intradispositivo en 395 (54.9%), ligera en 75 (10.4%) y moderada en 2 (0.3%). Se hace seguimiento en 626 pacientes (87.1%) durante 33 ± 27.5 meses, presentándose cefalea en 54 (8.6%), arritmias supraventriculares nuevas en 10 (1.6%), complicaciones en el sitio de punción en 4 (0.6%) y accidente vascular cerebral en uno (0.1%). Conclusión: El diseño del dispositivo Amplatzer® permite el cierre de la comunicación interauricular con una técnica sencilla y con seguridad para el paciente.

Introduction: Percutaneous closure of atrial septal defects is an alternative to surgical treatment. Objectives: We report the results of percutaneous closure of atrial septal defects with the Amplatzer® device. Method: We include patients taken to the catheterization laboratory from September 1997 to December 2011. Results: We proceeded with defect closure in 721 patients and in 85 the defect was considered not suitable for closure. The stretched diameter of the defect was 23 ± 6.7 mm (limits, 5-42). All devices were positioned successfully. In 15 cases (2.1%) the device was changed due to instability and in 6 (0.8%) the device embolized within the first 24 h, 4 were retrieved and repositioned (final success with intention to treat 719/806-89.2%). Immediate control showed complete closure in 247 patients (34.3%), leak through the device in 395 (54.9%), mild residual leak in 75 (10.4%) and moderate in 2 (0.3%). We have follow-up in 626 patients (87.1%) for 33 ± 27.5 months, with headache in 54 (8.6%), new supraventricular arrhythmia in 10 (1.6%), puncture site complications in 4 (0.6%), and stroke in one (0.1%). Conclusion: The design of the Amplatzer® device allows effective closure of atrial septal defects with a simple technique and patient safety.

Impact of nutritional support on length of hospitalization and mortality in children after open heart surgery

Background. Malnutrition is a common cause of morbidity in children with congenital heart disease (CHD). The aim of this study was to assess the impact of malnutrition and nutritional support on the length of hospitalization and mortality at the Pediatric Intensive Care Unit (PICU) in children with CHD after undergoing surgery. Methods. Clinical records (2000-2008) of patients £3 years old with CHD who were admitted for surgery were evaluated for nutritional status, nutritional support, and risk factors. Mortality was evaluated from the beginning of surgery and during the patient's stay at the PICU. Long-term hospitalization was considered according to the length of hospital stay on percentile >50. A multiple logistic regression model was used. Results. Two hundred eighty nine patients were included. Factors related to mortality were malnutrition before surgery (OR 3.447; 95% CI 1.006-11.812, p = 0.049), early or delayed enteral nutrition (OR 0.007; 95% CI 0.000-0.097, p = 0.000, and OR 0.011; 95% CI 0.001-0.126, p = 0.000, respectively), and early parenteral nutrition (OR 0.032; 95% CI 0.002-0.452, p = 0.000) vs. no nutritional support. Factors related to long-term stay were malnutrition at birth (OR 2.772; 95% CI 1.282-5.995, p = 0.010) and delayed parenteral nutrition (OR 12.049; 95% CI 1.626-94.724, p = 0.015). Conclusion. Malnutrition at birth and before surgery increases length of stay and mortality of children after open heart surgery. Early nutritional support reduces length of stay and mortality.

Conducto arterioso en el adulto: tratamiento transcateterismo. Resultados inmediatos y a mediano plazo / Patent ductus arteriosus in the adult: transcatheher treatment immediate and medium term results

INTRODUCTION: The anatomic changes of the patent ductus arteriosus (PDA) in adult patients, such as aortic aneurysm, calcification, or being short and sometimes friable, could complicate the surgical treatment. The transcatheter occlusion of PDA with different devices is currently accepted as safe and effective. We presented our experience with percutaneous occlusion of PDA in adult patients by means of three different devices. METHODS AND RESULTS: Between January 2000 and March 2005, 53 adult patients (47 women and 6 men) with PDA were treated for occlusion by means of percutaneous procedures. Average age was 25.3 years (Range, 16 to 54.7 years). Three different devices were used, 39 patients with Amplatzer for ductus arteriosus, 1 patient with Amplatzer for muscular interventricular communication, 11 with Gianturco coils, and 1 patient with Nit-Occlud. All devices were implanted successfully. Immediate complete closure was achieved in 31 patients (58.4%), in 20 patients (37.7%) with minimal leakage, and in 2 patients (3.89%) with moderate leak. Previous systolic pulmonary pressure had an average of 37.08 +/- 22.8. mm Hg (Range: 12-138 mm Hg) and went down to 28.75 +/- 10.25 mm Hg (Range: 16-57 mm Hg) with p d x 0.001. The average time follow-up was of 16.8 months (Range: 0.9 to 51.8 months) the occlusion was completed in 100%, in neither patients were observed complications related to implant of the devices. CONCLUSION: Transcatheter closure at PDA in adult patients with different devices is safe and feasible.