ABSTRACT
Resumen Objetivo: Presentar un score ajustado al riesgo de complicaciones durante el cateterismo cardiaco en cardiopatías congénitas. Diseño: Observacional, analítico y ambispectivo de 3,504 casos. Se incluyeron edad, cardiopatía, procedimiento, complicaciones mayores y menores. Métodos: 3,504 procedimientos realizados entre octubre de 1987 y mayo de 2019. Variables independientes: edad, cardiopatía, procedimiento y estadio clínico. Se categorizó como bajo riesgo 5 a 7 puntos, moderado riesgo 8 a 11 puntos y alto riesgo 12 a 22 puntos. El score fue validado mediante la prueba de Hosmer-Lemeshow y la curva ROC (receiver operating characteristic). Resultados: Las complicaciones fueron 177 (5%), 66 mayores (1.9%) y 111 menores (3.1%). Mortalidad de 0.4% (15 pacientes). El grupo de bajo riesgo (n = 825) tuvo 1.5% de complicaciones, el de moderado riesgo (n = 2.221) 4.9% y el de alto riesgo (n = 458) 12% (p < 0.001). El análisis de los datos retrospectivos (n = 2,953) fue validado con los prospectivos (n = 551) mediante la prueba de Hosmer-Lemeshow; dejó en evidencia que los valores predichos son similares a los observados. Conclusiones: Las complicaciones siguen presentándose a pesar de la evolución de la técnica. El score resultó útil para estratificar a los pacientes y conocer la probabilidad de complicaciones antes del procedimiento.
Abstract Objetive: to present a risk-ajusted score of complications during cardias catheterization in congenital heart disease. Design: observational, analitic, ambispective of 3.504 cases. The data analyzed included age, heart disease, type of procedure, major and minor complications. Methods: 3.504 procedures performed between october 1987 and may 2019. The variables were age, heart disease, procedere and clinical stege. Each patients was categorized as low risk 5 to 7 points, moderate risk 8 to 11 points and higt risk 12 to 22 points. The score was validated using the Hosmer-Lemeshow test and the ROC curve (Receiver Operating Characteristic). Results: complications 177 (5%) 66 major (1.9%) and 111 minor (3.1%). Mortality was 0.4% (15 patients). The low-risk group (n = 825) had 1.5% complications; moderate risk (n = 2,221) 4.9%; high risk (n: 458) 12% (p < 0.001). The analysis of the retrospective data (n = 2953) was validated with prospective (n = 551) using the Hosmer-Lemeshow test, showed that the predicted values are similar to those observed. Conclusions: Complications continue to occur despite the evolution of the technique. The score was useful for stratifying patients and knowing the probability of complication before the procedere.
ABSTRACT
Resumen Las cardiopatías congénitas son consideradas las malformaciones más frecuentes. En México cada año entre 12 y 16 mil niños nacen con algún tipo de cardiopatía congénita, y es la segunda causa de mortalidad en menores de 1 año y en niños de entre 1 y 4 años. Se analiza la problemática de la atención de las cardiopatías congénitas desde una perspectiva de políticas de salud en el país, con énfasis en lograr regionalizar su atención con el fin de racionalizar la utilización de los recursos disponibles y con el objetivo de atender al mayor número de pacientes y lograr los mejores resultados clínicos. Se enfatiza la necesidad de promover la cooperación entre las diferentes organizaciones de la sociedad civil y las instituciones para intercambiar ideas que permitan crear consensos y proyectos conjuntos para una mejor utilizació de los recursos disponibles para lograr la atención universal y de calidad de los niños con cardiopatía congénita en todo el país.
Abstract Congenital heart diseases are considered the most frequent malformations. In Mexico every year between 12 and 16 thousand children are born with some type of congenital heart disease and it is the second cause of mortality in children under 1 year of age and in children aged between 1 and 4 years. The problem of the care of congenital heart diseases is analyzed from a perspective of health policies in the country with an emphasis on regionalizing their care in order to rationalize the use of available resources and with the aim of serving the largest number of patients and achieve the best clinical results. It emphasizes the need to promote cooperation among the different civil society organizations and institutions to exchange ideas to create consensus and joint projects for a better use of available resources to achieve universal and quality care of children with congenital heart disease in all the country.
ABSTRACT
In this study we generated casting specimens of human cerebral blood vessels for twenty-five fetuses and thirty-six adults. The degrees of the angles were measured and comprised for those blood vessels frequently involved in the interventional catheterization.
En este estudio generamos muestras de los vasos sanguíneos cerebrales humanos en veinticinco fetos y treinta y seis adultos. Fueron medidos y comprendidos los ángulos de aquellos vasos sanguíneos implicados frecuentemente en intervenciones de cateterismo.
Subject(s)
Humans , Adult , Brain/blood supply , Catheterization/methods , Cerebral Arteries/anatomy & histology , Fetus/anatomy & histology , Brain/embryology , Cerebral Arteries/embryologyABSTRACT
Objective By using digital three-dimensional (3D) model of abdominal and pelvic vessels to investigate the relationship between the angle/position of the bifurcation of bilateral common iliac arteries and the length of the common iliac artery, thus to guide the endovascular interventional catheterization manipulation. Methods A total of 439 patients, who received abdominal and pelvic CTA at authors’ department during the period from Sep. 2011 to May 2013, were included in this study. By using digital 3D reformation technique, the 3D model of the abdominal and pelvic vessels as well as the lumbosacral vertebrae was established in all patients. With the help of mimics and geomagic software the angles between the left and right common iliac arteries and the lengths of common iliac arteries were determined, and the lumbar vertebra corresponding to the bifurcation of common iliac arteries was recorded. Using statistical software, the relationship between the bifurcation angle of bilateral common iliac arteries and the corresponding lumbar vertebra as well as the length of common iliac arteries was analyzed. Results The digital 3D model of the abdominal and pelvic vessels as well as the lumbosacral vertebrae was successfully reconstructed in all 439 patients. Both the angle between the left and right common iliac arteries and the corresponding lumbosacral level of bifurcation angle were clearly demonstrated on the model. The average angle was 49.1° ± 12.4°. The bifurcation was located at L3 -L4 level in 38 cases, at upper one-third level of L4 in 63 cases, at middle one third level of L4 in 89 cases, at lower one-third level of L4 in 135 cases and at L4 -L5 level in 114 cases. The average length of the left and right common iliac artery was (45.6 ± 15.6) mm and (43.3 ± 15.4) mm respectively. Pearson correlation analysis indicated that a negative correlation existed between the angle and the position level of the left and the right common iliac artery (r = -0.172, P< 0.05), and a negative correlation also existed between the angle and the length of the common iliac artery (left: r = -0.171, P<0.05; right: r = -0.164, P < 0.05). Conclusion The lower the opening position of the left and right common iliac artery is, and the bigger the intersection angle is, the shorter the length of corresponding common iliac artery will be. In this case, catheterization via femoral artery to contralateral iliac artery is a short path, and the catheterization procedure is easy to manipulate with higher success rate. On the contrary, the catheterization will be difficult, and the use of loop-technique will be needed. The digital 3D model of the abdominal and pelvic vessels as well as the lumbosacral vertebrae can help select the optimal catheterization path.
ABSTRACT
Experiencia local en la técnica de angioplastía con catéter-balón, realizada en siete pacientes con edad que oscila entre 1 mes a 27 años, siendo 5 varones y 2 mujeres, con diagnostico de coartación aórtica nativa. Una vez realizada la sedación, se colocó un introductor en la arteria femoral y se procedió al avance de guías y catéteres hasta la aorta transversa, con el objetivo de obtener imágenes angiografícas y medir presiones invasivas en todos los segmentos. El gradiente de presión pre intervención fue de 41.5mmHg en promedio (rango:21-69mmHg) disminuyó post intervención a 10mmHg en promedio (rango:0-20mmHg). El diámetro de la coartación pre dilatación en promedio fue de 4.3mm (rango: 2.3 a 9.4mm) y aumentó post dilatación a 8.4 mm (rango: 5.5 a 13.5mm). El resultado final fue satisfactorio, pues disminuyó significativamente el gradiente de presión, el diámetro aórtico coartado aumentó y los pulsos en las cuatro extremidades se tornaron simétricos. Se alcanzó estabilidad clínica y el procedimiento se demostró como favorable en todos los pacientes. Los controles postintervención hasta un año después mostraron que el gradiente se mantiene en el tiempo, salvo en el caso de la niña de un mes, que desarrolló recoartación aórtica y fue operada en condiciones electivas, como es usual para este grupo de edad.
Local experience in the technique of balloon catheter angioplasty, performed in seven patients aged between 1 month and 27 years, 5 males and 2 females, diagnosed with native aortic coarctation. After the sedation, the introducer was collocated in the femoral artery, and guide wires and catheters were pushed forward until the transverse aorta in order to obtain angiographic images and to measure invasive pressures in all the segments. The mean pressure gradient before the intervention was 41.5mmHg (range:21-69mmHg) and decreased post intervention to 10mmHg (range:0-20mmHg). The mean diameter of the coarctation pre dilatation was 4.3mm (range:2.3-9.4mm) and increased post dilation to 8.4mm(range:5.5-13.5mm). The final result was satisfactory because the pressure gradient was significantly reduced, the aortic diameter increased and the pulses in all four extremities symmetrical. Clinical stability was achieved and the procedure proved to be favorable for all the patients. Controls until one year post intervention showed that the gradient did not change over the time, except in the case of a one month old girl, who developed recoarctation and was operated in elective conditions, as it is usual for this group of age.
Subject(s)
AngioplastyABSTRACT
PURPOSE: This report reviews an 8-year treatment of pulmonary atresia, ventricular septal defect and diminutive pulmonary arteries, comparing first palliative management schemes. METHODS: Between January 1989 and March 1997, patients had their pulmonary artery anatomy evaluated before any surgical managements. Twenty-two patients had diminutive pulmonary arteries(Nakata index<90). Clinical records, hemodynamic data, and cineangiograms were examined in these patients. RESULTS: The median age of patients were 14 months and the mean Nakata index were 54.7+/-18.2(24.3-88.9). The cases were classified into 3 different groups according to different first palliative strategies. Group I(n=18) was treated by a right ventricular outflow tract reconstruction. Group II(n=2) was treated by unifocalization and Blalock-Taussig shunt, and Group III(n=2) by a central shunt. The mean Nakata index of Group I was 68.0+/-29.6 and Group II and III showed 71.9+/-13.1 and 41.0+/-13.1, respectively. The total correction was performed in 14 cases (77.8%) of Group I and in 1 case (50%) of Group II. Group Ihad 3 deaths. Coil embolization was performed in 6 cases before total correction, and balloon angioplasty was performed in 3 and 5 cases, before and after the total correction, respectively. After total correction, the peak systolic pressure ratio of the right ventricle to the aorta was 0.80+/-0.08 in 11 cases. 5 cases of those indicated that balloon angioplasty reduced the ratio from 0.89 to 0.78. CONCLUSION: These results of first palliative surgery on the right ventricular outflow tract reconstruction compared favorably with previous reports of disease's history and survival after complete repair.
Subject(s)
Humans , Angioplasty, Balloon , Aorta , Blood Pressure , Embolization, Therapeutic , Heart Septal Defects, Ventricular , Heart Ventricles , Hemodynamics , Palliative Care , Pulmonary Artery , Pulmonary AtresiaABSTRACT
PURPOSE: The proportion of interventional catheterization in congenital heart disease is being increased in Korea, especially in Sejong Heart Institute, so we performed statistical analysis on the cardiac catheterization cases. METHODS: Total 233 cases of congenital heart disease confirmed by cardiac catheterization at the Sejong Heart Institute between Jaunary 1995 and June 1995 were analyzed retrospectively. RESULTS: 1) The distribution of age has become more younger than that of previous reports that is, the proportion of the infant less than 1 year old was 34.8%. 2) The proportion of male sex was equal to that of female. TOF and TGA were observed predominantly in male patients, and PDA and UVH revealed female preponderance. 3) The relative frequencies of each individual congenital heart disease in order of frequency were as follows; TOF 37.3%, PDA 13.3%, VSD 8.2% and UVH 7.7%. 4) Among the 145 (62%) cases of hemodynamic study pre-operation and post-operation cases were 85 and 60 cases, respectively. The cases of interventional catheterization were 84 (36%), and those of endomyocardial biopsy were 4 (2%). 5) The frequencies of each interventional catheterization of 84 cases in order of frequency were as follows: defect closure 28 cases, balloon valvuloplasty 20 cases, balloon angioplasty 17 cases, coil embolization 15 cases, and balloon atrial septostomy 4 cases. 6) There were 2 cases of mortality associated with cardiac catheterization. CONCLUSIONS: The proportion of interventional catheterization in congenital heart disease is being increased in the Sejong Heart Institute, and this trend will spread to the other cardiac center in Korea.