Primer registro de procedimientos de intervencionismo cardiovascular pediátrico realizados en un laboratorio estatal de hemodinamia pediátrica en El Salvador / First record of pediatric cardiovascular interventional procedures performed in a state pediatric catheterization laboratory in El Salvador

Resumen Objetivo: Describir los tipos de cateterismo cardiaco que se realizan en el único laboratorio de hemodinamia pediátrica dentro de la red de salud pública de El Salvador, en colaboración con organizaciones sin fines de lucro. Material y método: Se realizó un estudio descriptivo retrospectivo de corte transversal en el periodo entre mayo de 2022 a enero de 2023, revisando los expedientes de todos los pacientes que pasaron a cateterismo cardiaco. Resultados: Se realizaron 54 procedimientos dentro de la sala de hemodinamia, 37 pacientes de sexo femenino. El peso fue de 20.6 ± 14.5 kg, de los procedimientos, 47 (87%) fueron terapéuticos y 7 (13%) diagnósticos. La oclusión del conducto arterioso se realizó en el 46% de los pacientes. No se reportaron complicaciones, los pacientes fueron dados de alta luego de 12 horas, todos los insumos fueron donados por fundaciones sin fines de lucro. Conclusiones: Nuestro laboratorio de hemodinamia realiza procedimientos de complejidad variada sin reportar hasta el momento complicaciones mayores. Nos vemos limitados debido al costo alto de algunos dispositivos, a la baja frecuencia de la utilización de estos y a la imposibilidad para adquirirlos en el mercado nacional.

Abstract Objective: To describe the types of cardiac catheterization that are performed in the only pediatric catheterization laboratory within the public health network of El Salvador, in collaboration with non-profit organizations. Material and method: A descriptive, retrospective, cross-sectional study was conducted in the period from May 2022 to January 2023, reviewing the records of all patients who underwent cardiac catheterization. Results: 54 procedures were performed in the catheterization room, 37 female patients. The weight was 20.6 ± 14.5 kg, of the procedures, 47 (87%) were therapeutic and 7 (13%) diagnostic. Occlusion of the ductus arteriosus was performed in 46% of the patients. No complications were reported, the patients were discharged after 12 hours, all supplies were donated by non-profit foundations. Conclusions: Our catheterization laboratory performs procedures of varied complexity without reporting any major complications to date. We are limited due to the high cost of some devices, the low frequency of their use and the impossibility of acquiring them in the national market.

Inequidad de la atención de las cardiopatías congénitas en los hospitales públicos de México. El falso derecho a la salud / Inequity of congenital heart disease care in the public hospitals of Mexico. The false right to health

Resumen La cardiología pediátrica y la cirugía cardiovascular han tenido avances importantes en los últimos años; las cardiopatías congénitas (CC) son una de las principales causas de mortalidad en niños. Muchos de los factores que determinan la evolución final de estos pacientes incluyen el tipo de cardiopatía y el tiempo del diagnóstico y tratamiento; infortunadamente, dos de los que presentan mayores efectos son el estado socioeconómico y el área geográfica de atención en México. El objetivo de este estudio es conocer el tipo de atención para los pacientes con CC en hospitales públicos del país.

Abstract Pediatric cardiology and cardiovascular surgery have made significant advances in recent years, congenital heart diseases (CHD) are one of the leading causes of mortality in children. Many of the factors that determine the final evolution of these patients include the type of heart disease, the time of diagnosis and treatment; unfortunately, in our country, two of those greatest impact area the socioeconomic status and the geographic area of attention. The objective of this study is to know the type of care for patients with CHD in public hospitals in the country.

Echocardiography in PICU: when the heart sees what is invisible to the eye / Ecocardiografia na UTIP: quando o coração vê o que é invisível aos olhos

ABSTRACT OBJECTIVE: Echocardiography has become an indispensable bedside diagnostic tool in the realm of pediatric intensive care units (PICU). It has proven to be an influential factor in the formula of clinical decision-making. This study aimed to delineate the impact of echocardiography on the management of critically ill pediatric patients in the PICU at Sultan Qaboos University Hospital, Oman. METHOD: This was a retrospective cohort study conducted in a five-bed PICU. Patients admitted to the PICU from January of 2011 to December of 2012 were reviewed. Those who have undergone bedside echocardiography during their ICU stay were recruited. Electronic patient record was used as data source. RESULTS: Over a-24-month period, 424 patients were admitted in this PICU. One hundred and one clinically indicated transthoracic echocardiograms were performed. 81.8% of these presented new findings (n = 82) that significantly impacted the clinical decision of patient management, namely, alteration in drug therapy and procedure, whereas no difference in the management was yielded in the remaining 17.8% of the studied cases. CONCLUSIONS: Echocardiography had a significant impact on the management of PICU patients. Such salutary effect was consequently reflected on the outcome. Pediatric intensivists are encouraged to acquire such bedside skill.

RESUMO OBJETIVO: A ecocardiografia se tornou uma ferramenta de diagnóstico relevante, indispensável no âmbito das unidades de terapia intensiva pediátrica (UTIP). Ela se tornou um fator influente na tomada de decisões clínicas. O objetivo deste estudo foi delinear o impacto da ecocardiografia sobre o manejo de pacientes pediátricos gravemente doentes na UTIP do Hospital Universitário Sultan Qaboos, em Omã. MÉTODO: Este é um estudo de coorte retrospectivo feito em uma UTIP de cinco leitos. Foram analisados pacientes internados na UTIP entre janeiro de 2011 e dezembro de 2012. Foram recrutados os pacientes que passaram por ecocardiografia durante sua internação na UTI. O registro eletrônico dos pacientes foi usado como fonte de dados. RESULTADOS: Em 24 meses, 424 pacientes foram internados em nossa UTIP, 101 pacientes foram encaminhados para ecocardiografias transtorácicas, 81,8% deles tiveram novos achados (n = 82) que afetaram significativamente a decisão clínica, como a terapia medicamentosa e os procedimentos, ao passo que não houve diferença no manejo nos outros 17,8% dos casos estudados. CONCLUSÕES: A ecocardiografia teve um impacto significativo sobre o manejo de pacientes da UTIP. Esse efeito refletiu-se nos resultados. Os intensivistas pediátricos devem ser incentivados a adquirir essa habilidade relevante.

Taquicardia supraventricular en pediatría: Presentación clínica y manejo. Experiencia del servicio de cardiología hospital de Niños JM de los Ríos. Caracas, Venezuela. 2001-2011

Introducción: La taquicardia paroxística supraventricular (TPSV) representa la segunda causa más frecuente de arritmias en pediatría (1). Objetivos 1. Determinar las características clínicas y el tratamiento en la emergencia. 2. Evaluar la respuesta al tratamiento y los fármacos utilizados. Metodología: Estudio retrospectivo de 69 casos con ingreso en el Servicio de Cardiología del Hospital de niños JM de los Ríos de 2001-2011. Criterio de Ingreso: pacientes con Diagnóstico de TPSV que ingresaron a la emergencia. Resultados: Se seleccionaron 69 pacientes. Edad promedio: 5,9 años (DE ± 3,5). Dos con antecedentes de Cardiopatía Congénita (2,9 %). La frecuencia cardíaca media fue de 284 lat./min (DE ± 30,66). El diagnóstico más frecuente fue TPSV por reentrada, en 35 pacientes (51%); el resto de los pacientes presentaron Wolff Parkinson White (WPW). Cinco pacientes respondieron a maniobras vagales. El tratamiento de elección en la crisis aguda fue Adenosina, y en casos de fallar el tratamiento inicial y de inestabilidad hemodinámica se utilizó la cardioversión eléctrica (16 pacientes). Para mantenimiento se indicó: Betabloqueantes y Amiodarona siendo efectivos (60,8%). Cuatro pacientes necesitaron ablación por radiofrecuencia (1 paciente presentó recaída posterior al tratamiento). Conclusiones: La presentación clínica de la TPSV varía con la edad. La mayoría de pacientes respondieron al tratamiento con adenosina. El tratamiento de mantenimiento con Betabloqueantes y Amiodarona es efectivo.

Paroxysmal supraventricular tachycardia (PSVT) is the most common pediatric arrhythmia. The objectives of this study were to determine the clinical features and treatment of PSVT in the emergency room and to evaluate the response to treatment and drugs employed. Methods: This is a retrospective study of 69 children admitted to the cardiology department of the Children's Hospital JM de los Rios from 2001 to 2011. Inclusion criteria: patients diagnosed with PSVT who were admitted to the emergency room. Results: 69 patients. Mean age: 5.9 years (SD ± 3.5). Two had a history of congenital heart disease (2.9%). The average heart rate was 284 beats / min (SD ± 30.66). The most frequent diagnosis was reentrant SVT, 35 patients (51%); the rest corresponded to Wolf Parkinson White syndrome. Five patients responded to vagal maneuvers. The treatment of choice in the acute crisis was adenosine. Electrical cardioversion was utilized in cases of initial treatment failure and hemodynamic inestability (16 patients). Maintenance treatment with beta-blockers and amiodarone was indicated in most cases (60.8%) with an effective response. Four patients required ablation, one of them relapsed. Conclusions: 1. clinical presentation of PSVT varies with age. 2. most patients responded to treatment with adenosine. 3. maintenance therapy with beta blockers and amiodarone is effective.

Genética y biología molecular de las cardiopatías congénitas y adquiridas / Genetics and molecular biology of the congenital, and acquired heart disease

El corazón es el primer órgano que se forma y funciona en el embrión, de tal suerte que todos los eventos subsecuentes en la vida del organismo dependen de la habilidad de este órgano para atender las demandas de oxígeno y nutrientes que éste requiere. Las anormalidades en la formación del corazón, la forma más común de defectos humanos al nacimiento, afecta al 1 % de los nacidos vivos, y su frecuencia en abortos espontáneos se eleva diez veces más. La patofisiología de este tipo de malformaciones congénitas se ha venido enriqueciendo en los últimos años con el conocimiento del Proyecto Genoma Humano; debido al gran avance que se ha producido en el conocimiento genético y molecular de los diferentes genes y cromosomas que suelen ser afectados y muchas veces heredados para producir una enfermedad congénita en general. Esta revisión trata de enfocar su atención sobre la información extraída de los análisis genéticos y moleculares en el diagnóstico, tratamiento y entendimiento de la patogénesis de las enfermedades cardiovasculares pediátricas, dirigidas tanto por los más comunes defectos cardíacos congénitos o heredados, como por los desórdenes esporádicos o adquiridos.

The heart is the first organ to form and function in the embryo, and all subsequent events in the life of the organism depend on the heart's ability to match its output with the organism's demands for oxygen and nutrients. Abnormalities in heart formation, the most common form of human birth defects, afflict nearly 1% of newborns, and their frequency in spontaneously aborted pregnancies is estimated to be tenfold higher. With the completion of the sequencing of the human genome, molecular genetic efforts directed at finding genes for monogenic traits have accelerated dramatically. Breakthroughs in molecular genetic technology have just begun to be applied in pediatric cardiology stemming from the use of chromosomal mapping and the identification of genes involved in both the primary etiology and as significant risk factors in the development of cardiac and vascular abnormalities. This review will focus on information provided by molecular and genetic analysis in the diagnosis, treatment and overall heart disorders.

Cirurgia cardíaca na infância: repercussöes na qualidade de vida do adolescente / Cardiac Surgery in Childhood. Impact in Young People Quality of Life

PURPOSE--To assess quality of life in patients submitted to surgical treatment of congenital heart disease in infancy. Quality of life has been assessed over social sciences backgrounds, but we have focused on the patient self-perception of their disease and related problems too. METHODS--We studied 134 adolescents, age ranged from 12 to 19 year-old, of both sexes, with any congenital heart disease, submitted to surgical treatment in infancy. They answered a questionnaire that covered their clinical, social, emotional, education and professional status. RESULTS--Ninety one percent qualified their lives as good because were symptom-free and living well without and physical restriction. CONCLUSION--The school performance was similar to the overall population engaged in Brazilian public schools. Their feelings, social relations and future plans were equal to the normal adolescents

Hiperaldosteronismo primário e tumores adrenais: experiência clínico-cirúrgica em nove pacientes / Cardiac Surgery in Childhood. Impact in Young People Quality of Life

PURPOSE--To report seven patients with diagnosis of primary aldosteronism, five of them due to aldosterone-producing adenoma (APA) and two due to idiopathic hyperaldosteronism (IHA), and two patients with adrenal non-producing tumors in order to discuss our experience on differential diagnosis and treatment of this hypertensive disease. METHODS--Hypokalemia and higher values of urinary potassium in the absence of diuretics were useful to the screening diagnosis of primary aldosteronism, reinforced by suppressed plasma renin activity either at rest and after deambulation and by higher values of plasma aldosterone. Computerized tomography in all patients and selenium-cholesterol scintigraphy were used to make the localization of tumors and differential diagnosis between APA and IHA. RESULTS--The patients with adrenal tumors were submitted to surgical treatment and the two patients with IHA were submitted to spironolacone therapy. After 1 to 5 years of follow-up, we observed cure of hypertension and hypokalemia in three patients after surgery and improvement of blood pressure control and normalization of serum potassium in the six others. CONCLUSION--The diagnosis of primary aldosteronism is important, besides its rarity, because surgical or appropriated clinical treatment provide cure of hypertension or improvement of blood pressure control in most of patients