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.

Mapping analysis of application of nursing interventions classification in pediatric cardiology nursing docu-mentation / 中华护理杂志

Objective To analyze the feasibility of nursing interventions classification in pediatric cardiology,and to provide references for standardizing nursing terms and promoting its clinical application in the future. Methods We collected nursing records in department of cardiology in a pediatric hospital from September 1st,2016,to November 31st,2016,and used mapping method to find out the conceptual congruence between nursing interventions classification (NIC-6th) and nursing records. We analyzed characteristics of standardized nursing interventions using dimensions of time and difficulty. Results Totally 71 nursing interventions were mapped from 4191 independent nursing statements,which involved 7 domains. Of the 4191 statements,3046 (95.33%) were labelled as "perfect fit",142 (4.44%) as "partial fit",and 7 (0.23%) as "not fit at all". The average difficulty of nursing interventions was 1.77 and the average time was 2.11. Conclusion Nursing interventions classification can describe daily nurs-ing activities in pediatric cardiology and can be used as standard nursing language in China. The extracted nursing interventions demonstrate certain specificity of specialty nursing,but still have defects. The results of this study can be used for analysis of staff performance.

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.

Pediatric tele-echocardiography in the diagnosis of congenital heart diseases in a regional referral hospital in eastern Bhutan.

Introduction: Congenital Heart Diseases are the commonest birth defects and the most common reason for out-country referral of pediatric patients in Bhutan.Without any qualified pediatric cardiologists in the country, early diagnosis and appropriate care of pediatric cardiac patients is often delayed or inappropriate. Collaboration through telemedicine between general pediatrician and pediatric cardiologist can improve the diagnosis of congenital heart diseases in Bhutan. Methods: Pediatric patients clinically suspected to have congenital heart diseases underwent Echocardiography at Mongar regional referral hospital. The Echocardiograms, performed by general pediatrician, were e-mailed to Pediatric Cardiologist working in UK, who gave the diagnosis after viewing the Echo-loops. This was compared with the final diagnosis made at tertiary cardiac centre in India.Results: 30 echocardiograms performed by general pediatrician at Mongar Hospital in eastern Bhutan were mailed to Pediatric Cardiologist working in UK. Of the thirty cases, 20 required no immediate referral and were put on medications and follow up plans. 10 of the 30 cases required early referral to tertiary care hospital in India. There was excellent concordance between the diagnosis made through tele-echocardiology and the final diagnosis made at tertiary cardiac centre. Conclusions: Tele-echocardiography between a general Pediatrician and a Pediatric Cardiologist can greatly enhance the diagnosis of congenital heart diseases in children.

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.

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

Pulsoterapia (altas doses de metil-prednisolona venosa) em crianças com cardite reumática. Estudo prospectivo de 40 episódios / Pulse Therapy (High Dosis of Intravenous Methyl-Prednisolone) in Children with Rheumatic Carditis. Prospective Study of 40 Episodes

PURPOSE--To use corticosteroids in a shorter period to treat rheumatic carditis, keeping the patient in the hospital; and verify the time interval of normalization of rheumatic activity tests with this method. METHODS--In 36 patients (40 episodes) intravenous methyl-prednisolone (1g/day) was administered. The number of series ranged from two to four, according to severity of the disease. The ages ranged from 6 to 17 years old, all of them fulfilled the criteria of Jones for diagnosis of rheumatic fever. They were submitted to treatment to eradicate the streptococcus, worms, PPD and dental focus extraction, before use of corticosteroids. RESULTS--In all patients the signals and symptoms of heart failure improved. In six cases occurred complications during pulse therapy that were easily controlled with clinical measures. Two series of methylprednisolone were used in 10 children, three in nine and four in 21 episodes. Eight patients were sent to valve replacement. The interval of time that laboratory tests of rheumatic activity became negative was 41.2 +/- 13.3 days. CONCLUSION--Using this IV corticotherapy it was possible decrease the amount of days of this medication, keeping the patient in the hospital. In this way we eliminate the problem of interruption of the treatment. There was not significative difference between oral and IV corticotherapy in order to the laboratory tests become negative.

Critério de relação ecocardiográfica. Um novo método para a indicação da valvotomia mitral com cateter-balão / Pulse Therapy (High Dosis of Intravenous Methyl-Prednisolone) in Children with Rheumatic Carditis. Prospective Study of 40 Episodes

PURPOSE--To find out new subjects that could be useful to select patients between 9 and 12 points, according to Block's Criteria, to mitral balloon valvotomy. METHODS--One hundred and forty patients underwent mitral balloon valvotomy. Among them, 29 (21) had between 9 and 12 points. These patients were divided into two groups: group A-patients with mitral valve area > or = 1.5cm2, immediately after balloon valvotomy and in the follow-up period; group B-patients with mitral valve area < 1.5cm2 immediately after or during the follow-up period, patients with severe mitral regurgitation after the procedure and patients who died in the follow-up period. All patients were analyzed by echocardiographic relation criteria (ERC): calcification + subvalvar disease/thickness + mobility. Each one was quantified from 1 to 4 points according to the degree of valvular disease. RESULTS--Group A was composed of 17 (51) and group B 12 (41) patients. The variables age, sex, previous mitral commissurotomy and atrial fibrillation did not show difference between groups. In group A mitral valve area (cm2) increased from 1.15 +/- 0.25 to 1.97 +/- 0.26 (p < 0.00001) keeping stable during the follow-up period. In group B percutaneous mitral balloon valvotomy resulted in an increase from 1.26 +/- 0.19 to 1.77 +/- 0.16 (p < 0.00001), however, there was an important decrease in the follow-up period to 1.34 +/- 0.15 (p < 0.00001). The ERC showed that all group A patients had a relation < 1. However, in group B, 10 patients (83), the relation was > or = 1, and in only 2 patients (17) was < 1 (p < 0.00001). CONCLUSION--The group of patients between 9 and 12 points in the Block's criteria is heterogenic, therefore, each case might be evaluated individually and the echocardiographic relation criteria should be used in order to select these patients to the procedure.

Objetivo - Diminuir o prazo de uso de corticoterapia na cardite reumática, mantendo o paciente internado e avaliar o tempo para negativação das provas de atividade da doença. Métodos - Foram tratados 36 pacientes entre 6 e 17 anos (40 episódios) com metilprednisolona venosa (1g/dia) em séries de três dias semanais. O número de séries variou de duas a quatro, dependendo da gravidade. Todos os pacientes preenchiam os critérios de Jones para diagnóstico de febre reumática. Todos foram submetidos a erradicação estreptocócica, PPD, tratamento de verminoses e dos focos dentários antes da corticoterapia. Resultados - Todos os pacientes melhoraram da insuficiência cardíaca na época da alta. Em 6 casos ocorreram intercorrências durante a pulsoterapia, mas foram controladas rapidamente. Foram realizadas duas séries em 10 pacientes, três em 9 e quatro em 21 episódios. Oito foram encaminhados para troca de válvula. O tempo de negativação das provas de atividade reumática e da alta hospitalarioi 41,2±13,3 dias. Conclusão - O esquema utilizado encurtou o tempo total de uso dos corticosteróides, podendo assim manter o paciente internado e eliminando-se a interrupção do tratamento da cardite. Não ocorreu diferença significativa quanto ao prazo de negativação das provas de atividade reumática entre o esquema clássico oral e a pulsoterapia