Analgesia, sedación y anestesia para cateterismo diagnóstico y/o terapéutico en pacientes pediátricos con cardiopatías congénitas en el Hospital Clínico de la Pontificia Universidad Católica de Chile: algunas recomendaciones / Analgesia, sedation and anesthesia in diagnostic or therapeutic catheterization in pediatric patients with congenital heart disease

Las presentes recomendaciones han sido elaboradas en base a nuestra experiencia, con el propósito de entregar algunas pautas sobre analgesia, sedación y anestesia para cateterismos diagnósticos y/o terapéuticos en pacientes pediátricos con cardiopatías congénitas, de acuerdo a la clasificación de riesgo de los mismos. El propósito de ésta es contribuir a disminuir la incidencia de eventos adversos asociados a morbilidad y mortalidad.

Recommendations based con clinical experience with analgesia, sedation and anesthesia in diagnostic or therapeutic cardiac catheterization in pediatric patients with congenital heart disease are outlined. These recommendations, based on clinical experience at a single institution (Catholic University Hospital in Santiago, Chile) are intended to help reduce de incidence of adverse effects, morbidity and mortality in this patient population.

Implante valvular aórtico transarterial: experiencia en Chile / Transcatheter aortic valve implantation: Experience in 17 patients

Background: Transcatheter aortic valve implantation (TAVI) is taking a leading role in the management of patients with severe aortic stenosis. Valve replacement surgery prolongs survival and is the technique of choice considering its historical background and long experience worldwide. Recently however, TAVI has positioned itself as the only standard therapy for symptomatic patients who are not candidates for surgery. Aim: To report the experience with this new technique comparing our results with those reported in the literature. Material and Methods: Between May 2010 and December 2011,17patients aged 81 ± 7.3 years (58.8% men with an Euro SCORE 29 ± 22.4%) underwent a TAVI. Results: The median transvalvular gradient was 54 ± 15.7 mmHg. All patients received a CoreValveTM. Technical success was 100%, with a post implant gradient of 6.29 ± 3.3 mmHg. Residual aortic regurgita-tion was observed in 94%, none greater than grade II. There were no complications at the vascular access site. One patient developed cardiac tamponade during the procedure. Permanent pacemaker implantation was required in 35.2%. Hospital mortality rate was 5.8%, a figure that remained unchanged at 30 days offollow-up. Conclusions: In high-risk patients with aortic stenosis, TAVI has a high success rate and a low rate of complications. Besides an appropriate patient selection, a trained multidisciplinary team and technical conditions to solve possible complications of the procedure are required.

Pediatric cardiology at Siriraj Hospital: past, present and future.

The incidence of congenital heart disease (CHD) at Siriraj Hospital for the year 2000 was 4.36 patients per 1,000 livebirths. Types of congenital heart diseases seen by the authors were VSD (18.3%), PDA (16.3%), ASD (16.3%), combined simple left to right shunt lesion (24.7%), tetralogy of Fallot (TF; 6%), D-TGA 2 per cent, other complex congenital heart 8 per cent. Overall 3 out of 1,000 livebirths will have congenital heart disease that will require immediate intervention including cardiac catheterization and surgical intervention. At the same period of time an average of 750 new cases of children were referred annually for evaluation and treatment of cardiac related problems. Reports of acquired heart disease such as acute rheumatic fever, myocarditis, Kawasaki's disease and arrhythmia problem were summarized here. The Division of Pediatric Cardiology performs both diagnostic and intervention cardiac catheterization in almost 310 children and adults with congenital heart disease yearly. Out of this 35 per cent had interventional procedures including balloon valvuloplasty, balloon angioplasty and stenting, device closure of atrial septal defect and patent ductus arteriosus and radiofrequecy ablation of abnormal conduction pathway. Major progress has been made in pediatric cardiac imaging over the past two decades. At Her Majesty's Cardiac Center, cardiac MRI has been used to evaluate patients with congenital heart disease since June 2000. There were 146 congenital heart disease patients who had cardiac MRI performed for the evaluation of anatomy, function, left to right shunt, and flow regurgitation quantification. Conclusion: Pediatric Cardiology practice has evolved over the past decade and expanded from clinical practice to therapeutic intervention procedures.

Comparison of two continuous wave doppler-echo methods in assessment of right-side intracardiac pressure: validation by simultaneous catheterization

Determination of right-side intracardiac pressures is important in clinical decision-making, evaluation of therapeutic interventions and postoperative follow-up in many cardiac diseases. To compare two methods [transseptal gradient and transtricuspid gradient] respectively with invasive measurements in the same patient, continuous wave Doppler-echo and left and right catheterization were performed in 27 patients with congenital ventricular septal defects and associated tricuspid regurgitation. Right ventricular and pulmonary artery systolic pressures were respectively estimated by subtracting transseptal peak gradient from systolic blood pressure or by maximal tricuspid regurgitant gradient plus assumed right atrial pressure. There were high correlations [r=0.944, Standard estimate error [SEE]=4.9 mmHg and r=0.932, SEE=5.6 mmHg] between transseptal method and invasive results, and excellent correlations [r=0.981, SEE=2.6 mmHg and r=0.983, SEE=2.8 mmHg] were also observed between transtricuspid method and catheter measurements. The present report further demonstrated that the Doppler technique was a reliable and accurate method in assessment of right ventricular and pulmonary artery systolic pressures, and the different Doppler method possessed its practical value and offered the alternative way in particular clinical status