Spanish cardiac catheterization in congenital heart diseases registry. First official report from the ACI-SEC and the GTH-SECPCC (2020)

Introduction and objectives: The Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) and the Spanish Society of Pediatric Cardiology Working Group on Interventional Cardiology (GTH-SECPCC) introduce their annual activity report for 2020, the starting year of the pandemic of coronavirus disease (COVID-19). Methods: All Spanish centers with cath labs and interventional activity in congenital heart diseases were invited to participate. Data were collected online, and analyzed by an external company together with members from the ACI-SEC and the GTH-SECPCC. Results: A total of 16 centers participated (all of them public) including 30 cath labs experienced in the management of congenital heart diseases, 7 of them (23.3%) dedicated exclusively to pediatric patients. A total of 1046 diagnostic studies, and 1468 interventional cardiac catheterizations were registered. The interventional procedures were considered successful in 93.4% of the cases with rates of major procedural complications and mortality of 2%, and 0.1%, respectively. The most frequent procedures were atrial septal defect closure (377 cases), pulmonary angioplasty (244 cases), and the percutaneous closure of the patent ductus arteriosus (199 cases). Conclusions: This report is the first publication from the Spanish Cardiac Catheterization in Congenital Heart Diseases Registry. The data recorded are conditioned by the COVID-19 pandemic. Diagnostic cardiac catheterization still plays a key role in this field. Most interventional techniques have reported excellent security and efficacy rates.

Refractory acquired hemophilia A (even more) complicated with SARS-CoV-2 infection

Background : Acquired hemophilia A (AHA) is caused by autoantibodies against coagulation factor VIII (FVIII). Treatment focuses on both eradicating the inhibitor and treating and preventing bleeding episodes. SARS-CoV-2 infection causes a high mortality hipercoagulable state. Aims : Review AHA case with high risk of bleeding and thrombotic complications. Methods : We present a patient with refractory AHA treated with immunosupression, SARS-CoV-2 infection and iliopsoas hematoma treated with recombinant porcine FVIII (rpFVIII). Results : 73 year old male was admitted because of ecchymosis, hematuria and anemia (Hb 8.5 g/dL). Coagulation tests showed APTT ratio 2.12, FVIII:C 1.8 UI/dL and anti-FVIII 156 BU. He was diagnosed with AHA and put on rFVIIa, prednisone and rituximab. Three weeks later he developed severe respiratory insuffiency, bilateral pneumonia and severe acute immflamatory response with a positive PCR test for SARS-CoV-2. Last dose of rituximab was postponed and treatment with metilprednisolone, tocilizumab, lopinavir/ritonavir, hidroxicloroquine and prophylactic heparin (LMWH) was started. He was enrolled on a clinical trial with remdesivir. 4 days later he related acute pain on the right hip with inability to walk. CT scan showed iliopsoas hematoma. Due to high thrombotic risk of using bypass agents, a request for rpFVIII (susoctocog alfa -Obizur®) was made. After SARS-CoV2 infection was resolved, treatment with mofetil mycophenolate was started (no response to previous treatment). Inhibitor title is <0.4 B. FVIII levels remain above 50 UI/dL Conclusions : Patients with AHA and SARS-CoV-2 infection are at high risk of bleeding and thrombotic events, complicating treatment with bypass agents. RpFVIII, allows to extend time between infusions, to monitor levels of FVIII. It is a good option to treat bleeding episodes without adding thrombotic risk. After tocilizumab administration a reduction on the inhibitor title was seen. It may be have a roll in refractory AHA. The use of LMWH is not well stablished for patients with Covid19 and AHA. Conclusions : Acquired postpartum hemophilia A represents the most frequent etiology in our series;the time to onset is very variable, ranging from the immediate postpartum up to 4 months.

Results of the scientific activity in Cienfuegos province in the first three months of COVID-19 outbreak. (Suplemento especial.) [Spanish]

Science plays a decisive role facing disaster situations, and the pandemic caused by SARSCoV- 2 has not been an exception. So, the aim of the present communication is to show how Cienfuegos province confronted COVID-19 from the organization of science and technical innovations in the period March-May, 2020. For its compliance, it was carried out by Cienfuegos' health systems and services a cross-sectional, descriptive study of the implemented actions on scientific basis during this period. There were used different techniques as documents review, interviews to key informants and focal gropus. It was known that the already established science and technical innovation's system was the organizational support for the development of researches during the above mentioned period, in which there were carried out 56 researches (50 articles, two cellphone apps and four informative brochures for the population), and 24 of them had been already published in three journals and one book. The study lines were focused in surveillance and control actions (15), medical education (11), psychologic health (6), health events'organization (9), medical care (10) and other five works on various topics. 87 authors participated in the 34 finished works, with special mention to the ones in the primary care level and three students. It can be said as a conclusion that the use of science, collective intelligence and instersectorial compliance of the decisions derived from it limited the virus spreading in Cienfuegos province. The decisions taken were due to scientific reasoning focused in actions for prevention, surveillance and control of positive and suspicious cases and their contacts.