Unidad médico-quirúrgica de Cardiología Pediátrica y Cardiopatías Congénitas del Hospital Universitario Ramón y Cajal de Madrid / Medical-surgical unit of Pediatric Cardiology and Congenital Heart Diseases of the Hospital Ramón y Cajal of Madrid

Desde su creación, en el año 1977 por el Dr. Manolo Quero, coincidiendo con la apertura del Hospital, el Servicio de Cardiología Pediátrica y Cardiopatías Congénitas del Hospital Ramón y Cajal, ha sido y es centro de referencia donde se siguen enfermos de toda la geografia española. Se creó para dar atención especializada a la gran demanda existente en aquellos años. Y, después de casi 40 años, tenemos la gran satisfacción de poder seguir viendo a esos niños, ya convertidos en adultos, y seguimos ofreciéndoles la asistencia necesaria para tratar las cardiopatías complejas de la mayoria de ellos. Este Servicio se ha caracterizado, tanto por su actividad asistencial como por su actividad docente e investigadora, que ha propiciado que sea distinguido como Centro de Referencia Nacional (CSUR). Hoy en día, contarnos con un Servicio mixto de 7 facultativos, provenientes de la Pediatria y de la Cardiología y especializados en la Cardiología Pediátrica y las Cardiopatías Congénitas. El Servicio cuenta con varias Unidades especializadas como la de Hemodinámica Intervencionista Infantil y en Cardiopatías Congénitas, Hipertensión Pulmonar Pediátrica y Unidad de Arritmias Pediátricas y en Cardiopatias Congenitas, entre otros. Nuestro Servicio se integra en un equipo multidisciplinar, compuesto por cirujanos cardiacos, intensivistas pediátricos, anestesistas, obstetras, radiólogos, rehabilitadores y enfermería especializada, entre otros, que permiten la atención integral al enfermo. La gran mayoría de las consultas externas se organizan con la filosofía de la consulta de alta resolución. Realizándose la mayoría de las exploraciones y técnicas complementarias (electrocardiograma, ecocardicigrafía, Holter, ergometría) en el mismo día de la consulta (AU)

Since its creation in 1977 by Dr. Manolo Quero, coinciding with the opening of the Hospital, the Ramon y Cajal Hospital Pediatric Cardiology and Congenital Heart Disease Unit has been and is a referral center where patients coming from any Spanish region can get specialized and personalized integral care for children with congenital heart disease. After almost 40 years, the Service has integrated also the care of our grown up patients with congenital heart defects, into a transversal care unit. This service is characterized by its healthcare activity and its teaching and research that have led it to be distinguished as a National Reference Center (CSUR) activity. Today we are 7 physicians who perform our functions in different sections and allowed to specialize and create units as Hemodynamics, pulmonary hypertension and arrhythmias among others. Our cardiology department is integrated into a also has a rnultidisciplinary team including cardiac surgeons, pediatric intensivists, anesthesiologists, radiologist, physiotherapist, among others that allow for comprehensive patient care nursing. Our outpatient visits are Organized with the philosophy of "high resolution" visits and all the complementary examinations and functional tests) EKG, echocardiography, Holter cardiopulmonary exercise testing, and sometimes in the MRI) are done in the same day of the external visit (AU)

Timing of Pulmonary Valve Replacement: How Much Can the Right Ventricle Dilate Before it Looses Its Remodeling Potential?

Congenital heart disease patients that develop secondary pulmonary regurgitation require a pulmonary valve replacement (PVR) in their follow-up. The indications for PVR in asymptomatic patients are debated. Most guidelines consider a RV end-diastolic volume (RVEDV) over 150 ml/m(2) as an indication for PVR. We analyzed clinical, echocardiographic and MRI variables of patients that underwent a surgical PVR between September 2006 and February 2013. The included patients were asymptomatic, without pulmonary stenosis and with both pre- and post-surgery MRI. Thirty-five patients (74.3 % males) were included. Mean age at PVR was 25.8 years (SD = 7.18), and weight was 64.5 Kg (SD = 12.03). The main diagnosis was tetralogy of Fallot (n = 28), pulmonary atresia (n = 2), primary pulmonary regurgitation (n = 2) and pulmonary regurgitation after percutaneous treatment (n = 2). The maximal RVEDV pre-PVR was 267 ml/m(2), and right ventricular end-systolic volume (RVESV) was 183 ml/m(2). RV size and function were established by MRI: Pre-PVR Post-PVR p RVEDV (ml/m(2)) 162 (SD = 39.1) 94 (SD = 23.6) <0.001 RVESV (ml/m(2)) 87 (SD = 28.9) 44 (SD = 15.7) <0.001 RVEF 44.8 % (SD = 8.17) 52 % (SD = 9.9) <0.001 Patients with a RVEDV under 170 ml/m(2) combined with a RVESV under 90 ml/m(2) had a favorable RV remodeling, defined as RVEDV under 110 ml/m(2) (sensitivity 87.5 %), RVESV under 55 ml/m(2) (sensitivity 100 %) and RVEF over 50 % (sensitivity 100 %). When deciding the optimal PVR timing in asymptomatic patients, both RVEDV and RVESV should be considered. Our results suggest that higher volumes than used in the clinical practice can achieve a good remodeling. Therefore, PVR could be performed later in the follow-up reducing the number of cardiac interventions.

Infective endocarditis in congenital heart disease: a frequent community-acquired complication.

BACKGROUND: Infective endocarditis (IE) is a severe complication in patients with congenital heart disease (CHD). Epidemiology, etiology, and outcome in this group are different to those of patients with acquired heart disease. METHODS: We reviewed all cases of proven and probable IE (Duke's criteria) diagnosed in our center during the last two decades. RESULTS: We observed 45 cases of IE in patients with CHD (age range 8 months to 35 years); these represented 5.5 % of all the episodes of IE in our institution during the study period. The most frequent CHD were ventricular septal defect (31 %), tetralogy of Fallot (19 %), and atrioventricular septal defect (11 %). Twenty cases of IE (44 %) were recorded in patients with non-corrected native-valve CHD. Of the 24 patients with prosthetic-valve IE, post-operative acquisition during the first 6 months was confirmed in 11 patients (range 4-110 days). IE was community-acquired in 62 % of cases. Streptococcus spp. were the most frequent etiologic agents (33 %), followed by Staphylococcus spp. (32 %). Surgery was required to treat IE in 47 % of patients (52 % in prosthetic-valve IE and 41 % in native-valve IE, p = ns). In comparison to native-valve IE, prosthetic-valve IE was significantly more nosocomial-acquired (61 vs. 14 %, p = 0.002), presented a higher heart failure rate at diagnosis (39 vs. 9 %, p = 0.035), and developed more breakthrough bacteremia episodes (19 vs. 0 %, p = 0.048). Global mortality was 24 % (75 % in patients with prosthetic-valve IE who required surgery and 0 % in patients with native-valve IE who required surgery, p = 0.001). Multivariate analysis excluding breakthrough bacteremia (100 % mortality in this condition) confirmed that nosocomial IE [odds ratio (OR), 23.7; 95 % confidence interval (CI), 2.3-239.9] and the presence of heart failure at diagnosis of IE (OR, 25.9; 95 % CI, 2.5-269.6) were independent factors associated with mortality. CONCLUSION: Half of all cases of IE in patients with CHD occurred in patients with non-corrected native-valve CHD and two-thirds were community-acquired. Streptococcus spp. were the most frequent etiological agents. Patients with prosthetic-valve IE present a worse outcome, especially those requiring surgery. Breakthrough bacteremia, nosocomial IE, and heart failure are independent factors of mortality in patients with CHD presenting IE.

Consenso clínico sobre la profilaxis de la infección por virus respiratorio sincitial y el uso del palivizumab en cardiología pediátrica / Clinical consensus on respiratory syncytial virus (RSV) infection prophylaxis and the use of palivizumab in paediatric cardiology

Antecedentes: Tras la finalización y análisis de resultados del estudio CIVIC, la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (SECPCC) plantea la necesidad de revisar sus recomendaciones para la prevención del VRS en niños con cardiopatías congénitas. Para considerar tanto la valoración de las nuevas evidencias disponibles como la experiencia preventiva acumulada por los cardiólogos infantiles, se propone efectuar dicha actualización mediante un método estructurado de consenso profesional. Objetivos: Desarrollar un consenso clínico español sobre la prevención de la infección por virus respiratorio sincitial, bajo el auspicio de la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. Métodos: Consenso Delphi modificado en 2 rondas. El estudio se efectuó en 4 fases: 1) constitución de un comité científico, impulsor del proyecto y responsable de la revisión bibliográfica y de la formulación de las recomendaciones a debate; 2) constitución de un panel experto multicéntrico con 75 representantes de la especialidad; 3) encuesta postal en 2 rondas con procesamiento intermedio de opiniones e informe a los panelistas, y 4) discusión de resultados en sesión presencial del comité científico. Resultados: Cincuenta y cinco expertos consultados completaron las 2 rondas de evaluación del cuestionario. En la primera ronda se lograron consensuar 44 de las 70 cuestiones analizadas. Tras la interacción del panel, se aumentó el consenso hasta un total de 54 ítems de la encuesta (el 77% de los contenidos propuestos). En las 16 cuestiones restantes no se consiguió un consenso suficientemente unánime, bien por disparidad de opiniones entre los profesionales, bien por falta de criterio establecido en la mayoría de los expertos. Conclusiones: Se presenta y actualiza una lista de recomendaciones profilácticas frente al virus respiratorio sincitial, cualificadas según el grado de acuerdo profesional en que se sustentan, que pueden considerarse vigentes hasta la aparición de nueva información científica que justifique su revisión (AU)

Background: Following the results of the CIVIC study, the SECPCC proposes to revise its recommendations for the prevention of RSV, taking into account the new evidence, as well as the preventive experience of paediatric cardiologists. For this purpose a structured method of professional consensus has been chosen. Objectives: To develop a Spanish clinical consensus on preventing infection by RSV under the auspices of the Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. Methods: Delphi Consensus modified in two rounds. The study was conducted in four phases: 1) constitution of a Scientific Committee for bibliographic review and submission of the recommendations for discussion, 2) constitution of an Expert Panel with 75 representatives in the speciality, 3) postal survey organised in two rounds and intermediate processing of opinions, and issuing of a report to the panellists, and 4) discussion of the results in a face-to-face meeting of the Scientific Committee. Results: Consensus was reached on 54 of the 70 preventive recommendations analysed. With respect to the 16 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. Conclusions: A set of recommendations for RSV prophylaxis in cardiology was developed and updated, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a further review (AU)

[Clinical consensus on respiratory syncytial virus (RSV) infection prophylaxis and the use of palivizumab in paediatric cardiology.]. / Consenso clínico sobre la profilaxis de la infección por virus respiratorio sincitial y el uso del palivizumab en cardiología pediátrica.

BACKGROUND: Following the results of the CIVIC study, the SECPCC proposes to revise its recommendations for the prevention of RSV, taking into account the new evidence, as well as the preventive experience of paediatric cardiologists. For this purpose a structured method of professional consensus has been chosen. OBJECTIVES: To develop a Spanish clinical consensus on preventing infection by RSV under the auspices of the Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. METHODS: Delphi Consensus modified in two rounds. The study was conducted in four phases: 1) constitution of a Scientific Committee for bibliographic review and submission of the recommendations for discussion, 2) constitution of an Expert Panel with 75 representatives in the speciality, 3) postal survey organised in two rounds and intermediate processing of opinions, and issuing of a report to the panellists, and 4) discussion of the results in a face-to-face meeting of the Scientific Committee. RESULTS: Consensus was reached on 54 of the 70 preventive recommendations analysed. With respect to the 16 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. CONCLUSIONS: A set of recommendations for RSV prophylaxis in cardiology was developed and updated, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a further review.

[Spanish multidisciplinary consensus on the prevention of respiratory syncytial virus infection in children]. / Consenso multidisciplinar español sobre la profilaxis de la infección respiratoria pediátrica por virus respiratorio sincitialConsenso.

BACKGROUND: A certain degree of feasibility exists in Spanish clinical practice with respect to interventions performed to prevent paediatric respiratory infection by RSV, including hygienic measures and intramuscular immunoprophylaxis with palivizumab. This task involves different paediatric specialties that may have a different perception of the magnitude of the problem and different professional criteria regarding the most appropriate actions. OBJECTIVES: To develop Spanish multidisciplinary consensus on preventing infection by RSV with the participation of the paediatric scientific societies involved (SNS, SSPC, SSPP and SSHPO). METHODS: Delphi Consensus modified in two rounds was used. The study was conducted in four phases: 1) constitution of a multidisciplinary Scientific Committee at the recommendation of the scientific entities participating in the study, for bibliographic review and submission of the recommendations to discussion; 2) constitution of an Expert Panel with 77 speciality representatives; 3) postal survey organised in two rounds and intermediate processing of opinions and issuing of a report for the panellists, and 4) discussion of the results in a meeting of the Scientific Committee. RESULTS: Consensus was reached on 48 of the 57 preventive recommendations analysed. With respect to the 9 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. Only in 3 recommendations was the opinion of the experts associated with the speciality of origin. CONCLUSIONS: A list of anti-RSV prophylactic recommendations was submitted, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a review thereof.

Consenso multidisciplinar español sobre la profilaxis de la infección respiratoria pediátrica por virus respiratorio sincitial. Consenso / Spanish multidisciplinary consensus on the prevention of respiratory syncytial virus infection in children

Antecedentes: Existe cierta variabilidad de práctica clínica en España sobre las intervenciones preventivas para evitar la infección respiratoria infantil por el virus respiratorio sincitial (VRS), entre las que se incluyen medidas higiénicas e inmunoprofilaxis intramuscular con palivizumab. Esta tarea implica varias especialidades pediátricas, que pueden tener distinta percepción de la magnitud del problema y distinto criterio profesional sobre las actuaciones apropiadas. Objetivos: Desarrollar un consenso multidisciplinar español sobre la prevención de la infección por VRS, con participación de las sociedades científicas pediátricas implicadas: Sociedad Española de Neonatología (SEN), Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (SECPCC), Sociedad Española de Neumología Pediátrica (SENP) y Sociedad Española de Hematología y Oncología Pediátrica (SEHOP). Métodos: Consenso Delphi modificado en dos rondas. El estudio se efectuó en cuatro fases: 1) constitución de un comité científico multidisciplinar, a propuesta de las sociedades científicas participantes, para la revisión bibliográfica y formulación de las recomendaciones a debate; 2) constitución de un panel experto con 77 representantes de las especialidades; 3) encuesta postal en dos rondas con procesamiento intermedio de opiniones e informe a los panelistas, y 4) discusión de resultados en sesión presencial del comité científico. Resultados: Se consensúan 48 de las 57 recomendaciones preventivas analizadas. En las nueve cuestiones restantes no se consigue acuerdo, bien por disparidad de opinión profesional, bien por falta de criterio establecido en la mayoría de los expertos. Sólo en tres recomendaciones, la opinión de los expertos se asocia a la especialidad de procedencia. Conclusiones: Se presenta una lista de recomendaciones profilácticas anti-VRS, cualificadas según el grado de acuerdo profesional en que se sustentan, que pueden considerarse vigentes hasta la aparición de nueva información científica que indique su revisión (AU)

Background: A certain degree of feasibility exists in Spanish clinical practice with respect to interventions performed to prevent paediatric respiratory infection by RSV, including hygienic measures and intramuscular immunoprophylaxis with palivizumab. This task involves different paediatric specialties that may have a different perception of the magnitude of the problem and different professional criteria regarding the most appropriate actions. Objectives: To develop Spanish multidisciplinary consensus on preventing infection by RSV with the participation of the paediatric scientific societies involved (SNS, SSPC, SSPP and SSHPO). Methods: Delphi Consensus modified in two rounds was used. The study was conducted in four phases: 1) constitution of a multidisciplinary Scientific Committee at the recommendation of the scientific entities participating in the study, for bibliographic review and submission of the recommendations to discussion; 2) constitution of an Expert Panel with 77 speciality representatives; 3) postal survey organised in two rounds and intermediate processing of opinions and issuing of a report for the panellists, and 4) discussion of the results in a meeting of the Scientific Committee. Results: Consensus was reached on 48 of the 57 preventive recommendations analysed. With respect to the 9 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. Only in 3 recommendations was the opinion of the experts associated with the speciality of origin. Conclusions: A list of anti-RSV prophylactic recommendations was submitted, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a review there of (AU)

Exploración cardiológica / No disponible

El soplo cardiaco es el motivo de consulta más frecuente en cardiología pediátrica. La inmensa mayoría de los casos vienen referidos desde la consulta de pediatría de Atención Primaria, y es aquí donde se plantean las primeras dudas acerca de la naturaleza del soplo: funcional u orgánico. En el presente trabajo se pretende recordar los puntos principales en los que se apoya el reconocimiento o al menos, la sospecha, de una u otra clase, de soplo cardiaco. Sin olvidar la gran importancia que tiene una historia clínica y una exploración pormenorizadas, se detiene principalmente en la exploración cardiovascular y, especialmente, en la descripción de los diferentes soplos, con especial atención a los de carácter funcional o inocente. También se sugieren algunas de las principales razones para derivar a un niño portador de soplo cardiaco, a la consulta de cardiología pediátrica. En el taller se presentarán casos clínicos característicos cuyo diagnóstico se discutirá de manera interactiva con los alumnos

The cardiac murmur is the mean cause of consulting in Paediatric Cardiology. The majority of the cases is referred from the Primary Care paediatrician, and is here where the doubts about the nature of the murmur (functional or pathologic) are first posed. The aim of the present work is to remember the main aspects to distinguish them, with special emphasis in the description of the different kind of murmurs, without forgetting to make a detailed physical exam and a complete clinical history. Also, some of the mean reasons to refer the case to the paediatric cardiologist are exposed. In the workshop, some characteristic cases will be presented with discussion of their diagnosis

La tetralogía de Fallot operada. Complicaciones en su evolución a largo plazo / Operated tetralogy of Fallot. Complications in its long term course

La tetralogía de Fallot es la cardiopatía congénita cianosante más frecuente en la edad pediátrica. Los óptimos resultados de su corrección quirúrgica con una elevada supervivencia ha incrementado la necesidad de un seguimiento a largo plazo después de dicha reparación. Durante el mismo, se pone de manifiesto la presencia de complicaciones tardías entre la que destacan la insuficiencia valvular pulmonar, la dilatación ventricular derecha secundaria a la misma, y la presencia de arritmias. Actualmente, el reemplazo valvular pulmonar está asociado con una mejoría clínica en pacientes sintomáticos con un impacto positivo sobre el tamaño y función del ventrículo derecho. Sin embargo no existen unos criterios unificados, tanto clínicos como de imagen, que indiquen el momento más óptimo para dicho reemplazo valvular. En el presente artículo ser revisan los aspectos teóricos del seguimiento de estos pacientes y las diferentes complicaciones tardías expresadas en la literatura, con especial atención a las indicaciones del reemplazo valvular pulmonar y a la consecuencias observadas en el curso clínico de estos pacientes (AU)

The Tetralogy of Fallot is the cyanotic congenital heart defect more frequent in the pediatric age. Its optimal surgical results with a high survival in the follow-up, has increased the need of a long follow-up after correction. This pursuit shows the presence of late complications, like the pulmonary valve insufficiency, the secondary right ventricular dilatation, and the presence of arrhythmias. Nowadays, the pulmonary valve replacement is associated with an improvement in symptomatic patients with a positive impact in the size and function of right ventricle. However, do not exist unified clinics criteria indicating the optimal moment of this valve replacement (AU)

[Early postoperative complications of thoracoscopy versus thoracotomy in pediatric idiopathic scoliosis]. / Estudio comparativo de las complicaciones postoperatorias inmediatas de la toracoscopia frente a la toracotomía en la escoliosis idiopática infantil.

INTRODUCTION: Thoracoscopic surgery has been used for anterior release, discectomy, and fusion in severe scoliosis or kyphosis. The indications of thoracoscopy for the treatment of pediatric spinal deformity are similar to those of thoracotomy-based spinal surgery. OBJECTIVE: We designed a comparative study to observe the immediate complications in the postoperative period after thoracoscopy or thoracotomy for scoliosis in the pediatric population. MATERIAL AND METHODS: The postsurgical complications of 63 interventions for idiopathic scoliosis over a 10-year period were analyzed. Conventional thoracotomy was used in 37 interventions (59 %) and thoracoscopy was used in 26 (41 %). RESULTS: In patients treated with the thoracolumbar endoscopic procedure, oral nutrition was resumed earlier, the mean length of hospital stay was lower, and debit drainage or requirement of surgical drainage were lower. CONCLUSIONS: Fewer immediate postsurgical complications were observed in scoliosis surgery when thoracoscopy was used.

Estudio comparativo de las complicaciones postoperatorias inmediatas de la toracoscopia frente a la toracotomía en la escoliosis idiopática infantil / Early postoperative complications of thoracoscopy versus thoracotomy in pediatric idiopathic scoliosis

Introducción La toracoscopia es una técnica quirúrgica que se utiliza en cirugía anterior, discectomía y fusión vertebral en pacientes con escoliosis o cifosis graves. Las indicaciones de la toracoscopia para el tratamiento de la deformidad espinal son similares a las de la toracotomía. Objetivo Nos planteamos el estudio comparativo de las complicaciones postoperatorias inmediatas de la toracoscopia frente a la toracotomía en escoliosis infantil. Material y métodos Se analizó, en un período de 10 años, el postoperatorio de 63 intervenciones quirúrgicas de escoliosis idiopática, de las cuales 37 (59 %) se realizaron mediante toracotomía convencional y 26 (41 %) mediante abordaje endoscópico toracolumbar. Resultados En el grupo de pacientes a los que se les practicó un abordaje endoscópico toracolumbar la tolerancia oral fue más precoz y el tiempo de estancia media, así como el débito y requerimiento de los drenajes quirúrgicos fue menor. Conclusiones Las complicaciones de la cirugía de escoliosis en el postoperatorio inmediato son menores cuando la técnica quirúrgica empleada es la toracoscopia

Introduction Thoracoscopic surgery has been used for anterior release, discectomy, and fusion in severe scoliosis or kyphosis. The indications of thoracoscopy for the treatment of pediatric spinal deformity are similar to those of thoracotomy-based spinal surgery. Objective We designed a comparative study to observe the immediate complications in the postoperative period after thoracoscopy or thoracotomy for scoliosis in the pediatric population. Material and methods The postsurgical complications of 63 interventions for idiopathic scoliosis over a 10-year period were analyzed. Conventional thoracotomy was used in 37 interventions (59 %) and thoracoscopy was used in 26 (41 %). Results In patients treated with the thoracolumbar endoscopic procedure, oral nutrition was resumed earlier, the mean length of hospital stay was lower, and debit drainage or requirement of surgical drainage were lower. Conclusions Fewer immediate postsurgical complications were observed in scoliosis surgery when thoracoscopy was used

[Early postoperative complications after scoliosis surgery]. / Complicaciones médicas precoces en el postoperatorio de cirugía de escoliosis.

Several medical complications can occur after scoliosis surgery in children and adolescents. New surgical techniques have allowed greater degrees of scoliosis correction but have also increased the possibility of postsurgical deficit due to their greater aggressivity. We analyzed the early postsurgical complications of scoliosis surgery in a pediatric intensive care unit over a 10-year period. Seventy-six surgical procedures were performed. Of these, no complications occurred in 55 (73%). Chest X-ray revealed pulmonary atelectasia in 8 patients (10%) and pleural effusion in 7 patients (9%). Symptoms and signs of infection related to surgery were observed in only 6 children (8%). The absence of severe medical complications may be related to new surgical techniques and an experienced team.

Complicaciones médicas precoces en el postoperatorio de cirugía de escoliosis / Early postoperative complications after scoliosis surgery

Diversas complicaciones médicas pueden ocurrir tras la cirugía de columna. Las técnicas quirúrgicas actuales han permitido mayor grado de corrección de la escoliosis, pero al mismo tiempo ha aumentado la posibilidad de déficit postoperatorio debido a su mayor agresividad. Se analizaron las complicaciones precoces en el postoperatorio de cirugía de escoliosis en una unidad de cuidados intensivos a lo largo de 10 años. Se realizaron 76 intervenciones quirúrgicas, de las cuales en 55 (73 %) no hubo ningún tipo de complicaciones. En 8 pacientes (10 %) se observó en la radiografía de tórax una atelectasia pulmonar, siete (9 %) desarrollaron derrames pleurales y únicamente en 6 niños (8 %) se pudo constatar síntomas y signos infecciosos relacionados con la intervención quirúrgica. La ausencia de complicaciones médicas graves se debió, posiblemente, a la asociación de nuevas técnicas con un equipo experimentado

Several medical complications can occur after scoliosis surgery in children and adolescents. New surgical techniques have allowed greater degrees of scoliosis correction but have also increased the possibility of postsurgical deficit due to their greater aggressivity. We analyzed the early postsurgical complications of scoliosis surgery in a pediatric intensive care unit over a 10-year period. Seventy-six surgical procedures were performed. Of these, no complications occurred in 55 (73 %). Chest X-ray revealed pulmonary atelectasia in 8 patients (10 %) and pleural effusion in 7 patients (9 %). Symptoms and signs of infection related to surgery were observed in only 6 children (8 %). The absence of severe medical complications may be related to new surgical techniques and an experienced team

Tumoración sólida cardíaca por hidatidosis / Solid cardiac mass due to hydatidosis

No disponible

[Non-surgical treatment of aortic coarctation and recoarctation]. / Tratamiento no quirúrgico de la coartación y recoartación de aorta.

OBJECTIVES: To analyze the results of nonsurgical treatment of aortic coarctation and recoarctation by evaluating the results of each technique, and its complications and outcome. PATIENTS AND METHODS: The results were as follows: 51 children underwent balloon dilatation due to recoarctation (86.5 %); two underwent dilation of a native coarctation (3.3 %) and six underwent stent implantation for recoarctation (10 %). Age ranged from 2 to 236 months (109 +/- 63.45 months) with a follow-up of between 1 and 156 months (38.87 +/-32.96 months). RESULTS: The mean predilatation gradient in children with recoarctation was 34 +/- 11.62 mmHg, which decreased to 11 +/- 5.38 mm Hg (p < 0.0001). In 12 patients (20.3 %) effective dilatation was not achieved. The size of the stenosis was 6.7 +/- 2.35 mm predilatation, which increased to 9.3 +/- 3.10 mm (p < 0.0001) after dilatation with a percentage increase of 50.97. There were very few complications. Six children required subsequent redilatation. The experience with stent showed a mean gradient of 32.83 +/- 10.62 mm Hg, which decreased to 7.3 +/- 3.8 mm Hg (p < 0.0001) with a balloon/stenosis ratio of 1.94. CONCLUSIONS: We conclude that the interventionist technique is highly effective in both native coarctation and recoarctation in the short term, as well as subsequently, with very few complications. The stent technique produces equally good results in older children, which is promising for the future.

Tratamiento no quirúrgico de la coartación y recoartación de aorta / Non-surgical treatment of aortic coarctation and recoarctation

Objetivos: Analizar los resultados del intervencionismo no quirúrgico sobre la recoartación y coartación de aorta, valorando los resultados de cada técnica, las complicaciones y su evolución. Pacientes y métodos: Los tratamientos fueron: 51 dilatados con balón por recoartación (86,5 por ciento), dos en los que se dilató una coartación nativa (3,3 por ciento) y seis en los que se ha implantado un tubo expansible (stent) por recoartación (10 por ciento). Las edades oscilan entre los 2 y los 236 meses (109 +/- 63,45 meses), con un tiempo de seguimiento entre 1 y 156 meses (38,87 +/- 32,96 meses). Resultados: El gradiente predilatación en los niños recoartados fue de 34 +/- 11,62 mmHg, que descendió a 11 +/- 5,38 mmHg (p < 0,0001). Doce casos (20,3 por ciento) no obtuvieron una dilatación eficaz. El tamaño de la estenosis fue de 6,7 +/- 2,35 mm predilatación y aumentó a 9,3 +/- 3,10 mm (p < 0,0001) con un incremento porcentual del 50,97. Las complicaciones fueron escasas. Seis niños precisaron redilatación posterior. La experiencia con stent muestra un gradiente medio de 32,83 +/- 10,62 mmHg que descendió a 7,3 3,8 mmHg (p < 0,0001) con una relación globo-estenosis de 1,94. Conclusiones: La técnica intervencionista es muy eficaz, tanto en coartación nativa como en recoartación de aorta, en resultados inmediatos y durante la evolución, y con escasas complicaciones. Los stents en niños mayores obtienen igualmente excelentes resultados, abriendo un futuro esperanzador (AU)

Presente y futuro del tratamiento de la insuficiencia cardíaca / Present and future of cardiac failure treatment

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[The bidirectional Glenn operation in 100 cases with complex congenital heat diseases: factors influencing surgical results]. / La operación de Glenn bidirectional en 100 casos con cardiopatías congénitas complejas: factores determinantes del resultado quirúrgico.

OBJECTIVE: The bidirectional Glenn shunt is a well established surgical technique in children with complex congenital heart disease. The present study is a retrospective analysis of patients undergoing this operation in order to assess the influence of different variables in the outcome. PATIENTS AND METHOD: From December 1990 to June 2000, 100 patients received a bidirectional Glenn shunt. Two groups were defined, based on the outcome. Group A (n = 15, unsuccessfully result) including death and need to reoperate, and Group B (n = 85, patients with good outcome). RESULTS: The mortality was 8%. Eight patients were reoperated at follow-up. The survivors were followed for a mean of 3.5 years. Mean pulmonary artery pressure 7 mmHg was a factor associated with poor clinical progress. Other variables (age less than 1 year, excessive pulmonary blood flow, double Glenn operation, significant anatomic anomalies, and arrythmias), were also associated with outcome. Significant variations were observed in the time of by-pass or the need for aortic clamp in cases with simultaneous operative repair of pulmonary branch stenosis. Actuarial survival rate, most more than 1 year was 92%, and freedom from reoperation at 3 years was 90%. CONCLUSIONS: The bidirectional Glenn shunt is an excellent palliation in patients with functionally single ventricle. Mean pulmonary artery pressure was the most important variable related with the outcome. We are encouraged to continue with tendency to perform bidirectional Glenn shunt preferably early, avoiding, whenever possible, previous palliative surgery.