[Pulmonary reperfusion syndrome after pulmonary stent implants in a patient with vascular tortuosity syndrome]. / Síndrome de reperfusión pulmonar tras implante de stents pulmonares en un paciente con síndrome de tortuosidad vascular.

Vascular tortuosity syndrome is a rare genetic disorder that causes tortuosity and stenosis of the pulmonary, systemic and / or coronary circulations. As a result of treatment of pulmonary stenosis, symptoms of pulmonary edema, known as lung reperfusion syndrome, may occur. The case is presented of an adolescent patient with vascular tortuosity syndrome who presented with a pulmonary reperfusion syndrome after multiple stent implants in the left pulmonary artery. After the procedure, the patient immediately developed an acute pulmonary edema with severe clinical deterioration, which required assistance with extracorporeal membrane oxygenation for recovery.

[Plastic bronchitis. A case report and review of the literature]. / Bronquitis plástica. A propósito de un caso y revisión de los casos asociados a cirugía de Fontan.

Plastic bronchitis is a rare complication in which bronchial casts of lymphatic origin develop in the tracheobronchial tree and cause airway obstruction. The main feature is expectoration of bronchial casts. This condition usually occurs in the postoperative period after the Fontan operation for congenital heart disease. Treatment modalities include mucolytics and chest physiotherapy, and in the most severe cases bronchoscopy to remove the casts and aerosolized urokinase or r-TPA. We describe a 12-year-old boy with pulmonary atresia with intact ventricular septum and severely hypoplastic right ventricle who underwent a modified Fontan operation at the age of 7 years. At the age of 12 years the patient started to present frequent episodes of coughing, dyspnea, and desaturation followed by difficult emission of white bronchial casts. An extracardiac Fontan conversion was performed to improve hemodynamics and symptoms. During the postoperative period frequent episodes of airway obstruction required bronchoscopy and finally improved with administration of aerosolized urokinase.

Development of a headspace solid-phase microextraction procedure for the determination of free volatile fatty acids in waste waters.

An analytical procedure based on headspace solid-phase microextraction (SPME) coupled to GC-flame ionization detection/Negative Chemical Ionization Mass Spectrometry has been developed for the determination of free volatile fatty acids (C2-C7) in waste water samples. Five different coatings have been evaluated and polydimethylsiloxane-Carboxen was the only fiber that allows a successful extraction of the shortest chain fatty acids (acetic and propionic). Several parameters such as extraction time and temperature, desorption conditions, agitation speed and sample volume have been optimized using the polydimethylsiloxane-Carboxen fiber. The linear dynamic range was over two-four orders of magnitude, depending on the acid. Procedural detection limits were in the low to medium microg/l levels and the RSDs were between 5.6% and 13.3%. To evaluate the applicability of the developed SPME procedure on real samples, fermented urban wastewaters were analysed.

Results of valvuloplasty in patients presenting deep venous insufficiency and recurring ulceration.

The purpose of this retrospective study was to assess mid-term results of valvuloplasty in patients presenting chronic recurring venous stasis ulceration. From 1988 to 1993, valvuloplasty was performed in the superficial femoral vein of 33 lower extremities in 28 patients presenting recurring ulceration. In 23 cases, previous surgery in the superficial venous system or perforating vein had failed. Preoperative work-up demonstrated primary deep venous insufficiency (PDVI) in 22 extremities (group I), proximal PDVI in association with distal postthrombotic syndrome (PTS) in 10 (group II), and Klippel-Trenaunay syndrome in 1. Hemodynamic assessment with tourniquet placement demonstrated a mean venous return time of 9 sec (+10, -8). Descending femoral phlebography showed Kistner grade 4 in 30 cases. Outcome was evaluated by clinical examination and Dupplex scan with photophlethysmography at follow-up times ranging from 2 to 7.6 years (mean: 51 months). Correlation between outcome of valvuloplasty and clinical findings was excellent. The incidence of poor clinical and hemodynamic results was higher for patients with PTS. Valve repair in association with surgery for superficial vein insufficiency and ligation of perforators gives good results in patients with isolated PDVI.

[Cardiac hydatid cyst in a child]. / Quiste hidatídico cardíaco en un niño.

Cardiac hydatid cyst is an uncommon disease, especially in children. The interventricular septum region is the most frequent localization. The cysts usually involve other organs making the etiologic diagnosis easier. Our young patient presented a single hydatid cyst. The etiologic diagnosis was difficult due to the negativity of the serologic tests and there were no other organs affected. Surgical ablation of the cyst was performed and histopathological analysis achieved.

[Fetal cardiac tumors]. / Tumores cardíacos fetales.

INTRODUCTION AND OBJECTIVES: Fetal cardiac tumors are rare and have a different histology than in adults: in the fetus, rhabdomyoma is more prevalent, but myxoma has not been described. We report our experience with nine fetuses with prenatally diagnosed primary cardiac tumours. METHODS: This is an observational and descriptive study of fetuses investigated because of the prenatal and echographic diagnosis of heart tumors. RESULTS: There were nine fetuses with thirteen cardiac masses among more than 700 fetal echocardiographic studies performed by pediatric cardiologists. Histology was available in four of them; three rhabdomyomas and once cavernous hemangioma. In one of the cases, the parents elected to interrupt the pregnancy; three patients died in the neonatal period (two as a direct consequence of the tumors and one due to sepsis) and we have no histological information regarding any of the other five fetuses. The subjects who survived beyond the neonatal period are mostly doing well. However, one developed tuberous sclerosis and another developed a hypoplastic left heart syndrome, perhaps due to the massive restriction of flow across the foramen ovale. The tumors in the other cases were well tolerated and hemodynamic or arrhythmic consequences were minimal of absent. No women with risk factors such as tuberous sclerosis were included in our study. CONCLUSIONS: Fetal cardiac tumors are rare and display a different histology. We recommend a conservative approach to treatment.

[Pre- and postoperative contribution of Doppler ultrasonography in superficial venous surgery of the popliteal fossa]. / Apport de l'écho-Doppler pré et postopératoire dans la chirurgie veineuse superficielle de la fosse poplitée.

AIMS OF THE STUDY: Does preoperative Duplex Scan (DS) allow to determine anatomy of the ending of the short saphenous vein (SSV), gastrocnemius vein (GV) and reflux in popliteal vein (PV), SSV and GV. Postoperative DS was performed to detect deep vein thrombosis (DVT) and GV thrombosis. MATERIAL AND METHODS: From June 94 to November 95 one hundred and eighty lower limbs operated for SSV were included consecutively and prospectively. Mean age in these 154 patients was 52 yr (24-80) with a sex ratio 4F/1M. An anatomical classification was previously defined. Type A: separate termination of SSV and GV; Type B: common ostium of SSV and GV in the popliteal vein; Type C: common trunk of the SSV and GV; Type D: Others. Forty-eight limbs (26.10%) had ligation of GV: 21 (11.10%) for reflux and 27 (16%) for anatomical or surgical reasons. Ten type A with GV reflux (10/31 = 32%) were not treated. Eighty two patients (45%) received preventive low molecular weight heparin (LMWH) treatment including the 48 limbs whose GV were ligated. RESULTS: Anatomical correlation between DS and surgery findings were calculated. Positive predictive values of DS in the different types were: A, 77%; B, 68%; C, 90%; D, 79%. That gave a global predictive value of 80%. Two limited DVT were identified in group D by postoperative DS (2/10 = 1.1%). These two patients had complete recanalization of PV without reflux. In the group of limbs which had ligation of GV we identified 37.5% of GV thrombosis. In the group without ligation of GV we found 3% of GV thrombosis. CONCLUSION: Duplex scanning appears to be the investigation of choice before surgery for superficial vein incompetence in the popliteal fossa. It is a reliable investigation to determine termination patterns of SSV and GV (80%). It brings to the surgeon essential information which helps in the management of surgical procedure and particularly to ligation of gastrocnemius veins. But at this time there is no consensus on this point. The occurrence of DVT after SSV surgery including GV ligation was very low. Two questions remain: is anticoagulation necessary in all patients or selective after surgery of the SSV? is Duplex Scan mandatory during postoperative monitoring? On the basis of this study, one recommendation can be made: A routine postoperative DS is necessary after ligation of the GV or when the dissection of the popliteal fossa has been extensive (Type D).

[Deep venous insufficiency and recurrent varicose veins after surgery of superficial venous insufficiency]. / Insuffisance veineuse profonde et récidive variqueuse après chirurgie de l'insuffisance veineuse superficielle.

Combination of deep and superficial venous insufficiency is far from exceptional and often causes severe chronic venous insufficiency (CVI). Does this association increase the risk of recurrent varicose veins after surgery of superficial insufficiency? After brief clinical and instrumental considerations in this situation, four series on this topic are analysed. Those published by Almgren, Guarnera, Darke and our personal series in which valve repair in the deep system was the inclusion criteria. Among the sixty seven patients included (80 lower limbs), fifty had previous surgery for varicose veins before valvuloplasty. Recurrence rate has been evaluated in both saphenous territories: great saphenous vein: 51% and short saphenous vein: 38.5%. It appears difficult to determine whether varicose vein recurrence is related to technical error at the initial operative procedure or due to the Primary Deep Vein Incompetence (PDVI). Nevertheless recurrence of varicose vein would appear to be frequent in the four series analysed. Many questions remain unanswered in this situation.

[Fetal supraventricular tachycardia]. / Taquicardias supraventriculares fetales.

BACKGROUND: Fetal supraventricular tachycardia is an infrequent and difficult to manage disease. Several therapeutic approaches have been proposed. We report our experience in its diagnosis and management. OBJECTIVES: Evaluation of the clinical features of fetal supraventricular tachycardia and efficacy of maternal and fetal medications in use for treatment. Immediate neonatal evolution is commented on. A therapeutic schema is proposed. PATIENTS: Nineteen fetuses with echocardiographically (M-mode and/or Doppler two dimensionally oriented) supraventricular tachycardia were diagnosed. RESULTS: Mean gestational age was 32 weeks; 8 fetuses had developed hydrops; 3 patients had dilated cardiomyopathy (two of them were hydropic). Two cases were prenatally diagnosed as atrial flutter (both of them without hydrops). Sixteen fetuses received transplacentary treatment: 8 with digital, 6 more associated with flecainide, direct administration of amiodarone to the fetus was added in two cases. Three patients died during follow-up (one postnatally, at third week of life), all of them had developed hydrops; arrhythmia characteristics were unmodified in three and control of cardiac rhythm was achieved in ten cases. CONCLUSIONS: In the majority of cases there are no cardiac malformations associated. It is possible to control the tachycardia, even if hydrops is present. It is not indicated to abbreviate the gestation. First election drugs are maternal digoxin and flecainide, they do not produce significant fetal or maternal secondary effects. Occasionally it is necessary to add or to change to other drugs or to propose more aggressive approaches.

[Incessant fetal tachycardia coinciding with supraventricular tachycardia of the mother]. / Taquicardia incesante fetal coincidiendo con taquicardia supraventricular de la gestante.

The case of a gestant diagnosed fetal arrhythmia in the 35th week of gestation is presented. A fetal echocardiography indicates an aneurysm of the interauricular septum and a fetal supraventricular tachycardia. Also is obtained an ambulatory 24-hour Holter electrocardiograph of the gestant and fetus rhythm. The register makes evident a gestant supraventricular tachycardia and as well a fetal supraventricular tachycardia, occurring in both without clinical company. Following the birth, the tachycardia in the newborn is identified to be automatic and incessant, requiring digital for its control. In postpartum registers of the mother no significant arrhythmia of any type is observed. We conclude that the ambulatory monitoring with a Holter electrocardiograph could be a good method of diagnosis and follow-up of fetal and gestant arrhythmias.

[Left heart catheterization by the transseptal route]. / Cateterismo cardíaco esquerdo por via transeptal.

PURPOSE: To analyse the transseptal catheterization technique, its indications and possible complications. METHODS: The transseptal catheterization has been undertaken in 233 patients, 202 children (aged 0.1 to 16 years) with congenital heart disease and 31 adults (aged 37 to 73 years) submitted to mitral valvuloplasty. The Mullins technique was employed to access left heart chambers. RESULTS: In the pediatric group, the indications for transseptal catheterization were coarctation of the aorta and valvular or subvalvular aortic stenosis. By this technique, multiple diagnostic analysis and therapeutic procedures, such as blade atrioseptostomy and mitral valvuloplasty, became available. Among the complications in the 2 groups, pericardial perforation was the most frequent, depending on the laboratory practice with this technique. CONCLUSION: The transseptal cardiac catheterization is a safe and effective technique to investigate hemodynamic data in several congenital heart diseases and is essential to many therapeutic procedures. The technique has a low incidence of complications when employed by experienced teams.

Physiological effects of ozone on cultivars of watermelon (Citrullus lanatus) and muskmelon (Cucumis melo) widely grown in Spain.

Two cultivars of watermelon (Citrullus lanatus) and muskmelon (Cucumis melo), which are widely grown in Spain, were exposed to ozone (70 nl litre(-1), 6 h d(-1)) for 21 days. Ozone sensitivity was assessed by recording the extent of visible injury, changes in fast-fluorescence kinetics, the relative-growth rate (R) of root (RR) and shoot (RS), and effects on the number of flowers produced per plant. Leaf gas exchange was measured in order to provide some indication of the factors underlying differential response to ozone. After 9-10 days of fumigation, all the cultivars developed typical visible symptoms of zone injury on the older leaves. However, significant (P < 0.05) changes in fast-fluorescence kinetics were detected prior to the development of visible foliar injury, indicating that detectable effects of ozone on primary photochemical processes supersede the appearance of visible symptoms. In both muskmelon and watermelon, there was a marked reduction in the rate of CO(2) assimilation as a result of exposure to ozone, and this was accompanied by a parallel decrease in stomatal conductance. Mean plant-relative-growth rate (R) was markedly (P < 0.01) suppressed by ozone in the two cultivars of watermelon, but there were no significant effects on R in muskmelon. Ozone reduced root growth relative to the shoot in three out of four cultivars-an effect that may be of considerable ecological significance. Moreover, exposure to ozone reduced flower production in both muskmelon and watermelon, which indicated effects on yield. There was no correlation between a variety of methods used to assess ozone sensitivity and visible injury, and reasons for this are discussed. This observation draws clear attention to the dangers in ranking plants for ozone sensitivity purely on the basis of visible symptoms. It is concluded from this study that ozone-insensitive genotypes should be identified and considered for planting in the major areas of melon production concentrated on the Mediterranean coast of Spain.

[Results of reconstructive surgery in deep venous reflux at the subinguinal stage. Apropos of 93 interventions]. / Résultats de la chirurgie restauratrice dans les reflux veineux profonds à l'étage sous-inguinal. A propos de 93 interventions.

This study is a retrospective analysis of results of 93 interventions performed between 1984 and 1991 with an uniform indication: deep venous valvular reflux. Out of these 93 procedures, fifty (54%) have been undertaken in post-thrombotic syndrome (PTS), thirty-seven (40%) in deep primary vein incompetence (DPVI). Technically speaking, 46 valvuloplasties, 26 transplantations, 12 transpositions and 9 Psathakis procedures have been performed. Sixty one patients have a follow-up from 2 to 7 years (mean 44 months). In majority, valvuloplasties have been done in DPVI. Clinical and hemodynamic results in this group are good in 80% of patients controlled. Conversely transpositions, transplantations and Psathakis procedures have been undertaken essentially in PTS. Results obtained in this group are less satisfactory in terms of clinical findings and particularly in hemodynamics. Each group is analysed in details.

[Therapeutic catheterization: the percutaneous closure of a persistent ductus arteriosus and of interatrial communication]. / Cateteristmo terapéutico: cierre percutáneo del ductus arteriosus persistente y comunicación interauricular.

Between february and december 1990, we attempted percutaneous closure of patent ductus arteriosus (PDA) in 26 patients and in one ostium secundum atrial septal defect (ASD). One of the PDA was right sided with right aortic arch and two were post surgical leaks. We used the "USCI-Rashkind PDA double disc occluder" and the newly designed "Lock Clamshell" occluder for the ASD. Twenty seven patients (20 females and 7 males), aged 1.3 to 16 years (M = 5.6) and weighing 9.5 to 56 kg (M = 21.3), were studied. Diagnosis was made clinically with the aid of Doppler colour flow echocardiography, with follow-up studies at 24 hours, 6 months and 1 year after the procedure. Diameter of the ductus varied from 1.6 to 8.2 mm (M = 2.6). Successful implant of the device was achieved in 25 cases (95%), of which 18 (72%) were totally occluded at 24 hours and 21 (84%) after 6 months, remaining small residual leaks in four (16%). In only one patient total occlusion was demonstrated 1 year after device implantation. We achieved 22 (88%) total occlusions. One case was not possible to occlude, due to its large size. Angiocardiography demonstrated adequate anatomy in 18, and difficult in 8 patients. Twelve and 17 mm devices were used in 16 and 9 patients, respectively. Successful second implant with subsequent total occlusion was achieved in one patient with a previous moderate residual leak. The ASD was central and single, with a diameter of 20 mm. Immediate total occlusion was achieved. We conclude that percutaneous PDA closure is a safe and effective procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

[Valve repair at the level of the sub-inguinal deep venous plexus. Gadget technique or efficacious surgery?]. / La réparation valvulaire au niveau du réseau veineux profond sous-inguinal. Gadget technique ou intervention efficace.

Between 1988 and 1990, the authors performed 35 valvuloplasties for major reflux syndrome involving the sub-inguinal deep venous system. Twenty two patients with a mean follow-up period of 23 months (1 year--3 years) were reviewed clinically and hemodynamically. Only one of the 10 patients with a chronic ulcer had developed a recurrence. This concerned the only postoperative thrombosis seen in this series. Results from a hemodynamic standpoint were as follows: Reflux evaluated preoperatively was Kistner type 4 with a popliteal venous reflux index (VRI) with a mean grade of 1.1. Postoperative evaluation (Duplex-Scan) showed the absence of reflux below the valvuloplasty in 86 p. cent of cases and VRI was normalised (less than 0.50) to the same extent. Mean venous filling time (PPG, peripheral pressure gradient measurement) after application of a supra-malleolar tourniquet was 8" (-8n + 4) preoperatively. It became normal in 13 patients and improved in 8 (mean of 82 p. cent). The results of valvuloplasty in this series confirm those published by other teams. They are notably superior to those offered by transposition and transplantation procedures. Unfortunately, this effective technique can only rarely be used in post-thrombotic syndromes and is useful essentially in Primary Deep Valve Insufficiency.

[The angiographic diagnosis of the connection of the persistent left vena cava superior to the left atrium by the absence of the roof of the coronary sinus in a child with a Holmes' heart]. / Diagnóstico angiográfico de la conexión de la vena cava superior izquierda persistente a la aurícula izquierda por ausencia de techo del seno coronario en un niño con corazón de Holmes.

We describe a patient with angiographic findings of a left superior persistent vena cava draining in the left atrium with absence of the coronary sinus' roof and coexisting with Holmes' heart. The diagnosis can be made by selective angiography in the left atrium, pulmonary vein or at the left superior vena cava. We want to emphasize the importance of knowing this sort of anomaly before surgical treatment.

[Extensive partial agenesis of the left pericardium. An anatomo-clinical correlation. Report of 2 cases]. / Agenesia parcial extensa do pericárdio esquerdo. Correlação anatomoclínica. Relato de dois casos.

The authors report on two patients with large partial congenital defect of the left pericardium, as observed at post-mortem examination. In both cases, diagnosis was made during life thanks to the clinical syndrome described by Abbott, Sothworth and Stenvenson. In the first case diagnosis was confirmed by pneumothorax proposed by Ellis et al and the second case was recognized by the clinical-radiological syndrome. The first patient was followed until his death. Because of an abnormal echogram, he was submitted to exploratory cardiotomy and small ASD, aneurysmatic dilation of Valsalva sinus and mitral regurgitation by ruptured chordae tendineae were found. The autopsy, besides the findings at the operation, showed residual adhesive pericarditis with a cavity at the postero-superior region of the heart behind the left auricle and a redundant tricuspid cusp. The association of congenital pericardium defect to mitro-tricuspid redundant cusps and aneurysmatic dilatation of the sinus of Valsalva--suggesting myxomatous degeneration--plus atrial septal defect as in case 1, has not been found in the medical literature. In the second patient the defect was recognized in spite of congestive heart failure and severe tricuspid regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Forma clínica isolada do "cor triatriatum". Novo sinal na radiologia convencional e aspectos particulares da ecocardiografia bidimensional / Isolated clinical form of cor triatriatum. New sign in conventional radiology and particular aspects of bidimensional echocardiography

E descrito um paciente com a forma do "cor-triatriatum" dando enfase aos achados da radiologia simples do torax e da ecocardiografia que ainda nao foram acentuados na literatura. No presente caso foi de fundamental importancia diagnostica uma forma inusitada de crescimento atrial esquerdo, vista na radiografia simples, que poderia ser um elemento utilissimo para o reconhecimento da anomalia