Canalización de los factores de riesgo cardiovascular tras un periodo de 25 años / Canalization evaluation of the cardiovascular risk factors after a 25-year period

INTRODUCCIÓN: Diferentes estudios indican que haber presentado algún tipo de factor de riesgo cardiovascular (FRCV) siendo niños predispone a seguir presentándolo de adultos. Nuestro objetivo fue analizar si los FRCV (sobrepeso/obesidad, hipertensión, síndrome metabólico) presentaban canalización en la edad adulta. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo, longitudinal y prospectivo con dos puntos de corte (1992 y 2018). Se ofreció participar en el estudio a los pacientes de la cohorte asturiana del estudio RICARDIN. Se realizaron determinaciones somatométricas, toma de tensión arterial y una extracción analítica en ayunas para determinar niveles de glucemia y perfil lipídico. Análisis estadístico: pruebas de correlación, pruebas t para datos pareados (variables cuantitativas) y pruebas de McNemar (variables categóricas); regresión logística binaria para calcular la odds ratio de presentar niveles elevados de un FRCV en 2018 tomando como variable independiente sus valores en 1992. RESULTADOS: Se estudiaron 72 pacientes. El 60% de los participantes con sobrepeso y el 100% de los que presentaban obesidad en 1992 lo seguían presentando en 2018. El tener hipercolesterolemia en 1992 multiplicaba por 4 el riesgo de presentarla en 2018 (OR= 4 IC95% [1,173-13,639], p= 0,027). Aquellos participantes con sobrepeso en la infancia presentaban niveles significativamente más altos de IMC, TAS, TAD y perímetro abdominal en la edad adulta. CONCLUSIONES: El sobrepeso y la hipercolesterolemia presentan una canalización significativa entre la infancia y la edad adulta. Dicha circunstancia obliga a iniciar el control de dichos FRCV en la infancia, para intentar evitar su perpetuación en el tiempo

INTRODUCTION: Different studies have indicated that having had any type of cardiovascular risk factor (CVRF) as a child predisposes to continuing to have it as an adult. Our objective has been to analyze if the CVRFs (overweight/obesity, hypertension, metabolic syndrome) had canalization in the adult age. MATERIAL AND METHODS: Observational, descriptive, longitudinal and prospective study with two cutoffs (1992 and 2018). Patients of the Asturian cohort of the RICARDIN study were offered to participate in the study. Somatometric measurements and blood pressure measurements as well as blood drawing at fasting to determine levels of glucose and lipid profile were performed. Statistical analysis: correlation tests, T tests for paired data (quantitative variables) and Mc Nemar tests (categorical variables); binary logistic regression to calculate the odds ratio of presenting elevated levels of CVRF in 2018, using their levels in 1992 as independent variable. RESULTS: 72 patients were studied. 60 % of the participants with overweightness and 100% of those who presented obesity in 1992 continued to present them in 2018. Having hypercholesterolemia in 1992 multiplied the risk of having it in 2018 4 times (OR= 4 CI95% [1.173-13.639], p= 0.027). Those participants who were overweight in childhood presented significantly higher levels of BMI, SBP, DBP and waist circumference in the adult age. CONCLUSIONS: Being overweight and having hypercholesterolemia presents a significant canalization between childhood and adult age. Said circumstance makes it necessary to initiate control of said CVRFs in childhood, to try to avoid their indefinite continuation over time

[Percutaneous balloon pulmonary valvuloplasty: the medium-term results in a series of 100 consecutive pediatric patients]. / Valvuloplastia pulmonar percutánea con balón: resultados a medio plazo de una serie de 100 pacientes pediátricos consecutivos.

OBJECTIVE: To study medium-term follow-up in children with pulmonary stenosis (PS) with percutaneous balloon pulmonary valvuloplasty (PBVP). PATIENTS AND METHODS: Medium-term follow-up results of 106 consecutive PBVP procedures in 100 patients of the same health center are presented. The mean age of the patients was 61.3 +/- 5.1 months, 31 of them with severe PS. RESULTS: After PBVP, and once infundibular contraction ceased, the procedure was defined as successful in 85 children. PBVP was repeated in five patients, achieving satisfactory results in 3. Eight patients suffered from re-stenoses and surgery was performed in 7 of them. The other 12 patients in which PBVP failed underwent surgery. Follow-up of these 88 patients showed a cessation in clinical symptomatology at a mean of 10 +/- 0.7 months. Five-year actuarial probability of achieving a normal EKG axis was 61.7 +/- 9.1%. However, neither ECG nor chest radiology were useful in the diagnosis of high residual gradients. Pulmonary regurgitation was observed in 92% of the children, mild in all of them. The residual transpulmonary gradient obtained immediately after PBVP was the only variable that affected long-term results. CONCLUSIONS: Our results confirm the medium-term success of PBVP in the treatment of PS. The five year actuarial probability of restenosis is 12.4%. Mild pulmonary regurgitation is observed in more than 90% of patients.

[Unilateral agenesis of the pulmonary artery. Experience with 4 cases]. / Agenesia unilateral de la arteria pulmonar. Experiencia en 4 casos.

We present our experience with four cases of unilateral pulmonary agenesis, 3 of the right artery and the other one of the left. Two of the patients had pulmonary hypertension and one of them died at two years of age. All cases were diagnosed by using pulmonary angiography. Aortography demonstrated the absence of circulatory supply to the lung and a contralateral aortic arch to the absent pulmonary artery. We have performed a review of the literature with an emphasis on the diagnostic aspects of this condition, and discuss the considerations for possible surgery in symptomatic patients.

[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)