[Inferior vena cava thrombosis after corrective surgery for tricuspid atresia (Fontan technique) in a pediatric patient]. / Trombosis en vena cava inferior tras cirugía correctora de atresia tricuspídea (Técnica de Fontán) en paciente pediátrico.

A 13-year-old boy weighing 35 Kg underwent surgery to correct pulmonary valve atresia by total caval-pulmonary anastomosis (Fontan procedure). During surgery and recovery, no adverse events were observed. On the third day after surgery, the patient developed signs of low cardiac output, renal failure, and right ventricular insufficiency. In spite of an antithrombotic treatment protocol with sodium heparin (10 IU/Kg/h), venous return was found to be impeded by 2 thrombi in the inferior vena cava. Thrombolysis with urokinase was ineffective, and surgical thrombectomy was only partially successful. Finally, a high dose of intravenous heparin was prescribed (25 IU/Kg/h) and the thrombi were dissolved. The importance of prophylactic antithromboembolic therapy following corrective surgery for congenital heart disease must be emphasized. Ultrasound monitoring of these patients, even in the absence of clinical signs, has proven effective for early detection of the thrombotic events described in this report.

[Acute myocardial infarction in childhood. Report of 2 cases]. / Infarto agudo de miocardio en la infancia. A propósito de dos casos.

We review two cases of agenesis of the left coronary trunk, a very rare congenital malformation. Both patients presented at our children's hospital with acute myocardial infarction, the mortality rate of which is high in infancy and childhood. The most common causes of myocardial infarction are anomalous origin of left coronary artery and Kawasaki disease. Less common causes are myocarditis and absence of the left coronary artery. The patients' main symptoms of acute myocardial infarction were non-specific--dyspnea and feeding problems--as is usual in acute coronary disease in children. A definitive diagnosis was made by cardiac catheterization. Both patients required surgery: saphenous vein bypass graft in one case and heart transplantation in the second. We describe both cases and review the literature.