Valoración pronóstica del switch arterial en la transposición de grandes arterias / Prognostic evaluation of arterial switch in the transposition of great arteries

Introducción y objetivos: El switch arterial es la intervención de elección para la transposición de grandes arterias con o sin comunicación interventricular. El objetivo ha sido la identificación de factores de riesgo de mortalidad hospitalaria. Métodos: Se intervinieron 121 niños entre enero de 1994 y junio de 2008. De ellos, 80 (66%) fueron diagnosticados de transposición con septo íntegro, y 41 (34%) con comunicación interventricular. Se recogieron variables del preoperatorio, de la intervención y del postoperatorio. Resultados: La edad fue de 11 [8 – 16] días y el peso de 3,5 [3,0 – 3,7] kg. A 11 niños (9,1%) se les cerró la comunicación interventricular. El 81,8% presentaba un patrón coronario normal. Se hizo cierre diferido del tórax en 38 pacientes (31,4%). La mortalidad hospitalaria fue del 11,6%, reduciéndose en los últimos 5 años al 2,1%. El peso, el patrón coronario anormal, el tiempo de circulación extracorpórea, la tensión arterial media al ingreso, el espacio muerto pulmonar y el cierre diferido del esternón fueron factores de riesgo de mortalidad. El modelo que mejor predice la muerte es el constituido por la tensión arterial media al ingreso y el cierre diferido del esternón. Conclusiones: La reducción en el tiempo de circulación extracorpórea y en el cierre diferido del esternón han contribuido a reducir la mortalidad. El patrón coronario anormal continúa siendo un factor de riesgo de mortalidad. En los niños con cierre diferido del esternón, una tensión arterial media al ingreso ≥ 47,5 mmHg es un objetivo a conseguir (AU)

Introduction and objectives: The arterial switch is the procedure of choice for transposition of great arteries, with or without ventricular septal defect. The aim of this study was to identify risk factors for hospital mortality. Methods: The study included 121 children between January 1994 and June 2008. Of these, 80 (66%) were diagnosed with intact ventricular septum, and 41 (34%) with ventricular septal defect. Variables were collected pre-operatively, during surgery, and postoperatively. Results: The mean age was 11 [8 to 16] days and a mean weight of 3.5 [3.0 to 3.7] kg. A ventricular septal defect was closed in 11 children (9.1%). A total of 81.8% had a normal coronary pattern. There was delayed closure of the chest in 38 patients (31.4%). The hospital mortality was 11.6%, decreasing over the past 5 years to 2.1%. The weight, abnormal coronary pattern, time of cardiopulmonary bypass, mean arterial pressure at admission, pulmonary dead space, and delayed closure of the chest, were risk factors of mortality. The model that best predicts the death, consists of the mean arterial pressure at admission, and delayed closure of the chest. Conclusions: The reduction in extracorporeal circulation time and the use of delayed closure of the chest, have helped to reduce mortality. The abnormal coronary pattern remains a risk factor for mortality. In children with delayed closure of the chest, a mean arterial pressure at admission ≥ 47.5 mmHg is a goal to achieve (AU)

[Prognostic evaluation of arterial switch in the transposition of great arteries]. / Valoración pronóstica del switch arterial en la transposición de grandes arterias.

INTRODUCTION AND OBJECTIVES: The arterial switch is the procedure of choice for transposition of great arteries, with or without ventricular septal defect. The aim of this study was to identify risk factors for hospital mortality. METHODS: The study included 121 children between January 1994 and June 2008. Of these, 80 (66%) were diagnosed with intact ventricular septum, and 41 (34%) with ventricular septal defect. Variables were collected pre-operatively, during surgery, and postoperatively. RESULTS: The mean age was 11 [8 to 16] days and a mean weight of 3.5 [3.0 to 3.7] kg. A ventricular septal defect was closed in 11 children (9.1%). A total of 81.8% had a normal coronary pattern. There was delayed closure of the chest in 38 patients (31.4%). The hospital mortality was 11.6%, decreasing over the past 5 years to 2.1%. The weight, abnormal coronary pattern, time of cardiopulmonary bypass, mean arterial pressure at admission, pulmonary dead space, and delayed closure of the chest, were risk factors of mortality. The model that best predicts death, consists of the mean arterial pressure at admission, and delayed closure of the chest. CONCLUSIONS: The reduction in extracorporeal circulation time and the use of delayed closure of the chest, have helped to reduce mortality. The abnormal coronary pattern remains a risk factor for mortality. In children with delayed closure of the chest, a mean arterial pressure at admission ≥ 47.5 mmHg is a goal to achieve.

[The psychoneurological status of newborn infants with congenital heart disease before surgical intervention]. / Estado psiconeurológico de los recién nacidos afectados de cardiopatía congénita antes de su intervención.

AIMS: This study was conducted to evaluate, from a psychological and neurological point of view, the situation of newborn infants (NI) suffering from congenital heart disease before they are treated surgically. At the same time, we aimed to compare this group of patients with another group of children who were considered to be healthy. PATIENTS AND METHODS: Patients psychological development was evaluated using developmental landmarks from the Observational Scale of Development (OSD), which provides a percentage of elements acquired in different areas. Behaviour was evaluated by the observational recording of particular patterns of behaviour. The neurological study was based on a detailed neonatal examination, performed by people from the Child Neurology Section at our hospital, and which took into account the different behaviours displayed by the NI: reactive, grasping, communicative and affective. RESULTS: Findings show significant differences both in the psychological and neurological variables studied. They show how, generally speaking, healthy infants score higher in the areas of development that were evaluated than children suffering from heart disease. Likewise, lower average scores were observed in heart disease patients who require an early intervention, as compared with those who will be submitted to surgery later on. From the neurological point of view, a number of significant differences were found in their muscular activity. CONCLUSIONS: This analysis, a groundbreaker in the study of infants suffering from heart disease before their surgical intervention, shows how newborn infants who have been submitted to surgery in the neonatal period present a significant degree of hypotonia, a certain frailness and retardation in their motor development.

Estado psiconeurológico de los recién nacidos afectados de cardiopatía congénita antes de su intervención / The psychoneurological status of newborn infants with congenital heart disease before surgical intervention

Objetivo. Este estudio se llevó a cabo para evaluar, desde un punto de vista psicológico y neurológico, la situación de los recién nacidos que padecen una cardiopatía congénita, antes de tratarse quirúrgicamente, y, a su vez, comparar este grupo de pacientes con otro grupo de niños considerados sanos. Pacientes y métodos. El desarrollo psicológico se evaluó mediante hitos evolutivos procedentes de la escala observacional del desarrollo, la cual proporciona un porcentaje de elementos adquiridos en diversas áreas. El comportamiento se evalúa mediante el registro observacional de determinados patrones de conducta. El estudio neurológico se basó en un detallado examen neurológico neonatal, realizado por personas adscritas a la Sección de Neurología Infantil de nuestro hospital, en el que se tuvieron en cuenta las distintas conductas del recién nacido: reactiva, prensora, comunicativa y afectiva. Resultados. Los resultados muestran diferencias significativas, tanto en las variables psicológicas estudiadas como en las neurológicas. Muestran que, en general, los niños sanos obtienen puntuaciones más altas en las áreas de desarrollo evaluadas que los niños afectados de cardiopatías. Asimismo, se observan menores puntuaciones medias en los cardiópatas que deben intervenirse precozmente, que en los que se intervendrán con posterioridad. Desde el punto de vista neurológico, se encontraron unas diferencias significativas en la actividad muscular. Conclusiones. El presente análisis, pionero en el estudio de los niños cardiópatas antes de su intervención, demuestra que los neonatos que se han intervenido en el período neonatal ya presentaban, de forma significativa, hipotonía, cierta fragilidad y retraso en el desarrollo motor (AU)

Aims. This study was conducted to evaluate, from a psychological and neurological point of view, the situation of newborn infants (NI) suffering from congenital heart disease before they are treated surgically. At the same time, we aimed to compare this group of patients with another group of children who were considered to be healthy. Patients and methods. Patients’ psychological development was evaluated using developmental landmarks from the Observational Scale of Development (OSD), which provides a percentage of elements acquired in different areas. Behaviour was evaluated by the observational recording of particular patterns of behaviour. The neurological study was based on a detailed neonatal examination, performed by people from the Child Neurology Section at our hospital, and which took into account the different behaviours displayed by the NI: reactive, grasping, communicative and affective. Results. Findings show significant differences both in the psychological and neurological variables studied. They show how, generally speaking, healthy infants score higher in the areas of development that were evaluated than children suffering from heart disease. Likewise, lower average scores were observed in heart disease patients who require an early intervention, as compared with those who will be submitted to surgery later on. From the neurological point of view, a number of significant differences were found in their muscular activity. Conclusions. This analysis, a groundbreaker in the study of infants suffering from heart disease before their surgical intervention, shows how newborn infants who have been submitted to surgery in the neonatal period present a significant degree of hypotonia, a certain frailness and retardation in their motor development (AU)

[Surgical cryoablation in a child with malignant ventricular tachycardia refractory to drugs and radiofrequency ablation]. / Crioablación quirúrgica en un niño con taquicardia ventricular maligna refractaria a fármacos y a ablación por radiofrecuencia.

A ten-months-old child with incessant monomorphic ventricular tachycardia is presented. Tachyarrhythmia is refractory to antiarrhythmic drugs and refractory to endocardial radiofrequency current ablation. Epicardial cryoablation of arrhythmogenic area without artificial circulation resulted in the abrupt termination of tachycardia. No tachyarrhythmias were inducible postoperatively. The reduction of ventricular rate by surgical cryoablation does produces resolution of the arrhythmia-induced cardiomyopathy.

[Study of colloidal osmotic pressure-total proteins--serum albumin relationship during and after extracorporeal circulation]. / Etude de la relation pression colloïdale osmotique-protéines totales--albuminémie pendant et après la circulation extra-corporelle.

A postoperative increase in the pulmonary extravascular fluid volume (PEFV) and a disturbance of pulmonary gas exchange are regularly observed in patients undergoing cardiac surgery. These alterations, due to a reduction in the colloidal osmotic pressure (COP) increase the morbidity and mortality when crystalloid solutions are infused. This study was based on 90 patients infused with 1,500 cc of crystalloid solution without albumin. The COP, total proteins, albumin and globulin were determined in the plasma preoperatively, during bypass and immediately postoperatively, in order to define a formula allowing calculation of the COP from the plasma proteins to avoid reaching dangerously high figures. The authors concluded that there is a direct correlation between COP and total proteins (total proteins = 1.36 + 0.24 COP) and a potential curve with an adjustment point between COP and albumin (albumin = 0.23 COP0.93). Determination of the COP from globulins is not recommended. The authors elaborated two normograms for everyday clinical use. These formulae allow the calculation of COP in children, elderly subjects and patients in a critical condition, thereby avoiding dangerous levels of COP during infusion of crystalloid solutions.

[Anomalous origin of left coronary artery in pulmonary artery]. / Origen anómalo de la arteria coronaria izquierda en la arteria pulmonar.

We report 2 infants aged 6 months and one year with an anomalous left coronary artery origin treated surgically at our centre with direct aortic reimplantation of the anomalous coronary. Evolution has been satisfactory, with a great improvement of ventricular function. The mitral incompetence and congestive heart failure have disappeared and myocardic perfusion electrocardiographic patterns were corrected. Because of the unfavorable natural course of the disease and the improvement in techniques of coronary revascularization in infants we recommend an early surgical treatment as soon as it be diagnosed. We consider that the most adequate surgical treatment is the direct aortic reimplantation of the anomalous coronary artery.