[Hemodynamic and angiocardiographic assessment of thoracopagus twins for surgical separation purposes]. / Evaluación hemodinámica y angiocardiográfica de gemelos toracópagos con finalidad de separación quirúrgica.

The rate of conjoined twins is 1 in 50,000 births. These patients usually have a common pericardial sac (90%) and conjoined hearts (75%). In case of shared heart there is a communication by a vascular channel between both atria and ventricles. If there is not ventricular communication, surgical separation is possible. We describe such a case in whom in spite that interventricular connections were present; surgical separation was decided because of the critical conditions of twin A in an effort to preserve the survival of twin B.

[Percutaneous transluminal angioplasty in aortic coarctation. The short- and median-term results]. / Angioplastía transluminal percutánea en coartación aórtica. Resultados a corto y mediano plazo.

Percutaneous transluminal angioplasty (PTA) was performed in 34 patients with aortic coarctation (Ao Co). One of them with coarctation after surgical correction, the rest were native Ao Co. We used one balloon in 28 patients and two balloons simultaneously in 6. They were separated in three groups according to the degree of aortic arc hypoplasia. Group I (mild to moderate hypoplasia N = 9) the gradient dropped 39% with angiographic improvement of 48% during the follow-up (m = 13.1 months). Three cases with restenosis, 2 were satisfactory dilated and one was sent to surgery. In Group II (severe hypoplasia N = 4) the gradient dropped 31% with angiographic improvement of 30% (follow-up 16.3 months). Two cases with recoarctation were sent to surgery. In Group III (without hypoplasia N = 21) we obtained dropped of gradient of 71% with angiographic improvement of 60% (follow-up 18.5 months). Two cases were redilated successfully. The complications were: cerebral hemorrhage with death due to hypertensive crisis, (1) cerebral embolism, (1) thrombosis in the puncture site 1 and small aneurysm in dilated zone. (1) We think PTA is a good choice to conventional surgery with low rate of morbidity-mortality. The results depend basically on the anatomic type of coarctation and degree of aortic arch hypoplasia.

[Percutaneous transluminal angioplasty using balloon catheter in a Blalock-Taussig pulmonary-systemic fistula]. / Angioplastia transluminal percutánea con catéter de globo en una fístula sistémico-pulmonar de Blalock-Taussig.

Percutaneous transluminal balloon angioplasty has been used successfully in the treatment of valvular and vascular stenosis. This article describes our experience with this technique to improve pulmonary blood flow in a patient with a severely stenotic Blalock-Taussig (B-T) systemic-to-right pulmonary artery anastomosis, with improvement in oxygen peripheric saturation from 33 to 78% immediately postdilatation and 69% three months later. Hemoglobin decreased from 20.4 to 18.9 gm/dl and hematocrit from 64% to 58.5%. In conclusion we think that this technique is an alternative instead of cardiac surgery, in these cases the procedure is only palliative.

[Valvuloplasty with balloon catheter in biologic prosthesis. Reality or illusion]. / Valvuloplastía con cáteter de globo en prótesis biológicas. Realidad o ilusión.

We performed catheter balloon valvuloplasty (CBV) on 8 stenotic operatively-excised bioprosthetic valves (2 Hancock and 6 Ionescu Shiley). Pathology of valves before CBV included degenerative changes: commissural fusion by mounds of calcific deposits (2 valves), fibrotic and focally calcified leaflets (7 valves) and stiff and thick valves (1 valve). Inflation of the balloon resulted in commissural splitting (2 valves), leaflet cracks and fractures (3 valves). Removal of the deflated balloon catheter was associated with debris dislodgement (3 valves). In one case the valve was unable to close with potential for acute regurgitation. Thus, CBV of bioprosthetic valves can split fused commissures by similar mechanisms as in native valves. CBV may fracture calcific deposits causing acute emboli. It can also disrupt the leaflets causing acute insufficiency. The findings suggest a limited role of CBV in the treatment of stenotic bioprosthetic valves in mitral and aortic position.

[Percutaneous pulmonary valvuloplasty. Short-term and long-term results]. / Valvuloplastía pulmonar percutánea. Resultados a corto y largo plazo.

Percutaneous angioplasty was performed in twenty consecutive patients, with congenital pulmonary valve stenosis. Ages ranged from eight months to thirty-two years (mean 9.5 years old). We achieved a valvular gradient dropping from 91 +/- 39 to 19 +/- 11 mm Hg (P less than 0.001) in early post angioplasty level and it was practically unchanged at three months and one year later. (19 +/- 12, 19 +/- 17 mm Hg) (P less than 0.001). Similar change was observed in the right ventricle systolic pressure which was diminished in a progressive way during the follow-up from 113 +/- 37 to 39 +/- 35 (P less than 0.001), 59 +/- 18 and 53 +/- 25 mm Hg (P less than 0.001) immediately, three months and one year later, respectively. The ratio right ventricle systolic pressure/left ventricle was diminished from 0.96 +/- 29 to 0.63 +/- 0.35 in the early post angioplasty period and later from 0.50 +/- 0.16 and 0.44 +/- 0.22 (P less than 0.001). Only one case had restenosis one year later and we repeated the angioplasty with good results. Most of the patients are asymptomatic, the pulmonary murmur features changed. We observed improvement in electrocardiographic and echocardiographic signs. One patient died of anesthetic complications. The remainder of patients did not have severe complications and they were discharged from 48 to 72 hours after angioplasty. In conclusion, valvuloplasty is an effective procedure in a short and long term basis. We considered valvuloplasty in congenital pulmonary valve stenosis the treatment of choice in this group of patients.

[Blade auricular septostomy]. / Septostomía auricular con navaja.

We describe the first case of BAS in our country in a three months old child with transposition of the great arteries, restrictive atrial septal defect (RASD) and intact interventricular septum. When he was 15 days old, we performed a balloon atrial septostomy. He had temporal improvement and six weeks later his cyanosis increased, and a new catheterization showed systemic arterial oxygen saturation of 30%, RASD and an interatrial pressure gradient of 2.1 mmHg (left atrium LA: 3.9 and right atrium RA: 1.8). We decided to perform a new septostomy with Park's blade atrial septostomy catheter. After the procedure the interatrial pressure gradient decreased to 0.2 mmHg (RA: 4.3 and LA: 4.5), the angiography shunt and atrial pressures increased. Five months later the child is alive and the systemic arterial oxygen saturation is 51.3%. The technique, advantages and complications are described.

[Transcatheter percutaneous commissurotomy in rheumatic mitral stenosis]. / Comisurotomía percutánea transcateterismo en la estenosis mitral reumática.

Percutaneous transcatheter balloon mitral commissurotomy was performed in an 11 year old girl. The atrial septum was perforated and an 8 mm angioplasty balloon was advanced the atrial septal perforation was then dilated to allow passage of 25 mm balloon valvuloplasty catheter across the mitral annulus. Transmitral balloon inflation acutely decreased the end diastolic transmitral gradient (23 mm Hg to 2 mm Hg). Immediate gradient reduction was associated with increases in cardiac output (3.4 to 5.3 L/min). Murmur intensity diminished immediately post-commissurotomy. Balloon commissurotomy did not produced mitral regurgitation. Five weeks later, follow-up catheterization was performed and did not show change in mitral valvular gradient (2 mmHg). Clinical improvement was evident.

[Percutaneous transluminal angioplasty in aortic coarctation. Report of a case]. / Angioplastía transluminal percutánea en coartación aórtica. Informe de un caso.

We describe the first case in our hospital of percutaneous transluminal angioplasty in a 16 years old boy with congenital coarctation of the aorta. The technique, hemodynamic findings, angiography before and after dilation and the advantages in comparison with the conventional cardiac surgery were analyzed. In our case the gradient decreased from 60 mmHg to 28 mmHg. We conclude that this procedure is an alternative treatment for patients with congenital coarctation of the aorta.

[Transcatheter pulmonary valvuloplasty]. / Valvuloplastía pulmonar transcateterismo.

We describe the first case of balloon pulmonary valvuloplasty performed in this country. This 12 year old girl had a transvalvular gradient of 94 mmHg and after the procedure it improved to 20 mmHg. Four months later, cardiac catheterization did not show any significative change in pulmonary valvular gradient (26 mmHg). We describe the technique, hemodynamic findings, complications, and advantages of this procedure. We also review the literature. We consider that balloon valvuloplasty should be the first choice procedure in the treatment of patients with congenital pulmonary valve stenosis.

[Crossed atrioventricular connection with straddling of the right atrioventricular valve]. / Conexion atrioventricular cruzada con cabalgamiento de la valvula atrioventricular derecha.

We describe one patient with crossed atrioventricular connection in situs inversus, concordant atrioventricular connection, double outlet right ventricle, and straddling of the right atrioventricular valve. Angiographic features are analyzed, pointing out the importance of selective angiography in order to define the atrioventricular and ventriculoarterial connections. The utility of bidimensional echocardiographic study before cardiac catheterization is emphasized in order to know the associated malformations.