Rescate transfemoral en un dispositivo TAVI transapical mal posicionado / Transfemoral rescue for a transapical malpositioned TAVI device

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Incidencia de las cardiopatías congénitas en la provincia de Badajoz / Incidence and clinical characteristics of congenital heart disease in Badajoz province, Spain

Introducción: Las cardiopatías congénitas son una patología sobre las que aún no hay un consenso claro respecto a su incidencia. El objetivo de este trabajo ha sido determinar su incidencia en la provincia de Badajoz. Material y métodos: Se ha realizado un estudio retrospectivo sobre las historias clínicas de los 742 pacientes vistos por primera vez en la Unidad de Cardiología Pediátrica del Hospital Materno-Infantil de Badajoz durante 1997. La incidencia de las cardiopatías congénitas se calcula sumando a los cardiópatas nacidos en 1997 y que manifestaron la patología ese mismo año, los que la presentaron en los años sucesivos respecto del total de recién nacidos en 1997. Esta última cifra se estima a partir del número de cardiópatas que nacieron antes de 1997 y que debutaron en 1997, comparando el número de recién nacidos de cada uno de esos años anteriores respecto al número de recién nacidos de 1997. Este total de cardiópatas se divide entre los recién nacidos en 1997 y se multiplica por 1.000. Resultados: El 15,6 % de los pacientes visitados en 1997 tenía patología cardíaca congénita. La incidencia sin considerar algunas cardiopatías leves (que tampoco suelen ser consideradas en otras publicaciones, como comunicación interauricular tipo ostium secundum pequeña, comunicación interventricular muscular pequeña, prolapso de la válvula mitral leve, válvula aórtica bicúspide, conducto arterial del prematuro, conducto arterial silente o arritmias congénitas) osciló entre 16,1 y 5,4 cardiópatas por 1.000 recién nacidos vivos y año. Conclusiones: La incidencia de las cardiopatías congénitas en la provincia de Badajoz oscila entre 16,1 y 5,4 por 1.000 recién nacidos vivos. Esta cifra se considera fiable y semejante a otras publicaciones recientes (AU)

Introduction: There is no clear consensus as regards the exact incidence of congenital heart disease. The objective of this study was to determine the incidence of congenital heart defects in Badajoz province (Spain). Material and methods: This is a retrospective study based on the clinical histories of 742 patients who were seen for the first time during 1997 in the paediatric cardiology unit of Badajoz Women and Children's Hospital. The incidence of congenital Heart defects is calculated by adding the number of patients assessed in 1997 and those who will be assessed in the future, considering the population born in 1997. The last figure is inferred from the number of patients who were born before 1997 and were assessed in that year, comparing the number of newborns between 1997 and previous years. The number of patients is divided by the total newborns in 1997 and multiplied by 1,000. Results: Congenital heart defects were found in 15.6 % of the patients seen during 1997. The incidence ranges from 16.1 to 5.4 new cardiac diseases per 1,000 newborn babies per year if some minor congenital heart defects that are not considered in other publications are excluded, such as interatrial communication of the ostium secundum type, interventricular communication of the small muscle, mild prolapsed mitral valve, bicuspid aortic valve, patent ductus arteriosus in prematures infants, silent ductus arteriosus and congenital arrhythmias. Conclusions: The incidence of congenital heart defects in Badajoz province range from 16.1 to 5.5 new cardiac diseases per 1,000 newborn babies per year. We consider that the incidence in the Badajoz province is reliable and similar to other recent publications (AU)

[Prognosis of organic mitral regurgitation and implications for surgical indications]. / Pronostic de l'insuffisance mitrale organique chronique et indications chirurgicales.

The term organic Mitral Regurgitation (MR) relates to MR secondary to anatomic alteration of the valvular or subvalvular mitral apparatus and refers to rheumatic MR and degenerative MR, i.e. mitral valve prolapse, which has become in the past 20 years the 1st cause of severe MR leading to surgery in western countries. Recent publications on the prognosis of patients with MR secondary to flail leaflet, showed that these patients incur excess mortality rates as compared to expected and that ten years after diagnosis, 90% of those will either be dead or operated on for severe symptoms. On the other hand, analysis of postoperative prognosis showed that the best results of surgical correction were observed in asymptomatic patients with normal pre-operative left ventricular function. The prognosis of these patients was then similar to that expected if a valvular repair was performed, making of mitral repair the hinge point of early surgical strategies.

An adult case with multiple cardiac valve prolapse and regurgitation.

A 56-year-old female had pure regurgitation in all cardiac valves. Color Doppler echocardiography showed a regurgitant jet in all cardiac valves. The severity of regurgitation due to the prolapse in all valves was moderate. The patient had no history of rheumatic fever, ischemic heart disease, endocarditis or hypertension. Physical characteristics of the patient were neither of Marfan's nor Ehlers-Danlos' syndrome. The etiology of regurgitation in all cardiac valves of this patient may be due to multiple valve prolapse.

[Four boys with multiple floppy valves involving all cardiac valves and hyperextensive joints].

We experienced four boys (two siblings) whose cardiac valves were all prolapsed, which have never been reported as a recognized disease. All had hyperextensive joints without any other stigmata of Marfan or Ehlers-Danlos syndrome. The severity and progression of regurgitation of each valve differed by a case, though they had similar echocardiographic findings consistent with the diagnosis of multiple floppy valves. Three of the four patients had severe aortic regurgitation, and two received aortic valve replacement. Their excised valves revealed myxomatous degeneration. The tricuspid valves were more thickened and redundant than the mitral valves. Although three patients had moderate tricuspid regurgitation, none of them had clinically important mitral regurgitation. We recommend aortic and/or mitral valve replacement, whenever the regurgitation exacerbates left ventricular dilatation. Aortic regurgitation deteriorated rapidly in one case due to valve rupture. In this case, moderate tricuspid regurgitation was relieved after aortic valve replacement. Skin fibroblast did not show any abnormalities in collagen biosynthesis.