Utility of Modified Ultrafiltration in Congenital Heart Disease Patients Operated with Cardiopulmonary Bypass

Modified ultrafiltration is used in cardiac surgery with cardiopulmonary bypass in order to diminish systemic inflammatory response syndrome. We aimed to show its utility for removing pro-inflammatory agents in operated pediatric patients with congenital heart disease and its impact at operative care. A clinical case-control trial was designed, including patients with simple congenital heart disease operated on with cardiopulmonary bypass in a 1-year period. We randomized them to a problem group (with modified ultrafiltration, n = 15) and a control group (without it, n = 16), and blood samples to measure interleukins (6 and 10); 3d and 4d complement fraction concentrations were taken at the following times: baseline, before cardiopulmonary bypass, after it, after modified ultrafiltration, and from the ultrafiltration concentrate. Operative clinical end points of success were defined as hemodynamic stability, absence of morbidity, and lack of mortality. We observed a higher significant interleukin 6 concentration in the problem group patients at baseline, as well as a higher removal of this pro-inflammatory agent at the ultrafiltration concentrate. Modified ultrafiltration has a positive impact over simple congenital heart disease surgery with cardiopulmonary bypass because of removing interleukin 6. We recommend its routine use when hemodynamic conditions are favorable

Impact of Modified Ultrafiltration in Congenital Heart Disease Patients Treated with Cardiopulmonary Bypass

Modified ultrafiltration is used in cardiac surgery with cardiopulmonary bypass in order to diminish systemic inflammatory response syndrome. We aimed to show its utility for removing pro-inflammatory agents in operated pediatric patients with congenital heart disease and its impact at operative care. A clinical case control trial was designed, including patients with simple congenital heart disease operated on with cardiopulmonary bypass in a 1-year period. We randomized them to a problematic group (with modified ultrafiltration, n = 15) and a control group (without it, n = 16), and blood samples to measure interleukins (6 and 10), 3d and 4d complement fraction concentrations were taken at the following times: baseline, before cardiopulmonary bypass, after it, after modified ultrafiltration, and from the ultrafiltration concentrate. Operative clinical end points of success were defined as hemodynamic stability, absence of morbidity, and lack of mortality. We observed a higher significant interleukin six concentration in the problematic group patients at baseline, as well as a higher removal of this pro-inflammatory agent at the ultrafiltration concentrate. Modified ultrafiltration has a positive impact over simple congenital heart disease surgery with cardiopulmonary bypass because of removing interleukin 6. We recommend its routinely use when hemodynamic conditions are favorable

Revascularización coronaria en enfermedad de Kawasaki

Kawasaki´s disease (KD) has surpassed rheumatic fever in many countries as the first cause of acquired heart disease in pediatric age, being the coronary aneurism its worst complication. We present a case of successful revascularization in a 5-year-old patient, with three-vessel coronary disease secondary to KD, who underwent a coronary bypass with anastomosis from the left internal mammary artery to the anterior descending artery, the right mammary artery to the marginal obtuse artery and the radial artery to the posterior descending artery. Close follow-up and choosing the right time to undergo surgery will prevent adverse events like permanent disability of the patient, ventricular dysfunction, arrhythmias, global infarction and sudden death.La enfermedad de Kawasaki (EK), ha sobrepasado en muchos países a la fiebre reumática como primera causa de cardiopatía adquirida en la edad pediátrica, siendo su secuela más grave los aneurismas coronarios. Presentamos el caso de revascularización quirúrgica exitosa en un paciente de 5 años de edad, con lesión trivascular coronaria secundaria a EK, a quien se le realizó una derivación coronaria con anastomosis de la arteria mamaria interna izquierda a la descendente anterior, la arteria mamaria derecha a la obtusa marginal y la arteria radial a la descendente posterior. Un seguimiento estrecho y la decisión oportuna de la cirugía evitarán sucesos desfavorables como incapacidad permanente del paciente, disfunción ventricular, arritmias, infarto al miocardio y muerte súbita

Pulmonary arterial hypertension in children with congenital heart disease: a deeper look into the role of endothelial progenitor cells and circulating endothelial cells to assess disease severity

Endothelial progenitor cells and circulating endothelial cells have been proposed as useful markers of severity and disease progression in certain vascular diseases, including pulmonary arterial hypertension. Our study focused on evaluating the levels of circulating endothelial progenitor cells and circulating endothelial cells in patients with congenital left-to-right shunts and pulmonary hypertension undergoing definitive repair. Endothelial progenitor cells (identified by simultaneous co-expression of CD45dim, CD34 + and KDR2 + surface antibodies) and circulating endothelial cells (identified by simultaneous co-expression of inherent antibodies CD45-, CD31+, CD146 + and CD105+) were prospectively measured in seventy-four children (including children with Down syndrome), median age six years (2.75–10), with clinically significant left-to-right shunts undergoing transcatheter or surgical repair and compared to thirty healthy controls. Endothelial progenitor cells and, particularly, circulating endothelial cells were significantly higher in children with heart disease and pulmonary arterial hypertension when compared to controls. Endothelial progenitor cells showed significant correlation with pulmonary vascular resistance index when measured both systemically (r = 0.259; p = 0.026) and in the superior vena cava (r = 0.302; p = 0.009). Children with Down syndrome showed a stronger correlation between systemic cellularity and pulmonary vascular resistance index (r = 0.829; p = 0.002). Endothelial progenitor cells were reduced along their transit through the lung, whereas circulating endothelial cells did not suffer any modification across the pulmonary circulation. In children with yet to be repaired left-to-right shunts, endothelial progenitor cells and circulating endothelial cell counts are increased compared to healthy subjects

Métodos de estratificación de riesgo en la cirugía de cardiopatías congénitas

En las últimas décadas se han desarrollado sistemas enfocados a estimar de una manera objetiva la eficiencia y calidad de los servicios médicos otorgados. En este tenor se han establecido sistemas para agrupar pacientes relacionados en su diagnóstico para facilitar la comparación de indicadores de funcionamiento, calidad y costos. En el caso de las cardiopatías congénitas y las opciones quirúrgicas para su corrección, ya se cuenta con métodos de estratificación de riesgo (RACHS-1 y Aristóteles), que aunque aún en proceso de evaluación y mejora, permiten estimar en forma más o menos precisa el resultado quirúrgico dependiendo tanto del tipo de cardiopatía, del tipo de reparación y de algunos otros elementos que influyen en el resultado final como lo son: peso, edad y anomalías asociadas principalmente. Creemos que los dos sistemas se complementan y que este tipo de sistemas de evaluación es el paso inicial para contar en México con una base de datos confiable que permita comparar los resultados obtenidos en las instituciones encargadas del manejo de pacientes con cardiopatías congénitas, con el propósito de incidir en políticas de salud institucionales y nacionales y que también sirva para compararnos con centros especializados en el extranjero

Giant aortic aneurysm and rhabdomyomas in infant with tuberous sclerosis (Case report)

We present the case of a giant aneurysm and dissection of the abdominal aorta in an eight month old infant. Imaging studies especially a helicoid computerized axial tomography with 3D reconstruction, showed a lesion which extended from the diaphragm to the iliac arteries. The clinical findings and the above mentioned studies revealed non-obstructive heart rhabdomyomas, tubers in the brain and the abdominal aortic aneurysm, all of which were consistent with the diagnosis of tuberous sclerosis