Correlación intraclase entre los hallazgos ecocardiográficos y los datos hemodinámicos en pacientes diagnosticados de hipertensión pulmonar idiopática en la Fundación Cardioinfantil - Instituto de Cardiología en Bogotá Colombia

Objectives: Pulmonary hypertension (PH) is defined as a mean pulmonary arterial pressure ? 25 mmHg. The diagnosis of idiopathic PH is made after a thorough study clinical and paraclinical including complete anatomical and functional assessment. The aim of this study is to describe echocardiographic findings and hemodynamic data obtained by cardiac catheterization and assess their degree of correlation. Materials and Methods: Descriptive cross-sectional study and analysis of matching variables through the comparison of pulmonary pressure measured by echocardiography and catheterization through Interclase correlation coefficient (ICC) and the Bland Altman. The study population were children aged 0 days to 18 years who presented Fundación Cardioinfantil – Instituto de Cardiología in Bogotá (Colombia) diagnosed with idiopathic PH evaluated between January 2010 and December 2013. Results: 29 patients diagnosed with idiopathic PH studied with echocardiography and cardiac catheterization were included. The degree of PH documented by echocardiography corresponded to severe in 38% of patients. After cardiac catheterization, the degree of PH was classified as severe in 66% of cases. In 18 patients (62%) pulmonary vascular reactivity test was performed, finding positive response in 7 cases (39%). The concordance analysis of pulmonary pressure measured by echocardiography and catheterization was performed in 20 subjects, with a confidence level of 95%. When comparing the measurement results in both tests is a difference of 15 mmHg which is statistically significant. The tests achieved an ICC of 0.55, with 95% of 0.16 to 0.79, which represents a force of moderate agreement. Conclusions: In the present study the severity of PH corresponded to severe in most patients evaluated for cardiac catheterization. Performing pulmonary vascular reactivity test for both diagnosis and accurate diagnostic decisions is essential. The concordance analysis of pulmonary pressure measured by echocardiography and catheterization through Intraclase Correlation coefficient and the Bland Altman documents a force of moderate agreemen

Descripción anatómica, clínica y sobrevida de los pacientes con atresia pulmonar que han sido llevados a angioplastia con stent en el ductus arterioso persistente en el periodo 2009-2014

Resumen: Objetivo: describir las características anatómicas, la evolución clínica y la sobrevida de los pacientes con atresia pulmonar que han sido llevados a angioplastia con stent en ductus arterioso persistente y determinar si existen diferencias significativas en la saturación al inicio y final del procedimiento y a las 6, 12 y 24 horas posprocedimiento. Materiales y métodos: estudio analítico, descriptivo tipo cohorte. La población de estudio se tomó de las bases de datos del servicio de Cardiología pediátrica de una institución especializada en la ciudad de Bogotá, Colombia. Se incluyeron pacientes con diagnóstico de atresia pulmonar sometidos a angioplastia, en tanto que se excluyeron aquellos con cirugía cardiovascular previa. El análisis estadístico se realizó en STATA® 12,0, mediante estadística descriptiva, curvas de Kaplan-Meier y ANOVA de medidas repetidas. Resultados: se identificaron 237 pacientes con atresia pulmonar. Se seleccionaron 30 de los cuales se excluyeron 5. En total se construyó una cohorte de 25 pacientes que fueron llevados a angioplastia, 52% con atresia pulmonar con comunicación interventricular. Edad promedio 12,2 días, peso 2.698 g, diámetro del DAP 3,8 mm (DE = 1,1), índice de McGoon media 1,35. El implante del stent fue exitoso en todos los pacientes; sin embargo 2 fallecieron en la sala de procedimientos y uno durante las 6 horas siguientes. Las complicaciones más frecuentes fueron paro cardiorrespiratorio (n = 2), trombosis del stent (n = 2) y bacteriemia (n = 2). La mortalidad a 30 días fue del 28% (n = 7); durante el tiempo total fue del 36% (n = 9). Por medio del ANOVA no se encontraron diferencias significativas en los promedios de saturación en los cinco tiempos de interés. Conclusiones: la atresia pulmonar es una patología compleja que requiere intervención invasiva para el mantenimiento de la capacidad circulatoria de los pacientes. Este estudio muestra que a pesar de una intervención efectiva, la mortalidad a los 30 días es elevada. No se encontraron diferencias en los tiempos de saturación, lo que sugiere que mantiene la saturación de los pacientes de una forma no distinta que con la prostaglandina E (PGE1) pero garantiza la permeabilidad del ductus. Abstract: Objective: the aim of this study is to describe the anatomical characteristics, the clinical progression, and survival of patients with pulmonary atresia subjected to angioplasty with a stent in patent ductus arteriosus (PDA), and to determine if there are significant difference in the saturation at the beginning and the end of the procedure, and at 6, 12, and 24 hours after the procedure. Materials and methods: An analytical and descriptive cohort study was conducted on a population taken from the database of a Paediatric Cardiology Department of a specialised institution in the city of Bogota, Colombia. Patients with pulmonary atresia subjected to angioplasty were included, and those with previous cardiovascular were excluded. The statistical analysis was performed using STATA® 12.0, by means of descriptive statistics, Kaplan-Meier curves and repeated measurements ANOVA. Results: A total of 237 patients with pulmonary atresia were identified. Of the 30 that were selected, 5 were excluded, leaving a total of 25 patients that were subjected to angioplasty. Interventricular communication was observed in 52%. The mean age was 12.2 days, with a mean weight of 2.698 g, a mean PDA diameter of 3.8 mm (SD = 1.1), and a mean McGoon index of 1.35. Although the stent implant was successful in all patients, two died in the procedures room, and another one during the following 6 hours. The most common complications were, cardiorespiratory arrest in 2 patients, thrombosis of the stent in 2, and bacteraemia in two patients. The mortality at 30 days was 28% (7), and 36% (9) during the total time. Using ANOVA, no significant differences were found in the saturation means at the five times of interest. Conclusions: Pulmonary atresia is a complicated condition that requires invasive intervention in order to maintain the circulatory capacity of the patients. This study shows that, despite an effective intervention, the 30-day mortality is elevated. No differences were, found in the saturation times, which suggest that saturation is maintained in the patients in a way not unlike that with prostaglandin E (PGE1), but ensures the patency of the ductus. Palabras clave: Angioplastia, Defectos cardiacos congénitos, Cateterismo cardiaco, Keywords: Angioplasty, Congenital cardiac defects, Cardiac catheterisatio

CHD and respiratory syncytial virus:Global expert exchange recommendations

AbstractBackgroundPalivizumab is the standard immunoprophylaxis against serious disease due to respiratory syncytial virus infection. Current evidence-based prophylaxis guidelines may not address certain children with CHD within specific high-risk groups or clinical/management settings.MethodsAn international steering committee of clinicians with expertise in paediatric heart disease identified key questions concerning palivizumab administration; in collaboration with an additional international expert faculty, evidence-based recommendations were formulated using a quasi-Delphi consensus methodology.ResultsPalivizumab prophylaxis was recommended for children with the following conditions: &lt;2 years with unoperated haemodynamically significant CHD, who are cyanotic, who have pulmonary hypertension, or symptomatic airway abnormalities; &lt;1 year with cardiomyopathies requiring treatment; in the 1st year of life with surgically operated CHD with haemodynamically significant residual problems or aged 1–2 years up to 6 months postoperatively; and on heart transplant waiting lists or in their 1st year after heart transplant. Unanimous consensus was not reached for use of immunoprophylaxis in children with asymptomatic CHD and other co-morbid factors such as arrhythmias, Down syndrome, or immunodeficiency, or during a nosocomial outbreak. Challenges to effective immunoprophylaxis included the following: multidisciplinary variations in identifying candidates with CHD and prophylaxis compliance; limited awareness of severe disease risks/burden; and limited knowledge of respiratory syncytial virus seasonal patterns in subtropical/tropical regions.ConclusionEvidence-based immunoprophylaxis recommendations were formulated for subgroups of children with CHD, but more data are needed to guide use in tropical/subtropical countries and in children with certain co-morbidities.</jats:sec