Incidencia y predictores de mortalidad y complicaciones a largo plazo en pacientes adultos con coartación de aorta

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 25-09-201

Reparación completa quirúrgica en adultos con situación Fallot no operada o solamente paliada: ¿ficción o realidad?

Introducción-objetivos: Los pacientes con situación Fallot sin operar o solamente paliados excepcionalmente sobreviven hasta la edad adulta. Si las arterias pulmonares tienen un calibre aceptable, creemos que la reparación completa quirúrgica es viable. A continuación, revisamos nuestra experiencia. Métodos: Estudio retrospectivo de 27 adultos con situación Fallot no operada o solo paliada y reparación completa quirúrgica entre 1991-2014. Resultados: Edad media ± desviación estándar: 35,6 ± 10,6 años, 59% varones, paliación previa 18,5%. Diagnóstico principal: ventrículo derecho bicameral + comunicación interventricular (48%), tetralogía de Fallot clásica (30%). Grado funcional NYHA: I-26%, II-30%, III-44%. Arritmia: 22%. Hematocrito medio: 49 ± 11%. Asociaban agenesia arteria pulmonar izquierda (11%), insuficiencia aórtica severa (11%). Las pruebas complementarias mostraban gradientes elevados entre ventrículo derecho-arteria pulmonar y buena contractilidad biventricular. Operados por esternotomía media con extracorpórea, hipotermia moderada y pinzamiento aórtico. Cierre de comunicación interventricular desde la aurícula derecha: 63%. Reconstrucción del tracto de salida derecho conservando la válvula pulmonar (78%), interponiendo bioprótesis (15%) y con parche transanular (7%). Cirugía asociada en 5 pacientes (18,5%): tricúspide (1), aórtica (4). Sin mortalidad hospitalaria. Seguimiento medio 8,4 ± 6,3 años (máximo 19,75). Un paciente fallece tardíamente. Reoperación en 3 pacientes (11%) por lesiones residuales. Actualmente grado funcional i65%, ii31%, iii4%, estando el 92% en ritmo sinusal. Conclusiones: La reparación completa del adulto con situación Fallot consigue mejoría clínica al eliminar la cianosis, cerrar los cortocircuitos intracardiacos y disminuir la sobrecarga de presión del ventrículo derecho. Esta reparación tiene resultados excelentes y permite superiores tasas de conservación del anillo pulmonar respecto a las series infantiles

New-onset atrial fibrillation during COVID-19 infection predicts poor prognosis

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has led toa paradigm shift in healthcare worldwide. Little is known about the impact on the cardiovascularsystem, and the incidence and consequences of new onset of atrial fibrillation (AF) in infected patientsremain unclear. The aim of this study was to analyze the cardiovascular outcomes of patients with newonset AF and coronavirus disease 2019 (COVID-19) infection.Methods: This observational study analyzed a sample of 160 consecutive patients hospitalized due toCOVID-19. A group with new-onset AF (n = 12) was compared with a control group (total: n = 148,sinus rhythm: n = 118, previous AF: n = 30). New-onset AF patients were significantly older andhypertensive, as well as presenting more frequently with a history of acute coronary syndrome andrenal dysfunction. This group showed a higher incidence of thromboembolic events (41.7% vs. 4.1%;p < 0.001), bleeding (33.3% vs. 4.7%, p = 0.005), a combined endpoint of thrombosis and death(58.3% vs. 19.6%, p = 0.006) and longer hospital stays (16.4 vs. 8.6 days, p < 0.001), with no differences in all-cause mortality.Results: In multivariate analysis, adjusted by potential confounding factors, new-onset AF demonstrateda 14.26 odds ratio for thromboembolism (95% confidence interval 2.86–71.10, p < 0.001).Conclusions: New-onset AF in COVID-19 patients presumably has a notable impact on prognosis.The appearance of new-onset AF is related to worse cardiovascular outcomes, considering it as an independent predictor of embolic events. Further studies are needed to identify patients with COVID-19at high risk of developing “de novo” AF, provide early anticoagulation and minimize the embolic risk ofboth entities

Trends in Adherence to the Mediterranean Diet in Spanish Children and Adolescents across Two Decades.

Unhealthy dietary habits determined during childhood may represent a risk factor to many of the chronic non-communicable diseases (NCDs) in adulthood. Mediterranean Diet (MD) adherence in children and adolescents (8–16 years) living in Spain was investigated using the KIDMED questionnaire in a comparative analysis of two cross-sectional nationwide representative studies: enKid (1998–2000, n = 1001) and PASOS (2019–2020, n = 3540). Taking into account the educational level of pupils, as well as the characteristics of the place of living, a significant association was found between a KIDMED score ≥ 8 (optimal MD adherence) and primary education as well as residency in an area of <50,000 inhabitants, while living in the southern regions was associated with non-optimal MD adherence (p < 0.001). Participants of the 2019–2020 study showed an increase in the consumption of dairy products (31.1% increase), pasta/rice (15.4% increase), olive oil (16.9% increase), and nuts (9.7% increase), as well as a decreased sweets and candies intake (12.6% reduction). In contrast, a significantly lower MD adherence was found when comparing the 2019–2020 (mean ± SE: 6.9 ± 0.04) and the 1998–2000 study (7.37 ± 0.08); p < 0.001), due to less consumption of fish (20.3% reduction), pulse (19.4% reduction), and fruits (14.9% reduction), and an increased intake of commercial goods/pastries or fast-food intake (both 19.4% increase). The lowest adherence was recorded for adolescents also in the most recent study, where 10.9% of them presented a KIDMED score ≤ 3. This study shows that eating habits are deteriorating among Spanish children and adolescents. Such findings point out the urgency of undertaking strong measures to promote the consumption of healthy, sustainable, and non-ultra-processed food, such as those available in an MD, not only at a scientific and academic level, but also at a governmental onePartial funding for open access charge: Universidad de Málag

La necesidad de un registro español de intervencionismo en cardiopatías congénitas y de estándares para la capacitación de centros

Durante las tres &#x00FA;ltimas d&#x00E9;cadas, el tratamiento percut&#x00E1;neo de las cardiopat&#x00ED;as cong&#x00E9;nitas ha evolucionado de una forma encomiable y, actualmente, es la terapia de elecci&#x00F3;n en muchas de ellas, como los defectos septales auriculoventriculares, la estenosis valvular pulmonar y la coartaci&#x00F3;n de aorta. En cardiopat&#x00ED;as complejas, que requieren m&#x00FA;ltiples intervenciones a lo largo de la vida del paciente, el implante de stents, y m&#x00E1;s recientemente de v&#x00E1;lvulas percut&#x00E1;neas, se han convertido en alternativas a la cirug&#x00ED;a. Desde 1990, la actividad de las salas de hemodin&#x00E1;mica se recoge en los registros de la Asociaci&#x00F3;n de Cardiolog&#x00ED;a Intervencionista de la Sociedad Espa&#x00F1;ola de Cardiolog&#x00ED;a (ACI-SEC)1. En las publicaciones anuales de estos registros existe un peque&#x00F1;o apartado dedicado a las cardiopat&#x00ED;as cong&#x00E9;nitas del adulto, en el que se menciona la actividad realizada, pero sin un an&#x00E1;lisis pormenorizado de resultados, complicaciones y mortalidad. La colaboraci&#x00F3;n de la ACI-SEC y el Grupo de Trabajo de Hemodin&#x00E1;mica de la Sociedad Espa&#x00F1;ola de Cardiolog&#x00ED;a Pedi&#x00E1;trica y Cardiopat&#x00ED;as Cong&#x00E9;nitas ha permitido realizar por primera vez en nuestro pa&#x00ED;s un registro de procedimientos realizados en pacientes con cardiopat&#x00ED;as cong&#x00E9;nitas de cualquier edad, desde la etapa fetal hasta la edad adulta, con la colaboraci&#x00F3;n de cardi&#x00F3;logos pediatras y de adultos2. La Sociedad..

The need for a Spanish registry of interventional procedures to treat congenital heart disease and standards for center accreditation

Over the last 3 decades, the percutaneous treatment of congenital heart diseases has made significant progress. Currently, it is the therapy of choice to treat many of these diseases like atrioventricular septal defects, pulmonary valve stenosis or coarctation of the aorta. Multiple procedures throughout the life of a patient are required to treat complex heart disease like stenting and, more recently, percutaneous valves, which have become additional alternatives to surgery. Since 1990, cath lab activity is regulated in the registries published by the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC).1 In the annual publications of these registries there is a small section dedicated to congenital heart disease in the adult population with details on the activity performed, but without an in-depth analysis of the outcomes, complications or mortality. The ACI-SEC and the Spanish Society of Pediatric Cardiology and Congenital Heart Disease Working Group on Hemodynamics have joined forces&#x2014;for the first time in our country&#x2014;to conduct a registry of the procedures performed in patients of all ages with congenital heart disease since the fetal stage until the adult age with the collaboration of pediatric and adult cardiologists.2 The Spanish Society of Cardiovascular and Endovascular Surgery has recently published a registry..

Intimal Sarcoma of the Pulmonary Artery:Diagnostic Value of Different Imaging Techniques

Depto. de MedicinaFac. de MedicinaTRUEpu

Development of dyspnea over several months in a young man

Depto. de MedicinaFac. de MedicinaTRUEpu