Hypertrophic cardiomyopathy in the systemic right ventricle in a patient with congenitally corrected transposition of the great arteries: A case report

Congenitally corrected transposition of the great arteries is a rare clinical entity, which usually presents during adulthood with associated defects; atrioventricular block, heart failure, systemic valve failure, and arrhythmias usually complicate the clinical course. Even rarer is associated hypertrophic cardiomyopathy, which complicates the disease course and clinical decision-making. Herein, we present a patient with this condition who underwent heart transplantation, with adequate clinical resolution.

[Congenital heart disease in Down's syndrome]

Background

Down syndrome is the most common chromosomal abnormality, it is associated with a wide variety of congenital heart defects, being considered as clinical elements of high infant morbidity and mortality. Objective.

Objective

To describe the clinical outcomes of patients with Down syndrome undergoing surgery and interventionism as treatment for congenital heart disease at this Institution.

Material and methods

368 patients with Down syndrome and associated congenital heart disease were diagnosed. The variables studied were weight, stature, sex, age, type of heart disease, corrective procedure, length of stay in the hospital and intensive care unit, morbidity and mortality.

Results

368 pediatric patients underwent surgical or interventional correction. Of which 197 (54%) were female, the median age was 24 months (interquartile range [IQR]: 14-48) in the surgical group and 36 months (IQR: 17-85) in the interventional group. The most frequent congenital heart diseases were: PCA (31%), IVC (28%), CAV (20%), ASD (16%) and tetralogy of Fallot with 4% respectively. Hospital stay was 9 days (IQR: 7-15) in the surgical group and 3 days (IQR: 2-5) in the hemodynamic group. Morbidities were postoperative infection in 30 patients (14%) and complete atrioventricular block in 19 patients (9%). Overall mortality including both surgical and interventional was 2%.

Conclusions

The therapeutic, surgical and interventional results in children with Down syndrome and congenital heart disease have improved very satisfactorily. The lower prevalence of the atrioventricular canal in the Mexican population is noteworthy. It is essential to carry out a cardiological evaluation of children with Down syndrome and those with congenital heart disease to correct them in a timely manner to promote survival and quality of life.

Clinical Characteristics and Outcomes in Adults With Moderate-to-Severe Complexity Congenital Heart Disease Undergoing Palliation or Surgical Repair

Background

Congenital heart disease (CHD) survival rate has improved dramatically due to advances in diagnostic and therapeutic techniques. However, concerning the unrepaired CHD population of moderate and severe complexity, the data regarding risk predictors and surgical outcomes are scarce. Our aim was to describe the surgical results and predictors of in-hospital outcomes in adult patients with moderate-to-severe complexity CHD that were not repaired in childhood.

Methods

We conducted a retrospective cohort study that included 49 adult patients with moderate-to-complex CHD who were treated in a single medical centre. Clinical and echocardiographic variables were obtained on admission, after surgical procedures and during follow-up.

Results

Most of the patients were female (66%). Left ventricular ejection fraction and right ventricular outflow tract fractional shortening were within the normal range. The median pulmonary artery systolic pressure was 37 (27-55) mm Hg. The median time was 118 (80-181) minutes for extracorporeal circulation and 76 (49-121) minutes for aortic cross-clamping. The most frequent complication was postoperative complete atrioventricular block (12.2%). In-hospital survival rate was 87.7%. The development of low cardiac output syndrome with predominant right ventricle failure in the postoperative period was the most important predictor of in-hospital death (P = 0.03).

Conclusions

Deciding to treat adults with CHD is challenging in moderate and severe unrepaired cases. Adequate clinical, functional, and imaging evaluation is essential to determine each patient's suitability for surgical management and to achieve the best clinical outcome for this population.

Replacement of Obstructed Right Ventricle to Pulmonary Artery Conduits: The Modified Peel Operation

Reconstruction of the right outflow tract with extracardiac conduits has made complete repair of complex cardiac malformations possible. However, reoperation is usually required for a right ventricle-to-pulmonary artery conduit obstruction. We describe a modified peel operation, where the sides and posterior half of the previously placed conduit are preserved, and a prosthetic roof is placed over the conduit remnant. This has been our current technique to manage conduit obstructions. It is a safe operation and to teach residents. This review aims to convey the technical details of each step of this technique.

Coronary Revascularization in Children at a Mexican Cardiac Center: Thirteen-Year Outcomes

BACKGROUND

The indications for pediatric coronary revascularization are diverse. There are a large proportion of patients with sequelae of severe inflammatory diseases such as Kawasaki disease, and other less common causes.

METHODS

Retrospective review of ten pediatric patients undergoing coronary artery bypass surgery from January 2004 to December 2016.

RESULTS

Ten children and adolescents ranging in age from 2 to 17 (median, 6) years at operation were followed up for as long as 13 years with a median follow-up of 2 years. The surgical indications include ischemia symptoms and/or coronary stenosis angiographically documented. Diagnoses include Kawasaki disease, anomalous origin of the left coronary artery from the pulmonary artery, and iatrogenic lesion of the right coronary artery. All the surgical procedures were performed with cardiopulmonary bypass with crystalloid cardioplegic arrest. The number of distal anastomoses was 1.6 per patient, and the left internal thoracic artery was used in one patient, the right internal thoracic artery in four patients, bilateral internal thoracic artery in four patients, and bilateral internal thoracic artery plus left radial artery in one patient, most frequently for right coronary artery revascularization. The patients underwent noninvasive diagnostic study during follow-up to evaluate their coronary status. The ten patients had no symptoms, and there was no mortality.

CONCLUSIONS

Although survival was excellent after pediatric coronary bypass in our center, we need to continue the follow-up. Coronary revascularization by means of arterial grafting is a safe and reliable surgical modality for coronary disease in children.

[Unusual diagnosis of an intrathoracic tumor, cavernosum lymphangioma. Case report]

BACKGROUND

Thoracic lymphangioma is a rare benign disease representing only 0.7-4.5% of all mediastinal tumors. Its etiology is currently unknown. Most are asymptomatic at first, and the condition is common in the pediatric age. We present a case to document this rare disease and describe the literature.

CLINICAL CASE

We present the case of a 5-year-old female without clinically significant medical history. The patient attended a routine physician visit where a heart murmur was discovered. A diagnostic protocol was initiated, finding a mass on chest x-rays, apparently with an intrathoracic localization. Chest computed tomography confirms a tumor of 13 × 11 cm localized in the anterior mediastinum. Laboratory studies were within normal parameters. Complete surgical resection was decided upon and histopathological diagnosis of cavernosum lymphangioma is confirmed. The patient experienced an adequate evolution without evidence of relapse at this timeConclusion: Characteristics of the case shown are consistent with those reported in the literature. Diagnostic management as well as the surgical plan was successful without presenting morbidity so far.

Possible relationship between neurocysticercosis and hematological malignancies

BACKGROUND

Previous studies have shown an increased frequency of chromosomal abnormalities in lymphocytes from animals and humans with cysticercosis. Some reports have suggested an association between cancer and cysticercosis. The aim of this study was to investigate the possible association between neurocysticercosis and cancer.

METHODS

We designed a mortality rate study from the autopsy files of the Department of Pathology at the General Hospital of Mexico. A total of 1,271 autopsy files were reviewed. All files in which a malignant neoplasia was found during autopsy were selected as cases. Autopsies in which no malignant disease was found were used as controls. The odds ratio was determined between the frequency of neurocysticercosis in patients with any malignant neoplasia and that of the controls.

RESULTS

Neurocysticercosis was more frequent in cases with malignant hematological diseases (MHD) than in controls (p = 0.01). The odds ratio for this association was 3.54, with 95% confidence interval from 1.17-9.79.

CONCLUSIONS

Most human cancers arise from the interaction of a multiplicity of factors, including xenobiotics and endogenous constituents. Therefore, while it will be difficult to demonstrate that neurocysticercosis is a causal agent of malignant hematological diseases (MHD), it should be considered as a potential risk factor for cancer induction in countries where cysticercosis remains a public health problem.