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C Zabal

Publications and source records attributed to C Zabal.

At least 19 recordsLinked to original sources
PubMed2003

The adult patient with native coarctation of the aorta: balloon angioplasty or primary stenting?

OBJECTIVE: To compare results of dilatation of native coarctation of the aorta with and without stent implantation. DESIGN: Open, observational, non-randomised study. PATIENTS: 54 consecutive adult patients: 32 with balloon angioplasty alone (group 1) and 22 with stent placement (group 2). INTERVENTIONS: Balloon dilatation from 1995 to 1997; dilatation with Palmaz stent placement from 1997 to 1999. MAIN OUTCOME MEASURES: The primary end point was a composite index of failure including heart related death, a residual gradient of > 20 mm Hg, the need of reintervention, and aneurysm formation. RESULTS: Peak systolic gradient (mean (SD)) was reduced both in group 1 (from 63.3 (22.8) to 10.7 (10.8) mm Hg, p < 0.001) and group 2 (from 63.9 (20.8) to 2.7 (4.3) mm Hg, p < 0.001), but Delta change was significantly greater in group 2. A residual gradient of > 10 mm Hg was shown to be the best cut off point to separate risk groups, representing a hazard ratio (HR) of 9.59 compared with a residual gradient of < or = 10 mm Hg (95% confidence interval (CI) 1.92 to 47.8). From multivariate Cox regression analysis, the only risk marker was the residual gradient (HR 8.9, 95% CI 1.2 to 63.0). The type of the coarctation and the use of stent were the factors associated with a residual gradient of < or = 10 mm Hg. CONCLUSIONS: Mid term outcome in adult patients with native aortic coarctation receiving percutaneous treatment is strongly related to the immediate residual gradient. When treating these cases, efforts should be made to obtain gradients under 10 mm Hg, either by angioplasty alone or by placing a stent. Patients with discrete aortic coarctation have similar mid term results when the immediate residual gradient is < or = 10 mm Hg despite the implantation of a stent. To achieve these gradients, patients with hypoplastic isthmus or tubular coarctation should be treated with primary stenting. Further studies including exercise tests and non-invasive imaging are still needed before definitive conclusions can be drawn.

Adult↗
PubMed2001

Surgical treatment for secundum atrial septal defects in patients >40 years old. A randomized clinical trial.

We prospectively examined whether surgical treatment of secundum atrial septal defects (ASDs) in patients > or =40 years old improves their long-term clinical outcome. Surgical treatment of secundum ASDs in adults > 40 years old is a subject of controversy because of the perception of good long-term clinical outcomes in patients with unrepaired ASDs and the lack of data from randomized trials. We recruited 521 patients > 40 years old with secundum ASDs referred for treatment; 48 were excluded. Patients were randomly assigned to surgical closure (n = 232) or medical treatment (n = 241). The primary and secondary end points were a composite of major cardiovascular events (death, pulmonary embolism, major arrhythmic event, embolic cerebrovascular event, recurrent pulmonary infection, functional class deterioration or heart failure) and overall mortality, respectively. We assessed possible prognostic markers. The analysis was performed on an intention-to-treat basis. The median follow-up period was 7.3 years (range 2 to 13). The risk of having the primary end point was significantly higher in the medical group, which had a univariate hazards ratio of 1.99 (95% confidence interval [CI] 1.23 to 3.22) and a multivariate hazards ratio of 1.85 (95% CI 1.08 to 3.17). Although the survival analysis did not reveal differences in overall mortality between the surgical and medical treatments (hazards ratio 1.71, 95% CI 0.76 to 3.86), the multivariate analysis, adjusted by age at entry, mean pulmonary artery pressure and cardiac index, demonstrated significant differences between the study groups (hazards ratio 4.09, 95% CI 1.41 to 11.89). Surgical closure was superior to medical treatment in improving both the composite of major cardiovascular events and overall mortality in patients > 40 years old with secundum ASDs. This superiority was related to the mean pulmonary artery pressure, age at diagnosis and cardiac index. Because of the higher risk of morbidity and mortality, we believe that anatomic closure should always be attempted as the initial treatment for ASDs in adults > 40 years old with pulmonary artery systolic pressure < 70 mm Hg and a pulmonary/systemic output ratio > or =1.7. The operation must be performed as soon as possible, even if the symptoms or the hemodynamic impact seems to be minimal.

Adult↗
PubMed2000

The adult patient with Ebstein anomaly. Outcome in 72 unoperated patients.

Knowledge of the long-term outcome in unoperated adult patients with Ebstein anomaly is limited, and the therapeutic approach is still controversial. We studied unoperated adult patients with Ebstein anomaly to define the patterns of presentation, anatomic characteristics, outcome, and predictive factors for survival. Seventy-two unoperated survivors of Ebstein anomaly aged over 25 years attended from 1972 to 1997 were reviewed and followed-up from 1.6 to 22.0 years. Patients were classified in 3 groups of severity according to the echocardiographic appearance of the septal leaflet attachment of tricuspid valve. The mean age at diagnosis was 23.9 +/- 10.4 years, and the most common clinical presentation was an arrhythmic event (51.4%). There were 30 (42%) deaths, including 6 from arrhythmia, 12 related to heart failure, 7 sudden, 2 unrelated, and 3 unascertained. According to Cox regression analysis, predictors of cardiac-related death included age at diagnosis (hazard ratio 0.89 for each year of age, 95% confidence intervals CI[ 0.84-0.94), male sex (3.93, 95% CI, 1.50-10.29), degree of echocardiographic severity (3.34, 95% CI, 1.78-6.24), and cardiothoracic ratio > or = 0.65 (3.57, 95% CI, 1.15-11.03). During follow-up, morbidity was mainly related to arrhythmia and refractory late hemodynamic deterioration. The magnitude of tricuspid regurgitation, cyanosis, and the New York Heart Association (NYHA) functional class at time zero were significant risk factors according to the univariate analysis, but not after multivariable confrontation. The results of this study suggest that pattern of presentation, clinical course, and prognosis of unoperated adult patients with Ebstein anomaly are influenced by several factors. Although the initial symptoms are usually mild and commonly related to supraventricular arrhythmias, these are not associated with the long-term outcome. The severity of the morbid anatomy was the main determinant of survival only in extreme cases, but not in those with mild or moderate deformations, which are more common in adults. Other independent risk factors such as cardiothoracic ratio, sex, age at diagnosis, and the echocardiographic evaluation may help to determine the therapeutic approach. Adult patients with Ebstein anomaly should not be considered as a simple low-risk group.

Adult↗
PubMed1998

Congenitally corrected transposition with atrioventricular septal defect.

We describe 4 cases of congenitally corrected transposition associated with atrioventricular septal defect, diagnosed by echocardiography and angiocardiography. Two had usual atrial arrangement and two had mirror imaged atrial arrangement . All cases were associated with subpulmonary valvar stenosis. All patients presented with cyanosis and were in sinus rhythm. Atrioventricular septal defect with common atrioventricular junction was easily diagnosed on the basis of a common atrioventricular valve permitting interatrial and interventricular communications. All patients had balanced right and left ventricles. The echocardiographic recognition of the ventricles was based on the presence of the moderator band within the morphologically right ventricle, the characteristics of the apical septal trabeculations, and the shape of the ventricles. Angiocardiographic recognition of the ventricles was achieved on the basis of right and left ventriculography. In one case with usual atrial arrangement, we recorded two His bundle potentials, one anteriorly and another posteriorly. Atrial stimulation revealed blocked atrioventricular conduction at the level of the posterior bundle, and normal atrioventricular conduction through the anterior bundle. In both cases with atrial mirror-imagery, only a posterior His bundle potential was found, with normal atrioventricular conduction revealed by atrial stimulation The clinical course with this combination depends on the other lesions present in addition to the common atrioventricular valve. Our electrophysiological studies show that the conduction system in presence of a common atrioventricular valve is as expected for congenitally corrected transposition with two atrioventricular valves.

Adolescent↗
PubMed1993

Primary hypertrophic osteoarthropathy: another heritable disorder associated with patent ductus arteriosus.

Patent ductus arteriosus (PDA) is a congenital malformation that has been linked to diverse heritable and chromosomal disorders. Primary hypertrophic osteoarthropathy (HOA) is a rare heritable syndrome in which digital clubbing and periostosis become evident without any underlying illness. The objective of this article is to describe four patients with coexisting PDA and primary HOA. Surgical closure of the ductus showed no effect on the skeletal changes. Primary HOA should be included among the heritable disorders that may be associated with PDA.

Child↗
PubMed1992

Total anomalous pulmonary venous connection in adults. Long-term follow-up.

Between 1961 and 1989, 19 patients with total anomalous pulmonary venous connection underwent surgical correction. Ages ranged from 18 to 38 years (mean 26.2 +/- 6.5 years). The anatomic variants included 10 patients with total anomalous pulmonary venous connection to the vertical vein, 6 patients with total anomalous pulmonary venous connection to the coronary sinus, and 2 with total anomalous pulmonary venous connection directly to the right atrium. The last patient had mixed connection to the coronary sinus and left vertical vein. Two patients died, one because of left atrial rupture and another of low cardiac output. Long-term follow-up after surgical repair ranged from 2 to 24 years (mean 7 +/- 6.2 standard deviation). Preoperative disability, assessed according to New York Heart Association criteria, showed 12 patients in functional class II and seven in class III. After treatment, 16 patients were in class I and one in class II (p less than 0.001). Echocardiographic evaluation of six patients revealed in all a normal left ventricular ejection fraction; the diastolic function was also normal except in one patient. The postoperative evaluation of the pulmonary arterial systolic pressure performed by both Doppler echocardiography and right cardiac catheterization in 14 patients showed a significant reduction of the mean pulmonary arterial systolic pressure from 51.1 +/- 3.4 to 37.4 +/- 14.4 mm Hg (p less than 0.01). The remaining three patients evaluated in the follow-up period only by clinical examination are in New York Heart Association functional class I. The anatomic characteristics of our patients were responsible for the long-term outcome without correction. Surgical treatment of older patients can be performed with satisfactory results and excellent long-term survival.

Adult↗
PubMedDate not supplied

[Fenestrated Fontan surgery in high risk patients].

A retrospective analysis is presented of all patients who had fenestrated Fontan procedure between january 1990 and may 1996. Surgery was indicated in the presence of anyone of the following risk factors: mean pulmonary pressure higher than 20 mmHg; pulmonary vascular resistance higher than 2 UW; ejection fraction less than 60%; systemic ventricular end diastolic pressure higher than 8 mmHg; Nakata index less than 200 mm2/m2, McGoon index less than 2. The diagnosis were: Absent right atrio-ventricular connection with concordance ventriculo-arterial connection 10 patients; pulmonary atresia with intact septum, 1 patient; Ebstein's malformation, 1 patient and absent left A-V connection with discordance VA connection, 1 patient. The mean of age was 6.7 years (range 2.5-11 years). Overall mortality was 23%. No significant difference in risk factors was found between survivals and no survivals. Nonsurvivors had between two an four risks factors. Postoperative complications were 1 patient with protein losing enteropathy and stroke (1 patient). The mean duration of pleural effusion was 16 days (range 4-45 days). We consider fenestrated Fontan procedure useful for patients with congenital heart disease with a one hypoplastic ventricle and one o more risks factors.

Child↗
PubMedDate not supplied

Ebstein's anomaly. Clinical profile in 174 patients.

The study population consisted of 148 patients who did not undergo surgical treatment and 26 who were operated, most of them diagnosed after the age of 2, with a follow-up from 6 months to 25.3 years. Patients were divided in three groups of clinical deterioration according to their functional class and cardiothoracic index (CTR) long-term follow-up in 148 nonoperated patients showed significant differences for mortality between groups I and III (p < 0.001), and between groups II and III (p < 0.02). Predictors of death included the association among functional class III or IV CTR > or = 65% with either cyanosis or arrhythmias (p < 0.05). The multivariate analysis showed that clinical deterioration (p < 0.0001), CTR (p < 0.0002) and functional class (p < 0.001), were significant for mortality. Kaplan-Meier analysis showed a survival rate of 81% in the overall patients free from surgical treatment. According to Kaplan-Meier analysis, the rate of survival was lower in patients with CTR > or = 65% (63.5%), in patients who had functional class IV (52.5%) and in patients included in group III of clinical deterioration (38.2%). Despite the fact that the association of functional class III or IV plus CTR > or = 65% with either cyanosis or arrhythmias is a good predictor for death, the mortality in patients who had only one of these variables was lower. Patients included in group II of clinical deterioration in stable condition presented long survival with medical treatment. Due to the high mortality rate found in group III, surgical treatment of Ebstein's anomaly must be done before deteriorating into group III. Surgical indication must be done considering the surgical risk of each group according to the experience of the Institution and comparing the rate of surgical mortality with the rate of survival without surgery.

Adolescent↗
PubMedDate not supplied

Interventional cardiology in congenital heart disease.

Interventional procedures for congenital heart disease have evolved dramatically in the last decade. Beginning with pulmonary and aortic valvuloplasty, nowadays, stents and various devices are placed inside the heart and vessels to palliate or correct different congenital defects. The present communication summarizes the experience with interventional cardiology in congenital heart disease of the Instituto Nacional de Cardiología "Ignacio Chávez" during the last five years.

Adolescent↗
PubMedDate not supplied

[Chromosome 22 (22q.11.2) deletion. Etiology of conotruncal heart abnormalities].

Important advances in the diagnosis and treatment of congenital heart disease (CHD) have been made in the past 50 years. Nowadays echocardiogram plays an important role in the diagnosis. This procedure is able to identify a wide range of malformations. Cardiac catheterization is mainly a therapeutic tool, surgery is now performed much earlier because CHDS are diagnosed sometimes before birth or very early in life. All this advances in the diagnosis and treatment of this group of patients, allows them not only a better quality of life but also the possibility of reaching adulthood and having children. The study of the etiology of CHD is a field that has not evolved as fast as the assessment and treatment. Nowadays we have a larger population of adults with CHD. The discovery of a microdeletion of chromosome 22 q11.2 associated with conotruncal cardiac defects, proves a common etiology for clinical phenotypes and conotruncal malformations. In order to identify, which of these patients share the same etiology and presented with this syndrome, we collected a group that shared not only heart defects of the conotruncal type but also specific phenotypic alterations such as broad nasal bridge, nasal dimple, high palate, and digitalization of the first finger among others. The first two patients studied with FISH technique were positive to monosomy of a locus on chromosome 22. Those patients with CHD of conotruncal type should undergo microdeletion testing so genetic counseling can be offered as well as appropriate treatment in areas such as cardiology and developmental psychology.

Child↗
PubMedDate not supplied

[Interventional catheterization in congenital heart diseases].

Since 1953 when the first percutaneous valvotomy procedure was performed at the Instituto Nacional de Cardiología "Ignacio Chávez", interventional cardiac catheterization applied to congenital heart disease has developed greatly, mostly in the past 15 years. From atrial septostomy to occlusion of intracardiac defects, this therapeutical modality has increased its applications, and has given us additional resources to treat our patients with congenital heart defects. In this article we present a general perspective of our experience with these new techniques.

Adolescent↗
PubMedDate not supplied

[Radiofrequency ablation and simultaneous insertion of an Amplatzer device in a patient with atrial septal defect and nodal reentry tachycardia].

The association of AV nodal reentry tachycardia and interatrial septal defect has not been described previously. This article reports a 47-year-old woman with an atrial septal defect (ostium secundum) and history of palpitations without documental tachycardia through resting and ambulatory electrocardiography. Rapid atrial pacing under the influence of isoproterenol, during an electrophysiology study, elicited and AV nodal reentry tachycardia of the common type. Successful radiofrequency catheter ablation was performed targeting the slow pathway. Immediately an Amplatzer device was used for closure of the septal defect. Both procedures were successful and without complications. What makes this case unusual is that both interventional procedures were performed during the same session.

Catheter Ablation↗
PubMedDate not supplied

[Late results of mitral valve replacement in 155 subjects under 16 years of age. Comparative study with 4 prosthesis].

We followed 155 children aged 6 to 16 years who underwent mitral valve replacement for rheumatic heart disease. Group I included 74 patients with Starr-Edwards prostheses and the mean follow-up period was 13 years. Group II was formed by 36 patients with Bjork-Shiley prostheses and a mean follow-up of 7.5 years. Group III consisted of 31 children with dura mater bioprostheses and a mean follow-up of 5.1 years. Finally, group IV included 14 patients followed a mean period of 4.9 years with Hancock xenografts. The four groups of patients were comparable before surgery. The criteria of the New York Heart Association (NYHA) were used to evaluate all patients before and 12 months after surgery. All patients with mechanical prostheses received anticoagulant therapy with acenocumarol from the first postoperative day. The incidence of complications such as thromboembolism, infective endocarditis, prosthetic dysfunction and death were determined at the end of the follow-up. The Fisher's exact test was used for nonparametric analysis and the two-tailed Student's T test for parametric results. All but two patients improved their NYHA clinical status after surgery (p less than 0.0001). Forty eight patients with mechanical prostheses were catheterized 1 to 7 years after the operation. The mean pulmonary arterial systolic pressure was reduced from 58 mmHg to 30 mmHg (p less than 0.001) and the mean pulmonary arterial wedge pressure decreased from 22 mmHg to 11 mmHg (p less than 0.001). There were no significant differences between the groups with mechanical and tissue prostheses in the incidence of thromboembolism and infective endocarditis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Corrected transposition of the great arteries].

Sixty-nine patients with Corrected Transposition of the Great Arteries were studied, with a mean age of 8.3 years. Forty-nine had atrial situs solitus (SS) and 20 atrial situs inversus (SI). The diagnosis was proved by echocardiography in 28 cases and in all by angiocardiography. In cases with SS, 29 presented ventricular septal defect (VSD), 20 had subvalvular pulmonary stenosis (SVPS), 13 tricuspid regurgitation (TR), 13 atrio-ventricular block (AVB), and seven without associated defects. In cases with SI, 13 had VSD, 14 SVPS, five IT, three AVB, and two without associated defects. The long-term follow-up of the atrioventricular (AV) conduction in 53 cases, ranging between 2 and 37 years (mean 8.3) showed at the beginning of the evaluation 37 cases with normal AV conduction, 14 with first degree AVB, and two with complete AVB. At the end of the follow-up 24 cases had normal AV conduction, 13 first degree, two second degree, four intermittent and 10 complete AVB. The contingency table showed that the possibility of developing changes of the AV conduction was greater in those cases who had an abnormality at the beginning with a relative risk of 2.27 (p = 0.03). Twenty-three cases had SVPS associated with VSD without significant symptoms. During a follow-up ranging from 1 to 20 years (mean 6.5 +/- 5.9), five of these patients were surgically corrected at ages from 6 to 11 years. The remaining cases have had a stable course. At the beginning of the study, 18 cases had TR, and it developed in five more patients during the same follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Arrhythmogenic dysplasia of the right ventricle: a cause of ventricular tachycardia in childhood].

We describe a 9-year old patient with arrhythmogenic right ventricular dysplasia. The patient presented with sustained ventricular tachycardia in an apparently normal heart. The diagnosis was suspected by the electrocardiographic morphology of the tachycardia and definitive diagnosis was made by right ventricular angiogram, echocardiogram and the ventricular endomyocardial biopsy findings (replacement of myocardial by adipose tissue and fibrosis). We believe that this condition may be a common etiology of ventricular tachycardia with left bundle branch block conduction pattern in children with otherwise normal hearts.

Adipose Tissue↗
PubMedDate not supplied

[Primary pulmonary arterial hypertension in children under 2 years of age].

A retrospective analysis of 18 patients under two years of age who suffered from primary pulmonary hypertension was made between july 1982 november 1988 in order to define their clinical course and prognosis. Perinatal history was irrelevant. In 13 patients diagnosis was established before the first year of life and in 8 of them in the neonatal period. All patients presented the same symptomatology: Cyanosis, dyspnea and/or repeated respiratory infections. The electrocardiogram showed various degrees of enlargement of the right atrium and right ventricle as well as an uneven ST segment in the precordial leads; these could not be related to the systolic or diastolic pressures of the right ventricle. In the chest roentgenogram the most important and constant feature was the heart enlargement. Cardiac catheterization showed a mean pulmonary systolic arterial pressure of 64.46 mmHg and a mean pulmonary arterial resistance of 6.4 U/m.2 These parameters could not be related to a bad prognosis. Three patients were given vasodilators (hydralazine) with positive clinical and echocardiographic results. Five patients died (27%) two months after the diagnosis was made and three months after the onset of symptomatology, four of them died due to congestive heart failure and one had sudden death. This study shows the early onset of the disease as well as its short term high mortality.

Age Factors↗
PubMedDate not supplied

[Comparative study of 2 mechanical mitral valves].

We present the long term follow-up of two groups of patients under 16 years of age in whom two different types of mitral valve prostheses were used for the treatment of mitral valve disease. Group I was formed by 74 patients with Starr-Edwards (6120) prosthesis and group II by 36 cases with Bjork-Shiley prosthesis. Group I was followed for a mean period of 11 years and group II for a mean period of 7.5 years. The clinical evolution of both groups assessed according to the New York Heart Association criteria showed improvement of the functional class (p less than 0.006). Twenty seven cases of group I and 21 of group II underwent cardiac catheterization for the evaluation of surgical results. In group I, the mean pulmonary arterial systolic pressure (PASP) decreased from 57 mmHg to 33 mmHg (p less than 0.001) and the mean pulmonary arterial wedge pressure (PAWP) from 20.8 mmHg to 12.1 mmHg (p less than 0.05). In group II, the mean PASP decreased from 59.2 mmHg to 28.5 mmHg (p less than 0.001) and the mean PAWP from 24.6 mmHg to 8.5 mmHg (p less than 0.001). There was statistically significant difference for a greater incidence of thromboembolism in group I (p = 0.037). No differences were found for bacterial endocarditis, dysfunction and death.

Adolescent↗