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C Zabal

Publications and source records attributed to C Zabal.

30 records · Page 2Linked to original sources
PubMedDate not supplied

[Rheumatic cardiopathy in children younger than 6 years of age].

UNLABELLED: Most of the published papers on Rheumatic Fever (RF) have not included the younger population. We selected 211 cases of children with RF younger than 6 years of age from 9,471 clinical files from 1944 to 1982. These were followed retrospectively to identify the presence of rheumatic activity, subsequent attacks and penicillin profilaxis. From de 211 cases, 209 had carditis; 57% of them were girls and 43% boys. There were no previous infections of the upper respiratory tract in 36% of the patients. The number of cases with RF increased abruptly after 3 years of age and continued increasing until 5 years of age when 70.5% of the population had there first clinically recognized attack. Lesions were present in the mitral valve in 80% of the cases, in the aortic valve in 12%, in the tricuspid in 5% and in the pulmonary valve in 3%. The death rate during the first attack was 20% being refractory heart failure the main cause of death. Thirteen cases suffered rheumatic pneumonia, 9 of whom died (69.2%). CONCLUSIONS: 1) The incidence of acute rheumatic fever in children under 6 years of age has decreased with time. 2) The death rate as well as the valvular damage decreased with the parents cooperation with the treatment. 3) The changes in the clinical picture and the severity of valve sequelea may be due to penicillin profilaxis and the better understanding of the disease.

Child, Preschool↗
PubMedDate not supplied

[Surgical alternatives in the treatment of double-outlet right ventricle].

Double-outlet right ventricle (DORV) is a type of ventriculo-arterial connection, in which both great arteries are connected to the morphologically right ventricle in at least 50% of their diameter. The relation of the great arteries with the ventricular septal defect (VSD) and the pulmonary stenosis, are important anatomical aspects in the election of the surgical technique. In this study we describe four patients with DORV, in whom different surgical techniques were used according to the specific anatomy of each case. Two patients had subaortic restrictive VSD, with subpulmonary stenosis in one of them. In the other two patients the VSD was subpulmonary with the aorta anterior and to the left, in one of these existed moreover a severe mixed pulmonary stenosis. It is concluded, that with different surgical techniques according to the specific anatomy of each patient, good results can be obtained in the surgical treatment of these complex congenital malformations.

Child↗
PubMedDate not supplied

[Discordance in the anatomy of the bronchial tree and atrial appendages].

It is well known, that in complex congenital heart disease, the bronchial anatomy reflects the atrial situs in the majority of patients. Few exceptions to this rule have been reported in the literature. We report four patients in whom we found discordance between the anatomy of the bronchial tree and the external aspect of the atrial appendages. Two patients had bronchial situs solitus with atrial levoisomerism, the third patient had bronchial levoisomerism with atrial situs solitus and in the fourth one we found inverted bronchial anatomy with levoisomerism of the atrial appendages. In three patients, broncho-atrial discordance was diagnosed clinically by bronchial tomography and selective atrial angiography, and in the other one the diagnosis was made by anatomical study. In this last patient, external atrial anatomy was found to be of levoisomerism, with an internal atrial aspect of situs inversus. Prediction of atrial arrangement by bronchial anatomy retains its diagnostic value. However, it is necessary to bear in mind that exceptions do exist. It is discussed how to suspect these exceptions, and the final diagnostic conduct is indicated.

Bronchi↗
PubMedDate not supplied

[Echocardiographic and Doppler study of pulmonary atresia with an intact interventricular septum].

Pulmonary atresia with intact ventricular septum represents a congenital cardiac lesion for which the prognosis depends on the patency of the ductus arteriosus. Nine children with pulmonary atresia and intact ventricular septum underwent echocardiographic studies before cardiac catheterization trying to visualize the anatomy of the outflow tract of the right ventricle, the dimension of the ventricular cavity, the characteristics of the tricuspid valve and finally the size and integrity of the interventricular septum. Using Doppler ultrasound it was possible to evaluate the function of the tricuspid valve and the patency of the ductus arteriosus. The results obtained were correlated with the angiographic and anatomic studies. We concluded that noninvasive assessment of this malformation permits an excellent correlation with the angiographic and anatomic studies.

Angiocardiography↗
PubMedDate not supplied

[Corrected transposition of the great arteries in patients over 65].

Three cases with corrected transposition of the great arteries in patients older than 65 years are described. Two had atrial situs solitus and one atrial situs inversus. One had pulmonary valvular stenosis with valvular calcification and a small ventricular septal defect in association with ischemic heart disease. This patient died due to cardiac failure at the age of 80 years. The second case was associated with ventricular septal defect, atrial septal defect and pulmonary hypertension. The third patient presented with mild tricuspid regurgitation. Although this congenital heart malformation is theoretically compatible with normal life, few patients have long survival because of associated congenital defects or the subsequent development of tricuspid regurgitation or atrioventricular block.

Aged↗
PubMedDate not supplied

[Radiofrequency ablation of an accessory left lateral pathway in an infant, using a transeptal approach].

We describe the case of a 4 month old child with supraventricular tachycardia detected on his second day of life, refractory to medical treatment, who was treated with radiofrequency catheter ablation of an accessory auriculoventricular pathway located on the left lateral wall. A venous femoral approach was used and the left atrium was entered through a patent foramen ovale, avoiding the risks of the arterial puncture and allowing us to administrate the radiofrequency current on the proper site. We discuss the potential risks of the therapeutic procedure in children and the benefits of the transeptal over the retrograde approaches for the treatment of left sided accessory pathways. Our conclusion is that catheter radiofrequency ablation of accessory pathways in children is possible with low risk, which can be diminished with the use of the transseptal approach when indicated.

Catheter Ablation↗
PubMedDate not supplied

[Truncus arteriosus communis and interrupted aortic arch].

The association between persistent truncus arteriosus and interrupted aortic arch is a rare but important condition since it has special clinical and therapeutic implications. In this article we present three cases with this malformation. The clinical characteristics are similar to patients with isolated truncus such as heart failure and cyanosis since birth, a protosystolic click, an ejection murmur over the left parasternal line, heart enlargement, increased pulmonary vascular markings and biventricular hypertrophy. The clinical suspicion of interrupted aortic arch is bases on the presence of asymmetric pulses in the upper and lower limbs, but this difference is present only when the arterial duct is restrictive. Because of that, the echocardiographic analysis, mainly, and the angiocardiogram, secondarily, are very important diagnostic tools. We analyze the echocardiographic diagnostic findings, as well as the angiocardiographic anatomy. Also, some important pathophysiological aspects are discussed.

Aorta, Thoracic↗
PubMedDate not supplied

[Pulmonary balloon valvulotomy. The results in 42 cases].

The percutaneous balloon valvulotomy is nowadays the treatment of choice for isolated pulmonary stenosis. Forty two patients with congenital pulmonary stenosis underwent balloon valvulotomy at the Instituto Nacional de Cardiología "Ignacio Chávez". Ages 1 month to 24 years, mean 7.6 +/- 5.9 years, with a follow-up of 28.3 +/- 14.8 months. With an infundibular gradient of 50 mm Hg or more a treatment with propranolol was given. After valvulotomy the total basal pressure gradient decrease from 82.9 +/- 40.6 mm Hg to 31.2 +/- 27.1 mm Hg (p < 0.00001). The patient's results were divided in two groups: with and without reactive infundibular obstruction. The 31 patients without infundibular obstruction had a total initial gradient of 71.6 +/- 33.5 mm Hg, and after valvulotomy the gradient was reduced to 18.9 +/- 11.2 mm Hg (p < 0.00001). The 11 patients with infundibular obstruction had a total initial gradient of 114.8 +/- 43.2 mm Hg, and after valvulotomy the valvular gradient was 12.4 +/- 8.5, the infundibular gradient 53.4 +/- 22.9 and the total gradient 65.9 +/- 29.1 mm Hg (p = 0.002 in relation to the basal gradient). All patients with infundibular obstruction (8 treated with Propranolol) and a follow-up of 8.5 +/- 9.8 months underwent Doppler examination, showing a progressive reduction of the total gradient. By six months no one had a total gradient greater than 50 mm Hg. These data confirm that balloon valvulotomy in valvular pulmonary stenosis is safe and effective, and that restenosis is very low. Good results relay on the use of proper balloon diameters (balloon diameter/pulmonary annulus relation of 1.2 to 1.5).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Reconstructive surgery of rheumatic mitral valvulopathy in patients under 18 years of age].

OBJECTIVE: To present our experience in 58 children (37 female, 21 male) aged 4 to 18 years (mean +/- SD = 14.9 +/- 2.7) with rheumatic mitral valve disease who underwent surgical reconstruction. METHODS: They were divided in four groups according to the abnormalities of the mitral apparatus: Group I had mitral regurgitation due to lesions located in the valvar structures with normal valvar movement (n = 1, 2%), group II mitral regurgitation with lesions located mainly in subvalvular structures with valve prolapse (n = 11, 19%), group III with mitral regurgitation due to lesion located both in valvular and subvalvular structures and restricted valvar motion (n = 38, 65%), and group IV included patients with stenosis (n = 8, 14%). RESULTS: Surgical mortality was 5% (3/58) and three patients (5%) were reoperated immediately. The 52 remaining patients were followed from 6 to 108 months (mean 45.8 +/- 30.1 months, 199 patient-years). Six cases were reoperated in the follow-up (3.0% per patient-year). The functional class using the criteria of the New York Heart Association was evaluated before and after the procedure: class I raised from two to 42 patients whereas it decreased in the others (class II from 13 to 7, class III from 38 to 3, class IV from 5 to none; p < 0.001). The cardiothoracic index decreased from 0.61 +/- 0.064 before surgery to 0.55 +/- 0.069 after surgery (p < 0.001). Thirty patients (57%) were evaluated with echo-Doppler in the follow-up period. There were no deaths in the follow-up period. CONCLUSIONS: Our data shows that reconstructive surgery of the mitral valve with rheumatic involvement offers good immediate and late results, with a low reoperation rate, avoiding the use of prosthetic valves as a first option.

Adolescent↗
PubMedDate not supplied

[Tetralogy of Fallot in adults].

We present the clinical and hemodynamic profile of 33 patients, older than the 18 year with tetralogy of Fallot. Cardiac catheterization and selective angiocardiography were performed in all cases. We excluded patients with valvular pulmonary atresia associated with tetralogy of Fallot. Most of the patients were in functional class II or IV of the New York Heart Association and all presented with cyanosis. In the electrocardiogram of 23 patients we found right bundle branch block. None had significant cardiomegaly, 19 of 20 cases had reduced pulmonary blood flow and reticular pattern in the lung fields as observed in the chest X-ray. We did not find correlation between the age and the degree of cyanosis, but the level of arterial desaturation correlated with the functional class. The right ventricular systolic pressure was elevated in all patients. In all cases but one the pulmonary arterial systolic pressure were normal of slightly increased. One case with mild pulmonary infundibular stenosis had pulmonary systolic pressure similar to the systemic pressure. Multivariate analysis for functional class showed significant value for cyanosis. Systemic-pulmonary shunt was performed in 10 patients with hypoplastic pulmonary arteries plus reduced pulmonary blood flow, with one postoperative death. We did not find postoperative mortality in patients who underwent corrective surgery. The anatomic and functional behavior of patients who underwent surgery, allowed better tolerance to their heart defects.

Adolescent↗
PubMedDate not supplied

[Percutaneous closure of an interatrial communication with the Amplatzer device. The first case in Mexico].

The Amplatzer septal occluder is a new device intended for the percutaneous closure of secundum atrial septal defects that has distinctive characteristics and important advantages over other available devices. We present the first successful closure of an atrial septal defect with this device in Mexico in a 19 year old man with a 16 mm secundum type septal defect.

Adult↗