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Introducción: Las taquiarritmias en pediatría son uno de las principales motivos cardiológicos de consulta a la guardia. Durante el primer año de vida presentan una significativa morbi-mortalidad, por lo que el tratamiento farmacológico inmediato es fundamental para reducir la misma. Hasta los 3 años existe la posibilidad de curación espontánea en un porcentaje de éstos pacientes. La indicación de procedimientos de ablación durante los primero 4 años de vida se limita a casos refractarios al tratamiento antiarrítmico, dado que cuanto menor peso presenta el paciente, más pequeño es el corazón y más riesgoso es el mismo. Las taquicardias en pacientes con cardiopatía empeora el pronóstico de la misma. A pesar que el tratamiento farmacológico ha permitido el control de la gran mayoría de ellas, en muchos casos se requieren más de una droga antiarrítmica, con mayor exposición a efectos adversos, y en muchos otros se vuelven refractarias. En las últimas 3 décadas se ha desarrollado en forma exponencial el tratamiento de las taquiarritmias por medio de la ablación por radiofrecuencia o por frío (crioablación). Estos procedimientos han permitido obtener la curación de la mayor parte de las taquiarritmias en pediatría. En nuestro trabajo se evaluaron las indicaciones de dichos procedimientos en una población pediátrica, como así también la tasa de éxito, recurrencia, y la morbimortalidad tanto globalmente, como en cada arritmia (AU)

In children, tachyarrhythmias are one of the main reasons for cardiological consultation at the Department of Emergency. In the first year of life, they are associated with significant morbiditymortality and therefore, immediate drug treatment is essential up to 3 years of age. The indication of ablation procedures during the first 4 years of life is limited to patients refractory to antiarrhythmic treatment, since the lower weight of the patient, the smaller the heart and the riskier the intervention. In patients with heart disease, tachycardia worsens the prognosis. Although pharmacological treatment controls the vast majority of tachyarrhythmias, more than one antiarrhythmic drug is often required, leading to greater exposure to adverse effects, and many become refractory. Over the past three decades, treatment of tachyarrhythmias has developed exponentially with the advent of radiofrequency or cold ablation (cryoablation). These procedures have led to the cure of most tachyarrhythmias in children. Our study assessed the indications for these procedures in a pediatric population, as well as the success and recurrence rates, and morbidity both overall and of each arrhythmia episode (AU)

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El tratamiento de los trastornos del ritmo cardíaco ha sufrido recientemente una verdadera revolución. El empleo de avanzadas terapéuticas por catéter para tratar una gran variedad de arritmias, utilizando diferentes fuentes de energía, han permitido evolucionar de un tratamiento antiguamente basado casi con exclusividad en el empleo de fármacos antiarrítmicos, como terapia aguda y/o preventiva, a uno actualmente curativo, con el consiguiente avance que estos últimos métodos conllevan para la calidad de vida de nuestros pacientes y sus familias. La tendencia ha continuado con el empleo de navegadores 3 D que ya no requieren el empleo de radiación ionizante para efectuar estos procedimientos y permiten una mayor exactitud para mejorar los excelentes resultados alcanzados. El desarrollo de dispositivos eléctricos como los marcapasos, sumado a la aparición de otros más avanzados como defibriladores y resincronizadores cardíacos también ha contribuido a mejorar la expectativa de vida de muchos niños con cardiopatías diversas. La mejora evidenciada con el empleo de registradores de eventos implantables y el seguimiento mediante monitoreo a distancia de los diferentes dispositivos eléctricos han demostrado mejorar los resultados obtenidos con dichos métodos a largo plazo. Sin duda con la ayuda de la genética en un futuro cercano será posible hacer tratamientos cada vez más específicos para ayudar en casos de arritmias graves hereditarias o causadas por mutaciones en los canales iónicos de las células cardíacas. Si bien existen aún controversias respecto de algunos ítems muy puntuales los mismos se irán aclarando con las experiencias colaborativas en marcha en diferentes centros médicos especializados (AU)

Recently, treatment of heart rhythm disorders has revolutionized. The use of advanced catheter-based therapies to treat a wide spectrum of arrhythmias, using different energy sources, has led the treatment to evolve from an almost exclusively antiarrhythmic drug-based treatment, such as acute and/or preventive therapy, to a currently curative one, with the consequent advance that these latter methods add to the quality of life of our patients and their families. The trend has continued with the use of 3D navigators that no longer require the use of ionizing radiation to perform these procedures and allow greater accuracy to improve the excellent results achieved. The development of electrical devices, such as pacemakers, coupled with the emergence of more advanced devices, such as defibrillators and cardiac resynchronizers, has also been useful to improve the life expectancy of many children with different types of heart disease. The advances evidenced by the use of implantable event loggers and remote monitoring of different electrical devices have shown to improve the long-term results obtained with such methods. Undoubtedly, with the help of genetics in the near future it will be possible to develop increasingly specific therapies to treat patients with severe hereditary arrhythmias or those caused by mutations in the ion channels of the heart cells. Although controversy still exists regarding some very specific issues, these will be clarified with the collaborative experience underway at different specialized medical centers

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El cateterismo cardíaco en niños ha mostrado un avance significativo en las últimas décadas, transformándose de un procedimiento casi exclusivamente diagnóstico en sus inicios a un método predominantemente terapéutico en la actualidad. Para ello han contribuido la aparición de múltiples tecnologías de imágenes, así como el creciente desarrollo de materiales de muy bajo perfil y gran versatilidad que permiten el empleo de dispositivos cada vez más específicos para tratar adecuadamente un sinnúmero de enfermedades cardíacas con gran eficacia y seguridad. Esta tendencia continúa creciendo día a día, con la ayuda de nuevas modalidades de tratamiento híbrido donde cardiólogos intervencionistas y cirujanos cardiovasculares interactúan para ayudarse mutuamente, de manera tal de resolver los problemas existentes o aquellos que se van generando con el correr de los años y que afectan la vida de nuestros pacientes. Existen aún como es lógico controversias en algunos casos especiales, que se irán resolviendo paulatinamente en base a la evidencia reunida con las diferentes terapéuticas médicas utilizadas para mejorar el presente y futuro de los niños con cardiopatías (AU)

Cardiac catheterization in children has shown significant progress in recent decades, transforming from an initially almost exclusively diagnostic procedure to a predominantly therapeutic method today. The emergence of multiple imaging technologies has contributed to this progress, as has the growing development of very low-profile and highly versatile materials that allow the use of increasingly specific devices to adequately treat different types of heart disease with great efficacy and safety. This trend continues to grow day by day, with the help of new hybrid treatment modalities where interventional cardiologists and cardiovascular surgeons interact with mutual support, in order to solve existing problems or those that are generated over the years affecting the lives of our patients. Obviously, there are still controversies in specific cases, which will gradually be resolved based on the evidence that becomes available with the use of different medical therapies used to improve the present and future of children with heart disease.(AU)

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Percutaneous balloon aortic valvotomy using one or more balloons in sequential approach was attempted in 11 non selected neonates with critical aortic valve stenosis. The procedure was complete in 9 (81%), and they represent the study group with a mean age of 19 days. Using a balloon/annulus ratio of 0.86, the transvalvar gradient decreased from 49 to 25 mmHg, and left ventricular systolic pressure fell from 112 mmHg to 96 mmHg (p < 0.01, respectively). Fifty-five percent (5/9) of the patients developed a new aortic regurgitation, only one with grade 3. The maximal instantaneous Doppler gradient recorded in 7 neonates before and after valvotomy dropped from 67 to 35 mmHg (p < 0.01); while the left ventricular shortening fraction increased from 15 to 31% (p < 0.01). The Doppler gradient was correlated with the left ventricular shortening fraction (r:0.72) and the aortic regurgitation with the balloon/annulus ratio (r:0.82). The balloon pulmonary valvotomy was unsuccessful in 2 neonates (22%), both with hypoplastic left ventricle, both of which died in the operating room. Echocardiographic features of reestenosis were not found in the follow-up period (14 +/- 10 months); only one patient may need a future surgical intervention because significant aortic insufficiency. The pulmonary balloon valvotomy is a safe and effective therapy that must be used as the first step in the management of neonates with critical aortic stenosis in absence of hypoplastic left ventricle.

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Percutaneous pulmonary balloon valvotomy using one balloon or more in sequential approach was attempted in 9 no selected neonates with critical pulmonary valve stenosis between March 1985 and October 1990 (mean age 10 + 8.6 days). The procedure was successful in seven of them (78%) in whom with a 1.22 + 0.2 balloon/annulus ratio the right ventricular systolic pressure decreased from 96 to 45 mmHg (p < 0.001), the transvalvular gradient from 65 to 23 mmHg (p < 0.001); and the systemic oxygen saturation increased from 69 to 86% (p < 0.001). In one patient the valve was not crossed. Two patients underwent surgery because unsuccessful balloon valvotomy result in the immediate and mid term period: hypoplastic right ventricle in one, and inferior vena cava thrombosis that prevent a second dilation in the other respectively. The mid term follow up showed a 62% (5/8) of successful result. Although the complex methodology and complications are not uncommon, the balloon pulmonary valvotomy is a safely and effective therapy for neonates with critical pulmonary stenosis.

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OBJECTIVES: The present study was designed to establish possible predictors of unfavorable outcome in infants with pulmonary valve stenosis. BACKGROUND: Balloon pulmonary valvuloplasty is the treatment of choice for typical pulmonary valve stenosis. Patients with dysplastic valves may be less suitable candidates for this procedure because they have morphologic abnormalities of the complex valve-anulus-trunk that cause the obstructive phenomenon. METHODS: Twenty-five children (mean age +/- SD 1.1 +/- 0.7 years) with normal anulus diameter underwent balloon pulmonary valvuloplasty using a balloon/anulus ratio of 1.2 +/- 0.11. From the lateral view of a right ventricular angiogram, the following variables were quantified and scored: A, supravalvular narrowing; B, texture of the valve surface; C, diastolic deformity of the Valsalva sinuses; D, trunk/anulus ratio; E, systolic valve motion; and F, presence of a contrast jet. Paired t test, stepwise multivariate correlation with "dummy" variable methods were applied for both hemodynamic and valve-anulus-trunk determinations. RESULTS: The right ventricular-pulmonary artery gradient decreased from 66 +/- 21 (range 40 to 120) to 24 +/- 11 (range 10 to 50) mm Hg (p less than 0.001), whereas the right ventricular systolic pressure decreased from 89 +/- 20 (range 60 to 130) to 48 +/- 15 (range 30 to 80) mm Hg (p less than 0.001). Only variables A, B and D had significant influence in a percent reduction in right ventricular pulmonary artery gradient (R2 0.94, SEE 5.7; p less than 0.001). A score greater than or equal to greater than 4 obtained by adding the values from these three variables was correlated with poor outcome. CONCLUSIONS: These data show that there is an adequate relation between scores and outcome. We conclude that children less than 2 years old with pulmonary valve stenosis and a score greater than or equal to 4 should not be candidates for balloon pulmonary valvuloplasty.

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