Browsing by Author "Valderrama, Paulo"

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    Extubation failure after cardiac surgery in children with Down syndrome
    (2023) Salgado, Fernanda; Larios, Guillermo; Valenzuela, Gonzalo; Amstein, Rodolfo; Valle, Patricio; Valderrama, Paulo
    Extubation failure (EF) after cardiac surgery is associated with poorer outcomes. Approximately 50% of children with Down syndrome (DS) have congenital heart disease. Our primary aim was to describe the frequency of EF and identify risk factors for its occurrence in a population of patients with DS after cardiac surgery. Secondary aims were to describe complications, length of hospital stay, and mortality rates. This report was a retrospective case-control study and was carried out in a national reference congenital heart disease repair center of Chile. This study includes all infants 0-12 months old with DS who were admitted to pediatric intensive care unit after cardiac surgery between January 2010 and November 2020. Patients with EF (cases) were matched 1:1 with children who did not fail their extubation (controls) using the following criteria: age at surgery, sex, and type of congenital heart disease. Overall, 27/226 (11.3%) failed their first extubation. In the first analysis, before matching of cases and controls was made, we found association between EF and younger age (3.8 months vs 5 months; p = 0.003) and presence of coarctation of the aorta (p = 0.005). In the case-control univariate analysis, we found association between an increased cardiothoracic ratio (CTR) (p = 0.03; OR 5 (95% CI 1.6-16.7) for a CTR > 0.59) and marked hypotonia (27% vs 0%; p = 0.01) with the risk of EF. No differences were found in ventilatory management.Conclusions: In pediatric patients with DS, EF after cardiac surgery is associated with younger age, presence of aortic coarctation, higher CTR reflecting the degree of cardiomegaly and hypotonia. Recognition of these factors may be helpful when planning extubation for these patients.
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    Myocardial function, mechanics and work by echocardiography in adolescents with severe obesity
    (2024) Larios, Guillermo; Uribe, Sergio; Trincado, Claudia; Arancibia-Galilea, Francisca; Valderrama, Paulo; Espejo, Juan Pablo; Amezquita, Maria Virginia; Barja, Salesa
    IntroductionObesity and its metabolic complications can impact the heart's structure and function in childhood, although demonstrating this impact has been challenging. New echocardiographic parameters such as left atrial strain (LA epsilon) and left ventricular strain (LV epsilon), as well as myocardial work (MW), could reveal subclinical alterations in cardiac function.ObjectiveThe aim is to evaluate the feasibility of these parameters in adolescents with severe obesity and explore their associations with body fat, metabolic comorbidities, and physical capacity.MethodsThis is a cross-sectional study in adolescents with obesity who underwent echocardiography with analysis of LA epsilon, LV epsilon and MW using speckle tracking. Feasibility and association with anthropometry, body fat percentage, comorbidities and cardiopulmonary test were analyzed.ResultsTwenty adolescents were recruited, 13 (65%) were males, median age 14.2 (interquartile range: 12.9-14.9) years old. The median Z-score for BMI (zBMI) was +3.03 (2.87-3.14), 14 (70%) had severe obesity (zBMI >=+3), 12 (60%) body fat >= 95th percentile, 9 (45%) high blood pressure (HBP) and 8 (40%) metabolic syndrome. The analysis of the echocardiographic parameters was feasible in 95% (LA epsilon) and 100% (LV epsilon and MW). LV epsilon was lower in adolescents with vs. without metabolic syndrome: 17.8% (17.5-19.3%) vs. 19.3% (18.3-20.3%), P = 0.046; and with vs. without HBP 17.8% (17.5-18.6%) vs. 19.7% (18.4-20.3%), P = 0.02. Those with body fat >= 95th percentile had lower LA epsilon and MW parameters, without association with cardiopulmonary test.ConclusionEchocardiographic evaluation of LA epsilon, LV epsilon and MW is feasible in adolescents with severe obesity. A higher proportion of body fat and the presence of comorbidities are associated with alterations in these new echocardiographic functional parameters suggesting myocardial impact of higher metabolic compromise.