Actualización en cardiología pediátrica y cardiopatías congénitas: técnicas de imagen, hipertensión arterial pulmonar, tratamientos híbridos y quirúrgicosUpdate on Pediatric Cardiology and Congenital Heart Disease: Imaging Techniques, Pulmonary Arterial Hypertension, Hybrid Treatment, and Surgical Treatment

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Resumen

En este artículo se realiza una revisión de las aportaciones más significativas publicadas entre septiembre de 2009 y agosto de 2010 sobre el campo de la cardiología pediátrica y las cardiopatías congénitas, centrándonos en técnicas de imagen, nuevos tratamientos en la hipertensión arterial pulmonar en pediatría y aspectos terapéuticos (tratamientos híbridos y quirúrgicos). En cuanto a las técnicas de imagen, se destaca el creciente diagnóstico de las cardiopatías congénitas en vida fetal y las nuevas aplicaciones ecocardiográficas (Doppler tisular, 2D speckle-tracking y ecocardiografía 3D) en la clínica diaria, así como el uso cada vez mayor de la tomografía computarizada cardiaca y la resonancia magnética para el diagnóstico y la función cardiaca, respectivamente. El intervencionismo cardiaco cada vez es más relevante y la cirugía cardiaca está avanzando, en algunos casos combinada con técnicas híbridas. Sin embargo, en cirugía cardiaca sigue habiendo controversias todavía sin respuestas claras, como la fenestración o no en la cirugía Fontan, el tipo de corrección en la hipoplasia izquierda o el tubo ideal en el reemplazo pulmonar, entre otras.

Abstract

This article contains a review of the most significant contributions to pediatric cardiology and congenital heart disease reported in publications between September 2009 and August 2010. The review focuses on imaging techniques, new treatment for pulmonary arterial hypertension in pediatric patients, and therapy in general (e.g. hybrid treatment and surgical treatment). With regard to imaging techniques, the review highlights the increasing application of congenital heart disease diagnosis during fetal life, the introduction of new echocardiographic techniques (e.g. tissue Doppler imaging, two-dimensional speckle-tracking imaging and three-dimensional echocardiography) into routine clinical practice, and the growing use of cardiac CT and magnetic resonance imaging in diagnosis and the assessment of cardiac function, respectively. The role played by cardiac interventions continues to increase and cardiac surgery is becoming more advanced and has, in some cases, been combined with hybrid techniques. However, there are still a number of controversial issues in cardiac surgery that have not yet been resolved, such as whether or not fenestration should be used with Fontan surgery, the optimum type of correction for hypoplastic left heart syndrome, and the best conduit for pulmonary artery replacement.

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