Tabla I. Cardiopatías congénitas graves según la clasificación de Hoffman (incluye la mayoría de los pacientes que se presentan como gravemente enfermos en el período recién nacido o en la primera infancia). |
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Todas las personas con cardiopatía cianótica |
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Dextrotransposición de las grandes arterias |
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Tetralogía de Fallot, incluyendo atresia pulmonar y válvula pulmonar ausente |
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Corazón derecho hipoplásico |
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Atresia tricuspídea |
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Atresia pulmonar con tabique ventricular intacto |
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Anomalía de Ebstein |
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Corazón izquierdo hipoplásico |
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Atresia aórtica |
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Atresia mitral |
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Ventrículo único |
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Ventrículo derecho de doble salida |
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Tronco arterioso |
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Conexión venosa pulmonar anómala total |
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Estenosis pulmonar crítica |
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Varias lesiones poco frecuentes, como doble salida del ventrículo izquierdo, ciertas malposiciones inusuales y algunas formas de levotransposición de las grandes arterias |
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Lesiones acianóticas |
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Defectos septales atrioventriculares |
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Comunicación interventricular grande |
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Conducto arterioso persistente grande |
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Estenosis aórtica crítica o grave |
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Estenosis pulmonar grave |
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Coartación aórtica crítica |
Tabla II. Edad media (en meses) de oxigenación con membrana extracorpórea (t de Student para muestras independientes). |
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n |
Edad |
Desviación |
p |
IC 95% |
IC 95% |
||
Denver a los 2 meses |
Normal |
40 |
10,55 |
19,103 |
|||
Alterado |
0 |
||||||
Denver a los 6 meses |
Normal |
35 |
11,34 |
20,279 |
0,116 |
–1,664 |
14,350 |
Alterado |
5 |
5,00 |
4,301 |
||||
Denver a los 12 meses |
Normal |
35 |
11,34 |
20,279 |
0,116 |
–1,664 |
14,350 |
Alterado |
5 |
5,00 |
4,301 |
||||
Denver a los 15 meses |
Normal |
33 |
11,88 |
20,679 |
0,060 |
–0,377 |
15,523 |
Alterado |
7 |
4,29 |
3,988 |
||||
Denver a los 18 meses |
Normal |
34 |
11,88 |
20,417 |
0,026 |
1,111 |
16,654 |
Alterado |
6 |
3,00 |
3,847 |
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Trastorno del lenguaje |
Normal |
36 |
11,28 |
19,985 |
0,085 |
–1,101 |
15,657 |
Alterado |
4 |
4,00 |
4,546 |
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Trastorno motor |
Normal |
35 |
11,34 |
20,279 |
0,116 |
–1,664 |
14,350 |
Alterado |
5 |
5,00 |
4,301 |
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Trastorno social |
Normal |
35 |
11,34 |
20,279 |
0,116 |
–1,664 |
14,350 |
Alterado |
5 |
5,00 |
4,301 |
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IC 95%: intervalo de confianza al 95%. |
Tabla III. Edad media (en meses) de cateterismo (t de Student para muestras independientes). |
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n |
Edad |
Desviación |
p |
IC 95% |
IC 95% |
||
Denver a los 2 meses |
Normal |
21 |
13,86 |
26,443 |
|||
Alterado |
0 |
||||||
Denver a los 6 meses |
Normal |
20 |
14,50 |
26,951 |
0,631 |
–44,324 |
71,324 |
Alterado |
1 |
1,00 |
|||||
Denver a los 12 meses |
Normal |
20 |
14,50 |
26,951 |
0,631 |
–44,324 |
71,324 |
Alterado |
1 |
1,00 |
|||||
Denver a los 15 meses |
Normal |
18 |
6,78 |
10,642 |
0,001 |
–75,78 |
–23,331 |
Alterado |
3 |
56,33 |
53,594 |
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Denver a los 18 meses |
Normal |
18 |
6,78 |
10,642 |
0,001 |
–75,78 |
–23,331 |
Alterado |
3 |
56,33 |
53,594 |
||||
Trastorno del lenguaje |
Normal |
18 |
6,78 |
10,642 |
0,001 |
–75,78 |
–23,331 |
Alterado |
3 |
56,33 |
53,594 |
||||
Trastorno motor |
Normal |
21 |
13,81 |
26,462 |
0,032 |
1,227 |
25,392 |
Alterado |
2 |
0,50 |
0,707 |
||||
Trastorno social |
Normal |
21 |
13,86 |
26,443 |
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Alterado |
0 |
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IC 95%: intervalo de confianza al 95%. |
Psychomotor development in patients with severe congenital heart disease Aim. Retrospective analysis of the neurodevelopment in the first two years of life in patients with severe congenital heart disease. Patients and methods. Out of 89 patients with severe congenital heart disease 19 were excluded due to a history of prematurity and/or chromosomopathy, four due to a history of ischemic stroke and two due to lack of medical history. Denver Test (DT) results at 2, 6, 12, 15 and 18 months, and results in motor, language and social interaction fields were achieved. Results. 59.4% were male and 40.6% female. The mean age of patients undergoing extracorporeal membrane oxygenation with pathological DT at 18 months was 3 months, compared to 11.88 months in those with normal DT. DT at 2 months was normal in 98.4% of patients, 87.5% at 6 and 12 months, 81.3% at 15 months and 85% at 18 months. Two patients with abnormal neurodevelopment normalized the DT before 24 months. The field of neurodevelopment most affected was language (15.6%), followed by motor (10.9%) and social interaction (8%). Conclusions. Psychomotor development delay, especially in the area of language, is more frequent in patients with severe congenital heart disease. The presence of cyanosis and the need for extracorporeal membrane oxygenation were the variables that are most associated with this type of pathology. Key words. Congenital heart disease. Denver Test. Early care. Language disorders. Neurodevelopment. Neurological morbidity. |