Pleurodesis con tetraciclinas tras intervención de Fontan

Torres Borrego, J.; Nieves Martínez Gil, C.; Pérez Ruiz, E.; Pérez Frías y, J.; Martínez Valverde, A.

doi:10.1016/S1695-4033(01)77631-X

Anales de Pediatría (English Edition)

ISSN: 2341-2879

The Spanish Pediatric Association (Asociación Española de Pediatría, AEP) has as one of its main objectives the dissemination of rigorous and up-to-date scientific information on the various areas of pediatrics. Annals of Pediatrics is an open access journal that serves as the Association's Scientific Expression Organ and constitutes the vehicle through which members communicate. Annals of Pediatrics publishes, in English and Spanish, original research papers on pediatrics, as well as review articles prepared by experts in each specialty, and guidelines or positioning documents prepared by the different Societies/Specialized Sections integrated into the Spanish Pediatric Association. The journal, a reference for Spanish-speaking pediatrics, is indexed in the most important international databases: Index Medicus/Medline IBECS, IME, SCOPUS, Science Citation Index Expanded, Journal Citations Report, Embase/Excerpta Medica, Directory of Open Access Journals (DOAJ).

Indexed in:

Index Medicus/Medline IBECS, IME, SCOPUS, Science Citation Index Expanded, Journal Citations Report, Embase/Excerpta Medica, Directory of Open Access Journals (DOAJ)

La pleurodesis química consiste en la fusión de ambas capas pleurales tras el contacto con determinadas sustancias, y se emplea como tratamiento de derrames persistentes o recurrentes que no responden a otras medidas terapéuticas. Su práctica está extendida en adultos (fundamentalmente en derrames pleurales malignos), mientras que la experiencia en niños es escasa.

La intervención de Fontan constituye el tratamiento de la atresia tricuspídea y otras cardiopatías que se comportan como un ventrículo único. Con frecuencia, esta técnica presenta complicaciones derivadas de la retención de líquidos (edemas, ascitis, derrame pleural y pericárdico y enteropatía pierdeproteínas). Ante la existencia de derrame pleural prolongado o recurrente, la pleurodesis química a través del tubo de drenaje constituye una alternativa de tratamiento segura y fiable.

Se comunica el caso de una paciente afectada de atresia tricuspídea que presentó derrame pleural y pericárdico persistentes tras intervención de Fontan, requiriendo pleurodesis química con tetraciclina para su resolución.

Palabras clave:

Atresia tricuspídea

Intervención de Fontan

Derrame

Derrame pericárdico

Pleurodesis química

Tetraciclinas

Chemical pleurodesis consists of the fusion of both pleural layers after contact with certain substances, and is used in the treatment of prolonged or recurrent pleural effusions refractory to other therapeutic approaches. This procedure has been extensively used in adults with malignant pleural effusion but has rarely been used in children.

The Fontan technique is used in the treatment of tricuspid atresia and other heart diseases that act as a single ventricle. This technique frequently presents complications due to fluid retention (edema, ascites, pleural and pericardial effusions and protein-losing enteropathy). With persistent or recurrent pleural effusion, chemical pleurodesis through the drainage tube might constitute a safe and reliable alternative treatment.

We report the case of a female patient with tricuspid atresia, who presented recurrent pleural effusion after undergoing the Fontan procedure. The disorder was resolved by chemical pleurodesis with tetracycline.

Key words:

Tricuspid atresia

Fontan technique

Pleural/pericardial effusion

Chemical pleurodesis

Tetracyclines

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Bibliografía

[1.]

S.A. Sahn.

The pleura.

Am Rev Respir Dis, 138 (1988), pp. 184-234

http://dx.doi.org/10.1164/ajrccm/138.1.184 | Medline

[2.]

R.H. Feldt, D.J. Driscoll, K.P. Offord, R.H. Cha, J. Perrault, H.V. Schaff, et al.

Protein-losing enteropathy after the fontan operation.

J Thorac Cardiovasc Surg, 112 (1996), pp. 672-680

http://dx.doi.org/10.1016/S0022-5223(96)70051-X | Medline

[3.]

T.M. Zellers, D.J. Driscoll, R.A. Humes, R.H. Feldt, F.J. Puga, G.K. Danielson.

Glenn shunt: effect on pleural drainage after modified Fontan operation.

J Thorac Cardiovasc Surg, 98 (1989), pp. 725-729

Medline

[4.]

J.M. Stewart, M.H. Gewitz, B.J. Clark, K.P. Seligman, A. Romano, G.A. Zeballos, et al.

The role of vasopresine and atrial natriuretic factor in postoperative fluid retention after the Fontan procedure.

JThorac Cardiovasc Surg, 102 (1991), pp. 821-829

[5.]

R.D. Mainwaring, J.J. Lamberti, J.W. Moore, G.F. Billman, J.C. Nelson.

Comparison of the hormonal response after bidirectional Glenn and Fontan procedures.

Ann Thorac Surg, 57 (1994), pp. 59-64

Medline

[6.]

R.L. Spicer, K.C. Urzak, J.W. Moore, R.D. Mainwaring, J.J. Lamberti.

Aortopulmonary collateral vessels and prolonged pleural effusions after modified Fontan procedures.

Am Heart J, 131 (1996), pp. 1164-1168

Medline

[7.]

F. Rodríguez Panadero.

Enfermedades de la pleura.

Medicina Interna, 13.a, pp. 836-844

[8.]

P.B. Walker-Renard, L.M. Vaughan, S.A. Sahn.

Chemical pleurodesis for malignant pleural effussions.

Ann Int Med, 120 (1994), pp. 56-64

Medline

[9.]

F.S. Vargas, J.R.C. Milanez, L.T.B. Filomeno, A. Fernández, A. Jatene, R.W. Light.

Intrapleural talc for the prevention of recurrence in benign or undiagnosed pleural effusions.

Chest, 106 (1994), pp. 1771-1775

Medline

[10.]

V. Webb WR, Ozmen, P.V. Moulder, B. Shabahang, J. Breaux.

Iodized talc pleurodesis for the treatment of pleural effusions.

J Thorac Cardiovasc Surg, 103 (1992), pp. 881-886

Medline

[11.]

D.H. Rehse, R.W. Aye, M.G. Florence.

Respiratory failure following talc pleurodesis.

Am J Surg, 177 (1999), pp. 437-440

Medline

[12.]

M.L. Jacobs, W.I. Norwood.

Fontan operation: influence of modifications on morbidity and mortality.

Ann Thorac Surg, 58 (1994), pp. 945-952

Medline

[13.]

J. Rychik, J.J. Rome, M.L. Jacobs.

Late surgical fenestration for complications after the Fontan operation.

Circulation, 96 (1997), pp. 33-36

Medline

[14.]

R.M. Sade, H.B. Wiles.

Pleuroperitoneal shunt for persistant pleural drainage after Fontan procedure.

J Thorac Cardiovasc Surg, 100 (1990), pp. 621-623

Medline

[15.]

A. Rothman, J.E. Mayer, M.D. Freed.

Treatment of chronic pleural effusions after the Fontan procedure with prednisone.

Am J Cardiol, 60 (1987), pp. 408-409

Medline

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