Utilidad de la Escala CHARM Para Establecer el Riesgo de Eventos Adversos Posterior a Cateterismo Cardiaco en Pacientes Pediátricos Intervenidos en la Fundación Cardiovascular de Colombia

Digital

Autores:: Riveros-Bustos, Nubia Carolina

Tipo de recurso:: Trabajo de grado de pregrado

Fecha de publicación:: 2023

Institución:: Universidad de Santander

Repositorio:: Repositorio Universidad de Santander

Idioma:: spa

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dc.title.spa.fl_str_mv	Utilidad de la Escala CHARM Para Establecer el Riesgo de Eventos Adversos Posterior a Cateterismo Cardiaco en Pacientes Pediátricos Intervenidos en la Fundación Cardiovascular de Colombia
dc.title.translated.none.fl_str_mv	Utility of the CHARM Scale to Establish the Risk of Adverse Events After Cardiac Catheterization in Pediatric Patients Operated at the Cardiovascular Fundation of Colombia
title	Utilidad de la Escala CHARM Para Establecer el Riesgo de Eventos Adversos Posterior a Cateterismo Cardiaco en Pacientes Pediátricos Intervenidos en la Fundación Cardiovascular de Colombia
spellingShingle	Utilidad de la Escala CHARM Para Establecer el Riesgo de Eventos Adversos Posterior a Cateterismo Cardiaco en Pacientes Pediátricos Intervenidos en la Fundación Cardiovascular de Colombia Cateterismo Cardíaco Cardiopatías Congénitas Predicción Cardiac Catheterization Heart Congenital Defects Forecasting
title_short	Utilidad de la Escala CHARM Para Establecer el Riesgo de Eventos Adversos Posterior a Cateterismo Cardiaco en Pacientes Pediátricos Intervenidos en la Fundación Cardiovascular de Colombia
title_full	Utilidad de la Escala CHARM Para Establecer el Riesgo de Eventos Adversos Posterior a Cateterismo Cardiaco en Pacientes Pediátricos Intervenidos en la Fundación Cardiovascular de Colombia
title_fullStr	Utilidad de la Escala CHARM Para Establecer el Riesgo de Eventos Adversos Posterior a Cateterismo Cardiaco en Pacientes Pediátricos Intervenidos en la Fundación Cardiovascular de Colombia
title_full_unstemmed	Utilidad de la Escala CHARM Para Establecer el Riesgo de Eventos Adversos Posterior a Cateterismo Cardiaco en Pacientes Pediátricos Intervenidos en la Fundación Cardiovascular de Colombia
title_sort	Utilidad de la Escala CHARM Para Establecer el Riesgo de Eventos Adversos Posterior a Cateterismo Cardiaco en Pacientes Pediátricos Intervenidos en la Fundación Cardiovascular de Colombia
dc.creator.fl_str_mv	Riveros-Bustos, Nubia Carolina
dc.contributor.author.none.fl_str_mv	Riveros-Bustos, Nubia Carolina
dc.contributor.jury.none.fl_str_mv	Santiago-Peña, Justo José Martínez-Vega, Ruth Aralí
dc.subject.proposal.spa.fl_str_mv	Cateterismo Cardíaco Cardiopatías Congénitas Predicción Cardiac Catheterization Heart Congenital Defects Forecasting
topic	Cateterismo Cardíaco Cardiopatías Congénitas Predicción Cardiac Catheterization Heart Congenital Defects Forecasting
description	Digital
publishDate	2023
dc.date.accessioned.none.fl_str_mv	2023-09-04T16:11:59Z
dc.date.available.none.fl_str_mv	2023-09-04T16:11:59Z
dc.date.issued.none.fl_str_mv	2023-07-26
dc.type.none.fl_str_mv	Trabajo de grado - Pregrado
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dc.identifier.instname.none.fl_str_mv	Universidad de Santander
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dc.relation.references.none.fl_str_mv	Bergersen L, Gauvreau K, Foerster SR, Marshall AC, McElhinney DB, Beekman RH, et al. Catheterization for Congenital Heart Disease Adjustment for Risk Method (CHARM). JACC Cardiovasc Interv. 2011 Sep;4(9):1037–46. Mosquera W. Radioprotección en cateterismo cardiaco pediátrico. Revista Colombiana de Cardiología. 2020 Mar;27:96–101. Boston Children Hospital. Cardiac Catheterization. 2021. p. 1–1. Children’s National Hospital. Cardiac Catheterization. 2020. Elshazali O, Ibrahim M, Elseed A. Management of Congenital Heart Disease in Low-Income Countries: The Challenges and the Way Forward. In: Congenital Heart Defects - Recent Advances. IntechOpen; 2022. Nguyen N, Leon-Wyss J, Iyer KS, Pezzella AT. Paediatric cardiac surgery in low-income and middle-income countries: a continuing challenge. Arch Dis Child. 2015 Dec;100(12):1156–9. Bennet D, Marcus R, Stokes M. Incidents and complications during pediatric cardiac catheterization. Pediatric Anesthesia. 2005 Oct 4;0(0):051004011653003. Bergersen L, Gauvreau K, Jenkins KJ, Lock JE. Adverse event rates in congenital cardiac catheterization: a new understanding of risks. Congenit Heart Dis. 2008;3(2):90–105. Lince-Varela R, Restrepo D, Lince M, Muñoz D, Vásquez F, Quijano JM, et al. Complicaciones relacionadas con el cateterismo cardíaco pediátrico y cardiopatías congénitas. Arch Cardiol Mex. 2022 Mar 28;91(4). Zaleski KL, Scholl RL, Thiagarajan RR, Porras D, Mah D, DiNardo JA, et al. Elective Extracorporeal Membrane Oxygenation Support for High-Risk Pediatric Cardiac Catheterization. J Cardiothorac Vasc Anesth. 2019 Jul;33(7):1932–8. Vitiello R, McCrindle BW, Nykanen D, Freedom RM, Benson LN. Complications associated with pediatric cardiac catheterization. J Am Coll Cardiol. 1998 Nov;32(5):1433–40. Mehta R, Lee KJ, Chaturvedi R, Benson L. Complications of pediatric cardiac catheterization: a review in the current era. Catheter Cardiovasc Interv. 2008 Aug 1;72(2):278–85. Kasar T, Tanıdır İC, Öztürk E, Gökalp S, Tunca Şahin G, Topkarcı MA, et al. Arrhythmia during diagnostic cardiac catheterization in pediatric patients with congenital heart disease. Turk Kardiyol Dern Ars. 2018 Dec;46(8):675–82. Odegard KC, Bergersen L, Thiagarajan R, Clark L, Shukla A, Wypij D, et al. The frequency of cardiac arrests in patients with congenital heart disease undergoing cardiac catheterization. Anesth Analg. 2014 Jan;118(1):175–82. Kang SL, Benson L. Recent advances in cardiac catheterization for congenital heart disease. F1000Res. 2018 Mar 26;7:370. Manda YR, Baradhi KM. Cardiac Catheterization Risks and Complications. 1st ed. Vol. 1. https://www.ncbi.nlm.nih.gov/books/NBK531461/; 2022. 1–10 p. Best KE, Rankin J. Long‐Term Survival of Individuals Born With Congenital Heart Disease: A Systematic Review and Meta‐Analysis. J Am Heart Assoc. 2016 Jun 13;5(6). Marino BS, Bird GL, Wernovsky G. Diagnosis and management of the newborn with suspected congenital heart disease. Clin Perinatol. 2001 Mar;28(1):91–136. McGovern E, Sands AJ. Perinatal management of major congenital heart disease. Ulster Med J. 2014 Sep;83(3):135–9. Vincenti M, Guillaumont S, Clarivet B, Macioce V, Mura T, Boulot P, et al. Prognosis of severe congenital heart diseases: Do we overestimate the impact of prenatal diagnosis? Arch Cardiovasc Dis. 2019 Apr;112(4):261–9. Tokel K, Gümüş A, Ayabakan C, Varan B, Erdoğan İ. Complications of cardiac catheterization in children with congenital heart disease. Turk J Pediatr. 2018;60(6):675. Jayaram N, Beekman RH, Benson L, Holzer R, Jenkins K, Kennedy KF, et al. Adjusting for Risk Associated With Pediatric and Congenital Cardiac Catheterization. Circulation. 2015 Nov 17;132(20):1863–70. Zühlke L, Lawrenson J, Comitis G, De Decker R, Brooks A, Fourie B, et al. Congenital Heart Disease in Low- and Lower-Middle-Income Countries: Current Status and New Opportunities. Curr Cardiol Rep. 2019 Nov 29;21(12):163. Zimmerman M, Sable C. Congenital heart disease in low-and-middle-income countries: Focus on sub-Saharan Africa. Am J Med Genet C Semin Med Genet. 2020 Mar;184(1):36–46. Laussen PC, Salvin J. Diagnostic and Therapeutic Cardiac Catheterization. In: Pediatric Critical Care. Elsevier; 2011. p. 266–76. Bourassa MG. The history of cardiac catheterization. Can J Cardiol. 2005 Oct;21(12):1011–4. Nossaman BD, Scruggs BA, Nossaman VE, Murthy SN, Kadowitz PJ. History of right heart catheterization: 100 years of experimentation and methodology development. Cardiol Rev. 2010;18(2):94–101. The Nobel Prize. https://www.nobelprize.org/prizes/medicine/1956/richards/facts/. 2022. Dickinson W. Richards Facts. Baim DS. Cardiac catheterization history and current practice standards. Grossman’s Cardiac Catheterization, Angiography, and Intervention Philadelphia: Lippincott Williams § Wilkins. 2006;3–13. Boehm W, Emmel M, Sreeram N. Balloon atrial septostomy: history and technique. Images Paediatr Cardiol. 2006 Jan;8(1):8–14. Fawzy ME. Mitral balloon valvuloplasty. J Saudi Heart Assoc. 2010 Jul;22(3):125–32. Rao PS, Agarwal A. Advances in the Diagnosis and Management of Congenital Heart Disease in Children. Children. 2022 Jul 15;9(7):1056. Yilmazer MM, Ustyol A, Güven B, Oner T, Demirpençe S, Doksöz O, et al. Complications of cardiac catheterization in pediatric patients: a single center experience. Turk J Pediatr. 2012;54(5):478–85. Prasad PA, Dominguez TE, Zaoutis TE, Shah SS, Teszner E, Gaynor JW, et al. Risk factors for catheter-associated bloodstream infections in a Pediatric Cardiac Intensive Care Unit. Pediatr Infect Dis J. 2010 Sep;29(9):812–5. Takikawa M, Nambu M, Yamamoto N, Azuma R, Kiyosawa T. Radiation-induced Skin Injury on the Upper Arm Following Cardiac Interventional Radiology: A Review and Case Report. Wounds. 2012 Apr;24(4):91–8. Berlin L. Radiation-Induced Skin Injuries and Fluoroscopy. American Journal of Roentgenology. 2001 Jul;177(1):21–5. Schneider H, Paul T. Infection prevention in catheter-interventional treatment of children and adults. GMS Hyg Infect Control. 2021;16:Doc14. Hanslik A, Kitzmuller E, Thom K, Haumer M, Mlekusch W, Salzer-Muhar-MUHAR U, et al. Incidence of thrombotic and bleeding complications during cardiac catheterization in children: comparison of high-dose vs. low-dose heparin protocols. Journal of Thrombosis and Haemostasis. 2011 Dec;9(12):2353–60. Agnoletti G, Bonnet C, Boudjemline Y, Le Bihan C, Bonnet D, Sidi D, et al. Complications of paediatric interventional catheterisation: an analysis of risk factors. Cardiol Young. 2005 Aug;15(4):402–8. Nykanen DG, Forbes TJ, Du W, Divekar AA, Reeves JH, Hagler DJ, et al. CRISP: Catheterization RISk score for pediatrics: A Report from the Congenital Cardiac Interventional Study Consortium (CCISC). Catheterization and Cardiovascular Interventions. 2016 Feb 1;87(2):302–9. Holzer RJ, Gauvreau K, Kreutzer J, Moore JW, McElhinney DB, Bergersen L. Relationship between procedural adverse events associated with cardiac catheterization for congenital heart disease and operator factors: results of a multi-institutional registry (C3PO). Catheter Cardiovasc Interv. 2013 Sep 1;82(3):463–73. Learn CP, Holzer RJ, Daniels CJ, Torres AJ, Vincent JA, Moore JW, et al. Adverse events rates and risk factors in adults undergoing cardiac catheterization at pediatric hospitals-results from the C3PO. Catheterization and Cardiovascular Interventions. 2013 May;81(6):997–1005. Enríquez LE, Prada M, Basto-Duarte MC, Muñoz-Pérez Y. The panorama for children with heart disease in Colombia. Colombian Journal of Anesthesiology. 2019 Oct;47(4):236–42. Sandoval N. Congenital Heart Disease in Colombia and Worldwide. Revista Colombiana de Cardiología. 2015 Jan;22(1):e1–2. Su Z, Zou Z, Hay SI, Liu Y, Li S, Chen H, et al. Global, regional, and national time trends in mortality for congenital heart disease, 1990–2019: An age-period-cohort analysis for the Global Burden of Disease 2019 study. EClinicalMedicine. 2022 Jan;43:101249. Wagdy R. The role of diagnostic cardiac catheterization for children with congenital heart diseases: local experience. Archives of Medical Science – Atherosclerotic Diseases. 2018 Jun 28;3(1):72–9. Reinhardt Z, De Giovanni J, Stickley J, Bhole VK, Anderson B, Murtuza B, et al. Catheter interventions in the staged management of hypoplastic left heart syndrome. Cardiol Young. 2014 Apr 8;24(2):212–9. Kreutzer J, Graziano JN, Stapleton G, Rome JJ. Late catheter interventions in hypoplastic left heart syndrome. Cardiol Young. 2011 Dec 13;21(S2):65–76. Nakanishi T. Cardiac Catheterization Is Necessary Before Bidirectional Glenn and Fontan Procedures in Single Ventricle Physiology. Pediatr Cardiol. 2005 Apr 5;26(2):159–61. James L, Tandon A, Nugent A, Malik S, Ramaciotti C, Greil G, et al. Rationalising the use of cardiac catheterisation before Glenn completion. Cardiol Young. 2018 May 6;28(5):719–24. Cerro MJ, Moledina S, Haworth SG, Ivy D, Dabbagh M Al, Banjar H, et al. Cardiac Catheterization in Children with Pulmonary Hypertensive Vascular Disease: Consensus Statement from the Pulmonary Vascular Research Institute, Pediatric and Congenital Heart Disease Task Forces. Pulm Circ. 2016 Mar;6(1):118–25. Cerro MJ, Moledina S, Haworth SG, Ivy D, Dabbagh M Al, Banjar H, et al. Cardiac Catheterization in Children with Pulmonary Hypertensive Vascular Disease: Consensus Statement from the Pulmonary Vascular Research Institute, Pediatric and Congenital Heart Disease Task Forces. Pulm Circ. 2016 Mar;6(1):118–25. Yang MC, Wu JR. Recent review of transcatheter closure of atrial septal defect. Kaohsiung J Med Sci. 2018 Jul;34(7):363–9. Weryński P, Skorek P, Wójcik A, Rudek-Budzyńska A, Dziewulska A, Rudziński A. Recent achievements in transcatheter closure of ventricular septal defects: a systematic review of literature and a meta-analysis. Kardiol Pol. 2021 Feb 25;79(2):161–9. Rao PS. Management of Congenital Heart Disease: State of the Art; Part I—ACYANOTIC Heart Defects. Children. 2019 Mar 8;6(3):42. Holoshitz N, Kenny D, Hijazi ZM. Hybrid Interventional Procedures in Congenital Heart Disease. Methodist Debakey Cardiovasc J. 2014 Apr 1;10(2):93. A. Moustafa G, Kolokythas A, Charitakis K, V. Avgerinos D. Diagnostic Cardiac Catheterization in the Pediatric Population. Curr Cardiol Rev. 2016 Apr 4;12(2):155–62. Glatz AC, Shah SS, McCarthy AL, Geisser D, Daniels K, Xie D, et al. Prevalence of and risk factors for acute occlusive arterial injury following pediatric cardiac catheterization: A large single-center cohort study. Catheterization and Cardiovascular Interventions. 2013 Sep 1;82(3):454–62. Ali SH. Adverse events in pediatric cardiac catheterization: Initial experience of Sohag university hospital. The Egyptian Heart Journal. 2016 Mar;68(1):45–51. Lee KE, Seo YJ, Kim GB, An HS, Song YH, Kwon BS, et al. Complications of Cardiac Catheterization in Structural Heart Disease. Korean Circ J. 2016;46(2):246. O’Byrne ML, Kennedy KF, Kanter JP, Berger JT, Glatz AC. Risk Factors for Major Early Adverse Events Related to Cardiac Catheterization in Children and Young Adults With Pulmonary Hypertension: An Analysis of Data From the IMPACT (Improving Adult and Congenital Treatment) Registry. J Am Heart Assoc. 2018 Mar 6;7(5). Vaiyani D, Kelleman M, Downey LA, Kanaan U, Petit CJ, Bauser-Heaton H. Risk Factors for Adverse Events in Children with Pulmonary Hypertension Undergoing Cardiac Catheterization. Pediatr Cardiol. 2021 Apr 29;42(4):736–42. Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2002 Jan;123(1):110–8. Quinn BP, Yeh M, Gauvreau K, Ali F, Balzer D, Barry O, et al. Procedural Risk in Congenital Cardiac Catheterization (PREDICT). J Am Heart Assoc. 2022 Jan 4;11(1).
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dc.publisher.none.fl_str_mv	Universidad de Santander
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spelling	Riveros-Bustos, Nubia Carolina2bcdfcca-ca77-44c3-9c0a-a470a0392d98-1Santiago-Peña, Justo José5227579d-57a7-4088-8052-0481cc27795f-1Martínez-Vega, Ruth Aralíb8e34904-0aae-4075-8f5a-5e2faa13adfc-12023-09-04T16:11:59Z2023-09-04T16:11:59Z2023-07-26DigitalIntroducción: El cateterismo cardiaco es un procedimiento mínimamente invasivo utilizado en el tratamiento de cardiopatías congénitas en niños. Comparado con la cirugía, tiene menos complicaciones. La escala de CHARM evalúa el riesgo de complicaciones en el cateterismo cardiaco pediátrico, considerando características clínicas, diagnóstico y tipo de procedimiento. El objetivo de este estudio es evaluar la utilidad de la Escala CHARM para predecir eventos adversos en las primeras 24 horas después del cateterismo cardiaco en pacientes pediátricos de la Fundación Cardiovascular de Colombia. Metodología: Estudio observacional analítico tipo cohorte retrospectiva donde se incluyeron todos los registros de pacientes llevados a cateterismo diagnostico y/o terapéutico en el periodo 2020-2022 mediante revisión de historia clínica. Fueron registradas las variables clínicas y demográficas. Las variables de exposición fueron la edad, categoría de riesgo del procedimiento, incidencia predicha por CHARM y parámetros de vulnerabilidad hemodinámica. Se realizó un análisis descriptivo de la muestra y posteriormente el rendimiento predictivo de cada una de las variables de exposición para predecir eventos adversos. Resultados: Se incluyeron 467 registros de cateterismo cardiaco con una mediana de edad de 2.5 años. Fue más prevalente el sexo masculino (56,3%) y el grupo etario de mayores de 5 años (33,8%). La incidencia general de eventos adversos fue de 3,8% (IC95% 2,5% - 6,0%). La Escala de CHARM OR 1,21 (IC95% 1,06 – 1,37) tiene una asociación estadísticamente significativa con un mayor riesgo de eventos adversos. La capacidad predictiva entre la Escala CHARM (AUC: 0,74) y el riesgo según el procedimiento (AUC 0,67) no fueron diferentes estadísticamente. La vulnerabilidad hemodinámica (p=0,375) y la edad (p=0,088) no se relacionan estadísticamente con los eventos adversos. Conclusión: La Escala CHARM tiene buen rendimiento predictivo de eventos adversos en nuestra población, aunque, es similar al riesgo predicho según el procedimiento a realizar.Introduction: Cardiac catheterization is a minimally invasive procedure used in the treatment of congenital heart disease in children. Compared to surgery, it has fewer complications. The CHARM scale evaluates the risk of complications in pediatric cardiac catheterization, considering clinical characteristics, diagnosis, and procedure type. The aim of this study is to assess the utility of the CHARM scale in predicting adverse events within the first 24 hours after cardiac catheterization in pediatric patients at the Cardiovascular Foundation of Colombia. Methods: This retrospective analytical cohort study included all records of patients who underwent diagnostic and/or therapeutic cardiac catheterization between 2020 and 2022, through medical chart review. Clinical and demographic variables were recorded. The exposure variables included age, procedure risk category, CHARM-predicted incidence, and hemodynamic vulnerability parameters. A descriptive analysis of the sample was conducted, followed by an evaluation of the predictive performance of each exposure variable for adverse events. Results: A total of 467 cardiac catheterization records were included, with a median age of 2.5 years. Male sex was more prevalent (56.3%), and the age group over 5 years accounted for 33.8%. The overall incidence of adverse events was 3.8% (95% CI 2.5% - 6.0%). The CHARM scale had a statistically significant association with an increased risk of adverse events (OR 1.21, 95% CI 1.06 - 1.37). The predictive ability of the CHARM scale (AUC: 0.74) and procedure-specific risk (AUC 0.67) did not differ statistically. Hemodynamic vulnerability (p=0.375) and age (p=0.088) did not show a statistically significant relationship with adverse events. Conclusion: The CHARM scale demonstrates good predictive performance for adverse events in our population, although it is similar to the predicted risk based on the procedure to be performed.PregradoEspecialista en Cuidado Intensivo PediátricoIntroducción 16 Planteamiento del Problema 18 Pregunta de Investigación 19 Justificación 20 Objetivos 22 Objetivo General 22 Objetivos Específicos 22 Marco Referencial 23 Cateterismo Cardiaco 23 Complicaciones del Cateterismo Cardiaco 24 Factores Asociados a las Complicaciones del Cateterismo Cardiaco 25 Metodología 29 Tipo de Estudio 29 Población de Estudio y Muestra 29 Criterios de Inclusión y Exclusión 29 Procedimientos 29 Revisión de Historia Clínica 29 Variables 29 Análisis Estadístico 35 Consideraciones Éticas, Bioéticas y de Integridad Científica 36 Resultados 37 Descripción de las Características Sociodemográficas y Clínicas de los Pacientes Sometidos a Cateterismo Cardiaco 37 Incidencia de Eventos Adversos en las Primeras 24 Horas Posteriores al Cateterismo Cardiaco en la Población de Estudio. 43 Relación de la aparición de eventos adversos severos en las primeras 24 horas posteriores al cateterismo cardiaco con la escala CHARM 45 Discusión 48 Limitaciones del Estudio 53 Conclusiones y Recomendaciones 54 Referencias Bibliográficas 55 Apéndices. 6265 papplication/pdfimage/jpegUniversidad de SantanderT 78.23 R492uRepositorio Digital Universidad de Santanderhttps://repositorio.udes.edu.cohttps://repositorio.udes.edu.co/handle/001/9134spaUniversidad de SantanderBucaramangaFacultad de Ciencias Médicas y de la SaludBucaramanga, ColombiaEspecialización en Cuidado Intensivo PediátricoBergersen L, Gauvreau K, Foerster SR, Marshall AC, McElhinney DB, Beekman RH, et al. Catheterization for Congenital Heart Disease Adjustment for Risk Method (CHARM). JACC Cardiovasc Interv. 2011 Sep;4(9):1037–46.Mosquera W. Radioprotección en cateterismo cardiaco pediátrico. Revista Colombiana de Cardiología. 2020 Mar;27:96–101.Boston Children Hospital. Cardiac Catheterization. 2021. p. 1–1.Children’s National Hospital. Cardiac Catheterization. 2020.Elshazali O, Ibrahim M, Elseed A. Management of Congenital Heart Disease in Low-Income Countries: The Challenges and the Way Forward. In: Congenital Heart Defects - Recent Advances. IntechOpen; 2022.Nguyen N, Leon-Wyss J, Iyer KS, Pezzella AT. Paediatric cardiac surgery in low-income and middle-income countries: a continuing challenge. Arch Dis Child. 2015 Dec;100(12):1156–9.Bennet D, Marcus R, Stokes M. Incidents and complications during pediatric cardiac catheterization. Pediatric Anesthesia. 2005 Oct 4;0(0):051004011653003.Bergersen L, Gauvreau K, Jenkins KJ, Lock JE. 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

Utilidad de la Escala CHARM Para Establecer el Riesgo de Eventos Adversos Posterior a Cateterismo Cardiaco en Pacientes Pediátricos Intervenidos en la Fundación Cardiovascular de Colombia

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