Myocardial strain pattern progress in patients with Coarctation of the Aorta undergoing aortic stenting.

BACKGROUND AND AIM: Ventricular function evaluation in coarctation of the aorta (CoA) has become more sophisticated and precise with speckle tracking, revealing subclinical changes. However, CoA stenting treatment effects in on myocardial strain are still controversial. This study aimed to estimate the extent to which changes in left ventricular global longitudinal strain (LV GLS) occur in patients with CoA who undergo stenting. METHODS: The study included 21 patients with CoA (median age: 15 years [8-39]) and 21 healthy individuals matched by age and gender. Clinical and echocardiographic evaluations were performed 1 day before, 6 months, and 1 year after stenting. Correlations between LV GLS and arm-leg gradient, isthmus gradient on echocardiogram, age at intervention, left ventricular mass, and ejection fraction were tested. RESULTS: Before treatment, patients with CoA had lower LV GLS than the control group (-18.4% ± 1.96 vs -21.5% ± 1.37; P < .01), showing significant increase to -19.4% ± 2.1 at 6 months and -20.7% ± 2.19 at 1 year, P < .001. Only 28.5% (6 patients) had preserved GLS before treatment, improving to 80.9% (17 patients) in 1 year. The only variable correlated with low LV GLS values before treatment was age at intervention (Spearman's index = -0.571; P = .007). CONCLUSION: Percutaneous therapy showed significant LV GLS improvement 12 months after aortic stenting. Older patients have lower GLS, suggesting that early intervention may have positive effects on preservation of LV systolic function.

Fetal interventions for congenital heart disease in Brazil.

Fetal interventions have been performed for some congenital heart diseases. However, these procedures have not gained wide acceptance due to concerns about their efficacy and safety. The aim of this study was to report on a preliminary experience with fetal cardiac interventions in Brazil. Twenty-two cardiac interventions were performed in 21 fetuses. Thirteen fetuses had critical aortic stenosis (CAS), 4 had hypoplastic left heart syndrome (HLHS) and intact interatrial septum or small patent foramen ovale, 1 had pulmonary atresia with intact ventricular septum (IVS), and 3 had critical pulmonary stenosis (CPS). The main outcome variables evaluated were technical success and procedural complications as well as pregnancy and postnatal outcomes. Success was achieved in 20 of 22 procedures (91%) with 1 failed aortic and 1 failed pulmonary valvuloplasties. There was 1 fetal death. No maternal complications occurred. One patient with CAS, severe mitral regurgitation, and hydrops died postnatally within 5 months of age. All patients with HLHS and restrictive atrial septum died after interventional or surgical procedures and prolonged hospitalizations. All patients with CPS/IVS survived and achieved a biventricular (BV) circulation after neonatal valvuloplasty and ductal stenting. A BV circulation was achieved in 4 of 8 patients with CAS and evolving HLHS (one still in utero), including 2 with initial borderline left ventricles (LV) in whom surgical LV overhaul was performed at 9 months of age. In this preliminary experience, the feasibility of fetal cardiac interventions and their outcomes were similar to those previously reported.

Stenting Options for Coarctation of the Aorta.

The narrowing of the lumen in coarctation of the aorta can be relieved with a high degree of immediate success by transcatheter methods. All methods are associated with immediate and longer-term complications, including dissection, aneurysm formation, and recoarctation. The introduction of the use of covered stents in aortic coarctation is encouraging because the material cover provides additional protection to the acutely disrupted aortic wall and can provide long-term protection of the dilated segment and the downstream area of poststenotic dilation. This review discusses the currently available options for stenting aortic coarctation.

Future Directions of Fetal Interventions in Congenital Heart Disease.

Fetal interventions for congenital heart disease have become important treatment modalities in the past 10 to 15 years. The basic hypothesis has been that a prenatal intervention may remodel cardiac morphology and function to such an extent that it may favorably alter the in utero natural history, resulting in improved prenatal and postnatal outcomes, including an increased likelihood of achieving biventricular circulation. This review discusses the current indications, techniques, and outcomes of fetal cardiac interventions and provides a glimpse into the future with regard to technical improvements and newer treatment modalities, such as maternal oxygenation and in utero pacemaker implantation.

Outcomes After Transcatheter ASD Closure.

Ostium secundum-type atrial septal defect closure has evolved from a surgical procedure requiring cardiopulmonary bypass to a percutaneous, catheter-based procedure usually requiring only an overnight hospital stay. The overall safety and effectiveness has compared favorably with surgical repair. Although rare, complications have been described, including erosion, device embolization, or malfunction and arrhythmias. The overall long-term clinical outcomes have been excellent: good quality of life, functional class improvement, and ventricular remodeling have been the rule after the procedure. It is mandatory to recommend indefinite follow-up of patients undergoing this procedure for potential long-term complications.

Percutaneous versus surgical closure of atrial septal defects in children and adolescents.

BACKGROUND: There is a scarcity of data comparing percutaneous and surgical closure of the secundum atrial septal defect (ASD). OBJECTIVES: Assessment of safety and efficacy of both methods of treatment in a referral center affiliated with the Ministry of Health. METHODS: Observational, prospective, non-randomized study of two cohorts of children and adolescents younger than 14 years, treated by catheterization or surgery. Data was collected prospectively in the percutaneous group (A) and retrospectively in the surgical group (B). RESULTS: A total of 75 patients (pts) were enrolled in group A from April 2009 to October 2011 and 105 pts were treated in group B from January 2006 to January 2011. Age was older and weight was higher in group B and the ASD diameter was similar in both groups. Technical success was achieved in all procedures and there were no deaths. Complications (most minor) occurred in 68% of group B and 4% of A (p < 0.001). Rates of total occlusion or non-significant residual shunts were similar in both groups. Median hospitalization time was 1.2 days in group A and 8.4 days in group B (p < 0.001). CONCLUSION: Both treatment modalities are safe and effective, showing excellent outcomes. However, the percutaneous treatment has lower morbidity and shorter in-hospital stay length. These observations support the concept that percutaneous treatment of atrial septal defects should be regarded as the method of choice to manage selected patients with this condition.

Avaliação de refluxos paraprotéticos por meio da ecocardiografia transesofágica tridimensional com Doppler colorido / Evaluation of paravalvular leaks through color Doppler three-dimensional transesophageal echocardiography

Fundamento: Os refluxos paraprotéticos são complicações comuns após cirurgia de troca valvar. A quantificação da gravidade, a localização e a morfologia dos refluxos paraprotéticos podem ser demonstradas por meio da ecocardiografia transesofágica tridimensional. Objetivo: Avaliar a correlação entre gravidade da regurgitação paravalvar, avaliada pela ecocardiografia tradicional bidimensional, usando a largura da vena contracta, e as medidas derivadas da avaliação pela ecocardiografia transesofágica tridimensional (comprimento, largura e área); avaliar o sucesso terapêutico da oclusão de refluxos paraprotéticos, guiada por ecocardiografia transesofágica tridimensional, e a correlação entre as medidas desta e as dos dispositivos para oclusão percutânea. Método: Estudo retrospectivo de 11 pacientes consecutivamente submetidos ao tratamento percutâneo de refluxos paraprotéticos entre 2014 e 2015, avaliados por meio de ecocardiografia transtorácica e ecocardiografia transesofágica tridimensional, no pré-operatório e no intraoperatório. Resultados: De um total de 20 refluxos paraprotéticos, 18 apresentaram sucesso técnico imediato. Não houve correlação entre as medidas da vena contracta bidimensional e as derivadas da ecocardiografia transesofágica tridimensional. Houve correlação forte entre o comprimento do defeito pela ecocardiografia transesofágica tridimensional e o comprimento do dispositivo para oclusão percutânea (rho = 0,929; p < 0,001), além de correlação moderada entre a área do defeito e a do dispositivo para oclusão percutânea (rho = 0,682; p = 0,002). Não houve correlação entre a largura do dispositivo para oclusão percutânea e a do defeito medida pela ecocardiografia transesofágica tridimensional (rho = 0,440; p = 0,067). Conclusão: Não houve correlação entre a medida da vena contracta bidimensional e as medidas derivadas da ecocardiografia transesofágica tridimensional. A escolha dos dispositivos para oclusão percutânea baseada nas medidas da ecocardiografia transesofágica tridimensional apresentou alta taxa de sucesso imediato, com ótima correlação entre o comprimento dos defeitos e dos dispositivos para oclusão percutânea. A correlação entre as áreas foi boa e não houve correlação entre as larguras

Background: Paravalvular leaks are a common complication after valve replacement surgery. Quantification of the severity, location and morphology of paravalvular leaks can be obtained by three-dimensional transesophageal echocardiography. Objective: To evaluate the correlation between the severity of paravalvular regurgitation by vena contracta measurement using bidimensional echocardiography, and measurements derived from three-dimensional transesophageal echocardiography (length, width and area). To evaluate the therapeutic success of three-dimensional transesophageal echocardiography-guided paravalvular leaks occlusion and the correlation between three-dimensional transesophageal echocardiography measurements and dimensions of devices for percutaneous occlusion. Method: Retrospective study of 11 patients consecutively submitted to percutaneous paravalvular leaks treatment between 2014 and 2015, using transthoracic echocardiography and between three-dimensional transesophageal echocardiography in the preoperative and intraoperative periods. Results: Out of a total of 20 paravalvular leaks, 18 showed immediate technical success. There was no correlation between the measurements of the bidimensional vena contracta and the measures derived from the three-dimensional transesophageal echocardiography. There was a strong correlation between the defect length measured by the three-dimensional transesophageal echocardiography and the device for percutaneous occlusion length (rho = 0.929; p < 0.001); and moderate between the defect area and the device for percutaneous occlusion area (rho = 0.682,p = 0.002). There was no correlation between the device for percutaneous occlusion width and the defect width measured by three-dimensional transesophageal echocardiography (rho = 0.440; p = 0.067). Conclusion: There was no correlation between the measurement of the bidimensional vena contracta and the measures derived from the three-dimensional transesophageal echocardiography. The choice of devices for percutaneous occlusion based on three-dimensional transesophageal echocardiography measurements showed a high success rate, with an excellent correlation between defect length and devices for percutaneous occlusion length. The correlation between the areas was good, and there was no correlation between the widths

Tratamento endovascular de aneurisma de aorta abdominal com fístula aorto-cava utilizando oclusor vascular concomitante a endoprótese bifurcada: relato de caso / Endovascular treatment of an abdominal aortic aneurysm with aortocaval fistula using a vascular occluder and a bifurcated endograft in a single intervention: case report

As fístulas aorto-cava são entidades raras e de etiologia variada, estando frequentemente associadas a significativa morbimortalidade. Acredita-se que o aumento da tensão da parede nos grandes aneurismas resulte em reação inflamatória e aderência à veia adjacente, culminando na erosão das camadas aderidas e na formação da fístula. O tratamento cirúrgico convencional tem altas taxas de mortalidade. Embolia pulmonar paradoxal e o vazamento são complicações temidas do tratamento endovascular. O uso de oclusor vascular associado a endoprótese bifurcada é boa opção no tratamento do aneurisma de aorta abdominal com fístula aorto-cava

Aortocaval fistulae are rare entities with a variety of etiologies and are very often associated with significant morbidity and mortality. It is believed that increased tension in the walls of large aneurysms can cause an inflammatory reaction resulting in adhesion to the adjacent vein and culminating in erosion of the adherent layers and fistula formation. Conventional surgical treatment has high mortality rates. Paradoxical pulmonary embolism and endoleaks are the most concerning complications linked with endovascular treatment. Using a vascular occluder in combination with a bifurcated endograft is a good option for the treatment of an abdominal aortic aneurysm with aortocaval fistula

Implante transcateter da valva pulmonar. Protocolo clínico de tratamento e requisitos para credenciamento de centros e operadores no Brasil / Transcatheter pulmonary valve implantation. Clinical treatment protocol and accreditation requirements for centers and interventionists in Brazil

O implante transcateter da valva pulmonar (ITVP) evoluiu significativamente desde sua introdução, no início dos anos 2000. Atualmente, esta técnica é uma opção segura e eficaz para o tratamento das disfunções valvares graves (estenose e/ou insuficiência) em biopróteses ou condutos cirúrgicos em posição pulmonar, em vários centros do mundo. No Brasil, os resultados iniciais com este procedimento em centros de referência foram similares àqueles observados na experiência global. O ITVP tem se demonstrado factível, seguro e eficaz em mãos treinadas na nossa realidade. Porém, antes da aplicação disseminada desta técnica em outros centros em nosso país, houve a necessidade de se estabelecerem alguns critérios para a seleção do paciente, a técnica de implante e o seguimento clínico, assim como para o treinamento e o credenciamento de novos operadores e centros. As orientações aqui descritas foram determinadas por um grupo de especialistas com experiência renomada em cardiopatias congênitas e ITVP, tendo sido encaminhadas ao Conselho Federal de Medicina (CFM). Representantes das diferentes sociedades médicas foram envolvidas na preparação deste documento, incluindo a Sociedade Brasileira de Cardiologia (SBC), a Sociedade Brasileira de Hemodinâmica e Cardiologia Invasiva (SBHCI) e a Sociedade Brasileira de Cirurgia Cardiovascular (SBCCV). Acreditamos que a rígida aderência às recomendações listadas neste documento oficial seja crucial para a segurança do paciente e para que ótimos resultados sejam alcançados imediatamente e a longo prazo. Uma vez consolidado em nosso meio, o ITVP abrirá caminho para a introdução de novas terapias valvares em cardiopatias congênitas

Transcatheter pulmonary valve implantation (TPVI) has evolved significantly since its introduction in the early 2000s. Currently, this technique is a safe and effective option for the treatment of severe valve dysfunction (stenosis and/or regurgitation) in bioprostheses or surgical conduits in pulmonary position, in several centers worldwide. In Brazil, the initial results with this procedure in reference centers were similar to those observed in the overall experience. TPVI was proven to be feasible, safe, and effective in trained hands in Brazil. However, prior to the widespread application of this technique to other centers in this country, it was necessary to establish some criteria for patient selection, implantation technique, and clinical follow-up, as well as for the training and accreditation of new interventionists and centers. The guidelines described here were determined by a group of experts with well-known experience in congenital heart disease and TPVI, and were referred to the Conselho Federal de Medicina (CFM, portuguese for Federal Council of Medicine). Representatives of the different medical societies were involved in the creation of this document, including the Sociedade Brasileira de Cardiologia (SBC, portuguese for Brazilian Society of Cardiology), the Sociedade Brasileira de Hemodinâmica e Cardiologia Invasiva (SBHCI, portuguese for Brazilian Society of Hemodynamics and Invasive Cardiology), and the Sociedade Brasileira de Cirurgia Cardiovascular (SBCCV, portuguese for Brazilian Society of Cardiovascular Surgery). The authors believe that strict adherence to the recommendations contained in this official document is crucial for patient safety and for optimal results to be achieved in both the short and long term. Once consolidated in Brazil, TPVI will open doors for the introduction of new valve therapies in congenital cardiopathies

Implante de marcapasso cardíaco definitivo por disfunção do nó sinusal, utilizando a veia cava superior, após angioplastia do trajeto em pós-operatório tardio de operação de Mustard e Senning / Permanent cardiac pacemaker implatation due to sinus node dysfunction, using the superior vena cava, after angioplasty in the late postoperative period of Mustard and Senning procedure

A síndrome do nó sinusal está comumente vinculada às lesões de células sinusais ou da junção sinoatrialou a afecções do tecido intersticial que circunda essas células. Nos casos avançados, o marcapasso cardíaco artificialé o tratamento mais difundido. O caso descrito relata a síndrome do nó sinusal de um paciente em evolução tardiado pós-operatório de operação de Mustard e Senning com complicações anatômicas, levando à necessidade deimplante de marcapasso definitivo, após angioplastia do trajeto, utilizando a veia cava superior.

Sick sinus syndrome is usually related to lesions of the sinus node and sinoatrial node cells or tocollagen tissue disease surrounding these cells. In advanced cases, pacemaker implantation is the most widespreadtreatment option. This is a case report of a patient with sick sinus syndrome in the late postoperative period ofMustard and Senning procedure with anatomical complications requiring definitive pacemaker implantationafter angioplasty through the superior vena cava.

Endoscopic treatment of tracheobronchial tree fistulas using atrial septal defect occluders: preliminary results.

Fistulas in the tracheobronchial tree (bronchopleural and tracheoesophageal fistulas) have a multifactorial etiology and present a variable incidence in the literature. In general, the related morbidity and mortality are high. Once such a fistula has been diagnosed, surgical closure is formally indicated. However, the clinical status of affected patients is usually unfavorable, which precludes the use of additional, extensive surgical interventions. In addition, attempts at endoscopic closure of these fistulas have seldom been successful, especially when the fistula is large in diameter. We report the cases of three patients submitted to endoscopic closure of fistulas, two of which were larger than 10 mm in diameter, by means of the insertion of atrial septal defect occluders. The procedure was minimally invasive, and the initial results were positive. The results indicate that this is a promising technique for the resolution of tracheobronchial tree fistulas.

Custo-Efetividade Incremental do Tratamento Cirúrgico vs. Percutâneo da Persistência do Canal Arterial com o Amplatzer® Duct Occluder em Crianças: Revisão Sistemática / Incremental Cost-Effectiveness of Surgical vs. Percutaneous Treatment of Patent Ductus Arteriosus with the AmplatzerTM Duct Occluder in Children: A Systematic Review

Introdução: A persistência do canal arterial (PCA) é uma cardiopatia congênita relativamente comum e as alternativas para o tratamento de canais > 2,5 mm são a cirurgia ou a oclusão percutânea com próteses do tipo rolha. Essas últimas, apesar de consideradas o método de escolha, não estão previstas pelo Sistema Único de Saúde (SUS). Nosso objetivo foi comparar a razão de custo-efetividade incremental (RCEI) de ambas as estratégias. Métodos: Revisão sistemática em relação a desfechos clínicos e criação de modelo de decisão para avaliação da RCEI do Amplatzer® Duct Occluder (ADO) em comparação ao tratamento cirúrgico, para o fechamento da PCA. Os custos para ambos os métodos foram aqueles reembolsados pelo SUS em 2010, e o custo do conjunto (dispositivo + materiais de apoio) foi estimado em R$ 10.000,00. Foi considerado como limiar uma disposição para pagar equivalente a três vezes o Produto Interno Bruto brasileiro, resultando em R$ 57.000,00 por ano de vida salvo. Resultados: As duas técnicas foram seguras e eficazes, com menor morbidade e tempo de internação no fechamento percutâneo. A expectativa de vida ajustada foi similar nos dois grupos, sendo um pouco melhor para o ADO. O custo total foi calculado em R$ 8.507,00 para cirurgia e em R$ 11.000,00 para o ADO. A RCEI foi calculada em R$ 71.380,00 por ano de vida ganho. Uma análise de limiar demonstrou que a redução do valor do conjunto completo do ADO em R$ 492,65 traria a RCEI para o limiar aceitável para incorporação ao SUS nos dias de hoje. Conclusões: O tratamento percutâneo apresentou morbidade e tempo de internação menores, além de efetividade incremental semelhante àquela do tratamento cirúrgico. Com os...

Background: Patent ductus arteriosus (PDA) is a relatively common congenital heart disease and the alternatives for the treatment of PDA > 2.5 mm are surgery or percutaneous occlusion with plugs. The latter, although considered the method of choice, are not provided by the Brazilian National Health System (Sistema Único de Saúde - SUS). Our objective was to compare the incremental cost-effectiveness ratio (ICER) of both strategies. Methods: Systematic review of clinical outcomes and development of a decision-making algorithm to evaluate the ICER of AmplatzerTM Duct Occluder (ADO) vs. surgical treatment for the closure of PDA. Costs for both methods were calculated based on the reimbursement figures paid by the SUS in 2010 and the cost of the percutaneous kit (device + support materials) was estimated at R$ 10,000.00. We used as a threshold the willingness to pay the equivalent of three times the Brazilian Gross Domestic Product, i.e., R$ 57,000.00 per year of life saved. Results: Both techniques were safe and effective with less morbidity and shorter hospitalization time for percutaneous closure. Adjusted life expectancy was similar in both groups, and slightly better for the ADO group. Total cost was calculated as R$ 8,507 for surgery and R$ 11,000.00 for ADO. ICER was calculated as R$ 71,380.00 per year of life saved. A threshold analysis showed that a reduction of R$ 492.65 in the cost of the ADO kit would reduce the ICER to an acceptable value for the incorporation of this technology by the SUS. Conclusions: Percutaneous occlusion was associated with less morbidity and shorter hospital stay with similar incremental effectiveness when compared to the surgical treatment. With the direct costs used in this study and considering that the entire population with PDA is treated with the ADO, percutaneous occlusion was less cost-effective. However, a slight reduction in the costs of the percutaneous kit would result...

Fechamento percutâneo versus cirúrgico da comunicação interatrial em crianças e adolescente / Percutaneous versus surgical closure of atrial septal defects in children and adolescents

FUNDAMENTO: Há uma paucidade de dados comparando o método percutâneo e o cirúrgico para tratamento da comunicação interatrial tipo ostium secundum. OBJETIVOS: Análise de segurança e eficácia comparando ambos os métodos tratamento em um hospital excelência com vínculo o Ministério de Saúde. MÉTODOS: Estudo observacional, prospectivo, não randomizado de duas coortes de crianças e adolescentes < 14 anos tratadas por meio do cateterismo intervencionista (grupo A) ou da cirurgia cardíaca convencional (grupo B). A coleta dos dados foi prospectiva no grupo A e retrospectiva no B. RESULTADOS: De abr/2009 a out/2011 foram alocados 75 pts no grupo A e entre jan/2006 e jan/2011foram tratados 105 pts no grupo B. A idade e o peso dos pacientes foram maiores no grupo B e o diâmetro da comunicação interatrial do tipo ostium secundum foi semelhante entre os grupos. Sucesso técnico foi observado em todos os procedimentos e não houve óbitos. Complicações (a maioria menores) foram encontradas em 68% no grupo B e em 4% do grupo A (p < 0,001). As taxas de fluxo residual não significativo ou de oclusão total do defeito foram semelhantes nos dois grupos. A mediana de internação foi de 1,2 dias após o procedimento percutâneo e 8,4 dias após a correção cirúrgica (p < 0,001). CONCLUSÃO: Ambos os tratamentos são seguros e eficazes com ótimos desfechos, porém o tratamento percutâneo apresenta menor morbidade e tempo de internação. Tais observações embasam a visão que essa forma de tratamento deve ser, hoje em dia, o método de escolha para pacientes selecionados com CIA do tipo ostium secundum.

BACKGROUND: There is a scarcity of data comparing percutaneous and surgical closure of the secundum atrial septal defect (ASD). OBJECTIVES: Assessment of safety and efficacy of both methods of treatment in a referral center affiliated with the Ministry of Health. METHODS: Observational, prospective, non-randomized study of two cohorts of children and adolescents younger than 14 years, treated by catheterization or surgery. Data was collected prospectively in the percutaneous group (A) and retrospectively in the surgical group (B). RESULTS: A total of 75 patients (pts) were enrolled in group A from April 2009 to October 2011 and 105 pts were treated in group B from January 2006 to January 2011. Age was older and weight was higher in group B and the ASD diameter was similar in both groups. Technical success was achieved in all procedures and there were no deaths. Complications (most minor) occurred in 68% of group B and 4% of A (p < 0.001). Rates of total occlusion or non-significant residual shunts were similar in both groups. Median hospitalization time was 1.2 days in group A and 8.4 days in group B (p < 0.001). CONCLUSION: Both treatment modalities are safe and effective, showing excellent outcomes. However, the percutaneous treatment has lower morbidity and shorter in-hospital stay length. These observations support the concept that percutaneous treatment of atrial septal defects should be regarded as the method of choice to manage selected patients with this condition.

Factibilidade, segurança e eficácia do fechamento percutâneo da comunicação interatrial em crianças pequenas / Feasibility, safety and efficacy of percutaneous atrial septal defect closure in infants

INTRODUÇÃO: A experiência com o fechamento percutâneo da comunicação interatrial (CIA) em crianças pequenas é limitada. Avaliamos a factibilidade, a segurança e a eficácia desse procedimento em crianças com peso < 20 kg. MÉTODOS: Estudo descritivo observacional de uma coorte de crianças < 20 kg submetidas a tratamento percutâneo. Pacientes com dilatação ventricular direita e sintomas evidentes foram incluídos. Implantamos próteses aprovadas pela ANVISA, sob monitorização ecocardiográfica transesofágica. Os pacientes foram avaliados 1 mês, 3 meses, 6 meses e 12 meses após. RESULTADOS: Entre outubro de 1997 e maio de 2012, 80 pacientes foram tratados. As medianas de idade e peso foram de 4 anos (1-12) e 13,5 kg (5-20), respectivamente, 20 pacientes apresentavam alguma síndrome genética (25%) e 4 pacientes (5%) apresentavam CIA adicional. Somente um paciente necessitou duas próteses. Dois pacientes tinham defeitos associados, os quais foram tratados no mesmo procedimento (estenose pulmonar valvar e fístula arteriovenosa). Um paciente desenvolveu bloqueio atrioventricular total durante o implante da prótese, resolvido espontaneamente 36 horas após a remoção da prótese, sem necessidade de implante de marca-passo. Esse paciente foi tratado percutaneamente 6 meses após com sucesso, sem complicações. Setenta e nove pacientes receberam alta hospitalar em até 24 horas após o procedimento. Fluxo residual discreto (1-2 mm) foi observado em 5% dos casos antes da alta. Após 6 meses de seguimento, não foi detectado fluxo residual. Não houve complicações tardias no seguimento. CONCLUSÕES: O fechamento percutâneo da CIA em crianças pequenas selecionadas e sintomáticas é uma alternativa tera­pêutica factível, segura e eficaz, devendo ser a primeira opção para seu tratamento.

BACKGROUND: The experience with percutaneous closure of atrial septal defect (ASD) in infants is limited. We sought to determine the feasibility, safety and efficacy of this procedure in children weighing < 20 kg. METHODS: Observational study of a cohort of children weighing < 20 kg undergoing percutaneous closure. Patients with right ventricular enlargement and evident symptoms were included. ANVISA approved devices were implanted under transesophageal echocardiography monitoring. Patients were evaluated 1, 3, 6 and 12 months after the procedure. RESULTS: Eighty patients were treated between October 1997 and May 2012. Median age and weight were 4 years (1-12) and 13.5 kg (5-20), respectively, 20 patients had a genetic syndrome (25%) and 4 patients (5%) had an additional ASD. Only one patient required 2 devices. Two patients had associated defects that were treated in the same procedure (pulmonary valve stenosis and arteriovenous fistula). One patient developed total atrioventricular block during device implantation, solved spontaneously 36 hours after device removal, with no need for pacemaker implantation. This patient was successfully treated percutaneously 6 months later without complications. Seventy-nine patients were discharged within 24 hours after the procedure. A mild residual shunt (1-2 mm) was observed in 5% of the cases before discharge. There was no residual shunt 6 months after the procedure. There were no complications in the late follow-up. CONCLUSIONS: Percutaneous ASD closure in selected symptomatic infants is a feasible, safe and effective alternative and should be the first option therapy.