[Endomyocardial biopsy. Revision and experience of 176 procedures]. / Biopsia endomiocárdica. Revisión y experiencia de 176 procedimientos.

Endomyocardial biopsy (EB) is often used in the clinical evaluation of several cardiac disease. Hundred-seventy-six consecutive procedures were performed in 65 patients, 43 men and 22 women mean age was 29.86 +/- 11.53 (range 4 days to 66 years). Group A, 26 postcardiac transplantation patients in whom 137 EB were performed (39 heterotopic and 98 orthotopic), average sample 5.2 biopsy for each patient. Group B (n = 39) was studied for several cardiac diseases during cardiac diagnostic catheterism. The jugular venous approach was performed in 3 patients (1.7%), femoral in 173 patients. Major complications were found in 3 (1.7%) cases consisting in cerebrovascular accident (stroke) and coronary fistula into the right ventricle. Endomyocardial biopsy provides a low incidence of adverse reactions, mortality was 0%.

[Patent ductus arteriosus closure with a Nit-Occlud device. Experience with 13 cases]. / Cierre de conducto arterioso persistente con dispositivo Nit-Occlud. Experiencia de 13 casos.

We report our experience with the percutaneous closure of patent ductus arteriosus with a Nit-Occlud device made of Nitinol (Nickel-Titanium alloy) in 13 patients; 10 women and 3 men, average age of 23.2 +/- 21.1 years. Average diameters were 3.8 +/- 0.8 mm and the morphologies, according to Krichenko's classification, were 10 type A, 2 type E, and 1 type C. The device was selected according to the aortic ampule and the narrowest part of the ductus. We implanted 8 occluders of 11 x 6 mm, 4 of 9 x 6 mm, and 1 of 7 x 6 mm. In three patients (25%) total occlusion was observed 15 minutes after implantation, in seven (54%) a trivial leak was observed, and in only two patients (16.6%) was the leak moderate to severe. In on patient, the occluder migrate to the pulmonary artery trunk and was successfully removed percutaneously; the patient was subjected then to surgical closure. Echocardiography follow-up 24 h later showed total occlusion in nine patients (69%). Six months after the procedure, two patient presented trivial leak (15%). One patient developed an endocarditic infection and died. We concluded that this occluder might be useful for this pathology, but further studies must be done.

[Repair of interatrial septal defect with an Amplatzer device. Experience with 3 cases]. / Cierre de comunicación interatrial con dispositivo de Amplatzer. Experiencia de 3 casos.

We performed transcatheter closure of an atrial septal defect (ASD) using an Amplatzer device in three patients, 2 women and 1 male child, aged 12, 54, and 4 years, respectively, coursing with ostium secundum ASD. Two with left to right shunt and the third with bidirectional shunt. The transesophageal echocardiogram revealed ASD with diameters of 13, 15, and 10 mm, the diameter with expanded catheter balloon was of 30, 26, and 17 mm, respectively. The superior border of the atrial septum was bigger than 5 mm in all three patients, whereas the inferior border could not be found through echocardiography in the patients aged 12 and 4 years. Amplatzer devices of 30, 26, and 17 mm were implanted, the inferior border of the first two could be supported on the aortic wall and the superior border on the septum. We observed a 100% occlusion in these two cases through ecocolor-Doppler. In the third patient, an inferior border of 16 mm and a superior border of 8 mm were determined, achieving and immediate and fast installation of the device with 100% occlusion. All three patients were in stable conditions, asymptomatic and without shunt at their one-month follow-up as revealed by a trans-thoracic echocardiography. It is concluded that the Amplatzer device is technically easy to install and yields adequate results even in patients with ample ASD and without inferior border of the inter-atrial septum.

Biopsia endomiocárdica: revisión y experiencia de 176 procedimientos / Endomyocardial biopsy: revision and experience of 176 procedures

Endomyocardial biopsy (EB) is often used in the clinical evaluation of several cardiac disease. Hundred-seventy-six consecutive procedures were performed in 65 patients, 43 men and 22 women mean age was 29.86 +/- 11.53 (range 4 days to 66 years). Group A, 26 postcardiac transplantation patients in whom 137 EB were performed (39 heterotopic and 98 orthotopic), average sample 5.2 biopsy for each patient. Group B (n = 39) was studied for several cardiac diseases during cardiac diagnostic catheterism. The jugular venous approach was performed in 3 patients (1.7%), femoral in 173 patients. Major complications were found in 3 (1.7%) cases consisting in cerebrovascular accident (stroke) and coronary fistula into the right ventricle. Endomyocardial biopsy provides a low incidence of adverse reactions, mortality was 0%.

Cierre de conducto arterioso persistente con dispositivo Nit-Occlud: Experiencia de 13 casos / Patent ductus arteriosus closure with a Nit-Occluded device: Experience with 13 cases

Se presenta la experiencia de 13 pacientes con diagnóstico de persistencia de conducto arterioso permeable tratados por vía percutánea con un dispositivo de nitinol (aleación de níquel y titanio), llamado Nit-Occlud. Fueron 10 mujeres y 3 hombres con edad promedio de 23.2 ±21.1 años. La angiografía en la aorta descendente previa al cierre reportó diámetro promedio del conducto arterioso de 3.8 ± 0.8 mm y la morfología del mismo fue de 10 conductos tipo A, 2 tipo E y 1 tipo C según la clasificación de Krichenko. El tamaño del oclusor seleccionado se basó en el diámetro de la ámpula aórtica y del sitio más estrecho del conducto. Se utilizaron 8 dispositivos 11x6 mm, 4 dispositivos 9x6 mm y 1 dispositivo 7x6 mm. Tres pacientes (25%) mostraron oclusión del 100% en forma inmediata (15 min después de la liberación del dispositivo), 7 (53%) presentaron fuga leve y difusa y sólo 2 pacientes (16.6%) mostraron fuga moderada a severa. Un paciente presentó migración del dispositivo a la rama izquierda de la arteria pulmonar (RIAP), se logró su rescate por vía percutánea enviándose el paciente posteriormente a cirugía. En el seguimiento ecocardiográfico a las 24 h 9 pacientes (69%) mostraron oclusión del 100%. A los 6 meses de seguimiento 10 tienen oclusión al 100% y sólo 2 pacientes tienen fuga residual leve (15%). Un paciente desarrolló cuadro de endocarditis infecciosa que finalmente provocó su deceso. Se concluye que el dispositivo Nit-Occlud es útil para el cierre de esta patología aunque hace falta mayor experiencia.

We report our experience with the percutaneous closure of patent ductus arteriosus with a Nit-Occlud device made of Nitinol (Nickel-Titanium alloy) in 13 patients; 10 women and 3 men, average age of 23.2 ±21.1 years. Average diameters were 3.8 + 0.8 mm and the morphologies, according to Krichenko's classification, were 10 type A, 2 type E, and 1 type C. The device was selected according to the aortic ampule and the narrowest part of the ductus. We implanted 8 occluders of 11 x 6 mm, 4 of 9 x 6 mm, and 1 of 7 x 6 mm. In three patients (25%) total occlusion was observed 15 minutes after implantation, in seven (54%) a trivial leak was observed, and in only two patients (16.6%) was the leak moderate to severe. In on patient, the occluder migrate to the pulmonary artery trunk and was successfully removed percutaneously; the patient was subjected then to surgical closure. Echocardiography follow-up 24 h later showed total occlusion in nine patients (69%). Six months after the procedure, two patient presented trivial leak (15%). One patient developed an endocarditic infection and died. We concluded that this occluder might be useful for this pathology, but further studies must be done.

Estudio comparativo entre dispositivos de Rashkind, Grifka y Coil para el cierre percutáneo del conducto arterioso / Comparative study between Rashkind, Grifka and Coil devices in the closure of patent ductus arteriosus

Evaluamos la eficacia de los dispositivos Grifka y Coil, comparándolos con el dispositivo de Rashkind, utilizados para el cierre percutáneo del conducto arterioso. Estudiamos 97 pacientes (36 hombres, 61 mujeres), analizando edad, sexo, diámetro del conducto, morfología, tipo de dispositivo, tiempo de oclusión, fuga persistente, requerimiento de 2o dispositivo y complicaciones. Se realizó análisis estadístico con t de Student y c2. La edad fue 7.82 ñ 6.89. A 45 pacientes se colocó Rashkind -17, a 19 Rashkind-12, a 18 Coil y a l3 bolsas de Grifka; en 2 pacientes no se colocó dispositivo. Hubo diferencias entre morfología y dispositivo empleado (p = 0.008), entre diámetro y dispositivo utilizado (p < 0.001). La oclusión fue inmediata en 26.7 por ciento con Rashkind-17, 57.9 por ciento Rashkind-12, 83.3 por ciento Coil y de 91.7 por ciento Grifka. A las 24 h, fue 60 por ciento Rashkind-17, 78.9 por ciento Rashkind-12, 94.4 por ciento Coil y 100 por ciento Grifka. Persistieron con fuga por más de un año 7 Rashkind-17 y 1 Rashkind 12, (p = 0.001), 4 pacientes tienen 2 dispositivos. Las complicaciones fueron: 15.5 por ciento para Rashkind-17, 26.3 por ciento Rashkind-12, 5.2 por ciento para Coil y de 30 por ciento para Grifka, (p = 0.004); embolizaron 1 Coil y 1 Grifka. El Coil y Grifka han mostrado mejor oclusión inmediata. Las indicaciones de cada dispositivo deberán ser establecidas de acuerdo a la morfología y tamaño del conducto arterioso.