BACKGROUND: Aortic stenosis is a frequent disease in the elderly, and is associated with other systemic pathologies that may contraindicate the surgical procedure. Another option for these patients is percutaneous aortic valve implantation, which is less invasive. We present our initial experience with this procedure. MATERIAL AND METHODS: Patients with aortic stenosis were included once selection criteria were accomplished. Under general anaesthesia and echocardiographic and fluosocopic control, a transcatheter aortic valve was implanted following s valvuloplasty. Once concluded the procedure, angiographic and pressure control was realized in order to confirm the valve function. RESULTS: Between November 2014 and May 2015, 6 patients were treated (4 males and 2 females), with a mean age of 78.83±5.66 years-old. The preoperative transvalvular gradient was 90.16±28.53mmHg and posterior to valve implant was 3.33±2.92mmHg (P<.05). Two patients had concomitant coronary artery disease which had been treated previously. One patient presented with acute right coronary artery occlusion which was immediately treated. However due to previous renal failure, postoperative sepsis and respiratory failure, the patient died one month later. CONCLUSION: It was concluded that our preliminary results showed that in selected patients percutaneous aortic valve implantation is a safe procedure with clinical improvement for treated patients.
Aortic Valve Stenosis/surgery , Transcatheter Aortic Valve Replacement , Aged , Aged, 80 and over , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/physiopathology , Female , Humans , Male , Patient Selection , Radiology, Interventional , Retrospective Studies , Transcatheter Aortic Valve Replacement/statistics & numerical data , Treatment Outcome
Patent ductus arteriosus (PDA) is the most common congenital heart disease in Mexico. The clinical manifestations of the PCA are from asymptomatic patients to the presence of heart failure. Its management should be individualized based on clinical, hemodynamic data and presence of pulmonary hypertension. Our objective was to provide current medical recommendations based on the best, available scientific evidence for the diagnosis, study and therapeutic decisions of the PCA. Established a standardized sequence to search for Practice Guidelines, based on the clinical questions about PCA diagnosis and treatment. Most of the recommendations were taken from selected guidelines and supplemented with the remaining material. The information is expressed in levels of evidence (E) and grade of recommendation (R) according to the characteristics of the study design and type of publications. Currently produces large amounts of medical information in a relatively short period of time which is necessary to have evidence-based CPG to facilitate and standardize the diagnostic decision-treatment to provide better care for children and adults with PCA.
Ductus Arteriosus, Patent/diagnosis , Ductus Arteriosus, Patent/therapy , Algorithms , Humans , Practice Guidelines as Topic
We report our experience on 42 patients treated with atrial septal defect (ASD) occlusion using Amplatzer device. Thirty patients were females and 12 were males, mean ages 26.5-years-old +/- 12 years (interval from 7 to 69 years). Average weight was 57.1 +/- 13.8 kg (32.3-85.0 kg). Forty-two devices (ranging diameters from 13 mm to 40 mm) were deployed, 40 of which were placed successfully and attempts were unsuccessful in two cases (diameter devices 36 mm and 40 mm, respectively). We used the "balloon on the left or right upper pulmonary vein" in 5 patients, achieving good deployment. Echocardiography showed total occlusion in 37 patients (93.5%), trivial leak in 2 (4.7%), and light leak in 1 patient (2.3%). Follow up was at 1 to 12 months (mean 6.5). Total occlusion was observed at one month on both patients with trivial leak, and at 6 months on the patient with light leak. Failure to deploy the device appropriately on the two patients with unsuccessful result was due to unfavorable anatomy: very large defects in both cases (occluder size 36 mm and 40 mm), very thin postero-superior 6 mm rim on one of them and aortic rim absence on the other one. Stretched diameters were 34 mm and 38 mm on patients with 36 mm and 40 mm devices, respectively. Both of them were sent to surgery. We conclude that percutaneus closure of atrial septal defect with the Amplatzer device is a save and have good results.
Heart Septal Defects, Atrial/surgery , Prostheses and Implants , Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Prosthesis Implantation/methods , Young Adult
We report our experience on 42 patients treated with atrial septal defect (ASD) occlusion using Amplatzer device. Thirty patients were females and 12 were males, mean ages 26.5-years-old +/- 12 years (interval from 7 to 69 years). Average weight was 57.1 +/- 13.8 kg (32.3-85.0 kg). Forty-two devices (ranging diameters from 13 mm to 40 mm) were deployed, 40 of which were placed successfully and attempts were unsuccessful in two cases (diameter devices 36 mm and 40 mm, respectively). We used the [quot ]balloon on the left or right upper pulmonary vein[quot ] in 5 patients, achieving good deployment. Echocardiography showed total occlusion in 37 patients (93.5%), trivial leak in 2 (4.7%), and light leak in 1 patient (2.3%). Follow up was at 1 to 12 months (mean 6.5). Total occlusion was observed at one month on both patients with trivial leak, and at 6 months on the patient with light leak. Failure to deploy the device appropriately on the two patients with unsuccessful result was due to unfavorable anatomy: very large defects in both cases (occluder size 36 mm and 40 mm), very thin postero-superior 6 mm rim on one of them and aortic rim absence on the other one. Stretched diameters were 34 mm and 38 mm on patients with 36 mm and 40 mm devices, respectively. Both of them were sent to surgery. We conclude that percutaneus closure of atrial septal defect with the Amplatzer device is a save and have good results.
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Heart Septal Defects, Atrial , Prostheses and Implants , Prosthesis Implantation/methods
The tricuspid atresia associated with persistent truncus arteriosus is a rare anomaly. A case is presented of one male patient of three months age in which was detected a cardiac murmur. The diagnosis was made by echocardiography and confirmed by cardiac catheterization. The first step of the palliation was done with disconnection of the trunk of the pulmonary artery combined with a systemic- to- pulmonary shunt of 4 mm. The patient died 24 hours later for persistent metabolic acidosis.
Humans , Infant , Male , Tricuspid Atresia , Truncus Arteriosus, Persistent , Cardiac Catheterization , Echocardiography , Fatal Outcome , Tricuspid Atresia , Truncus Arteriosus, Persistent
The tricuspid atresia associated with persistent truncus arteriosus is a rare anomaly. A case is presented of one male patient of three months age in which was detected a cardiac murmur. The diagnosis was made by echocardiography and confirmed by cardiac catheterization. The first step of the palliation was done with disconnection of the trunk of the pulmonary artery combined with a systemic- to- pulmonary shunt of 4 mm. The patient died 24 hours later for persistent metabolic acidosis.
Tricuspid Atresia/surgery , Truncus Arteriosus, Persistent/surgery , Cardiac Catheterization , Echocardiography , Fatal Outcome , Humans , Infant , Male , Tricuspid Atresia/diagnosis , Truncus Arteriosus, Persistent/diagnosis
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%.
Myocardium/pathology , Adolescent , Adult , Aged , Biopsy/adverse effects , Biopsy/methods , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged
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%.
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Myocardium/pathology , Biopsy/adverse effects , Biopsy/methods
UNLABELLED: Behçet's disease uncommon in the pediatric population. Intracardiac thrombus and bilateral pulmonary artery aneurysms are uncommon manifestations. We are reporting one case. A 14 years old patient was admitted, with high fever, dyspnea and hemoptysis since 4 months ago. Two years ago, fever, oral ulcers, aphthae (gingival, palate, tonsils), nose ulceration in and arthralgias-arthritis were noted. Chest radiograph showed round mass in the right lower lung field. The chest tomographic computed scan and pulmonary centellography were done to investigate malformations arterial. An Intracardiac thrombus of 27 x 12 mm was identified in the right ventricle by transthoracic echocardiography. Catheterization and pulmonary angiography showed an aneurism located in the right and left lobares arteries. Medical management with immunosuppressive and anticoagulation therapy resulted in complete remission of the clinical manifestations. Due to heamodynamic compromise surgical removal of the intracardiac thrombus was done. IN SUMMARY: The Behçet's disease is rare disease in children. Intracardiac thrombus and bilateral pulmonary artery aneurysms are rare complications. Medical treatment (immunosupressive and anticoagulation) is the first line therapy with resolution of the mucous, skin, cardiac and pulmonary manifestations.
Aneurysm/etiology , Behcet Syndrome/complications , Heart Diseases/etiology , Heart Ventricles , Pulmonary Artery , Thrombosis/etiology , Adolescent , Aneurysm/diagnosis , Heart Diseases/diagnosis , Humans , Male , Thrombosis/diagnosis
Behçet's disease uncommon in the pediatric population. Intracardiac thrombus and bilateral pulmonary artery aneurysms are uncommon manifestations. We are reporting one case. A 14 years old patient was admitted, with high fever, dyspnea and hemoptysis since 4 months ago. Two years ago, fever, oral ulcers, aphthae (gingival, palate, tonsils), nose ulceration in and arthralgias-arthritis were noted. Chest radiograph showed round mass in the right lower lung field. The chest tomographic computed scan and pulmonary centellography were done to investigate malformations arterial. An Intracardiac thrombus of 27 x 12 mm was identified in the right ventricle by transthoracic echocardiography. Catheterization and pulmonary angiography showed an aneurism located in the right and left lobares arteries. Medical management with immunosuppressive and anticoagulation therapy resulted in complete remission of the clinical manifestations. Due to heamodynamic compromise surgical removal of the intracardiac thrombus was done. IN SUMMARY: The Behçet's disease is rare disease in children. Intracardiac thrombus and bilateral pulmonary artery aneurysms are rare complications. Medical treatment (immunosupressive and anticoagulation) is the first line therapy with resolution of the mucous, skin, cardiac and pulmonary manifestations.
Adolescent , Humans , Male , Aneurysm , Behcet Syndrome , Heart Ventricles , Heart Diseases , Pulmonary Artery , Thrombosis , Aneurysm , Heart Diseases , Thrombosis
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.
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Ductus Arteriosus, Patent/surgery , Prostheses and Implants , Prosthesis Design
OBJECTIVE: We present two cases of Patent Foramen Ovale (PFO) treated with percutaneous Amplatzer device. METHOD: The first case corresponds to 48 years old woman with Ebstein's disease with moderate to severe hemodynamic repercussion and three cerebrovascular accidents, the last one under coumarin treatment, she received antiarrhythmic medication and despite of it developed 1st degree AV block, supraventricular and ventricular ectopia, rigth branch block. The second case corresponds to a 22 years old man with antecedents of cerebrovascular accident at the age of 21 with sequelae of convulsive crisis. Both patients were percutaneously treated with Amplatzer devices. The first patient was treated with a foramen ovale device and second with septal occluder due to the diameter of the foramen. Both patients have remained asymptomatic during the follow-up period. CONCLUSIONS: The PFO devices are indicated for patients with a history of cerebrovascular accidents.
Heart Septal Defects, Atrial/surgery , Prostheses and Implants , Prosthesis Implantation/methods , Adult , Ebstein Anomaly/complications , Female , Follow-Up Studies , Heart Septal Defects, Atrial/complications , Heart Septal Defects, Atrial/diagnosis , Humans , Male , Middle Aged , Stroke/prevention & control , Time Factors , Treatment Outcome
Propósito: Se presentan los 2 casos de foramen oval permeable tratados con dispositivo de Amplatzer por vía percutánea. Método: El primero del sexo femenino de 48 años y con antecedentes de enfermedad de Ebstein moderada a severa y de 3 accidentes vasculares cerebrales, siendo el último bajo efecto anticoagulante, manejada con antiarrítmicos a pesar de lo cual presentó bloqueo auriculoventricular (a-v) de primer grado, aumento del automatismo supraventricular y ventricular de diferente foco y bloqueo de rama derecha. El segundo paciente masculino de 22 años con antecedente de un evento embólico cerebral a los 21 años con secuelas de crisis convulsivas. Ambos fueron tratados por vía percutánea para implante de dispositivo de Amplatzer, el primero para foramen oval permeable (FOP) y el segundo con dispositivo para comunicación interatrial por el diámetro del foramen. Los dos pacientes se encuentran asintomáticos. Conclusiones: El cierre de FOP por vía percutánea está indicado en pacientes con antecedentes de eventos cerebrales transitorios o permanentes y se sospeche esta vía como fuente embolígena. La técnica es fácil de realizar pero se requiere de un mayor número de pacientes para concluir.
Objective: We present two cases of Patent Foramen Ovale (PFO) treated with percutaneous Amplatzer device. Method: The first case corresponds to 48 years old woman with Ebstein's disease with moderate to severe hemodynamic repercussion and three cerebrovascular accidents, the last one under coumarin treatment, she received antiarrhythmic medication and despite of it developed 1st degree AV block, supraventricular and ventricular ectopia, rigth branch block. The second case corresponds to a 22 years old man with antecedents of cerebrovascular accident at the age of 21 with sequelae of convulsive crisis. Both patients were percutaneously treated with Amplatzer devices. The first patient was treated with a foramen ovale device and second with septal occluder due to the diameter of the foramen. Both patients have remained asymptomatic during the follow-up period. Conclusions: The PFO devices are indicated for patients with a history of cerebrovascular accidents.
Adult , Female , Humans , Male , Middle Aged , Heart Septal Defects, Atrial/surgery , Prostheses and Implants , Prosthesis Implantation/methods , Ebstein Anomaly/complications , Follow-Up Studies , Heart Septal Defects, Atrial/complications , Heart Septal Defects, Atrial/diagnosis , Stroke/prevention & control , Time Factors , Treatment Outcome
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.
Ductus Arteriosus, Patent/surgery , Prostheses and Implants , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Prosthesis Design
OBJECTIVES: To analyze immediate and long-term results of balloon dilation for aortic coarctation in a three-center experience in Mexico, and to determine factors associated with increased risk. BACKGROUND: Results demonstrated that the procedure is effective and safe, however its use in some groups is still controversial, specially in neonates and infants. METHODS: In a ten-year period, 333 patients with aortic coarctation on underwent balloon dilation with an immediate success rate of 93.7% and a major complication incidence of 1.8%. Of the total cohort, 272 patients were followed for a period of 24.3 +/- 20 months. Demographic and procedural data were analyzed to determine factors related to a poor outcome or to sustained high blood pressure. RESULTS: Cox regression analysis found age (risk ratio 3.42 p = 0.0001), isthmic hypoplasia (risk ratio 4.64, p < 0.0001), and post-dilation gradient (risk ratio 2.19, p = 0.0113) as independent risk factors for a follow-up event, mainly restenosis. Age at dilation was the only independent factor related to sustained hypertension with a seven-fold increase in the risk. CONCLUSIONS: Balloon dilation is an effective and safe alternative to treat aortic coarctation. Patients younger than one year of age, with severe isthmic hypoplasia and a post-dilation gradient > 20 mmHg have the highest risk to develop an event in the follow-up period. When the dilation procedure is performed in patients older than 10 years of age, and specially those older than 20 years, the probability that they remain or develop high blood pressure is increase.
Angioplasty, Balloon , Aortic Coarctation/therapy , Adolescent , Adult , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Male , Mexico , Middle Aged
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.
Heart Septal Defects, Atrial/surgery , Prostheses and Implants , Child , Child, Preschool , Female , Humans , Male , Middle Aged
Nuestro objetivo es presentar la experiencia inicial de cierre de conducto arterioso, con un nuevo dispositivo de Gianturco-Grifka, en el Hospital General del Centro Médico "La Raza". Se trata de un paciente femenino de 4 años de edad, asintomática, a quien se le detectó soplo continuo a los 3 años 7 meses de edad. El estudio ecocardiográfico demostró la persistencia de conducto arterioso cónico largo, de 4.9 mm de diámetro, presión sistólica de la arteria pulmonar de 35 mm Hg, con QP/QS 1.6:1. El estudio hemodinámico diagnóstico encontró un conducto arterioso cónico largo de 5 mm de diámetro tipo A1 de Krichenko. Se procedió al cierre del conducto arterioso permeable con dispositivo de Gianturco-Grifka de 7 mm, hasta obtener la oclusión del 100 por ciento de dicho conducto, lo cual se verificó por angiografía. No se presentaron complicaciones ni accidentes durante el procedimiento. Es necesario el empleo de este dispositivo en un mayor número de pacientes para determinar a largo plazo sus beneficios y sus limitaciones, sin embargo podemos concluir que técnicamente es fácil de utilizar y se obtiene una mayor disminución de la fuga residual que se presenta con otros dispositivos.
Humans , Female , Child, Preschool , Heart Defects, Congenital/therapy , Cardiac Catheterization/methods , Ductus Arteriosus, Patent/therapy , Cardiology/trends , Congenital Abnormalities/therapy , Prostheses and Implants
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.
Humans , Male , Female , Infant , Child, Preschool , Adolescent , Adult , Biocompatible Materials/therapeutic use , Cardiac Catheterization/methods , Ductus Arteriosus, Patent/therapy , Heart Defects, Congenital/therapy
Se presenta la experiencia con el dispositivo de Gianturco-Grifka para el cierre del conducto arterioso permeable en 13 pacientes: 7 mujeres y 6 hombres con edad promedio 6.5 años. El ecocardiograma mostró el conducto arterioso permeable con diámetro de 5.4 + 1.09 mm, con morfología tipo C en 7 pacientes, tipo A en 5y tipo E en 1 paciente. Hemodinámicamente se identificaron 6 tipo A, 5 tipo C y 2 tipo E con diámetro de 5.69 + 1.15 mm. Tres pacientes presentaron hipertensión arterial pulmonar severa con buena respuesta al 02 al 100 por ciento. Se emplearon 13 dispositivos: 5 de 7mmy 8 de 9 mm. Doce pacientes mostraron oclusión de 100 por ciento en el angiograma inmediato (92 por ciento) y uno presentó fuga ligera. El ecocardiograma de 24 hrs reportó 100 por ciento de oclusión en 12 casos. Un paciente presentó migración del dispositivo a aorta descendente 2 horas después del cierre, que se rescató por vía percutánea. Concluimos que el dispositivo de Gianturco-Grifka es una alternativa para el cierre del conducto arterioso, principalmente para las variedades C, D y E con diámetro máximo de 9 mm. Sin embargo, se necesitan estudios más grandes con seguimiento estrecho, para conocer su comportamiento, a mediano y largo plazo
Humans , Male , Female , Ductus Arteriosus, Patent/surgery , Graft Occlusion, Vascular
El objetivo fue valorar la evolución a corto y largo plazo en pacientes sometidos a valvuloplastía pulmonar (VP), e identificar los factores pronóstico para el fracaso. Se estudiaron 109 pacientes, 60 mujeres y 49 hombres con edad promedio de 7.04 ñ 8.4 años. El gradiente pulmonar previo fue de 89.53 ñ 37.23 mmHg y post-valvulopastía de 20.8 ñ 19.41 mmHg. (p < 0.0001), 43 pacientes presentaron gradiente infundibular post-valvular en 8 años de seguimiento fue 20.75 ñ 14.32 (p< 0.001). El porcentaje de éxito fue 86.2 por ciento, con una mortalidad global de 1.9 por ciento, complicaciones menores en 15.2 por ciento, falla del procedimiento en 13.8 por ciento. El 66.1 por ciento tenía estenosis pulmonar aislada y el 33.9 por ciento, presentaba lesiones asociadas. La reestenosis fue del 6.7 por ciento. Separando el análisis entre el grupo de éxito y de fracaso, las variables significativas que se encontraron en el grupo de fracaso fueron edad menor de 3.5 años y la morfología valvular displásica (p< 0.05) o combinada (p< 0.05), teniendo mayor número de complicaciones (p< 0.05). Los resultados inmediatos en el grupo de fracaso fueron un gradiente alto post-valvuloplastía (p< 0.05). La valvuloplastía pulmonar es procedimiento electivo tanto por sus resultados inmediatos como a largo plazo, siendo en nuestro medio un método efectivo y seguro
Humans , Male , Female , Infant , Child, Preschool , Adolescent , Adult , Middle Aged , Catheterization , Catheterization/adverse effects , Pulmonary Valve Stenosis/surgery , Pulmonary Valve/surgery , Pulmonary Valve Stenosis/physiopathology , Follow-Up Studies , Blood Pressure/physiology , Pulmonary Valve
