Oclusão percutânea do canal arterial menor 3 mm com auxílio do biótomo / Bioptome - assisted technique for percutaneous occlusion of the patent ductus arteriosus > 3 mm

A oclusão percutânea do canal arterial de pequeno calibre com molas de Gianturco tem sido considerada como a primeira opção terapêutica na maioria dos centros do mundo. Entretanto, o emprego de molas para canais menor 3 mm está associado a maiores taxas de insucessos e complicações. Neste artigo, descrevemos os resultados da oclusão destes canais por meio da técnica anterógrada com o auxílio do biótomo, empregando-se principalemnte coils, 0,052 polegadas. De setembro de 2002 a agosto de 2006, 14 pacientes (2 do sexo masculino, mediana de idade e peso de 8 anos e 23,6 kg, respectivamente) foram submetidos ao procedimento. Treze pacientes possuiam canal arterial do tipo A e um do tipo C. O diâmetro mínimo variou de 3,1 a 5,2 mm (média igual 3,8 mais ou menos 0,6 mm). Sucesso no implante foi observado em 13 casos. Destes 2 necessitaram de implante de molas adicionais. no mesmo procedimento devido a fluxos residuais significativos. Cinco apresentaram oclusão completa imediata e 8 saíram da sala de cateterismo com fluxo residual discreto, difuso e de baixa velocidade. Não houve complicações relacionadas ao cateterismo. Durante o seguimento, os ecocardiogramas mostraram oclusão em 12 dos 13 pacientes. Nenhum apresentava distúrbios de fluxo na aorta ou na artéria pulmonar esquerda. Um paciente foi submetido a procedimento de reoclusão com implante de nova mola. A oclusão do PCA > 3 mm por meio da técnica de liberação controlada por biótomo por via anterógrada de molas de Gianturco (preferencialmente de 0,052 polegadas) é factível, de simples realização, de baixo custo, segura e eficaz.

Percutaneous occlusion of the small patent ductus arteriosus (PDA) with Gianturco coils is considered the first-line therapeutic option in most centers around the world. However, the use of coils to close ducti larger than 3 mm is associated with higher failure and complication rates. In this paper we report the outcomes of percutaneous occlusion of these larger PDAs employing the bioptome assisted anterograde technique mainly using 0.052" coils. From 9/2002 to 8/2006, 14 patients (2 male; median age 8 years and weight 23.6 kg) underwent the procedure. Thirteen patients had type A PDAs and one had a type C. Minimal diameter varied from 3.1 to 5.2 mm (mean = 3.8 ± 0.6 mm). Successful implantation was achieved in 13 cases. Of these, 2 required additional coils in the same procedure due to significant leaks. Five had immediate total occlusion and 8 left the catheterization laboratory with discrete, diffuse, low-velocity residual leaks. There were no complications related to the catheterization procedures. On follow-up, total occlusion was observed in 12 of the 13 patients at echocardiography and none had flow disturbances of the aorta or of the left pulmonary artery. A single patient required a re-occlusion procedure with implantation of an additional coil. Percutaneous occlusion of PDAs larger than 3 mm using the bioptome assisted anterograde technique mainly with 0.052" coils is feasible, easy to perform, cost effective, safe and efficacious.

One-month therapy with simvastatin restores endothelial function in hypercholesterolemic children and adolescents.

Simvastatin has been shown to restore endothelial function in children with familial hypercolesterolemia after 28 weeks of treatment. The aim of this study was to evaluate 1-month simvastatin treatment effect on endothelial function in hypercholesterolemic children and adolescents. Eighteen hypercholesterolemic patients (HC group) and 18 healthy controls, aged 6-18 years, were studied with medical history, physical examination, full lipid profile, serum apolipoprotein B (apo B), fibrinogen, hepatic transaminases, and creatine kinase concentrations. Flow-mediated dilatation (FMD) was performed by high-resolution ultrasound of the brachial artery. The HC group received simvastatin 10 mg/day for 1 month. Arterial diameter was measured by two experienced sonographers who were unaware of subjects' conditions. At baseline, FMD was impaired in the HC group (mean, 5.27 +/- 4.67%) compared to controls (mean, 15.05 +/- 5.97%) (p < 0.001). After treatment, we observed a significant reduction in total cholesterol (TC) (29%), low-density lipoprotein cholesterol (LDL-C); (37%), apo B concentrations (36%) and FMD restoration (mean, 12.94 +/- 7.66%), with an absolute increase of 7.66 +/- 8.58 (p = 0.001). These results show that children and adolescents with hypercholesterolemia present endothelial dysfunction, and simvastatin, in addition to significantly reducing TC, LDL-C, and apo B concentrations, restores endothelial function with 1-month treatment.

One-month therapy with simvastatin restores endothelial function in hypercholesterolemic children and adolescents

Simvastatin has been shown to restore endothelial function in children with familial hypercolesterolemia after 28 weeks of treatment. The aim of this study was to evaluate 1-month simvastatin treatment effect on endothelial function in hypercholesterolemic children and adolescents. Eighteen hypercholesterolemic patients (HC group) and 18 healthy controls, aged 6–18 years, were studied with medical history, physical examination, full lipid profile,

serum apolipoprotein B (apo B), fibrinogen, hepatic transaminases, and creatine kinase concentrations. Flow-mediated dilatation (FMD) was performed by high-resolution ultrasound of the brachial artery. The HC group received simvastatin 10 mg/day for 1 month. Arterial diameter was measured by two experienced sonographers who were unaware of subjects’ conditions. At baseline, FMD was impaired in the HC group (mean, 5.27 ± 4.67%) compared to controls

(mean, 15.05 ± 5.97%) (p < 0.001). After treatment, we observed a significant reduction in total cholesterol (TC) (29%), low-density lipoprotein cholesterol (LDL-C); (37%), apo B concentrations (36%) and FMD restoration (mean, 12.94 ± 7.66%), with an absolute increase of 7.66 ± 8.58 (p = 0.001). These results show that children and adolescents with hypercholesterolemia present endothelial dysfunction, and simvastatin, in addition to significantly

reducing TC, LDL-C, and apo B concentrations, restores endothelial function with 1-month treatment.

Identification of mildly oxidized low-density lipoprotein (electronegative LDL) and its auto-antibodies IgG in children and adolescents hypercholesterolemic offsprings

Oxidative modification of low-density lipoproteins (LDL) is an essential step in atherogenesis, generating minimally oxidized LDL, also called electronegative LDL [LDL(−)], which has chemotactic, cytotoxic and immunogenic properties.Methods and results: Serum LDL(−) and anti-LDL(−) auto-antibodies (IgG) were evaluated in 28 children and adolescents with familial hypercholesterolemia (FH) antecedents, with or without early coronary artery disease in first-degree relatives (eCAD), hypercholesterolemic (hc) or normocholesterolemic (nc) versus a control group of normocholesterolemic children without pathologic antecedents (C). ELISAmethod was used for detection of LDL(−) and anti-LDL(−) IgG. LDL(−) serum levels did not differ among the four groups (FH-eCADhc 41.4±24.9 g/dl; FH-hc 38.3±11.2 g/dl; FH-nc 47.3±17.0 g/dl and C 44.2±28.8 g/dl, p = 0.659). However, IgG anti-LDL(−) auto-antibodies were significantly higher in the control group in comparison to the FH groups with or without eCAD, independent of hypercholesterolemia or normocholesterolemia (FH-eCAD-hc 0.825±0.289 g/dl; FH-hc 0.667±0.307 g/dl; FH-nc 0.763±0.204 g/dl and C 1.105±0.233 g/dl, p = 0.006). When the auto-antibodies of groups with FH, with or without eCAD and with or without hypercholesterolemiawere compared, no differences were found (p = 0.509).Conclusion: These results showed that FH and/or eCAD children and adolescents have lower titers of auto-antibodies anti-LDL(−) than children from normal families, independent of serum LDL-cholesterol or serum LDL(−).

Identification of mildly oxidized low-density lipoprotein (electronegative LDL) and its auto-antibodies IgG in children and adolescents hypercholesterolemic offsprings.

BACKGROUND: Oxidative modification of low-density lipoproteins (LDL) is an essential step in atherogenesis, generating minimally oxidized LDL, also called electronegative LDL [LDL(-)], which has chemotactic, cytotoxic and immunogenic properties. METHODS AND RESULTS: Serum LDL(-) and anti-LDL(-) auto-antibodies (IgG) were evaluated in 28 children and adolescents with familial hypercholesterolemia (FH) antecedents, with or without early coronary artery disease in first-degree relatives (eCAD), hypercholesterolemic (hc) or normocholesterolemic (nc) versus a control group of normocholesterolemic children without pathologic antecedents (C). ELISA method was used for detection of LDL(-) and anti-LDL(-) IgG. LDL(-) serum levels did not differ among the four groups (FH-eCAD-hc 41.4 +/- 24.9 microg/dl; FH-hc 38.3 +/- 11.2 microg/dl; FH-nc 47.3 +/- 17.0 microg/dl and C 44.2 +/- 28.8 microg/dl, p = 0.659). However, IgG anti-LDL(-) auto-antibodies were significantly higher in the control group in comparison to the FH groups with or without eCAD, independent of hypercholesterolemia or normocholesterolemia (FH-eCAD-hc 0.825 +/- 0.289 microg/dl; FH-hc 0.667 +/- 0.307 microg/dl; FH-nc 0.763 +/- 0.204 microg/dl and C 1.105 +/- 0.233 microg/dl, p = 0.006). When the auto-antibodies of groups with FH, with or without eCAD and with or without hypercholesterolemia were compared, no differences were found (p = 0.509). CONCLUSION: These results showed that FH and/or eCAD children and adolescents have lower titers of auto-antibodies anti-LDL(-) than children from normal families, independent of serum LDL-cholesterol or serum LDL(-).

Efeito de um mês de tratamento com sinvastatina sobre a função endotelial de crianças e adolescentes com hipercolesterolemia / One-moth simvastatin therapy effect on endothelial function of children and adolescents with hypercholesterolemia

Objetivo: Esse estudo foi desenhado para avaliar se um mês de tratamento c sinvastatina 10 mg/dia melhora a função endotelial de crianças e adolescentes c hipercolesterolemia. Métodos: Estudo de corte, cego, controlado, com terapia aberta de curto-prazo. Foram estudados 18 crianças e adolescentes hipercolesterolêmico (grupo HC), com idade entre seis e 18 anos e 18 controles saudáveis com idade entre seis e 17 anos. Todos foram investigados com histórico médico, exame físico, PE lipídico completo, apolipoproteína B, fibrinogênio, transaminases hepáticas e creatino-fosfoquinase. Os critérios de inclusão foram: colesterol total > 199 mg/dl e LI colesterol > 129 mg/dl para o grupo HC; colesterol total  199 mg/dl; LDL-colesterol  129 mg/dl e história familiar negativa de hipercolesterolemia e doença arterial coronária prematura em parentes de primeiro grau, para o grupo controle. Foram excluído obesos, hipertensos, diabéticos, pacientes com síndrome nefrótica, insuficiência renal e doenças sistêmicas agudas ou crônicas, tabagistas, etilistas ou usuários de drogas ilícitas e pacientes com trigliceridemia  250 mg/dl. A avaliação da função endotelial obtida mensurando-se a dilatação fluxo-mediada por ultra-sonografia de alta resolução em todos os participantes ao ingresso no estudo e, no grupo HC, também ao final do tratamento. Todas as crianças do grupo HC receberam sinvastatina 10mg/dia durai um mês. Os diâmetros arteriais foram medidos por um único observador, de forma cega...