Double balloon pulmonary valvuloplasty: multi-track system versus conventional technique.

OBJECTIVES: To evaluate whether double balloon pulmonary valvuloplasty (DBPV) with the Multi-Track system (MTS) may help to simplify the procedure. BACKGROUND: DBPV is usually required for patients with pulmonary valve stenosis with large annulus. However, it needs two venous accesses and can be technically demanding. METHODS: From 07/03, 20 consecutive patients (19 +/- 10 yrs) with typical pulmonary valve stenosis underwent DBPV using the MTS (G1). The results were compared with those achieved by conventional DBPV performed in a matched historical group of 28 patients (21 +/- 11 yrs; P = NS) (G2). RESULTS: MTS balloons were easily advanced through the skin and inflated across the valve. Similar results were observed in regards to residual gradients (12 +/- 11 vs 14 +/- 10 mm Hg; P = NS) and right ventricular to systemic pressures (0.35 +/- 0.22 vs 0.37 +/- 0.26; P = NS). Procedure and fluoroscopic times were significant lower in G1 (78 +/- 24 vs 126 +/- 28; 15 +/- 12 vs 25 +/- 8 min, respectively; both P < 0.001). There was no major complication. Median follow-up was 1.8 yr for G1 and 5 yr for G2 (P = 0.037). At the last visit, peak instantaneous gradient across the right ventricular outflow tract by echocardiography was a mean 22 +/- 10 mm Hg for G1 and 25 +/- 9 mm Hg for G2 (P = NS). No patient had severe pulmonary insufficiency or required reintervention. CONCLUSIONS: The use of the MTS helped to expedite the procedure providing satisfactory midterm clinical outcomes, similar to those observed with the conventional DBPV technique.

Tratamento percutâneo versus cirúrgico da comunicação interatrial tipo Ostium Secundum em Adultos / Percutaneous closure versus surgical intervention of the secundum atrial septal defect in adults

Na última década, o fechamento percutâneo da comunicação interatrial tipo ostium secundum (CIA) emergiu como ótima alternativa terapêutica. Adultos com CIA representam um grupo de risco para o tratamento cirurgico devido a maior incidência de complicações que em crianças. Método: Neste estudo, comparamos a segurança e eficácia entre os dois métodos terapêuticos em pacientes >40 anos. Os pacientes foram alocados nos Grupos: Grupo I (GI) - percutâneo: 29 pacientes; Grupo II (GII) - cirúrgico: 20 pacientes, de acordo com a disponibilidade do uso de próteses e preferência do médico d referência e seguidos prospectivamente em um período de tempo contemporâneo. Resultados: Não houve diferença estatística entre os grupos em relação à idade, peso, Qp/Qs, pressão média da artéria pulmonar, pressão diastólica final do ventrículo esquerdo e prevalência de arritmias...

Double balloon pulmonary valvuloplasty: multi-track system versus conventional technique

the Multi-Track system (MTS) may help to simplify the procedure. Background: DBPV

is usually required for patients with pulmonary valve stenosis with large annulus. However,

it needs two venous accesses and can be technically demanding. Methods: From

07/03, 20 consecutive patients (19 6 10 yrs) with typical pulmonary valve stenosis

underwent DBPV using the MTS (G1). The results were compared with those achieved

by conventional DBPV performed in a matched historical group of 28 patients (21 6

11 yrs; P = NS) (G2). Results: MTS balloons were easily advanced through the skin and

inflated across the valve. Similar results were observed in regards to residual gradients

(12 6 11 vs 14 6 10 mm Hg; P = NS) and right ventricular to systemic pressures (0.35

6 0.22 vs 0.37 6 0.26; P = NS). Procedure and fluoroscopic times were significant

lower in G1 (78 6 24 vs 126 6 28; 15 6 12 vs 25 6 8 min, respectively; both P < 0.001).

There was no major complication. Median follow-up was 1.8 yr for G1 and 5 yr for G2

(P = 0.037). At the last visit, peak instantaneous gradient across the right ventricular

outflow tract by echocardiography was a mean 22 6 10 mm Hg for G1 and 25 6 9 mm

Hg for G2 (P = NS). No patient had severe pulmonary insufficiency or required reintervention.

Conclusions: The use of the MTS helped to expedite the procedure providing

satisfactory midterm clinical outcomes, similar to those observed with the conventional

Avaliação hemodinâmica da hipertensão arterial pulmonar secundária a cardiopatias congênitas / Hemodynamic evaluation of secundary pulmonary hypertension in congenital heart disease

A hipertensão arterial pulmonar (HAP) secundária a cardiopatias congênitas é uma enfarmidade comum em nosso meio devida a referências tardias para o tratamento. Nos pacientes com HAP, a avaliação hemodinâmica é um método importante para definir a reversibilidade do qudro e a indicação operatória. Neste artigo, revisamos os principais aspectos sobre a avaliação hemodinâmica da HAP na sala de cateterismo, discutindo os conceitos importantes para o cardiolodiasta (pediátrico e de adultos), intensivista ecocardiografista, cirurgião cardíaco e , principalmente, para o cardiologista invasivo (hemodinamicista).

Percutaneous closure of perimembranous ventricular septal defects with the Amplatzer device: technical and morphological considerations.

Percutaneous closure of perimembranous ventricular septal defects (VSDs) has been feasible, safe, and effective with the new Amplatzer membranous septal occluder. We report further experience with this device with emphasis on morphological aspects of the VSDs and technical issues. Ten patients (median age and weight, 14 years and 34.5 kg, respectively) with volume-overloaded left ventricles underwent closure under general anesthesia and transesophageal guidance (TEE). The VSD diameter was 7.1 +/- 4.0 mm by angiography and 7.8 +/- 3.7 mm by TEE. Three patients had defects associated with aneurysm-like formations (two with multiple exit holes), four had defects shrouded by extensive tricuspid valve tissue, two had defects with little or no tricuspid valve involvement, and one had a right aortic cusp prolapse with trivial aortic regurgitation. Implantation was successful in all patients, although in two the initial device had to be changed for a larger one. Kinkings in the delivery sheath, inability to position the sheath near the left ventricular apex, and device prolapse through the VSD prompted modifications in the standard technique of implantation. Device orientation was excellent except in one case. Nine patients had complete occlusion within 1-3 months. Device-related aortic or tricuspid insufficiency, arrhythmias, and embolization were not observed. Two patients had slight gradients across the left ventricular outflow tract, normalizing after 3 months. The Amplatzer membranous septal occluder was suitable to close a wide range of perimembranous VSD sizes and morphologies with good short-term outcomes. Longer follow-up is required.

Percutaneous closure of perimembranous ventricular septal defects with the amplatzer device: technical and morphological considerations

Percutaneous closure of perimembranous ventricular septal defects (VSDs) has beenfeasible, safe, and effective with the new Amplatzer membranous septal occluder. Wereport further experience with this device with emphasis on morphological aspects of theVSDs and technical issues. Ten patients (median age and weight, 14 years and 34.5 kg,respectively) with volume-overloaded left ventricles underwent closure under generalanesthesia and transesophageal guidance (TEE). The VSD diameter was 7.1 4.0 mm byangiography and 7.8 3.7 mm by TEE. Three patients had defects associated withaneurysm-like formations (two with multiple exit holes), four had defects shrouded byextensive tricuspid valve tissue, two had defects with little or no tricuspid valve involvement,and one had a right aortic cusp prolapse with trivial aortic regurgitation. Implantationwas successful in all patients, although in two the initial device had to be changedfor a larger one. Kinkings in the delivery sheath, inability to position the sheath near theleft ventricular apex, and device prolapse through the VSD prompted modifications in thestandard technique of implantation. Device orientation was excellent except in one case.Nine patients had complete occlusion within 1–3 months. Device-related aortic or tricuspidinsufficiency, arrhythmias, and embolization were not observed. Two patients hadslight gradients across the left ventricular outflow tract, normalizing after 3 months. TheAmplatzer membranous septal occluder was suitable to close a wide range of perimembranousVSD sizes and morphologies with good short-term outcomes. Longer follow-upis required.