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1.
J Transcat Intervent ; 26(supl. 1): 12-12, jun., 2018.
Artículo en Portugués | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1046715

RESUMEN

INTRODUÇÃO: O restabelecimento da função valvar pulmonar com implante percutâneo de próteses atualmente é realizado somente nos pacientes portadores de biopróteses, condutos ou homoenxertos posicionados na via de saída do VD. Próteses dedicadas para tratos de saída nativo estão sendo estudadas e implantadas com sucesso em diversos centros mundiais. OBJETIVOS: Apresentar a experiência inicial do implante percutâneo da VENUS-P Valve® em trato de saída nativo pulmonar. Serão demonstrados critérios de escolha dos pacientes, aspectos técnicos relacionados aos procedimentos e resultados de curto prazo. MATERIAIS E MÉTODOS: A prótese VENUS-P Valve® (Venus Medtech, Shanghai) é um stent de nitinol autoexpansível com uma valva de pericárdio porcino montada no seu interior. Possui aspecto de ampulheta e na extremidade distal o stent é de células abertas permitindo o fluxo para ambas artérias pulmonares. O seu sistema de entrega é 22 ou 24F. Os pacientes candidatos são avaliados com ecocardiografia transtorácica, angiotomografia, ressonância magnética e cateterismo cardíaco. São critérios de inclusão a presença de regurgitação pulmonar importante, com volumes diastólicos do VD>130ml/m2, sem estenoses na VSVD ou ramos pulmonares e trato de saída com no máximo 35mm de diâmetro após insuflação de cateter-balão medidor. O ecocardiograma transtorácico é o método padrão de escolha do diâmetro e comprimento da prótese. Todos os procedimentos foram realizados em sala híbrida, com anestesia geral endovenosa, profilaxia para endocardite bacteriana e heparina (TCA>250 seg). Os pacientes realizaram ecocardiografia transtorácica e avaliação clínica 24 horas e 30 dias após os procedimentos. RESULTADOS: Quatro pacientes (3 homens) foram submetidos ao implante percutâneo das valvas pulmonares em 2 dias consecutivos. O peso e idade médio foi de 62,2kg e 25,8 anos. A via de saída teve 30mm em média e a prótese utilizada apresentou diâmetro médio de 32mm. Três próteses tinham 25 mm de comprimento e a última 30mm. Houve sucesso no implante de todos os dispositivos com restabelecimento imediato da função valvar pulmonar. Uma prótese foi considerada em posição mais baixa no trato de saída porém sem interferência em estruturas cardíacas. Ao ecocardiograma de controle todos os dispositivos encontravam-se sem refluxo significativo, com fluxo preservado para as artérias pulmonares bilaterais e sem complicações relacionadas. Não houve complicações ou óbitos relacionados aos procedimentos. CONCLUSÕES: O restabelecimento da função valvar pulmonar em pacientes com trato de saída nativo com o implante percutâneo da VENUS-P Valve® mostrou-se uma excelente alternativa nesta experiência inicial. Os procedimentos são factíveis e seguros quando realizados por grupos experientes e familiarizados com o implante de stents na via de saída pulmonar. Por tratar-se de experiência inicial, acreditamos que um maior número de implantes e análise dos resultados tardios devem ser realizadas para incorporação definitiva destes dispositivos neste grupo selecionado de pacientes. (AU)


Asunto(s)
Humanos , Válvula Pulmonar/cirugía , Cateterismo Cardíaco/métodos
2.
Pediatr Cardiol ; 26(4): 431-9, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-15549617

RESUMEN

We report our experience with the use of covered stents for the management of coarctation of the aorta. From December 2001 to March 2004, nine patients (seven males; median age, 31 years; mean weight, 65 +/- 15 kg) underwent implantation. Indications included critical or atretic native coarctation (n = 4), patients >50 years of age (n = 2), associated patent ductus arteriosus (n = 1) or adjacent aneurysm (n = 1), and the presence of a circumferential fracture within a previously implanted stent (n = 1). The covered balloon-expandable Cheatham-Platinum stent and the self-expandable stent graft Braile were employed. Adequate implantation was observed in all patients. Gradients were reduced from 54 +/- 14 to 3 +/- 8 mmHg and the coarctation site increased from 2.4 +/- 2.9 to 15.9 +/- 4.3 mm. The patent ductus arteriosus was immediately closed and the aneurysm excluded. Two patients >35 years with aneurysmal ascending aorta and metallic aortic prosthesis had aneurysm formation at follow-up, with one undergoing aneurysm exclusion using a Braile stent. Although covered stents are useful in the management of selected patients with coarctation, aneurysm formation may still occur in patients with markers of aortic wall weakness. Refinements in the deployment technique and/or the stent design are needed to eliminate this risk.


Asunto(s)
Coartación Aórtica/cirugía , Implantación de Prótesis Vascular/instrumentación , Materiales Biocompatibles Revestidos , Politetrafluoroetileno , Stents , Adolescente , Adulto , Anciano , Coartación Aórtica/diagnóstico por imagen , Aortografía , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
3.
Arq Bras Cardiol ; 77(5): 471-86, 2001 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-11733820

RESUMEN

We report new percutaneous techniques for perforating the pulmonary valve in pulmonary atresia with intact ventricular septum, in 3 newborns who had this birth defect. There was mild to moderate hypoplastic right ventricle, a patent infundibulum, and no coronary-cavitary communications. We succeeded in all cases, and no complications related to the procedure occurred. The new coaxial radiofrequency system was easy to handle, which simplified the procedure. Two patients required an additional source of pulmonary flow (Blalock-Taussig shunt) in the first week after catheterization. All patients had a satisfactory short-term clinical evolution and will undergo recatheterization within 1 year to define the next therapeutic strategy. We conclude that this technique may be safely and efficiently performed, especially when the new coaxial radiofrequency system is used, and it may become the initial treatment of choice in select neonates with pulmonary atresia and intact ventricular septum.


Asunto(s)
Ablación por Catéter/métodos , Tabiques Cardíacos/patología , Atresia Pulmonar/cirugía , Válvula Pulmonar/cirugía , Resultado Fatal , Femenino , Humanos , Recién Nacido , Masculino
4.
Arq Bras Cardiol ; 77(6): 520-31, 2001 Dec.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-11799427

RESUMEN

OBJECTIVE - To report the results of percutaneous occlusion of persistent ductus arteriosus with the Amplatzer prosthesis in 2 Brazilian cardiological centers. METHODS - From May 1998 to July 2000, 33 patients with clinical and laboratory diagnosis of persistent ductus arteriosus underwent attempts at percutaneous implantation of the Amplatzer prosthesis. The median age was 36 months (from 6 months to 38 years), and the median weight was 14kg (from 6 to 92kg). Sixteen patients (48.5%) were under 2 years of age at the time of the procedure. All patients were followed up with periodical clinical and echocardiographic evaluations to assess the presence and degree of residual shunt and possible complications, such as pseudocoarctation of the aorta and left pulmonary artery stenosis. RESULTS - The minimum diameter of the arterial ducts ranged from 2.5 to 7.0mm (mean of 4.0+/-1.0, median of 3.9). The rate of success for implantation of the prosthesis was 100%. Femoral pulse was lost in 1 patient. The echocardiogram revealed total closure prior to hospital discharge in 30 patients, and in the follow-up visit 3 months later in the 3 remaining patients. The mean follow-up duration was 6.4+/-3.4 months. All patients were clinically well, asymptomatic, and did not need medication. No patient had narrowing of the left pulmonary artery or of the aorta. No early or late embolic events occurred, nor did infectious endarteritis. A new hospital admission was not required for any patient. CONCLUSION - The Amplatzer prosthesis for persistent ductus arteriosus is safe and highly effective for occlusion of ductus arteriosus of varied diameters, including large ones in small symptomatic infants.


Asunto(s)
Conducto Arterioso Permeable/cirugía , Embolización Terapéutica/instrumentación , Prótesis e Implantes , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Resultado del Tratamiento
5.
Arch Inst Cardiol Mex ; 69(4): 320-9, 1999.
Artículo en Inglés | MEDLINE | ID: mdl-10553188

RESUMEN

PURPOSE: To assess the results of reocclusion procedures for late residual shunts after transcatheter closure of the patent ductus arteriosus. MATERIAL AND METHODS: Nineteen patients underwent reocclusion procedures either with Rashkind technique (2 patients) or with coils. Mean age was 96.5 months and mean interval between the initial and the additional procedure was 15.7 months. In 5 patients, the duct was balloon-dilated prior to occlusion. RESULTS: In 3 patients the procedure was unsuccessful because it was impossible to cross the duct using either a guide wire or a catheter. Immediate or late complete occlusion occurred in 13 patients. Two patients required a third procedure for complete closure. One patient developed severe intravascular hemolysis after coil implantation and was sent to surgery. The rate of final late residual shunting decreased from 17.1% to 6.6% (5/76) in the umbrella group and from 15.8% to 1.8% (1/56) in the coil group. CONCLUSIONS: Reocclusion procedures are indicated after one year of persistent shunting following the primary procedure. They are generally effective and reduce significantly the rate of late residual shunting. In patients with tiny shunts, the duct may need to be dilated. Coils are preferred because of their low cost.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Conducto Arterioso Permeable/cirugía , Adolescente , Adulto , Cateterismo Cardíaco , Cateterismo , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Recurrencia , Reoperación
6.
Cardiol Young ; 9(4): 371-6, 1999 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-10476826

RESUMEN

In this report, we describe our experience with transcatheter occlusion of congenital coronary arterial fistulas in adults. From November 1992 to November 1996, 5 symptomatic patients, aged from 47 to 70 years, underwent transcatheter occlusion of fistulas using a retrograde arterial approach. All had chest pain or dyspnea on exertion. Detachable balloons were used in 4 patients, and Gianturco coils in 1. Detachable balloons were implanted through a Debrun system, while the coils were implanted through a 5 French right coronary Judkins catheter. Both were passed through an 8 French guiding catheter (Amplatz II). Each patient had a single fistula. The fistulas originated from the right coronary artery in 3 patients, and from the circumflex artery in 2. They drained into the pulmonary trunk in 3 patients, into the right atrium in 1, and into a bronchial artery in the other. All fistulas were occluded completely in the catheterization laboratory, and the procedures were uncomplicated. At follow up, 3 patients underwent coronary angiography, and there was no evidence of recanalization. Transcatheter embolization in adults of single congenital coronary fistulas with detachable balloons and coils is safe and effective and can be regarded as an acceptable alternative to surgery.


Asunto(s)
Fístula Arterio-Arterial/terapia , Anomalías de los Vasos Coronarios/terapia , Embolización Terapéutica , Anciano , Cateterismo Cardíaco , Angiografía Coronaria , Embolización Terapéutica/métodos , Atrios Cardíacos/anomalías , Humanos , Persona de Mediana Edad , Arteria Pulmonar/anomalías
7.
Arq Bras Cardiol ; 72(1): 59-69, 1999 Jan.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-10347912

RESUMEN

PURPOSE: Evaluation of the role of transesophageal echocardiography in percutaneous closure of atrial septal defects (ASD) with the Amplatzer septal occluder. METHODS: Patients were selected for percutaneous closure of ASD by transesophageal echocardiography (TEE), which was also used to monitor the procedure, helping to select the appropriate size of the Amplatzer device, to verify its position, and to access the immediate results of the procedure. During the follow-up, TEE was used to evaluate the presence and magnitude of residual shunt (RS), device position, and right cardiac chamber diameters. RESULTS: Twenty-two (40%) of a total of 55 studied patients were selected. Thirteen underwent Amplatzer device implantation, eight are still waiting for it, and one preferred the conventional surgical treatment. All procedures were successful, which was mainly due to proper patient selection. Six (23%) patients acutely developed RS, which spontaneously disappeared at the three-month follow-up examination in three patients. There was a significant reduction in the right ventricle diastolic diameter, from 27 mm (average) to 24 mm and 20 mm, one and three months after the procedure, respectively (p < 0.0076). CONCLUSION: With the aid of TEE, percutaneous closure of ASD can be successfully, safely, and effectively performed.


Asunto(s)
Cateterismo Cardíaco/métodos , Ecocardiografía Transesofágica , Defectos del Tabique Interatrial/diagnóstico por imagen , Defectos del Tabique Interatrial/terapia , Prótesis e Implantes , Adolescente , Adulto , Niño , Preescolar , Estudios de Evaluación como Asunto , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Selección de Paciente
8.
J Pediatr (Rio J) ; 75(6): 407-18, 1999.
Artículo en Portugués | MEDLINE | ID: mdl-14685496

RESUMEN

OBJECTIVE: Cardiac catheterization has begun to be employed for therapeutic purposes since the middle sixties. In this paper the authors review the current indications, technique and results related to each of the interventional procedures. It also includes a brief sample of the Instituto Dante Pazzanese experience for illustrative purpose. METHODS: The main procedures that are addressed include balloon and blade atrial septostomy (Rashkind and Park procedures), pulmonary valvuloplasty, aortic valvuloplasty, mitral valvuloplasty (for rheumatic mitral stenosis), angioplasty for coarctation of aorta with or without stent implantation, angioplasty for pulmonary artery stenosis with or without stent implantation, percutaneous occlusion of the patent ductus arteriosus, percutaneous occlusion of atrial septal defects and balloon dilation of stenosed Blalock-Taussig shunts. The authors make a review of the most important papers published in the literature about Interventional Pediatric Cardiology, including their own experience. RESULTS: Good or excelent therapeutic results are achieved for pulmonic stenosis, coarctation of aorta, patent ductus arteriosus, atrial septal defects and pulmonary branch stenosis. Satisfactory palliations are obtained for aortic stenosis, rheumatic mitral stenosis and complex congenital heart diseases that require balloon atrial septostomy. CONCLUSIONS: Due to the recent technological development, pediatric therapeutic heart catheterization makes it possible to treat or palliate about 30% of all congenital or acquired heart diseases with encouraging results, sparing some patients from the need of cardiac surgery.

9.
Arq Bras Cardiol ; 73(4): 373-81, 1999 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-10754591

RESUMEN

OBJECTIVE - To analyze immediate and late results of percutaneous mitral valvotomy (PMV) in patients < or = 18 year. METHODS - Between August '87 and July '97, 48 procedures were performed on 40 patients. The mean age was 15.6 years; 68.7% were females four of whom were pregnant. RESULTS - Success was obtained in 91.7% of the procedures. Immediate complications were severe mitral regurgitation (6.3%) and cardiac tamponade (2.0%). Late follow-up was obtained in 88.8% of the patients (mean value=43.2+/-33.9 months). NYHA functional class (FC) I or II was observed in 96.2% of the patients and restenosis developed in five patients, at a mean follow-up of 29.7+/-11.9 months. Three patients presented with severe mitral insufficiency and underwent surgery. Two patients died. CONCLUSION - PMV represents a valid therapeutic option in young patients. In these patients, maybe because of subclinical rheumatic activity, restenosis may have a higher incidence and occur at an earlier stage than in others persons.


Asunto(s)
Oclusión con Balón , Cateterismo , Estenosis de la Válvula Mitral/terapia , Adolescente , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estenosis de la Válvula Mitral/etiología , Embarazo , Cardiopatía Reumática/complicaciones , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
11.
Cardiol Young ; 8(3): 364-7, 1998 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-9731652

RESUMEN

The development of pulmonary arteriovenous fistulas after bidirectional cavopulmonary operations, such as the bidirectional Glenn shunt and Kawashima's procedure, has raised concern. Development of these fistulas, which are more frequent than initially thought, can represent a limiting factor in the late outcome of these patients and may even limit the indication for these types of surgery. Whether the fistulas can be reversed by transforming the surgical procedures has yet to be established. In the hope of avoiding this kind of complication, thought to be caused by the lack of passage of a hypothetical hepatic factor through the pulmonary circulation, we have developed an inverted type of bidirectional cavopulmonary connection in which the blood coming from the liver perfuses immediately both lungs. This is made possible by shunting via an intra-atrial tunnel the blood from the superior caval vein directly to the left atrium, and the blood from the inferior caval vein to the right branch of the pulmonary trunk (keeping its bifurcation intact). We describe findings in two patients undergoing successful surgery with this technique. Serial follow-up with contrast echocardiography did not show evidence of arteriovenous pulmonary fistulas. Despite our numbers being small, and the time of follow-up being limited, we believe that it is important to document these and similar cases.


Asunto(s)
Puente Cardíaco Derecho/métodos , Circulación Pulmonar , Angiografía , Fístula Arteriovenosa/etiología , Fístula Arteriovenosa/fisiopatología , Fístula Arteriovenosa/prevención & control , Puente Cardíaco Derecho/efectos adversos , Humanos , Lactante , Masculino , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/cirugía , Resultado del Tratamiento , Vena Cava Superior/diagnóstico por imagen , Vena Cava Superior/cirugía
12.
Arq Bras Cardiol ; 70(3): 147-53, 1998 Mar.
Artículo en Portugués | MEDLINE | ID: mdl-9674174

RESUMEN

PURPOSE: To evaluate our initial experience with percutaneous closure of secundum type atrial septal defects (ASD) with the Amplatzer septal occluder. METHODS: Seven patients underwent occlusion by anterograde approach, under general anesthesia and transesophageal echocardiography (TEE) guidance. One child had 2 ASD and a patent ductus arteriosus (PDA). The ASD size ranged from 8.7 to 20 mm as measured by TEE. A transthoracic echocardiogram was performed in the morning after the procedure. RESULTS: Eight devices were successfully implanted in 7 patients and the PDA was occluded with a Gianturco coil at the same session. In this patient, there was an episode of supraventricular tachycardia during the occlusion of one ASD which was reverted with adenosin. All patients were discharged the day after, with complete occlusion of all defects. CONCLUSION: The procedure is safe, effective and versatile. It can be applied as an initial alternative to the treatment of selected patients with ASD.


Asunto(s)
Defectos del Tabique Interatrial/cirugía , Prótesis e Implantes , Adolescente , Cateterismo Cardíaco/métodos , Niño , Preescolar , Ecocardiografía Transesofágica , Femenino , Humanos , Masculino , Diseño de Prótesis
14.
Arq Bras Cardiol ; 71(6): 769-80, 1998 Dec.
Artículo en Portugués | MEDLINE | ID: mdl-10347922

RESUMEN

PURPOSE: To evaluate the overall experience of our institution with percutaneous occlusion of the patent ductus arteriosus. METHODS: Since December/92, 150 patients underwent 178 procedures (85-Rashkind technique; 87-Gianturco coils; 6-Duct Occlud). Median age was 6.5 years (1 to 57). Mean minimum ductal diameter was 3.05 +/- 1.24 mm (1 to 8). Clinical and echocardiographic evaluations were performed periodically. RESULTS: Adequate implantation was achieved in 143 (95.3%) patients. Prevalence of immediate residual shunting was 52.1%, falling to 15.9% during follow-up. This figure decreased to 5.2% after new additional procedures. Umbrella and coil embolization occurred in 1 and 12 procedures, respectively. Hemolysis and mild stenosis of left pulmonary artery were observed in one patient each. There was no mortality. CONCLUSION: This therapeutic modality is safe and efficacious with good follow-up results.


Asunto(s)
Conducto Arterioso Permeable/terapia , Embolización Terapéutica/métodos , Prótesis e Implantes , Preescolar , Estudios de Seguimiento , Humanos , Lactante , Resultado del Tratamiento
15.
Arq Bras Cardiol ; 71(4): 613-7, 1998 Oct.
Artículo en Portugués | MEDLINE | ID: mdl-10347939

RESUMEN

We report a rare case of a 21 month old child with a coronary sinus atrial septal defect associated with perimembranous ventricular septal defect and no left superior vena cava. The diagnosis was made by transthoracic echocardiogram and confirmed by angiography. The patient was operated on uneventfully, both defects were closed with bovine pericardial patches and the flow from the coronary veins was directed towards the left atrium. An echocardiogram revealed complete closure of both defects.


Asunto(s)
Defectos del Tabique Interatrial/complicaciones , Defectos del Tabique Interventricular/complicaciones , Vena Cava Superior/anomalías , Femenino , Defectos del Tabique Interatrial/diagnóstico , Defectos del Tabique Interatrial/cirugía , Defectos del Tabique Interventricular/diagnóstico , Defectos del Tabique Interventricular/cirugía , Humanos , Lactante , Vena Cava Superior/cirugía
16.
Arq Bras Cardiol ; 68(5): 327-31, 1997 May.
Artículo en Portugués | MEDLINE | ID: mdl-9497520

RESUMEN

PURPOSE: To evaluate the results of percutaneous balloon valvuloplasty (PBV) for membranous subaortic stenosis (MSAS). METHODS: Seven patients with MSAS were submitted to PBV using the retrograde approach. Hemodynamic and angiographic studies were performed before and after the procedure. The balloon/annulus ratio varied between 0.9 to 1.05. RESULTS: The systolic gradient (SG) between the left ventricle (LV) and aorta was reduced from 57.8 +/- 11.6 to 22.0 +/- 8.6 mmHg (p < 0.001) and the LV systolic pressure from 154.5 +/- 30.3 to 118.7 +/- 18.4 mmHg (p < 0.001). One patient had arterial occlusion and was submitted to surgical embolectomy and another one showed severe mitral regurgitation combined with aortic insufficiency (AI) and required surgical valvuloplasty. There was no mortality. Four patients had a 11 +/- 10 month follow up: the SG measured by echocardiogram was 34 +/- 7 mmHg and no patient showed worsening of the AI. CONCLUSION: PBV is an effective procedure to reduce the subaortic SG, with an acceptable morbidity and persistence of the results in the short term follow up. PBV is a valid alternative as an initial mode of therapy in the management of patients with MSAS.


Asunto(s)
Estenosis de la Válvula Aórtica/terapia , Cateterismo , Adolescente , Válvula Aórtica , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Membranas
17.
Arq Bras Cardiol ; 68(5): 357-62, 1997 May.
Artículo en Portugués | MEDLINE | ID: mdl-9497525

RESUMEN

The association of pulmonary valve stenosis and patent ductus arteriosus is uncommonly found in clinical practice of pediatric cardiology. The authors describe 2 patients with this association that were successfully treated in the same procedure by interventional cardiology: first case, a 14 month old boy was submitted to percutaneous pulmonary valvoplasty with reduction of systolic gradient between pulmonary artery and right ventricle from 71 to 3 mmHg. The 2.0 mm of diameter and conical shape duct was successfully occluded using a 38-5-5 coil; second case, a 20 month old girl was submitted to percutaneous pulmonary valvoplasty with reduction of systolic gradient between pulmonary artery and right ventricle from 60 to 5 mmHg. An attempt to close the 3.5 mm of diameter and concial shape duct using coil was performed, but the device embolized into the pulmonary artery. After immediate retrieval, a 12 mm Rashkind umbrella was implanted. Indication of treatment of both conditions, technical aspects and complications related to the procedures, and patients follow up are also discussed.


Asunto(s)
Cateterismo Cardíaco/métodos , Conducto Arterioso Permeable/terapia , Estenosis de la Válvula Pulmonar/terapia , Conducto Arterioso Permeable/complicaciones , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Lactante , Masculino , Estenosis de la Válvula Pulmonar/complicaciones , Radiografía , Arterias Torácicas/diagnóstico por imagen
18.
Arq. bras. cardiol ; Arq. bras. cardiol;68(5): 357-362, maio 1997. ilus
Artículo en Portugués | LILACS | ID: lil-214045

RESUMEN

A associaçäo entre estenose pulmonar valvar e persistência do canal arterial näo é freqüente na prática clínica da cardiologia pediátrica. Säo descritos dois casos de portadores dessa associaçäo, tratados simultaneamente, em um mesmo procedimento, através do cateterismo intervencionista: 1§ caso, criança de 14 meses submetida a valvoplastia pulmonar percutânea com queda no gradiente sistólico entre a artéria pulmonar e o ventrículo direito de 71 para 3mmHg. O canal arterial, de 2,0mm de diâmetro e do tipo cônico foi ocluído com um coil 38-5-5; 2§ caso, criança de 20 meses submetida a valvoplastia pulmonar percutânea com queda no gradiente sistólico entre a artéria pulmonar e o ventrículo direito de 60 para 5mmHg. Tentativa de oclusäo do canal, de 3,5mm de diâmetro e do tipo cônico, utilizando-se coil foi realizada sem sucesso devido a embolizaçäo para a artéria pulmonar. O dispositivo foi imediatamente resgatado e uma umbrella de 12mm foi implantada com sucesso. Discute-se a indicaçäo de tratamento das condiçöes, aspectos técnicos e complicaçöes relativas ao procedimento e seguimento dos pacientes.


The association of pulmonary valve stenosis and patent ductus arteriosus is uncommonly found in clinical practice of pediatric cardiology. The authors describe 2 patients with this association that were successfully treated in the same procedure by interventional cardiology: first case, a 14 month old boy was submitted to percutaneous pulmonary valvoplasty with reduction of systolic gradient between pulmonary artery and right ventricle from 71 to 3 mmHg. The 2.0 mm of diameter and conical shape duct was successfully occluded using a 38- 5-5 coil; second case, a 20 month old girl was submitted to percutaneous pulmonary valvoplasty with reduction of systolic gradient between pulmonary artery and right ventricle from 60 to 5 mmHg. An attempt to close the 3.5 mm of diameter and conical shape duct using coil was performed, but the device embolized into the pulmonary artery. After immediate retrieval, a 12 mm Rashkind umbrella was implanted. Indication of treatment of both conditions, technical aspects and complications related to the procedures, and patients follow up are also discussed


Asunto(s)
Humanos , Lactante , Estenosis de la Válvula Pulmonar/terapia , Conducto Arterioso Permeable/terapia , Cateterismo Cardíaco , Estenosis de la Válvula Pulmonar/complicaciones , Conducto Arterioso Permeable/complicaciones
19.
Arq. bras. cardiol ; Arq. bras. cardiol;68(5): 327-331, maio 1997. ilus, tab
Artículo en Portugués | LILACS | ID: lil-214040

RESUMEN

OBJETIVO - Avaliar os resultados da valvoplastia percutânea por cateter baläo (VPCB) na estenose sub-aórtica em membrana (ESAM). MÉTODOS - Sete pacientes com diagnóstico de ESAM foram submetidos a VPCB por via retrógada. Estudos hemdinâmicos e angiográficos foram realizados antes e após o procedimento. A relaçäo baläo/anel variou de 0,9 a 1,05. RESULTADOS - O gradiente sistólico (GS) entre o ventrículo esquerdo (VE) e a aorta foi reduzido de 57,8ñ 11,6 para 22,0ñ8,6mmHg (p<0,001) e a pressäo sistólicaem VE de 154,5ñ30,3 para 118,7ñ18,4mmHG(p<0,001). Um paciente paresentou oclusäo arterial necessitando de embolectomia cirúrgica e um outro apresentou insuficiência mitral severa aliada a insuficiência aórtica (IAo), requerendo plastia cirúrgica. Näo tivemos mortalidade. Quatro pacientes tiveram seguimento de 11ñ10 meses: o GS pelo ecocardiograma foi de 34ñ7mmHG e näo houve progressäo de o. CONCLUSÄO: A VPCB é um procedimento eficaz na reduçäo imediata de gradiente subaórtico, com morbidade aceitável e com manutençäo dos resultados a curto prazo. Consideramos como uma alternativa válida na abordagem inicial dos pacientes com ESAM.


Asunto(s)
Humanos , Cateterismo , Estenosis de la Válvula Aórtica , Estudios de Seguimiento , Resultado del Tratamiento
20.
Arch Inst Cardiol Mex ; 66(2): 129-37, 1996.
Artículo en Español | MEDLINE | ID: mdl-8768630

RESUMEN

The authors report their experience with the percutaneous closure of the patent ductus arteriosus with the Rashkind technique. They performed 42 procedures with a success of 97.6% and one embolization episode. The mean age was 8.7 +/- 6.7 years, the mean weight was 25.0 +/- 15.8 Kg and the minimum diameter of the ductus was 4.0 +/- 1.3 mm. The immediate overall prevalence of residual shunt was 48.8% falling to 21% in a mean follow-up of 17 +/- 13 months in 29 cases. Two patients underwent late reocclusion: one with a new umbrella and the other with a coil. Another patient had an immediate severe residual shunt and it was reoccluded in the same procedure with a coil. The anatomical type and minimum internal diameter of the ductus, age and weight, size of the umbrella and the rotation of the umbrella were not predictors of residual shunt. There were no deaths, hemolysis, endarteritis or fracture of the umbrella's arms. One patient remained with a slight gradient in the left pulmonary artery. The authors conclude that the Rashkind technique is safe and efficient and has good long term results. It should be considered as the first line therapeutic modality in the treatment of selected patients with persistent ductus arteriosus.


Asunto(s)
Conducto Arterioso Permeable/terapia , Embolización Terapéutica/métodos , Academias e Institutos , Adolescente , Adulto , Brasil , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/métodos , Cardiología , Niño , Preescolar , Conducto Arterioso Permeable/diagnóstico , Embolización Terapéutica/instrumentación , Estudios de Evaluación como Asunto , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Persona de Mediana Edad
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