RESUMO
BACKGROUND: Stent implantation has become the preferred method of treatment for treating vessel stenosis in congenital heart diseases. The availability of covered stents may decrease complications and have an important role in the management of patients with complex anatomy. AIM: This study aims to evaluate the feasibility and safety of the pre-mounted cobalt-chromium stent-graft-covered ePTFE Aortic BeGraft in a broad spectrum of vascular lesions. METHODS: This is a multicenter retrospective results analysis of 107 implanted BeGraft stents between 2016 and 2022 in six different European centers. RESULTS: One hundred and four patients with a mean age of thirteen years (range 1-70 years) and with the body weight of 56.5 kg (range 11-115 kg) underwent the BeGraft stent implantation. Stents were implanted in the following conditions: aortic coarctation (74 patients), RVOT dysfunction (12 patients), Fontan circulation (7 patients), and miscellaneous (11 subjects with complex CHD). All the stents were implanted successfully. The median stent diameter was 16 mm (range 7-24 mm), and the median length was 39 mm (range 19-49 mm). Major complications occurred in five subjects (4.7%). During a median follow-up of fourteen (1-70) months, stents' re-dilatation was performed in five patients. CONCLUSIONS: The BeGraft stent can be used safely and effectively in a wide spectrum of congenital heart diseases. Whether these good results will be stable in the longer term still needs to be investigated in a follow-up given its recent introduction into clinical practice, in particular regarding stent fracture or neointimal proliferation.
Assuntos
Endocardite , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Pulmonar , Substituição da Valva Aórtica Transcateter , Humanos , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/cirurgia , Endocardite/diagnóstico por imagem , Endocardite/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento , Valva AórticaRESUMO
Acute myocarditis is an inflammatory disease of the myocardium, and it can present as severe heart failure in children. Differential diagnosis with genetic cardiomyopathy can be difficult. The objective of this study is to identify patterns of clinical presentation and to assess invasive and non-invasive measures to differentiate patients with acute myocarditis from patients with dilated genetic cardiomyopathy. We performed a retrospective descriptive study of all paediatric patients (0-16 years old) that presented with new-onset heart failure with left ventricle ejection fraction < 35% in whom we performed an endomyocardial biopsy (EMB) during the period from April 2007 to December 2020. The patients were classified into two groups: Group 1 included 18 patients with myocarditis. Group 2 included 9 patients with genetic cardiomyopathy. Findings favouring a diagnosis of myocarditis included a fulminant or acute presentation (77.8% vs 33.3%, p = 0.01), higher degree of cardiac enzyme elevation (p = 0.011), lower left ventricular dimension z-score (2.2 vs 5.4, p = 0.03) increase of ventricular wall thickness (88.8% vs 33.3%, p = 0.03) and oedema in the EMB. Seven (77.8%) patients with genetic cardiomyopathy had inflammation in the endomyocardial biopsy fulfilling the diagnostic criteria of inflammatory cardiomyopathy.Conclusion: Differentiating patients with a myocarditis from those with genetic cardiomyopathy can be challenging, even performing an EMB. Some patients with genetic cardiomyopathy fulfil the diagnostic criteria of inflammatory cardiomyopathy. Using invasive and non-invasive measures may be useful to develop a predictive model to differentiate myocarditis from genetic cardiomyopathy. What is Known: ⢠Acute myocarditis could present with cardiogenic shock in paediatric patients. ⢠Parvovirus B19 is the main cause of myocarditis in this population. What is New: ⢠Current diagnostic criteria for myocarditis have limited use in paediatric patients presenting with new-onset heart failure. ⢠Some patients with a genetic cardiomyopathy and a new-onset heart failure fulfill the diagnostic criteria of inflammatory cardiomyopathy.
Assuntos
Cardiomiopatia Dilatada , Miocardite , Adolescente , Biópsia , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/genética , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Miocardite/diagnóstico , Miocárdio , Estudos Retrospectivos , Volume SistólicoRESUMO
No disponible
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Cardiomiopatia Restritiva/complicações , Cardiomiopatia Restritiva/diagnóstico por imagem , Cardiomiopatia Restritiva/diagnóstico , Espanha , Estudos RetrospectivosRESUMO
Transcatheter valve can be an alternative option of pediatric valve replacement in high-risk patients. We present 2 cases of Edwards Sapien 3 implantation in tricuspid position.
Assuntos
Bioprótese , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Cateterismo Cardíaco/efeitos adversos , Criança , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Desenho de Prótese , Falha de Prótese , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgiaRESUMO
No disponible
Assuntos
Humanos , Feminino , Pré-Escolar , Coração Triatriado/diagnóstico , Comunicação Interatrial/diagnóstico , Coração Triatriado/fisiopatologia , Ecocardiografia , Comunicação Interatrial/fisiopatologiaRESUMO
Introducción y objetivos. Pasada 1 década desde el primer implante percutáneo de la válvula pulmonar (IPVP) Melody en España, se exponen sus resultados en cuanto a la función valvular y las complicaciones a corto y medio plazo. Métodos. Análisis descriptivo retrospectivo y multicéntrico nacional de los IPVP Melody en pacientes menores de 18 años desde el primer implante (de marzo de 2007 hasta el 1 de enero de 2016). Resultados. Se reclutaron 9 hospitales que contaban un total de 81 IPVP en 77 pacientes, cuyas medianas [intervalo intercuartílico] de edad y peso eran 13,3 [9,9-15,4] años y 46 [27-63] kg respectivamente. La enfermedad cardiaca más frecuente fue la tetralogía de Fallot (n = 27) y el sustrato anatómico más común, el conducto valvulado de yugular bovina (n = 31). Las incidencias de complicaciones intraprocedimiento y agudas fueron del 6 y el 8% (no hubo muertes periprocedimiento). La mediana del tiempo de seguimiento fue 2,4 [1,1-4,9] años. Se diagnosticó endocarditis infecciosa (EI) a 4 pacientes (5,6%), de los que 3 precisaron el explante de la válvula. En el periodo de seguimiento, la mortalidad fue del 1,3%, relacionada con EI. A los 5 años de seguimiento, el 80 ± 6,9% y el 83 ± 6,1% de los pacientes estuvieron libres de reintervención y recambio valvular pulmonar respectivamente. Conclusiones. El IPVP en pacientes pediátricos es una opción válida con buenos resultados hemodinámicos a corto y medio plazo. La incidencia de EI durante el seguimiento fue relativamente baja, si bien es la principal complicación que tener en cuenta (AU)
Introduction and objectives. A decade has passed since the first Spanish percutaneous pulmonary Melody valve implant (PPVI) in March 2007. Our objective was to analyze its results in terms of valvular function and possible mid-term follow-up complications. Methods. Spanish retrospective descriptive multicenter analysis of Melody PPVI in patients < 18 years from the first implant in March 2007 until January 1, 2016. Results. Nine centers were recruited with a total of 81 PPVI in 77 pediatric patients, whose median age and weight were 13.3 years (interquartile range [IQR], 9.9-15.4) and 46 kg (IQR, 27-63). The predominant cardiac malformation was tetralogy of Fallot (n = 27). Most of the valves were implanted on conduits, especially bovine xenografts (n = 31). The incidence of intraprocedure and acute complications was 6% and 8%, respectively (there were no periprocedural deaths). The median follow-up time was 2.4 years (IQR, 1.1-4.9). Infective endocarditis (IE) was diagnosed in 4 patients (5.6%), of which 3 required surgical valve explant. During follow-up, the EI-related mortality rate was 1.3%. At 5 years of follow-up, 80% ± 6.9% and 83% ± 6.1% of the patients were free from reintervention and pulmonary valve replacement. Conclusions. Melody PPVI was safe and effective in pediatric patients with good short- and mid-term follow-up hemodynamic results. The incidence of IE during follow-up was relatively low but was still the main complication (AU)
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Implante de Prótese de Valva Cardíaca/métodos , Cardiopatias Congênitas/cirurgia , Atresia Pulmonar/cirurgia , Registros de Doenças/estatística & dados numéricos , Estudos RetrospectivosRESUMO
INTRODUCTION AND OBJECTIVES: A decade has passed since the first Spanish percutaneous pulmonary Melody valve implant (PPVI) in March 2007. Our objective was to analyze its results in terms of valvular function and possible mid-term follow-up complications. METHODS: Spanish retrospective descriptive multicenter analysis of Melody PPVI in patients < 18 years from the first implant in March 2007 until January 1, 2016. RESULTS: Nine centers were recruited with a total of 81 PPVI in 77 pediatric patients, whose median age and weight were 13.3 years (interquartile range [IQR], 9.9-15.4) and 46kg (IQR, 27-63). The predominant cardiac malformation was tetralogy of Fallot (n = 27). Most of the valves were implanted on conduits, especially bovine xenografts (n = 31). The incidence of intraprocedure and acute complications was 6% and 8%, respectively (there were no periprocedural deaths). The median follow-up time was 2.4 years (IQR, 1.1-4.9). Infective endocarditis (IE) was diagnosed in 4 patients (5.6%), of which 3 required surgical valve explant. During follow-up, the EI-related mortality rate was 1.3%. At 5 years of follow-up, 80% ± 6.9% and 83% ± 6.1% of the patients were free from reintervention and pulmonary valve replacement. CONCLUSIONS: Melody PPVI was safe and effective in pediatric patients with good short- and mid-term follow-up hemodynamic results. The incidence of IE during follow-up was relatively low but was still the main complication.
Assuntos
Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas/estatística & dados numéricos , Valva Pulmonar , Adolescente , Bioprótese/estatística & dados numéricos , Cateterismo Cardíaco/estatística & dados numéricos , Feminino , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Masculino , Desenho de Prótese , Insuficiência da Valva Pulmonar/complicações , Insuficiência da Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/cirurgia , Sistema de Registros , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Tetralogia de Fallot/complicações , Resultado do TratamentoRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Miocardite/tratamento farmacológico , Interferon beta-1b/uso terapêutico , Imunossupressores/uso terapêutico , Miocardite/epidemiologia , Tempo para o Tratamento/estatística & dados numéricos , Disfunção Ventricular Esquerda/tratamento farmacológicoAssuntos
Antivirais/uso terapêutico , Imunossupressores/uso terapêutico , Interferon beta/uso terapêutico , Metilprednisolona/uso terapêutico , Ácido Micofenólico/uso terapêutico , Miocardite/tratamento farmacológico , Infecções por Parvoviridae/tratamento farmacológico , Doença Aguda , Pré-Escolar , Feminino , Humanos , Masculino , Miocardite/fisiopatologia , Miocardite/virologia , Infecções por Parvoviridae/fisiopatologia , Infecções por Parvoviridae/virologia , Volume SistólicoAssuntos
Trombose Coronária/complicações , Eletrocardiografia , Fibrinolíticos/administração & dosagem , Infarto do Miocárdio/etiologia , Terapia Trombolítica/métodos , Cateterismo Cardíaco , Trombose Coronária/diagnóstico , Ecocardiografia , Seguimentos , Humanos , Recém-Nascido , Injeções Intravenosas , Masculino , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapiaRESUMO
We report the usefulness of the Szabo (anchor-wire) technique and two modifications of such based on the same concept for stent implantation in congenital heart lesions. The modifications of the original technique are related to the localization of the cell of the stent through which the anchor wire, which stops the stent advancement, is introduced: proximal in the original technique and central or distal in the reported modifications. These techniques were performed in six patients: in two to maintain permeability of the ductus arteriosus, in three to achieve a fenestration of the interatrial septum, and in one to implant a stent in a right ventricle-to-pulmonary artery conduit close to the bifurcation. We describe the technique as well as the most important difficulties and complications encountered. The Szabo or anchor-wire technique concept is a new tool for stent implantation that can provide more accurate stent positioning compared with conventional angiographically guided implantation in different congenital heart defects. As with any new tool, this technique demands a learning curve and knowledge of potential complications.
Assuntos
Cardiopatias Congênitas/cirurgia , Stents , Cateterismo Cardíaco/métodos , Pré-Escolar , Angiografia Coronária , Ecocardiografia Transesofagiana , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Resultado do TratamentoRESUMO
No disponible
No disponible
Assuntos
Humanos , Masculino , Feminino , Adulto , Implantação de Prótese/métodos , Valva Pulmonar/inervação , Cardiopatias Congênitas/cirurgia , Insuficiência da Valva Aórtica/complicações , Imageamento por Ressonância Magnética/métodos , Valva Pulmonar/fisiopatologia , Valva Pulmonar , Ablação por Cateter , Estenose Aórtica Subvalvar/complicações , Estenose Aórtica Subvalvar , Estenose da Valva AórticaRESUMO
INTRODUCTION AND OBJECTIVES: A great variety of different types of vascular fistula are referred to cardiac catheterization laboratories for diagnosis and percutaneous occlusion. In addition, a wide range of devices is available for treating them percutaneously. The objectives of this study were to assess the usefulness and difficulty of treating vascular fistulas percutaneously using controlled-release coils or Amplatzer vascular plugs and to report on the complications and overall outcomes observed with these two devices. METHODS: Retrospective review of percutaneous embolizations performed from January 2004 through June 2008. RESULTS: In total, 51 vascular fistulas in 30 patients aged from 6 days to 28 years (mean, 8.4 years) underwent successful embolization. The underlying diagnoses were: 27 venous collaterals in 16 patients after the Glenn procedure, four surgical (i.e. Blalock-Taussig) fistulas, 11 pulmonary arteriovenous fistulas in three patients, two aortopulmonary collateral arteries in two patients, one venous collateral in a patient who underwent the Fontan procedure, one aortopulmonary artery fistula in a patient with Scimitar syndrome, one coronary arteriovenous fistula, three systemic arteriovenous fistulas in a newborn, and one fistula from the left atrium to the superior vena cava after the repair of anomalous pulmonary venous return. The lesions were treated percutaneously using 34 vascular plugs and 19 coils. CONCLUSIONS: Vascular fistulas can be occluded percutaneously with good RESULTS: Small fistulas can be closed using coils, while vascular plugs are preferable for large lesions. Both devices are highly effective as occluders and no particular difficulty or significant complication was observed.