[Interventionism in congenital heart disease in Chiapas. The history after thousand cases performed]. / El intervencionismo en cardiopatías congénitas en Chiapas. La historia luego de mil casos realizados.

Background: Congenital heart disease is the most common birth defect and the leading cause of childhood mortality in high-income countries. In these countries, the prognosis for a child born with congenital heart disease is excellent, with over 90% achieving adulthood. However, in the low and lower-middle-income countries, as ours, the outlook is starkly different. In Chiapas, because of the progress of the hemodynamics program, more and more types of congenital heart diseases are susceptible to being treated by cardiac catheterization. Objective: To show the global experience of the interventionism in congenital heart diseases in Chiapas from its inception to recent days. Method: Through a retrospective study from April 2016 to June 2023, we reviewed the electronic files of the total of patients who underwent cardiac catheterism during the same period of time. Results: A total of 1000 procedures were performed, 581 in female patients, with a median age of 4 years (1 day to 77 years). Of the total procedures, 115 (11.5%) were diagnostic catheterizations and 885 (88.5%) were interventional. Conclusions: Cardiac catheterization in pediatrics in Chiapas has displaced cardiac surgery in a large percentage, and the results that have been obtained are undoubtedly encouraging, which already represents a decentralization in the care of congenital heart diseases in our country.

Antecedentes: Las cardiopatías congénitas son el defecto congénito más común y la primera causa de mortalidad infantil en los países de alto ingreso económico. En estos países, el pronóstico de los pacientes nacidos con estos defectos es excelente, llegando el 90% de ellos hasta la edad adulta. Sin embargo, en los países de mediano o bajo ingreso económico, como el nuestro, el pronóstico es completamente distinto. En el Estado de Chiapas, como resultado del avance del programa de hemodinamia, cada vez más tipos de cardiopatías congénitas son susceptibles de ser tratadas por cateterismo cardiaco. Objetivo: Mostrar la experiencia global actual de la hemodinamia en cardiopatías congénitas en Chiapas después de haber alcanzado los primeros 1000 casos realizados desde el inicio de nuestro programa. Método: A través de un estudio retrospectivo que abarcó de abril de 2016 a junio de 2023 revisamos los expedientes electrónicos del total de pacientes que fueron llevados a cateterismo cardiaco durante ese periodo. Resultados: Se realizaron un total de 1000 procedimientos, 581 en pacientes del sexo femenino, con una mediana de edad de 4 años (1 día a 77 años). Del total de los procedimientos, 115 (11.5%) fueron cateterismos diagnósticos y 885 (88.5%) intervencionistas. Conclusiones: El cateterismo cardiaco en cardiopatías congénitas en el Estado de Chiapas ha desplazado a la cirugía cardiaca en un amplio porcentaje, y los resultados obtenidos son sin duda alentadores, lo cual representa ya una descentralización en la atención de las cardiopatías congénitas en nuestro país.

Partially open stent after balloon catheter iatrogenic perforation. How to solve this complication using a novel technique? The Mij-Her technique.

Complications related to pulmonary artery stenting are potentially life-threatening. We reported a novel technique of how to achieve the introduction of a partial dilated stent into a long sheath using a snare in the event of a iatrogenic perforation of a balloon catheter.There are no publications of similar techniques describing successful resolution of this type of complication.

Current outlook after 4 years since the beginning of interventional cardiology in congenital heart disease in Chiapas State / Panorama actual a 4 años del inicio de la cardiología intervencionista en cardiopatías congénitas en el Estado de Chiapas.

Introduction: As a result of technological advances, more and more types of congenital heart diseases are susceptible to being treated in the hemodynamic laboratory. The sum of more advanced imaging techniques as well as the development of a diversity of devices specially manufactured for use in children has allowed a better selection of patients and therefore that many of them can be corrected through cardiac catheterization or some patients with more complex congenital heart diseases require fewer surgical procedures or, if they do require them, that these may be of less complexity and risk. Objective: We decided to show the global experience of the interventionism in congenital heart diseases in Chiapas from its inception to recent days. Methods: Through a retrospective study from April 2016 to August 2020, we reviewed the electronic files of the total of patients who underwent cardiac catheterism during the same period of time. Results: A total of 510 procedures were performed, 300 in female patients, with a median age of 4 years (8 days - 77 years). Of the total procedures, 67 (13.1%) were diagnostic catheterizations and 443 (86.9%) were interventional. Conclusions: Cardiac catheterization in congenital heart disease in Chiapas has become a very valuable option with encouraging results which represents a possible decentralization in the care of congenital heart diseases in our country.

Introducción: Como resultado de avances tecnológicos, cada vez más tipos de cardiopatías congénitas son susceptibles a ser tratadas en el laboratorio de hemodinamia. La suma de técnicas de imagen más avanzadas, así como el desarrollo de una diversidad de dispositivos especialmente fabricados para su uso en niños ha permitido una mejor selección de pacientes y, por ende, que muchos de ellos pueden ser corregidos en su totalidad por medio de cateterismo cardiaco o bien que algunos pacientes con enfermedades cardiacas más complejas requieran menos procedimientos quirúrgicos o si los requieren, que estos sean de menor complejidad y riesgo. Objetivo: Decidimos mostrar la experiencia global de la hemodinamia en cardiopatías congénitas en Chiapas desde sus inicios hasta últimas fechas. Método: Mediante un estudio retrospectivo que abarcó de abril de 2016 a agosto de 2020 revisamos los expedientes electrónicos del total de pacientes que fueron llevados a cateterismo cardiaco durante ese periodo de tiempo. Resultados: Un total de 510 procedimientos fueron llevados a cabo, 300 en pacientes del sexo femenino, con una mediana de edad de 4 años (8 días - 77 años). Del total de procedimientos, 67 (13.1%) fueron cateterismos diagnósticos y 443 (86.9%) intervencionistas. Conclusión: El cateterismo cardiaco en cardiopatías congénitas en el Estado de Chiapas se ha convertido en una opción muy valiosa con resultados bastante alentadores, lo cual representa ya una posible descentralización en la atención de las cardiopatías congénitas en nuestro país.

Transcatheter Closure of Perimembranous Ventricular Septal Defects Using Different Generations of Amplatzer Devices: Multicenter Experience.

OBJECTIVES: To demonstrate safety and efficacy of using different generations of softer Amplatzer™ devices for ventricular septal defect (VSD) closure to avoid serious complications at follow-up. BACKGROUND: Transcatheter closure of perimembranous ventricular septal defects (PmVSD) is a well-established procedure; however, it is associated with unacceptable incidence of complete heart block. Great advantages have been achieved by using softer devices for VSD transcatheter closure. The first and second generation of Amplatzer™ occluders (AVP II, ADO, and ADO II) seem to offer a safe and attractive alternative for this procedure. These devices can be delivered using either an arterial (retrograde) or venous (prograde) approach. METHODS AND RESULTS: Patients with congenital PmVSD who underwent transcatheter closure using ADO, ADO II, and AVP II devices were included. Primary end point was to determine efficacy and safety of these generations of devices and to determine the incidence of complications at follow-up (complete AV block and aortic/tricuspid/mitral regurgitation). One hundred and nineteen patients underwent VSD closure at a median age of 5 years (8 months-54 years). During the catheterization, there were only minor complications and at follow-up of 36 ± 25.7 months (up to 99 months), the closure rate was high of 98.3% and freedom from AV block was 100%. CONCLUSIONS: The use of softer Amplatzer™ devices is a good alternative to achieve PmVSD closure safely with no risk of AVB during the procedure or at midterm follow-up.

Percutaneous closure of an acquired and iatrogenic left ventricular-right atrium communication (Gerbode defect) with an Amplatzer Vascular Plug II.

Gerbode defect is defined as an abnormal left ventricle-right atrium shunting which may have congenital or acquired origin, first described by Thurman in 1838, representing 0.08% of intracardiac shunts and <1% of the congenital heart diseases. The acquired defect can be classified as iatrogenic or non-iatrogenic, with previous cardiac surgery being the most common cause. Gerbode defect is classified depending on its position with respect to the tricuspid valve in supravalvular, infravalvular, or intermediate. Our purpose was to report a rare case of an iatrogenic and acquired Gerbode defect in a 10-year-old male patient following surgical correction of a partial anomalous pulmonary venous return of the right pulmonary veins to the right atrium. The defect was successfully closed percutaneously with an Amplatzer™ Vascular Plug II device. Percutaneous closure of acquired Gerbode defects could be considered as a good option using soft devices to reduce the possibility of severe complications such as complete heart block due to the location of the defect. .