Percutaneous closure of postoperative and post-traumatic ventricular septal deffects

Although uncommon, significant postoperative residual leaks may occur after repair of any type of a ventricular septal deffect (VSD). Post-traumatics VSDs are even rarer, but can be occasionally seen after penetrating or blunt chest trauma. When these defects are associated with significant left-to-rigth shunting (Qp/Qs > 1.5) with persistent left ventricular volume overload, intervention is generally recomended. Surgical treatment requires cardiopulmonary bypass with its attendent morbidity, increased hospital stay and possible long-term neurological impairment. With the envolving experience of transcatheter closure of postinfarction and native perimembranous and muscular VSDs, this less invasive method became an attractive alternative to manage these postoperative and post-traumatic deffects...

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

Stenting vs. balloon angioplasty for discrete unoperated coarctation of the aorta in adolescents and adults

More information is needed to clarify whether stenting is superior to balloon angioplasty (BA) for unoperated coarctation of the aorta (CoA). From September 1997, 21 consecutive adolescents and adults (24 6 11 years) with discrete CoA underwent stenting (G1). The results were compared to those achieved by BA performed in historical group of 15 patients (18 6 10 years; P = 0.103; G2). After the procedure, systolic gradient reduction was higher (99% 6 2% vs. 87% 6 17%; P = 0.015), residual gradients

lower (0.4 6 1.4 vs. 5.9 6 7.9 mm Hg; P = 0.019), gain at the CoA site higher (333% 6 172% vs. 190% 6 104%; P = 0.007), and CoA diameter larger (16.9 6 2.9 vs. 12.9 6 3.2 mm; P < 0.001) in G1. Aortic wall abnormalities were found in eight patients in G2 (53%) and in one in G1 (7%; P < 0.001). There was no major complication. Repeat catheterization (n = 33) and/or MRI (n = 2) was performed at a median follow-up of 1.0 year for G1 and 1.5 for G2 (P = 0.005). Gradient reduction persisted in both groups, although higher late gradients were seen in G2 (median of 0 mm Hg for G1 vs. 3 for

G2; P = 0.014). CoA diameter showed no late loss in G1 and a late gain in G2 with a trend to being larger in G1 (16.7 6 2.9 vs. 14.6 6 3.9 mm; P = 0.075). Two patients required late stenting due to aneurysm formation or stent fracture in G1. Aortic wall abnormalities did not progress and one patient required redilation in G2. Blood

pressure was similar in both groups at follow-up (126 6 12/81 6 11 for G1 vs. 120 6 15/80 6 10 mm Hg for G2; P = 0.149 and 0.975, respectively). Although satisfactory and similar clinical outcomes were observed with both techniques, stenting was a better means to relieve the stenosis and minimize the risk of developing immediate aortic

wall abnormalities.

Coarctação da aorta / Aorta of the coarctation

Coarctação da aorta é um estreitamento congênitoda aorta no nível do seu istmo imediatamente abaixo da artéria subclávia esquerda e adjacente ao local de implantação do canal arterial ou do ligamento arterioso. Menos frequentemente, tem localização entre a artéria subclávia esquerda, na aorta torácica baixa ou na aorta abdominal...

Coarctação da aorta / Aorta of the coarctation

Coarctação da aorta é um estreitamento congênitoda aorta no nível do seu istmo imediatamente abaixo da artéria subclávia esquerda e adjacente ao local de implantação do canal arterial ou do ligamento arterioso. Menos frequentemente, tem localização entre a artéria subclávia esquerda, na aorta torácica baixa ou na aorta abdominal...