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2.
Artigo em Inglês | MEDLINE | ID: mdl-31233784

RESUMO

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.

4.
Rev. esp. cardiol. (Ed. impr.) ; 71(4): 283-290, abr. 2018. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-171756

RESUMO

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 Retrospectivos
5.
Rev Esp Cardiol (Engl Ed) ; 71(4): 283-290, 2018 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29042164

RESUMO

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 Tratamento
11.
Pediatr Cardiol ; 33(7): 1089-96, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22361739

RESUMO

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 Tratamento
14.
Rev Esp Cardiol ; 62(7): 765-73, 2009 Jul.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-19709512

RESUMO

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.


Assuntos
Embolização Terapêutica/instrumentação , Próteses e Implantes , Fístula Vascular/terapia , Adulto , Criança , Pré-Escolar , Embolização Terapêutica/métodos , Humanos , Lactente , Recém-Nascido , Estudos Retrospectivos , Adulto Jovem
15.
Rev. esp. cardiol. (Ed. impr.) ; 62(7): 765-773, jul. 2009. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-123779

RESUMO

Introducción y objetivos. Hay gran variedad de fístulas vasculares que son remitidas a los laboratorios de cateterismo cardiaco para su diagnóstico y oclusión percutánea. Existe también una amplia gama de dispositivos utilizables en su tratamiento percutáneo. El objetivo es evaluar la utilidad, las dificultades, las complicaciones y los resultados en el tratamiento percutáneo de las fístulas vasculares mediante el uso de coils de liberación controlada o tapones vasculares de Amplatzer. Métodos. Revisión retrospectiva de las embolizaciones percutáneas realizadas desde enero de 2004 a junio de 2008. Resultados. Se embolizaron 51 fístulas vasculares en 30 pacientes con edades entre 6 días y 28 años (media, 8,4 años), con buen resultado. Diagnósticos: 27 colaterales venosas en 16 pacientes con Glenn; 4 fístulas quirúrgicas (Blalock-Taussig); 11 fístulas arteriovenosas pulmonares en 3 pacientes; 2 arterias colaterales aortopulmonares en 2 pacientes; 1 colateral venosa en 1 paciente con Fontan previo; 1 arteria aortopulmonar en un síndrome de cimitarra; 1 fístula arteriovenosa coronaria; 3 fístulas arteriovenosas sistémicas en 1 recién nacido, y una fístula entre aurícula izquierda y vena cava superior tras la cirugía de un retorno venoso pulmonar anómalo. En el tratamiento percutáneo de estas lesiones se emplearon 34 tapones vasculares y 19 coils. Conclusiones. Las fístulas vasculares pueden ser ocluidas percutáneamente con buen resultado. Los coils permiten el cierre de fístulas de menor diámetro y los tapones vasculares están indicados en las más amplias. Ambos dispositivos alcanzan una alta eficacia oclusora y no se han observado especiales dificultades ni complicaciones significativas (AU)


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 controlledrelease 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 forlarge lesions. Both devices are highly effective as occluders and no particular difficulty or significant complication was observed (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Embolização Terapêutica/métodos , Fístula Vascular/cirurgia , Dispositivo para Oclusão Septal , Cardiopatias Congênitas/cirurgia , Cateterismo Cardíaco/métodos
17.
Rev Esp Cardiol ; 61(3): 236-43, 2008 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-18361896

RESUMO

INTRODUCTION AND OBJECTIVES: Since the creation of the Adult Congenital Heart Disease Units and of the High Obstetric Risk Units, there has been increasing interest in hemodynamic and obstetric outcomes in pregnant woman with congenital heart disease. METHODS: Retrospective descriptive study of 56 women with congenital heart disease aged (mean [range]) 25 (18-40) years, who experienced a total of 84 pregnancies between January 1992 and August 2006. The women were divided into three pregnancy risk groups: A, low-risk; B, moderate-risk, and C, high-risk. RESULTS: The incidence of complications during pregnancy was 1.6%, 15%, and 20% in groups A, B, and C, respectively; the incidence during the puerperium was 2%, 23%, and 50%, respectively; and maternal mortality was 0%, 7.6%, and 25%, respectively. Overall, 69 children were born, and the prematurity rates in the three groups were 11%, 15%, and 100%, respectively. The following risk factors were studied: pulmonary hypertension, cyanosis, arrhythmia, left ventricular outflow tract obstruction, right ventricular dilatation, systemic right ventricle, and anticoagulation therapy. The risk factor most significantly associated with maternal or fetal morbidity or mortality was found to be pulmonary hypertension. CONCLUSIONS: Risk stratification in pregnant women with congenital heart disease provides prognostic information that can help multidisciplinary teams to target care to achieve the best results.


Assuntos
Cardiopatias/congênito , Cardiopatias/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Adolescente , Adulto , Feminino , Cardiopatias/complicações , Humanos , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Resultado da Gravidez , Transtornos Puerperais/epidemiologia , Estudos Retrospectivos , Fatores de Risco
18.
Rev. esp. cardiol. (Ed. impr.) ; 61(3): 236-243, mar. 2008. tab
Artigo em Espanhol | IBECS | ID: ibc-64888

RESUMO

Introducción y objetivos. Desde la creación de las Unidades de Cardiopatías Congénitas (CC) del Adulto y las Unidades Obstétricas de Alto Riesgo Cardiológico, ha habido creciente interés por la evolución hemodinámica y obstétrica de embarazadas con CC. Métodos. Estudio descriptivo retrospectivo de 56 mujeres con CC y media de edad de 25 (18-40) años, que iniciaron 84 gestaciones entre enero de 1992 y agosto de 2006. Se las distribuyó en 3 grupos de riesgo gestacional: A, bajo; B, moderado y C, alto. Resultados. Las incidencias de complicaciones durante la gestación fueron del 1,6, el 15 y el 20%, y durante el puerperio, el 2, el 23 y el 50%; la mortalidad materna fue 0, del 7,6 y del 25% de los grupos A, B y C respectivamente. Nacieron 69 niños y las tasas de prematuridad fueron del 11, el 15 y el 100% respectivamente. Los factores de riesgo principales fueron: la hipertensión pulmonar (HTP), la cianosis, la arritmia, la obstrucción del tracto de salida del ventrículo izquierdo, el ventrículo derecho (VD) dilatado, el VD sistémico necesidad de y la anticoagulación. La HTP fue el factor más importante asociado a morbimortalidad maternofetal. Conclusiones. La estratificación por riesgo en las gestantes con CC ofrece información pronóstica que permite adecuar la atención de equipos multidisciplinarios para conseguir resultados exitosos


Introduction and objectives. Since the creation of the Adult Congenital Heart Disease Units and of the High Obstetric Risk Units, there has been increasing interest in hemodynamic and obstetric outcomes in pregnant woman with congenital heart disease. Methods. Retrospective descriptive study of 56 women with congenital heart disease aged (mean [range]) 25 (18­40) years, who experienced a total of 84 pregnancies between January 1992 and August 2006. The women were divided into three pregnancy risk groups: A, low-risk; B, moderate-risk, and C, high-risk. Results. The incidence of complications during pregnancy was 1.6%, 15%, and 20% in groups A, B, and C, respectively; the incidence during the puerperium was 2%, 23%, and 50%, respectively; and maternal mortality was 0%, 7.6%, and 25%, respectively. Overall, 69 children were born, and the prematurity rates in the three groups were 11%, 15%, and 100%, respectively. The following risk factors were studied: pulmonary hypertension, cyanosis, arrhythmia, left ventricular outflow tract obstruction, right ventricular dilatation, systemic right ventricle, and anticoagulation therapy. The risk factor most significantly associated with maternal or fetal morbidity or mortality was found to be pulmonary hypertension. Conclusions. Risk stratification in pregnant women with congenital heart disease provides prognostic information that can help multidisciplinary teams to target care to achieve the best results


Assuntos
Humanos , Feminino , Gravidez , Cardiopatias Congênitas/complicações , Complicações Cardiovasculares na Gravidez/terapia , Fatores de Risco , Risco Ajustado/métodos , Estudos Retrospectivos , Resultado da Gravidez , Arritmias Cardíacas/complicações , Insuficiência Cardíaca/complicações
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