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2.
Artigo em Inglês | MEDLINE | ID: mdl-31943749

RESUMO

OBJECTIVE: Assess clinical performance of a new device for transcatheter closure of atrial septal defect (ASD). BACKGROUND: Previously-approved ASD Closure devices have known limitations. Device erosion has been associated with the AMPLATZER® septal occluder in patients with retro-aortic rim deficiency (<5 mm), while defects ≥18 mm are too large for the GORE® CARDIOFORM septal occluder. The GORE® CARDIOFORM ASD occluder (GCA), a hybrid of the approved devices, was designed to expand the eligible ASD population. METHODS: One-hundred and twenty-five ASD patients were enrolled in a prospective, multicenter registry. Descriptive clinical endpoints included: technical implant success, closure success, serious adverse events (SAE), clinically significant new arrhythmia, and wire frame fracture. Procedural outcomes and adverse events were adjudicated by an Echocardiography Core Lab and Independent Data Review Board, respectively. RESULTS: Median subject age was 12.3 years (range 2.9-84.7), with 72% of patients ≤18 years old. Median ASD stop-flow diameter was 17.0 mm (8.0-30.0), with 43% ≥18 mm. Deficient retro-aortic rim occurred in 57% of subjects, and 30% had both diameter ≥ 18 mm and deficient rim. Technical Implant Success was achieved in 120/125 (96%), though three devices were removed within 24 hr. At the scheduled 6-month evaluation, 112/117 returned for evaluation. All 112 had closure success. SAE occurred in 6/125 (4.8%) and 6/125 (4.8%) had clinically significant new arrhythmia. Wire frame fractures occurred in 37/104 (36%), without any associated clinical sequelae, residual shunt, or device instability. CONCLUSION: The GCA performed effectively and safely in this initial cohort, and led to FDA approval based on this data.

3.
Am J Cardiol ; 122(8): 1429-1436, 2018 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-30115424

RESUMO

Patients with the Marfan syndrome (MFS) are at risk for sudden death. The contribution of arrhythmias is unclear. This study examines the prevalence of arrhythmias in children with the MFS and their relation to clinical and/or echocardiographic factors. Data from the Pediatric Heart Network randomized trial of atenolol versus losartan in MFS were analyzed (6 months to 25 years old, aortic root diameter z-score > 3.0, no previous aortic surgery and/or dissection). Baseline 24-hour ambulatory electrocardiographic monitoring was performed. Significant ventricular ectopy (VE) and supraventricular ectopy (SVE) were defined as ≥10 VE or SVE/hour, or the presence of high-grade ectopy. Three-year composite clinical outcome of death, aortic dissection, or aortic root replacement was analyzed. There were 274 analyzable monitors on unique patients from 11 centers. Twenty subjects (7%) had significant VE, 13 (5%) significant SVE; of these, 2 (1%) had both. None had sustained ventricular or supraventricular tachycardia. VE was independently associated with increasing number of major Ghent criteria (odds ratio [OR] = 2.13/each additional criterion, p = 0.03) and greater left ventricular end-diastolic dimension z-score (OR = 1.47/each 1 unit increase in z-score, p = 0.01). SVE was independently associated with greater aortic sinotubular junction diameter z-score (OR = 1.56/each 1 unit increase in z-score, p = 0.03). The composite clinical outcome (14 events) was not related to VE or SVE (p ≥ 0.3), but was independently related to heart rate variability (higher triangular index). In conclusion, in this cohort, VE and SVE were rare. VE was related to larger BSA-adjusted left ventricular size. Routine ambulatory electrocardiographic monitoring may be useful for risk stratification in select MFS patients.


Assuntos
Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Síndrome de Marfan/complicações , Síndrome de Marfan/fisiopatologia , Adolescente , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/tratamento farmacológico , Atenolol/uso terapêutico , Criança , Pré-Escolar , Ecocardiografia , Eletrocardiografia Ambulatorial , Feminino , Humanos , Lactente , Losartan/uso terapêutico , Masculino , Estudos Retrospectivos
5.
Pacing Clin Electrophysiol ; 40(7): 798-802, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28568013

RESUMO

BACKGROUND: Ablation within the aortic cusp is safe and effective in adults. There are little data on aortic cusp ablation in the pediatric literature. We investigated the safety and efficacy of aortic cusp ablation in young patients. METHODS: A retrospective, descriptive study of aortic cusp ablation in five pediatric electrophysiology centers from 2008 to 2014 was performed. All patients <21 years of age who underwent ablation in the aortic cusps were included. Factors analyzed included patient demographics, procedural details, outcomes, and complications. RESULTS: Thirteen patients met inclusion criteria (median age 16 years [range 10-20.5] and median body surface area 1.58 m2 [range 1.12-2.33]). Substrates for ablation included: nine premature ventricular contractions or sustained ventricular tachycardia (69%), two concealed anteroseptal accessory pathways (APs) (15%), one Wolff-Parkinson-White with an anteroseptal AP (8%), and one ectopic atrial tachycardia (8%). Three-dimensional electroanatomic mapping in combination with fluoroscopy was used in 12/13 (92%) patients. Standard 4-mm-tip radiofrequency (RF) current was used in 11/13 (85%) and low-power irrigated-tip RF in 2/13 (15%). Angiography was used in 13/13 and intracardiac echocardiography was additionally utilized in 3/13 (23%). Ablation locations included: eight noncoronary (62%), three left (23%), and two right (15%) cusps. Ablation was acutely successful in all patients. At median follow-up of 20 months, there was one recurrence of PVCs (8%). There were no ablation-related complications and no valvular injuries observed. CONCLUSION: Arrhythmias originating from the coronary cusps in this series were successfully and safely ablated in young people without injury to the coronary arteries or the aortic valve.


Assuntos
Valva Aórtica/cirurgia , Arritmias Cardíacas/cirurgia , Ablação por Cateter/métodos , Adolescente , Arritmias Cardíacas/fisiopatologia , Mapeamento Potencial de Superfície Corporal , Criança , Técnicas Eletrofisiológicas Cardíacas , Feminino , Fluoroscopia , Humanos , Masculino , Ondas de Rádio , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
6.
Anesth Analg ; 123(5): 1201-1209, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27749349

RESUMO

Current practice of sedation and anesthesia for patients undergoing pediatric and congenital cardiac catheterization laboratory (PCCCL) procedures is known to vary among institutions, a multi-society expert panel with representatives from the Congenital Heart Disease Council of the Society for Cardiovascular Angiography and Interventions, the Society for Pediatric Anesthesia and the Congenital Cardiac Anesthesia Society was convened to evaluate the types of sedation and personnel necessary for procedures performed in the PCCCL. The goal of this panel was to provide practitioners and institutions performing these procedures with guidance consistent with national standards and to provide clinicians and institutions with consensus-based recommendations and the supporting references to encourage their application in quality improvement programs. Recommendations can neither encompass all clinical circumstances nor replace the judgment of individual clinicians in the management of each patient. The science of medicine is rooted in evidence, and the art of medicine is based on the application of this evidence to the individual patient. This expert consensus statement has adhered to these principles for optimal management of patients requiring sedation and anesthesia. What follows are recommendations for patient monitoring in the PCCCL regardless of whether minimal or no sedation is being used or general anesthesia is being provided by an anesthesiologist.


Assuntos
Anestesia Geral/normas , Cateterismo Cardíaco/normas , Sedação Consciente/normas , Cardiopatias Congênitas/terapia , Guias de Prática Clínica como Assunto/normas , Sociedades Médicas/normas , Anestesia Geral/métodos , Anestesiologia/métodos , Anestesiologia/normas , Criança , Sedação Consciente/métodos , Consenso , Cardiopatias Congênitas/diagnóstico , Humanos
8.
Catheter Cardiovasc Interv ; 86(7): 1195-203, 2015 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-26332722

RESUMO

OBJECTIVES: Assess impact of malattached septum primum (MASP) on transcatheter closure of interatrial communications. BACKGROUND: Large defect size and deficient rims have been described as predictors for complications and unsuccessful device placement in closure of interatrial communications. MASP is an underappreciated morphologic atrial septal variation whose prevalence in isolated atrial communications and its influence on percutaneous device closure has not been systematically assessed. METHODS: We retrospectively evaluated echocardiographic data of 328 patients scheduled for percutaneous secundum atrial septal defect (ASD) and patent foramen ovale (PFO) closure between January 2006 and January 2013. In ASD patients, defect size was measured by balloon stretch diameter while the length of the surrounding rims was measured in standard transthoracic and transesophageal views. Furthermore, the distance between septum primum and septum secundum as it attaches to the left atrial roof was evaluated in both, ASD and PFO patients. Septal anatomy of patients with procedural failure was compared to the anatomy of patients in whom the procedure was successful. RESULTS: Transcatheter defect closure was successful in 131 (92.3%) of 142 ASD patients (32.3 years ± 24.7 years) and in all 186 PFO patients (49.6 years ± 16.2 years). Thirteen (4%) patients were found to have MASP (1.6 mm-13 mm). Smaller retroaortic rim, inferior rim, and the presence of a MASP were independently associated with procedural failure in ASD patients (P = 0.02, P = 0.03, and P = 0.003, respectively). CONCLUSION: Smaller retroaortic and inferior rims, as well as MASP are independent risk factors for unsuccessful transcatheter ASD closure.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Forame Oval Patente/terapia , Comunicação Interatrial/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Feminino , Forame Oval Patente/diagnóstico por imagem , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interventricular , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Adulto Jovem
9.
Vasc Med ; 17(4): 235-8, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22848086

RESUMO

Isolated peripheral pulmonary artery stenosis presenting in adulthood is an uncommon cause of right ventricular hypertension and may be misdiagnosed as primary or thromboembolic pulmonary hypertension. Treatment consists of balloon angioplasty and stenting of the affected vessels, although the procedure can be complicated by reperfusion pulmonary edema.


Assuntos
Angioplastia com Balão , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/terapia , Artéria Pulmonar , Estenose da Valva Pulmonar/terapia , Adulto , Feminino , Humanos , Hipertensão Pulmonar/complicações , Artéria Pulmonar/diagnóstico por imagem , Edema Pulmonar/complicações , Estenose da Valva Pulmonar/complicações , Estenose da Valva Pulmonar/etiologia , Radiografia , Resultado do Tratamento , Pressão Ventricular
11.
Pediatr Cardiol ; 32(8): 1128-31, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21512787

RESUMO

The hemodynamics of isolated large ventricular septal defect with an intact atrial septum results in greater mitral valve (MV) annular dilation and an increased incidence of mitral regurgitation (MR). MR will resolve in most patients after surgical VSD closure alone without MV repair.


Assuntos
Septos Cardíacos/patologia , Insuficiência da Valva Mitral/epidemiologia , Valva Mitral/patologia , Dilatação Patológica , Feminino , Átrios do Coração , Comunicação Interventricular/epidemiologia , Hemodinâmica , Humanos , Lactente , Recém-Nascido , Masculino
13.
Circ Arrhythm Electrophysiol ; 4(2): 235-41, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21270102

RESUMO

BACKGROUND: Catheter ablation of left-sided atrial arrhythmias generally is performed using a transfemoral venous approach through the inferior vena cava (IVC). In this report, we assessed the feasibility of a percutaneous transhepatic approach to ablation of left-sided atrial arrhythmias in 2 patients with interruption of the IVC. METHODS AND RESULTS: Patient 1 had atrial flutter in the setting of complex congenital heart disease and prior Fontan for univentricular physiology and a single atrium. Patient 2 had atrial fibrillation. Percutaneous hepatic vein access was obtained with ultrasound and fluoroscopic guidance. Transseptal catheterization was performed in patient 2. After the procedure, the hepatic tract in patient 1 was cauterized using a bipolar radiofrequency catheter, and an Amplatzer vascular plug was used in patient 2 to obtain hemostasis. Percutaneous hepatic vein access was achieved without complications. After electroanatomical mapping, a linear lesion was placed between the single atrioventricular valve and the confluence of the hepatic veins in patient 1; this terminated the flutter, and bidirectional block was achieved. In patient 2, the pulmonary veins were electrically isolated using an extraostial approach, isolating the ipsilateral veins in pairs. Additionally, ablation of right-side atrial flutter was achieved by obtaining bidirectional block across a linear lesion between the tricuspid valve and confluence of the hepatic veins. Hemostasis of the transhepatic tract was attained in both patients. CONCLUSIONS: In patients with interrupted IVCs, a percutaneous transhepatic approach is a feasible alternative for performing catheter ablation of complex left-sided arrhythmias.


Assuntos
Fibrilação Atrial/cirurgia , Flutter Atrial/cirurgia , Ablação por Cateter/métodos , Cardiopatias Congênitas/complicações , Veias Hepáticas , Malformações Vasculares/complicações , Veia Cava Inferior/anormalidades , Adulto , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Flutter Atrial/complicações , Flutter Atrial/diagnóstico , Técnicas Eletrofisiológicas Cardíacas , Feminino , Técnicas Hemostáticas/instrumentação , Veias Hepáticas/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Punções , Radiografia Intervencionista , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia , Veia Cava Inferior/diagnóstico por imagem
14.
Semin Thorac Cardiovasc Surg ; 22(3): 259-61, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21167463

RESUMO

We report a case of a 68-year-old woman with a basal postmyocardial infarction ventricular septal defect that recurred 4 months after initial surgical repair. Successful transcatheter closure using an Amplatzer Muscular VSD Occluder was facilitated by direct percutaneous left ventricular access.


Assuntos
Cateterismo Cardíaco/métodos , Comunicação Interventricular/cirurgia , Infarto do Miocárdio/cirurgia , Dispositivo para Oclusão Septal , Idoso , Cateterismo Cardíaco/instrumentação , Angiografia Coronária , Feminino , Comunicação Interventricular/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Hemostasia , Humanos , Infarto do Miocárdio/diagnóstico por imagem , Recidiva , Fatores de Tempo , Ultrassonografia
15.
Semin Cardiothorac Vasc Anesth ; 14(1): 68-72, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20472633

RESUMO

Hemodynamically significant perivalvular regurgitation affects about 1.5% of all prosthetic valve implants. Reoperation carries increased risk--especially in the setting of concomitant comorbidities of left ventricular dysfunction, prior coronary artery bypass grafts, renal dysfunction, and advanced age. Transcatheter closure of the perivalvular regurgitant channel using a variety of occluders has been available for several years; however, recent improvements in technology and technique have made this therapy more effective and available to a wider group of patients. This article describes the recent advances and the state of the art of this therapy.


Assuntos
Cateterismo Cardíaco/métodos , Próteses Valvulares Cardíacas/efeitos adversos , Falha de Prótese , Ecocardiografia Transesofagiana/métodos , Humanos , Reoperação , Fatores de Risco , Resultado do Tratamento
17.
Pediatr Nephrol ; 24(12): 2459-62, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19653009

RESUMO

A 3-year-old girl with Alport syndrome presented with decompensated heart failure from hypertension-induced cardiomyopathy 6 months following renal biopsy. Selective renal angiography revealed a large left renal arteriovenous fistula (AVF) with poor perfusion to the left renal parenchyma. The AVF was treated by transcatheter embolization using an Amplatzer vascular plug. Her blood pressure normalized after embolization, and her cardiac function normalized over the following 4 months.


Assuntos
Fístula Arteriovenosa/terapia , Malformações Arteriovenosas/terapia , Embolização Terapêutica/instrumentação , Hipertensão/patologia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/patologia , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/patologia , Biópsia/instrumentação , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/patologia , Cardiomiopatia Dilatada/terapia , Cardiotônicos/uso terapêutico , Pré-Escolar , Ecocardiografia , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Rim/cirurgia , Nefropatias/diagnóstico por imagem , Nefropatias/patologia , Nefropatias/terapia , Milrinona/uso terapêutico , Radiografia , Resultado do Tratamento
18.
Nat Clin Pract Cardiovasc Med ; 5(8): 454-67, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18594551

RESUMO

Atrial-level repair for transposition of the great arteries is one of the greatest achievements of modern cardiovascular medicine, transforming a once fatal congenital heart condition into one with excellent long-term survival. Although atrial-level repair has been supplanted by the arterial switch, there remains a population of patients who underwent atrial-level repair as children and now require ongoing care as adults. Survival slowly continues to decline in this population mainly owing to systemic right ventricular dysfunction and sudden death. Other problems include sinus node dysfunction, atrial arrhythmias, systemic atrioventricular valve regurgitation, baffle problems, and pulmonary hypertension. Evaluation and management of these late complications is addressed.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/métodos , Átrios do Coração/cirurgia , Transposição dos Grandes Vasos/cirurgia , Adulto , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Humanos , Complicações Pós-Operatórias/etiologia , Transposição dos Grandes Vasos/epidemiologia , Transposição dos Grandes Vasos/fisiopatologia , Disfunção Ventricular Direita
19.
Catheter Cardiovasc Interv ; 71(7): 940-3, 2008 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-18412268

RESUMO

Pulmonary arteriovenous malformations (PAVMs) are a relatively uncommon but potentially life-threatening condition manifested by cyanosis, paradoxical embolization, brain abscess, and rupture. A variety of transcatheter closure devices have been used to occlude PAVMs however risks of device embolization, incomplete closure, or large delivery systems have made each of these methods sub-optimal. The Amplatzer Vascular Plug II (AVP II) is a new multisegmented, woven nitinol cylinder that can be deployed through a small delivery catheter. The AVP II differs from the original AVP in having a finer, more tightly woven nitinol frame and three, rather than one occlusive segment. The authors report the first use of the AVP II for occlusion of bilateral large arteriovenous malformations in a patient with hereditary hemorrhagic telangiectasia.


Assuntos
Malformações Arteriovenosas/terapia , Cateterismo de Swan-Ganz/instrumentação , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Telangiectasia Hemorrágica Hereditária/terapia , Adolescente , Ligas , Malformações Arteriovenosas/diagnóstico por imagem , Cateterismo Cardíaco , Desenho de Equipamento , Humanos , Masculino , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Telangiectasia Hemorrágica Hereditária/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
Nat Clin Pract Cardiovasc Med ; 4(8): 455-9, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17653118

RESUMO

BACKGROUND: A 51-year-old woman with a 5-year history of metastatic small bowel carcinoid disease developed fatigue and gradually worsening dyspnea on exertion, over 6 months. INVESTIGATIONS: Physical examination, transthoracic and transesophageal echocardiography, and aortography. DIAGNOSIS: Left-sided carcinoid disease associated with a patent foramen ovale. MANAGEMENT: Percutaneous transcatheter closure of the patent foramen ovale.


Assuntos
Doença Cardíaca Carcinoide/cirurgia , Neoplasias Cardíacas/cirurgia , Comunicação Interatrial/cirurgia , Aortografia , Doença Cardíaca Carcinoide/diagnóstico , Doença Cardíaca Carcinoide/patologia , Diagnóstico Diferencial , Ecocardiografia , Evolução Fatal , Feminino , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/secundário , Comunicação Interatrial/diagnóstico , Humanos , Neoplasias Intestinais/patologia , Intestino Delgado , Neoplasias Hepáticas/secundário , Pessoa de Meia-Idade
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