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1.
Ann R Coll Surg Engl ; 103(3): e91-e93, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645276
2.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500306

RESUMO

An 83-year-old man experienced left upper limb uncontrolled movements preceded by intense gasping during night rest, which progressed to unconsciousness and respiratory arrest requiring intubation. He was diagnosed with acute stroke due to distal occlusion of the basilar artery and received indication for endovascular thrombectomy. Standard endovascular approach includes percutaneous puncture of the femoral or radial arteries; however, the presence of unfavourable vascular anatomies (stenotic origin and tortuosity) did not allow catheterisation of the intracranial vessels through conventional access, and based on the consistent time lapse from onset of symptoms and deterioration of the clinical condition, a direct right vertebral artery ultrasound-guided puncture was performed. After one attempt of a triaxial technique, a complete recanalisation of the basilar artery and of its distal branches was achieved. Direct percutaneous puncture of the vertebral artery represents a rescue access strategy for treatment of posterior circulation stroke when other routes are not feasible.


Assuntos
Procedimentos Endovasculares/métodos , Punções/métodos , Trombectomia/métodos , Artéria Vertebral/cirurgia , Insuficiência Vertebrobasilar/cirurgia , Idoso de 80 Anos ou mais , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Artéria Femoral , Humanos , Masculino , Cirurgia Assistida por Computador , Ultrassonografia , Dispositivos de Oclusão Vascular , Artéria Vertebral/diagnóstico por imagem , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologia
4.
Cardiovasc Pathol ; 50: 107288, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32931920

RESUMO

Host response to an implanted biomaterial is a complex process involving microscopic changes in extracellular matrix (ECM) composition. Reliable pathology analysis is imperative for accurate assessment of the tissue response to an implanted device. Plastic histology is commonly used for histology evaluation of medical devices to assess the device-tissue interface; however, this technique is prone to variable staining that can confound histology interpretation. Appropriately, we propose using transmission electron microscopy (TEM) to confirm histologic ECM findings in order to provide sufficient host-response data. Tissue response to an absorbable shape memory polymer intravascular occlusion device with a nitinol wire backbone was evaluated. Representative plastic-embedded, micro-ground sections from 30-day, 60-day, and 90-day timepoints were analyzed. ECM regions were selected, and ultrathin sections were created for TEM evaluation. Histological changes in ECM composition were compared for light microscopy (LM) and TEM findings; specifically, TEM fibrillary patterns for collagen and fibrin were used to confirm LM results. Throughout this study, LM reveals inconsistent staining in plastic-embedded sections. TEM, on the other hand, provides clear insight into the tissue response by morphologically discerning distinct fibrillary patterns within ECM structures; loose to dense collagen surrounds the implant as fibrin degrades, demonstrating progression of postimplant ECM maturation. Moreover, TEM serves as a definitive method for confirming tissue substrate morphology when LM findings prove ambiguous.


Assuntos
Matriz Extracelular/patologia , Reação a Corpo Estranho/patologia , Técnicas Hemostáticas/instrumentação , Microscopia Eletrônica de Transmissão , Dispositivos de Oclusão Vascular , Artefatos , Desenho de Equipamento , Matriz Extracelular/ultraestrutura , Colágenos Fibrilares/ultraestrutura , Humanos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento
7.
Vasc Endovascular Surg ; 54(7): 612-617, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32721190

RESUMO

PURPOSE: Vascular closure device (VCD) use following antegrade femoral access may present unique challenges relative to retrograde access. We retrospectively compared safety and efficacy of these devices between antegrade and retrograde patient cohorts undergoing percutaneous intervention. MATERIALS AND METHODS: Over a 5-year period, a consecutive series of 107 limbs in 84 patients underwent VCD arteriotomy closure following percutaneous revascularization using an antegrade approach (VCD-A). Device deployment success rates, time to ambulation, and complication rates were compared to a contemporaneous control group of 401 limbs in 305 patients who underwent closure following retrograde access (VCD-R) during revascularization or embolization procedures. RESULTS: Closure was attempted in VCD-A using 53 StarClose, 35 Perclose, and 19 Angio-Seal devices. Hemostasis (without supplemental manual compression) was achieved in 86/107 (80.4%) limbs. Closure was attempted in VCD-R using 215 StarClose, 119 Perclose, and 67 Angio-Seal devices with hemostasis in 357/401 (89.0%) limbs. Device deployment failure occurred in 7/107 (6.5%) of VCD-A and 20/401 (5.0%) of VCD-R (P = .52), independent of specific device type. Femoral pseudoaneurysm developed in 1/107 and 1/401 of VCD-A and VCD-R (P = .31), and minor hematoma developed in 3/107 and 8/401 of the VCD-A and VCD-R (P = .61). Mean time to ambulation was 204.1 minutes in VCD-A and 204.8 minutes in VCD-R (P = .97). CONCLUSION: Antegrade femoral closure was associated with high rates of technical success and low complications, similar to retrograde closure. Time to ambulation was the same in both groups despite higher heparin doses in the antegrade patients.


Assuntos
Cateterismo Periférico , Artéria Femoral , Hemorragia/prevenção & controle , Técnicas Hemostáticas/instrumentação , Dispositivos de Oclusão Vascular , Idoso , Idoso de 80 Anos ou mais , Cateterismo Periférico/efeitos adversos , Desenho de Equipamento , Feminino , Hemorragia/etiologia , Técnicas Hemostáticas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Caminhada
8.
J. negat. no posit. results ; 5(7): 702-720, jul. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-194131

RESUMO

OBJETIVO: Reflejar nuestra frustración al perder un paciente, no porque su infrecuente patología sea de por sí muy grave, sino por el acumulo sobreañadido de otros motivos diagnósticos, y terapéuticos en un entorno hospitalario de epidemia Covid-19. MÉTODO: Primero describimos el proceso diagnóstico, terapéutico y evolutivo (27 febrero al 25 marzo 2020) de un varón de 73 años portador de una fístula aorto-entérica secundaria a un bypass aorto-bifemoral, implantado doce años antes en otro hospital. Después presentamos nuestra experiencia (1978-2020) en este tipo de situaciones, y finalmente realizamos una revisión de la literatura (1953-2020) al respecto. RESULTADOS: A) Caso clínico: ausencia de diagnóstico precoz, fracaso de la técnica operatoria elegida, importantes complicaciones postoperatorias (hemorragia, infarto cerebral y neumonía bilateral por coronavirus) que finalizo en exitus. B) Experiencia personal: cuatro casos (incluido el referido). C) Revisión de la literatura: tres revisiones sistemáticas: 564 casos (1953-1993); 386 casos en 58 publicaciones (1991-2006), 823 pacientes en 216 publicaciones (1995-2015) y 20 casos en 14 publicaciones (2016-2020). CONCLUSIÓN: Si en situaciones normales una fístula aorto-entérica es una condición que amenaza seriamente la vida del paciente (hemorragia y/o infección), no debe extrañar que en situaciones excepcionales esa situación de gravedad se incremente. No obstante, de estas malas experiencias estamos obligados a sacar enseñanzas que beneficien a otros en el futuro


OBJECTIVE: To reflect our frustration when losing a patient, not because their infrequent pathology is in itself very serious, but because of the accumulation of other diagnostic and therapeutic reasons in a hospital environment of the Covid-19 epidemic. METHOD: First we describe the diagnostic, therapeutic and evolutionary process (February 27 to March 25, 2020) of a 73-year-old male with an aorto-enteric fistula secondary to an aorto-bifemoral bypass, implanted twelve years earlier in another hospital. Then we present our experience (1978-2020) in this type of situation, and finally we carried out a review of the literature (1953-2020) in this regard. RESULTS: A) Clinical case: absence of early diagnosis, failure of the chosen operative technique, significant postoperative complications (hemorrhage, cerebral infarction and bilateral coronavirus pneumonia) that ended in death. B) Personal experience: four cases (including the referred one). C) Literature review: three systematic reviews: 564 cases (1953-1993); 386 cases in 58 publications (1991-2006), 823 patients in 216 publications (1995-2015) and 20 cases in 14 publications (2016-2020). CONCLUSION: If in normal situations an aorto-enteric fistula is a condition that seriously threatens the patient's life (hemorrhage and / or infection), it should not be surprising that in exceptional situations this serious situation increases. However, from these bad experiences we are obliged to draw lessons that will benefit others in the future


Assuntos
Humanos , Masculino , Idoso , Fístula Intestinal/complicações , Fístula/complicações , Aorta/lesões , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Complicações Pós-Operatórias , Hemorragia Gastrointestinal/etiologia , Dispositivos de Oclusão Vascular
9.
Circ Cardiovasc Interv ; 13(6): e008702, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32527190

RESUMO

BACKGROUND: Procedural anticoagulation with bivalirudin (BIV), trans-radial intervention (TRI), and use of a vascular closure device (VCD) are thought to mitigate percutaneous coronary intervention (PCI)-related bleeding. We compared the impact of these bleeding avoidance strategies (BAS) for PCIs stratified by bleeding risk. METHODS: We performed a retrospective cohort analysis of PCIs from 18 facilities within one health care system from 2009Q3 to 2017Q4. Bleeding risk was assessed per the National Cardiovascular Data Registry CathPCI bleeding model, with procedures stratified into 6 categories (first, second, third quartiles, 75th-90th, 90th-97.5th, and top 2.5th percentiles). Regression models were used to assess the impact of BAS on bleeding outcome. RESULTS: Of 74 953 PCIs, 9.4% used no BAS, 12.0% used BIV alone, 20.8% used TRI alone, 26.8% used VCD alone, 5.4% used TRI+BIV, and 25.6% used VCD+BIV. The crude bleeding rate was 4.4% overall. Only 2 comparisons showed significant trends across all risk strata: VCD+BIV versus no BAS, odds ratio (95% CI) range: first quartile, 0.36 (0.18-0.72) to top 2.5th percentile, 0.50 (0.32-0.78); TRI versus no BAS, odds ratio (95% CI) range: first quartile, 0.15 (0.06-0.38) to top 2.5th percentile, 0.49 (0.28-0.86). TRI had lower odds of bleeding compared with BIV for all risk strata except the top 2.5th percentile. Addition of BIV to TRI did not change the odds of bleeding for any risk strata. Factors potentially limiting use of TRI (renal failure, shock, cardiac arrest, and mechanical circulatory support) were present in ≤10% of procedures below the 90th percentile. CONCLUSIONS: Among individual BAS, only TRI had consistently lower odds of bleeding across all risk strata. Factors potentially limiting TRI were found infrequently in procedures below the 90th percentile of bleeding risk. For transfemoral PCI, VCD+BIV had lower odds of bleeding compared with no BAS across all risk strata.


Assuntos
Antitrombinas/administração & dosagem , Cateterismo Periférico , Hemorragia/prevenção & controle , Técnicas Hemostáticas , Hirudinas/administração & dosagem , Fragmentos de Peptídeos/administração & dosagem , Intervenção Coronária Percutânea , Artéria Radial , Idoso , Antitrombinas/efeitos adversos , Cateterismo Periférico/efeitos adversos , Feminino , Técnicas Hemostáticas/efeitos adversos , Técnicas Hemostáticas/instrumentação , Hirudinas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Fragmentos de Peptídeos/efeitos adversos , Intervenção Coronária Percutânea/efeitos adversos , Punções , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Estados Unidos , Dispositivos de Oclusão Vascular
12.
Vascular ; 28(6): 756-759, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32437239

RESUMO

INTRODUCTION: Incidental arterial puncture is one of the main complications associated with central venous catheter placement. Manual compression to achieve hemostasis in subclavian and carotid artery punctures is often ineffective because of the anatomical arterial position. Accidental cannulation has traditionally been treated with open surgery or endovascular treatment, but such procedures are not exempt from complications. OBJECTIVES: Report our experience with ultrasound-guided off-label use of Perclose ProGlide (Abbott Vascular Inc., Santa Clara, CA, USA) in patients with iatrogenic arterial cannulation. METHODS: Six unstable patients with accidental arterial catheterization during placement of a central venous catheter: five of them in the subclavian artery and one in the right common carotid artery. Ultrasound-guided percutaneous closure was performed at bedside using a Perclose ProGlide (Abbott Vascular Inc., Santa Clara, CA, USA). RESULTS: All patients underwent duplex ultrasound 6, 12, 24, and 48 h postprocedure, and no complications associated with percutaneous closure (embolism, ischemia, stenosis, or arterial occlusion, bleeding, pseudoaneurysm, etc.) were described. CONCLUSIONS: Accidental artery puncture during central venous catheterization is an uncommon situation but can be effectively managed by using percutaneous vascular closure device. It is a reliable alternative that should be considered as a first-line approach before endovascular or open surgery, specially in patients with unstable conditions in which it is possible to be performed without transfer to an operation room.


Assuntos
Lesões das Artérias Carótidas/terapia , Cateterismo Venoso Central/efeitos adversos , Hemorragia/terapia , Técnicas Hemostáticas/instrumentação , Doença Iatrogênica , Artéria Subclávia/lesões , Dispositivos de Oclusão Vascular , Lesões do Sistema Vascular/terapia , Lesões das Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/etiologia , Artéria Carótida Primitiva/diagnóstico por imagem , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Técnicas Hemostáticas/efeitos adversos , Humanos , Estudos Retrospectivos , Artéria Subclávia/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia de Intervenção , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
13.
Cardiovasc Intervent Radiol ; 43(7): 1084-1090, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32419078

RESUMO

PURPOSE: To describe a percutaneous "purse-string-like" technique to downsize the femoral access sheath achieving early pelvis and limb reperfusion during complex endovascular aortic repair, while maintaining a sheath in place. MATERIALS AND METHODS: After ultrasound-guided femoral catheterization, two Perclose ProGlide vascular closure devices (VCD) are employed with the pre-close technique. When the deployment of aortic components is complete, the large delivery sheath is exchanged for a smaller non-occlusive one (≤ 10 F) and the rail suture of both VCDs is pulled to achieve hemostasis. At the end of the procedure, the access is closed according to standard technique. RESULTS: Fifty-eight femoral accesses were downsized achieving hemostasis with a completion percutaneous closure success of 95% (55/58). The median ischemic time to the limb was 66 min (IQR 31-131) for the main access and 65 min (IQR 30-100) for the contralateral one. When compared to a 1:2 propensity score-matched cohort who did not undergo access downsizing, no differences in closure success were recorded (95% vs. 89%, p = 0.19). However, hemostasis required more frequently an additional ProGlide in the downsizing group (26 cases, 45% vs. 17 cases, 15%; p < .001). CONCLUSION: Percutaneous purse-string-like sheath downsizing to restore perfusion to limbs and pelvis during complex endovascular aortic repair is feasible with high closure success rates, although a third ProGlide is more frequently needed to achieve hemostasis. The impact of this practice on SCI rates requires further evaluation in larger series as part of a multimodal approach for spinal cord protection.


Assuntos
Aneurisma Aórtico/cirurgia , Procedimentos Endovasculares/métodos , Artéria Femoral/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Dispositivos de Oclusão Vascular , Idoso , Aorta/diagnóstico por imagem , Aorta/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Estudos de Coortes , Estudos de Viabilidade , Feminino , Artéria Femoral/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
14.
J Vasc Access ; 21(6): 1017-1022, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32340544

RESUMO

Veno-arterial extracorporeal membrane oxygenation is a form of mechanical circulatory support for patients with refractory decompensated heart failure. Blood is drawn from a large vein and pumped back to a large artery, usually a femoral artery through large bore catheters. When the heart recovers, the extracorporeal membrane oxygenation support can be terminated and the catheters are decannulated. The bleeding at the venous side can be controlled by prolonged compression; however, the arteriotomy wound needs to be repaired. Conventionally, the arteriotomy wounds require open vascular repair in the operating theater. The novel application of percutaneous vascular closure devices, which have been commonly used in vascular operations and percutaneous structural heart interventions, could be applied for closure of arteriotomy wounds at the bedside after extracorporeal membrane oxygenation support. The post-close ProGlide (Abbott Vascular) technique was shown to be safe and could potentially save time and manpower. The wounds are much smaller as compared with the conventional open repair and potentially, the chance of wound infection can be reduced. However, the success of percutaneous bedside closure requires careful prior planning and technique training. Backup plans with vascular surgeons' standby are essential in case of failure of closure. Staffs in the extracorporeal membrane oxygenation centers need to be familiar with the preparation, the procedure as well as the device application technique for successful percutaneous closure. The long learning curve and the limited case load mean that such skills are best trained by simulation scenarios. This article described how this new technique and the team logistics can be trained by simulation.


Assuntos
Cateterismo/instrumentação , Cateteres de Demora , Instrução por Computador , Remoção de Dispositivo/educação , Educação de Pós-Graduação em Medicina , Oxigenação por Membrana Extracorpórea/instrumentação , Hemorragia/prevenção & controle , Técnicas Hemostáticas , Treinamento por Simulação , Competência Clínica , Remoção de Dispositivo/efeitos adversos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Hemorragia/etiologia , Técnicas Hemostáticas/instrumentação , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Dispositivos de Oclusão Vascular
16.
Cardiovasc Intervent Radiol ; 43(5): 781-786, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32166353

RESUMO

PURPOSE: After any procedure through the percutaneous gastrostomy (PG), a PG tube should be kept in place until a mature tract develops. For this period of maturation which takes about 2 to 4 weeks, tube dislodgement, leakage, or peritonitis can occur. Complications from PG tube maintenance can be prevented by closing the PG immediately after the procedure. The purpose of this study was to evaluate the feasibility and safety of immediate PG closure using Perclose ProGlide. MATERIALS AND METHODS: A 2-week survival study was performed in a swine model. We applied one Perclose ProGlide device for closing a 13-Fr PG (n = 3) and two devices for closing a 20-Fr PG (n = 3). Body weight, temperature and laboratory findings were observed. Autopsy and microscopic examination were performed after 2 weeks. RESULTS: All the swine subjects did not demonstrate any sign of systemic inflammatory responses in terms of fever and laboratory findings. From autopsy results, five pigs showed complete healing of the PG. One pig that underwent 20-Fr gastrostomy site closure with double Perclose ProGlide had scanty semitransparent fluid in the peritoneal cavity but that was not indicative of inflammation. En bloc tissue samples from all the pigs demonstrated complete wound healing of the PG sites. CONCLUSION: Percutaneous application of single or double Perclose ProGlide devices is feasible and safe for the PG closure in a swine model. LEVEL OF EVIDENCE: No level of evidence, Animal study.


Assuntos
Gastrostomia/instrumentação , Gastrostomia/métodos , Técnicas de Sutura/instrumentação , Dispositivos de Oclusão Vascular , Animais , Feminino , Modelos Animais , Suturas , Suínos , Fatores de Tempo , Resultado do Tratamento
17.
Ann Thorac Surg ; 110(4): e307-e309, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32145194

RESUMO

The case provided suggests that an ultrasound-navigated Manta device works well in closing percutaneously the peripheral arterial extracorporeal membrane oxygenation cannulation site. Ultrasonography use during extracorporeal membrane oxygenation decannulation can further diminish the possible device-related technical failures (toggle or collagen protrusion through the vessel wall, toggle stacking into calcifications, or delivery failure of the collagen pad) leading to bleeding and vascular complications. Further studies are needed on this topic.


Assuntos
Cânula , Remoção de Dispositivo/métodos , Oxigenação por Membrana Extracorpórea/instrumentação , Ultrassonografia de Intervenção , Dispositivos de Oclusão Vascular , Humanos , Masculino , Pessoa de Meia-Idade
18.
J Endovasc Ther ; 27(3): 414-420, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32193971

RESUMO

Purpose: To evaluate the safety and effectiveness of the MANTA percutaneous vascular closure device in patients undergoing percutaneous endovascular aneurysm repair (PEVAR) or thoracic endovascular aortic repair (TEVAR). Materials and Methods: The SAFE MANTA Study (ClinicalTrials.gov identifier NCT02908880) was a prospective, single-arm, multicenter trial in patients undergoing endovascular interventions using large-bore sheaths (transcatheter aortic valve replacement, PEVAR, or TEVAR) at 20 sites in North America. Patient selection intended to test the MANTA device in populations without morbid obesity, severe calcification, or a severely scarred femoral access area. Of the 263 patients enrolled in the primary analysis cohort, 53 (20.2%) patients (mean age 74.9±8.9 years; 41 men) underwent PEVAR (n=51) or TEVAR (n=2) procedures and form the cohort for this subgroup analysis. Per protocol a single MANTA device was deployed in all PEVAR/TEVAR cases. Results: The mean time to hemostasis in the PEVAR/TEVAR cohort was 35±91 seconds, with a median time of 19 seconds vs 24 seconds in the overall SAFE MANTA population. The MANTA device met the definition for technical success in 52 (98%) of 53 PEVAR/TEVAR cases compared with 97.7% in the overall SAFE MANTA population. One (1.9%) major complication (access-site stenosis) occurred in this subgroup compared to 14 (5.3%) events in the SAFE population. In the PEVAR/TEVAR group, 1 pseudoaneurysm was noted prior to discharge, another at 30-day follow-up, and one at 60 days. One (1.9%) of the 3 minor pseudoaneurysms was treated with ultrasound-guided compression and the other 2 required no treatment. Conclusion: The MANTA device demonstrated a short time to hemostasis and low complication rates compared with published literature results of other percutaneous closure devices. Time to hemostasis and complication rates were comparable between the PEVAR/TEVAR patients and the full SAFE MANTA study cohort. The MANTA device provides reliable closure with a single percutaneous device for PEVAR/TEVAR procedures.


Assuntos
Aorta Torácica/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular , Cateterismo Periférico , Procedimentos Endovasculares , Hemorragia/prevenção & controle , Hemostasia , Técnicas Hemostáticas/instrumentação , Dispositivos de Oclusão Vascular , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Cateterismo Periférico/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Hemorragia/sangue , Hemorragia/etiologia , Técnicas Hemostáticas/efeitos adversos , Humanos , Masculino , América do Norte , Estudos Prospectivos , Punções , Fatores de Tempo , Resultado do Tratamento
19.
Pediatr Cardiol ; 41(3): 546-552, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32198582

RESUMO

Interventional cardiology has made extraordinary advances over recent years, but most are still limited to addressing single intracardiac or valvular lesions. This debate considers whether complete interventional repair of more complex congenital defects might become achievable. Tetralogy of Fallot (ToF) is probably the first candidate where complete interventional repair might be achieved-given that various components of the defect have already been successfully addressed-albeit as either a palliative intervention (RVOT stenting) or to address the sequelae of standard surgery (percutaneous PVR). This article considers the challenges that would need to be overcome in terms of the morphology of the condition, the age limitations, and the necessary technological advancements that would be required-while setting these against the benchmark of current surgical outcomes and the parallel progress that is being developed in surgical correction. While complete interventional repair of ToF may still be beyond current techniques, a hybrid approach between surgeons and intentional cardiologists can strive to create a life-long paradigm of care that minimizes the need for surgery and focuses on the maintenance of a healthy right ventricle, such that patients born with ToF can achieve normal life expectancy.


Assuntos
Tetralogia de Fallot/cirurgia , Dispositivos de Oclusão Vascular/tendências , Cardiologia/tendências , Feminino , Ventrículos do Coração/cirurgia , Humanos , Masculino , Valva Pulmonar/cirurgia , Stents , Resultado do Tratamento
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