RESUMO
OBJECTIVES: This study aimed to develop a method for retrieval of the new meshed nitinol atrial septal defect occluders - Ceraflex and Occlutech. BACKGROUND: The newly developed atrial septal defect occluders have potential benefits considering implantation, but concerns regarding their removal in case of embolisation have been raised. METHODS: Over 21 years, 1449 patients underwent interventional atrial septal defect occlusion in our institution. We reviewed the cases of embolisation of the device, developed a strategy for device removal, and tested it on the benchside and in animal tests. RESULTS: In 11 patients (0.8%), the intended atrial septal defect occlusion was complicated by an embolisation of the device. In contrast to the Amplatzer septal occluders, retrieval of Occlutech devices larger than 16 mm with snare techniques was impossible. In benchside tests, this was confirmed and a new method for removal of large meshed devices was developed. This involved the commercially available Maslanka® biopsy forceps. The feasibility of this technique in vivo was tested in a pig model. During animal tests, using the Maslanka biopsy forceps it was possible to interventionally retrieve embolised Ceraflex and Occlutech devices of different sizes - 10, 16, 30, and 40 mm - into a 12-F sheath. CONCLUSION: It was impossible to retrieve Occlutech and Ceraflex devices larger than 16 mm into a large sheath in vivo and during benchside tests. However, this was feasible on the bench and in vivo using the Maslanka biopsy forceps even with the largest available devices.
Assuntos
Cateterismo Cardíaco/instrumentação , Remoção de Dispositivo/métodos , Embolia/terapia , Comunicação Interatrial/terapia , Falha de Prótese , Dispositivo para Oclusão Septal , Adolescente , Adulto , Idoso , Angiografia , Animais , Cateterismo Cardíaco/efeitos adversos , Criança , Embolia/etiologia , Feminino , Comunicação Interatrial/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Animais , Estudo de Prova de Conceito , Desenho de Prótese , Suínos , Resultado do Tratamento , Adulto JovemRESUMO
This report describes a premature newborn with pulmonary atresia and an intact ventricular septum who presented with a significant fistula between the right ventricle and the left anterior descending coronary artery (LAD). The right ventricle was not decompressed to prevent myocardial damage. After 2 months, the fistula had closed spontaneously. The pulmonary valve was opened, and biventricular circulation was achieved.
Assuntos
Anomalias dos Vasos Coronários , Fístula , Comunicação Interventricular , Recém-Nascido Prematuro , Atresia Pulmonar , Remissão Espontânea , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Fístula/diagnóstico por imagem , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/terapia , Humanos , Recém-Nascido , MasculinoRESUMO
BACKGROUND: Aortic valvuloplasty (AoVP) is an established procedure regarded as a valid alternative for surgical management of congenital aortic valve stenosis. However, its long-term efficacy in preventing or postponing aortic valve surgery remains uncertain for the individual patient. Therefore, the aim of this study was to study the long-term results of AoVP in pediatric patients and its efficacy in preventing or postponing aortic valve surgery. METHODS AND RESULTS: We reviewed up to 17.5 years of follow-up data of all 188 patients who received AoVP at the Deutsches Herzzentrum München. The patients were divided into those < 1 month of age (group < 1 month; n=68) and those > or = 1 month of age (group > or = 1 month; n=120) at the time of AoVP. After the first and second AoVP, moderate and severe aortic regurgitation developed in 29% and 14%, respectively, of the patients in group < 1 month and in 19% and 29%, respectively, of the patients in group > or = 1 month. Survival after 10 years free from aortic valve surgery was 59% (95% confidence interval, 45 to 73) in group < 1 month and 70% (95% confidence interval, 59 to 81) in group > or = 1 month. CONCLUSIONS: This study shows that the long-term results of AoVP of congenital aortic valve stenosis in pediatric patients and its efficacy in preventing or postponing aortic valve surgery are very good. About two thirds of the patients are free from aortic valve surgery 10 years after AoVP.
Assuntos
Estenose da Valva Aórtica/terapia , Valva Aórtica , Cateterismo/tendências , Implante de Prótese de Valva Cardíaca/tendências , Adolescente , Adulto , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/cirurgia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Taxa de Sobrevida/tendências , TempoRESUMO
We report on successful occlusion of a large unrestrictive PDA in an adult patient with pulmonary hypertension.
Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/instrumentação , Permeabilidade do Canal Arterial/cirurgia , Implantação de Prótese/métodos , Adulto , Feminino , Comunicação Interventricular/cirurgia , Humanos , Desenho de Prótese , Resultado do TratamentoRESUMO
We report on successful treatment of persistent late postoperative chylothorax with coil occlusion of significant aortopulmonary collaterals in a young infant with functionally univentricular heart after bidirectional cavopulmonary connection.
Assuntos
Quilotórax/terapia , Embolização Terapêutica , Neovascularização Patológica/terapia , Complicações Pós-Operatórias/terapia , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Indução de Remissão , Fatores de TempoRESUMO
Early shunt stenosis may occur after a Norwood-Sano operation. We report our experience with three patients who were treated successfully by stent implantation into the Sano shunt. Hence, a surgical shunt revision could be avoided.
Assuntos
Implante de Prótese Vascular/efeitos adversos , Oclusão de Enxerto Vascular/terapia , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Stents , Constrição Patológica , Oclusão de Enxerto Vascular/etiologia , Ventrículos do Coração/cirurgia , Humanos , Recém-Nascido , Masculino , Artéria Pulmonar/cirurgiaRESUMO
AIMS: The current study was designed to assess midterm results of stent implantation into the aorta for native and recurrent coarctation (CoA) in children and young adults. METHODS AND RESULTS: Forty-three patients (native CoA, 8; female, 12) were treated with stent implantation at a median age of 16.8 years (range 7.9-44.8 years). Only stents dilatable to an adult size aorta were implanted. All but two patients with functionally univentricular hearts had arterial hypertension. Exercise tests, 24-h blood pressure, clinical examination, echocardiography, and elective catheterization were used to assess follow-up. The narrowed segment was widened significantly from a median of 8 to 12.4 mm (P < 0.0005). The peak-to-peak gradient between the ascending and the descending aorta was lowered significantly from a median of 22 mmHg to 1 mmHg (P < 0.0005). No major complications occurred. The systolic blood pressure at the right arm was lowered significantly (P < 0.0005) from 144 mmHg before stent implantation to 128 mmHg at the last visit. At a median follow-up of 30 months (3-72 months), 68% of all patients were classified to be normotensive. CONCLUSION: Stent implantation for selected patients with recurrent and native CoA is safe and may effectively reduce the blood pressure gradient across the CoA site. We suggest using only stents dilatable to an adult size aorta. However, arterial hypertension persists in a significant number of the patients. Impaired elastic properties of the aorta may be the cause for this finding.