RESUMO
A 10-yr-old child with impaired venous access (bilateral occlusion of internal jugular veins, subclavian veins, and inominate veins) underwent an isolated small bowel transplant. He presented with lethargy, shortness of breath 13 months into his follow-up and was diagnosed to have chylopericardium. MR venography and lymphangiography could not demonstrate the site of lymphatic leak. His chyloperciardium was treated with pericardiocentesis and MCT diet. The most likely cause for the chylopericardium was venous occlusion of the subclavian veins with backpressure resulting in a lymphatic leak. A brief review of literature along with treatment options is discussed.
Assuntos
Veias Braquiocefálicas/patologia , Intestino Delgado/transplante , Veias Jugulares/patologia , Derrame Pericárdico/complicações , Derrame Pericárdico/diagnóstico , Veia Subclávia/patologia , Criança , Dispneia , Doença de Hirschsprung/complicações , Doença de Hirschsprung/cirurgia , Humanos , Letargia , Linfonodos/patologia , Linfografia/métodos , Angiografia por Ressonância Magnética/métodos , Nutrição Parenteral , Resultado do Tratamento , Triglicerídeos/metabolismoRESUMO
BACKGROUND: Several devices such as coils and Amplatzer duct occluder (ADO) are used for catheter closure of patent arterial ducts (PDA). These carry a high success rate but residual shunts, suboptimal device orientation, and technical problems are encountered. The Amplatzer duct occluder II (ADO II) is designed to address these limitations. OBJECTIVES: To evaluate the technical features of the new ADO II device for PDA closure and document the immediate/early closure rate, complications and device behavior during implantation. METHODS: Prospective, two center study from February 2008 to January 2009. Twenty-seven patients (18 females) received the ADO II. The median age was 22 months (range: 7 months-68 years) and the median weight was 11.7 kg (range: 6.9-108). The median PDA diameter was 2.6 mm (range: 1-4.4). The approach was arterial in 13 and venous in 14 patients. Follow-up included echocardiography at 1 day and 1 month postimplantation. RESULTS: All implantations were technically successful with immediate complete angiographic closure in 21 and trivial contrast flow in six patients. The median procedure time was 43 min (range: 15-82) and the fluoroscopy time was 6 min (range: 2.2-26.5). Echocardiography confirmed no residual shunts on the following day. There were no complications. CONCLUSION: The new ADO II is a versatile and very effective device for closure of PDAs of various shapes, lengths, and up to diameters of 5.5 mm. The disc articulations, high early closure rate, arterial or venous approach options, and small diameter delivery catheter are all beneficial features.