Juliana Neves

New transcatheter techniques for creation or enlargement of atrial septal defects in infants with complex congenital heart disease

To describe a series of 8 consecutive infants (5 with transposition of the great arteries [TGA] and 3 with hypoplastic left heart syndrome [HLHS]) who underwent nonconventional septostomy techniques.

Occlusion of the perimembranous ventricular septal defect using CERA® devices†

High incidence of atrioventricular (AV) block has been the major limitation of percutaneous closure of perimembranous ventricular septal defect (PMVSD).

Double balloon pulmonary valvuloplasty : Multi-track system versus conventional technique

Objectives: To evaluate whether double balloon pulmonary valvuloplasty (DBPV) with the Multi‐Track system (MTS) may help to simplify the procedure. Background: DBPV is usually required for patients with pulmonary valve stenosis with large annulus. However, it needs two venous accesses and can be technically demanding. Methods: From 07/03, 20 consecutive patients (19 ± 10 yrs) with typical pulmonary valve stenosis underwent DBPV using the MTS (G1). The results were compared with those achieved by conventional DBPV performed in a matched historical group of 28 patients (21 ± 11 yrs; P = NS) (G2). Results: MTS balloons were easily advanced through the skin and inflated across the valve. Similar results were observed in regards to residual gradients (12 ± 11 vs 14 ± 10 mm Hg; P = NS) and right ventricular to systemic pressures (0.35 ± 0.22 vs 0.37 ± 0.26; P = NS). Procedure and fluoroscopic times were significant lower in G1 (78 ± 24 vs 126 ± 28; 15 ± 12 vs 25 ± 8 min, respectively; both P < 0.001). There was no major complication. Median follow‐up was 1.8 yr for G1 and 5 yr for G2 (P = 0.037). At the last visit, peak instantaneous gradient across the right ventricular outflow tract by echocardiography was a mean 22 ± 10 mm Hg for G1 and 25 ± 9 mm Hg for G2 (P = NS). No patient had severe pulmonary insufficiency or required reintervention. Conclusions: The use of the MTS helped to expedite the procedure providing satisfactory midterm clinical outcomes, similar to those observed with the conventional DBPV technique.

Surface Modification of Polyester Fabric by Non-Thermal Plasma Treatment

In the present study it was carried out a surface modification of polyester fabric by plasma treatment with aim of providing hidrophilicity to fabric. In the process it were used three different gaseous atmosphere with mixtures of argon, nitrogen and/or oxygen [(1) Ar + N2 (4:2), (2) Ar + N2 + O2 (4:2:2) and N2 + O2 (2:0.6)] and maintained others parameters such as pressure, current and time of treatment fixed at 1.35 mBar, 0.08 A and 30 minutes, respectively. The plasma treatment was monitored by optical emission spectroscopy (OES) to identify the species presents in the plasma reactor. Chemical changes in the fabric surface after plasma treatments were determined by Fourier Transform Infrared (FTIR) and X-ray photoelectron spectroscopy (XPS). Wicking properties were used to evaluate hydrophilicity of the fabric. Wicking measurement showed that the hydrophilicity of polyester fabric was remarkably improved after treatment and was explained by XPS analysis indicating higher presence of functional groups containing nitrogen and oxygen.

Right Patent Ductus Arteriosus With an Ipsilateral Aortic Arch: Percutaneous Closure With Amplatzer Devices

The association of a right aortic arch with an ipsilateral patent ductus arteriosus is rare, especially when there are no other intracardiac anomalies. We report three female patients aged 26, 35 and 9 years with this combination in whom previous attempts at surgical closure by thoracotomy and sternotomy were unsuccessful and who subsequently underwent successful percutaneous closure of the defects using Amplatzer devices. In two patients, although angiography demonstrated the presence of type-A patent ductus arteriosus, it was not possible to determine the minimum diameter accurately and it was necessary to measure it using a sizing balloon. An Amplatzer duct occluder was used in two patients and an Amplatzer muscular ventricular septal defect occluder, in the other. In all patients, full closure was confirmed in the catheterization laboratory and the patients were discharged on the same day with no complications. Percutaneous closure of a right patent ductus arteriosus associated with a right aortic arch is feasible, safe and effective.

Conducto arterioso persistente a la derecha con arco aórtico ipsolateral: cierre percutáneo con dispositivos Amplatzer

La asociacion de arco aortico a la derecha con persistencia del conducto arterioso ipsolateral es rara, principalmente cuando no hay otras anomalias intracardiacas asociadas. Comunicamos los casos de 3 pacientes del sexo femenino de 26, 35 y 9 anos con esta enfermedad e intentos previos infructuosos de cierre quirurgico a traves de toracotomia y esternotomia, a quienes se realizo cierre percutaneo del defecto con dispositivos tipo Amplatzer con exito. En 2 pacientes, aunque las angiografias documentaron la presencia de persistencia del conducto arterioso tipo A, no se pudo definir bien el diametro minimo y fue necesario determinarlo con el balon medidor. Se implantaron Amplatzer Duct Occluder en 2 pacientes y Amplatzer para comunicacion interventricular muscular en el otro. En todos se corroboro el cierre completo del defecto en la sala de hemodinamica y fueron dados de alta sin complicaciones. El cierre percutaneo del conducto derecho en presencia de arco aortico a la derecha es factible, seguro y efectivo.

Transhepatic access for atrioseptostomy in a neonate

We report a case in which a neonate with complete transposition of the great arteries was submitted to an atrial septostomy through transhepatic access due to congenital interruption of the inferior vena cava. The technical aspects of the procedure are discussed.

Oclusão Percutânea do Canal Arterial com a Prótese Amplatzer ® Vascular Plug II: Experiência Inicial em Três Centros de Referência

BACKGROUND: The conventional devices available for the percutaneous occlusion of patent ductus arteriosus (PDA) may present limitations, especially in small patients and in adults with larger ductus arteriosus. The Amplatzer® Vascular Plug II (AVP II) device has been used in these scenarios with promising results. This study is aimed at presenting the early experience with the AVP II device in three reference centers. METHODS: Prospective study, with retrospective data collection, of patients undergoing PDA occlusion with AVP II since 2011. The devices were implanted using the anterograde approach under general anesthesia, except for one patient. Technical aspects, immediate occlusion and complication rates were assessed. RESULTS: Forty patients (67.5% female) with median age of 56.7 months (6 months to 654.7 months) and median weight of 17.3 kg (5 kg to 93 kg) were included. Of these, 36 had type A PDA, 3 had type E PDA and 1 had type C PDA. Mean diameters of the ductus and the device were 3.7 ± 1.5 mm and 9.4 ± 3.6 mm, respectively. In 3 patients the initial device had to be replaced by another device with a different size. In one patient, an unsuccessful attempt was made to implant 2 devices. This patient was referred for surgical repair. In 5 patients a mild protrusion of the disc towards the aorta was observed, but did not cause significant pressure gradients. Residual flow was observed in 2 patients. There were no significant complications. CONCLUSIONS: The AVP II device is a safe and effective alternative for the treatment of PDA, especially in those with limitations to the conventional occlusion procedure.

Pulmonary hypertension in infants linked to horseshoe lung: case report

This is the case report of a young infant with early respiratory distress and pulmonary hypertension, diagnosed as a variant of horseshoe lung and we have reviewed the literature to seek information about this rare pulmonary malformation and its cardiac and hemodynamic repercussions.This is the case report of a young infant with early respiratory distress and pulmonary hypertension, diagnosed as a variant of horseshoe lung and we have reviewed the literature to seek information about this rare pulmonary malformation and its cardiac and hemodynamic repercussions.

Punção da artéria axilar para intervenções percutâneas em lactentes portadores de cardiopatias congênitas: "à procura de um caminho mais curto e mais seguro"

ABSTRACT Axillary Artery Access for PercutaneousInterventions in Infants with Congenital HeartDisease: “In Search of a Shorterand Safer Pathway” Background: Axillary artery access (AxA) has been used inadults with good results, however, its use in neonates andinfants has not been extensively reported. This study wasaimed at reporting our initial experience using this accessin different cardiac interventions in this age group. Method: From January 2009 to September 2010, 11 children weresubmitted to different cardiac interventions using AxA. Theprocedure was performed with a 21 G needle followed bythe insertion of a 4 F or a 5 F pediatric sheats. Results: Meanage was 26 ± 12 days and mean weight was 4.2 ± 1.7 Kg.The cardiac interventions performed were: stenting of thearterial duct (6), aortic valvoplasty (1), aortic angioplasty(2), stent implantation in a Blalock-Taussig shunt (1) andstent redilation in the arterial duct (1). Right AxA puncturewas successfully obtained in all patients without technicaldifficulties. Mean procedure and fluoroscopy times were52 ± 15 minutes and 13 ± 4 minutes, respectively. Pneumotho-rax without hemodynamic involvement was the single compli-cation in one patient. The other patients did not have anyabnormalities. There were no ischemic or neurologiccomplications in the ipsilateral limb. Mean time of IntensiveCare Unit (ICU) stay was 48 ± 16 hours. There were nodeaths during the interventional procedures and one patientdied of sepsis at the ICU 5 days after the procedure.