Raul Arrieta

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).

Oclusão percutânea do forame oval patente com prótese PREMERE TM: resultados preliminares da primeira experiência no Brasil

ABSTRACT Percutaneous Occlusion of Patent Foramen Ovalewith the PREMERE TM Device: Preliminary Results ofthe First Experience in Brazil Background: Patent foramen ovale is observed in 27% to30% of the population and may be associated to embolicevents, among them the cryptogenic stroke. The PREMERE TM device, specially developed to correct patent foramenovale, has a low profile, reduced amount of metal and aleft anchor with a small total surface to minimize the riskof thrombus formation. Clinical and echocardiographicresults were evaluated immediately after the procedureand 3 and 6 months after device implantation. Method: From May 2008 to June 2009, the device was implantedin 14 patients with patent foramen ovale with prior cere-bral embolic events, confirmed by computerized tomographyand/or cranial magnetic resonance imaging. Echocardio-graphic patent foramen ovale was diagnosed whenmicrobubbles were detected in the left atrium within threeheartbeats after opacification of the right atrium. Patientswith patent foramen ovale with interatrial septal aneurysm> 2 cm, those with atrial fibrilation/flutter or with otherdiseases that might explain the cryptogenic stroke wereexcluded.

Does Ad Hoc Coronary Intervention Reduce Radiation Exposure? - Analysis of 568 Patients.

Background Advantages and disadvantages of ad hoc percutaneous coronary intervention have been described. However little is known about the radiation exposure of that procedure as compared with the staged intervention. Objective To compare the radiation dose of the ad hoc percutaneous coronary intervention with that of the staged procedure Methods The dose-area product and total Kerma were measured, and the doses of the diagnostic and therapeutic procedures were added. In addition, total fluoroscopic time and number of acquisitions were evaluated. Results A total of 568 consecutive patients were treated with ad hoc percutaneous coronary intervention (n = 320) or staged percutaneous coronary intervention (n = 248). On admission, the ad hoc group had less hypertension (74.1% vs 81.9%; p = 0.035), dyslipidemia (57.8% vs. 67.7%; p = 0.02) and three-vessel disease (38.8% vs. 50.4%; p = 0.015). The ad hoc group was exposed to significantly lower radiation doses, even after baseline characteristic adjustment between both groups. The ad hoc group was exposed to a total dose-area product of 119.7 ± 70.7 Gycm2, while the staged group, to 139.2 ± 75.3 Gycm2 (p < 0.001). Conclusion Ad hoc percutaneous coronary intervention reduced radiation exposure as compared with diagnostic and therapeutic procedures performed at two separate times.

Case 2 / 2018 - Coronary-Cavitary Fistula of Right Ventricular Coronary Artery 5 Years after its Occlusion by Interventional Catheterization

DOI: 10.5935/abc.20180048 Clinical data: Heart murmur detected in routine clinical examination at the age of 8 years, with no other manifestations. The patient was diagnosed as having coronary-cavitary fistula between right coronary artery and right ventricle, which was confirmed by echocardiography. The fistula was then occluded by interventional catheterization, and patient was asymptomatic, with full physical and mental health until the age of 13; in this period, the patient received no drug treatment.

Case 1/2017 - Percutaneous Repair of Right Atrioventricular Valve Insufficiency and Blalock-Taussig Shunt after Fontan Operation in Single Ventricle

Twenty-seven-year old male patient reporting tiredness during exercise for three years, after total cavopulmonary connection with extracardiac conduit fenestration and closure with stiches of the free end of right atrioventricular valve (AV) for severe failure in double inlet left ventricle, pulmonary atresia, and aorta arising from rudimentary right ventricle. The patient had undergone right and left BlalockTaussig shunts at 17 days and 9 months, respectively, and bidirectional Glenn shunt at 19 years old. The patient had arterial oxygen saturation of 84-88% during exercise and 93% at rest.

Case 5/2016 - Native Coarctation of the Aortic Arch, Relieved By Percutaneous Treatment in an Adult.

Clinical data: the patient had a good clinical course after repair of severe coarctation of the aortic isthmus with end-to-end technique, closure of the interventricular communication at 18 days of life, and relief of moderate subaortic stenosis at 3 years of age. Currently, the patient can tolerate well routine exercise, with no symptoms. At last evaluation, blood pressure in the right arm was 140/70 mmHg and the systolic pressure in the left arm and lower limbs was 90 mmHg, suggesting aortic arch obstruction. Previous evaluations have shown a pressure gradient of 15 mmHg between the upper limbs.

Case 2/2016 - Scimitar Sign with Right Pulmonary Vein Drainage into the Right Atrium

Clinical data: the characteristic signs of the scimitar syndrome with right pulmonary hypoplasia were discovered in an asymptomatic patient through routine chest X-ray, in the presence of dengue. On physical examination, the patient was in good general health status, eupneic, normal skin color, with normal pulses. His weight was 54 kg, height 155 cm, blood pressure of 100/60 mmHg, heart rate of 88 bpm. The aorta was not palpable at the sternal notch. In the precordium, there were mild impulses at the left and right sternal borders and the apex beat was not palpable. Heart sounds were normal, with constant splitting of the second heart sound, with discreet and rough ejection systolic murmur in the pulmonary area. The liver was not palpable and in the lungs, breath sounds were less audible in the right lower pulmonary lobe.

Case 1/2016 - Aortic Coarctation and Atrial Septal Defect submitted to Percutaneous Repair in Adult Patient

Clinical data: Heart murmur was identified at auscultation in childhood, but the diagnosis of aortic coarctation associated with atrial septal defect was attained when the patient was 15 years old. The patient practiced regular physical activity and did not report symptoms for up to 5 years, when he became sedentary. He received specific anti-hypertensive medication. Physical examination: patient was eupneic, acyanotic, obese, ample pulses in the upper limbs and decreased in the lower limbs. Weight: 113 kg; height: 177 cm; Body Mass Index (BMI): 36.1 kg/m2; RUL BP was the same in the LUL, 149/89 mmHg; right inferior limb BP = 113/77 mmHg; Heart rate (HR): 82 bpm; oxygen saturation of 95%. The aorta was clearly palpable at the suprasternal notch. The apex beat was not palpable in the precordium and there were no systolic impulses in the left sternal border (LSB). Normal heart sounds; constant split second sound and rough systolic murmur + / ++ / 4, was heard in the upper LSB. The liver was not palpable.

Coarctação da Aorta em Crianças com Menos de 25 kg: Tratamento Percutâneo por Punção da Artéria Axilar

Introducao: O tratamento percutâneo da coarctacao da aorta e metodo de escolha em criancas acima de 6 meses de idade e sem hipoplasia do arco aortico. No entanto, nos pacientes com menos de 25 kg, a via de acesso classica (femoral) pode representar um problema, principalmente nos implantes de stents, devido ao tamanho dos introdutores. O objetivo deste estudo foi relatar a experiencia com a puncao da arteria axilar como via de acesso para o tratamento percutâneo de pacientes com coarctacao da aorta e peso < 25 kg. Metodos: A puncao foi realizada com agulha 21 G, com o braco abduzido em 90o, sendo introduzido fio-guia 0,014 polegada, posicionado na aorta descendente. Um introdutor 5 F pediatrico de 7 cm foi inicialmente utilizado para realizacao do procedimento, sendo substituido, quando necessario, por um introdutor maior. Apos a intervencao, foi realizada compressao hemostatica manual. Resultados: Foram tratadas dez criancas, sendo oito com recoarctacao poscirurgica e duas com coactacao nativa, com idades de 51,1 ± 30,8 meses e peso de 15,8 ± 5,8 kg. A puncao foi realizada em todos os casos sem dificuldade tecnica, e a mediana do calibre do introdutor foi de 7 F. Em oito pacientes, foram implantados oito stents e, em dois, foi realizada apenas angioplastia com balao. Houve sucesso tecnico em todos os casos. Apos a retirada do introdutor, nao houve perda de pulso definitiva e um paciente apresentou pequeno hematoma local. Conclusoes: Na nossa experiencia, o acesso axilar por meio de puncao mostrou ser uma alternativa segura e eficaz neste grupo de pacientes.

Case 3/2015 A 32-year-old Female Patient with Coarctation of the Aorta, Bicuspid Aortic Valve and Dilatation of the Ascending Aorta

Clinical data: The patient reports that a heart murmur had been heard at childhood; however, the diagnosis of coarctation of the aorta was made 1 month ago by echocardiogram and CT scan, performed due to recent complaints of tired legs. She performed physical activities on a regular basis and did not report headache. She was not receiving any specific medication.