Santiago Raul Arrieta

Percutaneous Occlusion of Patent Ductus Arteriosus with the Amplatzer® Vascular Plug II Device: Early Experience in Three Reference Centres

ABSTRACT Background The conventional devices available for the percutaneous occlusion of a patent ductus arteriosus (PDA) may have limitations, especially in small children and adults with a large ductus arteriosus. The Amplatzer® Vascular Plug II (AVP II) device has been used in these scenarios with promising results. This study aims to report an early experience with the AVP II device at three reference centres. Methods This was a prospective study with retrospectively collected data from patients who had undergone PDA occlusion with the AVP II since 2011. The devices were implanted using the anterograde approach under general anaesthesia, except for in one patient. Technical aspects, immediate occlusion, and complication rates were assessed. Results Forty patients (67.5% females) with a median age of 56.7 months (6 months to 654.7 months) and a median weight of 17.3xa0kg (5xa0kg to 93xa0kg) were included. Of these, 36 had a type A PDA, three had a type E PDA, and one had a type C PDA. The mean diameters of the ductus and of the device were 3.7xa0±xa01.5xa0mm and 9.4xa0±xa03.6xa0mm, respectively. In 3 patients, the initial device had to be replaced by another device of a different size. In one patient, an unsuccessful attempt led to the use of two implant devices. This patient was later referred for surgical repair. In five patients, a mild protrusion of the disc towards the aorta was observed, but the protrusion did not cause a significant pressure gradient. Residual flow was observed in two patients. There were no significant complications. Conclusions The AVP II device is a safe and effective alternative for PDA treatment, especially in patients with limitations to the conventional occlusion procedure.

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.

Valvuloplastia aórtica por cateter balão na estenose aórtica degenerativa: impacto terapêutico em pacientes em condição clínica in extremis

INTRODUCAO: A valvuloplastia aortica por cateter balao (VAB) e utilizada como estrategia paliativa em pacientes inelegiveis tanto para troca valvar cirurgica quanto para implante valvar aortico transcateter, ou como ponte para essas modalidades de tratamento. Nao se sabe o impacto terapeutico da VAB quando realizada como medida de salvamento para pacientes em condicoes clinicas extremas (in extremis). METODOS: Foram analisados pacientes com estenose aortica grave de etiologia degenerativa submetidos a VAB entre julho de 2008 e janeiro de 2013. Os pacientes foram divididos entre o grupo in extremis (definido pela presenca de duas ou mais das seguintes disfuncoes orgânicas: ventilacao mecânica, instabilidade hemodinâmica, terapia renal dialitica, coagulopatia ou disfuncao hepatica graves) e o grupo controle, que incluiu os demais pacientes. RESULTADOS: Um total de 19 pacientes realizaram VAB no periodo. A condicao clinica in extremis esteve presente em 42,1%. Os pacientes do grupo in extremis tiveram EUROSCORE II mais elevado (41,1 ± 24,7 vs. 15,9 ± 14,0; P = 0,01) e fracao de ejecao do VE mais baixa que o grupo controle (33,9 ± 17,3% vs. 49,0 ± 12,5%; P = 0,04). Nenhum paciente do grupo in extremis sobreviveu ao periodo intra-hospitalar, enquanto que, no grupo controle, a mortalidade foi de 27,3% (P < 0,01). CONCLUSOES: Para o tratamento de pacientes com estenose aortica grave de etiologia degenerativa, a VAB tem resultado desfavoravel quando indicada para pacientes com duas ou mais disfuncoes orgânicas, ou seja, em condicao clinica in extremis.

Balloon aortic valvuloplasty in degenerative aortic stenosis: therapeutic impact on patients in extremis

ABSTRACT Background Balloon aortic valvuloplasty (BAV) is used as a palliative strategy in patients who are not eligible for valve replacement surgery, transcatheter aortic valve implantation, or as a bridge to these treatment modalities. The impact of BAV as a salvage procedure for patients in extreme clinical conditions ( in extremis ) is unknown. Methods Patients with severe degenerative aortic stenosis undergoing BAV between July 2008 and January 2013 were evaluated. Patients were divided into the in - extremis group (defined by the presence of two or more of the following organ dysfunctions: mechanical ventilation, hemodynamic instability, dialysis, coagulopathy or severe hepatic dysfunction) and the control group, which included the remaining patients. Results A total of 19 patients underwent BAV. The clinical condition in - extremis was present in 42.1% of them. Patients from the in - extremis group had a higher EUROSCORE II (41.1 ± 24.7 vs. 15.9 ± 14.0; P = 0.001) and LV ejection fraction lower than the control group (33.9 ± 17.3% vs. 49.0 ± 12.5; P = 0.04). None of the patients in the in - extremis group survived past the hospitalization period, whereas the control group mortality was 27.3% (P Conclusions BAV has an unfavorable result in patients with severe degenerative aortic stenosis with two or more organ dysfunctions, that is, patients in extremis .

Hipertensão pulmonar em lactente associada a pulmão em ferradura: relato de caso

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.

Hipertensión pulmonar en lactante asociada a pulmón en herradura: caso clínico

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.

Intervenções Percutâneas no Pós-Operatório Tardio de Cirurgia de Correção Atrial para Transposição das Grandes Artérias

SUMMARY Cardiac Interventions in the Late Follow-Up ofAtrial Repair for Transposition of theGreat Arteries Obstruction of the venous pathways after atrial repair fortransposition of the great arteries is not uncommon andcan be, in some cases, fatal. The surgical treatment ofthese complications is a high-risk procedure. Nowadays,percutaneous balloon angioplasty or stenting have beenused with good results. We report two cases of percutaneoustreatment of systemic and pulmonary “baffle” obstructions. DESCRIPTORS: Stents. Transposition of great vessels. Heartatria, surgery. RESUMO A obstrucao dos tuneis intra-atriais, no pos-operatorio tardiode cirurgia de correcao atrial para o tratamento da trans-posicao das grandes arterias, nao e uma complicacaoinfrequente, podendo ate, em alguns casos, ser fatal. Otratamento cirurgico de tais lesoes pode apresentar altosindices de morbidade e mortalidade. Recentemente, otratamento percutâneo mediante implante de stent ou pormeio de angioplastia com cateter-balao tem sido utilizadocom bons resultados. Relatamos dois casos de tratamentopercutâneo de obstrucoes dos tuneis intra-atriais sistemicoe pulmonar.

Perfuração Cardíaca Durante Cateterismo em um Lactente com Estenose Valvar Pulmonar: Resultados Satisfatórios Pela Abordagem Híbrida

We report a case in which a 10-month-old infant underwent an unsuccessful attempt at percutaneous pulmonary balloon valvuloplasty (PBV) due to cardiac perforation. The child was subsequently managed by median sternotomy, suture of the bleeding site in the right atrium and intraoperative PBV through a sheath placed in the right ventricular outflow tract.