RESUMO
OBJECTIVE: To assess the efficacy and safety of the Nit-Occlud ASD-R (PFM S.R.L, La Paz, Bolivia) in the percutaneous closure of secundum atrial septal defects (ASD). PATIENTS AND METHODS: Fifty-three consecutive patients with median age of 11 years (range 3-67) and mean weight 27.1 kg (range 13-75 kg), treated in two cardiology centers between May 2007 and March 2011. RESULTS: Mean fluoroscopy time was 14 minutes (5-53), mean procedure time was 70 minutes (45-150), mean defect size, as measured by the stop-flow technique, was 17.8 mm (5.6-31), and mean stent size of the implanted device was 18 mm (6-28), which is 0.98 times the defect size. Successful closure of the ASD without major complications was achieved in 49 of 53 patients. In 71.4% of patients in whom device implantation was accomplished, there was no evidence of a persistent shunt at the completion of the procedure. This closure rate increased to 91.7% after 24 hours, with 95.8% closure after three months and 100% closure after six months. Device embolization occurred in one patient within 24 hours of implantation and required surgical device removal and ASD closure. There were no other major complications and no deaths during the period of follow-up (average 72 months; range 59-105 months). CONCLUSION: The Nit-Occlud ASD-R device is safe and effective with very good closure rates.
Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interatrial/cirurgia , Dispositivo para Oclusão Septal , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Países em Desenvolvimento , Feminino , Fluoroscopia , Seguimentos , Comunicação Interatrial/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Cirurgia Assistida por Computador , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Los miembros del Task Force pediátrico del Pulmonary Vascular Research Institute (PVRI, su sigla en Inglés) fueron conscientes de la necesidad de desarrollar una clasificación funcional de la hipertensión pulmonar en niños. La clasificación que se propone sigue el mismo patrón y utiliza los mismos criterios de la clasificación de la hipertensión pulmonar específica para adultos de Dana Point. Fue necesario incluir modificaciones para los niños, teniendo en cuenta que la edad, el crecimiento físico y la madurez influyen en la expresión funcional de la enfermedad. Es necesario definir el estado clínico del niño, pues ello facilita revisar la evolución del mismo en una forma consistente y objetiva a medida que él/ella crecen. Particularmente en los niños más jóvenes, se trató de incluir indicadores objetivos como el crecimiento, la necesidad de alimentos suplementarios y los registros de asistencia al colegio y a la guardería. Esto ayuda a monitorear la evolución clínica y la respuesta al tratamiento a través de los años y facilita el desarrollo de algoritmos de tratamiento en estos pacientes. Se presenta un artículo de consenso sobre una clasificación aplicable a los niños con hipertensión pulmonar que se discutió en la reunión anual del PVRI que se llevó a cabo en Panamá en febrero de 2011.
The members of the Pediatric Task Force of the Pulmonary Vascular Research Institute (PVRI) were aware of the need to develop a functional classification of pulmonary hypertension in children. The proposed classification follows the same pattern and uses the same criteria as the Dana Point pulmonary hypertension specific classification for adults. Modifications were necessary for children, since age, physical growth and maturation influences the way in which the functional effects of a disease are expressed. It is essential to encapsulate a child's clinical status, to make it possible to review progress with time as he/she grows up, as consistently and as objectively as possible. Particularly in younger children we sought to include objective indicators such as thriving, need for supplemental feeds and the record of school or nursery attendance. This helps monitor the clinical course of events and response to treatment over the years. It also facilitates the development of treatment algorithms for children. We present a consensus paper on a functional classification system for children with pulmonary hypertension, discussed at the Annual Meeting of the PVRI in Panama City, February 2011.
Assuntos
Hipertensão , Criança , Hipertensão PulmonarRESUMO
Las clasificaciones actuales de la hipertensión pulmonar han contribuido significativamente al conocimiento de la enfermedad vascular pulmonar, han facilitado ensayos farmacológicos y han mejorado nuestro conocimiento de las cardiopatías congénitas del adulto; sin embargo estas clasificaciones no son aplicables completamente a la enfermedad en el niño. La clasificación que aquí se propone se basa principalmente en la práctica clínica. Los objetivos específicos de esta nueva clasificación son mejorar las estrategias diagnósticas, promover la investigación clínica, mejorar nuestro conocimiento de la patogénesis, de la fisiología y de la epidemiología de la enfermedad y orientar el desarrollo de modelos de la enfermedad humana en el laboratorio y estudios en animales; también puede servir como un recurso docente. Se hace énfasis en los conceptos de maladaptación perinatal, alteraciones del desarrollo e hipoplasia pulmonar como factores causantes de la hipertensión pulmonar pediátrica; así mismo, en la importancia de los múltiples síndromes malformativos congénitos, genéticos y cromosómicos en la presentación de la hipertensión pulmonar pediátrica. La enfermedad vascular pulmonar hipertensiva en niños se divide en diez grandes categorías.
Current classifications of pulmonary hypertension have contributed a great deal to our understanding of pulmonary vascular disease, facilitated drug trials, and improved our understanding of congenital heart disease in adult survivors. However, these classifications are not applicable readily to pediatric disease. The classification system that we propose is based firmly in clinical practice. The specific aims of this new system are to improve diagnostic strategies, to promote appropriate clinical investigation, to improve our understanding of disease pathogenesis, physiology and epidemiology, and to guide the development of human disease models in laboratory and animal studies. It should be also an educational resource. We emphasize the concepts of perinatal maladaptation, maldevelopment and pulmonary hypoplasia as causative factors in pediatric pulmonary hypertension. We highlight the importance of genetic, chromosomal and multiple congenital malformation syndromes in the presentation of pediatric pulmonary hypertension. We divide pediatric pulmonary hypertensive vascular disease into 10 broad categories.
Assuntos
Humanos , Hipertensão , Cardiopatias Congênitas , Pediatria , Artéria PulmonarRESUMO
BACKGROUND: Patent ducti arteriosi (PDAs) are more frequent and larger at high altitude than at sea level. A novel PDA closure device, the Nitocclud PDA-R, is designed specifically for both large and medium size PDAs. The initial clinical experience with a new nitinol-based device in high altitude patients with large PDAs is described. METHODS: The Nitocclud PDA-R is a self-expandable, self-centering, repositionable occluder made of one nitinol wire without use of welding. It contains several polyester membranes, is delivered with a central guide wire and is released by retraction of the central wire into the delivery catheter. The efficacy of this device was evaluated at several high altitude centers. RESULTS: Fifty-one patients without other congenital cardiac defects underwent transcatheter closure of PDA. Complete occlusion of the PDA was achieved in 98% of the patients. Nearly 49% of the patients had no shunt immediately after device implantation. Echocardiography revealed a complete closure rate by Doppler interrogation of 69% after 24 hr, 96% after 6 months, and 98% after 1 year. In two cases, device embolization was observed after release, and in both cases the device was easily retrieved with standard interventional techniques. There have been no episodes of delayed device migration, endocarditis, hemolysis, wire fracture, device disruption, or death. CONCLUSIONS: The Nitocclud PDA-R device is safe and effective and can easily close very large PDAs. This device has a high rate of complete occlusion within 1 year and is easily retrieved if embolized.
Assuntos
Ligas , Altitude , Cateterismo Cardíaco/instrumentação , Permeabilidade do Canal Arterial/terapia , Adolescente , Adulto , Argentina , Bolívia , Cateterismo Cardíaco/efeitos adversos , Criança , Pré-Escolar , Remoção de Dispositivo , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/fisiopatologia , Ecocardiografia Doppler em Cores , Desenho de Equipamento , Feminino , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/terapia , Hemodinâmica , Humanos , Lactente , Masculino , Membranas Artificiais , Poliésteres , Estudos Prospectivos , Terapêutica , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Interventional closure of patent arterial duct has become an accepted alternative to surgical closure. Clinical trial with "Nit-Occlud® PDA-R". METHODS AND RESULTS: To assess the safety and efficacy of the device, we performed a prospective clinical study between June, 2009 and December, 2010 in La Paz, Bolivia. In all, 29 - 22 female patients and 7 male patients - out of 59 patients were selected on the basis of inclusion criteria. The procedures were performed under sedation at an age and weight of 5.7 years and 22.7 kilograms, respectively, with 4-6 French arterial sheaths and 5-7 French venous sheaths. The minimal diameter of the duct was 3.5 millimetres. The procedure, fluoroscopy, and hospitalisation times were 96.4 minutes (55 to 145), 13.1 minutes (3 to 25.2), and 24 hours, respectively. The "Nit-Occlud® PDA-R" was successfully deployed in all patients. Immediate, 24-hour, 1-, 3-, and 6-month closure rates were 65.5%, 79.3%, 96.5%, and 100%, respectively. The systolic pulmonary pressure diminished from 37 millimetres of mercury (21 to 57) before the intervention to 31 millimetres of mercury (21 to 45) after the intervention. No early or late embolisation, haemolysis, left pulmonary artery, or descending aorta obstruction occurred. CONCLUSIONS: We conclude that the "Nit-Occlud® PDA-R" device is safe and effective in closing patent arterial duct up to a diameter of 8 millimetres.
Assuntos
Cateterismo Cardíaco/métodos , Permeabilidade do Canal Arterial/terapia , Próteses e Implantes , Adolescente , Adulto , Ligas , Bolívia , Criança , Pré-Escolar , Doença Crônica , Permeabilidade do Canal Arterial/complicações , Feminino , Fluoroscopia , Humanos , Hipóxia/complicações , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto JovemRESUMO
The members of the Pediatric Task Force of the Pulmonary Vascular Research Institute (PVRI) were aware of the need to develop a functional classification of pulmonary hypertension in children. The proposed classification follows the same pattern and uses the same criteria as the Dana Point pulmonary hypertension specific classification for adults. Modifications were necessary for children, since age, physical growth and maturation influences the way in which the functional effects of a disease are expressed. It is essential to encapsulate a child's clinical status, to make it possible to review progress with time as he/she grows up, as consistently and as objectively as possible. Particularly in younger children we sought to include objective indicators such as thriving, need for supplemental feeds and the record of school or nursery attendance. This helps monitor the clinical course of events and response to treatment over the years. It also facilitates the development of treatment algorithms for children. We present a consensus paper on a functional classification system for children with pulmonary hypertension, discussed at the Annual Meeting of the PVRI in Panama City, February 2011.
RESUMO
Current classifications of pulmonary hypertension have contributed a great deal to our understanding of pulmonary vascular disease, facilitated drug trials, and improved our understanding of congenital heart disease in adult survivors. However, these classifications are not applicable readily to pediatric disease. The classification system that we propose is based firmly in clinical practice. The specific aims of this new system are to improve diagnostic strategies, to promote appropriate clinical investigation, to improve our understanding of disease pathogenesis, physiology and epidemiology, and to guide the development of human disease models in laboratory and animal studies. It should be also an educational resource. We emphasize the concepts of perinatal maladaptation, maldevelopment and pulmonary hypoplasia as causative factors in pediatric pulmonary hypertension. We highlight the importance of genetic, chromosomal and multiple congenital malformation syndromes in the presentation of pediatric pulmonary hypertension. We divide pediatric pulmonary hypertensive vascular disease into 10 broad categories.
RESUMO
Experiencia local en la técnica de angioplastía con catéter-balón, realizada en siete pacientes con edad que oscila entre 1 mes a 27 años, siendo 5 varones y 2 mujeres, con diagnostico de coartación aórtica nativa. Una vez realizada la sedación, se colocó un introductor en la arteria femoral y se procedió al avance de guías y catéteres hasta la aorta transversa, con el objetivo de obtener imágenes angiografícas y medir presiones invasivas en todos los segmentos. El gradiente de presión pre intervención fue de 41.5mmHg en promedio (rango:21-69mmHg) disminuyó post intervención a 10mmHg en promedio (rango:0-20mmHg). El diámetro de la coartación pre dilatación en promedio fue de 4.3mm (rango: 2.3 a 9.4mm) y aumentó post dilatación a 8.4 mm (rango: 5.5 a 13.5mm). El resultado final fue satisfactorio, pues disminuyó significativamente el gradiente de presión, el diámetro aórtico coartado aumentó y los pulsos en las cuatro extremidades se tornaron simétricos. Se alcanzó estabilidad clínica y el procedimiento se demostró como favorable en todos los pacientes. Los controles postintervención hasta un año después mostraron que el gradiente se mantiene en el tiempo, salvo en el caso de la niña de un mes, que desarrolló recoartación aórtica y fue operada en condiciones electivas, como es usual para este grupo de edad.
Local experience in the technique of balloon catheter angioplasty, performed in seven patients aged between 1 month and 27 years, 5 males and 2 females, diagnosed with native aortic coarctation. After the sedation, the introducer was collocated in the femoral artery, and guide wires and catheters were pushed forward until the transverse aorta in order to obtain angiographic images and to measure invasive pressures in all the segments. The mean pressure gradient before the intervention was 41.5mmHg (range:21-69mmHg) and decreased post intervention to 10mmHg (range:0-20mmHg). The mean diameter of the coarctation pre dilatation was 4.3mm (range:2.3-9.4mm) and increased post dilation to 8.4mm(range:5.5-13.5mm). The final result was satisfactory because the pressure gradient was significantly reduced, the aortic diameter increased and the pulses in all four extremities symmetrical. Clinical stability was achieved and the procedure proved to be favorable for all the patients. Controls until one year post intervention showed that the gradient did not change over the time, except in the case of a one month old girl, who developed recoarctation and was operated in elective conditions, as it is usual for this group of age.
Assuntos
AngioplastiaRESUMO
Se presenta el caso clínico de un recien nacido masculino con el diagnóstico de atresia pulmonar por fusión valvar y perfusión pulmonar ductus dependiente; a quién se realizó una valvuloplastía pulmonar percutánea con guía fluoroscópica para restablecer un flujo anterógrado efectivo desde el ventrículo derecho al árbol vascular pulmonar.