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OBJECTIVE: To evaluate mid-term results with Percutaneous aortic valvuloplasty (PAV). MATERIAL AND METHODS: Records of 70 patients treated with percutaneous aortic valvuloplasty with at least 6 months follow-up were reviewed. RESULTS: The 70 patients with PAV aged 3 months to 36 years, mean 10.5 +/- 10.6 years, 40) 63%) were male and 26 (37%) female. Initial systolic peak gradient decreased from 84 +/-20 to 31 +/- 16 mmHg (p < 0.05), while the reduction percentage ranged from 25 to 100%, mean 60 +/- 22. Balloon/aortic annulus index was 0.9 +/- 0.17. Ten (14.1 %) patients developed aortic insufficiency after PAV. Follow-up ranged from 6 to 168 months, mean +/- 48 months. At end of follow-up, 21 patients (30%) were considered failed cases and 49 (70%) patients had a successful outcome. CONCLUSIONS: This study showed a series with the longest follow-up in Latin America with PAV. New prospective and multicentric studies are needed in this region.

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OBJECTIVE: To evaluate the safety and efficacy of transcatheter closure of secundum atrial septal defects and fenestrated Fontan with the Amplatzer septal occluder. METHODS: Fifteen consecutive patients, with a significant interatrial communications, were considered for the procedure; four patients with defects that were too large or with deficient margins were excluded after initial transesophageal echocardiography. RESULTS: Eleven procedures were performed in 11 patients (10 atrial septal defects and 1 fenestrated Fontan) aged 9 to 38 years, mean 17.7 +/- 9 years; body weight 30 to 87 kg, mean 51.4 +/- 16. The stretched balloon diameter of the defects ranged from 8 to 28 mm, mean 18.8 +/- 6.9; the diameter of the devices ranged from 10 to 30 mm, mean 20.8 +/- 6. Immediate total occlusion rate was 18.1%, rising to 63.6% after 24 hours. Total occlusion rate at one month reached 100%. Severe transient sinus bradycardia in one (9%) was the only complications. At follow-up (10 to 26 months, mean 13.2 +/- 5.0) all patients remain asymptomatic with no residual shunt. CONCLUSIONS: The Amplatzer septal occluder is very efficient and offered interventional interatrial communications closure in 100% of our group of consecutive patients with excellent intermediate results.

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BACKGROUND: Our objective was to compare results of two therapeutic modalities to treat congenital aortic coarctation: intraluminal aortoplasty without endoluminal stent installation (patients in group A) vs. surgical aortic resection (patients in group B). Trans-coarctation gradient pressure was evaluated prior to and immediately after treatment. Re-coarctation, aneurysm formation, in-hospital morbidity and mortality, and complications related to treatment were also evaluated. METHODS: A clinical, randomized, multicenter study was performed in pediatric patients with congenital aortic coarctation. Immediate and mid- to late therapeutic results were evaluated. With regard to statistics, we evaluated event variations by Kaplan-Meier model, nonparametric Wilcoxon test, Mann-Whitney U test, two-tailed Student t and chi-square tests, and Fisher analysis. Significance was considered relevant when p<0.05. RESULTS: There were no differences in demographic variables, procedure failure, complications, mortality, or aortic aneurysm between groups A and B, respectively. Intraluminal angioplasty and surgical aortic resection were similarly effective in reducing trans-coarctation pressure gradient, as well as arterial systemic pressure. However, differences were found between groups A and B at follow-up. Group A showed higher re-coarctation (50 vs. 21%). Absence of peripheral arterial pulses in limbs was higher in group A (50 vs. 21%), as well as persistence of arterial hypertension (49 vs. 19%); these differences were significant (p<0.05). On the other hand, complications observed after surgical aortic resection were more serious than post-angioplasty complications, but these differences were not statistically significant. CONCLUSIONS: Although re-coarctation and persistency of arterial hypertension were less frequent after surgical aortic resection, complications observed with this procedure are more serious than complications related to angioplasty, although these differences are not statistically significant.

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Objective: To evaluate the safety and efficacy of transcatheter closure of secundum atrial septal defects and fenestrated Fontan with the Amplatzer septal occluder. Methods: Fifteen consecutive patients, with a significant interatrial communications, were considered for the procedure; four patients with defects that were too large or with deficient margins were excluded after initial transesophageal echocardiography. Results: Eleven procedures were performed in 11 patients (10 atrial septal defects and 1 fenestrated Fontan) aged 9 to 38 years, mean 17.7 ± 9 years; body weight 30 to 87 kg, mean 51.4 ± 16. The stretched balloon diameter of the defects ranged from 8 to 28 mm, mean 18.8 ± 6.9; the diameter of the devices ranged from 10 to 30 mm, mean 20.8 ± 6. Immediate total occlusion rate was 18.1%, rising to 63.6% after 24 hours. Total occlusion rate at one month reached 100%. Severe transient sinus bradycardia in one (9%) was the only complications. At follow-up (10 to 26 months, mean 13.2 ± 5.0) all patients remain asymptomatic with no residual shunt. Conclusions: The Amplatzer septal occluder is very efficient and offered interventional interatrial communications closure in 100% of our group of consecutive patients with excellent intermediate results.

Objetivo: Evaluar la seguridad y eficacia del cierre transcateterismo de defectos septales atriales y Fontan fenestrado mediante el dispositivo de Amplatzer. Método: Quince enfermos consecutivos con comunicaciones interauriculares significativas fueron considerados inicialmente; se excluyeron 4 de ellos por defectos demasiado grandes o con bordes deficientes después de ecocardiografía transesofágica inicial. Resultados: Se realizaron 11 procedimientos en 11 enfermos (10 con defectos septales auriculares y uno con Fontan fenestrado), el rango de edad fue de 9 a 38 años, media 17.9 ± 9 años; peso de 30 a 87 kg, media 51.4 ± 16. El diámetro de balón ajustado al defecto varió de 8 a 28 mm, media 18.8 ± 6.9; el diámetro de los dispositivos varió de 10 a 30 mm, media 20.8 ± 6. La oclusión total inmediata ocurrió en el 18.1%, subiendo a 63.6% a las 24 horas. La oclusión total en el 100% de los enfermos se obtuvo al mes de seguimiento. Complicaciones: Se produjo severa bradicardia sinusal transitoria en un enfermo (9%). El seguimiento varió de 10 a 26 meses, media 13.2 ± 5.0. Todos los enfermos se encuentran asintomáticos sin corto circuito residual. Conclusiones: El oclu-sor Amplatzer es muy eficiente y ofrece el cierre de las comunicaciones interauriculares en el 100% de nuestro grupo de enfermos consecutivos con excelentes resultados a mediano plazo. (Arch Cardiol Mex 2003; 73:185-189).

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OBJECTIVE: To evaluate immediate and midterm results with percutaneous aortic valvoplasty. MATERIAL AND METHODS: We reviewed the records of 141 patients undergoing percutaneous aortic valvopasty over a period of 13 years. RESULTS: The patients were aged from 2 months to 40 years, with a mean of 10.9 +/- 9.9 years. Of the total, 90 (63+/%) were male. The initial systolic peak-to-peak gradient decreased from 163 +/- 52 mmHg to 32 +/- 18 mmHg (p < 0.01) after valvoplasty in all 141 patients, while the proportional reduction ranged from 0 to 100%, with a mean of 72 +/- 27%. The index of the size of the balloon to the diameter of the valvar orifice was 0.88 +/- 0.19 in 128 patients. The follow-up ranged from 6 to 168 months, with a mean 51 +/- 48 months in 70 patients. A significant difference was found in those failing after dilation when the initial evaluation was compared to the final evaluation of patients with follow-up. In those failing, the number of patients rose from 12 (17%) to 21 (30%) (p < 0.01). In contrast, in those in whom we achieved success, there was not such a great difference between the initial and final evaluation: 58 (83%) versus 49 (70%) (p < 0.1). The actuarial freedom curve of patients not needing new percutaneous aortic valvoplasty or surgery, by 182 months, was at 87% and 82% respectively. CONCLUSION: We have reviewed the largest series of patients in Latin-America reported thus far after undergoing percutaneous aortic valvoplasty, concentrating on mid term follow-up and limitations. New prospective and multicentric studies are needed from our region.

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Complex congenital heart disease with pulmonary atresia is ductus arteriosus-dependent. Two palliative treatments have been available for years: a systemic pulmonary shunt and prostaglandin E1 infusion. Recently, interventional cardiology has offered a new procedure for these patients: stenting of the patent arterial duct. We report a case with univentricular heart and pulmonary atresia in which percutaneous balloon angioplasty and stenting of the arterial ductus were performed successfully. Nineteen months later the patient is in good clinical conditions with 75% of oxygen saturation.

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Complex congenital heart disease with pulmonary atresia is ductus arteriosus-dependent. Two palliative treatments have been available for years: a systemic pulmonary shunt and prostaglandin E1 infusion. Recently, interventional cardiology has offered a new procedure for these patients: stenting of the patent arterial duct. We report a case with univentricular heart and pulmonary atresia in which percutaneous balloon angioplasty and stenting of the arterial ductus were performed successfully. Nineteen months later the patient is in good clinical conditions with 75 of oxygen saturation.

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BACKGROUND: The double-chambered right ventricle (DCRV) is increasingly recognized as a distinct obstruction entity. The nature of the obstruction is not well defined. METHODS: Patients with DCRV were prospectively studied during the last 4 years according to the following criteria: 1) pressure gradient by echo Doppler and cardiac catheterization within the right ventricle; 2) angiographic demonstration, and 3) surgical confirmation. RESULTS: From March 1997 to March 2001, 10 new cases were included. Age ranged from 2 to 14 years (mean 9.5 +/- 4.4 years), weight ranged from 9.9 to 75 kg (mean 23 +/- 13.6 kg), and height from 0.85 to 1.48 m (mean 114 +/- 19 cm). Systolic gradient by echo Doppler ranged from 20 to 135 mmHg (mean 86 +/- 44 mmHg) and by cardiac catheterization, 18 to 130 mmHg (mean 78 +/- 35 mmHg). In terms of angiographic findings, in six patients the right ventriculogram showed an oblique and low obstruction; in four patients the obstruction was high and horizontal. With regard to surgical findings, angiographic findings were confirmed by the surgeon except in one patient, in whom both types of obstruction were present. No mortality was observed. With follow-up 4 to 40 months after surgery (mean 24 +/- 15 months), 8 of 10 patients were evaluated; all corresponded to class I NYHA. Systolic gradient by echo Doppler ranged from 0 to 11 mmHg (mean 4 +/- 6 mmHg). CONCLUSIONS: DCRV IS PRODUCED BY THE FOLLOWING THREE TYPES OF MUSCULAR OBSTRUCTIONS: low and oblique obstruction; high and horizontal obstruction, and mixed obstruction. Mid-term surgical results are satisfactory.

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INTRODUCTION: We analyzed the clinical and angiographic outcome, including follow-up, in diabetic, patients treated with percutaneous transluminal coronary angioplasty (PTCA) and stenting. MATERIAL AND METHODS: Between January 1995 and December 1999, 770 patients were treated with PTCA, 137 of them with diabetes (DM), 17.7% received 160 stents, average 1.16 stent/patient. Mean age was 58.70 +/- 8.44 years (range 35 to 80 years) and there were 92 men and 45 women. According to the clinical presentation, there were 54% with severe angina based on criteria from the Canadian Cardiovascular Society (CCS). Sixty two percent of patients had prior myocardial infarction and 68% had multivessel disease. Mean vascular obstruction was 90 +/- 6.3% and the ejection fraction was 45.3 +/- 8.7%. RESULTS: The immediate angiographic success was 94.4% in patients with DM. There were complications in 8.4% (acute myocardial infarction, and thrombosis). The average follow-up was 10 mouths (range 6 to 36) in 94% of the cases. The mortality was 4.3%. CONCLUSIONS: These results show that PTCA and stenting in patients with DM is a successful procedure, with few clinical and angiographics complications.

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INTRODUCTION: We analyzed the clinical and angiographic outcome, including follow-up, in diabetic, patients treated with percutaneous transluminal coronary angioplasty (PTCA) and stenting. MATERIAL AND METHODS: Between January 1995 and December 1999, 770 patients were treated with PTCA, 137 of them with diabetes (DM), 17.7 received 160 stents, average 1.16 stent/patient. Mean age was 58.70 +/- 8.44 years (range 35 to 80 years) and there were 92 men and 45 women. According to the clinical presentation, there were 54 with severe angina based on criteria from the Canadian Cardiovascular Society (CCS). Sixty two percent of patients had prior myocardial infarction and 68 had multivessel disease. Mean vascular obstruction was 90 +/- 6.3 and the ejection fraction was 45.3 +/- 8.7. RESULTS: The immediate angiographic success was 94.4 in patients with DM. There were complications in 8.4 (acute myocardial infarction, and thrombosis). The average follow-up was 10 mouths (range 6 to 36) in 94 of the cases. The mortality was 4.3. CONCLUSIONS: These results show that PTCA and stenting in patients with DM is a successful procedure, with few clinical and angiographics complications.

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