RESUMO
The difficult performance of certain percutaneous interventions in the field of congenital heart disease is well known. Crossing pulmonary arteries in patients who have previously undergone surgical repair or stenotic pulmonary veins in infants can be typical examples of these technical challenges in the catheterization laboratory. The Venture wire 6 Fr control catheter (St Jude Medical) is compatible with a steerable tapered radiopaque tip that can be manually angulated (up to 90°) by clockwise rotation of a knob located in the proximal handle. This mechanism directs any 0.014â³ guidewire and provides back-up support. This catheter has been successfully used in coronary artery intervention for crossing severely tortuous vessels, extreme angulations of side-branch ostia, jailed stents, saphenous vein graft anastomoses, and chronic total occlusions. We report the first use of the Venture wire control catheter (St Jude Medical) in the field of congenital heart disease. Patient #1 was diagnosed with pulmonary atresia and ventricular septal defect and had a proximally migrated stent in the pulmonary trunk and severe left pulmonary artery stenosis. We have used this catheter in order to cross this stent and perform left pulmonary artery stent placement. Patient #2 had postoperative vein restenosis after surgery. The Venture catheter was used to reach the obstructed insertion of the right medium lobe pulmonary vein from a transseptal approach. Techniques from coronary interventional colleagues can help interventional cardiologists in the field of congenital heart disease to treat complex situations.
Assuntos
Cateteres Cardíacos , Intervenção Coronária Percutânea/instrumentação , Atresia Pulmonar/terapia , Estenose da Valva Pulmonar/terapia , Criança , Cardiopatias Congênitas/patologia , Cardiopatias Congênitas/terapia , Humanos , Lactente , Masculino , Intervenção Coronária Percutânea/métodos , Artéria Pulmonar/patologia , Atresia Pulmonar/patologia , Estenose da Valva Pulmonar/patologia , Veias Pulmonares/patologia , Resultado do TratamentoRESUMO
OBJECTIVES: The aim of this article is to report a 16-year experience with percutaneous balloon aortic valvuloplasty (BAVP) in newborns and young infants up to 3 months of age in a tertiary care cardiac reference center in a developing country and to determine its value in postponing open heart surgery. BACKGROUND: Congenital aortic stenosis (AS) is a potentially life threatening disorder. BAVP and surgical procedures have similar short and medium-term efficacy. METHODS: Thirty-one consecutive newborns and young infants with critical AS underwent BAVP in our department from 1991 to 2007. Mean patient age at time of the procedure was 22 days (range 2-92 days) and mean weight was 3,310 g (1,840-4,400 g). RESULTS: There was a significant reduction in mean Doppler-derived peak gradient across the aortic valve immediately after the procedure (75.1 ± 22 versus 32.2 ± 13.02, P < 0.001), and this finding was maintained throughout follow-up. Since 2003, when the carotid approach became routine practice, no major vascular complications were observed. Mean time of follow-up was 81 months (5 days-196 months) with only two deaths (7.4%). Only 24% patients required surgical reintervention on the aortic valve during follow-up. Survival free from aortic valve surgery was 80% at 24 months, 66% at 63 months, and 50% at 80 months. CONCLUSION: Percutaneous intervention for relief of critical aortic stenosis in newborns in a tertiary center of a developing country is safe and has excellent short and long-term results comparable to other centers throughout the world.
Assuntos
Estenose da Valva Aórtica/terapia , Artérias Carótidas , Cateterismo/métodos , Artéria Femoral , Estenose da Valva Aórtica/congênito , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Brasil , Procedimentos Cirúrgicos Cardíacos , Cateterismo/efeitos adversos , Cateterismo/mortalidade , Países em Desenvolvimento , Intervalo Livre de Doença , Ecocardiografia Doppler , Feminino , Hemodinâmica , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Masculino , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
A partir da década de 60, os bloqueadores dos canais de cálcio, também chamados antagonistas do cálcio, têm demonstrado sua utilidade terapêutica para uma grande variedade de doenças cardiovasculares. Existem três subgrupos: 1) derivados diidropiridínicos (nifedipina); 2) derivados da papaverina (verapamil); 3) derivados benzotiazepínicos (diltiazem), que possuem efeitos conhecidos e sao disponíveis em nosso meio. Este artigo resume as importantes características dessas drogas, bem como seu uso no tratamento da hipertensao arterial, cardiopatia isquêmica, arritmias cardíacas e outras condiçoes da prática médica.
Assuntos
Humanos , Bloqueadores dos Canais de Cálcio/farmacologia , Bloqueadores dos Canais de Cálcio/uso terapêutico , Interações MedicamentosasRESUMO
Os autores realizaram um estudo retrospectivo de 263 videolaparoscopias ginecológicas durante o período de maio/92 a abril/94 no Hospital Pompéia. Os dados avaliados foram idade, procedência, indicaçoes, hipóteses diagnósticas, achados diagnósticos, procedimentos realizados, duraçao, complicaçoes e conversoes à laparotomia. Em relaçao à literatura os achados sobrepoem-se quando comparadas as complicaçoes e a validade da técnica. Os autores concluem que a videolaparoscopia é um método eficaz e definitivo na propedêutica ginecológica atual.