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Conducto arterioso en el adulto: Tratamiento transcateterismo. Resultados inmediatos y a mediano plazo
García-Montes, José Antonio;Zabal Cerdeira, Carlos;Calderón-Colmenero, Juan;Juanico Enríquez, Antonio;Cardona Garza, Alejandro;Colín Ortiz, José Luis;Buendía Hernández, Alfonso;
Archivos de cardiología de México , 2006,
Abstract: introduction: the anatomic changes of the patent ductus arteriosus (pda) in adult patients, such as aortic aneurysm, calcification, or being short and sometimes friable, could complicate the surgical treatment. the transcatheter occlusion of pda with different devices is currently accepted as safe and effective. we presented our experience with percutaneous occlusion of pda in adult patients by means of three different devices. methods and results: between january 2000 and march 2005, 53 adult patients (47 women and 6 men) with pda were treated for occlusion by means of percutaneous procedures. average age was 25.3 years (range, 16 to 54.7 years). three different devices were used, 39 patients with amplatzer for ductus arteriosus, 1 patient with amplatzer for muscular interventricular communication, 11 with gianturco coils, and 1 patient with nit-occlud. all devices were implanted successfully. immediate complete closure was achieved in 31 patients (58.4%), in 20 patients (37.7%) with minimal leakage, and in 2 patients (3.89%) with moderate leak. previous systolic pulmonary pressure had an average of 37.08 ± 22.8. mm hg (range: 12-138 mm hg) and went down to 28.75 ± 10.25 mm hg (range: 16-57 mm hg) with p d-0.001. the average time follow-up was of 16.8 months (range: 0.9 to 51.8 months) the occlusion was completed in 100%, in neither patients were observed complications related to implant of the devices.
Cierre percutáneo del conducto arterioso persistente con dispositivo Amplatzer en ni?os: resultados inmediatos y a un a?o
Parra-Bravo, J Rafael;Cruz-Ramírez, Arturo;Toxqui-Terán, Alejandra;Juan-Martínez, Enriqueta;Chávez-Fernández, Alejandro;Lazo-Cárdenas, César;Beirana-Palencia, Luisa;Estrada-Flores, José;
Archivos de cardiología de México , 2009,
Abstract: objective: percutaneous closure of patent ductus arteriosus (pda) is a well established technique. our objective was to determine the safety and efficacy of the amplatzer occluder for the treatment of pda in children. methods: from november 2005 to june 2007 we reviewed the clinical records of 39 patients (23 girls and 16 boys), with a mean age of 19.8 ± 13.7 months and weight 9.2 ± 3.2 kg, who underwent percutaneous closure of a pda with an amplatzer device. the forty one percent of the patients (16/39) were < 1 year of age, and 71.8 % (28/39) weighed < 10 kg. the age of children with body weight < 10 kg was 13.1 ±6.1 months (range 5-33 months). the morphology of the pda was determined by a lateral aortogram and classified according to krichenko. all the patients were followed-up with radiologic and echocardiographic control at 24 hours, 1, 3, 6 and 12 months postinsertion (median 20 months). results: the pda diameter ranged between 2.0 mm to 12 mm (3.6 mm ± 2.0 mm) in the 39 patients included. pda types according to krichenko were: type a = 25 (64.1%), type b = 1 (2.6%), type c = 5 (12.8%), type d = 2 (5.1%) and type e = 3 (7.7%). three patients had a residual pda post-surgical closure attempt. qp/qs ratio was 2.4 ± 1.5 (range 1.0-6.7) and the relation psp/pss was 0.49 ± 0.18 (range: 0.21-0.87). pulmonary hypertension was present in 16 patients (41%). the amplatzer occluder was implanted successfully in 36/39 patients (92.3%). the procedure failed in three cases: 1) difficulty to place the device due to wrong assessment of the ductus size; 2) difficulty to advance the device due to angulation (kinking) of the releasing system; 3) migration of the device to descending aorta. the mean time of fluoroscopy and for the entire procedure was 13.2 ± 6.3 minutes and 65.3 ± 21.9 minutes, respectively. there were no deaths with the procedure. minor and mayor complications occurred in eight patients, all of them but one, in children with body weight < 10 kg. in the 36 success
Efectividad de la Indometacina en el cierre del Conducto Arterioso Persistente en recién nacidos Pretérmino de la Maternidad "Concepción Palacios"
B Fernández,C Méndez,M de L da Silva,F Rumbao
Revista de la Facultad de Medicina , 2003,
Abstract: RESUMEN. Objetivo: Determinar la efectividad de la indometacina en el cierre del conducto arterioso en recién nacidos pretérmino. Métodos: Se realizó un estudio prospectivo, descriptivo y comparativo en 90 recién nacidos con persistencia del conducto arterioso que recibieron indometacina entre enero de 1996 y diciembre de 1999. Cada ciclo constó de tres dosis de indometacina. Ambiente: Maternidad "Concepción Palacios". Resultados: Todos los recién nacidos estudiados presentaron sepsis, 83,3% presentó anemia, 71,1% trastornos metabólicos, 68,9% acidosis metabólica, 43,3% tuvo alteraciones hemodinámicas, 34,4% sobrehidratación y 11,1% barotrauma. El 66,7% de los recién nacidos requirió 1 ciclo de indometacina para lograr el cierre del conducto. Los recién nacidos que presentaron anemia, estados hipervolémicos y barotrauma necesitaron más ciclos de indometacina. Conclusión: La indometacina, tiene una efectividad del 66,7% en el cierre del conducto arterioso persitente. ABSTRACT: Objective: Determine the effectiveness of indomethacin in the closure of the ductus arteriosus in preterm newborn. Methods: It was made a prospective, descriptive and comparative study in 90 premature newborn with patent ductus arteriosus who received indomethacin between January, 1996 and December 1999. Each cycle consisted of three doses of indomethacin. Place: Maternidad "Concepción Palacios". Results: All patients had sepsis, 83.3% anemia, 71.1% metabolic upheavals, 68.9% metabolic acidosis, 43.3% hemodinamic alterations, 34.4% water overload and 11.1% barotrauma. Sixty newborn (66,7%) required one indomethacin cycle in order to the ductus closure. Childhood with anemia, hypervolemia and/or barotrauma needed more indomethacin cycles. Conclusion: The indometacin had 66,7% of effectiveness for the closure of ductus arteriosus.
Tratamiento de la persistencia del conducto arterioso con el coil desprendible de gianturco
Rafael Gutiérrez,Abdón Castro,Nubia Berrios,Carlos Mas
Revista Costarricense de Cardiología , 2000,
Abstract: Se encontraron 43 pacientes con persistencia del conducto arterioso en un período de 26 meses. Dos pacientes tenían además una estenosis pulmonar valvular y tres pacientes defectos septales (dos comunicaciones interventriculares y un canal AV). Se observaron tres casos con migración del coil a la pulmonar, de los cuales se logró extraer dos. El tama o del coil más usado es el de 5 mm y cinco vueltas y el siguiente es el de 8 mm y cinco vueltas. Cuatro pacientes ameritaron dos coils para cerrar el conducto arterioso. En siete pacientes se encontró hipertensión arterial pulmonar de leve a moderada de los cuales cinco eran síndrome de Down. El diámetro del ductus más frecuentemente observado fue el de 2 mm. con una variación de 1,7 a 4 mm. La edad al momento del cierre varió de 6 meses a 10 a os con una media de 42,9 meses +-26,3 meses; el peso varió de 7 a 30 kilos con una media de 14,9 kilos+-5,5 kilos. We found 43 patients with patent ductus arteriosus in a period of 26 months. Two patients had a pulmonary valve stenosis and three patients show septum defects( ventricular septal defect in two and one with an AV canal). We have three patients with migration of the coil to the pulmonary artery without consequences. The size of the coil more frequently used was 5 mm and 5 loops. Four patient need two coils for closure of the PDA. Seven patients show pulmonary hypertension from mild to moderate, five of them were Down syndrome. The diameter of the ductus more frequently observed was 2 mm. The age at the moment of the closure was 6 months to 10 years mean 42,9 months+-26,3 months; the weight was from 7 kilos to 30 kilos mean 14,9+-5,5 kilos.
Cierre percutáneo del conducto arterioso permeable utilizando el Amplatzer vascular Plug II
Parra-Bravo, Rafael;Beirana-Palencia, Luisa;Corona-Rodríguez, Antonio;Alarcón-Elguera, Laura;Tejeda-Hernández, Norma;Aguilar-Segura, Perla;Lazo-Cárdenas, César;Arellano-Llamas, Abril;
Archivos de cardiología de México , 2011,
Abstract: the amplatzer vascular plug ii (avp ii) is a self-expanding occluder device, indicated for arterial and venous occlusion in the peripheral circulation. objective: to describe our initial clinical experience with the avp ii, in the percutaneous closure of small patent ductus arteriosus. method: we retrospectively analyzed seven patients who underwent percutaneous closure of patent ductus arteriosus. the avp ii was chosen with a diameter greater than 50% of the minimum diameter of the ductus arteriosus. results:patients showed a ductus arteriosus with a diameter of 1.5 ± 1.4 (range: 0.8 - 4.7mm). successful implant was achieved with adequate angiographic occlusion in 6 patients. one patient was sent to surgery. we only found a major complication. transthoracic echocardiography at 24 hours, confirmed the complete occlusion in this patients. the follow-up was 10.6 ± 9.1 months. conclusion: the avp ii in this group of patients was shown to be safe and effective for percutaneous closure of patent ductus arteriosus.
Cierre de conducto arterioso persistente con dispositivo Nit-Occlud: Experiencia de 13 casos
Munayer Calderón, Jaime E;Aldana Pérez, Tomás;Lázaro Castillo, José Luis;San Luis Miranda, Raúl;Ramírez Reyes, Homero;Amaya Hernández, Antonio;Carpio Hernández, Juan C;
Archivos de cardiología de México , 2005,
Abstract: we report our experience with the percutaneous closure of patent ductus arteriosus with a nit-occlud device made of nitinol (nickel-titanium alloy) in 13 patients; 10 women and 3 men, average age of 23.2 ±21.1 years. average diameters were 3.8 + 0.8 mm and the morphologies, according to krichenko's classification, were 10 type a, 2 type e, and 1 type c. the device was selected according to the aortic ampule and the narrowest part of the ductus. we implanted 8 occluders of 11 x 6 mm, 4 of 9 x 6 mm, and 1 of 7 x 6 mm. in three patients (25%) total occlusion was observed 15 minutes after implantation, in seven (54%) a trivial leak was observed, and in only two patients (16.6%) was the leak moderate to severe. in on patient, the occluder migrate to the pulmonary artery trunk and was successfully removed percutaneously; the patient was subjected then to surgical closure. echocardiography follow-up 24 h later showed total occlusion in nine patients (69%). six months after the procedure, two patient presented trivial leak (15%). one patient developed an endocarditic infection and died. we concluded that this occluder might be useful for this pathology, but further studies must be done.
Cierre percutáneo de la comunicación interventricular perimembranosa con el dispositivo de Amplatzer?: Resultados inmediatos y a mediano plazo
Zabal, Carlos;García Montes, José Antonio;Calderón Colmenero, Juan;Patino Bahena, Emilia;Buendía Hernández, Alfonso;Attie, Fause;
Archivos de cardiología de México , 2005,
Abstract: object: to report the immediate and mid-term follow-up results of the amplatzer? membranous vsd occluder for the percutaneous occlusion of the perimembranous vsd. background: percutaneous perimembranous vsd occlusion is still considered an experimental method where a variety of devices have been tested. nowadays, more than 500 membranous amplatzer? devices have been implanted worldwide with encouraging results. method: we included 6 patients (1 man and 5 women) with a mean age of 9.9 years (range, 3 to 17.5) in whom percutaneous perimembranous vsd closure was attempted. results: in one of the patients, positioning of the device was not possible (intention to treat success rate, 83.3%). in the remaining five patients, there was a single defect. the vsd mean diameter with echo was 7 ± 1.7 mm (range, 5.1 to 9) and with angio was 6.9 ± 1 (range, 6 to 8). mean pulmonary pressure was 20.2 ± 7.7 mm hg (range, 12-30) and qp/qs was 1.69 ± 0.65 (range, 1.2-2.8). a single device was use in all cases. immediate angiographic control showed complete occlusion in two patients, trivial shunt in one, and mild shunt in two. follow-up was at least 4 months. only one patient has residual trivial shunt, the rest of the defects are completely closed. conclusion: the special design of the amplatzer? membranous vsd occluder allows percutaneous closure of this defect in a safe and effective way, with good mid-term results. in se lected cases, this is a good alternative to surgery in the treatmen of this cardiac defect.
Cierre transcatéter de ductus arterioso persistente Transcatheter closure of patent ductus arteriosus
Alejandro álvarez J,Yanessa Carrillo R,Eugenio Sanhueza H,Rodrigo Nazal L
Revista chilena de pediatría , 2012,
Abstract: El cierre percutáneo del ductus arterioso persistente (DAP) es una técnica bien establecida y es la primera elección en esta patología. Objetivo: Comunicar nuestra experiencia pionera en la región, de los primeros 6 casos tratados percutaneamente de DAP cuyo diámetro menor fue inferior a 3 mm, cerrados con técnica transcatéter con coil de liberación controlada. Pacientes y Método: Desde diciembre de 2010 a septiembre de 2011 se han intervenido en el Hospital Las Higueras de Talcahuano con cateterismo intervencional 6 pacientes de sexo femenino portadoras de DAP. Tres eran portadoras de un ductus Krichenko A1, dos ductus de tipo Krichenko A2 y uno de tipo E. Bajo anestesia general, se efectuó sondeo cardíaco vía arteria femoral y aortografía. Con un catéter multipropósito se canalizó el ductus y a través de este se avanzó el coil, efectuando el cierre del defecto desde extremo pulmonar al aórtico con el coil de liberación controlada (COOK R). Resultados: En todos los pacientes se logró cierre angiográfico ductal, sin shunt residual a la ecocardiografía previo al alta. El procedimiento duró un promedio de 55 minutos, el tiempo de fluoroscopia promedio fue de 14 minutos y no se registraron complicaciones, los pacientes fueron dados de alta al día siguiente de la intervención, post radiografía tórax y ecocardiograma. En los controles posteriores las ninas se encuentran asintomáticas, con dispositivo in sede a los controles ecocardiográficos. Conclusión: El cierre de DAP por vía percutánea es una técnica efectiva, segura y menos invasiva, realizada hace alg n tiempo en nuestro país en la capital, siendo este el primer reporte regional. Percutaneous closure of patent ductus arteriosus (PDA) is a wellknown technique and is the first choice for this condition. Objective: To report our pioneer experience in the region, the first 6 percutaneously treated PDA cases. The smallest diameter was less than 3 mm and they were closed using transcatheter technique with controlled-release coils in Las Higueras Hospital, Talcahuano. Patients and Methods: Between December, 2010 and September, 2011, six female patients carrying PDA were treated via interventional catheterization. Three presented a type A1 from Krichenko ductus arteriosus, two patients of the type A2 and one patient of the type E. Under general anesthesia, cardiac catheterization was performed via the femoral artery and aorto-graphy. The ductus was reached using a multipurpose catheter and through this, the coil was inserted closing the abnormality from the pulmonary to the aortic end using the controlled-rele
Cierre transcatéter de ductus arterioso persistente con espirales de Gianturco Transcatheter ductal closure technique using Gianturco coils
Felipe Heusser R.,Cristián Clavería R.,Claudia Trincado G.,Francisco Garay G.
Revista chilena de pediatría , 2001,
Abstract: Objetivo: evaluar retrospectivamente el rendimiento del cierre del ductus arterioso persistente (DAP) con técnica transcatéter, utilizando espirales (coils) de Gianturco. Pacientes y Método: entre octubre de 1996 y septiembre de 2000, 22 pacientes de peso mayor de 10 kg (10,5 a 59), portadores de DAP de hasta 4 mm en su diámetro menor, fueron sometidos a esta técnica de cierre. Bajo sedación con midazolam y ketamina, se efectuó sondeo cardíaco vía arteria y vena femoral derechas, y aortografía. Por medio de un catéter multipropósito se avanzó espiral de Gianturco a través del ductus desde su extremo aórtico hasta posicionarlo en el DAP. Resultados: se logró cierre angiográfico ductal en 22 pacientes (100%), observándose mínima filtración residual por ecocardiograma con Doppler color en 3 pacientes (14%), consignándose ausencia de filtración a los 15 días en dos de ellos. Todos los pacientes fueron dados de alta a las 24 horas. Cuatro pacientes presentaron embolización del espiral, los que fueron recuperados durante el procedimiento. Conclusión: el cierre transcateterismo de DAP con espirales de Gianturco es una técnica segura y efectiva, constituyendo una muy buena alternativa al cierre quirúrgico, con el beneficio adicional de no requerir anestesia general ni toracotomía. A retrospective review of our experience of the transductal closure technique using Gianturco coils (GC). Patients and Methods: Between october 1996 and september 2000, 22 patients with patent ductus arteriosus (PDA) of a diameter of 4mm or less, and a body weight of at least 10 kg (10.5-59) underwent transcatheter closure using GC, and sedation with iv midazolam and ketamine. Cardiac catheterization using the right femoral artery and vein with aortic angiography were performed. Subsequently a 4 French multipurpose catheter was passed through the ducts from the aortic side and a GC introduced and installed in the PDA. Results: Ductal closure was obtained in 22 patients (100%), 3 (14%) had minimal filtration, demonstrated by colour Doppler, that in 2 disappeared 15 days later. All patients were discharged within 24 hours post-procedure. 4 had embolization of the coil, which in all cases was retrieved during the procedure. Conclusion: Transcatheter ductal closure with GC is a safe and effective technique, that provides an excellent alternative to surgical closure, with the additional benefit of not requiring a general anaesthesia or thoracotomy
Cierre percutáneo de conducto arterioso y de comunicación interventricular muscular con dispositivos de Amplatzer en paciente con hipertensión pulmonar acentuada
García-Montes, José Antonio;Zabal Cerdeira, Carlos;Calderón-Colmenero, Juan;Espinóla, Nilda;Fernández de la Reguera, Guillermo;Buendía Hernández, Alfonso;
Archivos de cardiología de México , 2005,
Abstract: surgical treatment of multiple muscular ventricular septal defects with associated lesions and severe pulmonary hypertension has a high morbility and mortality. closure of these defects by the amplatzer muscular vsd occluder is an alternative to surgery, avoiding the need of cardiopulmonary bypass. we present the case of a 38 year-old woman with signs of heart failure in nyha functional class iv, with two muscular ventricular septal defects, patent ductus arteriosus and severe pulmonary hypertension, that were treated with three amplatzer muscular vsd occluders, with significant reduction of pulmonary pressure and functional class improvement.
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