November 2007
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12 Reads
Radiología
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November 2007
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12 Reads
Radiología
November 2007
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11 Reads
Radiología
March 2003
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5 Reads
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1 Citation
Revista Portuguesa de Cardiologia
July 2000
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9 Reads
Revista Espa de Cardiologia
This report describes the unusual association between the interruption of the aortic arch type B and aortopulmonary window type II in a neonate. When the patient was 20 days old, a one-stage surgical repair was done through left side thoracotomy without circulatory by-pass, making a left carotid artery to descending aorta anastomosis, closing the window with a hemaclip, respectively. A routine 2-D Doppler color echocardiography performed in the immediate postoperative period showed the absence of blood flow in the right pulmonary artery. The patient required a new intervention, changing the position of the clip in order to restore the normal pulmonary blood flow. Eight months after surgery, the "neoaortic arch" grows in harmony with the body surface area, without signs of cerebral circulatory deficiency or significant gradient at any level.
March 2000
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24 Reads
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8 Citations
Revista Espa de Cardiologia
To analyze the efficacy of balloon pulmonary valvuloplasty (BPV) as the elective treatment for neonatal critical pulmonary valvar stenosis (PVS). The results of clinical and echocardiographic features before and after the BPV were reviewed in 29 neonates (18+/-12 days of life). Different hemodynamic and 2-D color Doppler echocardiographic were evaluated. The BPV result was classified as favourable if no other balloon or surgical therapy was required to normalise pulmonary flow and achieve a sustained right ventricle-pulmonary artery (RV-PA) Doppler gradient below 40 mmHg. It was considered unfavourable if the neonate died, needed surgery or redilation and/or the RV-PA Doppler gradient was > or =40 mm Hg. The study developed in three phases: pre BPV immediate post BPV until the hospital discharge (14+/-11 days), and in the mid-term follow-up of between 8 and 96 months (51+/-31 months). Mortality was not registered with BPV. The RV/left ventricular systolic pressure decreased from 1.4+/-0.3 to 0.8+/-0.3 (p<0.01) as a consequence of the dilation, and the the systemic oxygen saturation increased from 85 +/-12 to 92+/-6% (p<0.01). The RV-PA Doppler gradient diminished from 86+/-18 to 28+/-16 mm Hg immediately after BPV (p<0.01) and was registered at 13+/-6 mm Hg in the follow-up (n = 24). The RV-PA junction Z value grew from -1.25+/-0.9 before valvuloplasty to -0.51 +/-0.7 at the final echocardiogram (p<0.01). No changes in the tricuspid diameter were detected between both periods of time. Five neonates obtained unsatisfactory results: 4 in the immediate post BPV (systemic-pulmonary artery shunt 2, transannular patch 2), and 1 in the mid-term follow-up (valvectomy + transannular patch). The actuarial curve reflects that 82,7% of the patients were free form reinterventions at 8 years. BPV is safe and effective to relief PVS in the neonate. The balloon promotes advantageous changes in both, pulmonary annulus and the right ventricle. In addition, the RV-PA Doppler gradient observations in the follow-up, support the expectation that the BPV is a "curative" therapy.
March 1999
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9 Reads
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6 Citations
Revista Espa de Cardiologia
Catheter occlusion of the persistent ductus arteriosus with Rashkind device is an alternative to the surgical closure demonstrated in children, however a few results have been reported of occlusion in adults. From 1990 to 1996 in 127 patients with persistent ductus arteriosus undergoing occlusion by Raskind device. Two groups according age: 105 children (< 14 years) and 22 adults (> 14 years), were studied retrospectively. The results were analysed by immediate aortogram and follow-up at 24 hours, 6 and 12 months by color-Doppler echocardiograms. The adults were frequently asymptomatic (86%) and with high incidence (59%) of silent ductus. Similar QP/QS (1.61 +/- 0.47 in adults vs 1.49 +/- 0.51) was calculated although pulmonary pressure was superior in children (12.50 +/- 2.97 vs 16.84 +/- 5.88 mmHg; p = 0.003). In group > 14 years the ductal anatomy favorable (Krichenko type A or B) was more frequent (91% vs 73%; p = 0.06) and ductal diameter significantly higher (3.03 +/- 1.50 vs 2.41 +/- 0.96 mm; p = 0.009). In adults 17 mm umbrella were used more frequently (91 vs 61%; p = 0.02). Absence complications (embolization, bacteremia, haemolysis, proximal stenosis of the left pulmonary artery) were found in adults against 4.72% in children. The occlusion were more effective in adults specially in early controls: 55% vs 34% (p = 0.09), 82% vs 69%, 91% vs 77% and 95% vs 83% (p > 0.10). Multivariate analysis identified age as an independent predictor of complete occlusion. Our experience in transcatheter occlusion of persistent ductus arteriosus with Rashkind device in adults support the efficacy, safety and excellent early results despite higher incidence of silent asymptomatic ductus.
March 1999
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7 Reads
Revista Espa de Cardiologia
Introduction. Catheter occlusion of the persistent ductus arteriosus with Rashkind device is an alternative to the surgical closure demostrated in children, however a few results have been reported of occlusion in adults. Method From 1990 to 1996 in 127 patients with persistent ductus arteriosus undergoing occlusion by Rasking device. Two groups according age: 105 children (< 14 years) and 22 adults (> 14 years), were estudied retrospectively. The results were analysed by immediate aortogram and follow-up at 24 hours, 6 and 12 months by color-Doppler echocardiograms. Results. The adults were frequently asymptomatic (86%) and with high incidence (59%) of silent ductus. Similar QP/QS (1.61 +/- 0.47 in adults vs 1.49 +/- 0.51) was calculated although pulmonary pressure was superior in children (12.60 +/- 2.97 vs 16.84 +/- 5.88 mmHg; p = 0.003). In group > 14 years the ductal anatomy favorable (Krichenko type A or B) mas more frequent (91% vs 73%; p = 0.06) and ductal diameter significantly higher (3.03 +/- 1.50 vs 2.41 +/- 0.96 mm; p = 0.009). In adults 17 mm umbrella were used more frequenly (91 vs 61%; p = 0.02). Absence complications (embolization, bacteremia, haemolysis, proximal stenosis of the left pulmonary artery) were found in adults against 4.72% in children. The occlusion mere more effective in adults specially in early controls: 55% vs 34%, (p = 0.09), 82% vs 69%, 91% vs 77 % and 95% vs 83% (p > 0.10). Multivariate analysis identified age as an independent predictor of complete occlusion. Conclusion. Our experience in transcatheter occlusion of persistent ductus arteriosus with Rashkind device in adults support the efficacy, safety and excellent early results despite higher incidence of silent asymptomatic ductus.
October 1998
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7 Reads
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4 Citations
Anales Espanoles de Pediatria
To study medium-term follow-up in children with pulmonary stenosis (PS) with percutaneous balloon pulmonary valvuloplasty (PBVP). Medium-term follow-up results of 106 consecutive PBVP procedures in 100 patients of the same health center are presented. The mean age of the patients was 61.3 +/- 5.1 months, 31 of them with severe PS. After PBVP, and once infundibular contraction ceased, the procedure was defined as successful in 85 children. PBVP was repeated in five patients, achieving satisfactory results in 3. Eight patients suffered from re-stenoses and surgery was performed in 7 of them. The other 12 patients in which PBVP failed underwent surgery. Follow-up of these 88 patients showed a cessation in clinical symptomatology at a mean of 10 +/- 0.7 months. Five-year actuarial probability of achieving a normal EKG axis was 61.7 +/- 9.1%. However, neither ECG nor chest radiology were useful in the diagnosis of high residual gradients. Pulmonary regurgitation was observed in 92% of the children, mild in all of them. The residual transpulmonary gradient obtained immediately after PBVP was the only variable that affected long-term results. Our results confirm the medium-term success of PBVP in the treatment of PS. The five year actuarial probability of restenosis is 12.4%. Mild pulmonary regurgitation is observed in more than 90% of patients.
February 1998
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8 Reads
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2 Citations
Revista Espa de Cardiologia
The selection of patients for balloon aortic valvuloplasty is a vital clinical challenge in neonatal aortic stenosis. The present study was designed to establish possible predicting factors for poor results after balloon therapy. 2D echocardiographic, Doppler color and clinical variables (grade of cardiac failure, aortic "anulus", mitral anulus, left ventricular diameter, ascending aorta, instantaneous Doppler gradient, and grade of aortic regurgitation) were analyzed in 32 neonates submitted to balloon dilation at 22 +/- 18 days of life. The evaluations were conducted during three periods in respect to balloon therapy (A: before; B: immediately after, and C: mid-term follow-up). The outcome in both, B and C periods was defined as favorable (all survivors with Doppler gradient < or = 70 mmHg and no other intervention on the valve) and unfavorable (death, first stage of univentricularization, valvular replacement or survivors with Doppler gradient > 70 mmHg). Mean values between subgroups were compared by Wilcoxon test; unconditional logistic regression was used to analyze the impact of cardiac failure and anatomic variables (continuous, categorized or Z) on the outcome. The Doppler gradient decreased from 70 +/- 28 to 34 +/- 14 mmHg after the valvuloplasty, and no changes were detected in the follow-up period (36 +/- 8 mmHg). An immediate favorable result was obtained in 72% of the patients; its consisted of 50% in period C. Nine neonates had an immediate unfavorable outcome (6 deaths and 3 with Norwood operation). In the follow-up, three patients had valvular replacement, one patient Doppler gradient > 70 mmHg and one patient with left ventricular endomyocardial abnormalities died. The severe cardiac failure (odds ratio: 33; CL 2.4-443; p = 0.008) and all categorized anatomic variables (aortic "anulus" < or = 6 mm; mitral anulus < or = 9 mm; ascending aorta < or = 8 mm; left ventricular diameter < or = 13 mm) were related with the immediate poor outcome. At 7.6 years, survival and freedom with no valvular replacement nor reintervention probability rates were 83% and 67%, respectively. 2D echo Doppler provides essential information about the anatomic and functional lesions coexisting with severe or critical aortic stenosis in neonates. Patients with left heart hypoplasia and severe heart failure should not be candidates for balloon valvuloplasty. The degree of residual aortic regurgitation and endomyocardial abnormalities of the left ventricle play an important role in the mid-term follow-up.
February 1998
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3 Reads
Revista Espa de Cardiologia
Objectives. The selection of patients for balloon aortic valvuloplasty is a vital clinical challenge in neonatal aortic stenosis. The present study was designed to establish possible predicting factors for poor results after balloon therapy. Patients and methods. 2D echocardiographic, Doppler color and clinical variables (grade of cardiac failure, aortic << anulus >>, mitral anulus, left ventricular diameter, ascending aorta, instantaneous Doppler gradient, and grade of aortic regurgitation) were analyzed in 32 neonates submitted to balloon dilation at 22 +/- 18 days oflife. The evaluations were conducted during three periods in respect to balloon theraphy CA: before; B: immediately after, and C: mid-term follow-np). The outcome in both, B and C periods was defined as favorable Call survivors with Doppler gradient less than or equal to 70 mmHg and noother intervention on the valve) and unfavorable (death, first stage of univentricularization, valvular replacement or survivors with Doppler gradient > 70 mmHg). Mean values between subgroups were compared by Wilcoxon test; unconditional logistic regression was used to analyze the impact of cardiac failure and anatomic variables (continuous, categorized or Z) on the outcome. Results. The Doppler gradient decreased from 70 +/- 28 to 34 +/- 14 mmHg after the valvuloplasty, and no changes were detected in the follow-up period (36 +/- 8 mmHg). An immediate favorable result was obtained in 72% of the patients; its consisted of 50% in period C. Nine neonates had an immediate unfavorable outcome (6 deaths and 3 with Norwood operation). In the follow-up, three patients had valvular replacement, one patient Doppler gradient > 70 mmHg and one patient with left ventricular endomyocardial abnormalities died. The severe cardiac failure (odds ratio: 33; CL 2.4-443; p = 0.008) and all categorized anatomic variables (aortic << anulus >> less than or equal to 6 mm; mitral anulus less than or equal to 9 mm; ascending aorta less than or equal to 8 mm; left ventricular diameter less than or equal to 13 mm) were related with the immediate poor outcome. At 7.6 years, survival and freedom with no valvular replacement nor reintervention probability rates were 83% and 67%, respectively. Conclusions. 2D echo Doppler provides essential information about the anatomic and functional lesions coexisting with severe or critical aortic stenosis in neonates. Patients with left heart hypoplasia and severe heart failure should not be candidates for balloon valvuloplasty. The degree of residual aortic regurgitation and endomyocardial abnormalities of the left ventricle play an important role in the mid-term follow-up.
... Percutaneous balloon valvuloplasty has proved to be an effective method for abolishing the gradient between the left ventricle and the aorta in children with congenital aortic stenosis [3][4][5][6] , with a small midterm frequency of restenosis [7][8][9] . Although studies concerning this pathology are increasing, the experience regarding its performance in the neonate period is still limited [10][11][12][13][14] . Because surgical treatment of aortic stenosis in neonates is associated with significant morbidity and mortality [15][16][17][18][19] , even though it has become more promising in this last decade [20][21][22][23] , the treatment with percutaneous balloon valvuloplasty may play an important therapeutical role in this special group of patients. ...
February 1998
Revista Espa de Cardiologia
... Immediate, short and intermediate results of BPV have been well documented (5)(6)(7). However, documented data on long term follow up are scare (8)(9)(10)(11). The purpose of this study is to describe the results of long-term follow up of BPV in 96 patients with congenital pulmonary valve stenosis. ...
October 1998
Anales Espanoles de Pediatria
... Porstmann et al were the first to report the percutaneous closure of a patent ductus arteriosus (PDA). 1 During the 1960s, Rashkind designed the "double umbrella" device, which was later used extensively. [2][3][4][5] In the 1990s Gianturco coils were used 6 and then Jackson coils with a controlled release system. 7 Later on, devices appeared with different anchoring and release systems, such as the Sideris button, 8 the Grifka bag 9 and the Amplatzer device. ...
March 1999
Revista Espa de Cardiologia
... In our study, the mean diameter of PVA as well as TVA were significantly increased after BPV during the period of follow-up starting at 3 months after BPV compared to their pre-BPV values indicating the growth of both PV and TV. These findings were in accordance with the results published by other researchers [3,13,14]. ...
March 2000
Revista Espa de Cardiologia