Epidemiología del diagnóstico prenatal de defectos congénitos en la provincia de Holguín / Epidemiology of prenatal diagnosis of congenital defects in Holguín province

Introducción: En Cuba, los defectos congénitos constituyen la segunda causa de muerte en niños menores de un año, por lo cual ocupan un lugar prioritario en los programas médicos sociales del país. Objetivo: Evaluar el comportamiento epidemiológico del diagnóstico prenatal de los defectos congénitos en Holguín, Cuba. Métodos: Se realizó un estudio descriptivo y transversal de la epidemiología de los defectos congénitos en la provincia de Holguín, Cuba, en el periodo de enero 2011- junio de 2020. Resultados: Los años con mayor número de defectos congénitos diagnosticados fueron: 2011, 2012, 2017 y 2018 con 308, 253, 290 y 236 pacientes, respectivamente. Los defectos congénitos más frecuentes fueron: cardiovasculares (comunicación interventricular, canal auriculoventricular, transposición de grandes vasos e hipoplasia de cavidades), renales (pielocaliectasia, hidronefrosis, riñones poliquísticos), y del sistema nervioso central (ventriculomegalia, hidrocefalia). El grupo de edad materna donde se realizó mayor número de diagnósticos fue entre 20-24 años, la mayoría en el segundo trimestre de la gestación; en el primer trimestre, el mayor número de defectos congénitos correspondió a los defectos de pared anterior. La tasa de mortalidad infantil por defectos congénitos se mantuvo estable en la mayoría de los años estudiados. Conclusiones: La estabilidad y perfeccionamiento del programa de diagnóstico prenatal de los defectos congénitos, y el asesoramiento genético adecuado, han tenido un resultado epidemiológico favorable en la provincia.

Introduction: congenital defects in Cuba are the second cause of death in children under one year of age that is why they occupy a priority place in the social medical programs of the country. Objective: to evaluate the epidemiological manifestation of the prenatal diagnosis of congenital defects in Holguín, Cuba. Methods: a descriptive and cross-sectional study of the epidemiology of birth defects was carried out in Holguín province, Cuba from January 2011 to June 2020. Results: the years with the highest number of diagnosed birth defects were 2011, 2012, 2017 and 2018 with 308, 253, 290 and 236 patients, respectively. The most frequent birth defects were cardiovascular (ventricular septal defect, atrioventricular canal, transposition of the great vessels and hypoplasia of cavities), renal (pyelokaliectasia, hydronephrosis and polycystic kidneys), and central nervous system (ventriculomegaly and hydrocephalus). The maternal age group in which the highest number of diagnoses was made was between 20-24 years, mostly in the second trimester of pregnancy; the largest number of congenital defects in the first trimester corresponded to anterior wall defects. The infant mortality rate due to congenital defects remained stable in most of the years studied. Conclusions: the stability and improvement of the prenatal diagnosis program for congenital defects, as well as an adequate genetic counseling, have had a favourable epidemiological result in the province.

Clinical and anatomopathological descriptions of dog with arterious Hemitruncus: case report / [Descrições clínicas e anatomopatológicas de cão com hemitruncus arterioso: relato de caso

The anomalous origin of the pulmonary trunk in the ascending aorta, defined as arterious hemitruncus, is a rare congenital malformation in dogs, caused by a defect in the spiral septum. Thus, given the unusual occurrence in the canine species, the systemic severity and the high lethality, the aim of this study was to describe this heart disease in a three-month-old male German Spitz puppy, emphasizing clinical changes of the necropsy and microscopics. The animal had cyanosis, dyspnea and weakness and was forwarded for necropsy after sudden death. Numerous changes were detected in the post-mortem examination, including in the heart, as cardiomegaly and absence of the arterial ligament, which was replaced by the complete fusion between the ascending aorta and the pulmonary trunk, after leaving both the left and right ventricles, respectively and, among the microscopic findings, cardiomyocyte hypertrophy stood out. The association of these findings with the history indicated the diagnosis of arterious hemitruncus followed by cardiorespiratory failure, emphasizing the importance of out complementary cardiological exams in young symptomatic patients for the survival of those affected. Arterious hemitruncus, although rare, must be added in the differential diagnosis of other heart diseases that cause similar clinical signs.(AU)

A origem anômala do tronco pulmonar em aorta ascendente, definida como hemitruncus arterioso, é uma malformação congênita rara em cães, causada por defeito no septo espiral. Assim, diante da ocorrência incomum na espécie canina, da gravidade sistêmica e da alta letalidade, o objetivo deste trabalho foi descrever essa doença cardíaca em um filhote de três meses de idade, macho, Spitz Alemão, enfatizando as alterações clínicas, de necropsia e microscópicas. O animal apresentava cianose, dispneia e fraqueza e foi encaminhado para necropsia após morte súbita. Inúmeras alterações foram detectadas no exame post-mortem, inclusive no coração, como cardiomegalia e ausência do ligamento arterioso, o qual foi substituído pela fusão completa entre aorta ascendente e tronco pulmonar, após a saída de ambas dos ventrículos esquerdo e direito, respectivamente, e, dentre os achados microscópicos, destacou-se a hipertrofia de cardiomiócitos. A associação desses achados com o histórico indicou o diagnóstico de hemitruncus arterioso seguido de insuficiência cardiorrespiratória, ressaltando-se a importância de exames complementares cardiológicos em pacientes jovens sintomáticos na sobrevida dos acometidos. O hemitruncus arterioso, apesar de raro, deve ser acrescido no diagnóstico diferencial de outras cardiopatias que causam sinais clínicos similares.(AU)

Cor triatriatum sinister, una anomalía clásica pero un tanto olvidada: A propósito de un caso / Cor triatriatum sinister, a classic but somewhat forgotten anomaly: Apropos of a case

RESUMEN Un corazón con tres aurículas, que sumaba cinco cámaras en total, fue un hecho que sorprendió a la medicina hace ya más de un siglo. Este raro defecto cardíaco congénito tiene muy baja incidencia, lo cual hace que sea muy poco conocido por las jóvenes generaciones de médicos dedicados a las enfermedades cardiovasculares. El cor triatriatum sinister generalmente se diagnostica en la temprana infancia y es considerado una causa congénita de estenosis mitral. La conducta quirúrgica es de elección para poder liberar el obstáculo al adecuado flujo sanguíneo a través de la aurícula izquierda. Se presenta el caso de un adulto joven con síntomas típicos de estenosis mitral, sin aparentes elementos claves al examen físico y con un ecocardiograma que evidencia esta anomalía, apenas vista y publicada en nuestro medio en pacientes adultos.

ABSTRACT A heart with three atria, totaling five chambers in all, was a fact that surprised medicine more than a century ago. This rare congenital heart defect has a very low incidence, which makes it very little known to the young generations of doctors dedicated to cardiovascular diseases. The cor triatriatum sinister is usually diagnosed in early childhood, and it is considered a congenital cause of mitral stenosis. Surgical approach is the choice to release the obstacle in order to adequate blood flow through the left atrium. We present the case of a young adult with typical symptoms of mitral stenosis, without apparent key elements on the physical examination and that the echocardiogram showed this anomaly, hardly seen and published in our field in adult patients.

Surgical strategies and results for repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals: experience of a single tertiary center

Abstract Objective: To evaluate surgical management and results of patients with pulmonary atresia and ventricular septal defect with major aortopulmonary collateral arteries (PA/VSD/MAPCAs). Methods: We reviewed a consecutive series of patients with PA/VSD/MAPCAs between January 2012 and October 2018. Study patients were separated into Group A, efficient MAPCAs; Group B, hypoplastic MAPCAs; Group C, severe hypoplastic MAPCAs at all divisions; and Group D, distal stenosis at most MAPCAs divisions. Results: Thirty-six patients were included in the study. Median age at operation time was 5.5 months (2-110 months), median weight was 8 kg (2.5-21 kg), and median number of MAPCAs was three (1-6). In Group A, 14 patients underwent single-stage total correction (TC); in Group B, 18 patients underwent unifocalization and central shunting; and in Group C, four patients had aortopulmonary window creation and collateral ligation. No patient was placed in Group D. Seventy percent of patients (n=25) had the TC operation. Early mortality was not seen in Group A, but the other two groups had a 13.6% mortality rate. At the follow-up, three patients had reintervention, two had new conduit replacement, and one had right ventricular outflow tract reconstruction. Conclusion: Evaluating patients with PA/VSD/MAPCAs in detail and subdividing them is quite useful in determining the appropriate surgical approach. With this strategy, TC can be achieved in most patients. Single-stage TC is better than other surgical methods due to its lower mortality and reintervention rates. Care should be taken in terms of early postoperative intensive care complications and reintervention indications during follow-ups.

Clinical and Epidemiological Profiles of Patients Admitted to a Pediatric Cardiac Intensive Care Unit

Abstract Background: Congenital and acquired heart diseases are important causes of morbidity and mortality in children. In critical congenital heart defects, when treatment is not adequate, clinical manifestations may lead to death in the neonatal period. Objective: To establish the clinical and epidemiological profile of patients admitted to the pediatric cardiac intensive care unit (UTI) in a tertiary hospital. Methods: This was a cross-sectional study conducted from January 2013 to December 2014, based on analysis of patients' medical records. The study sample was composed of 307 children and adolescents with congenial and acquired heart diseases. The score Risk Adjustement for Congenital Heart Surgery 1 (RACHS-1) was used for categorization of the various surgical procedures. Descriptive statistics were calculated using the Satistical Package for Social Sciences (SPSS). Categorical variables were compared using the Pearson's chi-square test, considering a level of significance of 5%. Results: There was a predominance of patients aged between 28 days and one year (44%). Congenital heart diseases (91.9%) prevailed over acquired heart diseases (8.1%). Extracorporeal circulation was used in 138 patients who underwent surgical procedures, lasting from 12 to 261 minutes. Most patients (88.9%) were discharged from the ICU and 11.1% died. Using the score RACHS-1, corrective cardiac surgery was performed in 75.8% and paliative surgery in 24.2% of the patients. Conclusions: Patients aged between 28 days to one year, with cyanotic congenital heart disease, undergoing cardiac surgery with extracorporeal circulation duration longer than 120 minutes are at a higher risk of death.

Caracterización de cardiopatías congénitas en Manizales 2010-2016 / Characterization of Congenital Heart Defects in Manizales 2010-2016 / Caracterização de cardiopatias congênitas em Manizales, Colômbia, 2010-2016

Resumen: Las cardiopatías congénitas son la tercera causa de malformaciones congénitas y una de las principales responsables de la mortalidad en periodo neonatal en el mundo; se originan a partir de alteraciones en el desarrollo embrionario. La incidencia es variable; en Colombia, se estima que afectan del 2 al 3 % de los recién nacidos vivos. En 2015, 20,8 % de los niños menores de cinco años afectados con cardiopatías congénitas fallecieron a causa de estas alteraciones. El presente es un estudio descriptivo y retrospectivo. Se incluyeron los datos de 252 historias clínicas de pacientes con diagnóstico de cardiopatía congénita entre los años 2010 y 2016, el 56 % de la población encontrada fue de sexo femenino. Predominaron las cardiopatías congénitas no cianosantes (87 %). La mayor prevalencia fue el ductus arterioso permeable (35,3 %). La ecocardiografía Doppler se utilizó en 98,4 % de los casos; con respecto al manejo, el 47,2 % de los pacientes estuvieron en seguimiento, siendo este más común que las alternativas médicas o quirúrgicas. En conclusión, el ductus arterioso permeable, la comunicación interventricular y la comunicación interatrial son las cardiopatías no ciano-santes más frecuentes en la población estudiada y se asocian a hipertensión pulmonar que ameritan mayor seguimiento. La tetralogía de Fallot fue la cardiopatía congénita cianosante más común.

Abstract: Congenital heart defects are the third cause of congenital malformations and one of the main causes of mortality in the neonatal period in the world; they originate from alterations in embryonic development. The incidence is variable; in Colombia, it is estimated that they affect 2 to 3% of live newborns. In 2015, 20.8% of children under the age of five affected with congenital heart defects died from these disorders. This is a descriptive and retrospective study. Data of 252 clinical records of patients diagnosed with congenital heart defect between 2010 and 2016 were included, showing that 56% of this population were female. Acyanotic Congenital Heart Diseases predominated (87%). The highest prevalence was patent ductus arteriosus (35.3%). Doppler echocardiography was used in 98.4% of cases; regarding management, 47.2% of patients were in follow-up, this being more common than medical or surgical alternatives. In conclusion patent ductus arteriosus, ventricular septal defect and interatrial septal defect are the most frequent acyanotic heart diseases in the population under study and they are associated with pulmonary hypertension that require higher follow-up. Tetralogy of Fallot was the most common cyanotic congenital heart disease.

Resumo: As cardiopatias congênitas são a terceira causa de malformações congênitas e uma das principais responsáveis pela mortalidade no período neonatal no mundo. São originadas a partir de alterações no desenvolvimento embrionário. A incidência é variável; na Colômbia, é estimado que afetam de 2 a 3 % dos recém-nascidos vivos. Em 2015, 20,8 % das crianças menores de cinco anos afetadas com cardiopatias congênitas faleceram por causa dessas alterações. Este estudo é descritivo e retrospectivo. Foram incluídos dados de 252 prontuários de pacientes com diagnóstico de cardiopatia congênita entre 2010 e 2016, 56 % da população encontrada foi do sexo feminino. Predominaram as cardiopatias congênitas não cianóticas (87 %). A maior persistência foi o dueto arterioso permeável (35,3 %). A ecocardiografìa Doppler foi utilizada em 98,4 % dos casos; quanto ao manejo, 47,2 % dos pacientes estiveram em seguimento, o que foi mais comum do que as alternativas médicas ou cirúrgicas. Em conclusão, o ducto arterioso permeável, a comunicação interventricular e a comunicação interatrial são as cardiopatias não cianóticas mais frequentes na população estudada e são associadas com a hipertensão pulmonar que merecem maior seguimento. A tetralogia de Fallot foi a cardiopatia congènita cianòtica mais comum.

Relato de caso sobre comunicação interventricular pós-infarto agudo do miocárdio / Case report on acute postinfarction myocardial interventricular septal rupture

O presente artigo relata dois casos de pacientes, os quais foram admitidos na emergência do Instituto de Moléstias Cardiovasculares (IMC) com dor tipicamente anginosa, caracterizada como dor retroesternal em aperto, com irradiação para a face medial do braço esquerdo e relacionada ao esforço, com melhora no repouso. No exame físico, apresentavam taquicardia e sudorese. O eletrocardiograma evidenciou sinais de isquemia miocárdica em ambos os pacientes. Após as medidas iniciais serem tomadas, um dos pacientes foi submetido à terapia trombolítica e o outro à angioplastia para implantação de stent . Mais tarde, foi identificada a comunicação interventricular (CIV), seguido da necessidade de correção cirúrgica da mesma. Ambos os pacientes evoluíram bem, apesar da alta taxa de mortalidade desta condição

This paper reports two cases of patients who were admitted to the emergency room of the Instituto de Moléstias Cardiovasculares (IMC) with typically anginal pain, characterized by tight retrosternal pain radiating to the inside left arm, related to stress and improving with rest. Physical examination showed tachycardia and excessive sweating. Electrocardiogram showed signs of myocardial ischemia in both patients. After the initial measures were taken, one of the patients received thrombolytic therapy, and the other angioplasty for stent implantation. Later, interventricular septum rupture (IVSR) was identified, followed by the need for surgery to correct it. Both patients recovered well, despite the high mortality rate of this condition

Repair of double orifice left av valve (dolavv) with endocardial cushion defect in adult

Abstract Double orifice left atrioventricular valve (DOLAVV) or double orifice mitral valve (DOMV) is a rare congenital cardiac anomaly manifesting either as an isolated lesion (mitral stenosis or mitral insufficiency) or in association with other congenital cardiac defects. Signs of mitral valve disease are usually present along with the symptoms of associated coexistent congenital heart diseases. Mitral insufficiency due to annular dilatation is seen when DOLAVV is associated with endocardial cushion defects. Surgical intervention like mitral valve repair or replacement is required in 50% of patients and yields good results. We report a case of a 56-year-old lady who successfully underwent surgical correction of DOLAVV with partial atrioventricular canal defect.

Relato de um caso de associação de VACTERL e discussão acerca de seus aspectos prognósticos / Case report of VACTERL association and discussion about its prognostic aspects

Associação de VACTERL corresponde à combinação de três ou mais das seguintes malformações: Vertebrais, atresia Anal, alterações Cardíacas, fístula Traqueo-esofágica com atresia de Esôfago, anomalias Renais e de membros (Limbs). Sua etiologia ainda é desconhecida, mas acredita-se que seja multifatorial, associada a mutações em genes como FOXF1 e ZIC3 e a fatores de risco maternos. No presente relato, descreve-se um caso de associação de VACTERL diagnosticado no Hospital Universitário Regional de Maringá (HURM). Paciente L.P.N., sexo feminino, um dia de vida, foi referenciada para UTI neonatal devido ao quadro de desconforto respiratório, cianose e salivação intensa na sala de parto, sendo diagnosticada com atresia de esôfago. No 9º dia de vida realizou-se correção cirúrgica da atresia esofá- gica e fístula traqueo-esofágica. Outras malformações foram observadas, detectando-se comunicação interventricular perimembranosa moderada e rim direito ausente, sugerindo diagnóstico de VACTERL. Com três anos e nove meses, apresenta-se eutrófica, saudável e em acompanhamento multiprofissional. Apesar de ser uma afecção rara, esta associação necessita de expertise dos profissionais de saúde, para que haja detecção precoce e tratamento de suas alterações e complicações. Além disso, se manejada da forma correta, a criança apresenta boa evolução e perspectivas de uma vida normal. O prognóstico depende da extensão e da gravidade das anomalias associadas, bem como da capacitação dos pais e equipe profissional (AU)

VACTERL Association corresponds to the combination of three or more of the following defects: Vertebral, Anal atresia, Cardiac changes, Tracheo-esophageal fistula, Esophagus atresia, Renal anomalies and Limbs. Its etiology is still unknown, but believed to be multifactorial, associated with mutations in genes as FOXF1 and ZIC3 and maternal risk factors. This report describes a case of VACTERL diagnosed in the Regional University Hospital of Maringá (HURM). L.P.N. female patient, 1 day in life, was referred to neonatal ICU due to respiratory discomfort, cyanosis and salivation in the delivery room, and diagnosed with esophageal atresia. On the 9th day of life surgical repair of esophageal atresia and tracheoesophageal fistula was performed. Other malformations were observed by detecting moderate perimembranous ventricular septal defect and absent right kidney, suggesting perimembranous ventricular septal defect and absent right kidney, suggesting VACTERL diagnostic. At the age of 3 years and 9 months, presents eutrophic, healthy, and in multiprofessional follow up. Despite being a rare disease, this association requires expertise of health professionals, in order to be early detected and to treat its alterations and complications. Also, if handled correctly, the child shows good performance and prospects of a normal life. The prognosis depends on the extent and severity of associated anomalies, as well as the training of parents and professional staff (AU)

Vena cava superior izquierda / Left superior vein cava

Mujer de 72 años con fibrilación auricular paroxística ingresó en la sala de electrofisiología para un aislamiento de venas pulmonares. La evaluación inicial con ecocardiografía intracardiaca reveló una dilatación significativa del seno coronario (fig. 1), la cual permitía el libre movimiento del catéter en su interior. De manera interesante, la ubicación del catéter decapolar en la parte lateral del seno generaba un aumento severo del automatismo atrial. Ante la sospecha de una vena cava superior izquierda persistente, se realizó reconstrucción tridimensional (EnSite NavX, St Jude Medical®) logrando visualizar el trayecto de la vena cava superior izquierda en su totalidad y su relación con el seno coronario (fig. 2). Durante el desarrollo embriológico normal, la vena cava superior izquierda involuciona y su trayecto intrapericárdico se convierte en la vena (ligamento) de Marshall. Aunque se ha documentado en aproximadamente el 0,2% de los pacientes llevados a estudio electrofisiológico (convirtiéndola en la alteración de las venas torácicas más común), pasa inadvertida debido a la ausencia de manifestaciones hemodinámicas1. De hecho, la mayoría se diagnostica de manera casual durante exámenes ordenados por otras razones.

Visualização de Artéria Septal ao Eco Transtorácico em Paciente com Cardiomiopatia Hipertrófica / Septal Artery Viewed on Transthoracic Echocardiography in Patient with Hypertrophic Cardiomyopathy

Apresentamos um caso de uma paciente do sexo feminino,40 anos, negra, em acompanhamento há 15 anos porcardiomiopatia hipertrófica não obstrutiva. Apresenta-seassintomática. Realizou ecocardiograma transtorácico derotina evidenciando átrio esquerdo de 28 mL/m2, fraçãode ejeção de 69% (Simpson) e importante hipertrofia septalassimétrica, com parede posterior medindo 8 mm e septomedindo 34 mm (relação 4,8) e gradiente de pico da via desaída do ventrículo esquerdo de 14 mmHg. O espessamentoseptal importante permitiu a visualização inusitada, no corteapical 4 câmaras com o uso do color Doppler, de uma artériaseptal, ramo da artéria descendente anterior...

A Congenital Gerbode Defect associated with a Rare Structural Abnormality of the Mitral Valve Diagnosed in an Adult Patient

We report the case of a rare association of a congenital Gerbode defect with severe mitral regurgitation due to abnormal linear structure of mitral valve, diagnosed in an adult patient. The case highlights the importance of a thorough examination interpreting the echocardiographic findings on a pathophysiological basis. It also underlines the complementary role of different imaging techniques with transesophageal echocardiography, allowing the precise assessment of both structural and functional abnormalities in such a complex case. The patient underwent mitral valve replacement with a bileaflet mechanical prosthesis and repair of the Gerbode defect. The imaging findings were confirmed during the surgical procedure, leading to a good outcome.

Complete atrioventricular septal defect: a clinicopathologic study of 35 cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the autopsy characteristics, pathologic type, malfomation and genetic characteristics of complete atrioventricular septal defect (CAVSD).</p><p><b>METHODS</b>Thirty five cases of CAVSD were collected from Maternal and Child Hospital of Haidian District during Jan.2003 to Jan.2015. Autoptic material, clinical history and chromosome examination were reviewed.</p><p><b>RESULTS</b>Among 35 cases of CAVSD between 18-38 gestational weeks, there were 26 cases with CAVSD A (74.3%, 26/35), 1 case with CAVSD B (2.8%, 1/35) and 8 cases with CAVSD C (22.8%, 8/35). Only CAVSD malformation was seen in 4 cases (11.4%, 4/35). Multiple malformations were seen in 31 cases (88.6%, 31/35). Combined malformations most frequently occurred in cardiovascular, respiratory and locomotor system. Among 15 cases with chromosome examination, chromosome aberrations was found in 13 cases (13/15) and trisomy-21 was found in 11 cases (11/15).</p><p><b>CONCLUSIONS</b>CAVSD is a rare disease and CAVSD A is the most common type. CAVSD is usually combined with other malformations and chromosome aberrations.</p>

Oclusão percutânea de comunicação interatrial ou de forame oval guiada por ecocardiograma intracardíaco / Percutaneous closure of atrial septal defect or foramen ovale guided by intracardiac echocardiography

O ecocardiograma transesofágico (ECO-TE) é o método mais utilizado para guiar otratamento percutâneo da comunicação interatrial (CIA) e do forame oval (FOP), mas a necessidade de um outro profissional para realizá-lo e de anestesia geral constituem inconvenientes para seu emprego. Oecocardiograma intracardíaco (ECO-IC) apresenta-se como alternativa ao ECO-TE, pois pode ser realizado pelo próprio operador e demanda apenas anestesia local, com leve ou nenhuma sedação. Nosso objetivo foi relatar a experiência do serviço com a oclusão de CIA/FOP guiada por ECO-IC. Métodos: O ECO-IC utiliza cateter de ultrassom, que é introduzido por via venosa em câmaras cardíacas direitas e, por meio de posicionamento variável do transdutor, obtém as imagens adequadas para a intervenção. Foram avaliadas as taxas de sucesso do procedimento e as complicações. Resultados: De 2011 a 2015, foram realizados 201 procedimentos guiados pelo ECO-IC, sendo 139 empacientes com CIA e 62 com FOP. A maioria dos pacientes era do sexo feminino (64,2%), as idades variaramde 7 a 78 anos (36,6 ± 19,3 anos) e o peso variou de 28 a 92 kg (62,5 ± 13,0 kg). Foram utilizadas próteses Occlutech Figulla®, e todas as intervenções tiveram sucesso, com tempos de fluoroscopia de 5,7 ± 2,4 minutos e tempo de procedimento de 21,5 ± 6,4 minutos. Dois pacientes (2,0%) apresentaram taquicardia supraventricular transitória e outros dois pacientes evoluíram com fístula arteriovenosa na via de acesso, com resolução espontânea no primeiro mês. Conclusões: O ECO-IC forneceu informações anatômicas precisas para guiar o fechamento da CIA/FOP com sucesso e eliminou as principais desvantagens do ECO-TE...

Transesophageal echocardiography (TEE) is the most widely used method to guide the percutaneous treatment of atrial septal defect (ASD) and patent foramen ovale (PFO), but the necessity of another professional to perform it and the need for general anesthesia are potential disadvantages. Intracardiac echocardiography (ICE) is seen as an alternative to TEE, as it can be performed by the interventionist and requires only local anesthesia with mild or no sedation. The aim of this study was to report our experience with ASD/PFO occlusion guided by ICE. Methods: The ICE uses an ultrasound catheter, which is intravenously inserted in the right heart chambers and acquires images for the intervention through variable positioning of the transducer. Success and complication rates of the procedure were evaluated. Results: From 2011 to 2015, 201 procedures guided by ICE were performed, comprising 139 in patients with ASD and 62 in those with PFO. Most patients were female (64.2%), ages ranged from 7 to 78 years (36.6 ±19.3 years), and weight ranged from 28 to 92 kg (62.5 ± 13.0 kg). Occlutech Figulla® prostheses were used and all interventions were successful, with fluoroscopy time of 5.7 ± 2.4 minutes and procedure time of 21.5 ± 6.4 minutes. Two patients (2.0%) had transient supraventricular tachycardia and two others had arteriovenous fistula at the access site, with spontaneous resolution in the first month of follow-up. Conclusions: ICE provided accurate anatomical information to guide the closure of the ASD/PFO and successfully eliminated the main drawbacks of TEE...