Registro español de implante percutáneo de la válvula pulmonar Melody en menores de 18 años / Pediatrics Spanish Registry of percutaneous melody pulmonary valve implantation in patients younger than 18 years

Introducción y objetivos. Pasada 1 década desde el primer implante percutáneo de la válvula pulmonar (IPVP) Melody en España, se exponen sus resultados en cuanto a la función valvular y las complicaciones a corto y medio plazo. Métodos. Análisis descriptivo retrospectivo y multicéntrico nacional de los IPVP Melody en pacientes menores de 18 años desde el primer implante (de marzo de 2007 hasta el 1 de enero de 2016). Resultados. Se reclutaron 9 hospitales que contaban un total de 81 IPVP en 77 pacientes, cuyas medianas [intervalo intercuartílico] de edad y peso eran 13,3 [9,9-15,4] años y 46 [27-63] kg respectivamente. La enfermedad cardiaca más frecuente fue la tetralogía de Fallot (n = 27) y el sustrato anatómico más común, el conducto valvulado de yugular bovina (n = 31). Las incidencias de complicaciones intraprocedimiento y agudas fueron del 6 y el 8% (no hubo muertes periprocedimiento). La mediana del tiempo de seguimiento fue 2,4 [1,1-4,9] años. Se diagnosticó endocarditis infecciosa (EI) a 4 pacientes (5,6%), de los que 3 precisaron el explante de la válvula. En el periodo de seguimiento, la mortalidad fue del 1,3%, relacionada con EI. A los 5 años de seguimiento, el 80 ± 6,9% y el 83 ± 6,1% de los pacientes estuvieron libres de reintervención y recambio valvular pulmonar respectivamente. Conclusiones. El IPVP en pacientes pediátricos es una opción válida con buenos resultados hemodinámicos a corto y medio plazo. La incidencia de EI durante el seguimiento fue relativamente baja, si bien es la principal complicación que tener en cuenta (AU)

Introduction and objectives. A decade has passed since the first Spanish percutaneous pulmonary Melody valve implant (PPVI) in March 2007. Our objective was to analyze its results in terms of valvular function and possible mid-term follow-up complications. Methods. Spanish retrospective descriptive multicenter analysis of Melody PPVI in patients < 18 years from the first implant in March 2007 until January 1, 2016. Results. Nine centers were recruited with a total of 81 PPVI in 77 pediatric patients, whose median age and weight were 13.3 years (interquartile range [IQR], 9.9-15.4) and 46 kg (IQR, 27-63). The predominant cardiac malformation was tetralogy of Fallot (n = 27). Most of the valves were implanted on conduits, especially bovine xenografts (n = 31). The incidence of intraprocedure and acute complications was 6% and 8%, respectively (there were no periprocedural deaths). The median follow-up time was 2.4 years (IQR, 1.1-4.9). Infective endocarditis (IE) was diagnosed in 4 patients (5.6%), of which 3 required surgical valve explant. During follow-up, the EI-related mortality rate was 1.3%. At 5 years of follow-up, 80% ± 6.9% and 83% ± 6.1% of the patients were free from reintervention and pulmonary valve replacement. Conclusions. Melody PPVI was safe and effective in pediatric patients with good short- and mid-term follow-up hemodynamic results. The incidence of IE during follow-up was relatively low but was still the main complication (AU)

Pediatrics Spanish Registry of Percutaneous Melody Pulmonary Valve Implantation in Patients Younger Than 18 Years.

INTRODUCTION AND OBJECTIVES: A decade has passed since the first Spanish percutaneous pulmonary Melody valve implant (PPVI) in March 2007. Our objective was to analyze its results in terms of valvular function and possible mid-term follow-up complications. METHODS: Spanish retrospective descriptive multicenter analysis of Melody PPVI in patients < 18 years from the first implant in March 2007 until January 1, 2016. RESULTS: Nine centers were recruited with a total of 81 PPVI in 77 pediatric patients, whose median age and weight were 13.3 years (interquartile range [IQR], 9.9-15.4) and 46kg (IQR, 27-63). The predominant cardiac malformation was tetralogy of Fallot (n = 27). Most of the valves were implanted on conduits, especially bovine xenografts (n = 31). The incidence of intraprocedure and acute complications was 6% and 8%, respectively (there were no periprocedural deaths). The median follow-up time was 2.4 years (IQR, 1.1-4.9). Infective endocarditis (IE) was diagnosed in 4 patients (5.6%), of which 3 required surgical valve explant. During follow-up, the EI-related mortality rate was 1.3%. At 5 years of follow-up, 80% ± 6.9% and 83% ± 6.1% of the patients were free from reintervention and pulmonary valve replacement. CONCLUSIONS: Melody PPVI was safe and effective in pediatric patients with good short- and mid-term follow-up hemodynamic results. The incidence of IE during follow-up was relatively low but was still the main complication.

Implantación electiva de stent recubierto en la coartación y recoartación en el joven y en el adulto / Elective implantation of covered stents for coarctation and recoarctation in adolescents and adults

Introducción y objetivos. El stent es un tratamiento eficaz en la coartación y la recoartación. Sin embargo, en jóvenes y adultos pueden ocurrir rotura de pared y disección de aorta y, en el seguimiento, aneurismas. Con el fin de reducir estas complicaciones, implantamos el stent recubierto mayoritariamente de manera electiva. Métodos. Desde 2005 realizamos el procedimiento en 17 pacientes (2 adolescentes y 15 adultos) acceso femoral, 16 de manera electiva y en 1 como rescate. Seguimos técnica de Mullins con implantación de stent recubierto de NuMED®. Resultados. Buena aposición del stent en 17 casos, con acampanamiento distal en 8. Reducción del gradiente de 40±16 a 2±2mmHg (p<0,001) y aumento del diámetro de luz de 4±2 a 19±3mm (p<0,001). Se comentan dos casos excepcionales: uno con rotura que se trató de rescate con stent en el stent, y otro con obstrucción total y aneurisma intercostal que presentó una evolución fatal, pues murió a las 48 h del procedimiento (se muestra la necropsia). El seguimiento clínico fue de 4 años, con estudio con ecocardiograma Doppler, y en 13 de los pacientes con otra técnica de imagen, todos ellos con buena evolución. Conclusiones. El stent recubierto es un tratamiento eficaz en la coartación y la recoartación del joven y el adulto, de elección en los casos con anatomía compleja, y es necesario como dispositivo de rescate en los casos de stent no recubierto (AU)

Introduction and objectives. Stent implantation is an effective therapy for aortic coarctation and recoarctation. However, in adolescents and adults, aortic wall rupture and dissection can occur, as well as aneurysms during follow-up. In order to reduce these complications, we electively implant covered stents. Methods. Since 2005, we have performed the procedure using femoral access in 17 patients (2 adolescents and 15 adults), 16 electively and 1 as a rescue procedure. We used the Mullins technique in all cases, implanting a NuMED® covered stent. Results. Good stent apposition was achieved in all 17 procedures; 8 patients required a distal flare. Gradient was reduced from 40 (16) mmHg to 2 (2) mmHg (P<.001) and lumen diameter increased from 4 (2) mm to 19 (3) mm (P<.001). Two exceptional cases are discussed: one patient with aortic wall rupture who underwent a rescue procedure using a stent within a covered stent and another patient with total obstruction and intercostal aneurysm in whom the outcome was fatal at 48 h postprocedure (autopsy is shown). Four-year clinical follow-up included Doppler echocardiography; an additional imaging technique was required in 13 patients. All patients recovered well and there were no complications. Conclusions. Covered stents are effective in treating coarctation and recoarctation in adolescents and adults, are the treatment of choice in patients with complex anatomy, and must be available in the operating room as a rescue device when implanting a conventional stent (AU)

Elective implantation of covered stents for coarctation and recoarctation in adolescents and adults.

INTRODUCTION AND OBJECTIVES: Stent implantation is an effective therapy for aortic coarctation and recoarctation. However, in adolescents and adults, aortic wall rupture and dissection can occur, as well as aneurysms during follow-up. In order to reduce these complications, we electively implant covered stents. METHODS: Since 2005, we have performed the procedure using femoral access in 17 patients (2 adolescents and 15 adults), 16 electively and 1 as a rescue procedure. We used the Mullins technique in all cases, implanting a NuMED(®) covered stent. RESULTS: Good stent apposition was achieved in all 17 procedures; 8 patients required a distal flare. Gradient was reduced from 40 (16) mmHg to 2 (2) mmHg (P<.001) and lumen diameter increased from 4 (2) mm to 19 (3) mm (P<.001). Two exceptional cases are discussed: one patient with aortic wall rupture who underwent a rescue procedure using a stent within a covered stent and another patient with total obstruction and intercostal aneurysm in whom the outcome was fatal at 48 h postprocedure (autopsy is shown). Four-year clinical follow-up included Doppler echocardiography; an additional imaging technique was required in 13 patients. All patients recovered well and there were no complications. CONCLUSIONS: Covered stents are effective in treating coarctation and recoarctation in adolescents and adults, are the treatment of choice in patients with complex anatomy, and must be available in the operating room as a rescue device when implanting a conventional stent.

Embolia pulmonar múltiple tras vertebroplastia con polimetilmetacrilato, con evolución fatal a pesar de la extracción percutánea de un microfragmento / Multiple fatal pulmonary embolism during polymethyl-methacrylate vertebroplasty with successful percutaneous retrieval of a large cement fragment

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Ablación con radiofrecuencia de una taquicardia de aurícula izquierda en un niño de 3 meses sin foramen oval permeable / Radiofrequency ablation of left atrial tachycardia in a three-month-old infant without patent foramen ovale

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Stent-graft deployment for aortic rupture after stenting for aortic recoarctation.

We present the case of a 62-year-old woman who presented with recoarctation and then experienced rupture of the aorta and severe clinical deterioration after a stent was deployed. She was treated immediately by intrastent deployment of a stent-graft, which resolved the extremely serious situation.

[Percutaneous closure of complex fistula between the internal mammary artery and a lobar branch of a pulmonary artery]. / Cierre percutáneo de una fístula compleja entre la arteria mamaria interna y la arteria lobar pulmonar.

A through review of the literature identified only 20 reported cases of fistula involving the internal mammary (internal thoracic) artery and a lobar branch of a pulmonary artery. Surgical closure was frequently done to avoid complications associated with this anomaly. We report the first patient in whom percutaneous treatment was accomplished with a combined technique involving an Amplatzer Duct Occluder device and coils.

Cierre percutáneo de una fístula compleja entre la arteria mamaria interna y la arteria lobar pulmonar / Percutaneous closure of complex fistula between the internal mammary artery and a lobar branch of a pulmonary artery

Tras una revisión exhaustiva de la literatura, hemos encontrado tan sólo 20 casos reportados de fístulas entre la arteria mamaria interna (AMI) y las arterias pulmonares.Frecuentemente se indica su cierre quirúrgico por las complicaciones que pueden acarrear. Presentamos el primer caso en el que el tratamiento se realiza de forma percutánea mediante una técnica mixta con un dispositivo Amplatzer Duct Occluder (ADO) asociado a coils. (AU)

[Occlusion of the first septal branch with microcoils in a patient with hypertrophic obstructive cardiomyopathy]. / Oclusión con micro-colis de la primera rama septal en el tratamiento de un paciente con miocardiopatía hipertrófica obstructiva.

Nonsurgical septal reduction by induced septal infarction is one of the management options in the treatment of patients with hypertrophic obstructive cardiomyopathy. Good immediate and long-term clinical and hemodynamic results have been reported with this technique for occlusion of the first septal branch of the anterior descending coronary artery followed by ethanol infusion. This is the first report of a case in which nonsurgical septal reduction with microcoils has been attempted.

Oclusión con micro-coils de la primera rama septal en el tratamiento de un paciente con miocardiopatía hipertrófica obstructiva / Occlusion og the first septal branch with microcoils in a patient with hypertrophic obstructive cardiomyopathy

La ablación no quirúrgica del septo mediante la inducción de un infarto septal es una de las alternativas existentes en el tratamiento de la miocardiopatía hipertrófica obstructiva. Se han comunicado buenos resultados clínicos y hemodinámicos con esta técnica, inmediatos y a largo plazo, cuando se emplea la oclusión de la primera rama septal de la coronaria descendente anterior y la posterior infusión de etanol. Éste es el primer caso comunicado en el que se intenta efectuar la ablación no quirúrgica del septo con micro-coils (AU)

[Guided transcatheter valvulotomy in pulmonary atresia with intact ventricular septum]. / Valvulotomía mecánica percutánea dirigida en la atresia pulmonar con septo íntegro.

Transcatheter valvulotomy in pulmonary atresia with an intact ventricular septum can be used as a first step to create biventricular circulation and to stimulate further development of the hypoplastic right ventricle. We describe our experience in a case of a neonate with this congenital cardiac defect who underwent successful transcatheter perforation of the atretic pulmonary valve. This report highlights the utility of a special technique based on the use of a gooseneck snare positioned just above the atretic valve to guide the advance of a coronary guidewire. Other therapeutic alternatives are considered.

Valvulotomía mecánica percutánea dirigida en la atresia pulmonar con septo íntegro / Guided transcatheter valvulotomy in pulmonary atresia with intact ventricular septum

La valvulotomía percutánea con catéter en la atresia pulmonar con septo íntegro puede ser el primer paso para establecer una circulación en serie con el posterior desarrollo del ventrículo derecho. Presentamos nuestra experiencia en un neonato con esta cardiopatía, al que realizamos una apertura mecánica, haciendo especial referencia a la técnica empleada con guía especial para desobstrucción coronaria y dirigida con catéter-lazo abierto sobre la válvula pulmonar atrésica. Se exponen otras técnicas alternativas y se discute la evolución de esta paciente en función de su desarrollo anatómico (AU)

Ventrículo único de morfología izquierda corregido a los 49 años con buena evolución / 49-Year-old patient with left morphology single ventricle who underwent surgical repair and uncomplicated course

Presentamos el caso de una paciente de 51 años con ventrículo único izquierdo y cámara rudimentaria anterior corregido en 1997 con la técnica de Fontan. El estudio postoperatorio con ecocardiografía, Holter, gammagrafía de perfusión pulmonar, ventriculografía isotópica, resonancia magnética y analítica no demostró alteraciones.La paciente está asintomática. Creemos que es el caso de más edad corregido con esta anomalía (AU)