Occlusion of the perimembranous ventricular septal defect using CERA® devices.

BACKGROUND: High incidence of atrioventricular (AV) block has been the major limitation of percutaneous closure of perimembranous ventricular septal defect (PMVSD). METHODS: Prospective, multicenter, nonrandomized study including 55 patients who were submitted to 56 procedures from March 2010 to November 2010. Inclusion criteria were PMVSD with diameter ≥ 5 mm or if ≤5 mm with hemodynamic significance and age ≥ 1 year. Exclusion criteria were fixed pulmonary arterial hypertension and associated congenital heart disease needing surgical repair. Procedures were performed under general anesthesia and monitored by transthoracic echocardiography (TTE). The device choice was based on left ventricle (LV) angiography and on TTE images. PMVSDs were crossed by retrograde approach. RESULTS: Mean age was 9.3 ± 7.5 years, and mean weight was 29.1 ± 15.9 kg. Thirty-five (63.6%) patients were females. Mean pulmonary arterial mean pressure, mean LV diastolic diameter, and mean Q(p) /Q(s) were 24.0 ± 6.5 mm Hg, 43.0 ± 5.9 mm, and 2.2 ± 0.8, respectively. Associated nonsurgical malformations were present in 9 (16.3%) patients, and PMVSDs were multifenestrated in 16 (46.2%) cases. Mean PMVSDs diameter was 5.8 ± 1.8 mm by angiography and 6.8 ± 2.3 mm by TTE. New rhythm disturbance without clinical significance was observed in 29% of the patients and was reversible in 87.5%. After procedure, trivial residual shunt was present in 5 (8.9%) patients and moderate residual shunt in other 5 (8.9%). At late FU (mean of 298.7 ± 88.9 days), 91% of the patients had no residual shunts. Third-degree AV block and severe aortic regurgitation occurred in one patient each. CONCLUSIONS: In this experience, PMVSD closure with CERA® devices showed to be safe and effective with low incidence of complications at immediate and mid-term FU.

Occlusion of the perimembranous ventricular septal defect using CERA devices

Background: High incidence of atrioventricular (AV) block has been the major limitationof percutaneous closure of perimembranous ventricular septal defect (PMVSD). Methods:Prospective, multicenter, nonrandomized study including 55 patients who weresubmitted to 56 procedures from March 2010 to November 2010. Inclusion criteriawere PMVSD with diameter 5 mm or if 5 mm with hemodynamic significance andage 1 year. Exclusion criteria were fixed pulmonary arterial hypertension and associatedcongenital heart disease needing surgical repair. Procedures were performedunder general anesthesia and monitored by transthoracic echocardiography (TTE). Thedevice choice was based on left ventricle (LV) angiography and on TTE images.PMVSDs were crossed by retrograde approach. Results: Mean age was 9.3 6 7.5years, and mean weight was 29.1 6 15.9 kg. Thirty-five (63.6%) patients were females.Mean pulmonary arterial mean pressure, mean LV diastolic diameter, and mean Qp/Qswere 24.0 6 6.5 mm Hg, 43.0 6 5.9 mm, and 2.2 6 0.8, respectively. Associated nonsurgicalmalformations were present in 9 (16.3%) patients, and PMVSDs were multifenestratedin 16 (46.2%) cases. Mean PMVSDs diameter was 5.8 6 1.8 mm by angiographyand 6.8 6 2.3 mm by TTE. New rhythm disturbance without clinical significance wasobserved in 29% of the patients and was reversible in 87.5%. After procedure, trivialresidual shunt was present in 5 (8.9%) patients and moderate residual shunt in other 5(8.9%). At late FU (mean of 298.7 6 88.9 days), 91% of the patients had no residualshunts. Third-degree AV block and severe aortic regurgitation occurred in one patienteach. Conclusions: In this experience, PMVSD closure with CERAVR devices showed tobe safe and effective with low incidence of complications at immediate and mid-termFU.

Analysis of the Takeuchi procedure for the treatment of anomalous origin of the left coronary artery from the pulmonary artery.

BACKGROUND: Evaluation of a case series of anomalous origin of the left coronary artery from the pulmonary artery corrected with the Takeuchi procedure, analyzing their immediate and late surgical outcomes as well as the related morbidity. OBJECTIVE: To report a case series of anomalous origin of the left coronary artery from the pulmonary artery corrected with the Takeuchi procedure. METHODS: The analysis was based on data collected from the medical records of 12 patients undergoing surgical correction between 1981 and 2003. RESULTS: The mean age of the patients was 5.9 +/- 1.7 months. The predominant manifestation was heart failure, especially in the infants. The baseline electrocardiogram showed a Q wave in DI and aVL and signs of myocardial ischemia in ten cases. Echocardiogram with a pattern of dilated cardiomyopathy and mitral regurgitation was found in six patients. The mean age at surgical correction was 31.8 +/- 14.3 months. The immediate surgical mortality was 16% (two patients), from cardiac dysfunction. In the outpatient follow-up we observed that the symptoms, ischemic electrocardiographic changes, cardiac function and mitral regurgitation improved. Three cases progressed with supravalvar pulmonary stenosis during follow-up. CONCLUSION: This heart disease should be suspected in every infant presenting with heart failure. Surgical correction with the Takeuchi procedure has proven efficient, with a low mortality rate. Cardiac function returns to normal and mitral regurgitation improves after surgical correction.

Análise da técnica de takeuchi usada para o tratamento da origem anômala da artéria coronária esquerda do tronco pulmonar / Analysis of the takeuchi procedure for the treatment of anomalous origin of the left coronary artery from the pulmonary artery

FUNDAMENTO: Avaliação dos casos de origem anômala da artéria coronária esquerda do tronco pulmonar operados com a técnica de Takeuchi, analisando o resultado cirúrgico imediato e tardio e a morbidade destes pacientes. OBJETIVO: Relato uma série de casos de origem anômala da artéria coronária esquerda do tronco pulmonar operados com a técnica de Takeuchi. Métodos: Realizou-se a análise com coleta de dados dos prontuários de doze pacientes submetidos à correção cirúrgica no período de 1981 a 2003. RESULTADOS: A idade média dos pacientes foi de 5,9 ± 1,7 meses. A clínica preponderante foi insuficiência cardíaca, principalmente nos lactentes. O eletrocardiograma inicial em dez casos mostrou onda Q em DI e aVL e sinais de isquemia miocárdica. No ecocardiograma, observaram-se padrão de miocardiopatia dilatada em seis pacientes e insuficiência mitral. A idade média da correção cirúrgica foi de 31,8 ± 14,3 meses. A mortalidade cirúrgica imediata foi de 16 por cento (dois pacientes) por disfunção cardíaca. No acompanhamento ambulatorial, houve a melhora da sintomatologia e das alterações isquêmicas no eletrocardiograma, retorno da função cardíaca e melhora da insuficiência mitral. Durante o acompanhamento, três casos evoluíram com estenose supravalvar pulmonar. CONCLUSÃO: A suspeita clínica dessa cardiopatia deve ser feita em todo lactente com insuficiência cardíaca. A correção cirúrgica com o emprego da técnica de Takeuchi se mostra eficaz, com baixo índice de mortalidade. Após a correção, há um retorno à normalidade da função cardíaca e a melhora da insuficiência mitral.

BACKGROUND: Evaluation of a case series of anomalous origin of the left coronary artery from the pulmonary artery corrected with the Takeuchi procedure, analyzing their immediate and late surgical outcomes as well as the related morbidity. OBJECTIVE: To report a case series of anomalous origin of the left coronary artery from the pulmonary artery corrected with the Takeuchi procedure. METHODS: The analysis was based on data collected from the medical records of 12 patients undergoing surgical correction between 1981 and 2003. RESULTS: The mean age of the patients was 5.9 ± 1.7 months. The predominant manifestation was heart failure, especially in the infants. The baseline electrocardiogram showed a Q wave in DI and aVL and signs of myocardial ischemia in ten cases. Echocardiogram with a pattern of dilated cardiomyopathy and mitral regurgitation was found in six patients. The mean age at surgical correction was 31.8 ± 14.3 months. The immediate surgical mortality was 16 percent (two patients), from cardiac dysfunction. In the outpatient follow-up we observed that the symptoms, ischemic electrocardiographic changes, cardiac function and mitral regurgitation improved. Three cases progressed with supravalvar pulmonary stenosis during follow-up. CONCLUSION: This heart disease should be suspected in every infant presenting with heart failure. Surgical correction with the Takeuchi procedure has proven efficient, with a low mortality rate. Cardiac function returns to normal and mitral regurgitation improves after surgical correction.