Experiencia en angioplastia percutánea de recoartación de aorta en un solo centro. Resultados a corto, medio y largo plazo / Experience in percutaneous angioplasty of aortic recoartation in a single centre. Short, medium and long-term outcomes

Resumen Introducción: La angioplastia con balón es una técnica que ofrece buenos resultados, especialmente en los casos de recoartación tras cirugía correctora. Objetivo: Analizar los resultados de un centro hospitalario a partir de la introducción de la técnica. Método: Se analizaron 73 pacientes con una edad media de 3.3 años; el 74% eran menores de 1 año y el 72.6% estaban por debajo de 10 kg de peso. Todos los pacientes incluidos fueron casos de recoartación tras cirugía correctora. Resultados: Se observó un resultado efectivo en el 93.1% de los casos, con gradiente residual < 20 mmHg. Durante el seguimiento, el 20.5% precisaron reintervención, la cual fue más frecuente en caso de angioplastia sobre el arco, lesiones asociadas y menores de 1 año. Solo se objetivó una complicación grave relacionada con el procedimiento, que correspondió a una rotura aórtica que no pudo ser solventada con implante de stent cubierto. Conclusiones: La angioplastia percutánea de recoartación de aorta es una técnica segura y efectiva, en especial en los casos de recoartación tras cirugía correctora de lesiones circunscritas al istmo.

Abstract Introduction: Balloon angioplasty is a technique with good outcomes, specially in cases aortic recoartation after correcting surgery. Objective: To analyze our centre results since the introduction of the technique. Method: We analyzed 73 patients with medium age of 3,3 years; 74% were under 1 years old and 72,6% under 10 kg weight. All patients included were cases of recoartation after surgery. Results: Effective results was achieved in 93,1%, obtaining residual gradient less than 20 mmHg. During the following up 20,5% of patients required reintervention, being more frequent in case of aortic arch hypoplasia, associated lesions or patients under 1 year. Only a severe complication was referred, a case of aortic rupture that couldn’t be solved with a covered stent. Conclusions: Percutaneous angioplasty of aortic recoartation is a safe and effective technique, specially in discrete istmic lesions after correcting surgery.

Aneurismas de la circulación colateral en la coartación aórtica, ¿son una contraindicación para el tratamiento percutáneo? Respuesta / Collateral aneurysms in aortic coarctation. a contraindication for percutaneous intervention? Response

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Tratamiento percutáneo con stent de la coartación atrésica de aorta en el adulto / Percutaneous stent placement to treat coarctation of aorta due to atresia in adult patients

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Tratamiento percutáneo del síndrome de vena cava superior tras implantación de electrodos y/o cirugía de cardiopatías congénitas / Percutaneous treatment of superior vena cava syndrome after pacemakers electrodes implantation and/or surgical correction of congenital heart disease

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[Pulmonary atresia with intact ventricular septum. Perforation and pulmonary valvuloplasty using a modified mechanical technique. Medium-term follow-up]. / Atresia pulmonar con septo íntegro. Perforación y valvuloplastia pulmonar mediante técnica mecánica modificada. Seguimiento a medio plazo.

INTRODUCTION AND OBJECTIVES: In patients with pulmonary atresia with intact ventricular septum (PAIVS), radiofrequency-assisted perforation of the valve is the most widely used initial therapy when the anatomy is favorable. We report our experience with a modified mechanical technique that gave good results. METHODS: Between November 2001 and October 2006, valve opening was carried out successfully in 11 consecutive neonates with a favorable anatomy (i.e., Alwi groups A and B, and tricuspid valve Z-score -1.1 [1.3]). The technique involved snare-assisted anterograde or retrograde perforation with the soft tip of a special guidewire used for chronic total coronary artery occlusions, use of an arteriovenous loop, and progressive balloon dilatation from a diameter of 2 mm to a maximum diameter of 9.6 [1.2] mm. RESULTS: Valve opening was achieved in all patients, and right ventricular (RV) systolic pressure fell from 97 [17] mmHg to 48 [13] mmHg (P< .001). No pericardial effusion or cardiac tamponade was observed, though one neonate died 24 hours after the procedure due to pulmonary embolism. Six patients (54%) were discharged without any further intervention, while 4 (36%) required an additional increase in pulmonary blood flow. During the follow-up period of 25 [21] months, two patients died. Eight (72%) survived and were in New York Heart Association functional class 1. Two required additional surgery on the outflow tract, one of whom also needed a one-and-a-half ventricular repair. Data indicate that the valves remain open as RV structures grow, though without any change in the tricuspid valve Z-score. CONCLUSIONS: Pulmonary valvuloplasty using a mechanical technique proved effective in patients with PAIVS. Modification of the standard mechanical technique by using the soft tip of a special guidewire used for chronic total coronary artery occlusions was less aggressive and improved results. In patients with a favorable anatomy, results were comparable to those obtained using the radiofrequency technique.

Atresia pulmonar con septo íntegro. Perforación y valvuloplastia pulmonar mediante técnica mecánica modificada. Seguimiento a medio plazo / Pulmonary atresia with intact ventricular septum. Perforation and pulmonary valvuloplasty using a modified mechanical technique. Medium-term follow-up

Introducción y objetivos. En la atresia pulmonar con septo íntegro, si la anatomía es favorable, el tratamiento inicial más extendido es la apertura valvular mediante radiofrecuencia. Presentamos nuestra experiencia mediante una técnica mecánica modificada con buenos resultados. Métodos. Entre noviembre de 2001 y octubre de 2006 realizamos apertura valvular en 11 casos consecutivos con anatomía favorable (grupo A y B de Alwi e índice z tricúspide de ­1,1 ± 1,3), mediante perforación anterógrada guiada por lazo o retrógrada mediante guías especiales para la obstrucción crónica total coronaria por su parte blanda y circuito arteriovenoso y dilatación progresiva con balón monorraíl coronario desde 2 mm de diámetro hasta un máximo de 9,6 ± 1,2 mm. Resultados. Se realizó la apertura valvular en todos los casos con reducción de la presión sistólica del ventrículo derecho de 97 ± 17 a 48 ± 13 mmHg (p < 0,001). No se observaron derrame ni taponamiento en ningún caso, y un neonato falleció a las 24 h por un tromboembolismo pulmonar. Seis casos (54%) fueron dados de alta sin otro procedimiento, y 4 (36%) precisaron un flujo pulmonar adicional. El seguimiento fue de 25 ± 21 meses. Dos pacientes fallecieron, mientras que 8 (72%) sobrevivieron y se encontraban en situación funcional I. Dos precisaron cirugía adicional del tracto de salida y en uno de ellos, además, del ventrículo y medio. Persisten datos de desobstrucción valvular con crecimiento de estructuras en el ventrículo derecho, aunque sin cambios en el índice z valvular. Conclusiones. La valvuloplastia pulmonar con técnica mecánica sigue siendo válida en la atresia pulmonar con septo íntegro. La modificación de la técnica mecánica clásica mediante guías especiales para la obstrucción crónica total coronaria por su parte blanda es menos agresiva y mejora sus resultados. En esta serie con anatomía favorable los resultados son superponibles a los obtenidos mediante radiofrecuencia (AU)

Introduction and objectives. In patients with pulmonary atresia with intact ventricular septum (PAIVS), radiofrequency-assisted perforation of the valve is the most widely used initial therapy when the anatomy is favorable. We report our experience with a modified mechanical technique that gave good results. Methods. Between November 2001 and October 2006, valve opening was carried out successfully in 11 consecutive neonates with a favorable anatomy (i.e., Alwi groups A and B, and tricuspid valve Z-score ­1.1 [1.3]). The technique involved snare-assisted anterograde or retrograde perforation with the soft tip of a special guidewire used for chronic total coronary artery occlusions, use of an arteriovenous loop, and progressive balloon dilatation from a diameter of 2 mm to a maximum diameter of 9.6 [1.2] mm. Results. Valve opening was achieved in all patients, and right ventricular (RV) systolic pressure fell from 97 [17] mmHg to 48 [13] mmHg (P<.001). No pericardial effusion or cardiac tamponade was observed, though one neonate died 24 hours after the procedure due to pulmonary embolism. Six patients (54%) were discharged without any further intervention, while 4 (36%) required an additional increase in pulmonary blood flow. During the follow-up period of 25 [21] months, two patients died. Eight (72%) survived and were in New York Heart Association functional class 1. Two required additional surgery on the outflow tract, one of whom also needed a one-and-a-half ventricular repair. Data indicate that the valves remain open as RV structures grow, though without any change in the tricuspid valve Z-score. Conclusions. Pulmonary valvuloplasty using a mechanical technique proved effective in patients with PAIVS. Modification of the standard mechanical technique by using the soft tip of a special guidewire used for chronic total coronary artery occlusions was less aggressive and improved results. In patients with a favorable anatomy, results were comparable to those obtained using the radiofrequency technique (AU)

[Stenting in primary pulmonary hypertension with compression of the left main coronary artery]. / El stent en la compresión del tronco coronario izquierdo en la hipertensión pulmonar primaria.

Primary pulmonary hypertension is often associated with angina-like chest pain of uncertain etiology. Left main coronary artery compression by the pulmonary artery is a treatable cause of angina and should be considered in these patients. We describe a patient presenting with primary pulmonary hypertension, clinical angina and extrinsic compression of the left main coronary artery by the pulmonary artery, who was treated with direct stenting.

Corazón en criss-cross con discordancia auriculoventricular y ventrículo arterial / Criss-cross heart with discordant atrioventricular connection and arterial ventricle

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