The use of a wire control catheter to treat complex pulmonary artery or vein anatomy.

The difficult performance of certain percutaneous interventions in the field of congenital heart disease is well known. Crossing pulmonary arteries in patients who have previously undergone surgical repair or stenotic pulmonary veins in infants can be typical examples of these technical challenges in the catheterization laboratory. The Venture wire 6 Fr control catheter (St Jude Medical) is compatible with a steerable tapered radiopaque tip that can be manually angulated (up to 90°) by clockwise rotation of a knob located in the proximal handle. This mechanism directs any 0.014″ guidewire and provides back-up support. This catheter has been successfully used in coronary artery intervention for crossing severely tortuous vessels, extreme angulations of side-branch ostia, jailed stents, saphenous vein graft anastomoses, and chronic total occlusions. We report the first use of the Venture wire control catheter (St Jude Medical) in the field of congenital heart disease. Patient #1 was diagnosed with pulmonary atresia and ventricular septal defect and had a proximally migrated stent in the pulmonary trunk and severe left pulmonary artery stenosis. We have used this catheter in order to cross this stent and perform left pulmonary artery stent placement. Patient #2 had postoperative vein restenosis after surgery. The Venture catheter was used to reach the obstructed insertion of the right medium lobe pulmonary vein from a transseptal approach. Techniques from coronary interventional colleagues can help interventional cardiologists in the field of congenital heart disease to treat complex situations.

Relief of severe immediate postoperative superior vena cava stenosis with covered stent: case report with midterm follow up.

Sinus venous atrial septal defects are commonly associated with abnormal pulmonary venous connection. Numerous surgical techniques have been proposed with excellent short- and long-term outcomes. Pulmonary and superior vena cava obstructions, as well as rhythm disturbances, are the most common problems seen during follow up. However, acute postoperative superior vena cava obstruction with successful percutaneous covered-stent implantation has not been reported in the literature. The objective of this study is to report a unique case of acute obstruction of the superior vena cava on the first postoperative day after sinus venous atrial septal defect repair in an infant who was successfully relieved by a percutaneous angioplasty with covered-stent implantation, and the midterm follow up after this intervention.

Implante de stent não-valvado na via de saída do ventrículo direito: forma simples e efetiva de retardar nova intervenção cirúrgica / Non-valved stent implantation in right ventricle outflow tract: a simple way to postpone new surgical intervention

Introdução: A ampliação da via de saída do ventrículo direito (VSVD), com ou sem condutos, é frequente no tratamento de doenças cardíacas congênitas. Entretanto, a durabilidade desses condutos é restrita e o implante de stent se torna uma boa opção para desobstrução da VSVD. O objetivo deste estudo é relatar a experiência de um centro terciário no implante de stent não-valvado e seus resultados a curto e médio prazos. Método: Entre setembro de 2000 e janeiro de 2009, 11 pacientes com indicação de reintervenção cirúrgica receberam stents para desobstrução da VSVD. A média de idade no momento do procedimento foi de 12,5 ± 8,3 anos (1-28 anos) e o peso médio foi de 35 ± 20,9 kg (6-62 kg). A média de seguimento do estudo foi de 12,5 ± 6 meses (0-48 meses). Resultados: A média da pressão sistólica no ventrículo direito diminuiu de 99 ± 23 mmHg (pré-procedimento) para 57 ± 12 mmHg após o implante do stent (p < 0,001), assim como, ao ecocardiograma transtorácico, o gradiente ventrículo direito-artéria pulmonar (VD-AP) caiu de 69 ± 19 mmHg para 33 ± 20 mmHg (p < 0,01). Em 40% dos casos houve necessidade de reintervenção, em média, 22 meses após o procedimento. Houve um caso de fratura de stent, um caso de insucesso e um óbito não relacionado ao procedimento. Conclusão: A angioplastia da VSVD com stent não-valvado é uma medida paliativa, altamente efetiva e segura, capaz de retardar a necessidade de reintervenção cirúrgica. Além disso, permite o crescimento somático dos pacientes jovens e a redução do dano ao ventrículo direito para futuro implante de stents valvados para tratamento da insuficiência pulmonar livre.

Background: Right ventricle outflow tract (RVOT) reconstruction is frequently used to repair cardiac malformations. However, the lifetime of these conduits is short and stent implantation is a good option to relieve obstructed RVOT. The objective of this study is to report the experience of a tertiary center with non-valved stent implantation and its short and medium term results. Methods: Between September 1990 and January 2009, 11 late postoperative patients were submitted to stent implantation due to RVOT obstruction. Mean age at the time of procedure was 12.5 ± 8.3 years (1-28 years), and mean weight was 35 ± 20.9 kg (6-62 kg). Mean follow-up time was 12.5 ± 6 months (0-48 months). Results: Mean systolic right ventricular pressures decreased from 99 ± 23 mmHg before to 57 ± 12 mmHg (p < 0.001) after stent implantation. At echocardiogram, RV to PA gradient decreased from 69 ± 19 mmHg to 33 ± 20 mmHg (p < 0.01). Forty percent of the patients required percutaneous or surgical reintervention during a mean time of 22 months after the procedure. There was one case of stent fracture, relieved with the implantation of another stent, one case of failure, and one death not related to the procedure. Conclusion: Non-valved stent implantation in obstructed RVOT is a highly effective and safe palliative approach. Moreover, it allows the somatic growth of young patients and does not preclude future percutaneous implantation of valved stents to treat free pulmonary regurgitation.