RESUMEN
BACKGROUND: There is limited published outcome data on the STARFlex device for transcatheter closure of atrial septal defects (ASD). AIM: To contribute to the long term outcomes of ASD device closure with the STARFlex device. METHODS: Results of a prospective FDA approved clinical trial (1999-2001) from a single institution of the STARFlex device for simple ASD was reviewed. The inclusion criteria included age >or=2 years, isolated secundum ASD, evidence of right ventricular volume overload, and maximum stretched diameter <22 mm. A retrospective review of the original study data with most recent follow-up was performed. Clinical success in the trial was defined as complete closure or residual leak Asunto(s)
Cateterismo Cardíaco/instrumentación
, Defectos del Tabique Interatrial/terapia
, Adolescente
, Adulto
, Cateterismo Cardíaco/efectos adversos
, Procedimientos Quirúrgicos Cardíacos
, Niño
, Preescolar
, Remoción de Dispositivos
, Ecocardiografía Doppler en Color
, Electrocardiografía
, Diseño de Equipo
, Falla de Equipo
, Femenino
, Estudios de Seguimiento
, Migración de Cuerpo Extraño/etiología
, Migración de Cuerpo Extraño/cirugía
, Defectos del Tabique Interatrial/diagnóstico por imagen
, Defectos del Tabique Interatrial/fisiopatología
, Hemodinámica
, Humanos
, Masculino
, Persona de Mediana Edad
, Estudios Retrospectivos
, Factores de Tiempo
, Resultado del Tratamiento
, Adulto Joven
RESUMEN
Mullins et al. [6] reported the first use of stent implantation to treat stenotic branch pulmonary arteries in 1988. In the early to mid-1990s, numerous reports confirmed its safety and efficacy, but there were limited stent and balloon designs and stent implantations were performed using relatively large delivery systems (10- to 12-Fr sheaths) [7, 8]. The general accepted patient size was limited to those weighing 12 kg or greater. Intraoperative stent implantation for branch pulmonary artery stenosis was reported in the early to mid-1990s [1-3, 5, 9]. Indications in these early reports included small patient size or difficult anatomy or patients who had additional cardiac lesions and needed surgery independent of the branch stenosis. The idea was to take advantage of the open-heart exposure provided in the operating room to permit direct access to the stenotic segment. Hence, all intraoperative stent implants were performed under direct visualization on bypass. There were no discussions on advantages over the routine percutaneous approach. Currently, with advances in stent and balloon technology as well as increased operator experience, many of those reported cases probably would have undergone cardiac catheterization for a percutaneous stent implant rather than open-heart surgery. The purpose of this report is to review the current indications, advantages, and disadvantages of intraoperative stent implantation as well as to discuss the techniques that are helpful to optimize intraoperative stent positioning. The role and advantages of intraoperative angiography will also be presented.
Asunto(s)
Estenosis de la Válvula Pulmonar/terapia , Stents/normas , Angiografía , Cateterismo/métodos , Catéteres de Permanencia/normas , Niño , Humanos , Cuidados Intraoperatorios , Implantación de Prótesis/normas , Estenosis de la Válvula Pulmonar/patologíaRESUMEN
OBJECTIVES: The study evaluated the safety and efficacy of stent reconstruction of stenotic/occluded iliofemoral veins (IFV) and inferior vena cava (IVC). BACKGROUND: Patients with congenital heart defects and stenotic or occluded IFV/IVC may encounter femoral venous access problems during future cardiac surgeries or catheterizations. METHODS: Twenty-four patients (median age 4.9 years) underwent implantation of 85 stents in 22 IFV and 6 IVC. Fifteen vessels were severely stenotic and 13 were completely occluded. Although guide wires were easily passed across the stenotic vessels, occluded vessels required puncture through the thrombosed sites using a stiff wire or transseptal needle. Once traversed, the occluded site was dilated serially prior to stent implantation. RESULTS: Following stent placement, the mean vessel diameter increased from 0.9 +/- 1.6 to 7.4 +/- 2.6 mm (p < 0.05). Twenty-one of 28 vessels had long segment stenosis/occlusion requiring two to seven overlapping stents. Repeat catheterizations were performed in seven patients (9 stented vessels) at mean follow-up of 1.6 years. Seven vessels remained patent with mean diameter of 6.4 +/- 2.0 mm. Two vessels were occluded, but they were easily recanalized and redilated. Echocardiographic follow-up in two patients with IVC stents demonstrated wide patency. In four additional patients, a stented vessel was utilized for vascular access during subsequent cardiac surgery (n = 3) and endomyocardial biopsy (n = 1). Therefore, 13 of 15 stented vessels (87%) remained patent at follow-up thus far. CONCLUSIONS: Stenotic/obstructed IFV and IVC may be reconstructed using stents to re-establish venous access to the heart for future cardiac catheterization and/or surgeries.
Asunto(s)
Angioplastia de Balón , Cateterismo Cardíaco , Vena Femoral , Vena Ilíaca , Stents , Vena Cava Inferior , Preescolar , Constricción Patológica/terapia , Femenino , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/terapia , Humanos , Masculino , Resultado del TratamientoRESUMEN
The aim of this study was to review contemporary techniques, devices, and results of transcatheter occlusion of surgical shunts in 2 pediatric cardiac programs. Closure of superfluous surgical shunts may reduce cardiac work and risk of endocarditis. Previous studies have shown that transcatheter closure of shunts is feasible, but have not demonstrated acceptable efficacy or safety. In addition, the performance of new techniques and devices has not been reviewed. Between 1993 and 1998, 18 patients with congenital heart disease underwent transcatheter closure of 19 Blalock-Taussig shunts. Detachable and standard Gianturco coils and Gianturco-Grifka vascular occlusion devices were employed. All 19 shunts had complete closure. Eight shunts had initial placement of detachable coils. Five shunts had stents placed that bridged the pulmonary end of the shunts. These 5 and 4 additional shunts had closure by standard coils. Two shunts were closed with Gianturco-Grifka devices. There were no complications, no embolizations, and no requirement for surgery precipitated by the procedures. This review of contemporary techniques, devices, and results suggests that transcatheter occlusion of surgical shunts is effective and safe.
Asunto(s)
Cateterismo Cardíaco , Procedimientos Quirúrgicos Cardíacos , Embolización Terapéutica , Cardiopatías Congénitas/cirugía , Implantación de Prótesis Vascular/métodos , Preescolar , Embolización Terapéutica/instrumentación , Humanos , Reoperación , StentsRESUMEN
The presence of an intra-atrial patch (IAP) has been considered a relative contraindication to transseptal puncture (TSP). The purpose of this study is to determine the efficacy and safety of the TSP through baffles, conduits, pericardial patches and other prosthetic materials in the intra-atrial septum. We reviewed the records of all pediatric patients with IAP who underwent TSP at Texas Children's Hospital from November 1979 through February 1998. The review included the cardiac diagnoses, indications for TSP, technical difficulties and follow up echocardiograms specifically addressing residual atrial shunts A total of 1958 TSP were performed. Thirty-nine patients had IAP. Cardiac diagnoses in those 39 patients included D-transposition of the great arteries after Mustard (10) or Senning procedure (6), single ventricle variant post-Fontan operation (4), total anomalous venous return repair (4), atrioventricular canal repair (9) and atrial septal defect with patch repair (6). Patients' age ranged from 1-31 years (median 7 years). The duration from the time of surgical repair to TSP ranged from 0.1-21 years (median 5 years). Indications for TSP included diagnostic and therapeutic intervention for pulmonary venous obstruction (12), creation of a baffle fenestration (2), prosthetic mitral valve evaluation (1), left ventricular outflow tract evaluation (1), access the left heart for hemodynamic evaluation (23). The IAP was traversed in 38/39 patients (97.5%), followed by diagnostic or therapeutic prograde left-heart catheterization. No complications were encountered. Follow up echocardiography in 30/38 PTS demonstrated no residual shunting across the atrial septum except for two cases in which the atrial baffle had been intentionally fenestrated. Transseptal puncture through an intra-atrial patch is a safe procedure. This technique is effective in permitting diagnostic and therapeutic left heart catheterization and does not result in residual shunting through the patch.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Atrios Cardíacos/cirugía , Cardiopatías Congénitas/cirugía , Tabiques Cardíacos/cirugía , Implantación de Prótesis , Punciones , Adolescente , Adulto , Angiografía , Cateterismo Cardíaco , Procedimientos Quirúrgicos Cardíacos/normas , Niño , Preescolar , Ecocardiografía , Estudios de Factibilidad , Atrios Cardíacos/diagnóstico por imagen , Cardiopatías Congénitas/diagnóstico por imagen , Humanos , Lactante , Estudios RetrospectivosRESUMEN
We present a 1,600 g infant who underwent successful balloon aortic valvuloplasty from the right carotid artery approach. A simple technique to facilitate access to the left ventricle and expedite the procedure is described. Issues unique to performing balloon aortic valvuloplasty on such a small child are discussed.
Asunto(s)
Estenosis de la Válvula Aórtica/terapia , Cateterismo/métodos , Enfermedades del Prematuro/terapia , Recien Nacido Prematuro , Humanos , Recién Nacido de Bajo Peso , Recién NacidoRESUMEN
We describe a novel technique to prevent the displacement or migration of a newly implanted stent as a consequence of any subsequent catheter and sheath manipulation during the same catheterization procedure. The technique involves reinflation of the dilation balloon within the stent immediately after implant followed by advancing the long delivery sheath carefully over the balloon as the balloon is slowly deflated within the stent. The technique was used successfully in 78 stents in 30 patients without stent dislodgment or migration.
Asunto(s)
Cateterismo Cardíaco/métodos , Cateterismo/métodos , Migración de Cuerpo Extraño/prevención & control , Stents , Adolescente , Adulto , Niño , Preescolar , Humanos , Lactante , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVES: The purpose of this study was to evaluate the feasibility, safety and efficacy of using a snare-assisted technique to coil occlude the moderate to large size patent ductus arteriosus (PDA). BACKGROUND: Transcatheter occlusion of small PDAs using Gianturco coils is safe and effective. However, in larger size PDAs and/or those with short PDA length, the procedure still carries risks of coil embolization, incomplete occlusion and failure to implant the coil. METHODS: From January 1994 to June 1997, the records of 104 consecutive snare-assisted coil occlusions of moderate to large PDAs (minimum diameter >2.0 mm) were reviewed. Immediate and intermediate outcomes including complete and partial occlusion, failure to implant and complications were analyzed with respect to ductal type and size. RESULTS: Patient age ranged from 0.1 to 70.1 years (median 3.3 years). Minimum PDA diameter ranged from 2.1 to 6.8 mm (mean 3.0 +/- 0.9 mm). Angiographic types were A-62, B-13, C-6, D-14 and E-9. Using the snare-assisted technique, coil placement was successful in 104/104 patients (100%), irrespective of size or angiographic type. Immediate complete closure was observed in 73/104 (70.2%) and was related to smaller PDA size, but not to angiographic type. Complete closure was documented in 102/104 (98.1%) at 2- to 16-month follow-up. Successful closure was unrelated to PDA size or type. Coil embolization to the pulmonary artery occurred in 3/104 (2.9%) patients and was not related to PDA size or type. The need for multiple coils was found in 28/104 patients (26.9%), and was related to larger PDA size, but not to angiographic type. CONCLUSIONS: The snare-assisted delivery technique allows successful occlusion of moderate to large PDAs up to 6.8 mm, irrespective of angiographic type. This technique permits improved control and accuracy of coil placement, and facilitates delivery of multiple coils.
Asunto(s)
Cateterismo Cardíaco/instrumentación , Conducto Arterioso Permeable/terapia , Embolización Terapéutica/instrumentación , Adolescente , Adulto , Anciano , Aortografía , Niño , Preescolar , Diseño de Equipo , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Prótesis e Implantes , Resultado del TratamientoRESUMEN
Thirty-two patients (median age 4.5 years) underwent transcatheter Gianturco coil occlusion of a patent ductus arteriosus. Transthoracic echocardiography was performed the day after coil placement and at intermediate follow-up (median 8.6 months). Echocardiographic results were compared with angiographic and hemodynamic data obtained during catheterization. Two-dimensional (2D) echocardiography performed the day after ductal occlusion displayed evidence of coil protrusion into the left pulmonary artery in 28 of 31 patients (90%) and into the descending aorta in 17 of 29 (59%). However, pulsed Doppler analysis demonstrated normal left pulmonary arterial flow velocities in 28 of 29 patients (97%) and normal descending aortic flow velocities in 26 of 27 (96%). Pulse Doppler results were corroborated by angiographic and hemodynamic catheterization data, which showed no evidence of adjacent vessel obstruction. Peak Doppler velocities among patients with and without 2D echocardiographic left pulmonary artery or descending aorta coil impingement did not differ significantly. The discrepancy between 2D and pulse Doppler findings did not change significantly at intermediate follow-up. Thus, transcatheter occlusion of the patent ductus arteriosus with properly implanted Gianturco coils does not cause significant obstruction to flow in the left pulmonary artery or descending aorta despite frequently misleading 2D echocardiographic images of coil impingement on these vessels.
Asunto(s)
Aorta Torácica , Arteriopatías Oclusivas/etiología , Conducto Arterioso Permeable/terapia , Embolización Terapéutica/efectos adversos , Arteria Pulmonar , Adolescente , Adulto , Angiografía , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/fisiopatología , Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/fisiopatología , Velocidad del Flujo Sanguíneo , Cateterismo Cardíaco , Niño , Preescolar , Conducto Arterioso Permeable/diagnóstico por imagen , Ecocardiografía Doppler , Embolización Terapéutica/instrumentación , Estudios de Seguimiento , Humanos , Lactante , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/fisiopatología , Estudios RetrospectivosRESUMEN
We report an infant with a large patent ductus arteriosus (PDA) and a hypoplastic aortic isthmus presenting with factitious coarctation due to high ductal flow. Following transcatheter occlusion of the PDA with a Gianturco-Grifka vascular occluder, the aortic gradient resolved, thereby eliminating the need for surgery on the isthmus.
Asunto(s)
Aorta/patología , Conducto Arterioso Permeable/cirugía , Presión Sanguínea , Cateterismo Cardíaco , Angiografía Coronaria , Conducto Arterioso Permeable/diagnóstico por imagen , Conducto Arterioso Permeable/fisiopatología , Humanos , Lactante , Flujo Sanguíneo RegionalRESUMEN
The purpose of this study was to assess the feasibility of stent dilation of venous obstructions/occlusions to permit transvenous pacing lead implantation. Innominate vein or superior vena cava (SVG) obstruction may preclude the implantation of transvenous pacing leads. Patients with d-transposition of the great arteries, after a Mustard or Senning procedure, and children with previously placed transvenous pacing leads are at higher risk for this vascular complication. From May 1993 to January 1996, eight pediatric patients who underwent transvenous pacing lead implantation or replacement were found to have significant innominate vein or SVC obstruction or occlusion. Utilizing intravascular stents, a combined interventional and electrophysiological approach was used to relieve the venous obstruction and to permit implantation of a new transvenous pacing lead. Two patients had complete SVC occlusion requiring puncture through the obstruction with a transseptal needle. Vessel recanalization was achieved with balloon dilation and stent implantation. The remaining six patients had severe venous obstruction with a mean minimum diameter of 3.1 +/- 3.3 mm. The mean pressure gradient across the obstructed veins was 8.6 +/- 7.3 mmHg. Following implantation of 15 Palmaz P308 stents in eight vessels, the mean diameter increased to 14.2 +/- 1.9 mm and the mean pressure gradient across the stented vessels decreased to 1.0 +/- 2.0 mmHg. A transvenous pacing lead was implanted successfully through the stent(s) immediately or 6-8 weeks later. Innominate vein and SVC obstruction can be safely and effectively relieved with intravascular stents and permit immediate or subsequent transvenous pacing lead implantation.
Asunto(s)
Implantación de Prótesis Vascular , Venas Braquiocefálicas , Estimulación Cardíaca Artificial/métodos , Cateterismo/métodos , Electrodos Implantados , Stents , Síndrome de la Vena Cava Superior/terapia , Adolescente , Adulto , Venas Braquiocefálicas/diagnóstico por imagen , Cateterismo Cardíaco , Niño , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/etiología , Constricción Patológica/terapia , Estudios de Seguimiento , Humanos , Masculino , Flebografía , Estudios Retrospectivos , Síndrome de la Vena Cava Superior/diagnóstico por imagen , Síndrome de la Vena Cava Superior/etiologíaRESUMEN
OBJECTIVES: This report describes the results of the Food and Drug Administration's phase 1 and 2 clinical trials of intravascular stents at Texas Children's Hospital. BACKGROUND: Since the late 1980s, intravascular stent implantation for the treatment of arterial and venous stenoses in congenital heart disease has been highly successful. METHODS: Stents were placed in postoperative pulmonary artery (PA) stenoses, congenital PA stenoses or stenoses of systemic veins/venous anastomoses. Prospective collection of data according to protocol was done before intervention, after stent implantation and at follow-up catheterization. RESULTS: At stent implantation, pressure gradients decreased significantly in all three groups (mean +/- SD): from 46 +/- 25 to 10 +/- 13 mm Hg in postoperative PA stenoses (p < 0.001); from 71 +/- 45 to 15 +/- 21 mm Hg in congenital PA stenoses (p < 0.001); and from 7 +/- 6 to 1 +/- 2 mm Hg in stenoses of systemic veins/venous anastomoses stenoses (p < 0.001). Vessel diameters markedly increased: from 6 +/- 3 to 12 +/- 3 mm in postoperative PA stenoses (p < 0.001); from 3 + 1 to 9 + 1 mm in congenital PA stenoses (p < 0.001); and from 3 +/- 4 to 12 +/- 4 mm in stenoses of systemic veins/venous anastomoses (p < 0.001). In the postoperative and congenital PA stenoses groups, right ventricular pressure decreased (right ventricular pressure indexed to femoral artery pressure ratio): from 0.63 +/- 0.2 to 0.41 +/- 0.02 (p < 0.001) and from 0.71 +/- 0.3 to 0.55 +/- 0.35 (p = 0.04), respectively. Perfusion to a single affected lung increased from 31 +/- 17% to 46 +/- 14% (p < 0.001). On recatheterization (mean 14 months), results varied minimally. Repeat angioplasty of residual stent stenoses was safe and effective. Complications included four early patients with stent migration, three with stent thrombosis and two deaths. There were no late complications. Significant restenosis occurred in only three patients. CONCLUSIONS: Intravascular stents for the treatment of vascular stenoses in congenital heart disease provide excellent immediate and long-term results.
Asunto(s)
Cardiopatías Congénitas/cirugía , Arteria Pulmonar/anomalías , Arteria Pulmonar/cirugía , Stents , Adolescente , Adulto , Niño , Preescolar , Constricción Patológica , Femenino , Migración de Cuerpo Extraño/etiología , Humanos , Lactante , Masculino , Stents/efectos adversos , Trombosis/etiología , Resultado del TratamientoRESUMEN
BACKGROUND: A completed Fontan circulation is the goal in the management of patients with single-ventricle physiology. To achieve this end, a two-stage rather than a single-stage approach is carried out routinely at many centers. Some groups have advocated baffle fenestration for virtually all patients to minimize post-Fontan complications. Other centers perform single-stage Fontan operations and do not fenestrate. Thus controversies have arisen regarding the indications for the staged procedure versus single stage and for fenestration versus no fenestration. METHODS AND RESULTS: The preoperative risk factors and postoperative course were characterized in 61 consecutive patients (median age, 3.3 years) undergoing a single-stage, nonfenestrated Fontan. The patients were followed for 3.5+/-1.9 years. The relationship between preoperative risk factors and mortality and morbidity was assessed. Preoperative risk factors assessed included age <2 years (n=18), branch pulmonary artery stenosis (n=20), elevated mean pulmonary artery pressure >15 mm Hg (n=16), atrioventricular valve regurgitation (n=5), and decreased ventricular function (n=2). Total caval pulmonary anastomosis was performed in 53 patients. Additional surgery was required at the time of the Fontan in 25 patients (41%). The median duration of mechanical ventilation was 1 day; median chest tube drainage was 5.5 days (range, 1 to 35). Oxygen saturation rose significantly postoperatively, from 83% to 95%. Early mortality was 4.9%; one patient died from pacemaker failure 9 months postoperatively, and one patient underwent successful heart transplant 4 months post-Fontan. One- and 5-year actuarial survival was 93%. No preoperative risk factor was associated with a failed Fontan or significant effusions. CONCLUSIONS: A single-stage, nonfenestrated Fontan was performed in a large group of patients with excellent surgical results and intermediate outcome. There is no evidence that a two-stage approach and/or baffle fenestration is required for a large cohort of patients who are candidates for a Fontan operation.
Asunto(s)
Procedimiento de Fontan , Cardiopatías Congénitas/cirugía , Adolescente , Adulto , Niño , Preescolar , Cardiopatías Congénitas/mortalidad , Hemodinámica , Humanos , Lactante , Tiempo de Internación , Factores de RiesgoRESUMEN
A novel method using a snare and bioptome to provide bidirectional control of a Gianturco coil for occlusion of a patent ductus arteriosus with a shallow ampulla and Pott's shunts is presented. This method greatly reduces the risk of coil embolization and optimizes coil position in difficult cases.
Asunto(s)
Conducto Arterioso Permeable/patología , Conducto Arterioso Permeable/cirugía , Adulto , Niño , Humanos , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
A case of a pediatric patient found to have coexisting coarctation of the aorta and patent ductus arteriosus who underwent balloon dilation of the coarctation and coil occlusion of the ductus in a single cardiac catheterization is presented. Review of the English literature revealed no previous reports of this combination of transcatheter interventions during a single catheterization procedure.
Asunto(s)
Coartación Aórtica/complicaciones , Coartación Aórtica/terapia , Cateterismo Cardíaco , Cateterismo , Conducto Arterioso Permeable/complicaciones , Conducto Arterioso Permeable/terapia , Aortografía , Preescolar , Humanos , Masculino , Resultado del TratamientoRESUMEN
BACKGROUND AND HYPOTHESIS: Although results of surgical ligation of the patent ductus arteriosus (PDA) in the pediatric age group are excellent, surgical management of the adult with a PDA may be more problematic. The PDA that presents in adulthood may be calcified and friable, rendering simple ligation via a thoracotomy difficult, inadequate, and hazardous. Patch closure of the ductus arteriosus from either the aortic or pulmonary artery orifice using cardiopulmonary bypass or transient aortic cross-clamping is necessary but increases surgical risk. Furthermore, older patients with diseases unrelated to their PDA and patients with Down's syndrome may have higher risks with intubation, general anesthesia, and surgery. Early results of percutaneous transcatheter occlusion of the PDA with Gianturco coils performed under sedation and local anesthesia are promising. METHODS: Six adults with mean age of 39.1 years (range 23.1-62.0 years) were found to have an isolated PDA with mean minimum diameter of 2.7 mm (range 1.0-5.0 mm) at cardiac catheterization. All underwent percutaneous transcatheter occlusion of the PDA using Gianturco coils. RESULTS: Coil implantation was successful in all patients. There were no complications and all were discharged home within 24 hours. Complete ductal occlusion was seen immediately in 4 of 6 patients (67%) while 2 of 6 (33%) had small residual leaks. However, complete occlusion was achieved in all patients by 6 months following the procedure. CONCLUSION: Transcatheter occlusion of the PDA using coils is safe and efficacious in adults.
Asunto(s)
Conducto Arterioso Permeable/terapia , Adulto , Cateterismo Cardíaco , Femenino , Humanos , Masculino , Métodos , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
UNLABELLED: Because late repair of coarctation of the aorta (COA) is associated with premature cardiovascular disease in adult life, early detection and treatment is important. OBJECTIVES: To determine the timing of referral to see whether early detection of COA has improved in the past decade, to evaluate the pattern of and reasons for medical center referral, and to assess the clinical signs relating to the diagnosis of COA. METHODS: The records of 50 consecutive patients older than 1 year who had surgical repair of COA from 1980 to 1990 were reviewed. The age of referral, pattern of referral, and presence of standard clinical signs of COA were analyzed, and data were compared with those from the previous decade. RESULTS: The mean and median ages at referral were 8.4 and 5.8 years, respectively. Pediatricians accounted for 64% of the referrals. A specific diagnosis of COA was made in 2 (4%) of 50 patients before referral to a pediatric cardiologist. The most consistent clinical findings were a cardiac murmur and a systolic blood pressure gradient between the arms and legs of greater than 10 mm Hg, which were both present in all patients. Lower-extremity pulses were decreased in 37 (74%) and absent in 9 (18%). Forty-seven children (94%) had upper-extremity hypertension (> 95th percentile for age); 25 (50%) had systolic blood pressure higher than 140 mm Hg. COA would have been missed in 82% of children if absent lower-extremity pulses were required as a diagnostic feature. These findings were similar to those reported by our institution in the previous decade, suggesting that early detection has not improved. CONCLUSIONS: The timing of, reasons for, and sources of referral for COA in this study, compared with data from the previous decade, indicate no improvement in early detection of COA by pediatricians. Screening all children for COA by routinely measuring upper- and lower-extremity blood pressures during at least one physical examination after the newborn period is mandatory.
Asunto(s)
Coartación Aórtica/diagnóstico , Coartación Aórtica/cirugía , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Ciudad de Nueva York , Examen Físico/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Factores de TiempoRESUMEN
A 2-month-old child with Down syndrome and a large patent ductus arteriosus underwent transcatheter closure using a new Food and Drug Administration-approved occlusion device. This device is described, along with its usefulness for other vascular defects.
Asunto(s)
Cateterismo Cardíaco/instrumentación , Conducto Arterioso Permeable/terapia , Diseño de Equipo , Humanos , LactanteRESUMEN
Coexisting aortopulmonary collaterals in patients diagnosed with a patent ductus arteriosus (PDA) are rare findings. Percutaneous transcatheter closure of PDA and requisite aortography offer an unique opportunity to identify and treat these systemic arterial anomailes, which would be missed by echocardiographic evaluation alone. The significance of these collaterals is unclear, but it may contribute to left heart dilation from additional left to right shunting in patients with an otherwise isolated small PDA. Of 18 patients undergoing transcatheter occlusion of a PDA with Gianturco coils, 2 were found to an additional significant aortopulmonary collaterals, which were also occluded.
Asunto(s)
Cateterismo Cardíaco , Circulación Colateral , Conducto Arterioso Permeable/fisiopatología , Conducto Arterioso Permeable/terapia , Aortografía , Niño , Preescolar , Conducto Arterioso Permeable/diagnóstico por imagen , Femenino , Humanos , Masculino , Arteria Pulmonar/diagnóstico por imagenRESUMEN
A 17-year-old male with neurofibromatosis presented with severe hypertension secondary to an abdominal aortic coarctation and bilateral renal artery stenoses. Despite previous surgical bypass grafts and aggressive medical management, including treatment with diuretics, beta-blocker, calcium channel blocker, angiotensin converting enzyme (ACE) inhibitors, and direct vasodilator agents, severe hypertension persisted. Following intravascular stent placement in the aorta and both renal arteries, blood pressures normalized.