RESUMEN
We present the initial experience of closing of patent ductus arteriosus (PDA) with a new device; Gianturco-Grifka, at the General Hospital of The Medical Center "La Raza". The patient was a 4 year's old girl, in whom we detected continuous murmur in the second intercostal space, echocardiography showed a long conical patent ductus arteriosus 4.9 mm of diameter, systolic pressure of the pulmonary artery was 35 mm Hg with QP/QS 1.6:1. Hemodynamic study revealed a long conical ductus arteriosus 5 mm of diameter, type A1 from Krichenko classification. We proceeded to occlude the PDA with a Gianturco-Grifka device of 7 mm. Immediately after the PDA occlusion the shunt disappeared, there were no complications during the procedure. More cases are needed to determine long term benefits and limitations, of this procedure. However we conclude that technically it is easy to use. There is greater decrease of residual shunt that the one reported with other devices.
Asunto(s)
Cardiología/instrumentación , Conducto Arterioso Permeable/terapia , Cateterismo Cardíaco , Preescolar , Femenino , Humanos , MéxicoRESUMEN
We describe the case of a 26-year-old female in functional class I (NYHA), with aortic origin of the right pulmonary artery associated with a persistent ductus arteriosus and severe pulmonary artery hypertension (101/40-70 mm Hg), which remained elevated (89/40-60 mm Hg) after the administration of 100% oxygen. Right pulmonary artery pressure (125/60-86 mm Hg) was higher than that of main pulmonary artery and similar to aorta pressure. The patient was successfully treated: surgical closure of the ductus arteriosus and end-to-end anastomosis between the pulmonary artery and right pulmonary artery were carried out. Systolic pulmonary arterial pressure, estimated by echocardiography Doppler, was 60 mm Hg six months after surgery. Cross-sectional echocardiogram showed the anastomosis of the right pulmonary artery with the main pulmonary artery. Pulmonary gammagraphy showed both lungs perfused through the main pulmonary artery; right lung perfusion was lesser than left lung perfusion, 30 vs. 70% respectively. Aortic origin of a right or left pulmonary artery is a heart disease seen in patients during the course of the first year of life. Its frequency is < 1% among all the congenital cardiopathies and the survival rate to adult life is very low. The originality of this paper is the presentation of a rare congenital cardiopathy treated surgically in an adult.
Asunto(s)
Conducto Arterioso Permeable/diagnóstico por imagen , Arteria Pulmonar/anomalías , Adulto , Femenino , Humanos , Arteria Pulmonar/diagnóstico por imagen , Radiografía , Cintigrafía , UltrasonografíaRESUMEN
We present our early experience with the Gianturco-Grifka device for transcatheter closure of patent ductus arteriosus. Grifka occlusion was attempted in 13 patients (7 female, 6 male), median patient age was 6.5 years. Echocardiographic evaluation showed a mean ductal diameter of 5.47 +/- 1.09 mm, and the morphology was type C in 7 patients, type A in 5 and type E in 1 patient. The angiographic ductal morphology was 6 type A, 5 type C and 2 type E. Mean PDA diameter was 5.69 +/- 1.15 mm. Three patients had pulmonary hypertension. They were given supplemental oxygen (100%), decreasing their pulmonary pressures. A total of 13 devices were implanted, 5 of 7 mm and 8 of 9 mm. Twelve patients had complete ductal occlusion documented by aortic angiography (92%), one patient presented residual shunt (8%). Color echocardiography at 24 hrs documented complete occlusion in 12 cases. One device embolized to the descending aorta 2 hours after closure, and it was successfully retrieved in the catheterization lab. We conclude that the Gianturco-Grifka device is an appropriate alternative for transcatheter closure of the PDA. This technique can be performed in ductus arteriosus type C, D and E, with diameter < 9 mm. More clinical trials are needed to establish the long-term results of this technique.
Asunto(s)
Conducto Arterioso Permeable/cirugía , Procedimientos Quirúrgicos Cardíacos/instrumentación , Niño , Preescolar , Diseño de Equipo , Femenino , Humanos , Lactante , MasculinoRESUMEN
The purpose of this study was to demonstrate the usefulness of two-dimensional and Doppler echocardiography for diagnosing double mitral valve orifices (DMVO) in addition to identifying associated pathologies. We report five cases, three male and two female with an age ranging from 4 to 44 years old (mean age: 17 years), with the diagnosis of DMVO according to the following characteristics: using two-dimensional echocardiography on the short parasternal axis, both orifices were observed; apical in which the "seagull sign" was identified in both chambers, in addition to identifying the flows of each orifice by pulsed and codified color Doppler obtaining the corresponding gradients. With respect to the associated pathologies, all patients presented some type of malformation, such as subaortic ring, patent ductus arteriosus, coarctation of the aorta, bicuspid aorta and pulmonary stenosis. Using the color Doppler echocardiography allows an adequate anatomical and functional definition of DMVO.