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2.
Kardiol Pol ; 81(3): 259-264, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36594530

RESUMEN

BACKGROUND: Transcatheter closure of atrial septal defect (ASD) has become the treatment of choice for most patients. About 5% of them suffer from transient headache episodes (THE) after the procedure, whose etiology is unclear. AIMS: To evaluate risk factors for THE occurrence after transcatheter closure of ASD in the pediatric population. METHODS: Eight hundred and forty patients, after transcatheter ASD closure with nitinol devices, from a single center, were included in retrospective analysis. THE was defined as occurring up to 24 hours after the procedure. A logistic regression model including age, weight, ASD diameter, device size, presence of nitinol coating on the device, fluoroscopy time, application of balloon calibration, device oversizing, and residual shunt after 24 hours was created to evaluate risk factors for THE occurrence. RESULTS: There were 40 patients with THE (4.8%), 70% female and 30% male. The median age was 13 (7.35-16) years. In patients with headache, balloon calibration (BC) was performed more frequently (82.5% vs. 43.3%; P <0.001). The balloon waist median (interquartile range [IQR]), 19 (16-22) mm vs. 15 mm (12-18) mm (P <0.001), and device size median (IQR), 18 (13.5-22) mm vs. 14 (11-17) mm (P <0.001) were larger, and residual shunt after 24 hours (12.5% vs. 4.9%; P = 0.03) and a year (7.5 vs. 1.0%; P <0.001) were more frequent. ASD size and the prevalence of double/multiple ASD were similar in both groups. Age, BC application, no nickel release protection, duration of fluoroscopy, and device oversizing were predictors of THE (P <0.001). CONCLUSIONS: BC during percutaneous ASD closure and the lack of a protective layer against nickel release on the device are risk factors for headache occurrence in the early postprocedural period.


Asunto(s)
Defectos del Tabique Interatrial , Dispositivo Oclusor Septal , Humanos , Niño , Masculino , Femenino , Adolescente , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/métodos , Estudios Retrospectivos , Defectos del Tabique Interatrial/cirugía , Defectos del Tabique Interatrial/etiología , Cefalea/etiología , Resultado del Tratamiento , Ecocardiografía Transesofágica , Dispositivo Oclusor Septal/efectos adversos
3.
Kardiol Pol ; 79(3): 287-293, 2021 03 25.
Artículo en Inglés | MEDLINE | ID: mdl-33599452

RESUMEN

BACKGROUND: Transcatheter patent ductus arteriosus (PDA) closure has become the first­choice method of treatment in the majority of patients. However, device selection poses a challenge. AIMS: This study aimed to analyze periprocedural and 1­year outcomes of PDA transcatheter closure performed with different devices throughout a 25­year time period in a single center. METHODS: All 1036 patients who underwent transcatheter PDA closure between 1993 and 2020 were included in retrospective analysis. Various devices were used: the Rashkind device (RD; n = 25), coils (n = 469), nitinol duct occluders type I (DO I; n = 300), type II (n = 32), type II additional sizes (ADO II AS; n = 209), as well as off­label devices: vascular plugs and atrial septal and muscular ventricular septal defect occluders (n = 17). Data on 24­hour and 1­year follow­up were available for 100% and 78.9% of the study patients, respectively. RESULTS: The procedure was successful in 98.6% of the study patients, with a major complication rate of 0.2%. Complete PDA closure after a year was observed in 81.8% of the patients treated with RD, 93.7% of those with coils, and 100% of those with duct occluders. There were no differences between Amplatzer DO I (n = 159) and its DO I copies manufactured in China (n = 141) with regard to success, efficacy, and complication rates. Recently, ADO II AS has replaced coils and become the preferred device to close small­to­moderate PDA. CONCLUSIONS: Transcatheter PDA closure with all types of nitinol duct occluders is safe and effective, with no residual shunting at 1­year follow­up. Due to higher efficacy, ADO II AS has replaced coils in the treatment of smaller PDA.


Asunto(s)
Conducto Arterioso Permeable , Dispositivo Oclusor Septal , Cateterismo Cardíaco , China , Conducto Arterioso Permeable/cirugía , Humanos , Lactante , Estudios Retrospectivos , Resultado del Tratamiento
5.
J Interv Cardiol ; 2020: 4585124, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32410916

RESUMEN

OBJECTIVES: Patent ductus arteriosus (PDA) in elderly patients is an uncommon anomaly, and the duct itself is often calcified and fragile; therefore, transcatheter closure is more difficult. The aim is to analyse periprocedural and one-year follow-up results of transcatheter closure of PDA in such patients. Methods and results. Retrospective analysis of 33 elective patients aged ≥55 years (median 63; 56-85; 29 women), in whom PDA was closed percutaneously between 2002 and 2018 in two tertiary centres. All but three patients were symptomatic, with most in NYHA II (n = 14) and III (n = 11) class; pulmonary hypertension (n = 22), arterial hypertension (n = 22), duct calcifications (n = 17), atrial fibrillation (n = 15), significant mitral regurgitation (n = 5), and decompensated renal failure (n = 2) were observed. Different devices were applied depending on PDA morphology; nitinol wire mesh occluders with symmetrical articulating discs have been the most used in recent years (n = 11). Follow-up was conducted at an outpatient clinic (28/33 patients). The procedure was successful in all patients. There was one embolisation, followed by implantation of a larger device. No major complications were noted. A small residual shunt was present in echocardiography in one patient after one year. NYHA class improved in all but two patients (with multiple comorbidities). CONCLUSIONS: Transcatheter PDA closure in elderly patients is safe and efficient with a high complete closure rate and few complications. Amplatzer duct occluder type II is an attractive device in such patients.


Asunto(s)
Cateterismo Cardíaco/métodos , Conducto Arterioso Permeable/cirugía , Complicaciones Posoperatorias , Implantación de Prótesis , Dispositivo Oclusor Septal , Ecocardiografía/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Diseño de Prótesis , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/métodos , Estudios Retrospectivos , Resultado del Tratamiento
8.
J Cardiol ; 74(4): 381-387, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31023567

RESUMEN

BACKGROUND: We aimed to evaluate medium- and long-term outcomes of transcatheter closure (TC) of ruptured sinus of Valsalva aneurysm (RSVA), which is a rare and mostly congenital heart disease. METHODS: Retrospective analysis included 23 patients (14 males) aged 15-79 years (y; 39.9±18.5) selected for TC of RSVA between 2007 and 2017 in two tertiary centers in Poland and Ukraine. Fifteen patients were in New York Heart Association (NYHA) class III or IV before TC; 5 patients had acquired RSVA after previous cardiac surgery. We applied 22 duct, 3 muscular, and 1 atrial septal Amplatzer or Amplatzer-like occluders by the anterograde venous approach after arterio-venous loop creation in all but 1 patient. Mean follow-up conducted in outpatient clinic was 5.5±3.5 (1-11)y. RESULTS: The procedure was successful in 19/23 patients (82.6%). Four procedures were abandoned and the device percutaneously retrieved due to coronary artery compression (1 patient), transient increase of aortic regurgitation (AR; 1 patients) or embolization (2 patients). New onset of significant AR was noted in one of the latter patients after device removal. NYHA class improved in all treated patients but 2, in whom it remained stable (p<0.05), with 10 patients in class I. Three patients needed percutaneous re-intervention during follow-up because of significant residual shunt in 1 and late recurrent RSVA in 2 patients. The follow-up of the remaining patients was uneventful. Neither erosion, embolization, new AR, nor death were observed. CONCLUSIONS: The percutaneous closure of RSVA is a safe and effective method of treatment with good clinical outcome. However, although not described previously, recurrent shunts after TC of RSVA are possible and can be treated successfully with another transcatheter intervention.


Asunto(s)
Rotura de la Aorta/cirugía , Cateterismo Cardíaco/métodos , Procedimientos Quirúrgicos Cardíacos/métodos , Seno Aórtico/cirugía , Adolescente , Adulto , Anciano , Cateterismo Cardíaco/efectos adversos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Polonia/epidemiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del Tratamiento , Ucrania/epidemiología , Adulto Joven
10.
Kardiol Pol ; 76(8): 1257-1262, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29862489

RESUMEN

BACKGROUND: Atrial septal defect (ASD) type 2, according to current standards, is closed percutaneously usually after the child has reached the age of four to five years. There are limited data regarding such treatment in younger infants. AIM: We sought to evaluate the feasibility, safety, and efficacy of percutaneous ASD closure in children under three years of age. METHODS: The research group consisted of 157 children less than three years old with haemodynamically significant ASD, who underwent effective transcatheter ASD closure in a single tertiary centre between 1999 and 2014. The mean procedural age of the treated children was 2.2 years and mean weight was 12.5 kg. In all cases nitinol wire mesh devices were applied (mostly Amplatzer Septal Occluders). ASD was closed using standard technique (except a few cases wherein the left disc of the implant was inserted initially into the right pulmonary vein to prevent oblique position of the device). Procedure-related complications were divided into major and minor ones. RESULTS: Atrial septal defect was closed in 149 children: 97 with a single ASD and 52 with double/multiple ASD. The procedure was abandoned in eight patients (three with single and five with double/multiple ASD). No death or implant embolisation occurred during the procedure or follow-up, and there was one case of major postprocedural complications. Normalisation of the right ventricular diameter occurred in all patients during one-year follow-up. In the majority of children acceleration of physical development and resolution of accompanying morbidity were observed in follow-up. CONCLUSIONS: Percutaneous ASD closure can be performed safely in children under three years of age with low risk of peri- or postprocedural complications.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Defectos del Tabique Interatrial/cirugía , Seguridad del Paciente , Dispositivo Oclusor Septal , Aleaciones , Preescolar , Estudios de Seguimiento , Humanos , Lactante , Resultado del Tratamiento
12.
Postepy Kardiol Interwencyjnej ; 12(3): 231-7, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27625686

RESUMEN

INTRODUCTION: Balloon angioplasty (BAP) and aortic or pulmonary balloon valvuloplasty (BAV, BPV) are well-established treatment options in congenital heart defects. Recently, significant technological progress has been made and new catheters have been implemented in clinical practice. AIM: To analyze the results of BAP, BAV and BPV with the new balloon catheter Valver and its second generation Valver II, which the company Balton (Poland) launched and developed. These catheters have not been clinically evaluated yet. MATERIAL AND METHODS: We performed 64 interventions with Valver I and Valver II. With Valver I the following procedures were performed: 17 BPV (including 9 in tetralogy of Fallot - TOF), 10 BAV and 27 BAP in coarctations of the aorta (CoA) - including 9 native and 18 after surgery. With Valver II ten interventions were done - 3 BPV, 2 pulmonary supravalvular BAP (after switch operations), 2 BAP of recoarctations and 3 other BAP. Age of the patients ranged from a few days to 40 years. RESULTS: All procedures were completed successfully, without rupture of any balloon catheters. The pressure gradient drop was statistically significant in all groups: BPV in isolated pulmonary valvular stenosis 28.1 mm Hg (mean), BPV in TOF 18.7 mm Hg, BAV 32.8 mm Hg, BAP in native CoA 15.4 mm Hg and in recoarctations 18.6 mm Hg. In 3 cases during rapid deflation of Valver I, wrinkles of the balloons made it impossible to insert the whole balloon into the vascular sheath (all were removed surgically from the groin). No such complication occured with Valver II. CONCLUSIONS: Valver balloon catheters are an effective treatment modality in different valvular and vascular stenoses.

13.
Eur Child Adolesc Psychiatry ; 23(9): 845-50, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24276672

RESUMEN

BACKGROUND: Nitric oxide (NO) is involved in eating behavior and inflammatory response. Moreover, there is evidence that NO production is altered in patients with anorexia nervosa (AN). AIM: To assess whether the overproduction of NO in AN can affect NO level in exhaled air. MATERIALS AND METHODS: Exhaled NO level was studied in 23 girls with AN and compared with that of healthy age- and gender-matched nonatopic controls. RESULTS: Exhaled NO levels were significantly higher in girls with AN compared with healthy age-matched controls. CONCLUSIONS: It appears that anorexia nervosa was accompanied by a higher level of exhaled NO, likely resulting from a systemic increase in NO production because of the severe catabolic state.


Asunto(s)
Anorexia Nerviosa/metabolismo , Óxido Nítrico/análisis , Adolescente , Anorexia Nerviosa/diagnóstico , Biomarcadores/análisis , Pruebas Respiratorias , Espiración , Femenino , Humanos , Masculino , Polonia , Pruebas de Función Respiratoria
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