RESUMO
Balloon atrial septostomy (BAS) is a palliative procedure performed in the preoperative management of patients with transposition of great arteries (TGA), to improve the mixing of blood between the 2 systems. This report describes experience at the Clínica Cardiovascular Santa Maria in Medellin, Colombia. Between 2002 and 2010, 22 patients with TGA underwent BAS. Patient age at the time of the procedure was 21 days on average; 68% of patients were male. Average weight was 2.96 kg and interatrial gradient was between 4 and 12 mm Hg. The average systemic oxygen saturation at the beginning of the procedure was 60%, with a final saturation of 90%. Z5 atrioseptostomy balloons were used in 18 patients (81%), using Rashkind technique; Tyshak balloon catheters were used in 3 patients (13%) with the Shrivastava technique; and static high-pressure peripheral angioplasty balloons were used in 3 patients (13%). Two patients underwent BAS with 2 types of balloons. Although there were no complications clearly attributable to the procedure, 14% of patients had evidence of focal brain injury on the postoperative magnetic resonance image. Six patients died (27%), 5 of them because of postoperative complications and 1 because of infectious complications at another institution. All postoperative deaths occurred before 2006. The BAS is a safe technique for preoperative stabilization of patients with TGA.
RESUMO
La presencia de una comunicación interauricular no restrictiva es obligatoria para mantener un gasto cardíaco adecuado o para lograr una mezcla de sangre aceptable en algunos pacientes portadores de cardiopatías congénitas complejas. Describimos un paciente en quien luego de un intento fallido de dilatación estática con balón de una comunicación interauricular restrictiva se utilizó un balón con cuchillas con éxito para su ampliación.
A nonrestrictive atrial septal defect is mandatory in order to maintain an adequate cardiac output or to achieve an acceptable blood mixing in some patients with complex congenital heart defects. We successfully performed a blade balloon septostomy in a patient with a restrictive atrial septal defect who had previously undergone a failed static balloon dilation of the atrial septum.
RESUMO
La hipertensión arterial pulmonar es una enfermedad rara que afecta a personas de mediana edad, predominando en el sexo femenino. La sobrevida es de 2,8 años, luego del diagnóstico. Desde el año 1980 (donde se realizó el primer trasplante pulmonar) hasta la fecha, el tratamiento médico presentó un gran progreso, lo que ha relegado a los tratamientos intervensionistas, como la septostomía, a un segundo plano.La primer septostomía fue realizada en el año1983 y hasta la actualidad sólo se realizaron aproximadamente 300 procedimientos en todo el mundo. Por este motivo presentamos un caso clínico donde el tratamiento intervencionista por medio de la septostomía auricular nos muestra una solución transitoria como puente hacia el trasplante pulmonar
The pulmonary hypertension is a rare disease that affects peoplein the third and fourth decade of life; the predominance is in female sex. Since the first pulmonary transplant, made in 1980, de medical treatment and the interventional procedures have had a great progress. The first septostomy was in 1983 and nowadays, there have been 300 septostomies around the world. We introduced a case report of a septostomy like a bridge to a pulmonary transplant
A hipertensão arterial pulmonar é uma doença rara que afeta a pessoas de meia idade, predominando o sexo feminino. Estudos epidemiológicos mostrarão que o diagnóstico realiza-se 2 anos depois do inicio dos sintomas e a sobrevida é de 2,8 anos logo do diagnóstico. Mas, em pacientes em classe funcional IV a mesma diminui a 6 meses. Desde o ano 1980 (onde se realizou o primeiro transplante pulmonar) até a data, o tratamento médico apresentou um grande progresso, o que há relegado aos tratamentos intervencionistas como a septostomía em um segundo plano e o seu desuso. A primeira septostomía foi realizada no ano 1983 e até hoje só foram realizados aproximadamente 300 procedimentos em todo o mundo. Por esse motivo nós apresentamos um caso clínico, onde o tratamento intervencionista pelo meio da septostomía auricular nos mostra uma solução transitória mas efetiva como ponte até o transplante pulmonar