Mid-Term Outcomes after Percutaneous Closure of the Secundum Atrial Septal Defect with the Figulla-Occlutech Device.

Objectives: To evaluate the mid-term outcomes after percutaneous closure of the secundum atrial septal defects (ASD) using the Figulla-Occlutech device (FOD).

Background: Transcatheter closure has become the method of choice for most patients with ASD. Although the FOD may have some advantageous characteristics there is a paucity of data on later outcomes after the use of this relatively new device.

Percutaneous versus surgical closure of atrial septal defects in children and adolescents.

Background: There is a scarcity of data comparing percutaneous and surgical closure of the secundum atrial septal defect (ASD).

Objectives: Assessment of safety and efficacy of both methods of treatment in a referral center affiliated with the Ministry of Health.

Methods: Observational, prospective, non-randomized study of two cohorts of children and adolescents younger than 14 years, treated by catheterization or surgery.

Percutaneous closure of Blalock-Taussig shunts using Gianturco coils.

Permeability of a Blalock-Taussig shunt can increase the risk of endocarditis and ventricular overload. Percutaneous embolization of these shunts gives variable results. We report our experience in 10 patients with percutaneous closure of modified Blalock-Taussig shunts using retrograde arterial embolization with Gianturco coils.

Prevalence and surgical approach of supravalvular pulmonary stenosis after Jatene operation for transposition of great arteries.

Background: The Transposition of the Great Arteries is the most frequent congenital cyanogenic cardiopathy in the neonatal period, corresponding to 7% of all congenital cardiopathies. Among the operations for surgical treatment, the Jatene operation, with arterial correction, is the treatment of choice. During the late postoperative evolution, some problems were observed, with the most common being the occurrence of supravalvular stenosis at the neopulmonary, regardless of the type of surgical technique used.

Percutaneous closure of postoperative and post-traumatic ventricular septal defects.

Although uncommon, significant postoperative residual leaks may occur after repair of any type of ventricular septal defect (VSD). Post-traumatic VSDs are even rarer, but can be occasionally seen after penetrating or blunt chest trauma. When these defects are associated with significant left-to-right shunting (Qp/Qs > 1.

New transcatheter techniques for creation or enlargement of atrial septal defects in infants with complex congenital heart disease.

Objectives: To describe a series of 8 consecutive infants (5 with transposition of the great arteries [TGA] and 3 with hypoplastic left heart syndrome [HLHS]) who underwent nonconventional septostomy techniques.

Background: For some complex congenital heart defects, an unrestrictive atrial septal defect (ASD) is essential to achieve an adequate cardiac output and/or systemic saturation. In some scenarios, the use of conventional septostomy techniques may be technically difficult, hazardous, and/or ineffective.

Transhepatic access for atrioseptostomy in a neonate.

We report a case in which a neonate with complete transposition of the great arteries was submitted to an atrial septostomy through transhepatic access due to congenital interruption of the inferior vena cava. The technical aspects of the procedure are discussed.

[Right patent ductus arteriosus with an ipsilateral aortic arch: percutaneous closure with amplatzer devices].

The association of a right aortic arch with an ipsilateral patent ductus arteriosus is rare, especially when there are no other intracardiac anomalies. We report three female patients aged 26, 35 and 9 years with this combination in whom previous attempts at surgical closure by thoracotomy and sternotomy were unsuccessful and who subsequently underwent successful percutaneous closure of the defects using Amplatzer devices. In two patients, although angiography demonstrated the presence of type-A patent ductus arteriosus, it was not possible to determine the minimum diameter accurately and it was necessary to measure it using a sizing balloon.

Double balloon pulmonary valvuloplasty: multi-track system versus conventional technique.

Objectives: To evaluate whether double balloon pulmonary valvuloplasty (DBPV) with the Multi-Track system (MTS) may help to simplify the procedure.

Background: DBPV is usually required for patients with pulmonary valve stenosis with large annulus. However, it needs two venous accesses and can be technically demanding.

Endovascular stenting for aortic coarctation.

Surgery had been the traditional treatment for native coarctation of the aorta, one of the most common cardiovascular congenital malformations. As a less invasive mode of treatment, balloon angioplasty has emerged as an alternative to surgery but has not gained universal acceptance due to its rates of restenosis secondary to vessel recoil and concerns over aortic wall injury resulting in aneurysm formation. To overcome these problems, endovascular stents were introduced in the management of this condition.

Intracoronary ultrasound assessment late after the arterial switch operation for transposition of the great arteries.

Objectives: This research was undertaken to assess the status of the coronary wall morphology late after the arterial switch operation (ASO) for transposition of the great arteries employing intravascular ultrasound (IVUS).

Background: Long-term patency of the reimplanted coronary arteries is a key issue after ASO. Follow-up studies have demonstrated coronary obstruction in up to 8% of patients that may be related to progressive fibrocellular intimal thickening.

Stenting vs. balloon angioplasty for discrete unoperated coarctation of the aorta in adolescents and adults.

More information is needed to clarify whether stenting is superior to balloon angioplasty (BA) for unoperated coarctation of the aorta (CoA). From September 1997, 21 consecutive adolescents and adults (24 +/- 11 years) with discrete CoA underwent stenting (G1). The results were compared to those achieved by BA performed in historical group of 15 patients (18 +/- 10 years; P = 0.

Transcatheter closure of secundum atrial septal defects with complex anatomy.

The aim of this study was to evaluate the feasibility, safety and efficacy of transcatheter closure of secundum atrial septal defects (ASD) in patients with complex anatomy. From September 1997 to July 2003, a total of 40 patients (median age, 34 years; 65% female) with complex ASDs, defined as the presence of a large defect (stretched diameter >26 mm) associated with a deficient rim (n=23); multiple defects (n=8); a multi-fenestrated septum (n=5); and defects associated with an aneurysmal septum irrespective of their size (n=4) underwent closure. The Helex device was used in 4 patients and the Amplatzer in the remaining.

Transcatheter closure of perimembranous ventricular septal defects.

The isolated perimembranous ventricular septal defect is one of the most common congenital cardiac malformations. Although surgery has been performed and has a low associated risk, it still involves morbidity due to factors such as residual leaks, atrioventricular block, postpericardiotomy syndrome and arrhythmias. It has been speculated that percutaneous closure of these defects could minimize such complications.

Percutaneous closure of perimembranous ventricular septal defects with the Amplatzer device: technical and morphological considerations.

Percutaneous closure of perimembranous ventricular septal defects (VSDs) has been feasible, safe, and effective with the new Amplatzer membranous septal occluder. We report further experience with this device with emphasis on morphological aspects of the VSDs and technical issues. Ten patients (median age and weight, 14 years and 34.

Initial experience in Brazil with the Helex septal occluder for percutaneous occlusion of atrial septal defects.

Objective: To evaluate the initial clinical experience with the Helex septal occluder for percutaneous closure of atrial septal defects.

Methods: Ten patients underwent the procedure, 7 patients with ostium secundum atrial septal defects (ASD) with hemodynamic repercussions and 3 patients with pervious foramen ovale (PFO) and a history of stroke. Mean age was 33.

Short- and midterm follow-up results of valvuloplasty with balloon catheter for congenital aortic stenosis.

Objective: To report short and midtem follow-up results of balloon aortic valvuloplasty to treat congenital aortic stenosis.

Methods: Seventy-five patients (median age: 8 years) underwent the procedure through the retrograde femoral or carotid route.

Results: The procedure was completed in 74 patients (98.

Recanalization of a discrete atretic right pulmonary artery segment with a new radiofrequency system.

We describe a case in which a discrete atretic segment of the right pulmonary artery (due to a Blalock-Taussig shunt) was reconstructed using a new radiofrequency system, balloon dilation, and stent implantation in an 18-month-old patient. The shunt was coil-occluded. The technique and applications of this novel approach are discussed.

Percutaneous occlusion of the patent ductus arteriosus with the amplatzer device for atrial septal defects.

We report two cases in which adult patients with large and short patent ductus arteriosus with shallow/no aortic ampulla and associated pulmonary hypertension had the defects successfully closed percutaneously using Amplatzer devices designed for atrial septal defect occlusion. The defects were stretched with a sizing balloon for optimal ductal size determination and device selection. Surgical treatment for associated discrete membranous subaortic stenosis was deferred in one patient because of significant gradient reduction in the left ventricular outflow tract after ductal occlusion.

Obliteration of a competitive forward flow from the ventricle after a bidirectional cavopulmonary shunt with an Amplatzer duct occluder.

A 7-month-old boy who was status post-bidirectional Glenn shunt implantation with residual ventricular flow to the pulmonary arteries (PA) presented with massive edema of the head and systemic desaturation soon after surgery. After test occlusion, an Amplatzer duct occluder was implanted at the PA banding site with subsequent decrease in the PA pressure, resolution of the edema and extubation.