Catheterization – ABC CARDIOL

ABCIC

Review Article

My Approach to Transcatheter Closure of Atrial Septal Defect: Step-by-Step and Current Contraindications

Angele Azevedo Alves Mattoso et al. Joberto Pinheiro Sena Gilson Soares Feitosa Filho Maria Lúcia Duarte

Abstract

All patients who are candidates for transcatheter closure of an ostium secundum atrial septal defect (ASD) should undergo a detailed echocardiographic assessment using 2D transesophageal echocardiography (TEE) prior to the procedure. It is essential for a comprehensive analysis of interatrial septal anatomy and for determining defect eligibility for the procedure. The type, number, size, location and morphology of the ASD, as well as the quality of the surrounding septal tissue and its relationship with adjacent cardiac structures, should be carefully assessed. 3D TEE may complement this assessment by providing additional relevant anatomical information. During the procedure, TEE plays a fundamental role in real-time guidance, allowing proper deployment of the septal occluder device as well as immediate assessment of the result and early detection of potential complications. This article presents a practical approach to transcatheter closure of ostium secundum ASD, with emphasis on echocardiographic aspects in the pre-procedural, intraprocedural, and post-procedural phases.

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ABC

Research Letter

Percutaneous Patent Ductus Arteriosus Closure in a Conjoined Twin: Case Report

Paulo Correia Calamita et al. Jonathan Guimarães Lombardi Mayra Rosana Palmeira Barreto Orlando Carlos Barbosa … Maurício Lopes Prudente Zacarias Calil Hamu Giulliano Gardenghi

Abstract

Conjoined twin patients with patent ductus arteriosus and hemodynamic repercussions have a worse prognosis. In the present case report, we demonstrate the first successful percutaneous closure of the ductus arteriosus with the Piccolo© device (Abbot Structural Heart, Plymouth, MN, USA) in this type of clinical situation.

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ABCIC

Case Report

Stent Implantation in the Right Ventricular Outflow Tract to Pulmonary Artery in a Child with Pentalogy of Cantrell: Case Report

Jonathan Guimarães Lombardi et al. Paulo Correia Calamita Laura Moreira Tannus Mayra Rosana Palmeira Barreto … Luiza Emylce Pelá Rosado Giulliano Gardenghi

Introduction

Pentalogy of Cantrell is a syndrome that was first described in 1958. It is characterized by 5 main malformations: defect in the lower sternum, defect in the anterior pericardium, defect in the upper abdomen, deficiency of the anterior diaphragm, and heart defects. The syndrome is rare, with an incidence of 1 in 65,000 live births. It is characterized by midline defects resulting from defective development of the septum transversum. Other congenital heart lesions associated with pentalogy of Cantrell may include atrial septal defect, pulmonary valve stenosis, tetralogy of Fallot, dextrocardia, anomalous pulmonary venous connection, tricuspid atresia, and truncus arteriosus. Children with pentalogy of Cantrell constitute a population with high morbidity and mortality. In this case report, we demonstrate a hemodynamic procedure performed in a patient with this rare congenital anomaly.

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ABCHF

Viewpoint

Urgent Right Heart Catheterization in Cardiogenic Shock: Let us Spread this Idea

Simone L. Savaris et al. Suellen R. R. Siqueira Ivna G. C. V. Lima

Pulmonary artery catheter and cardiogenic shock

CS can be divided into four phenotypes according to blood volume and peripheral perfusion, and PAC data are essential for adequately characterizing the phenotype and institution of treatment. The wet profile is when the pulmonary artery occlusion pressure (PAOP) is > 18 mmHg, and the dry profile is when the PAOP is 2.5 L/min/m is identified or cold when the CI is < 2.5 L/min/m. ()

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ABCIC

Original Article

Correlation Between Echocardiographic and Hemodynamic Measurements in Right Atrium and Right Ventricle Assessments of Patients with Pulmonary Hypertension

Ana Tereza Azeredo Bastos Brito et al. João Batista Masson Silva Daniela do Carmo Rassi Daniela Graner Schuwartz Tannus Silva … Sandra Araújo Costa Diogo Sampaio de Oliveira Flavio de Souza Veiga Jardim Leandro Zacarias F. de Freitas Aguinaldo F. de Freitas Júnior Salvador Rassi

Abstract

Introduction

Pulmonary hypertension (PH), a serious clinical condition, can lead to right ventricular systolic dysfunction (RVSD) with prognostic implications. Patients with suspected PH should undergo transthoracic echocardiography (TTE) for diagnosis and evaluation as the main screening and follow-up exam.

Objective

To verify the associations of and agreement between measurements of mean pressure in the right atrium (RA) and RVSD with TTE

Method

Individuals diagnosed with PH were included. All patients underwent TTE and RCC. The following were evaluated by TTE: right atrial area (RAA), mean right atrial pressure through the diameter and collapsibility of the inferior vena cava (RMAPTTE), RA strain (RAS), tricuspid annular plane systolic excursion, fractional area change, RV free wall strain, and tricuspid s’ wave. Mean RA pressure (RMAPRCC) and cardiac index (CI) were evaluated through the RCC.

Results

Of the 16 patients, 13 were female. The mean patient age was 44.4 (±14.9) years. An association was found between RMAPRCC and AAD, RMAPTTE, and RAS (r=0.845, r=0.621, and r=-0.523, respectively; p<0.05). There was an association between the mortality risk categories measured by the RAA and RMAPRCC measures (X2=10.42; p=0.003), with moderate agreement (k=0.44; p=0.012). RVSDJ was present in 10 patients. There was an association between RVSD (present or absent) and CI (r=0.522; p=0.04) with moderate agreement (k=0.43; p=0.037).

Conclusion

The TTE and RCC measurements showed an association in the assessment of mean right atrial pressure, especially between RAA and RMAPRCC. An association with RVSD and moderate agreement between methods were also noted.

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ABC

Original Article

Percutaneous Closure of Ductus Arteriosus in Preterm Babies: The Initial Brazilian Experience

João Luiz Langer Manica et al. Juliana Rodrigues Neves Raul Arrieta Pedro Abujamra … Raul Ivo Rossi Filho Luiz Carlos Giuliano Germana Coimbra Pablo Tomé Teixeirense João Henrique Aramayo Rossi Rodrigo Nieckel da Costa Salvador André Bavaresco Cristóvão Carlos Pedra

Abstract

Background

The presence of patent ductus arteriosus can be as high as 50% in preterm babies. Hemodynamically significant patent ductus arteriosus is a common cause of delayed weaning of respiratory support and an important risk factor of necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia in this population.

Objective

The aim of this study is to describe an initial experience of percutaneous closure of the ductus arteriosus in preterm infants weighing less than 2 kg.

Methods

This was a prospective study, comprised of 14 consecutive patients submitted to percutaneous closure of ductus arteriosus between March 2020 and February 2021 in 6 institutions in Brazil.

Results

Mean gestational age was 28.45±3.14 weeks, mean age at the procedure was 38.85±17.35 days and mean weight was 1.41 ±0.41 kg; 79% of the patients were under mechanical ventilation, and 79% had been submitted, on average, to a 1.5 cycle of non-steroidal anti-inflammatory drugs. Most patients were weaned off of mechanical ventilation in a mean of 12.6 ±7.24 days after the procedure. Success rate was 100%. No procedure-related mortality was observed.

Conclusion

This study concluded that percutaneous closure of ductus arteriosus in premature babies below 2 kg has satisfactory results and a low complication rate in this study sample.

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ABC

Original Article

Does Ad Hoc Coronary Intervention Reduce Radiation Exposure? – Analysis of 568 Patients

Márcio A. M. Truffa et al. Gustavo M.P. Alves Fernando Bernardi Antonio Esteves Filho … Expedito Ribeiro Micheli Z. Galon André Spadaro Luiz J. Kajita Raul Arrieta Pedro A. Lemos

Background:

Advantages and disadvantages of ad hoc percutaneous coronary intervention have been described. However little is known about the radiation exposure of that procedure as compared with the staged intervention.

Objective:

To compare the radiation dose of the ad hoc percutaneous coronary intervention with that of the staged procedure

Methods:

The dose-area product and total Kerma were measured, and the doses of the diagnostic and therapeutic procedures were added. In addition, total fluoroscopic time and number of acquisitions were evaluated.

Results:

A total of 568 consecutive patients were treated with ad hoc percutaneous coronary intervention (n = 320) or staged percutaneous coronary intervention (n = 248). On admission, the ad hoc group had less hypertension (74.1% vs 81.9%; p = 0.035), dyslipidemia (57.8% vs. 67.7%; p = 0.02) and three-vessel disease (38.8% vs. 50.4%; p = 0.015). The ad hoc group was exposed to significantly lower radiation doses, even after baseline characteristic adjustment between both groups. The ad hoc group was exposed to a total dose-area product of 119.7 ± 70.7 Gycm2, while the staged group, to 139.2 ± 75.3 Gycm² (p < 0.001).

Conclusion:

Ad hoc percutaneous coronary intervention reduced radiation exposure as compared with diagnostic and therapeutic procedures performed at two separate times.

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ABC

Original Article

A Comparison of Radiation Dose Between Standard and 3D Angiography in Congenital Heart Disease

João Luiz Langer Manica et al. Mônica Scott Borges Rogério Fachel de Medeiros Leandro dos Santos Fischer … Gabriel Broetto Raul Ivo Rossi Filho

Background:

The use of three-dimensional rotational angiography (3D-RA) to assess patients with congenital heart diseases appears to be a promising technique despite the scarce literature available.

Objectives:

The objective of this study was to describe our initial experience with 3D-RA and to compare its radiation dose to that of standard two-dimensional angiography (2D-SA).

Methods:

Between September 2011 and April 2012, 18 patients underwent simultaneous 3D-RA and 2D-SA during diagnostic cardiac catheterization. Radiation dose was assessed using the dose-area-product (DAP).

Results:

The median patient age and weight were 12.5 years and 47.5 Kg, respectively. The median DAP of each 3D-RA acquisition was 1093µGy.m² and 190µGy.m² for each 2D-SA acquisition (p<0.01). In patients weighing more than 45Kg (n=7), this difference was attenuated but still significant (1525 µGy.m²vs.413µGy.m², p=0.01). No difference was found between one 3D-RA and three 2D-SA (1525µGy.m² vs.1238 µGy.m², p = 0.575) in this population. This difference was significantly higher in patients weighing less than 45Kg (n=9) (713µGy.m² vs.81µGy.m², P = 0.008), even when comparing one 3D-RA with three 2D-SA (242µGy.m², respectively, p<0.008). 3D-RA was extremely useful for the assessment of conduits of univentricular hearts, tortuous branches of the pulmonary artery, and aorta relative to 2D-SA acquisitions.

Conclusions:

The radiation dose of 3D-RA used in our institution was higher than those previously reported in the literature and this difference was more evident in children. This type of assessment is of paramount importance when starting to perform 3D-RA.

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ABC

Artigo Original

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

Rodrigo Nieckel da Costa et al. Marcelo Silva Ribeiro Fabricio Leite Pereira Simone Rolim Fontes Pedra … Marcelo Biscegli Jatene Ieda Biscegli Jatene Carlos R. Ferreiro Maria Virginia Tavares Santana Valmir Fernandes Fontes Carlos Augusto Cardoso Pedra

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. Data was collected prospectively in the percutaneous group (A) and retrospectively in the surgical group (B). RESULTS: A total of 75 patients (pts) were enrolled in group A from April 2009 to October 2011 and 105 pts were treated in group B from January 2006 to January 2011. Age was older and weight was higher in group B and the ASD diameter was similar in both groups. Technical success was achieved in all procedures and there were no deaths. Complications (most minor) occurred in 68% of group B and 4% of A (p < 0.001). Rates of total occlusion or non-significant residual shunts were similar in both groups. Median hospitalization time was 1.2 days in group A and 8.4 days in group B (p < 0.001). CONCLUSION: Both treatment modalities are safe and effective, showing excellent outcomes. However, the percutaneous treatment has lower morbidity and shorter in-hospital stay length. These observations support the concept that percutaneous treatment of atrial septal defects should be regarded as the method of choice to manage selected patients with this condition.

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ABC

Artigo Original

Ablation of typical atrial flutter: a prospective randomized study of cooled-tip versus 8-mm-tip catheters

Sissy L. Melo et al. Mauricio I. Scanavacca Francisco C. C. Darrieux Denise T. Hachul Eduardo A. Sosa

OBJECTIVES: Both ablation catheters with closed irrigated system and 8mm tip-catheters have been shown to be more effective for typical atrial flutter radiofrequency (RF) ablation when compared to conventional 4 mm tip catheter. Considering the differences in complexity and costs of both systems, a prospective study was designed to compare the efficacy and safety of cooled-tip and 8mm-tip catheters for atrial flutter ablation. METHODS: Fifty-two consecutive patients underwent RF ablation of cavotricupsid isthmus (CTI) for the treatment of typical atrial flutter, using catheter with closed irrigation system (n=26) or 8 mm-tip catheter (n=26). The RF pulses were applied point-by-point for 60 seconds, with power limited at 50 w for the irrigated catheter and by temperature control (60ºC / 70 w) for the 8mm catheter. RESULTS: The CTI block was successfully performed in 98.1%. Four patients in the irrigated group needed to switch to the other group. There was no significant difference with regard to ablation parameters, such as total time of RF ablation (591.1±309.0s vs 486.2±250.8s), total procedure duration (86.4±23.6 vs 78.1±22.5min) and time of fluoroscopy (17.0±6.7 vs 15.4±4.6min). During follow-up of 10.6 months in average, one patient in the irrigated group had recurrence of typical atrial flutter. CONCLUSION: Efficacy and safety of CTI ablation was comparable between both techniques (irrigated catheter and 8mm-tip catheter). The complexity of irrigated catheter makes it less competitive.

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