Alejandro Peirone - Academia.edu (original) (raw)

Papers by Alejandro Peirone

Research paper thumbnail of Percutaneous closure of complex atrial septal defects implanting two devices: initial experience with pfm Nit Occlud® ASD-R and PFO devices

Research paper thumbnail of Biomonitoreo de la microcirculación durante cirugía cardiovascular

Revista Chilena de Anestesia, 2020

Introduction: Microcirculation, which encompasses the blood vessels smaller than 100 microns, wor... more Introduction: Microcirculation, which encompasses the blood vessels smaller than 100 microns, works as an interconnected biological system; its main functions are ensuring tissue perfusion and oxygenation. During extracorporeal circulation (CPB), a "systemic inflammatory response" (SIRS) with microcirculatory endothelial dysfunction may occur[1],[2]. Objective: To indirectly evaluate microcirculation, using "tissue oxygenation" markers central venous oxygen saturation (SvcO 2) oxygen extraction index (O 2EI) and the "perfusion markers", as the Delta marker or the venoarterial CO 2 difference (Difv-aCO 2) and arterial and venous lactate concentration. Aside from the tissue perfusion marker, a new marker has been considered: the "respiratory quotient", which is the ratio of the carbon dioxide released to oxygen consumed (Pv-aCO 2 / Ca-vO 2). [3],[4],[5]. Methods: Between March 1st and August 1st, 2018, 34 patients with congenital cardiopathies that underwent CPB surgery were studied. They were divided in groups A: 15p (RASCH score 1 and 2) and B: 19p (RASCH score 3, 4 and 5). Results: Variables derived from oxygen: SvcO 2 and O 2 EI did not present statistically significative differences, nor did the tissue perfusion marker Dif.v-aCO 2. However, the other perfusion markers, such as serum lactate and respiratory quotient Pv-aCO 2 / Ca-vO 2 , showed significant differences (p< 0,001). Conclusions: Respiratory quotient assessment Pv-aCO 2 / Ca-vO 2 , which has been endorsed by numerous publications related to septic shock, proves a great tool to expose hidden shock and as a reliable marker of evolution and adverse effects. Patel y cols[6] show its use on pediatric patients with congenital cardiopathies after CPB surgery. As we replicated their experience, we found

Research paper thumbnail of Reemplazo percutáneo de válvulas cardíacas derechas con técnica "válvula en válvula" en cardiopatías congénitas: experiencia inicial en Argentina

Revista Argentina de Cardiologia, Dec 27, 2023

Research paper thumbnail of ASD-R PFM device

Research paper thumbnail of Ventajas de la ecocardiografía tridimensional transesofágica como soporte en el cierre de la comunicación interauricular

Revista de la Facultad de Ciencias Médicas de Córdoba, Sep 12, 2018

La comunicación interauricular (CIA) es una de las cardiopatías congénitas más frecuentes y en ap... more La comunicación interauricular (CIA) es una de las cardiopatías congénitas más frecuentes y en aproximadamente 85% de ellas, el defecto se encuentra localizado en la fosa oval constituyendo el tipo "ostium secundum" de comunicación interatrial. El tratamiento de elección en este tipo de defectos es el cierre percutáneo mediante implante de dispositivos autoexpandibles de doble disco (1). Desde fines de la década del 90, una nueva herramienta para visualización de estos defectos está disponible en la práctica cotidiana cardiovascular, el ecocardiograma Doppler color tridimensional, que muestra su utilidad en el diagnóstico de numerosas patologías cardíacas congénitas, estructurales y funcionales y en la planificación del tratamiento de patologías valvulares o en la determinación de la función ventricular (2). El septum interauricular es una estructura compleja y el ecocardiograma tridimensional tiene la ventaja de poder observarlo desde su cara derecha o izquierda (3). Durante el procedimiento de implante de dispositivos en la sala de hemodinamia, es mandatorio la guía con imágenes para descartar defectos múltiples, bordes deficientes del defecto y aneurismas del septum interauricular. Además, se debe controlar el correcto posicionamiento en el septum interauricular de dicho dispositivo, con el objetivo de disminuir complicaciones como la erosión de estructuras adyacentes al sobredimensionar el tamaño del oclusor o la embolización al subestimar el tamaño del defecto. También, pueden determinarse otras posibles contraindicaciones para el cierre percutáneo (tabla 1) (4-6) .

Research paper thumbnail of Percutaneous left atrial appendage closure: in a patient with hereditary hemorrhagic telangiectasia and atrial fibrillation

PubMed, 2011

Introducción: Dentro de las complicaciones más importantes de la fibrilación auricular (FA) se en... more Introducción: Dentro de las complicaciones más importantes de la fibrilación auricular (FA) se encuentra el accidente vascular encefálico embólico (AVE), siendo la terapia anticoagulante oral (TACO) la principal herramienta para su prevención. Cerca de un 20% de los pacientes con FA presentan condiciones clínicas que impiden su uso. Como la orejuela izquierda (OI) ha sido identificada como el principal sitio de formación de trombos en la FA no valvular, se ha postulado que su oclusión podría disminuir la incidencia de eventos embólicos en este tipo de pacientes. Con este objetivo se han desarrollado múltiples técnicas, tanto quirúrgicas como dispositivos percutáneos para el cierre de esta estructura. En esta publicación se presenta la experiencia del cierre percutáneo de la OI en tres pacientes, con el uso del dispositivo Amplatzer Cardiac Plug (ACP). Métodos: Los tres pacientes tenían alto riesgo embólico y contraindicación para uso de TACO. El procedimiento se realizó en el laboratorio de hemodinamia, bajo guía radioscópica y ecocardiográfica, con anestesia general. Resultados: Se logró la oclusión completa de la OI en todos los pacientes, realizando además el cierre de un foramen oval permeable (FOP) en uno de ellos. Uno de los pacientes presentó derrame pericárdico el cual requirió pericardiocentesis. Los pacientes no presentaron otras complicaciones. Luego de un seguimiento de 6 meses no se han evidenciado eventos embólicos en ninguno de ellos. Conclusión: En esta experiencia preliminar, hemos comprobado la factibilidad de la oclusión de la OI con el uso del dispositivo Amplatzer Cardiac Plug, en pacientes con FA con alto riesgo embólico y malos candidatos a TACO. Percutaneous closure of Left Atrial Appendage with the Amplatzer Cardiac Plug Device in patients with atrial fibrillation. Preliminary data. Embolic Stroke is a major concern in patients with atrial fibrillation. Anticoagulant therapy is the preferred tool to prevent this complication, but some patients have contraindications to anticoagulation. Most of the thrombus originate at the left atrial appendage (LAA), so the closure of LAA could prevent embolization of thrombus.

Research paper thumbnail of Accidente cerebrovascular isquémico en pacientes con cierre percutáneo del foramen oval permeable

Revista Argentina de Cardiología, Jan 6, 2017

Introducción: El foramen oval permeable se encuentra en alrededor del 50% de los pacientes que ha... more Introducción: El foramen oval permeable se encuentra en alrededor del 50% de los pacientes que han sufrido un accidente cerebrovascular criptogénico. La recurrencia de un accidente cerebrovascular isquémico luego del cierre percutáneo del foramen oval permeable es de alrededor del 1% anual. Objetivo: Evaluar la prevalencia de recurrencia de accidente cerebrovascular isquémico en nuestra población tratada con cierre percutáneo del foramen oval permeable. Material y métodos: Se incluyeron en forma retrospectiva desde enero de 2007 hasta septiembre de 2015 todos los pacientes con diagnóstico de accidente cerebrovascular isquémico criptogénico a quienes mediante técnica percutánea se les ocluyó un foramen oval permeable. En el seguimiento se detectaron los casos en los que se diagnosticó recurrencia de evento en la forma de un nuevo accidente cerebrovascular isquémico y/o ataque isquémico transitorio posterior al cierre percutáneo. Resultados: Se incluyeron 28 pacientes, con edad promedio al momento del procedimiento de 47 años (20-71 años), el 50% eran mujeres, el 79% habían tenido un accidente cerebrovascular y el 21% un ataque isquémico transitorio. El puntaje de RoPE fue de 7,07 puntos (3-10 puntos). El cierre percutáneo fue exitoso en todos los casos. En un período de seguimiento (mediana 989 días, intervalo intercuartil 670-1.766 días) se identificaron dos pacientes (7%) que tuvieron un nuevo accidente cerebrovascular. En ambos pacientes se repitió un ecocardiograma transesofágico y se encontró foramen oval permeable cerrado sin fugas residuales. Conclusiones: La frecuencia de recurrencia de accidente cerebrovascular es baja luego del cierre percutáneo del foramen oval permeable y posiblemente un buen número de los casos recurrentes no sean prevenibles con su cierre.

Research paper thumbnail of Percutaneous closure of the patent ductus arteriosus using the Nit-Occlud PDA-R (reverse) device: initial experience reporting immediate and short-term results

PubMed, Dec 1, 2011

Purpose: To review the initial clinical outcomes of patent ductus arteriosus (PDA) closure using ... more Purpose: To review the initial clinical outcomes of patent ductus arteriosus (PDA) closure using the new Nit-Occlud PDA-R device (NOPDA-R). Materials and methods: The NOPDA-R is a self-expandable, nitinol-made, premounted and cone-shaped device with two distinctive features: reverse reconfiguration of the distal disc and a peculiar "snare-like" release mechanism. From May to December 2010, 20 consecutive patients were included. Results: Median age was 4.7 years (range, 6 months to 21 years) and weight was 16.4 kg (range, 6-49 kg). Mean PDA diameter at its narrowest point, usually the pulmonary end, was 2.92 ± 0.61 mm (range, 2.1-4.5 mm), length was 7.05 ± 1.17 mm (range, 4.7-9.2 mm) and diameter of the aortic ampulla was 9.52 ± 1.62 mm (range, 6-13 mm). Pulmonary artery mean pressure was 20.6 ± 4.49 mmHg (range, 14-28 mmHg) and Qp/Qs ratio was 2.0 ± 0.29 (range, 1.6- 2.5). Implantation success rate was 100%. The median cylinder diameter of the device was 6.53 ± 1.05 mm (range, 5.5-8.5 mm) leading to a final selected device 124% larger (cylinder diameter) than the narrowest PDA diameter. Assessed by transthoracic color-Doppler echocardiography at 24 hours, 1 month, and 3 months after implantation, complete closure was achieved in 60%, 90%, and 95% of patients, respectively. There were no complications and all patients were discharged home the next day. Conclusion: Percutaneous PDA closure using the new NOPDA-R device was feasible, safe, and effective. Longer follow-up time and a larger number of patients are required to assess long-term performance.

Research paper thumbnail of Percutaneous Closure of Ruptured Sinus of Valsalva Aneurysm in a Child Using a Patent Ductus Arteriosus Device

World Journal for Pediatric and Congenital Heart Surgery, Oct 19, 2022

Ruptured sinus of Valsalva aneurysm is rare, although if left untreated, potentially fatal diseas... more Ruptured sinus of Valsalva aneurysm is rare, although if left untreated, potentially fatal disease. Surgical approach has been the main treatment in most series; nevertheless, percutaneous closure has been described in selected cases. We report a 5-year-old boy presenting with rapid clinical deterioration who underwent percutaneous closure using a patent ductus arteriosus device, with the resolution of symptoms. Descriptions of this technique being utilized in children are infrequent in the literature.

Research paper thumbnail of Ecografía Doppler de vasos abdominales. Nuevo paradigma de monitoreo en inestabilidad hemodinámica

Revista chilena de anestesia, 2021

Research paper thumbnail of Cierre percutáneo de comunicación interauricular multifenestrada con aneurisma del septum interauricular

Revista argentina de cardioangiología intervencionista., Mar 30, 2010

El cierre percutáneo de comunicación interauricular con dispositivo es actualmente un tratamiento... more El cierre percutáneo de comunicación interauricular con dispositivo es actualmente un tratamiento eficaz y seguro. La ecocardiografía intracardiaca (ICE) como guía durante estos procedimientos es una alternativa novedosa frente a la ecocardiografía transesofágica. El objetivo del ...

Research paper thumbnail of Percutaneous Closure of Atrial Septal Defects in Patients with an Aberrant Retroaortic Coronary Artery: Is It Safe?

Congenital Heart Disease, Jul 3, 2013

Coexistence of an ostium secundum type atrial septal defect and a coronary artery anomaly with an... more Coexistence of an ostium secundum type atrial septal defect and a coronary artery anomaly with an aberrant retroaortic course is a rare congenital anomaly that may potentially complicate percutaneous atrial septal defects (ASD) closure. If the anterosuperior rim of the defect is deficient, the abnormally located coronary artery may be compressed or distorted by the implanted device causing myocardial ischemia, arrhythmias, and eventually sudden cardiac death. Due to the potential occurrence of these fatal cardiac events, diagnosis of an aberrant coronary artery with a retroaortic course must be established before percutaneous ASD closure. In this report, two patients with this rare association are described in whom percutaneous closure of the defect was feasible and uneventful. The importance of a careful periprocedural, noninvasive echocardiographic coronary artery imaging is emphasized, and the rational for percutaneous atrial septal defect closure in this unusual anatomic arrangement is proposed.

Research paper thumbnail of Magnetic resonance lymphangiography in group 1 paediatric pulmonary arterial hypertension

Pulmonary Circulation

Pulmonary hypertension could have thoracic lymphatic abnormalities caused by right ventricular fa... more Pulmonary hypertension could have thoracic lymphatic abnormalities caused by right ventricular failure. Since there is no description of such abnormalities, the purpose of this study was to investigate them with magnetic resonance. Prospective review magnetic resonance T2‐weighted lymphangiography was performed between January 2017 and October 2019 through quantitative thoracic duct diameter, diameter index and qualitative lymphatic abnormalities types: 1 – little or none abnormalities, 2 – abnormalities in supraclavicular region, 3 – abnormalities extending into the mediastinum and 4 – abnormalities extending into the lung. Five patients with group 1 pulmonary arterial hypertension participated in this study. The mean age was 12.44 ± 4.92 years, three male and two female. The quantitative analysis yielded the following results: mean thoracic duct diameter of 2.92 ± 0.16 mm and thoracic duct index 2.28 ± 1.03 mm/m2. Qualitative lymphangiography abnormalities were type 1 in three pat...

Research paper thumbnail of Tetralogy of Fallot Repair After Neonatal Right Ventricular Outflow Tract Stenting: Initial Multicenter Experience in Argentina

World Journal for Pediatric and Congenital Heart Surgery, Dec 18, 2022

Research paper thumbnail of Immediate and Mid-term Outcomes of Blalock-Taussig Shunt versus Right Ventricular Outflow Tract Stenting in Symptomatic Neonates with Tetralogy of Fallot

Revista Argentina de Cardiologia, Feb 1, 2022

Background: The initial management of symptomatic neonate patients with tetralogy of Fallot (TOF)... more Background: The initial management of symptomatic neonate patients with tetralogy of Fallot (TOF) associated with unfavorable anatomy and significantly reduced pulmonary vascular flow is controversial and continues to be a clinical challenge. Objective: The aim of this study was to describe the clinical evolution and to compare branch pulmonary artery growth in symptomatic neonatal TOF patients who received a modified Blalock Taussig (mBT) shunt versus right ventricular outflow tract stent placement (RVOTs) at the Department of Cardiology, Hospital de Niños de Córdoba, between March 2011 and March 2021. Methods: A retrospective, observational study identified 113 patients with TOF, 20 of which (18%) were symptomatic neonates requiring initial palliative intervention. Categorical variables are expressed as percentage and continuous variables as median and interquartile range (IQR). A p value <0.05 was considered significant. Results: Among the 20 patients included in the study, 11 (55%) formed the mBT shunt group and 9 (45%) the RVOTs group. In the mBT shunt group, pre-palliation right pulmonary artery (RPA) Z score was-3 (IQR 4.20) and increased to-1.6 (IQR 1.56) (p= 0.11), and left pulmonary artery (LPA) Z score of-2.5 (IQR 4.8) increased to-1.80 (IQR 2.36) (p= 0.44). In the RVOTs group, RPA Z score prior to the palliative procedure was-3.45 (IQR 3.83) and increased to-2.5 (IQR 3.58) (p= 0.021) and LPA Z score of-4.10 (IQR 2.51) increased to-2.00 (IQR 3.75) (p= 0.011). Pre-intervention O2 saturation of 75% (IQR 6) increased to 87% (IQR 9) in the mBT shunt group (p= 0.005) and from 75% (IQR 16) to 91% (IQR 13) in the RVOTs group (p= 0.008). Mean length of hospital stay after the procedure was 10 days (IQR 11) in the mBT shunt group and 6 days (IQR 2) in the RVOTs group (p= 0.095). Conclusions: In symptomatic neonates with TOF, both palliative strategies improved the clinical condition. In patients who received RVOTs, there was greater branch pulmonary artery growth. A larger number of cases and longer-term follow-up will be necessary to confirm these findings.

Research paper thumbnail of Impresión tridimensional en doble vía de salida del ventrículo derecho para simplificar la reparación intraventricular

Revista Argentina de Cardiología, Jan 6, 2018

Research paper thumbnail of Hybrid Strategy in the Management of Congenital Heart Defects. Initial Results in a Multicentric Experience

Revista Argentina de Cardiología, 2021

Background: The hybrid approach implies the close collaboration between surgical and intervention... more Background: The hybrid approach implies the close collaboration between surgical and interventional cardiology teams forthe treatment of complex congenital heart diseases to reduce the number of interventions by using less invasive techniques,avoid the limitations due to the size of vascular accesses and the use of cardiopulmonary bypass.Objectives: The aim of this study is to evaluate the indications, techniques, initial results and short-term follow-up of thehybrid approach.Methods: We conducted a retrospective analysis of patients treated with hybrid approach between March 2014 and September2020. Fourteen procedures were performed in 13 patients. Mean age was 16.8 years (1 day-13 years); 50% were neonates, 57%were male and mean weight was 9 kg (1.9-70 kg). The hybrid procedures performed included stenting in coarctation of theaorta (4 patients), ductal stenting (3 patients), stenting of pulmonary artery branches (1 patient), neonatal aortic valvuloplasty(4 patients) and perventri...

Research paper thumbnail of Selección de pacientes para cierre percutáneo de foramen oval permeable con ecocardiograma Doppler color transtorácico. Una estrategia diferente

Revista Argentina de Cardiologia, 2020

Research paper thumbnail of P20.03: Prenatal diagnosis of fetal primary cardiac fibroma: a case report

Ultrasound in Obstetrics & Gynecology, 2019

Research paper thumbnail of Bloqueo auriculoventricular completo reversible durante el cierre percutáneo de comunicación interauricular

Archivos de Cardiología de México, 2017

Review of registry of complications and recommendatios to minimize future risk. Catheter Cardiova... more Review of registry of complications and recommendatios to minimize future risk. Catheter Cardiovasc Interv. 2004;63:496-502. 4. DiBardino DJ, McElhinney DF, Kaza AK, et al. Analysis of the US Food and Drug Administration manufacturer and user facility device experience database for adverse events involving Amplatzer Septal Occluder devices and comparison with the Society of Thoracic Surgery Congenital Cardiac Surgery database.

Research paper thumbnail of Percutaneous closure of complex atrial septal defects implanting two devices: initial experience with pfm Nit Occlud® ASD-R and PFO devices

Research paper thumbnail of Biomonitoreo de la microcirculación durante cirugía cardiovascular

Revista Chilena de Anestesia, 2020

Introduction: Microcirculation, which encompasses the blood vessels smaller than 100 microns, wor... more Introduction: Microcirculation, which encompasses the blood vessels smaller than 100 microns, works as an interconnected biological system; its main functions are ensuring tissue perfusion and oxygenation. During extracorporeal circulation (CPB), a "systemic inflammatory response" (SIRS) with microcirculatory endothelial dysfunction may occur[1],[2]. Objective: To indirectly evaluate microcirculation, using "tissue oxygenation" markers central venous oxygen saturation (SvcO 2) oxygen extraction index (O 2EI) and the "perfusion markers", as the Delta marker or the venoarterial CO 2 difference (Difv-aCO 2) and arterial and venous lactate concentration. Aside from the tissue perfusion marker, a new marker has been considered: the "respiratory quotient", which is the ratio of the carbon dioxide released to oxygen consumed (Pv-aCO 2 / Ca-vO 2). [3],[4],[5]. Methods: Between March 1st and August 1st, 2018, 34 patients with congenital cardiopathies that underwent CPB surgery were studied. They were divided in groups A: 15p (RASCH score 1 and 2) and B: 19p (RASCH score 3, 4 and 5). Results: Variables derived from oxygen: SvcO 2 and O 2 EI did not present statistically significative differences, nor did the tissue perfusion marker Dif.v-aCO 2. However, the other perfusion markers, such as serum lactate and respiratory quotient Pv-aCO 2 / Ca-vO 2 , showed significant differences (p< 0,001). Conclusions: Respiratory quotient assessment Pv-aCO 2 / Ca-vO 2 , which has been endorsed by numerous publications related to septic shock, proves a great tool to expose hidden shock and as a reliable marker of evolution and adverse effects. Patel y cols[6] show its use on pediatric patients with congenital cardiopathies after CPB surgery. As we replicated their experience, we found

Research paper thumbnail of Reemplazo percutáneo de válvulas cardíacas derechas con técnica "válvula en válvula" en cardiopatías congénitas: experiencia inicial en Argentina

Revista Argentina de Cardiologia, Dec 27, 2023

Research paper thumbnail of ASD-R PFM device

Research paper thumbnail of Ventajas de la ecocardiografía tridimensional transesofágica como soporte en el cierre de la comunicación interauricular

Revista de la Facultad de Ciencias Médicas de Córdoba, Sep 12, 2018

La comunicación interauricular (CIA) es una de las cardiopatías congénitas más frecuentes y en ap... more La comunicación interauricular (CIA) es una de las cardiopatías congénitas más frecuentes y en aproximadamente 85% de ellas, el defecto se encuentra localizado en la fosa oval constituyendo el tipo "ostium secundum" de comunicación interatrial. El tratamiento de elección en este tipo de defectos es el cierre percutáneo mediante implante de dispositivos autoexpandibles de doble disco (1). Desde fines de la década del 90, una nueva herramienta para visualización de estos defectos está disponible en la práctica cotidiana cardiovascular, el ecocardiograma Doppler color tridimensional, que muestra su utilidad en el diagnóstico de numerosas patologías cardíacas congénitas, estructurales y funcionales y en la planificación del tratamiento de patologías valvulares o en la determinación de la función ventricular (2). El septum interauricular es una estructura compleja y el ecocardiograma tridimensional tiene la ventaja de poder observarlo desde su cara derecha o izquierda (3). Durante el procedimiento de implante de dispositivos en la sala de hemodinamia, es mandatorio la guía con imágenes para descartar defectos múltiples, bordes deficientes del defecto y aneurismas del septum interauricular. Además, se debe controlar el correcto posicionamiento en el septum interauricular de dicho dispositivo, con el objetivo de disminuir complicaciones como la erosión de estructuras adyacentes al sobredimensionar el tamaño del oclusor o la embolización al subestimar el tamaño del defecto. También, pueden determinarse otras posibles contraindicaciones para el cierre percutáneo (tabla 1) (4-6) .

Research paper thumbnail of Percutaneous left atrial appendage closure: in a patient with hereditary hemorrhagic telangiectasia and atrial fibrillation

PubMed, 2011

Introducción: Dentro de las complicaciones más importantes de la fibrilación auricular (FA) se en... more Introducción: Dentro de las complicaciones más importantes de la fibrilación auricular (FA) se encuentra el accidente vascular encefálico embólico (AVE), siendo la terapia anticoagulante oral (TACO) la principal herramienta para su prevención. Cerca de un 20% de los pacientes con FA presentan condiciones clínicas que impiden su uso. Como la orejuela izquierda (OI) ha sido identificada como el principal sitio de formación de trombos en la FA no valvular, se ha postulado que su oclusión podría disminuir la incidencia de eventos embólicos en este tipo de pacientes. Con este objetivo se han desarrollado múltiples técnicas, tanto quirúrgicas como dispositivos percutáneos para el cierre de esta estructura. En esta publicación se presenta la experiencia del cierre percutáneo de la OI en tres pacientes, con el uso del dispositivo Amplatzer Cardiac Plug (ACP). Métodos: Los tres pacientes tenían alto riesgo embólico y contraindicación para uso de TACO. El procedimiento se realizó en el laboratorio de hemodinamia, bajo guía radioscópica y ecocardiográfica, con anestesia general. Resultados: Se logró la oclusión completa de la OI en todos los pacientes, realizando además el cierre de un foramen oval permeable (FOP) en uno de ellos. Uno de los pacientes presentó derrame pericárdico el cual requirió pericardiocentesis. Los pacientes no presentaron otras complicaciones. Luego de un seguimiento de 6 meses no se han evidenciado eventos embólicos en ninguno de ellos. Conclusión: En esta experiencia preliminar, hemos comprobado la factibilidad de la oclusión de la OI con el uso del dispositivo Amplatzer Cardiac Plug, en pacientes con FA con alto riesgo embólico y malos candidatos a TACO. Percutaneous closure of Left Atrial Appendage with the Amplatzer Cardiac Plug Device in patients with atrial fibrillation. Preliminary data. Embolic Stroke is a major concern in patients with atrial fibrillation. Anticoagulant therapy is the preferred tool to prevent this complication, but some patients have contraindications to anticoagulation. Most of the thrombus originate at the left atrial appendage (LAA), so the closure of LAA could prevent embolization of thrombus.

Research paper thumbnail of Accidente cerebrovascular isquémico en pacientes con cierre percutáneo del foramen oval permeable

Revista Argentina de Cardiología, Jan 6, 2017

Introducción: El foramen oval permeable se encuentra en alrededor del 50% de los pacientes que ha... more Introducción: El foramen oval permeable se encuentra en alrededor del 50% de los pacientes que han sufrido un accidente cerebrovascular criptogénico. La recurrencia de un accidente cerebrovascular isquémico luego del cierre percutáneo del foramen oval permeable es de alrededor del 1% anual. Objetivo: Evaluar la prevalencia de recurrencia de accidente cerebrovascular isquémico en nuestra población tratada con cierre percutáneo del foramen oval permeable. Material y métodos: Se incluyeron en forma retrospectiva desde enero de 2007 hasta septiembre de 2015 todos los pacientes con diagnóstico de accidente cerebrovascular isquémico criptogénico a quienes mediante técnica percutánea se les ocluyó un foramen oval permeable. En el seguimiento se detectaron los casos en los que se diagnosticó recurrencia de evento en la forma de un nuevo accidente cerebrovascular isquémico y/o ataque isquémico transitorio posterior al cierre percutáneo. Resultados: Se incluyeron 28 pacientes, con edad promedio al momento del procedimiento de 47 años (20-71 años), el 50% eran mujeres, el 79% habían tenido un accidente cerebrovascular y el 21% un ataque isquémico transitorio. El puntaje de RoPE fue de 7,07 puntos (3-10 puntos). El cierre percutáneo fue exitoso en todos los casos. En un período de seguimiento (mediana 989 días, intervalo intercuartil 670-1.766 días) se identificaron dos pacientes (7%) que tuvieron un nuevo accidente cerebrovascular. En ambos pacientes se repitió un ecocardiograma transesofágico y se encontró foramen oval permeable cerrado sin fugas residuales. Conclusiones: La frecuencia de recurrencia de accidente cerebrovascular es baja luego del cierre percutáneo del foramen oval permeable y posiblemente un buen número de los casos recurrentes no sean prevenibles con su cierre.

Research paper thumbnail of Percutaneous closure of the patent ductus arteriosus using the Nit-Occlud PDA-R (reverse) device: initial experience reporting immediate and short-term results

PubMed, Dec 1, 2011

Purpose: To review the initial clinical outcomes of patent ductus arteriosus (PDA) closure using ... more Purpose: To review the initial clinical outcomes of patent ductus arteriosus (PDA) closure using the new Nit-Occlud PDA-R device (NOPDA-R). Materials and methods: The NOPDA-R is a self-expandable, nitinol-made, premounted and cone-shaped device with two distinctive features: reverse reconfiguration of the distal disc and a peculiar "snare-like" release mechanism. From May to December 2010, 20 consecutive patients were included. Results: Median age was 4.7 years (range, 6 months to 21 years) and weight was 16.4 kg (range, 6-49 kg). Mean PDA diameter at its narrowest point, usually the pulmonary end, was 2.92 ± 0.61 mm (range, 2.1-4.5 mm), length was 7.05 ± 1.17 mm (range, 4.7-9.2 mm) and diameter of the aortic ampulla was 9.52 ± 1.62 mm (range, 6-13 mm). Pulmonary artery mean pressure was 20.6 ± 4.49 mmHg (range, 14-28 mmHg) and Qp/Qs ratio was 2.0 ± 0.29 (range, 1.6- 2.5). Implantation success rate was 100%. The median cylinder diameter of the device was 6.53 ± 1.05 mm (range, 5.5-8.5 mm) leading to a final selected device 124% larger (cylinder diameter) than the narrowest PDA diameter. Assessed by transthoracic color-Doppler echocardiography at 24 hours, 1 month, and 3 months after implantation, complete closure was achieved in 60%, 90%, and 95% of patients, respectively. There were no complications and all patients were discharged home the next day. Conclusion: Percutaneous PDA closure using the new NOPDA-R device was feasible, safe, and effective. Longer follow-up time and a larger number of patients are required to assess long-term performance.

Research paper thumbnail of Percutaneous Closure of Ruptured Sinus of Valsalva Aneurysm in a Child Using a Patent Ductus Arteriosus Device

World Journal for Pediatric and Congenital Heart Surgery, Oct 19, 2022

Ruptured sinus of Valsalva aneurysm is rare, although if left untreated, potentially fatal diseas... more Ruptured sinus of Valsalva aneurysm is rare, although if left untreated, potentially fatal disease. Surgical approach has been the main treatment in most series; nevertheless, percutaneous closure has been described in selected cases. We report a 5-year-old boy presenting with rapid clinical deterioration who underwent percutaneous closure using a patent ductus arteriosus device, with the resolution of symptoms. Descriptions of this technique being utilized in children are infrequent in the literature.

Research paper thumbnail of Ecografía Doppler de vasos abdominales. Nuevo paradigma de monitoreo en inestabilidad hemodinámica

Revista chilena de anestesia, 2021

Research paper thumbnail of Cierre percutáneo de comunicación interauricular multifenestrada con aneurisma del septum interauricular

Revista argentina de cardioangiología intervencionista., Mar 30, 2010

El cierre percutáneo de comunicación interauricular con dispositivo es actualmente un tratamiento... more El cierre percutáneo de comunicación interauricular con dispositivo es actualmente un tratamiento eficaz y seguro. La ecocardiografía intracardiaca (ICE) como guía durante estos procedimientos es una alternativa novedosa frente a la ecocardiografía transesofágica. El objetivo del ...

Research paper thumbnail of Percutaneous Closure of Atrial Septal Defects in Patients with an Aberrant Retroaortic Coronary Artery: Is It Safe?

Congenital Heart Disease, Jul 3, 2013

Coexistence of an ostium secundum type atrial septal defect and a coronary artery anomaly with an... more Coexistence of an ostium secundum type atrial septal defect and a coronary artery anomaly with an aberrant retroaortic course is a rare congenital anomaly that may potentially complicate percutaneous atrial septal defects (ASD) closure. If the anterosuperior rim of the defect is deficient, the abnormally located coronary artery may be compressed or distorted by the implanted device causing myocardial ischemia, arrhythmias, and eventually sudden cardiac death. Due to the potential occurrence of these fatal cardiac events, diagnosis of an aberrant coronary artery with a retroaortic course must be established before percutaneous ASD closure. In this report, two patients with this rare association are described in whom percutaneous closure of the defect was feasible and uneventful. The importance of a careful periprocedural, noninvasive echocardiographic coronary artery imaging is emphasized, and the rational for percutaneous atrial septal defect closure in this unusual anatomic arrangement is proposed.

Research paper thumbnail of Magnetic resonance lymphangiography in group 1 paediatric pulmonary arterial hypertension

Pulmonary Circulation

Pulmonary hypertension could have thoracic lymphatic abnormalities caused by right ventricular fa... more Pulmonary hypertension could have thoracic lymphatic abnormalities caused by right ventricular failure. Since there is no description of such abnormalities, the purpose of this study was to investigate them with magnetic resonance. Prospective review magnetic resonance T2‐weighted lymphangiography was performed between January 2017 and October 2019 through quantitative thoracic duct diameter, diameter index and qualitative lymphatic abnormalities types: 1 – little or none abnormalities, 2 – abnormalities in supraclavicular region, 3 – abnormalities extending into the mediastinum and 4 – abnormalities extending into the lung. Five patients with group 1 pulmonary arterial hypertension participated in this study. The mean age was 12.44 ± 4.92 years, three male and two female. The quantitative analysis yielded the following results: mean thoracic duct diameter of 2.92 ± 0.16 mm and thoracic duct index 2.28 ± 1.03 mm/m2. Qualitative lymphangiography abnormalities were type 1 in three pat...

Research paper thumbnail of Tetralogy of Fallot Repair After Neonatal Right Ventricular Outflow Tract Stenting: Initial Multicenter Experience in Argentina

World Journal for Pediatric and Congenital Heart Surgery, Dec 18, 2022

Research paper thumbnail of Immediate and Mid-term Outcomes of Blalock-Taussig Shunt versus Right Ventricular Outflow Tract Stenting in Symptomatic Neonates with Tetralogy of Fallot

Revista Argentina de Cardiologia, Feb 1, 2022

Background: The initial management of symptomatic neonate patients with tetralogy of Fallot (TOF)... more Background: The initial management of symptomatic neonate patients with tetralogy of Fallot (TOF) associated with unfavorable anatomy and significantly reduced pulmonary vascular flow is controversial and continues to be a clinical challenge. Objective: The aim of this study was to describe the clinical evolution and to compare branch pulmonary artery growth in symptomatic neonatal TOF patients who received a modified Blalock Taussig (mBT) shunt versus right ventricular outflow tract stent placement (RVOTs) at the Department of Cardiology, Hospital de Niños de Córdoba, between March 2011 and March 2021. Methods: A retrospective, observational study identified 113 patients with TOF, 20 of which (18%) were symptomatic neonates requiring initial palliative intervention. Categorical variables are expressed as percentage and continuous variables as median and interquartile range (IQR). A p value <0.05 was considered significant. Results: Among the 20 patients included in the study, 11 (55%) formed the mBT shunt group and 9 (45%) the RVOTs group. In the mBT shunt group, pre-palliation right pulmonary artery (RPA) Z score was-3 (IQR 4.20) and increased to-1.6 (IQR 1.56) (p= 0.11), and left pulmonary artery (LPA) Z score of-2.5 (IQR 4.8) increased to-1.80 (IQR 2.36) (p= 0.44). In the RVOTs group, RPA Z score prior to the palliative procedure was-3.45 (IQR 3.83) and increased to-2.5 (IQR 3.58) (p= 0.021) and LPA Z score of-4.10 (IQR 2.51) increased to-2.00 (IQR 3.75) (p= 0.011). Pre-intervention O2 saturation of 75% (IQR 6) increased to 87% (IQR 9) in the mBT shunt group (p= 0.005) and from 75% (IQR 16) to 91% (IQR 13) in the RVOTs group (p= 0.008). Mean length of hospital stay after the procedure was 10 days (IQR 11) in the mBT shunt group and 6 days (IQR 2) in the RVOTs group (p= 0.095). Conclusions: In symptomatic neonates with TOF, both palliative strategies improved the clinical condition. In patients who received RVOTs, there was greater branch pulmonary artery growth. A larger number of cases and longer-term follow-up will be necessary to confirm these findings.

Research paper thumbnail of Impresión tridimensional en doble vía de salida del ventrículo derecho para simplificar la reparación intraventricular

Revista Argentina de Cardiología, Jan 6, 2018

Research paper thumbnail of Hybrid Strategy in the Management of Congenital Heart Defects. Initial Results in a Multicentric Experience

Revista Argentina de Cardiología, 2021

Background: The hybrid approach implies the close collaboration between surgical and intervention... more Background: The hybrid approach implies the close collaboration between surgical and interventional cardiology teams forthe treatment of complex congenital heart diseases to reduce the number of interventions by using less invasive techniques,avoid the limitations due to the size of vascular accesses and the use of cardiopulmonary bypass.Objectives: The aim of this study is to evaluate the indications, techniques, initial results and short-term follow-up of thehybrid approach.Methods: We conducted a retrospective analysis of patients treated with hybrid approach between March 2014 and September2020. Fourteen procedures were performed in 13 patients. Mean age was 16.8 years (1 day-13 years); 50% were neonates, 57%were male and mean weight was 9 kg (1.9-70 kg). The hybrid procedures performed included stenting in coarctation of theaorta (4 patients), ductal stenting (3 patients), stenting of pulmonary artery branches (1 patient), neonatal aortic valvuloplasty(4 patients) and perventri...

Research paper thumbnail of Selección de pacientes para cierre percutáneo de foramen oval permeable con ecocardiograma Doppler color transtorácico. Una estrategia diferente

Revista Argentina de Cardiologia, 2020

Research paper thumbnail of P20.03: Prenatal diagnosis of fetal primary cardiac fibroma: a case report

Ultrasound in Obstetrics & Gynecology, 2019

Research paper thumbnail of Bloqueo auriculoventricular completo reversible durante el cierre percutáneo de comunicación interauricular

Archivos de Cardiología de México, 2017

Review of registry of complications and recommendatios to minimize future risk. Catheter Cardiova... more Review of registry of complications and recommendatios to minimize future risk. Catheter Cardiovasc Interv. 2004;63:496-502. 4. DiBardino DJ, McElhinney DF, Kaza AK, et al. Analysis of the US Food and Drug Administration manufacturer and user facility device experience database for adverse events involving Amplatzer Septal Occluder devices and comparison with the Society of Thoracic Surgery Congenital Cardiac Surgery database.