Francisco Chamié - Academia.edu (original) (raw)
Papers by Francisco Chamié
Revista Brasileira de Cardiologia Invasiva, 2014
Background: Transcatheter occlusion of ostium secundum atrial septal defects using commercial ava... more Background: Transcatheter occlusion of ostium secundum atrial septal defects using commercial available devices is a safe and effective procedure. We present our experience with two new generation coated nitinol wire devices. Methods: We report device characteristics, implantation technique and outcomes of patients with atrial septal defects treated with the Lifetech CERA™ ASD Occluder and the Cocoon Septal Occluder. Results: Procedures were performed in 49 patients, 37 were female. Ages ranged from 7 to 68 years and body weight from 17 to 90 kg. The aortic rim was present in 34.7% and atrial septal aneurysms in 14.3% of the patients. Mean diameter was 13 ± 7 mm whereas the balloon stretched diameter was 22 ± 7 mm. Implantation was possible in all cases and 55 devices were used. Forty-five CERA™ and four Cocoon devices were used. Three patients required occlusion of a second orifice. During the procedures the first device had to be replaced by a larger one in two cases, and in the third case it was replaced due to a tuliplike malformation of the left atrial disc. Immediate occlusion occurred in 91.9% and in 95.9% at 6 months. There were no deaths or other significant complications. Conclusions: The use of both CERA™ and Cocoon devices was simple and reproducible in experienced hands. Short-term occlusion rates were similar to the ones obtained with the Amplatzer™ device. More studies and long-term follow-up are required to determine the actual advantages of coated nitinol wire devices.
Revista Brasileira de cardiologia invasiva, 2012
Revista Brasileira de Cardiologia Invasiva, Apr 1, 2015
Background: The wide morphological variety of coarctation of the aorta (CoA) and some complicatio... more Background: The wide morphological variety of coarctation of the aorta (CoA) and some complications resulting from the implantation of conventional stents has made the utilization of covered stents (CS) desirable. We describe our experience with the use of CS to treat CoA in children and adults. Methods: The records of patients that received CS were retrospectively reviewed. The procedures were performed according to the established technique. Use of CS as primary treatment were assessed, as well as those deployed due to complications resulting from the initial procedure. Results: Between 2007 and 2014, CS were used in 14 patients, 9 (64.3%) of whom were males. The mean age was 19.5 ± 10.5 years, and the mean weight 61.7 ± 25.5 kg. Bicuspid aortic valve was present in 74% of cases, and two patients had patent ductus arteriosus. Subatretic aortic coarctations were found in five patients. Eleven patients had systemic arterial hypertension, and 73% had normalized blood pressure levels after stent dilation. Implantation was possible in all cases. Primary implants were performed in ten (71.4%) patients with native coarctation and in four patients as a second device to correct problems originating from previous procedures. The mean time of follow-up was 51.7 ± 29.8 months. Three minor complications were related to procedures, and there were no deaths. Conclusions: The use of CS was safe and effective in this small case series. Further studies focusing on the long-term evolution and the possibility of CS redilation are needed to support its use in children.
Revista Brasileira de Cardiologia Invasiva, Dec 1, 2013
Revista Brasileira de Cardiologia Invasiva, Mar 1, 2013
background: Percutaneous closure of patent ductus arteriosus is a safe, effective and easily repr... more background: Percutaneous closure of patent ductus arteriosus is a safe, effective and easily reproducible method. Adult patent ductus arteriosus may present degenerative changes that increase surgical risk and favor percutaneous closure. We report a single center experience with percutaneous closure of patent ductus arteriosus in adults and highlight specific technical aspects of this procedure. Methods: The records of patients ≥ 20 years of age submitted to patent ductus arteriosus closure between March 2001 and December 2012 were evaluated. Cases were selected by transthoracic echocardiography. results: We analyzed 33 patients, most of them females (72.7%), with mean age of 30.9 ± 12.8 years and weight of 63.9 ± 12.4 kg. Only 3 patients had symptoms and 2 had associated congenital defects, treated in the same procedure. Implants were possible in all cases. One Flipper Coil, 19 Amplatzer TM Duct Occluders type I, 3 Amplatzer TM Duct Occluders type II, 8 Cera TM PDA Occluders and 2 Muscular VSD devices were used. Sizing balloons were used in 5 cases. Mean follow-up was 46.1 ± 42.9 months and was obtained in 84.9% of patients. Two cases presented residual shunts immediately after the procedure. There were no major complications or deaths. Conclusions: Percutaneous closure of adult patent ductus arteriosus may be performed safely and effectively with the devices used in this study.
Revista Brasileira de Cardiologia Invasiva, 2015
Defeitos congênitos múltiplos são tradicionalmente corrigidos cirurgicamente, mas, atualmente, po... more Defeitos congênitos múltiplos são tradicionalmente corrigidos cirurgicamente, mas, atualmente, podem ser tratados percutaneamente. Existem poucos relatos na literatura atestando sua eficácia e segurança. Objetivamos descrever uma experiência com a realização de procedimentos combinados para tratar diferentes defeitos, congênitos e estruturais, numa mesma sessão terapêutica. Métodos: Desde 2007, foram tratados, numa mesma sessão terapêutica, diferentes defeitos. Todos foram selecionados por ecocardiograma. Os procedimentos foram realizados segundo as técnicas tradicionais já descritas para cada defeito encontrado. Resultados: Foram tratados dez pacientes, cinco do sexo masculino, com idades de 1 a 67 anos, e pesos de 11 a 90 kg. O defeito mais prevalente de forma isolada foi a persistência do canal arterial (PCA, n = 5), seguido da comunicação interatrial ostium secundum (CIA OS, n = 4) e da comunicação interventricular (CIV, n = 4). As combinações mais frequentes foram CIV com PCA (n = 2) e CIV com CIA OS (n = 2). Foram dilatadas duas estenoses valvares pulmonares com CIA OS e com forame oval patente (FOP), e uma coarctação de aorta com PCA. Adicionalmente, foi ocluído um apêndice atrial esquerdo com FOP e foi embolizada uma fístula aortopulmonar com PCA. Todos os procedimentos foram bem-sucedidos. O tempo médio de seguimento foi de 31 ± 28,1 meses, havendo apenas duas complicações. Não houve nenhum óbito. Conclusões: A pequena série de casos relatada mostrou que os procedimentos combinados foram seguros e eficazes, podendo ser reproduzidos por operadores experientes em centros especializados, podendo vir a se constituir como primeira opção terapêutica para esses pacientes.
PubMed, Jul 1, 1996
Purpose: To report our experience with PDA closure with Gianturco coils. Methods: Between Septemb... more Purpose: To report our experience with PDA closure with Gianturco coils. Methods: Between September 1995 and January 1996, nine patients underwent cardiac catheterization to have patent ductus arteriosus occlusion by Gianturco coils. Selection criteria were age > or = 6 months and narrowest PDA internal diameter < 4 mm. 4F to 6F Judkins right coronary catheters were used to deliver the coils. One loop was delivered in the pulmonary artery and two loops delivered in the descending aorta across the ductus. Angiography after the procedure confirmed complete closure. Follow-up after coil placement occurred the next day, one month and three months by means of color flow mapping. Results: Of the nine patients, seven had successful implants. In one no coil was delivered. In the first patient, there is a small residual shunt visualized by color flow doppler that persists after three months of the implant. One patient received two coils, other received three coils and the remainder received one coil each. There were no coil migration, or significant complication related to the implants. Conclusion: The coil occlusion of the ductus is a safe, effective and low-cost procedure, and should be included among non surgical technics of ductal closure.
Revista Brasileira de Cardiologia Invasiva, Mar 1, 2012
Background: The percutaneous closure of a patent ductus arteriosus (PDA) has been considered the ... more Background: The percutaneous closure of a patent ductus arteriosus (PDA) has been considered the treatment of choice by most authors, and several devices with different structural characteristics have been used. The initial experience with the novel Cera TM PDA Occluder is reported. Methods: From March of 2010 through December of 2011, patients weighing over 5 kg with a PDA diagnosed by transthoracic echocardiogram (TTE) with colour Doppler flow mapping and no associated defects underwent the procedure. Follow-up was performed by TTE one, three, and six months after the procedure, and yearly thereafter. Results: Overall, 18 patients were referred for percutaneous occlusion; 61.2% were female. The mean age and weight were 13.7 ± 9.3 years and 42.9 ± 20.1 kg, respectively. Regarding morphology, 11 were type A, six were type E, and one had a residual postoperative defect. The mean diameter was 4.2 mm. Implantation was possible in all patients. Ten 6-4 mm, one 8-6 mm, three 10-8 mm, and four 12-10 mm devices were used. All defects were completely closed by the first follow-up TTE. Deaths or complications were not observed in this series. Conclusions: The Cera TM prosthesis may be used for the occlusion of small or large defects, and delivers to excellent results in children and adults. The procedure is easy, safe, has a high efficacy and low morbidity, and may be an excellent option for the percutaneous closure of a PDA. Due to its flexibility, oversized devices greater than 2 mm should be used.
Revista Brasileira de cardiologia invasiva, 2015
Background: Multiple congenital defects are traditionally corrected surgically, but nowadays can ... more Background: Multiple congenital defects are traditionally corrected surgically, but nowadays can be treated percutaneously. There are few reports in the literature attesting to its efficacy and safety. We aimed to describe an experience with combined procedures to treat different congenital and structural defects, in a single therapeutic session. Methods: Since 2007, different defects were treated in a single treatment session. All were selected by echocardiography. The procedures were performed using traditional techniques already described for each defect. Results: Ten patients were treated, five males, aged 1-67 years, weighting 11-90 kilograms. The most prevalent isolated defect was patent ductus arteriosus (PDA, n = 5), followed by ostium secundum atrial septal defects (osASD, n = 4) and ventricular septal defects (VSD, n = 4). The most common combinations were VSD with PDA (n = 2) and VSD with osASD (n = 2). Two pulmonary valve stenosis were dilated with osASD and patent foramen ovale (PFO), and one aortic coarctation with PDA. Additionally, a left atrial appendage with PFO was occluded and an aortopulmonary fistula with PDA was embolized. All procedures were successful. The mean follow-up was 31 ± 28.1 months, with only two complications. There were no deaths. Conclusions: The small number of reported cases showed that the combined procedures were safe and effective and can be reproduced by experienced operators in specialized centers and may be considered as the first therapeutic option in these patients.
Revista de Pediatria SOPERJ, 2006
Objetivo: Relatar o caso de um lactente internado no setor de Pediatria do Hospital Municipal da ... more Objetivo: Relatar o caso de um lactente internado no setor de Pediatria do Hospital Municipal da Piedade (HMP) com história de estridor respiratório desde o nascimento e pneumopatias de repetição, sendo diagnosticado o anel vascular tipo duplo arco aórtico (DAA). O DAA é uma anomalia do arco aórtico, definido como um anel vascular completo, onde a aorta se bifurca formando dois arcos. O arco direito surge como persistência do arco aórtico direito e o arco esquerdo, que geralmente permanece atrésico; abraçam a região traqueoesofágica. Geralmente estas crianças apresentam sintomas inespecíficos desde o nascimento relacionados principalmente ao trato respiratório. Assim sendo, muitas vezes esses lactentes são classificados genericamente como "bebês chiadores" ou confundidos com afecções pulmonares ou com refluxo gastroesofágico, retardando o tratamento definitivo e aumentando a morbidade destas crianças. Descrição: Sexo masculino, 2 meses, branco, natural do Rio de Janeiro, apresentando desde o nascimento estridor respiratório e pneumonias de repetição. Foi encaminhado ao nosso Hospital para investigação do estridor pelo serviço de pneumologia infantil, sendo indicada internação. Ao exame físico notava-se a hiperextensão do pescoço adotada pelo lactente, estridor e o déficit pondero-estatural. Mãe informava dificuldades na alimentação, visto que o menor apresentava vômitos freqüentes. Seguindo os critérios de investigação de bebê chiador e estridor respiratório foram solicitados os exames como radiografia simples de tórax e ecocardiograma ,que foram normais.A broncoscopia evidenciou uma compressão extrínseca antero-posterior. O esofagograma com bário mostrou compressão bilateral do esôfago torácico, ao nível de T4-T5. O estudo angiográfico por cateterismo diagnosticou o anel vascular tipo DAA. Comentários: O presente relato tem o objetivo de alertar os pediatras quanto à dificuldade do diagnóstico de anel vascular e ressaltar a importância deste diagnóstico diferencial na investigação de crianças com sintomas respiratórios crônicos classificados como bebês chiadores.
Cardiology in The Young, Jul 1, 2000
Major abnormalities of pulmonary circulation are uncommon in the patient with pulmonary atresia a... more Major abnormalities of pulmonary circulation are uncommon in the patient with pulmonary atresia and intact ventricular septum. Non-confluent pulmonary arteries have only rarely been described in this setting. In this case report, we describe a patient in whom the pulmonary arteries are non-confluent, with the right pulmonary artery supplied through a right-sided arterial duct, and the left pulmonary artery most likely through a fifth aortic arch, thus providing a systemic-to-pulmonary arterial connection. We discuss the various forms of non-confluent pulmonary arteries in the setting of pulmonary atresia and intact ventricular septum.
Revista Brasileira de Cardiologia Invasiva, 2013
background: Percutaneous closure of patent ductus arteriosus is a safe, effective and easily repr... more background: Percutaneous closure of patent ductus arteriosus is a safe, effective and easily reproducible method. Adult patent ductus arteriosus may present degenerative changes that increase surgical risk and favor percutaneous closure. We report a single center experience with percutaneous closure of patent ductus arteriosus in adults and highlight specific technical aspects of this procedure. Methods: The records of patients ≥ 20 years of age submitted to patent ductus arteriosus closure between March 2001 and December 2012 were evaluated. Cases were selected by transthoracic echocardiography. results: We analyzed 33 patients, most of them females (72.7%), with mean age of 30.9 ± 12.8 years and weight of 63.9 ± 12.4 kg. Only 3 patients had symptoms and 2 had associated congenital defects, treated in the same procedure. Implants were possible in all cases. One Flipper Coil, 19 Amplatzer TM Duct Occluders type I, 3 Amplatzer TM Duct Occluders type II, 8 Cera TM PDA Occluders and 2 Muscular VSD devices were used. Sizing balloons were used in 5 cases. Mean follow-up was 46.1 ± 42.9 months and was obtained in 84.9% of patients. Two cases presented residual shunts immediately after the procedure. There were no major complications or deaths. Conclusions: Percutaneous closure of adult patent ductus arteriosus may be performed safely and effectively with the devices used in this study.
Revista Brasileira de Cardiologia Invasiva, 2009
Revista Brasileira de cardiologia invasiva, Mar 1, 2014
Revista Brasileira de Cardiologia Invasiva, 2013
Journal of Transcatheter Interventions, May 22, 2019
Percutaneous left atrial appendage closure is an invasive option for cardioembolic event preventi... more Percutaneous left atrial appendage closure is an invasive option for cardioembolic event prevention and it is indicated for patients presenting non-valvular atrial fibrillation and oral anticoagulation therapy failure or contraindication. There is limited data addressing the technical success of percutaneous left atrial appendage closure in patients with complex anatomy and history of previous atrial septal defect repair surgery. We report a case of left atrial appendage closure performed with the LAmbre™ device (LifeTech Scientific, Shenzhen, China) in a patient with a left atrial appendage of complex anatomy, and history of previous surgery for atrial septal defect repair.
Revista Brasileira de Cardiologia Invasiva, Jul 1, 2015
A fibrilação atrial (FA) aumenta o risco de eventos tromboembólicos por êmbolos originados em apê... more A fibrilação atrial (FA) aumenta o risco de eventos tromboembólicos por êmbolos originados em apêndice atrial esquerdo (AAE). Métodos mecânicos para a oclusão do AAE foram desenvolvidos como alternativa à anticoagulação oral. O objetivo deste trabalho foi apresentar uma experiência inicial com o AMPLATZER ® Cardiac Plug. Métodos: Incluímos pacientes com FA permanente ou paroxística, que apresentavam contraindicações ou complicações derivadas da anticoagulação oral. Pacientes com anatomia e medidas do AAE compatíveis com o oclusor, e sem trombos foram selecionados por meio de ecocardiograma transesofágico. Resultados: Foram realizados 14 procedimentos em 13 pacientes (5M:8F), com média de idade de 66,7 anos. Sangramento significativo e acidentes vasculares cerebrais prévios foram encontrados em 69,2% e em 53,8%, respectivamente. A FA era permanente em 84,6% e paroxística no restante da amostra. Os diâmetros médio do óstio e da zona alvo mediram 23,9 mm e 20,8 mm, respectivamente. AAE bilobulados foram observados em 76,9%. Os procedimentos foram possíveis em todos os casos. Dezesseis dispositivos foram usados em 13 pacientes, numa razão de 1,2:1, e apenas 1 paciente precisou de um segundo dispositivo para oclusão do AAE. O tempo médio de acompanhamento foi de 12,2 meses. Todos os AAE permanecem fechados e sem defeito residual até o momento. Houve apenas um óbito tardio não relacionado ao procedimento. Conclusões: A oclusão do AAE com o dispositivo de AMPLATZER ® Cardiac Plug mostrou ser segura e eficaz nesta pequena série de pacientes. Os resultados iniciais são encorajadores e apontam para o fechamento transcateter do AAE como alternativa para a anticoagulação oral em pacientes selecionados.
Revista Brasileira de cardiologia invasiva, Jul 1, 2015
Background: Atrial fibrillation (AF) increases the risk of thromboembolic events caused by emboli... more Background: Atrial fibrillation (AF) increases the risk of thromboembolic events caused by emboli originating in the left atrial appendage (LAA). Mechanical methods for LAA occlusion have been developed as an alternative to oral anticoagulation. The aim of this study was to present an initial experience with the AMPLATZER ® Cardiac Plug. Methods: Patients with permanent or paroxysmal AF and with contraindications or complications of oral anticoagulation were included. Patients with LAA anatomy and measures compatible with the occluder, and without thrombi, were selected through transesophageal echocardiography. Results: A total of 14 procedures were performed in 13 patients (5M:8F), with mean age of 66.7 years. Significant bleeding and previous strokes were found in 69.2% and 53.8%, respectively. AF was permanent in 84.6% and paroxysmal in the remainder. The mean diameters of the ostium and the landing zone were 23.9 mm and 20.8 mm, respectively. Bilobulated LAA was observed in 76.9%. Procedures were possible in all cases. Sixteen devices were used in 13 patients, a ratio of 1.2:1, and only one patient required a second device for LAA occlusion. The mean follow-up was 12.2 months. All LAA remain closed, with no residual defect to date. There was only one late death, unrelated to the procedure. Conclusions: LAA occlusion using the AMPLATZER ® Cardiac Plug device was shown to be safe and effective in this small series of patients. The initial results are encouraging and indicate the transcatheter closure of the LAA as an alternative to oral anticoagulation therapy in selected patients.
Jornal De Pediatria, May 15, 2000
Objective: children s chest X-ray calcification images can be related to pulmonary, mediastinal a... more Objective: children s chest X-ray calcification images can be related to pulmonary, mediastinal and rarely cardiac parenchymatous pathology. This report describes cases of cardio thoracic calcifications. We emphasize the importance of chest X-ray to track thoracic calcifications. In spite of the fact that it is rare, the cardiac etiology must be considered due to the possibility of surgical treatment. Methods: regarding the period from 1988 to 1997 the authors reviewed the chest X-rays of 2108 patients. In 3 of them thoracic calcifications of cardiac etiology were observed. Results: of these three patients, two were 7 years old and the third was 3 years old. Case 1 presented a calcification in the right atrium topography caused by a heart tumor of Fibroma type. In case 2 the calcification was in the pulmonary trunk, presenting as a calcified aneurysm of the ductus arteriosus. In case 3 the child had pulmonary stenosis and the chest X-ray showed a calcified image on the left cardiac boards caused by a thrombo in the right ventricle wall. Conclusion: the authors emphasize the importance of chest X-ray in the diagnosis of thoracic calcifications, and comment that in spite of the being rare, the cardiac causes should be considered due to the possibility of surgical treatment.
Revista Brasileira de Cardiologia Invasiva, 2014
Background: Transcatheter occlusion of ostium secundum atrial septal defects using commercial ava... more Background: Transcatheter occlusion of ostium secundum atrial septal defects using commercial available devices is a safe and effective procedure. We present our experience with two new generation coated nitinol wire devices. Methods: We report device characteristics, implantation technique and outcomes of patients with atrial septal defects treated with the Lifetech CERA™ ASD Occluder and the Cocoon Septal Occluder. Results: Procedures were performed in 49 patients, 37 were female. Ages ranged from 7 to 68 years and body weight from 17 to 90 kg. The aortic rim was present in 34.7% and atrial septal aneurysms in 14.3% of the patients. Mean diameter was 13 ± 7 mm whereas the balloon stretched diameter was 22 ± 7 mm. Implantation was possible in all cases and 55 devices were used. Forty-five CERA™ and four Cocoon devices were used. Three patients required occlusion of a second orifice. During the procedures the first device had to be replaced by a larger one in two cases, and in the third case it was replaced due to a tuliplike malformation of the left atrial disc. Immediate occlusion occurred in 91.9% and in 95.9% at 6 months. There were no deaths or other significant complications. Conclusions: The use of both CERA™ and Cocoon devices was simple and reproducible in experienced hands. Short-term occlusion rates were similar to the ones obtained with the Amplatzer™ device. More studies and long-term follow-up are required to determine the actual advantages of coated nitinol wire devices.
Revista Brasileira de cardiologia invasiva, 2012
Revista Brasileira de Cardiologia Invasiva, Apr 1, 2015
Background: The wide morphological variety of coarctation of the aorta (CoA) and some complicatio... more Background: The wide morphological variety of coarctation of the aorta (CoA) and some complications resulting from the implantation of conventional stents has made the utilization of covered stents (CS) desirable. We describe our experience with the use of CS to treat CoA in children and adults. Methods: The records of patients that received CS were retrospectively reviewed. The procedures were performed according to the established technique. Use of CS as primary treatment were assessed, as well as those deployed due to complications resulting from the initial procedure. Results: Between 2007 and 2014, CS were used in 14 patients, 9 (64.3%) of whom were males. The mean age was 19.5 ± 10.5 years, and the mean weight 61.7 ± 25.5 kg. Bicuspid aortic valve was present in 74% of cases, and two patients had patent ductus arteriosus. Subatretic aortic coarctations were found in five patients. Eleven patients had systemic arterial hypertension, and 73% had normalized blood pressure levels after stent dilation. Implantation was possible in all cases. Primary implants were performed in ten (71.4%) patients with native coarctation and in four patients as a second device to correct problems originating from previous procedures. The mean time of follow-up was 51.7 ± 29.8 months. Three minor complications were related to procedures, and there were no deaths. Conclusions: The use of CS was safe and effective in this small case series. Further studies focusing on the long-term evolution and the possibility of CS redilation are needed to support its use in children.
Revista Brasileira de Cardiologia Invasiva, Dec 1, 2013
Revista Brasileira de Cardiologia Invasiva, Mar 1, 2013
background: Percutaneous closure of patent ductus arteriosus is a safe, effective and easily repr... more background: Percutaneous closure of patent ductus arteriosus is a safe, effective and easily reproducible method. Adult patent ductus arteriosus may present degenerative changes that increase surgical risk and favor percutaneous closure. We report a single center experience with percutaneous closure of patent ductus arteriosus in adults and highlight specific technical aspects of this procedure. Methods: The records of patients ≥ 20 years of age submitted to patent ductus arteriosus closure between March 2001 and December 2012 were evaluated. Cases were selected by transthoracic echocardiography. results: We analyzed 33 patients, most of them females (72.7%), with mean age of 30.9 ± 12.8 years and weight of 63.9 ± 12.4 kg. Only 3 patients had symptoms and 2 had associated congenital defects, treated in the same procedure. Implants were possible in all cases. One Flipper Coil, 19 Amplatzer TM Duct Occluders type I, 3 Amplatzer TM Duct Occluders type II, 8 Cera TM PDA Occluders and 2 Muscular VSD devices were used. Sizing balloons were used in 5 cases. Mean follow-up was 46.1 ± 42.9 months and was obtained in 84.9% of patients. Two cases presented residual shunts immediately after the procedure. There were no major complications or deaths. Conclusions: Percutaneous closure of adult patent ductus arteriosus may be performed safely and effectively with the devices used in this study.
Revista Brasileira de Cardiologia Invasiva, 2015
Defeitos congênitos múltiplos são tradicionalmente corrigidos cirurgicamente, mas, atualmente, po... more Defeitos congênitos múltiplos são tradicionalmente corrigidos cirurgicamente, mas, atualmente, podem ser tratados percutaneamente. Existem poucos relatos na literatura atestando sua eficácia e segurança. Objetivamos descrever uma experiência com a realização de procedimentos combinados para tratar diferentes defeitos, congênitos e estruturais, numa mesma sessão terapêutica. Métodos: Desde 2007, foram tratados, numa mesma sessão terapêutica, diferentes defeitos. Todos foram selecionados por ecocardiograma. Os procedimentos foram realizados segundo as técnicas tradicionais já descritas para cada defeito encontrado. Resultados: Foram tratados dez pacientes, cinco do sexo masculino, com idades de 1 a 67 anos, e pesos de 11 a 90 kg. O defeito mais prevalente de forma isolada foi a persistência do canal arterial (PCA, n = 5), seguido da comunicação interatrial ostium secundum (CIA OS, n = 4) e da comunicação interventricular (CIV, n = 4). As combinações mais frequentes foram CIV com PCA (n = 2) e CIV com CIA OS (n = 2). Foram dilatadas duas estenoses valvares pulmonares com CIA OS e com forame oval patente (FOP), e uma coarctação de aorta com PCA. Adicionalmente, foi ocluído um apêndice atrial esquerdo com FOP e foi embolizada uma fístula aortopulmonar com PCA. Todos os procedimentos foram bem-sucedidos. O tempo médio de seguimento foi de 31 ± 28,1 meses, havendo apenas duas complicações. Não houve nenhum óbito. Conclusões: A pequena série de casos relatada mostrou que os procedimentos combinados foram seguros e eficazes, podendo ser reproduzidos por operadores experientes em centros especializados, podendo vir a se constituir como primeira opção terapêutica para esses pacientes.
PubMed, Jul 1, 1996
Purpose: To report our experience with PDA closure with Gianturco coils. Methods: Between Septemb... more Purpose: To report our experience with PDA closure with Gianturco coils. Methods: Between September 1995 and January 1996, nine patients underwent cardiac catheterization to have patent ductus arteriosus occlusion by Gianturco coils. Selection criteria were age > or = 6 months and narrowest PDA internal diameter < 4 mm. 4F to 6F Judkins right coronary catheters were used to deliver the coils. One loop was delivered in the pulmonary artery and two loops delivered in the descending aorta across the ductus. Angiography after the procedure confirmed complete closure. Follow-up after coil placement occurred the next day, one month and three months by means of color flow mapping. Results: Of the nine patients, seven had successful implants. In one no coil was delivered. In the first patient, there is a small residual shunt visualized by color flow doppler that persists after three months of the implant. One patient received two coils, other received three coils and the remainder received one coil each. There were no coil migration, or significant complication related to the implants. Conclusion: The coil occlusion of the ductus is a safe, effective and low-cost procedure, and should be included among non surgical technics of ductal closure.
Revista Brasileira de Cardiologia Invasiva, Mar 1, 2012
Background: The percutaneous closure of a patent ductus arteriosus (PDA) has been considered the ... more Background: The percutaneous closure of a patent ductus arteriosus (PDA) has been considered the treatment of choice by most authors, and several devices with different structural characteristics have been used. The initial experience with the novel Cera TM PDA Occluder is reported. Methods: From March of 2010 through December of 2011, patients weighing over 5 kg with a PDA diagnosed by transthoracic echocardiogram (TTE) with colour Doppler flow mapping and no associated defects underwent the procedure. Follow-up was performed by TTE one, three, and six months after the procedure, and yearly thereafter. Results: Overall, 18 patients were referred for percutaneous occlusion; 61.2% were female. The mean age and weight were 13.7 ± 9.3 years and 42.9 ± 20.1 kg, respectively. Regarding morphology, 11 were type A, six were type E, and one had a residual postoperative defect. The mean diameter was 4.2 mm. Implantation was possible in all patients. Ten 6-4 mm, one 8-6 mm, three 10-8 mm, and four 12-10 mm devices were used. All defects were completely closed by the first follow-up TTE. Deaths or complications were not observed in this series. Conclusions: The Cera TM prosthesis may be used for the occlusion of small or large defects, and delivers to excellent results in children and adults. The procedure is easy, safe, has a high efficacy and low morbidity, and may be an excellent option for the percutaneous closure of a PDA. Due to its flexibility, oversized devices greater than 2 mm should be used.
Revista Brasileira de cardiologia invasiva, 2015
Background: Multiple congenital defects are traditionally corrected surgically, but nowadays can ... more Background: Multiple congenital defects are traditionally corrected surgically, but nowadays can be treated percutaneously. There are few reports in the literature attesting to its efficacy and safety. We aimed to describe an experience with combined procedures to treat different congenital and structural defects, in a single therapeutic session. Methods: Since 2007, different defects were treated in a single treatment session. All were selected by echocardiography. The procedures were performed using traditional techniques already described for each defect. Results: Ten patients were treated, five males, aged 1-67 years, weighting 11-90 kilograms. The most prevalent isolated defect was patent ductus arteriosus (PDA, n = 5), followed by ostium secundum atrial septal defects (osASD, n = 4) and ventricular septal defects (VSD, n = 4). The most common combinations were VSD with PDA (n = 2) and VSD with osASD (n = 2). Two pulmonary valve stenosis were dilated with osASD and patent foramen ovale (PFO), and one aortic coarctation with PDA. Additionally, a left atrial appendage with PFO was occluded and an aortopulmonary fistula with PDA was embolized. All procedures were successful. The mean follow-up was 31 ± 28.1 months, with only two complications. There were no deaths. Conclusions: The small number of reported cases showed that the combined procedures were safe and effective and can be reproduced by experienced operators in specialized centers and may be considered as the first therapeutic option in these patients.
Revista de Pediatria SOPERJ, 2006
Objetivo: Relatar o caso de um lactente internado no setor de Pediatria do Hospital Municipal da ... more Objetivo: Relatar o caso de um lactente internado no setor de Pediatria do Hospital Municipal da Piedade (HMP) com história de estridor respiratório desde o nascimento e pneumopatias de repetição, sendo diagnosticado o anel vascular tipo duplo arco aórtico (DAA). O DAA é uma anomalia do arco aórtico, definido como um anel vascular completo, onde a aorta se bifurca formando dois arcos. O arco direito surge como persistência do arco aórtico direito e o arco esquerdo, que geralmente permanece atrésico; abraçam a região traqueoesofágica. Geralmente estas crianças apresentam sintomas inespecíficos desde o nascimento relacionados principalmente ao trato respiratório. Assim sendo, muitas vezes esses lactentes são classificados genericamente como "bebês chiadores" ou confundidos com afecções pulmonares ou com refluxo gastroesofágico, retardando o tratamento definitivo e aumentando a morbidade destas crianças. Descrição: Sexo masculino, 2 meses, branco, natural do Rio de Janeiro, apresentando desde o nascimento estridor respiratório e pneumonias de repetição. Foi encaminhado ao nosso Hospital para investigação do estridor pelo serviço de pneumologia infantil, sendo indicada internação. Ao exame físico notava-se a hiperextensão do pescoço adotada pelo lactente, estridor e o déficit pondero-estatural. Mãe informava dificuldades na alimentação, visto que o menor apresentava vômitos freqüentes. Seguindo os critérios de investigação de bebê chiador e estridor respiratório foram solicitados os exames como radiografia simples de tórax e ecocardiograma ,que foram normais.A broncoscopia evidenciou uma compressão extrínseca antero-posterior. O esofagograma com bário mostrou compressão bilateral do esôfago torácico, ao nível de T4-T5. O estudo angiográfico por cateterismo diagnosticou o anel vascular tipo DAA. Comentários: O presente relato tem o objetivo de alertar os pediatras quanto à dificuldade do diagnóstico de anel vascular e ressaltar a importância deste diagnóstico diferencial na investigação de crianças com sintomas respiratórios crônicos classificados como bebês chiadores.
Cardiology in The Young, Jul 1, 2000
Major abnormalities of pulmonary circulation are uncommon in the patient with pulmonary atresia a... more Major abnormalities of pulmonary circulation are uncommon in the patient with pulmonary atresia and intact ventricular septum. Non-confluent pulmonary arteries have only rarely been described in this setting. In this case report, we describe a patient in whom the pulmonary arteries are non-confluent, with the right pulmonary artery supplied through a right-sided arterial duct, and the left pulmonary artery most likely through a fifth aortic arch, thus providing a systemic-to-pulmonary arterial connection. We discuss the various forms of non-confluent pulmonary arteries in the setting of pulmonary atresia and intact ventricular septum.
Revista Brasileira de Cardiologia Invasiva, 2013
background: Percutaneous closure of patent ductus arteriosus is a safe, effective and easily repr... more background: Percutaneous closure of patent ductus arteriosus is a safe, effective and easily reproducible method. Adult patent ductus arteriosus may present degenerative changes that increase surgical risk and favor percutaneous closure. We report a single center experience with percutaneous closure of patent ductus arteriosus in adults and highlight specific technical aspects of this procedure. Methods: The records of patients ≥ 20 years of age submitted to patent ductus arteriosus closure between March 2001 and December 2012 were evaluated. Cases were selected by transthoracic echocardiography. results: We analyzed 33 patients, most of them females (72.7%), with mean age of 30.9 ± 12.8 years and weight of 63.9 ± 12.4 kg. Only 3 patients had symptoms and 2 had associated congenital defects, treated in the same procedure. Implants were possible in all cases. One Flipper Coil, 19 Amplatzer TM Duct Occluders type I, 3 Amplatzer TM Duct Occluders type II, 8 Cera TM PDA Occluders and 2 Muscular VSD devices were used. Sizing balloons were used in 5 cases. Mean follow-up was 46.1 ± 42.9 months and was obtained in 84.9% of patients. Two cases presented residual shunts immediately after the procedure. There were no major complications or deaths. Conclusions: Percutaneous closure of adult patent ductus arteriosus may be performed safely and effectively with the devices used in this study.
Revista Brasileira de Cardiologia Invasiva, 2009
Revista Brasileira de cardiologia invasiva, Mar 1, 2014
Revista Brasileira de Cardiologia Invasiva, 2013
Journal of Transcatheter Interventions, May 22, 2019
Percutaneous left atrial appendage closure is an invasive option for cardioembolic event preventi... more Percutaneous left atrial appendage closure is an invasive option for cardioembolic event prevention and it is indicated for patients presenting non-valvular atrial fibrillation and oral anticoagulation therapy failure or contraindication. There is limited data addressing the technical success of percutaneous left atrial appendage closure in patients with complex anatomy and history of previous atrial septal defect repair surgery. We report a case of left atrial appendage closure performed with the LAmbre™ device (LifeTech Scientific, Shenzhen, China) in a patient with a left atrial appendage of complex anatomy, and history of previous surgery for atrial septal defect repair.
Revista Brasileira de Cardiologia Invasiva, Jul 1, 2015
A fibrilação atrial (FA) aumenta o risco de eventos tromboembólicos por êmbolos originados em apê... more A fibrilação atrial (FA) aumenta o risco de eventos tromboembólicos por êmbolos originados em apêndice atrial esquerdo (AAE). Métodos mecânicos para a oclusão do AAE foram desenvolvidos como alternativa à anticoagulação oral. O objetivo deste trabalho foi apresentar uma experiência inicial com o AMPLATZER ® Cardiac Plug. Métodos: Incluímos pacientes com FA permanente ou paroxística, que apresentavam contraindicações ou complicações derivadas da anticoagulação oral. Pacientes com anatomia e medidas do AAE compatíveis com o oclusor, e sem trombos foram selecionados por meio de ecocardiograma transesofágico. Resultados: Foram realizados 14 procedimentos em 13 pacientes (5M:8F), com média de idade de 66,7 anos. Sangramento significativo e acidentes vasculares cerebrais prévios foram encontrados em 69,2% e em 53,8%, respectivamente. A FA era permanente em 84,6% e paroxística no restante da amostra. Os diâmetros médio do óstio e da zona alvo mediram 23,9 mm e 20,8 mm, respectivamente. AAE bilobulados foram observados em 76,9%. Os procedimentos foram possíveis em todos os casos. Dezesseis dispositivos foram usados em 13 pacientes, numa razão de 1,2:1, e apenas 1 paciente precisou de um segundo dispositivo para oclusão do AAE. O tempo médio de acompanhamento foi de 12,2 meses. Todos os AAE permanecem fechados e sem defeito residual até o momento. Houve apenas um óbito tardio não relacionado ao procedimento. Conclusões: A oclusão do AAE com o dispositivo de AMPLATZER ® Cardiac Plug mostrou ser segura e eficaz nesta pequena série de pacientes. Os resultados iniciais são encorajadores e apontam para o fechamento transcateter do AAE como alternativa para a anticoagulação oral em pacientes selecionados.
Revista Brasileira de cardiologia invasiva, Jul 1, 2015
Background: Atrial fibrillation (AF) increases the risk of thromboembolic events caused by emboli... more Background: Atrial fibrillation (AF) increases the risk of thromboembolic events caused by emboli originating in the left atrial appendage (LAA). Mechanical methods for LAA occlusion have been developed as an alternative to oral anticoagulation. The aim of this study was to present an initial experience with the AMPLATZER ® Cardiac Plug. Methods: Patients with permanent or paroxysmal AF and with contraindications or complications of oral anticoagulation were included. Patients with LAA anatomy and measures compatible with the occluder, and without thrombi, were selected through transesophageal echocardiography. Results: A total of 14 procedures were performed in 13 patients (5M:8F), with mean age of 66.7 years. Significant bleeding and previous strokes were found in 69.2% and 53.8%, respectively. AF was permanent in 84.6% and paroxysmal in the remainder. The mean diameters of the ostium and the landing zone were 23.9 mm and 20.8 mm, respectively. Bilobulated LAA was observed in 76.9%. Procedures were possible in all cases. Sixteen devices were used in 13 patients, a ratio of 1.2:1, and only one patient required a second device for LAA occlusion. The mean follow-up was 12.2 months. All LAA remain closed, with no residual defect to date. There was only one late death, unrelated to the procedure. Conclusions: LAA occlusion using the AMPLATZER ® Cardiac Plug device was shown to be safe and effective in this small series of patients. The initial results are encouraging and indicate the transcatheter closure of the LAA as an alternative to oral anticoagulation therapy in selected patients.
Jornal De Pediatria, May 15, 2000
Objective: children s chest X-ray calcification images can be related to pulmonary, mediastinal a... more Objective: children s chest X-ray calcification images can be related to pulmonary, mediastinal and rarely cardiac parenchymatous pathology. This report describes cases of cardio thoracic calcifications. We emphasize the importance of chest X-ray to track thoracic calcifications. In spite of the fact that it is rare, the cardiac etiology must be considered due to the possibility of surgical treatment. Methods: regarding the period from 1988 to 1997 the authors reviewed the chest X-rays of 2108 patients. In 3 of them thoracic calcifications of cardiac etiology were observed. Results: of these three patients, two were 7 years old and the third was 3 years old. Case 1 presented a calcification in the right atrium topography caused by a heart tumor of Fibroma type. In case 2 the calcification was in the pulmonary trunk, presenting as a calcified aneurysm of the ductus arteriosus. In case 3 the child had pulmonary stenosis and the chest X-ray showed a calcified image on the left cardiac boards caused by a thrombo in the right ventricle wall. Conclusion: the authors emphasize the importance of chest X-ray in the diagnosis of thoracic calcifications, and comment that in spite of the being rare, the cardiac causes should be considered due to the possibility of surgical treatment.