INTRODUÇÃO: O acesso através da punção da artéria axilar (AAx) tem sido utilizado em adultos com bons resultados, porém seu uso em neonatos e lactentes jovens tem sido pouco relatado. Nosso objetivo foi relatar a experiência inicial com o uso desse acesso em diferentes intervenções nessa faixa etária de pacientes. MÉTODO: De janeiro de 2009 a setembro de 2010 foram incluídas 11 crianças submetidas a diferentes procedimentos intervencionistas realizados através de punção da AAx. O procedimento foi realizado com agulha 21 G, sendo utilizados introdutores 4 F ou 5 F pediátricos. RESULTADOS: A média de idade foi de 26 ± 12 dias e o peso médio, de 4,2 ± 1,7 kg. Os procedimentos intervencionistas realizados foram: implante de stent no canal arterial (6), valvoplastia aórtica (1), angioplastia aórtica (2), implante de stent em Blalock-Taussig (1), e redilatação do stent do canal arterial (1). A punção da AAx direita foi realizada com sucesso em todos os pacientes e sem dificuldade técnica. Os tempos médios do procedimento e da fluoroscopia foram de, respectivamente, 52 ± 15 minutos e 13 ± 4 minutos. Apenas um paciente teve como complicação um pneumotórax sem repercussão hemodinâmica, e os demais pacientes não apresentaram intercorrências. Não houve complicações isquêmicas nem neurológicas no membro puncionado. O tempo médio de internação na Unidade de Tratamento Intensivo (UTI) foi de 48 ± 16 horas. Não houve mortalidade durante os procedimentos intervencionistas e um paciente faleceu na UTI cinco dias após por sepse. CONCLUSÃO: O acesso axilar obtido por punção demonstrou ser uma alternativa segura e eficaz para a realização de diferentes procedimentos intervencionistas em neonatos e lactentes com cardiopatias congênitas.

BACKGROUND: Axillary artery access (AxA) has been used in adults with good results, however, its use in neonates and infants has not been extensively reported. This study was aimed at reporting our initial experience using this access in different cardiac interventions in this age group. METHOD: From January 2009 to September 2010, 11 children were submitted to different cardiac interventions using AxA. The procedure was performed with a 21 G needle followed by the insertion of a 4 F or a 5 F pediatric sheats. RESULTS: Mean age was 26 ± 12 days and mean weight was 4.2 ± 1.7 Kg. The cardiac interventions performed were: stenting of the arterial duct (6), aortic valvoplasty (1), aortic angioplasty (2), stent implantation in a Blalock-Taussig shunt (1) and stent redilation in the arterial duct (1). Right AxA puncture was successfully obtained in all patients without technical difficulties. Mean procedure and fluoroscopy times were 52 ± 15 minutes and 13 ± 4 minutes, respectively. Pneumothorax without hemodynamic involvement was the single complication in one patient. The other patients did not have any abnormalities. There were no ischemic or neurologic complications in the ipsilateral limb. Mean time of Intensive Care Unit (ICU) stay was 48 ± 16 hours. There were no deaths during the interventional procedures and one patient died of sepsis at the ICU 5 days after the procedure. CONCLUSION: In our experience AxA proved to be a safe and effective alternative for different interventional procedures in neonates and infants with congenital heart diseases.

A obstrução dos túneis intra-atriais, no pós-operatório tardio de cirurgia de correção atrial para o tratamento da transposição das grandes artérias, não é uma complicação infreqüente, podendo até, em alguns casos, ser fatal. O tratamento cirúrgico de tais lesões pode apresentar altos índices de morbidade e mortalidade. Recentemente, o tratamento percutâneo mediante implante de stent ou por meio de angioplastia com cateter-balão tem sido utilizado com bons resultados. Relatamos dois casos de tratamento percutâneo de obstruções dos túneis intra-atriais sistêmico e pulmonar.

Obstruction of the venous pathways after atrial repair for transposition of the great arteries is not uncommon and can be, in some cases, fatal. The surgical treatment of these complications is a high-risk procedure. Nowadays, percutaneous balloon angioplasty or stenting have been used with good results. We report two cases of percutaneous treatment of systemic and pulmonary "baffle" obstructions.

PURPOSE: Evaluation of the role of transesophageal echocardiography in percutaneous closure of atrial septal defects (ASD) with the Amplatzer septal occluder. METHODS: Patients were selected for percutaneous closure of ASD by transesophageal echocardiography (TEE), which was also used to monitor the procedure, helping to select the appropriate size of the Amplatzer device, to verify its position, and to access the immediate results of the procedure. During the follow-up, TEE was used to evaluate the presence and magnitude of residual shunt (RS), device position, and right cardiac chamber diameters. RESULTS: Twenty-two (40%) of a total of 55 studied patients were selected. Thirteen underwent Amplatzer device implantation, eight are still waiting for it, and one preferred the conventional surgical treatment. All procedures were successful, which was mainly due to proper patient selection. Six (23%) patients acutely developed RS, which spontaneously disapeared at the three-month follow-up examination in three patients. There was a significant reduction in the right ventricle diastolic diameter, from 27mm (average) to 24mm and 20mm, one and three months after the procedure, respectively (p<0.0076). CONCLUSION: With the aid of TEE, percutaneous closure of ASD can be successfully, safely, and effectively performed.