OBJECTIVE: To evaluate the effectiveness of the Amplatzer™ septal occluder in the treatment of ostium secundum atrial septal defects (OS ASDs). METHODS: Retrospective cohort study conducted between November 1998 and September 2005 involving 101 OS ASD transcatheter occlusion procedures in our institution. All procedures were conducted in the hemodynamic laboratory under general anesthesia with transoesophageal echocardiographic monitoring (TEE). Clinical and echocardiography assessments of the patients were conducted at 30 days, six months and on an annual basis. The results are presented as averages, standard deviations and percentages. Event-free survival was estimated using the Kaplan-Meier curve. RESULTS: From the 101 patients, 60 (59.4%) were females. Mean age, weight, height, body mass index and body surface area were, respectively: 24.3 ± 18.31 years, 51.88 ± 23.76kg, 140.59 ± 39.3cm, 23.18 ± 18.9kg/m² and 1.24 ± 0.21m². The prevalence of interatrial septum aneurysms was 4.95%, and 98 cases had an isolated defect. ASD diameters were 21.47 ± 6.96mm using an angiography and 21.22 ± 7.93 mm using a TEE. The average size of the implanted devices was 23.92 ± 7.25mm, ranging from 9mm to 40mm. The procedure time was 90.47 ± 26.67 minutes and the average hospital stay was 2.51 ± 0.62 days. Clinical and echocardiography follow-up was conducted at 12.81 ± 8.41 months and all devices were securely anchored without any residual shunts. The procedure success rate was 93% (94/101). In five cases adequate deployment of the device was not possible and 2 patients presented residual ASD. No major complications occurred. CONCLUSION: The Amplatzer™ septal occluder is an effective OS ASD transcatheter treatment device.
OBJETIVO: Avaliar a efetividade da prótese de Amplatzer® para tratamento de comunicação interatrial tipo ostium secundum (CIA OS). MÉTODOS: Estudo de coorte histórica entre novembro de 1998 e setembro de 2005, em que foram realizados 101 procedimentos para oclusão percutânea de CIA OS em nossa instituição. Os procedimentos foram efetuados no laboratório de hemodinâmica, sob anestesia geral e com monitorização por ecocardiografia transesofágica (ETE). Os pacientes foram acompanhados clinicamente e com ecocardiografia em 30 dias, seis meses e depois anualmente. O resultados são apresentados em média, desvio padrão e porcentual, e a sobrevida livre de eventos foi estimada pela curva de Kaplan-Meier. RESULTADOS: Dos 101 pacientes, 60 (59,4%) eram mulheres. As médias para idade, peso, altura, índice de massa corporal e superfície corporal foram, respectivamente, de 24,3 + 18,31 anos, 51,88 + 23,76 kg, 140,59 + 39,3 cm, 23,18 + 18,9 kg/m², e 1,24 + 0,21 m². A prevalência de aneurisma do septo interatrial foi de 4,95%, e 98 casos eram de defeito único. O diâmetro das CIAs foi de 21,47 + 6,96 mm pela angiografia e de 21,22 + 7,93 mm pela ETE. As próteses implantadas mediam 23,92 + 7,25 mm, variando de 9 mm a 40 mm. O tempo de procedimento foi de 90,47 + 26,67 minutos e a média de internação hospitalar, de 2,51 + 0,62 dias. Os seguimentos clínico e ecocardiográfico ocorreram com 12,81 + 8,41 meses e todas as próteses estavam bem ancoradas e sem shunt residual. O sucesso do procedimento foi de 93% (94/101). Em cinco casos não se conseguiu liberação adequada do dispositivo e dois pacientes apresentaram CIA residual. Não foram registradas complicações maiores. CONCLUSÃO: A prótese de Amplatzer® mostrou-se efetiva para o tratamento percutâneo de CIA OS.
OBJECTIVE: Evaluation of the long-term clinical results of the Fontan operation in patients with tricuspid atresia. METHODS: A retrospective analysis was made at the Instituto de Cardiologia do Rio Grande do Sul (Institute of Cardiology of Rio Grande do Sul), from August 1980 through January 2000, of 25 patients with a long-term follow-up, out of a series of 36 patients who underwent the Fontan operation or one of its variants due to tricuspid atresia. Their mean age at surgery was 5.4±3.1 years, and their mean weight was 15.8±6.1 kg, the majority of them (63.9%) being males. Four patients underwent the classical Fontan operation, 12 the Kreutzer variant, 6 the Björk variant, 9 total cavopulmonary shunt with a fenestrated tube, and 5 total cavopulmonary shunt with a nonfenestrated tube. RESULTS: The patients were followed-up on an outpatient basis, with a mean long-term survival time of 5.5±4.2 years (50 days to 17.8 years) and a late mortality rate of 8%. Arterial saturation increased from 77.2±18.8% in the preoperative period to 91±6.7% upon the last outpatient visit (p>0.05). At the final check, most (67%) patients were asymptomatic and 87% could tolerate exercise. Ten (40%) patients experienced some kind of complication during the long-term follow-up, such as cardiac arrhythmia, cyanosis, protein-losing enteropathy, neurological events, right heart failure, intolerance to exercise and reoperation. CONCLUSION: The results indicate that, once the immediate postoperative period is over, during which the adaptations to the new circulatory physiology occur, the evolution of patients with tricuspid atresia who underwent the Fontan operation is satisfactory, in spite of a low, yet significant, morbidity.