Intervencionismo percutáneo en la corrección fisiológica de la DTGA disfuncionante

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1 Intervencionismo percutáneo en la corrección fisiológica de la DTGA disfuncionante Josep Girona, Gerard Martí Hospital Universitario Materno- Infantil Vall d Hebron. Barcelona

2 CORRECCIÓN FISIOLOGICA DISFUNCIONANTE

3 CORRECCIÓN FISIOLOGICA DISFUNCIONANTE Estenosis de los canales Dehiscencia de suturas

4 Catheter Cardiovasc Interv Sep;54(1):72-6. Simultaneous transcatheter occlusion of two atrial baffle leaks and stent implantation for SVC obstruction in a patient after Mustard repair. Sharaf E, Waight DJ, Hijazi ZM. Closure of the two leaks using the Amplatzer device and stent implantation

5 Catheter Cardiovasc Interv Sep;54(1):72-6. Simultaneous transcatheter occlusion of two atrial baffle leaks and stent implantation for SVC obstruction in a patient after Mustard repair. Sharaf E, Waight DJ, Hijazi ZM. Closure of the two leaks using the Amplatzer device and stent implantation Invasive Cardiol Apr;13(4): Transcatheter treatment of IVC channel obstruction and baffle leak after Mustard procedure for d-transposition of the great arteries using Amplatzer ASD device and multiple stents. Schneider DJ, Moore JW. The University of Illinois College of Medicine and Children's Hospital of Illinois. Single stent was placed to relieve the obstruction, followed by placement of an Amplatzer septal occluder device which assumed suboptimal position after release.

6 Catheter Cardiovasc Interv Sep;54(1):72-6. Simultaneous transcatheter occlusion of two atrial baffle leaks and stent implantation for SVC obstruction in a patient after Mustard repair. Sharaf E, Waight DJ, Hijazi ZM. Closure of the two leaks using the Amplatzer device and stent implantation Invasive Cardiol Apr;13(4): Transcatheter treatment of IVC channel obstruction and baffle leak after Mustard procedure for d-transposition of the great arteries using Amplatzer ASD device and multiple stents. Schneider DJ, Moore JW. The University of Illinois College of Medicine and Children's Hospital of Illinois. Single stent was placed to relieve the obstruction, followed by placement of an Amplatzer septal occluder device which assumed suboptimal position after release. Echocardiography.2010 May 10. Utility of Intracardiac Echocardiography for Atrial Baffle Leak Closure in Repaired Transposition of the Great Arteries. Kuppahally SS, Litwin SE, Green LS, Ishihara SM, Freedman RA, Michaels AD. Division of Cardiology, University of Utah, Salt Lake City, Utah. We report the first use of ICE for baffle leak closure, which provided a good definition of the complex anatomy and guided the procedure

7 Eur J Echocardiogr May;10(3): Epub 2009 Jan 23. The missing leak: a case report of a baffle-leak closure using real-time 3D transoesophageal guidance. Klein AJ, Kim MS, Salcedo E, Fagan T, Kay J. We report a case of a patient with TGA and a baffle leak that was both identified and percutaneously closed with the assistance of real-time 3D

8 Eur J Echocardiogr May;10(3): Epub 2009 Jan 23. The missing leak: a case report of a baffle-leak closure using real-time 3D transoesophageal guidance. Klein AJ, Kim MS, Salcedo E, Fagan T, Kay J. We report a case of a patient with TGA and a baffle leak that was both identified and percutaneously closed with the assistance of real-time 3D Catheter Cardiovasc Interv Nov;66(3): Interventions in leaks and obstructions of the interatrial baffle late after Mustard and Senning correction for transposition of the great arteries. Daehnert I, Hennig B, Wiener M, Rotzsch C. Klinik für Kinderkardiologie, Herzzentrum, Universität Leipzig, Leipzig, Germany A retrospective observational study identified 13 long-term survivors of atrial correction for TGA (median age, 20.5 years; range, ) with atrial inflow obstruction and/or interatrial defects-five stents were placed for obstruction of the superior caval vein, three for obstruction of the inferior caval vein, and one for obstruction of the pulmonary venous return. Five septal occluders were implanted

9 Eur J Echocardiogr May;10(3): Epub 2009 Jan 23. The missing leak: a case report of a baffle-leak closure using real-time 3D transoesophageal guidance. Klein AJ, Kim MS, Salcedo E, Fagan T, Kay J. We report a case of a patient with TGA and a baffle leak that was both identified and percutaneously closed with the assistance of real-time 3D Catheter Cardiovasc Interv Nov;66(3): Interventions in leaks and obstructions of the interatrial baffle late after Mustard and Senning correction for transposition of the great arteries. Daehnert I, Hennig B, Wiener M, Rotzsch C. Klinik für Kinderkardiologie, Herzzentrum, Universität Leipzig, Leipzig, Germany A retrospective observational study identified 13 long-term survivors of atrial correction for TGA (median age, 20.5 years; range, ) with atrial inflow obstruction and/or interatrial defects-five stents were placed for obstruction of the superior caval vein, three for obstruction of the inferior caval vein, and one for obstruction of the pulmonary venous return. Five septal occluders were implanted Rev Esp Cardiol Dec;50(12): Stent implantation in systemic venous baffle obstruction after Mustard-type operation repair in an adult. Benito F, Sánchez C, Oliver J. Hospital La Paz. Madrid. Successful stent implantation to relieve symptomatic superior vena cava obstruction and baffle dehiscence after Mustard repair in an adult patient

10 CORRECCIÓN FISIOLOGICA DISFUNCIONANTE Retrospective follow up study of 137 patients surviving hospitalisation for TGA atrial switch procedure (Mustard or Senning) in a single institution Late outcome of Senning and Mustard procedures for correction of transposition of the great arteries. Dos L, Teruel L, Ferreira IJ, Rodriguez-Larrea J, Miro L, Girona J, Albert DC, Gonçalves A, Murtra M, Casaldaliga J. Heart 2005 May;91(5): Hospital Infantil Vall d Hebron. Barcelona Nº de casos 8 Edad 22 to 37 (30) años Diagnóstico inicial 8 D-TGA Cirugía 4 Senning, 4 Mustard Cables MCP 2 Defectos 9 Leaks, 4 estenosis

11 Oclusión efectiva 7/9 ASO 6/7 (9 to 34 (17)) ADO 1/7 Oclusión inefectiva 2/9 Embolización 1/2 (recaptura+cirugía)) No liberación 1/2 (cirugía) Resolución de estenosis 3/4

12 Cierre percutáneo de dehiscencia Resultados: Leaks: 9 Oclusión eficaz 7 Oclusión ineficaz 2 ASO 6 ADO 1 Embolización (24h) 1 No liberación 1

13 Angioplastia en estenosis Resultados: Estenosis: 4 Solución: 3 Escasa mejoría: 1

14 TECNICA (cierre dehiscencias) Acceso venoso femoral (cateterismo completo) Localización del defecto : utilidad Paso de guía y catéter ++ Angiografía +/- ETE/ICE +++ Medición del defecto: RX + ETE (balloon stop flow) Dispositivos Amplatzer (ASO, ADO) No stents recubiertos por amplio tamaño canales

15 TECNICA (cierre dehiscencias) Dificultades Embolización dispositivo (24h after) 1 Inestabilidad del dispositivo 2 Relación dispositivos empleados/implantados 14/6 (2.3) Escasa o nula información angiográfica Anecdótico: Atrapamiento del tejido del dispositivo con la sonda del IVUS

16 SEGUIMIENTO: 0,6 to 9,8 años (3,77) Correcta posición y función del disp 7/7 Mejoría clínica 5/6 Desaparición de la cianosis 1/1 (6) No descenso de HTAP 1/1 (6) Cirugía en implantación fallida 2/2 (8) Arritmia post-implante 1/6 Arritmia post-cirugía 2/2

17 Dehiscencia canal superior

18 Estenosis relacionada con cables MCP

19 2 leaks ocluidos con sendos ASO

20 Atrapamiento tejido ASO Estabilización con balón

21 Medición del defecto Dispositivo cruzado Correcta posición final

23 Conclusiones: Las dehiscencias de las suturas tras la corrección fisiológica de la DTGA pueden ser tratadas percutáneamente Es necesario el uso de ETE / ICE Los dispositivos diseñados para la oclusión de otros defectos tienen gran utilidad en este procedimiento La angioplastia es efectiva en la resolución de las estenosis de los canales creados quirúrgicamente El uso de stents se halla condicionado por el diámetro de los canales quirúrgicos y por las estructuras vecinas

24 Gracias

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