Avaliação ecocardiográfica tardia de crianças e adolescentes submetidos à oclusão percutânea do canal arterial com o dispositivo mola de liberação controlada

Abstract

Percutaneous PDA closure was established itself as an effective and safe therapy especially in the last 20 years. The learning curve and the follow-up of these patients showed low percentage of postoperative complications. The immediate complications can be: device embolization, hemolysis, vascular complications (access road), recurrent laryngeal nerve injury, residual shunt. Vascular narrowing of the isthmus of the aorta (Ao) and left pulmonary artery (LPE) are potential complications related to the use of these devices. Thus, echocardiography is the method of choice for the evaluation of these patients after the percutaneous closure of the PDA. This imaging method provides hemodynamic data as the residual flow through the duct and using the Bernoulli equation, estimate the pressure gradient of the aortic isthmus (Ao) and the left pulmonary artery (LPE). The objective of the study was to evaluate hemodynamic and possible late complications data by transthoracic echocardiography in patients undergoing percutaneous PDA closure with controlled release coil, between January 2002 and July 2013, at the Biocor Hospital. A prospective observational study was conducted by echocardiographic evaluation of 43 patients. The hemodynamic data were observed: residual flow, flow velocity level at the left pulmonary artery and flow rate of the aortic isthmus. The age of the patients in the moment of the performance of echocardiography and the age at the moment of the intervention were evaluated and correlated with the flow rate at the isthmus Ao and at the LPE. As regards the flow rates at the level of LPE and isthmus were confronted the data obtained from the patients after surgery and the control group: 27 children referred for echocardiographic assessment of an innocent murmur. Only three of the 43 patients studied had residual flow through the ductus arteriosus, one moderate flow. The average flow rate for the LPE level was 1.00 m / s and the maximum velocity was 1.6 m / s. The median pressure gradient at this region was 4.00 mmHg. The median for the flow velocity at the isthmus Ao was 1.18 m / s and the pressure gradient of 5.57 mmHg. The patients age at the echocardiography assesment and at the time of percutaneous closure of the patent ducts arteriosus were not correlated with the flow velocities found in the aortic isthmus and left pulmonary artery.