Browsing by Autor "Heath, Alexandra"

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ANGIOPLASTÍA PERCUTÁNEA EN COARTACIÓN AORTICA
(Rev. Méd. La Paz, 2010) Heath, Alexandra; Villanueva, Jorge; Freudenthal, Franz; Mendes, Janne; Pozo, Edgar; Sánchez, Álvaro
Experiencia local en la técnica de angioplastía con catéter-balón, realizada en siete pacientes con edad que oscila entre 1 mes a 27 años, siendo 5 varones y 2 mujeres, con diagnostico de coartación aórtica nativa. Una vez realizada la sedación, se colocó un introductor en la arteria femoral y se procedió al avance de guías y catéteres hasta la aorta transversa, con el objetivo de obtener imágenes angiografícas y medir presiones invasivas en todos los segmentos. El gradiente de presión pre intervención fue de 41.5mmHg en promedio (rango:21-69mmHg) disminuyó post intervención a 10mmHg en promedio (rango:0-20mmHg). El diámetro de la coartación pre dilatación en promedio fue de 4.3mm (rango: 2.3 a 9.4mm) y aumentó post dilatación a 8.4 mm (rango: 5.5 a 13.5mm). El resultado final fue satisfactorio, pues disminuyó significativamente el gradiente de presión, el diámetro aórtico coartado aumentó y los pulsos en las cuatro extremidades se tornaron simétricos. Se alcanzó estabilidad clínica y el procedimiento se demostró como favorable en todos los pacientes. Los controles postintervención hasta un año después mostraron que el gradiente se mantiene en el tiempo, salvo en el caso de la niña de un mes, que desarrolló recoartación aórtica y fue operada en condiciones electivas, como es usual para este grupo de edad.
Angioplastía pulmonar percutánea en atresia pulmonar neonatal
(Rev. bol. ped., 2009) Heath, Alexandra; Freudenthal T, Franz; Villanueva, William; Rodríguez, Alfredo; Ríos, Roxana; Ramírez, Mariana
Se presenta el caso clínico de un recién nacido masculino con el diagnóstico de atresia pulmonar por fusión valvar y perfusión pulmonar ductus dependiente; a quien se le realizó una valvuloplastía pulmonar percutánea con guía fluoroscópica para reestablecer un flujo anterógrado efectivo desde el ventrículo derecho al árbol vascular pulmonar.
Chronic hypobaric hypoxia, patent arterial duct and a new interventional technique to close it.
(2012) Freudenthal, Franz P; Heath, Alexandra; Villanueva, Jorge; Mendes, Janne; Vicente, Ximena; von Alvensleben, Inge; Echazú, Gabriel; Navarro, Joaquin; Lang, Nora; Kozlik-Feldmann, Rainer
BACKGROUND: Interventional closure of patent arterial duct has become an accepted alternative to surgical closure. Clinical trial with "Nit-Occlud® PDA-R". METHODS AND RESULTS: To assess the safety and efficacy of the device, we performed a prospective clinical study between June, 2009 and December, 2010 in La Paz, Bolivia. In all, 29 - 22 female patients and 7 male patients - out of 59 patients were selected on the basis of inclusion criteria. The procedures were performed under sedation at an age and weight of 5.7 years and 22.7 kilograms, respectively, with 4-6 French arterial sheaths and 5-7 French venous sheaths. The minimal diameter of the duct was 3.5 millimetres. The procedure, fluoroscopy, and hospitalisation times were 96.4 minutes (55 to 145), 13.1 minutes (3 to 25.2), and 24 hours, respectively. The "Nit-Occlud® PDA-R" was successfully deployed in all patients. Immediate, 24-hour, 1-, 3-, and 6-month closure rates were 65.5%, 79.3%, 96.5%, and 100%, respectively. The systolic pulmonary pressure diminished from 37 millimetres of mercury (21 to 57) before the intervention to 31 millimetres of mercury (21 to 45) after the intervention. No early or late embolisation, haemolysis, left pulmonary artery, or descending aorta obstruction occurred. CONCLUSIONS: We conclude that the "Nit-Occlud® PDA-R" device is safe and effective in closing patent arterial duct up to a diameter of 8 millimetres.
Prolonged postnatal adaptation and enhanced prevalence of congenital heart diseases due to altitude may contribute to newborn mortality in Bolivia.
(2025) Heath, Alexandra; von Alvensleben, Inge; Spielvogel, Jesús Ardiles; Freudenthal, Pablo; Trapp, Johannes; Noya, Ivanna; Gálvez, Miguel; Mendizábal, Fanny; Gonzales, Mariana; Apaza, Ceylan; Sanga, Leibniz; Mc Cann, Erin; Julian, Colleen G
Highland populations suffer from significant infant mortality due to chronic ambient hypoxia, which increases the risk of congenital heart disease (CHD) and neonatal pulmonary hypertension. Neither the prevalence of these conditions nor the effectiveness of neonatal cardiac screening to identify CHD or pulmonary hypertension among neonates born at altitudes >4000 m in Bolivia has been reported. In a study of 1033 newborns in El Alto, Bolivia (4150 m), we determined the prevalence of CHD and prolonged postnatal adaptation. We also tested the accuracy of a neonatal cardiac screening tool in identifying infants with/without these conditions. Finally, diagnoses were contrasted between offspring born to parents of lowland versus highland origin. CHD was found in 54 neonates (5.2%), with the most common diagnoses being patent ductus arteriosus and atrial septal defect. Pulmonary hypertension without CHD was observed in 64 neonates (6.8%), with seven cases of persistent pulmonary hypertension of the newborn (PPHN). The neonatal cardiac screening tool showed a sensitivity of 45% and specificity of 99% for CHD, and 35% sensitivity and 92% specificity for prolonged pulmonary adaptation. Offspring of highland-origin women tended to have increased CHD risk, while those from lower altitudes were predisposed to prolonged postnatal adaptation and PPHN; paternal altitude of origin had no statistic significance but showed same tendency. The high prevalence of relevant CHD and prolonged pulmonary adaptation in neonates born >4000 m in Bolivia likely contributes to the high infant mortality rates observed. The poor sensitivity of the pilot neonatal cardiac screening instrument underscores the need to develop evidence-based tools optimized for use in low-resource, high-altitude settings.