Papers by Francisco Garay
Eurointervention, 2006
Background: Pulmonary regurgitation may result in progressive right ventricle dilation and failur... more Background: Pulmonary regurgitation may result in progressive right ventricle dilation and failure, arrhythmias and death. The implantation of a pulmonic valve at an appropriate age may restore the right ventricular function and may result in improved symptoms. Aim: To evaluate the percutaneous Cribier-Edwards Aortic valve when deployed in the pulmonic position. Methods and results: Acute animal testing was performed on a total of 3 pigs and 3 sheep (35-40 kg). They were catheterised through the jugular and femoral vein. The native pulmonic valve was measure by ICE and angiography. The valve was implanted using standard stent deployment techniques through a 22F sheath positioned in either the femoral or jugular vein. In three sheep the valve was small for the native valve; therefore it was implanted in the branch pulmonary artery. In the three pigs, implantation over the native valve was successful and the valve had mild angiographic regurgitation with a catheter through it. The chr...
Eurointervention, 2006
Background: Pulmonary regurgitation may result in progressive right ventricle dilation and failur... more Background: Pulmonary regurgitation may result in progressive right ventricle dilation and failure, arrhythmias and death. The implantation of a pulmonic valve at an appropriate age may restore the right ventricular function and may result in improved symptoms. Aim: To evaluate the percutaneous Cribier-Edwards Aortic valve when deployed in the pulmonic position. Methods and results: Acute animal testing was performed on a total of 3 pigs and 3 sheep (35-40 kg). They were catheterised through the jugular and femoral vein. The native pulmonic valve was measure by ICE and angiography. The valve was implanted using standard stent deployment techniques through a 22F sheath positioned in either the femoral or jugular vein. In three sheep the valve was small for the native valve; therefore it was implanted in the branch pulmonary artery. In the three pigs, implantation over the native valve was successful and the valve had mild angiographic regurgitation with a catheter through it. The chronic animal model consisted of two protocols. Protocol one: Valve implantation into native pulmonary valve in 8 sheep (35-40 kg). In five, the valve was implanted through the jugular vein over a wire into the native valve without incidents and completed 20 weeks survival. In two sheep, the valve migrated acutely due to distensibility of the native pulmonary artery. One sheep had a schedule survival of 10 weeks with a paravalvular leak. Protocol two: Valve implantation into a pulmonary conduit in 4 sheep (40-50 kg). For this, a conduit was surgically implanted (Edwards Prima Plus) between the right ventricle and pulmonary artery and the native pulmonary valve of the animals was destroyed, then a few weeks later, the percutaneous valve was implanted via the jugular vein. Three animals survived the implantation to 20 weeks. One death occurred during implantation not related to the valve. Angiography showed trivial to mild regurgitation. Conclusions: The percutaneous implanted Edwards pulmonic valve functions well under pulmonary pressure and can be delivered from femoral or jugular vein. Acute and early chronic (20 weeks) animal studies are encouraging. Non-diseased native valve, especially in sheep is problematic for the chronic animal model. Pre-surgical implantation of a conduit into the pulmonary artery provides an ideal deployment zone for a percutaneous valve.
![Research paper thumbnail of [Hypoplastic left heart syndrome: 10 year experience with staged surgical management]](https://attachments.academia-assets.com/84708695/thumbnails/1.jpg)
Revista chilena de pediatria, Jan 8, 2015
Hypoplastic left heart syndrome (HLHS) is a lethal congenital heart disease in 95% of non-treated... more Hypoplastic left heart syndrome (HLHS) is a lethal congenital heart disease in 95% of non-treated patients. Surgical staging is the main form of treatment, consisting of a 3-stage approach, beginning with the Norwood operation. Long term survival of treated patients is unknown in our country. 1) To review our experience in the management of all patients seen with HLHS between January 2000 and June 2012. 2) Identify risk factors for mortality. Retrospective analysis of a single institution experience with a cohort of patients with HLHS. Clinical, surgical, and follow-up records were reviewed. Of the 76 patients with HLHS, 9 had a restrictive atrial septal defect (ASD), and 8 had an ascending aorta ≤2mm. Of the 65 out of 76 patients that were treated, 77% had a Norwood operation with pulmonary blood flow supplied by a right ventricle to pulmonary artery conduit, 17% had a Norwood with a Blalock-Taussig shunt, and 6% other surgical procedure. Surgical mortality at the first stage was 2...
Journal of interventional cardiology, Jan 2, 2015
Transcatheter patent ductus arteriosus (PDA) closure is difficult in small patients in part due t... more Transcatheter patent ductus arteriosus (PDA) closure is difficult in small patients in part due to the diverse PDA morphology. We describe a multicenter pediatric experience using the Amplatzer Vascular Plug II device (AVP II) to occlude PDA. All patients undergoing transcatheter closure of PDA with AVP II from April 2008 until May 2012 were included. Clinical, angiographic, and echocardiographic data were collected. One hundred and seventy-seven procedures were performed. Median age was 14 months (2-180) with median weight 9.7 kg (4.7-68). The morphological PDA classification was Type A in 66 (37.1%), Type C in 27 (15.3%), Type D in 17 (9.6%), and Type E in 67 (37.9%). The median minimum PDA diameter was 2.6 mm (1.2-7.7 mm). The implanted device sizes were: 4 mm in 17 patients (9.6%), 6 mm in 81 (45.8%), 8 mm in 56 (31.6%), 10 mm in 18 (10.2%), and 12 mm in 5 (2.8%). The implanted device was mean of 2.6 + 0.7 times the ductus narrowest diameter and mean of 1 + 0.5 times the ductus ...
Revista chilena de cardiología, 2013
Se revisaron los registros clínicos de los pacientes mayores de 4 años intervenidos por una CoAo ... more Se revisaron los registros clínicos de los pacientes mayores de 4 años intervenidos por una CoAo nativa o recoartación en el Hospital Clínico de la Universidad Católica entre los años 2007 y 2012. Se realizaron estadísticas descriptivas y se utilizó el test de Wilcoxon signed rank, con una p <0,05. En ese período se realizaron 27 intervenciones en pacientes con CoAo. El promedio de edad fue 20.6 años (5 -64); 8 (30%) eran mujeres y 8 (30%) menores de 14 años. Quince pacientes (55%) tenían una cardiopatía congénita asociada, de los cuales 9 (33%) tenían válvula aórtica bicúspide, 3 (11%) una comunicación interventricular (CIV) y 3 co-existencia de ambas entidades (11%). Nueve (33%) pacientes eran hipertensos. En 20 (74%) pacientes la intervención fue sobre una coartación aórtica nativa y en 7 (26%) sobre una recoartación (2 con cirugía previa y 5 con angioplastia anterior). Se implantó un stent en 23 (85%) pacientes y se utilizó sólo balón en 4 (15%). En 26 pacientes (96%) se logró una reducción del gradiente a menos de 20 mmHg (gradiente pre 32 vs gradiente post 6 mmHg, p<0,01). Hubo complicaciones del sitio de punción en 3 pacientes (2 hematomas y 1 disección focal en el origen de la arteria ilíaca externa) y complicaciones mayores en 2 pacientes (disección aórtica tipo B) que requirieron tratamiento intervencional (uno percutáneo y uno quirúrgico). No hubo mortalidad en nuestra serie. Conclusiones: La intervención endovascular es una opción de tratamiento efectiva para la CoAo.
Netherlands Heart Journal, 2016
Introduction The Venus p-valve (MedTech, Shanghai, China) is a self-expanding percutaneous heart ... more Introduction The Venus p-valve (MedTech, Shanghai, China) is a self-expanding percutaneous heart valve designed to be implanted in a native patched right ventricle outflow tract. The worldwide clinical experience with this valve is just beginning and the results have so far been encouraging. We present our initial early experience implanting the Venus p-valve in the native right ventricle outflow tract of patients with Tetralogy of Fallot repaired with a transannular patch. Methods In 10 selected patients a procedure for percutaneous pulmonary valve implantation was performed using the Venus p-valve. The patients mean age was 32 years (13-57), mean weight 59.6 kg (40-80). All patients had Tetralogy of Fallot with moderate to severe pulmonary regurgitation and an indication for pulmonary valve replacement. The implantation procedure was successful in all the patients resulting in an immediately functional valve. No procedure-related complications were observed. Follow-up after 12 months (4-21) resulted in an improvement in NYHA class. There was a reduction of the mean right ventricle diastolic volume from 139 ml/m 2 (105-179) to 78 ml/m 2 (65-100) and improvement in the regurgitation fraction from 42% (29-58) to 1% (0-5), as seen on routine F. Garay
Introduction: Transcatheter patent ductus arteriosus (PDA) closure is difficult in small patients... more Introduction: Transcatheter patent ductus arteriosus (PDA) closure is difficult in small patients in part due to the diverse PDA morphology. We describe a multicenter pediatric experience using the Amplatzer Vascular Plug II device (AVP II) to occlude PDA. Methods: All patients undergoing transcatheter closure of PDA with AVP II from April 2008 until May 2012 were included. Clinical, angiographic, and echocardiographic data were collected.
Revista Medica De Chile, 2004
Background: DiGeorge syndrome is characterized by developmental defects of the heart, parathyroid... more Background: DiGeorge syndrome is characterized by developmental defects of the heart, parathyroid glands and thymus. Aim: To describe the clinical variability of DiGeorge syndrome and its relation with immunodeficiency. Patients and methods: A three years retrospective chart review from three hospitals of Santiago, Chile was conducted. We included patients with neonatal diagnosis of DiGeorge syndrome. Clinical and immunologic data were collected from their initial evaluation. Results: We found 9 patients with DiGeorge syndrome. All had dysmorphic facies, hypocalcemia and congenital heart disease. Three patients had hypoparathyroidism, 4 had interrupted aortic arch type B, 4 had tetralogy of Fallot and 1 had coarctation of aorta. Six patients had other malformations and associated diseases. FISH studies, performed in 8 patients, found the 22q11.2 microdeletion in all. Most patients had low CD3, CD4 and CD8 T cell counts, that ranged for CD3 T cells, between 256/mm3 and 3,664/mm3, for...
Heart Views, 2006
Ventricular septal defect (VSD) accounts for approximately 20% of all forms of congenital heart d... more Ventricular septal defect (VSD) accounts for approximately 20% of all forms of congenital heart disease. The conventional treatment has been the surgical closure of these defects. Percutaneous closure of VSD had been attempted in the past but it was not until the development of Amplatzer Muscular VSD occluder device that the higher closure rates and safety of the procedure made it an attractive alternative to the surgical closure. Amplatzer VSD devices have also been designed to close perimembranous and post infarction muscular VSDs and the results have been encouraging. In addition to the percutaneous conventional approach, an intraoperative (perventricular) technique has been developed to allow safe VSD closure with Amplatzer devices in small infants with poor vascular access avoiding the need of cardiopulmonary bypass or in infants with concomitant cardiac defects requiring surgical repair. In this review the transcatheter VSD closure with Amplatzer VSD occluders will be discusse...
Revista medica de Chile, 2004
BACKGROUND Norwood procedure is used as the first stage in the palliative treatment of the hypopl... more BACKGROUND Norwood procedure is used as the first stage in the palliative treatment of the hypoplastic heart syndrome and can be used, with some technical modifications, in other forms of univentricular heart with aortic stenosis or hypoplasia. These patients have a high mortality (50%), derived from the procedure itself and from their abnormal physiological status. AIM To report our experience with the Norwood procedure. PATIENTS AND METHODS Retrospective analysis of all patients subjected to the Norwood procedure between February, 2000 and June 2003. RESULTS Thirteen patients (9 females, age range 5-60 days and median weight of 3.3 kg) were operated. Eight had hypoplastic heart syndrome and five had a single ventricle with aortic arch hypoplasia. The diagnosis was done in utero in eight patients. All technical variations, according to the disposition and anatomy of the great vessels, are described. Cardiac arrest with profound hypothermia was used in all and regional cerebral perf...
World Journal for Pediatric and Congenital Heart Surgery
Transcatheter pulmonary valve replacement has become an attractive alternative to surgical approa... more Transcatheter pulmonary valve replacement has become an attractive alternative to surgical approach in patients with dysfunctional right ventricular outflow tract. However, in certain cases, an unfavorable anatomy might complicate optimal valve deployment and stability. Several techniques have been described to reshape the landing zone and allow proper implantation of the transcatheter valve. Among them, the hybrid approach has gained attention as an interesting method for off-pump pulmonary valve replacement in patients with dilated right ventricular outflow tract. But to date, there is no standardized method to resize and reshape the landing zone for the stented valve. Here, we describe a reproducible method based on simple geometric rules to allow adequate remodeling of the main pulmonary artery to the desired dimensions in a single attempt, followed by perventricular implantation of a Venus P-valve.
Arquivos Brasileiros de Cardiologia
Pediatric Cardiology
Tetralogy of Fallot (ToF) treatment is difficult in patients with surgical risk factors or unfavo... more Tetralogy of Fallot (ToF) treatment is difficult in patients with surgical risk factors or unfavorable anatomy. Stent implantation in the right ventricular outflow tract (RVOT) is an option for these patients. We report our initial experience in Chile with RVOT stenting in patients with ToF. Retrospective and descriptive study conducted in three pediatric cardiovascular centers in Chile between 2012 and 2015, including all ToF patients with stent in the RVOT as first procedure. Clinical records, echocardiographic, interventional, and surgical reports were reviewed for demographics and information of RVOT and pulmonary arteries. 12 newborns with ToF were included (75% female). Median age was 20 days (1-70) and mean weight was 2178 g (1400-3414). Saturations increased after the procedure from 74.3% (55-88) to 88.5% (80-98%), (p < 0.01). No complications or mortality were related to interventions. Follow-up was 11 months (7-36). Median right and left pulmonary arteries Z-score increased from − 4.0 (− 5.2 to − 0.3) and − 1.5 (− 4.8 to − 0.26) to + 0.53 (0.0 to 2.2) and + 1.1 (0.5 to 2.9), (p < 0.05), respectively. Nakata index increased from 63 mm 2 /mm 2 (35 to 143) to 162 mm 2 /mm 2 (107 to 197), (p < 0.05). Surgical repair was performed at a median of 4 months (2-7). Transannular patch repair was necessary in all patients and there was no surgical mortality. RVOT stenting is a safe and useful option for patients with ToF and surgical risk factors or unfavorable anatomy. It increases the pulmonary blood flow, improving saturation and pulmonary artery growth as a bridge for surgical repair.
Journal of Pediatric Genetics
We report the case of a 3-year-old girl, who is the third child of nonconsanguineous parents, wit... more We report the case of a 3-year-old girl, who is the third child of nonconsanguineous parents, with short stature, hypertrophic cardiomyopathy, and mild dysmorphic features; all suggestive of Noonan syndrome. In addition, the patient presents with feeding difficulties, deep palmar and plantar creases, sparse hair, and delayed psychomotor and language development, all characteristics frequently observed in cardiofaciocutaneous syndrome. Molecular analysis of the Ras/ MAPK pathway genes using high-resolution melting curve analysis and gene sequencing revealed a de novo KRAS amino acid substitution of leucine to tryptophan at codon 53 (p.L53W). This substitution was recently described in an Iranian patient with Noonan syndrome. The findings described in this report expand the phenotypic heterogeneity observed in RASopathy patients harboring a KRAS substitution, and advocate for the inclusion of genes with low mutational frequency in genetic screening protocols for Noonan syndrome and ot...
Cardiology Procedures, 2016
Revista Chilena De Pediatria, Nov 1, 1999
Revista medica de Chile
DiGeorge syndrome is characterized by developmental defects of the heart, parathyroid glands and ... more DiGeorge syndrome is characterized by developmental defects of the heart, parathyroid glands and thymus. To describe the clinical variability of DiGeorge syndrome and its relation with immunodeficiency. A three years retrospective chart review from three hospitals of Santiago, Chile was conducted. We included patients with neonatal diagnosis of DiGeorge syndrome. Clinical and immunologic data were collected from their initial evaluation. We found 9 patients with DiGeorge syndrome. All had dysmorphic facies, hypocalcemia and congenital heart disease. Three patients had hypoparathyroidism, 4 had interrupted aortic arch type B, 4 had tetralogy of Fallot and 1 had coarctation of aorta. Six patients had other malformations and associated diseases. FISH studies, performed in 8 patients, found the 22q11.2 microdeletion in all. Most patients had low CD3, CD4 and CD8 T cell counts, that ranged for CD3 T cells, between 256/mm3 and 3,664/mm3, for CD4 T cells, between 224/mm3 and 2,649/mm3, for...
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Papers by Francisco Garay