Tratamento Simultâneo da Estenose Pulmonar Valvar e da Persistência do Canal Arterial Através do Cateterismo Intervencionista

The association of pulmonary valve stenosis and patent ductus arteriosus is uncommonly found in clinical practice of pediatric cardiology. The authors describe 2 patients with this association that were successfully treated in the same procedure by interventional cardiology: first case, a 14 month old boy was submitted to percutaneous pulmonary valvoplasty with reduction of systolic gradient between pulmonary artery and right ventricle from 71 to 3 mmHg. The 2.0 mm of diameter and conical shape duct was successfully occluded using a 385-5 coil; second case, a 20 month old girl was submitted to percutaneous pulmonary valvoplasty with reduction of systolic gradient between pulmonary artery and right ventricle from 60 to 5 mmHg. An attempt to close the 3.5 mm of diameter and conical shape duct using coil was performed, but the device embolized into the pulmonary artery. After immediate retrieval, a 12 mm Rashkind umbrella was implanted. Indication of treatment of both conditions, technical aspects and complications related to the procedures, and patients follow up are also discussed. A associacao entre estenose pulmonar valvar e persistencia do canal arterial nao e frequente na pratica clinica da cardiologia pediatrica. Sao descritos dois casos de portadores dessa associacao, tratados simultaneamente, em um mesmo procedimento, atraves do cateterismo intervencionista: 1o caso, crianca de 14 meses submetida a valvoplastia pulmonar percutânea com queda no gradiente sistolico entre a arteria pulmonar e o ventriculo direito de 71 para 3mmHg. O canal arterial, de 2,0mm de diâmetro e do tipo conico foi ocluido com um coil 38-5-5; 2o caso, crianca de 20 meses submetida a valvoplastia pulmonar percutânea com queda no gradiente sistolico entre a arteria pulmonar e o ventriculo direito de 60 para 5mmHg. Tentativa de oclusao do canal, de 3,5mm de diâmetro e do tipo conico, utilizando-se coil foi realizada sem sucesso devido a embolizacao para a arteria pulmonar. O dispositivo foi imediatamente resgatado e uma umbrella de 12mm foi implantada com sucesso. Discute-se a indicacao de tratamento das condicoes, aspectos tecnicos e complicacoes relativas ao procedimento e seguimento dos pacientes.