Case report
Utilisation of the snare technique for left ventricular lead placement in a patient with persistent left superior vena cava
Utilização da técnica de snare para implantação de életrodo ventricular em doente com veia cava superior esquerda persistente
Gustavo Lima da Silva
, João de Sousa, Pedro Marques
Autor para correspondência
Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal
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A) LCx maximum pixel intensity multiplanar reconstruction or MIP-MPR. B). Cardiac 3D volume rendering oriented like cranial RAO showing LCx and aneurysm. C) 3-month-follow-up coronary CT scan. LCx centreline curved multiplanar reconstruction. D) LCx 3D rendering. E) LCX straight line reconstruction derived from curved centreline. MPR (so called virtual IVUS). Axial images (red mark) revealing the stent.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Iván J. Núñez-Gil, Pedro Marcos Alberca, Nieves Gonzalo, Luis Nombela-Franco, Pablo Salinas, Antonio Fernández-Ortiz" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Iván J." "apellidos" => "Núñez-Gil" ] 1 => array:2 [ "nombre" => "Pedro Marcos" "apellidos" => "Alberca" ] 2 => array:2 [ "nombre" => "Nieves" "apellidos" => "Gonzalo" ] 3 => array:2 [ "nombre" => "Luis" "apellidos" => "Nombela-Franco" ] 4 => array:2 [ "nombre" => "Pablo" "apellidos" => "Salinas" ] 5 => array:2 [ "nombre" => "Antonio" "apellidos" => "Fernández-Ortiz" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117309666?idApp=UINPBA00004E" "url" => "/08702551/0000003700000002/v1_201803150415/S0870255117309666/v1_201803150415/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S0870255117302688" "issn" => "08702551" "doi" => "10.1016/j.repc.2017.11.007" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "1121" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "rev" "cita" => "Rev Port Cardiol. 2018;37:179-99" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5382 "formatos" => array:3 [ "EPUB" => 166 "HTML" => 4487 "PDF" => 729 ] ] "pt" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artigo de Revisão</span>" "titulo" => "Canalopatias cardíacas: o papel das mutações nos canais de sódio" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => array:2 [ 0 => "pt" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "179" "paginaFinal" => "199" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Cardiac channelopathies: The role of sodium channel mutations" ] ] "contieneResumen" => array:2 [ "pt" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3493 "Ancho" => 3167 "Tamanyo" => 880043 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Complexo proteico macromolecular, subunidades α e ciclo de vida dos canais de sódio Nav1.5. <span class="elsevierStyleBold">(A)</span> O canal Nav1.5 integra um complexo macromolecular e interatua com diversas proteínas, entre as quais: subunidades β, caveolina‐3, MOG1, anquirina, sintrofina e citoesqueleto. Retirado e adaptado de Liu et al. (2014)<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">7</span></a> e de Amin et al. (2010).<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">22</span></a><span class="elsevierStyleBold">(B)</span> O ciclo de vida do Nav1.5 inicia‐se no núcleo, onde ocorre a transcrição do gene SCN5A e respetiva regulação por fatores de transcrição (FOXO1, NF‐KB e TBX5). Contudo, os microRNAs também regulam os níveis de mRNA. No retículo endoplasmático ocorre a tradução proteica e, após ocorrer <span class="elsevierStyleItalic">folding</span> apropriado e <span class="elsevierStyleItalic">assembly</span> de proteínas, essas são transportadas para a membrana celular (<span class="elsevierStyleItalic">trafficking</span>). Mutações ou variantes de <span class="elsevierStyleItalic">splicing</span> podem levar à formação de uma proteína Nav1.5 <span class="elsevierStyleItalic">misfolded</span> e pode ser ativada a via PERK com vista ao <span class="elsevierStyleItalic">down regulation</span> dos seus níveis de mRNA. A PKA, PKC, o stresse oxidativo (ERO) e os estados metabólicos (NADH e NAD<span class="elsevierStyleSup">+</span>) podem modular o <span class="elsevierStyleItalic">trafficking</span> do canal. O NEDD4 regula a degradação mediada pela ubiquitina. Retirado e adaptado de Liu et al. (2014)<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">7</span></a>.</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">CAV3: caveolina‐3; ERO: espécies reativas de oxigénio; FOXO1: <span class="elsevierStyleItalic">forkhead box protein O1</span>; MOG1: <span class="elsevierStyleItalic">Ran guanine nucleotide release factor</span>; NaChIP: <span class="elsevierStyleItalic">Na</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">‐channel‐interacting protein</span>; NEDD4: <span class="elsevierStyleItalic">E3 ubiquitin‐protein ligase NEDD4</span>; NF‐κB: factor nuclear NF‐κB; PERK: factor de iniciação da tradução eucariótica 2α‐cinase 3; PKA: proteína cínase dependente de AMPc (proteína cínase A); PKC: proteína cínase C; TBX5: fator de transcrição T‐box TBX5.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Diana João Fonseca, Manuel Joaquim Vaz da Silva" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Diana João" "apellidos" => "Fonseca" ] 1 => array:2 [ "nombre" => "Manuel Joaquim" "apellidos" => "Vaz da Silva" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204918300114" "doi" => "10.1016/j.repce.2017.11.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918300114?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117302688?idApp=UINPBA00004E" "url" => "/08702551/0000003700000002/v1_201803150415/S0870255117302688/v1_201803150415/pt/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Utilisation of the snare technique for left ventricular lead placement in a patient with persistent left superior vena cava" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "201.e1" "paginaFinal" => "201.e3" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Gustavo Lima da Silva, João de Sousa, Pedro Marques" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Gustavo" "apellidos" => "Lima da Silva" "email" => array:1 [ 0 => "gustavolssilva@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "João" "apellidos" => "de Sousa" ] 2 => array:2 [ "nombre" => "Pedro" "apellidos" => "Marques" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Utilização da técnica de <span class="elsevierStyleItalic">snare</span> para implantação de életrodo ventricular em doente com veia cava superior esquerda persistente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 999 "Ancho" => 2000 "Tamanyo" => 108620 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Left ventricle lead final position: (A) Right anterior oblique view; (B) Left anterior oblique view.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Persistence of the left superior vena cava (PLSVC) occurs in about 0.3-0.7% of the general population. It is an anatomic variant of particular importance in patients who need cardiac resynchronisation therapy.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 77-year-old male with ischaemic heart disease, on ambulatory NYHA IV, depressed left ventricular (LV) function (ejection fraction of 20%) and left bundle branch block (QRS width of 170 msecs), on optimised medical therapy. PLSVC was identified during an attempted left-sided CRT-D implantation at another institution. Cardiac magnetic resonance confirmed the diagnosis of PLSVC with anastomosis to the coronary sinus (CS) ostium. Right-sided CRT-D implantation was then performed with successful placement of the right atrium and right ventricular apical defibrillator leads, although with LV lead implantation failure. The patient was therefore referred to our department for LV lead placement.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The left subclavian vein (LSV) was punctured for percutaneous sheath insertion. The sheath was advanced through the PLSVC to the CS and venography was performed (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A and B), followed by selective cannulation of the posterior cardiac vein (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>, black arrow). A guide wire (Acuity Whisper<span class="elsevierStyleSup">®</span>, Boston Scientific, Inc.) was introduced and advanced through the anterior collateral veins and the anastomotic vein directly back to the PLSVC (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>, white arrow). A snare system (En Snare 30<span class="elsevierStyleSup">®</span>, Merit Medical Systems, Inc.) was introduced through a second sheath via the LSV up to the PLSVC (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>, black arrow), and the distal end of the guidewire was gradually pulled towards the skin surface. Both ends of the guidewire were under the operator's control. The LV lead was advanced in an antidromic fashion through the guidewire to the anterolateral position (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>A and B). The LV lead pacing threshold was 0.8 V at 0.5 msec. The LV lead was subsequently tunnelled (Lead-extension Accessory kit, Medtronic) subcutaneously to reach the right pocket and was connected to the previously implanted generator. No complications occurred.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion and conclusion</span><p id="par0020" class="elsevierStylePara elsevierViewall">There are previous case reports of CS and LV tributaries cannulation via the right subclavian vein in patients with PLSVC. However, this patient had been subjected to a prior unsuccessful right-sided LV lead implantation procedure. The most common causes of failure are tumultuous flow in the CS ostium and impossibility to use balloon occlusion catheters in a giant CS.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">LV lead implantation through a left-sided approach in PLSVC is feasible but technically challenging. The use of a snare system to assist the placement of the LV lead was chosen due to the presence of small vessels (collaterals) in the posterolateral area with adequately sized vessels in the lateral area. The snare technique has been described in patients where delivery of the LV lead to the target vessel cannot be obtained with the standard approach. It is a safe technique and it reduces percutaneous implant failure and the subsequent need for a surgical approach.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">2,3</span></a> However, its use in patients with anatomical variants such as PLSVC had not been previously described.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The snare system is a useful new tool for LV lead implantation in patients with PLSVC and an adequate venous collateral anatomy.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1000310" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec963299" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1000309" "titulo" => "Resumo" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec963300" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion and conclusion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-07-19" "fechaAceptado" => "2017-01-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec963299" "palabras" => array:3 [ 0 => "Persistence of the left superior vena cava" 1 => "Cardiac resynchronisation therapy" 2 => "Snare technique" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec963300" "palabras" => array:3 [ 0 => "Veia cava superior esquerda persistente" 1 => "Ressincronização cardíaca" 2 => "Técnica <span class="elsevierStyleItalic">snare</span>" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Persistence of the left superior vena cava occurs in about 0.3-0.7% of the general population. It is of particular importance in patients who need cardiac resynchronisation therapy. We present a unique case in which a snare system and tunnelling tool were used to place the left ventricular lead in a patient with persistence of the left superior vena cava.</p></span>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A veia cava superior esquerda persistente ocorre em 0,3-0,7% da população geral e é de particular importância em doentes que necessitam de terapêutica de ressincronização cardíaca. Apresentamos um caso único onde foram usados um sistema de <span class="elsevierStyleItalic">snare</span> e tunelizador para a implantação do elétrodo esquerdo num doente com veia cava superior esquerda persistente.</p></span>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1005 "Ancho" => 2000 "Tamanyo" => 100056 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A, B) Venography in posterior-anterior view.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1249 "Ancho" => 1200 "Tamanyo" => 102037 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Snare technique: Selective cannulation of the posterior cardiac vein (black arrow). Guidewire advanced through the anterior collateral veins and anastomotic vein directly back to the PLSVC (white arrow). Snare system introduced through a second sheath via the LSV up to the PLSVC (black arrow). LSV: left subclavian vein; PLSVC: persistence of the left superior vena cava.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 999 "Ancho" => 2000 "Tamanyo" => 108620 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Left ventricle lead final position: (A) Right anterior oblique view; (B) Left anterior oblique view.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hybrid right-left cardiac resynchronization therapy defibrillator implantation in persistent left superior vena cava" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Anselmino" 1 => "M.C. Marocco" 2 => "C. Amellone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/europace/eun371" "Revista" => array:6 [ "tituloSerie" => "Europace" "fecha" => "2009" "volumen" => "11" "paginaInicial" => "533" "paginaFinal" => "534" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19112072" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful implantation of a left ventricular lead for cardiac resynchronization therapy in extremely unfavourable coronary venous anatomy: “over the wire” technique" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "W. Kranig" 1 => "R. Grove" 2 => "G. Lüdorff" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Herzschrittmacherther Elektrophysiol" "fecha" => "2004" "volumen" => "32" "paginaInicial" => "211" "paginaFinal" => "217" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Goose neck snare for LV lead placement in difficult venous anatomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.J. Worley" 1 => "D.C. Gohn" 2 => "R.W. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 11 | 4 | 15 |
| 2024 Outubro | 45 | 28 | 73 |
| 2024 Setembro | 54 | 23 | 77 |
| 2024 Agosto | 47 | 27 | 74 |
| 2024 Julho | 41 | 25 | 66 |
| 2024 Junho | 56 | 44 | 100 |
| 2024 Maio | 57 | 62 | 119 |
| 2024 Abril | 40 | 31 | 71 |
| 2024 Maro | 44 | 22 | 66 |
| 2024 Fevereiro | 27 | 15 | 42 |
| 2024 Janeiro | 29 | 22 | 51 |
| 2023 Dezembro | 25 | 24 | 49 |
| 2023 Novembro | 32 | 20 | 52 |
| 2023 Outubro | 32 | 20 | 52 |
| 2023 Setembro | 22 | 14 | 36 |
| 2023 Agosto | 31 | 25 | 56 |
| 2023 Julho | 24 | 7 | 31 |
| 2023 Junho | 32 | 7 | 39 |
| 2023 Maio | 54 | 30 | 84 |
| 2023 Abril | 29 | 2 | 31 |
| 2023 Maro | 25 | 18 | 43 |
| 2023 Fevereiro | 37 | 18 | 55 |
| 2023 Janeiro | 24 | 14 | 38 |
| 2022 Dezembro | 40 | 21 | 61 |
| 2022 Novembro | 40 | 31 | 71 |
| 2022 Outubro | 32 | 21 | 53 |
| 2022 Setembro | 40 | 33 | 73 |
| 2022 Agosto | 38 | 34 | 72 |
| 2022 Julho | 42 | 35 | 77 |
| 2022 Junho | 35 | 27 | 62 |
| 2022 Maio | 39 | 34 | 73 |
| 2022 Abril | 47 | 30 | 77 |
| 2022 Maro | 39 | 46 | 85 |
| 2022 Fevereiro | 29 | 41 | 70 |
| 2022 Janeiro | 45 | 27 | 72 |
| 2021 Dezembro | 26 | 33 | 59 |
| 2021 Novembro | 56 | 38 | 94 |
| 2021 Outubro | 40 | 45 | 85 |
| 2021 Setembro | 26 | 34 | 60 |
| 2021 Agosto | 47 | 35 | 82 |
| 2021 Julho | 37 | 31 | 68 |
| 2021 Junho | 35 | 27 | 62 |
| 2021 Maio | 47 | 39 | 86 |
| 2021 Abril | 53 | 48 | 101 |
| 2021 Maro | 85 | 12 | 97 |
| 2021 Fevereiro | 104 | 24 | 128 |
| 2021 Janeiro | 40 | 18 | 58 |
| 2020 Dezembro | 33 | 14 | 47 |
| 2020 Novembro | 36 | 24 | 60 |
| 2020 Outubro | 19 | 16 | 35 |
| 2020 Setembro | 88 | 21 | 109 |
| 2020 Agosto | 18 | 9 | 27 |
| 2020 Julho | 49 | 10 | 59 |
| 2020 Junho | 52 | 15 | 67 |
| 2020 Maio | 32 | 5 | 37 |
| 2020 Abril | 37 | 30 | 67 |
| 2020 Maro | 47 | 9 | 56 |
| 2020 Fevereiro | 82 | 52 | 134 |
| 2020 Janeiro | 35 | 10 | 45 |
| 2019 Dezembro | 29 | 10 | 39 |
| 2019 Novembro | 39 | 10 | 49 |
| 2019 Outubro | 69 | 17 | 86 |
| 2019 Setembro | 15 | 5 | 20 |
| 2019 Agosto | 22 | 7 | 29 |
| 2019 Julho | 50 | 11 | 61 |
| 2019 Junho | 32 | 18 | 50 |
| 2019 Maio | 48 | 15 | 63 |
| 2019 Abril | 24 | 14 | 38 |
| 2019 Maro | 39 | 8 | 47 |
| 2019 Fevereiro | 52 | 8 | 60 |
| 2019 Janeiro | 16 | 5 | 21 |
| 2018 Dezembro | 33 | 13 | 46 |
| 2018 Novembro | 69 | 10 | 79 |
| 2018 Outubro | 61 | 25 | 86 |
| 2018 Setembro | 39 | 11 | 50 |
| 2018 Agosto | 25 | 10 | 35 |
| 2018 Julho | 29 | 0 | 29 |
| 2018 Junho | 48 | 13 | 61 |
| 2018 Maio | 25 | 16 | 41 |
| 2018 Abril | 86 | 37 | 123 |
| 2018 Maro | 94 | 39 | 133 |
| 2018 Fevereiro | 0 | 40 | 40 |
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