51
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Kang SL, Jivanji S, Mehta C, Tometzki AJ, Derrick G, Yates R, Khambadkone S, de Giovanni J, Stumper O, Dhillon R, Bhole V, Slavik Z, Rigby M, Noonan P, Smith B, Knight B, Richens T, Wilson N, Walsh K, James A, Thomson J, Bentham J, Hayes N, Nazir S, Adwani S, Shauq A, Ramaraj R, Duke C, Taliotis D, Kudumula V, Yong SF, Morgan G, Rosenthal E, Krasemann T, Qureshi S, Crossland D, Hermuzi T, Martin RP. Outcome after transcatheter occlusion of patent ductus arteriosus in infants less than 6 kg: A national study from United Kingdom and Ireland. Catheter Cardiovasc Interv 2017; 90:1135-1144. [PMID: 28799706 DOI: 10.1002/ccd.27212] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/13/2017] [Accepted: 06/25/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study aimed to report our national experience with transcatheter patent ductus arteriosus (PDA) occlusion in infants weighing <6 kg. BACKGROUND The technique of transcatheter PDA closure has evolved in the past two decades and is increasingly used in smaller patients but data on safety and efficacy are limited. METHODS Patients weighing < 6 kg in whom transcatheter PDA occlusion was attempted in 13 tertiary paediatric cardiology units in the United Kingdom and Ireland were retrospectively analyzed to review the outcome and complications. RESULTS A total of 408 patients underwent attempted transcatheter PDA closure between January 2004 and December 2014. The mean weight at catheterization was 4.9 ± 1.0 kg and mean age was 5.7 ± 3.0 months. Successful device implantation was achieved in 374 (92%) patients without major complication and of these, complete occlusion was achieved in 356 (95%) patients at last available follow-up. Device embolization occurred in 20 cases (5%). The incidence of device related obstruction to the left pulmonary artery or aorta and access related peripheral vascular injury were low. There were no deaths related to the procedure. CONCLUSIONS Transcatheter closure of PDA can be accomplished in selected infants weighing <6 kg despite the manufacturer's recommended weight limit of 6 kg for most ductal occluders. The embolization rate is higher than previously reported in larger patients. Retrievability of the occluder and duct morphology needs careful consideration before deciding whether surgical ligation or transcatheter therapy is the better treatment option.
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Affiliation(s)
- Sok-Leng Kang
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, England, United Kingdom
| | - Salim Jivanji
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, England, United Kingdom
| | - Chetan Mehta
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Andrew J Tometzki
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, England, United Kingdom
| | - Graham Derrick
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, England, United Kingdom
| | - Robert Yates
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, England, United Kingdom
| | - Sachin Khambadkone
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, England, United Kingdom
| | - Joseph de Giovanni
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Oliver Stumper
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Rami Dhillon
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Vinay Bhole
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, England, United Kingdom
| | - Zdenek Slavik
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, England, United Kingdom
| | - Michael Rigby
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, England, United Kingdom
| | - Patrick Noonan
- Department of Paediatric Cardiology, Royal Hospital for Children Glasgow, Glasgow, Scotland, United Kingdom
| | - Ben Smith
- Department of Paediatric Cardiology, Royal Hospital for Children Glasgow, Glasgow, Scotland, United Kingdom
| | - Brodie Knight
- Department of Paediatric Cardiology, Royal Hospital for Children Glasgow, Glasgow, Scotland, United Kingdom
| | - Trevor Richens
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, England, United Kingdom
| | - Neil Wilson
- Department of Paediatric Cardiology, Children's Hospital Colorado, Denver, Colorado
| | - Kevin Walsh
- Department of Paediatric Cardiology, Our Lady's Children Hospital, Dublin, Ireland
| | - Adam James
- Department of Paediatric Cardiology, Our Lady's Children Hospital, Dublin, Ireland
| | - John Thomson
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, Yorkshire, United Kingdom
| | - Jamie Bentham
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, Yorkshire, United Kingdom
| | - Nicholas Hayes
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, England, United Kingdom
| | - Sajid Nazir
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, England, United Kingdom
| | - Satish Adwani
- Department of Paediatric Cardiology, Oxford University Hospitals, Oxford, England, United Kingdom
| | - Arjamand Shauq
- Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, England, United Kingdom
| | - Ram Ramaraj
- Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, England, United Kingdom
| | - Christopher Duke
- Department of Paediatric Cardiology, University Hospitals of Leicester, Leicester, England, United Kingdom
| | - Demetris Taliotis
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, England, United Kingdom
| | - Vikram Kudumula
- Department of Paediatric Cardiology, University Hospitals of Leicester, Leicester, England, United Kingdom
| | - San-Fui Yong
- Department of Paediatric Cardiology, University Hospitals of Leicester, Leicester, England, United Kingdom
| | - Gareth Morgan
- Department of Paediatric Cardiology, Children's Hospital Colorado, Denver, Colorado
| | - Eric Rosenthal
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, England, United Kingdom
| | - Thomas Krasemann
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, England, United Kingdom
| | - Shakeel Qureshi
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, England, United Kingdom
| | - David Crossland
- Department of Paediatric Cardiology, Newcastle-upon-Tyne Hospitals, Newcastle, England, United Kingdom
| | - Tony Hermuzi
- Department of Paediatric Cardiology, Newcastle-upon-Tyne Hospitals, Newcastle, England, United Kingdom
| | - Robin P Martin
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, England, United Kingdom
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52
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Kim SH. Recent advances in pediatric interventional cardiology. KOREAN JOURNAL OF PEDIATRICS 2017; 60:237-244. [PMID: 29042864 PMCID: PMC5638720 DOI: 10.3345/kjp.2017.60.8.237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/01/2017] [Accepted: 07/09/2017] [Indexed: 01/27/2023]
Abstract
During the last 10 years, there have been major technological achievements in pediatric interventional cardiology. In addition, there have been several advances in cardiac imaging, especially in 3-dimensional imaging of echocardiography, computed tomography, magnetic resonance imaging, and cineangiography. Therefore, more types of congenital heart diseases can be treated in the cardiac catheter laboratory today than ever before. Furthermore, lesions previously considered resistant to interventional therapies can now be managed with high success rates. The hybrid approach has enabled the overcoming of limitations inherent to percutaneous access, expanding the application of endovascular therapies as adjunct to surgical interventions to improve patient outcomes and minimize invasiveness. Percutaneous pulmonary valve implantation has become a successful alternative therapy. However, most of the current recommendations about pediatric cardiac interventions (including class I recommendations) refer to off-label use of devices, because it is difficult to study the safety and efficacy of catheterization and transcatheter therapy in pediatric cardiac patients. This difficulty arises from the challenge of identifying a control population and the relatively small number of pediatric patients with congenital heart disease. Nevertheless, the pediatric interventional cardiology community has continued to develop less invasive solutions for congenital heart defects to minimize the need for open heart surgery and optimize overall outcomes. In this review, various interventional procedures in patients with congenital heart disease are explored.
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Affiliation(s)
- Seong-Ho Kim
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
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53
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Morville P, Akhavi A. Transcatheter closure of hemodynamic significant patent ductus arteriosus in 32 premature infants by amplatzer ductal occluder additional size-ADOIIAS. Catheter Cardiovasc Interv 2017; 90:612-617. [DOI: 10.1002/ccd.27091] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/30/2017] [Accepted: 03/25/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Patrice Morville
- Pediatric and Pediatric Cardiology, Head of NICU; American Memorial Hospital; Reims France
| | - Ahmad Akhavi
- NICU, Department of Pediatrics; American Memorial Hospital; Reims France
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54
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McElhinney DB. Small and preterm infants: The shrinking frontier of transcatheter patent ductus arteriosus closure. Catheter Cardiovasc Interv 2017; 89:1066-1068. [PMID: 28432825 DOI: 10.1002/ccd.27076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 03/29/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Doff B McElhinney
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Stanford, Palo Alto, California
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55
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Kenny DP, Hijazi ZM. Current Status and Future Potential of Transcatheter Interventions in Congenital Heart Disease. Circ Res 2017; 120:1015-1026. [DOI: 10.1161/circresaha.116.309185] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 02/03/2023]
Abstract
Percutaneous therapies for congenital heart disease have evolved rapidly in the past 3 decades. This has occurred despite limited investment from industry and support from regulatory bodies resulting in a lack of specific device development. Indeed, many devices remain off-label with a best-fit approach often required, spurning an innovative culture within the subspecialty, which had arguably laid the foundation for many of the current and evolving structural heart interventions. Challenges remain, not least encouraging device design focused on smaller infants and the inevitable consequences of somatic growth. Data collection tools are emerging but remain behind adult cardiology and cardiac surgery and leading to partial blindness as to the longer-term consequences of our interventions. Tail coating on the back of developments in other fields of adult intervention will soon fail to meet the expanding needs for more precise interventions and biological materials. Increasing collaboration with surgical colleagues will require development of dedicated equipment for hybrid interventions aimed at minimizing the longer-term consequences of scar to the heart. Therefore, great challenges remain to ensure that children and adults with congenital heart disease continue to benefit from an exponential growth in minimally invasive interventions and technology. This can only be achieved through a concerted collaborative approach from physicians, industry, academia, and regulatory bodies supporting great innovators to continue the philosophy of thinking beyond the limits that has been the foundation of our specialty for the past 50 years.
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Affiliation(s)
- Damien P. Kenny
- From the Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland; and Weill Cornell Medical College, Sidra Medical and Research Center, Doha, Qatar
| | - Ziyad M. Hijazi
- From the Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland; and Weill Cornell Medical College, Sidra Medical and Research Center, Doha, Qatar
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56
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Backes CH, Rivera BK, Bridge JA, Armstrong AK, Boe BA, Berman DP, Fick T, Holzer RJ, Hijazi ZM, Abadir S, Justino H, Bergersen L, Smith CV, Kirpalani H. Percutaneous Patent Ductus Arteriosus (PDA) Closure During Infancy: A Meta-analysis. Pediatrics 2017; 139:peds.2016-2927. [PMID: 28087683 DOI: 10.1542/peds.2016-2927] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Patent ductus arteriosus (PDA) is a precursor to morbidity and mortality. Percutaneous (catheter-based) closure is the procedure of choice for adults and older children with a PDA, but use during infancy (<1 year) is not well characterized. OBJECTIVE Investigate the technical success and safety of percutaneous PDA closure during infancy. DATA SOURCES Scopus, Web of Science, Embase, PubMed, and Ovid (Medline) were searched through December 2015 with no language restrictions. STUDY SELECTION Publications needed to clearly define the intervention as percutaneous PDA closure during infancy (<1 year of age at intervention) and must have reported adverse events (AEs). DATA EXTRACTION The study was performed according to the Systematic Reviews and Meta-Analysis checklist and registered prospectively. The quality of the selected studies was critically examined. Data extraction and assignment of AE attributability and severity were independently performed by multiple observers. Outcomes were agreed on a priori. Data were pooled by using a random-effects model. RESULTS Thirty-eight studies were included; no randomized controlled trials were found. Technical success of percutaneous PDA closure was 92.2% (95% confidence interval [CI] 88.8-95.0). Overall AE and clinically significant AE incidence was 23.3% (95% CI 16.5-30.8) and 10.1% (95% CI 7.8-12.5), respectively. Significant heterogeneity and publication bias were observed. LIMITATIONS Limitations include lack of comparative studies, lack of standardized AE reporting strategy, and significant heterogeneity in reporting. CONCLUSIONS Percutaneous PDA closure during infancy is feasible and associated with few catastrophic AEs; however, the limitations constrain the interpretability and generalizability of the current findings.
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Affiliation(s)
- Carl H Backes
- Centers for Perinatal Research, .,Cardiovascular and Pulmonary Research, and.,The Heart Center, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | | | - Jeffrey A Bridge
- Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Innovation in Pediatric Practice, and
| | - Aimee K Armstrong
- Cardiovascular and Pulmonary Research, and.,The Heart Center, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Brian A Boe
- Cardiovascular and Pulmonary Research, and.,The Heart Center, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Darren P Berman
- Cardiovascular and Pulmonary Research, and.,The Heart Center, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Tyler Fick
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Ralf J Holzer
- Department of Pediatrics, Weill Cornell Medical College, New York, New York.,Cardiac Catheterization and Interventional Therapy, Sidra Cardiac Program, Sidra Medical and Research Center, Doha, Qatar
| | - Ziyad M Hijazi
- Department of Pediatrics, Weill Cornell Medical College, New York, New York.,Cardiac Catheterization and Interventional Therapy, Sidra Cardiac Program, Sidra Medical and Research Center, Doha, Qatar
| | - Sylvia Abadir
- Department of Pediatric Cardiology, CHU mère-enfant Sainte-Justine, Université de Montréal, Quebec, Canada
| | - Henri Justino
- Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Lisa Bergersen
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Charles V Smith
- Center for Developmental Therapeutics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Washington; and
| | - Haresh Kirpalani
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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57
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Transcatheter Closure of Patent Ductus Arteriosus in Extremely Premature Newborns. JACC Cardiovasc Interv 2016; 9:2429-2437. [DOI: 10.1016/j.jcin.2016.09.019] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/12/2016] [Accepted: 09/08/2016] [Indexed: 11/19/2022]
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58
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Sathanandam S, Justino H, Waller BR, Radtke W, Qureshi AM. Initial clinical experience with the Medtronic Micro Vascular Plug™ in transcatheter occlusion of PDAs in extremely premature infants. Catheter Cardiovasc Interv 2016; 89:1051-1058. [DOI: 10.1002/ccd.26878] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/06/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Shyam Sathanandam
- Division of Pediatric Cardiology, Department of Pediatrics; University of Tennessee Health Science Center, LeBonheur Children's Hospital; Memphis Tennessee
| | - Henri Justino
- Division of Pediatric Cardiology, Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology; Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - B. Rush Waller
- Division of Pediatric Cardiology, Department of Pediatrics; University of Tennessee Health Science Center, LeBonheur Children's Hospital; Memphis Tennessee
| | - Wolfgang Radtke
- Division of Pediatric Cardiology, Department of Pediatrics; A.I. Dupont Hospital For Children; Wilmington Delaware
| | - Athar M. Qureshi
- Division of Pediatric Cardiology, Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology; Texas Children's Hospital, Baylor College of Medicine; Houston Texas
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59
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Wang-Giuffre EW, Breinholt JP. Novel use of the medtronic micro vascular plug for PDA closure in preterm infants. Catheter Cardiovasc Interv 2016; 89:1059-1065. [DOI: 10.1002/ccd.26855] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 10/11/2016] [Accepted: 10/12/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Elizabeth W. Wang-Giuffre
- Division of Pediatric Cardiology, Department of Pediatrics; University of Texas Health Science Center at Houston; Houston Texas
| | - John P. Breinholt
- Division of Pediatric Cardiology, Department of Pediatrics; University of Texas Health Science Center at Houston; Houston Texas
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60
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Narin N, Pamukcu O, Baykan A, Sunkak S, Ulgey A, Uzum K. Percutaneous PDA Closure in Extremely Low Birth Weight Babies. J Interv Cardiol 2016; 29:654-660. [DOI: 10.1111/joic.12352] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Nazmi Narin
- Division of Pediatric Cardiology; Erciyes University School of Medicine; Kayseri Turkey
| | - Ozge Pamukcu
- Division of Pediatric Cardiology; Erciyes University School of Medicine; Kayseri Turkey
| | - Ali Baykan
- Division of Pediatric Cardiology; Erciyes University School of Medicine; Kayseri Turkey
| | - Suleyman Sunkak
- Division of Pediatric Cardiology; Erciyes University School of Medicine; Kayseri Turkey
| | - Ayse Ulgey
- Division of Anesthesiology; Erciyes University School of Medicine; Kayseri Turkey
| | - Kazim Uzum
- Division of Pediatric Cardiology; Erciyes University School of Medicine; Kayseri Turkey
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61
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Abstract
Objective: Our hypothesis was that percutaneous PDA closure in babies less than 2 kg was a safe and effective method. The aim of this study is to share our experience in transcatheter PDA closure in infants whose body weight is less than 2 kg in order to support our hypothesis. Methods: Between July 1997 and October 2014, 382 percutaneous PDA closures were done in our center. Nineteen patients who weighed less than 2 kg were included in this retrospectively study. The other inclusion criteria were 1) being symptomatic and PDA was thought as a possible contributor of medical state and 2) persistence of PDA after medical closure treatment. Patients who had sepsis and bleeding diathesis were excluded. According to size and shape of PDA, different types of devices were used such as detachable coils and Amplatzer duct occluders. Data was expressed as mean (SD) or median (minimum–maximum). Comparisons of means and medians were performed with Student’s t-test and with Mann–Whitney U test, respectively. Results: The median patient age and weight were 32 days and 1603 g (range 910–2000 g) respectively. Mean PDA diameter was 3.2±1.3 mm. Morphology of PDA was type A in 7 patients, type C in 10, type E in 1, and type B in 1 patient. There were no reported major complications. Stenosis of left pulmonary artery was detected in four patients, all of which resolved in 6 months follow-up. Conclusion: Percutaneous PDA closure in babies less than 2 kg is a safe and effective method that can be an alternative to surgery. Main distinguishing feature of this study is that it includes the largest cohort of patients less than 2 kg whose PDA closed percutaneously.
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62
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Boudjemline Y. Covidien micro vascular plug in congenital heart diseases and vascular anomalies: A new kid on the block for premature babies and older patients. Catheter Cardiovasc Interv 2016; 89:114-119. [PMID: 27392516 DOI: 10.1002/ccd.26622] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 03/13/2016] [Accepted: 05/23/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate the safety, feasibility, and efficacy of the MVP™ microvascular plug(Covidien) for closure of vascular anomalies in patients with congenital heart diseases (CHD). BACKGROUND The MVP™ is a novel device with PTFE integrated. The device has been recently introduced in the radiological field and reported exclusively for neurological anomalies. METHODS All CHD patients receiving the device from April 2015 until July 2015 were included in the study and followed up clinically as well as by transthoracic echocardiography. Standard safety and follow-up such as vascular complications, embolization rate, and residual shunting were assessed. RESULTS Twelve patients with a median age of 2.6-years (0.03-12.6 years) and a mean weight of 13 kg (2.8-34.2 kg) were included. Devices were delivered from the femoral artery in 10 and from the femoral vein in 2 patients. Devices were used for closure of patent ductus arteriosus (PDA) closure (n = 5), aorto-pulmonary collaterals or Blalock-Taussig shunt (n = 5), veno-venous fistula (n = 1), and coronary fistula (n = 1). One device was retrieved before release due to inappropriate size estimation (PDA spasm). The PDA was successfully closed using a PDA device (Lifetech, Medtronic). Immediate angiographic evaluation showed minimal or no shunt in 90% (10/11 patients) and 100% occlusion rate after a mean follow-up of 3.2-months. There was no device embolization, hemolysis, or any other complication following closure. CONCLUSIONS The delivery of new MVP™ micro vascular plug system (Covidien) is safe and effective in patients with CHD for closure of a variety of vascular abnormalities. The low profile of the device and the sheathless nature of the procedure make it particularly interesting for PDA closure in premature babies. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Younes Boudjemline
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Necker Hospital for Sick Children-HEGP, Assistance Publique des Hopitaux de Paris, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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63
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Identifying Gaps in Technology for Congenital Interventions: Analysis of a Needs Survey from Congenital Interventional Cardiologists. Pediatr Cardiol 2016; 37:925-31. [PMID: 27064094 DOI: 10.1007/s00246-016-1372-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/19/2016] [Indexed: 10/22/2022]
Abstract
We carried out a device-needs survey to evaluate the gaps in device and equipment availability for congenital interventional cardiologists. As the complexity and demand for more complete solutions to congenital heart lesions increase, there is a growing need for modification and development of devices and equipment to support this endeavor. The survey was sent out via e-mail to members of the Congenital Cardiovascular Interventional Study Consortium and the Society for Cardiac Angiography and Interventions with a reach of over 350 congenital interventionalists. Responses were received from 68 cardiologists in 8 countries. In terms of the most desired device, 41 % ranked bioresorbable stents as their first choice from a list of 12 possible devices. Similarly, 23 % ranked large covered stents as their first choice. Twenty-seven percent of participants believed bioresorbable stents would have the greatest potential to improve morbidity of their patients, with another 27 % reporting that covered stents would have the greatest impact. Fifty percent of participants reported that they would like to see large covered stents available in their country. These data point toward a perceived need for the development/approval of bioresorbable stents for the pediatric age group, as well as the need to approve the use of large covered stents in the pediatric age group in the USA.
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64
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Schwartz MC, Nykanen D, Winner LH, Perez J, McMahan M, Munro HM, Suguna Narasimhulu S. Transcatheter Patent Ductus Arteriosus Occlusion in Small Infants. CONGENIT HEART DIS 2016; 11:647-655. [DOI: 10.1111/chd.12360] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Matthew C. Schwartz
- The Heart Center, Arnold Palmer Hospital for Children; Orlando Fla USA
- College of Medicine; University of Central Florida; Orlando Fla USA
| | - David Nykanen
- The Heart Center, Arnold Palmer Hospital for Children; Orlando Fla USA
- College of Medicine; University of Central Florida; Orlando Fla USA
| | | | - Jose Perez
- Division of Neonatology; Winnie Palmer Hospital; Orlando Fla USA
| | - Michael McMahan
- Division of Neonatology; Winnie Palmer Hospital; Orlando Fla USA
| | - Hamish M. Munro
- Division of Cardiac Anesthesiology; Arnold Palmer Hospital for Children; Orlando Fla USA
| | - Sukumar Suguna Narasimhulu
- College of Medicine; University of Central Florida; Orlando Fla USA
- Division of Cardiac Intensive Care; Arnold Palmer Hospital for Children; Orlando Fla USA
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65
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Pan XB, Ouyang WB, Wang SZ, Liu Y, Zhang DW, Zhang FW, Pang KJ, Zhang Z, Hu SS. Transthoracic Echocardiography-Guided Percutaneous Patent Ductus Arteriosus Occlusion: A New Strategy for Interventional Treatment. Echocardiography 2016; 33:1040-5. [PMID: 27038152 DOI: 10.1111/echo.13207] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Percutaneous patent ductus arteriosus (PDA) occlusion has become the preferred therapeutic option, which uses fluoroscopy as the guidance. To reduce the x-ray exposure, PDA occlusion using the Amplatzer Duct Occluder II (ADO II) under guidance of transthoracic echocardiography only was conducted. This single center study aims to access the safety and efficiency of this new strategy. METHODS AND RESULTS From June 2013 to May 2015, 63 consecutive PDA patients underwent transthoracic echocardiography-guided PDA occlusion through the femoral artery. Outpatient follow-up was conducted at 1, 3, and 6 months, and yearly. Sixty-two patients successfully underwent echocardiography-guided percutaneous PDA occlusion. One patient was converted to minimally invasive transthoracic occlusion due to failure of delivery sheath passage through tortuous PDA. Mean procedure duration was 24.3 ± 7.0 minutes; ADO II diameter averaged 4.6 ± 0.9 mm; 8 cases showed traces of residual shunt immediately after operation which resolved after 24 hours; and mean hospital stay was 3.4 ± 0.5 days. There was no occluder migration, hemolysis, pericardial effusion, pulmonary branch or aortic stenosis at mean 13.5 ± 4.8 months follow-up. CONCLUSIONS This study demonstrated that percutaneous PDA occlusion can be successfully performed under guidance of transthoracic echocardiography only and appears safe and effective while avoiding radiation and contrast agent use.
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Affiliation(s)
- Xiang-Bin Pan
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wen-Bin Ouyang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shou-Zheng Wang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yao Liu
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Da-Wei Zhang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Feng-Wen Zhang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kun-Jing Pang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhe Zhang
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Sheng-Shou Hu
- National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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The new Occlutech(®) patent ductus arteriosus occluder: Single centre experience. Arch Cardiovasc Dis 2016; 109:384-9. [PMID: 26988839 DOI: 10.1016/j.acvd.2015.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/02/2015] [Accepted: 12/08/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transcatheter therapy is the first-line treatment for closure of patent ductus arteriosus (PDA). A range of different devices have been used. AIM To report our experience using the new Occlutech(®) PDA occluder for closure of PDA. METHODS All consecutive patients receiving an Occlutech(®) PDA occluder for closure of PDA from March 2014 to May 2015 were included in the study. Occluders were implanted using a conventional technique. After cardiac catheterization, transthoracic echocardiography was performed sequentially. Residual shunting and procedural and mid-term complications, including embolization, device-induced left pulmonary artery stenosis and aortic coarctation, were systematically assessed and reported. RESULTS Fifty-six patients (35 females) with a median age of 1 year (range: 29 days to 24 years) were included in the study. PDAs were closed successfully using device number 5/3.5 in 17 patients, 6/4 in 28 patients, 7/5 in four patients, 8/6 in six patients and 10/8 in one patient. Post-implantation angiography showed no residual shunt in 10 patients (17.8%), moderate intraprosthetic shunt in 43 patients (76.8%) and severe shunt in three patients (5.4%). One device embolized in the right pulmonary artery 1hour after successful closure; the device was retrieved surgically after unsuccessful snaring. After a mean follow-up of 10 months (range: 3-17.8 months), no residual shunt or device-related complications were noted. CONCLUSION The new Occlutech(®) PDA occluder allows safe and efficient PDA closure, similar to existing devices.
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Abstract
Despite several reports describing echocardiography for the guidance of ductal closure, two-dimensional angiography remains the mainstay imaging tool; three-dimensional rotational angiography has the potential to overcome some of the drawbacks of standard angiography, and reconstructed image overlay provides reliable guidance for device placement. We describe arterial duct closure solely from venous approach guided by live three-dimensional image overlay.
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Backes CH, Cheatham SL, Deyo GM, Leopold S, Ball MK, Smith CV, Garg V, Holzer RJ, Cheatham JP, Berman DP. Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications. J Am Heart Assoc 2016; 5:JAHA.115.002923. [PMID: 26873689 PMCID: PMC4802484 DOI: 10.1161/jaha.115.002923] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous closure of patent ductus arteriosus (PDA) in term neonates is established, but data regarding outcomes in infants born very preterm (<32 weeks of gestation) are minimal, and no published criteria exist establishing a minimal weight of 4 kg as a suitable cutoff. We sought to analyze outcomes of percutaneous PDA occlusion in infants born very preterm and referred for PDA closure at weights <4 kg. METHODS AND RESULTS Retrospective analysis (January 2005-January 2014) was done at a single pediatric center. Procedural successes and adverse events were recorded. Markers of respiratory status (need for mechanical ventilation) were determined, with comparisons made before and after catheterization. A total of 52 very preterm infants with a median procedural weight of 2.9 kg (range 1.2-3.9 kg) underwent attempted PDA closure. Twenty-five percent (13/52) of infants were <2.5 kg. Successful device placement was achieved in 46/52 (88%) of infants. An adverse event occurred in 33% of cases, with an acute arterial injury the most common complication. We observed no association between weight at time of procedure and the risk of an adverse event. No deaths were attributable to the PDA closure. Compared to precatheterization trends, percutaneous PDA closure resulted in improved respiratory status, including less exposure to mechanical ventilation (mixed effects logistic model, P<0.01). CONCLUSIONS Among infants born very preterm, percutaneous PDA closure at weights <4 kg is generally safe and may improve respiratory health, but risk of arterial injury is noteworthy. Randomized clinical trials are needed to assess clinically relevant differences in outcomes following percutaneous PDA closure versus alternative (surgical ligation) management strategies.
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Affiliation(s)
- Carl H Backes
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Sharon L Cheatham
- Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Grace M Deyo
- The Heart Center, Nationwide Children's Hospital, Columbus, OH
| | - Scott Leopold
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Molly K Ball
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Charles V Smith
- Center for Developmental Therapeutics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA
| | - Vidu Garg
- Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Ralf J Holzer
- Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - John P Cheatham
- Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Darren P Berman
- Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
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Philip R, Rush Waller B, Agrawal V, Wright D, Arevalo A, Zurakowski D, Sathanandam S. Morphologic characterization of the patent ductus arteriosus in the premature infant and the choice of transcatheter occlusion device. Catheter Cardiovasc Interv 2015; 87:310-7. [DOI: 10.1002/ccd.26287] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 08/19/2015] [Accepted: 10/03/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Ranjit Philip
- Division of Pediatric Cardiology; University of Tennessee Health Science Center, Le Bonheur Children's Hospital; Memphis Tennessee
- Department of Pediatrics; University of Tennessee Health Science Center, Le Bonheur Children's Hospital; Memphis Tennessee
| | - B. Rush Waller
- Division of Pediatric Cardiology; University of Tennessee Health Science Center, Le Bonheur Children's Hospital; Memphis Tennessee
- Department of Pediatrics; University of Tennessee Health Science Center, Le Bonheur Children's Hospital; Memphis Tennessee
| | - Vijaykumar Agrawal
- Department of Radiology; University of Tennessee Health Science Center, Le Bonheur Children's Hospital; Memphis Tennessee
| | - Dena Wright
- Division of Pediatric Cardiology; University of Tennessee Health Science Center, Le Bonheur Children's Hospital; Memphis Tennessee
- Department of Pediatrics; University of Tennessee Health Science Center, Le Bonheur Children's Hospital; Memphis Tennessee
| | - Alejandro Arevalo
- Division of Pediatric Cardiology; University of Tennessee Health Science Center, Le Bonheur Children's Hospital; Memphis Tennessee
- Department of Pediatrics; University of Tennessee Health Science Center, Le Bonheur Children's Hospital; Memphis Tennessee
| | - David Zurakowski
- Department of Biostatistics; Harvard Medical School; Boston Massachusetts
| | - Shyam Sathanandam
- Division of Pediatric Cardiology; University of Tennessee Health Science Center, Le Bonheur Children's Hospital; Memphis Tennessee
- Department of Pediatrics; University of Tennessee Health Science Center, Le Bonheur Children's Hospital; Memphis Tennessee
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Baspinar O, Sahin DA, Sulu A, Irdem A, Gokaslan G, Sivasli E, Kilinc M. Transcatheter closure of patent ductus arteriosus in under 6 kg and premature infants. J Interv Cardiol 2015; 28:180-9. [PMID: 25832591 DOI: 10.1111/joic.12196] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/28/2015] [Accepted: 03/05/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Transcatheter closure of a patent ductus arteriosus (PDA) has always been considered risky for infants weighing <6 kg and preterms. We present our findings regarding transcatheter closures of PDA. METHODS The inclusion criteria were a weight of <6 kg and the presence of PDA symptoms. The study subjects were divided into two groups: <6 kg and premature infants. RESULTS A total of 69 infants were included. The mean ages and weights of the <6 kg and the preterms were 5.4 ± 2.7 months and 30.3 ± 19.9 days, and 4.6 ± 0.8 and 1.7 ± 0.3 kg, respectively. Type C PDAs were most frequently observed in the premature group, and type A was in <6 kg. Sixteen of the patients were premature infants, and 81.2% of them had an extremely low birth weight. All of the premature infants had comorbidities, and had been receiving respiratory support therapy. Transcatheter closure was successfully completed in 81.2% of the premature infants and 94.3% of the <6-kg infants. Major complications occurred in 4 patients (one death and three device embolizations). The patient's age was found to be the main risk factor. The most frequently used device was the Amplatzer duct occluder II in additional sizes (84.6%) in the preterms and the Amplatzer duct occluder I (34%) and II (34%) in the <6-kg group. CONCLUSION The transcatheter closure of PDA is relatively safe and effective in preterms and in infants <6 kg. The selection of a suitable device based on the type of PDA is critical to the success of the procedure.
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Affiliation(s)
- Osman Baspinar
- Department of Pediatric Cardiology, Gaziantep University, Medical Faculty,, Gaziantep, Turkey
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