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Jea SJ, Kwon HJ, Jang GY, Lee JY, Kim SJ, Son CS, Lee JW. Complications of transcatheter closure of atrial septal defects using the amplatzer septal occluder. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.4.401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Seo Jin Jea
- Departments of Pediatrics, College of Medicine, Korea University, Ansan, Korea
| | - Hyo Jin Kwon
- Departments of Pediatrics, College of Medicine, Korea University, Ansan, Korea
| | - Gi Young Jang
- Departments of Pediatrics, College of Medicine, Korea University, Ansan, Korea
| | - Jae Young Lee
- Departments of Pediatric Cardiology, Sejong Heart Institute, Sejong General Hospital, Bucheon, Korea
| | - Soo Jin Kim
- Departments of Pediatric Cardiology, Sejong Heart Institute, Sejong General Hospital, Bucheon, Korea
| | - Chang Sung Son
- Departments of Pediatrics, College of Medicine, Korea University, Ansan, Korea
| | - Joo Won Lee
- Departments of Pediatrics, College of Medicine, Korea University, Ansan, Korea
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152
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Bruch L, Winkelmann A, Sonntag S, Scherf F, Rux S, Grad MO, Kleber FX. Fenestrated occluders for treatment of ASD in elderly patients with pulmonary hypertension and/or right heart failure. J Interv Cardiol 2007; 21:44-9. [PMID: 18086135 DOI: 10.1111/j.1540-8183.2007.00324.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Atrial septal defect (ASD) occlusion in adult patients with advanced age and left or right heart diastolic or systolic heart failure and in patients with pulmonary arterial hypertension bears a considerable risk of deterioration of heart failure. Therefore, we conducted this feasibility trial in 15 ASD patients with pulmonary hypertension and/or right heart failure using a fenestrated Amplatzer septal occluder (AGA Medical Corporation, Golden Valley, MN), allowing an overflow of blood in both directions in case of univentricular diastolic or systolic heart failure. In all patients, the device could be implanted without complications. All symptomatic patients showed an improvement in the New York Heart Association (NYHA) class, and no right or left heart decompensation occurred. On echocardiography, right ventricular end diastolic dimension (RVEDD) and pulmonary artery pressure (PAP) decreased significantly, whereas left ventricular end diastolic dimension (LVEDD) increased. Our series of 15 patients with fenestrated ASD occlusion shows that high-risk ASD occlusion can safely be accomplished with excellent clinical results and without complications by a fenestrated occluder.
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Affiliation(s)
- Leonhard Bruch
- From the Department of Internal Medicine/Cardiology, Unfallkrankenhaus Berlin Academic Teaching Hospital, Berlin, Germany
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153
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Abstract
PURPOSE OF REVIEW The cardiac catheterization lab has concerns for both patient care and for safety. As the cardiac catheterization lab continues to evolve, the demand for anesthesia services will certainly increase. The role of the anesthesiologist in the cardiac catheterization lab must be defined in this changing environment. RECENT FINDINGS Procedures in the cardiac catheterization lab are more complex, take longer, and involve higher acuity patients. Many of these cases require general anesthesia rather than sedation, and require management of unstable hemodynamics. Knowledge of echocardiography and fluoroscopy is beneficial. Anesthesiologists should be active in developing sedation and practice management guidelines. Radiation exposure and safety is an important concern. SUMMARY The anesthesiologist is becoming an integral part of the cardiac catheterization lab team, and an important element in maintaining a high level of patient care with minimal complications in the evolving modern day cardiac catheterization lab.
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Affiliation(s)
- Douglas C Shook
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, USA.
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154
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Javois AJ, Roberson DA. Unusual atrial septal anatomy resulting in an interatrial chamber: the true triatrial heart? Pediatr Cardiol 2007; 28:224-8. [PMID: 17505865 DOI: 10.1007/s00246-006-0057-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report two patients who were found to have nearly identical, very peculiar atrial septal anatomy. The septum actually consisted of two distinct septa with discrete defects creating an interatrial chamber. The orifice from the left atrium was unrestrictive, but the orifice to the right atrium was restrictive. Overall, there was net left-to-right shunting. This finding represents a clinical dilemma: Left untreated, the interatrial chamber might be a nidus for thrombus formation, but attempting device closure might result in incomplete obliteration of the chamber, also resulting in potential locus for clot formation. Clot formation might lead to systemic embolization. Angiographic findings are correlated with echocardiographic findings. Embryology and treatment options are considered.
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Affiliation(s)
- A J Javois
- The Heart Institute for Children, Advocate Hope Children's Hospital, Oak Lawn, IL 60453, USA.
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155
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Hörer J, Eicken A, Müller S, Schreiber C, Cleuziou J, Prodan Z, Holper K, Lange R. Risk factors for prolonged intensive care treatment following atrial septal defect closure in adults. Int J Cardiol 2007; 125:57-61. [PMID: 17462760 DOI: 10.1016/j.ijcard.2007.02.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2006] [Revised: 01/08/2007] [Accepted: 02/17/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND Today, percutaneous or surgical closure of atrial septal defects (ASD) in adults are considered effective and safe treatments. However, some cases of severe left ventricular dysfunction after ASD closure were observed. This study aims at identifying predictors for prolonged intensive care unit stay, and postoperative inotropic support after ASD closure. METHODS Records of 281 adult patients who had undergone surgical closure of a secundum ASD between 1974 and 2000 at an age over 30 years (mean 43.8, maximum 76 years) were reviewed retrospectively. The endpoints were defined as prolonged intensive care unit stay (>2 days), and postoperative inotropic support (Dopamine, Dobutamine or Adrenalin). RESULTS Thirty-day mortality rate was 0.7% (2 patients). Prolonged intensive care unit stay was observed in 70 patients (25%). Postoperative inotropic support was necessary in 84 patients (30%). Independent risk factors for prolonged intensive care unit stay in multivariate analysis were preoperative atrial fibrillation (p=0.011), and larger ASD (p=0.026). Older age at operation (p<0.001) and longer time on extracorporeal circulation (p<0.001) emerged as independent risk factor for postoperative use of inotropic support in multivariate analysis. CONCLUSIONS Surgical ASD closure in adults is usually safe. However, a distinct subgroup of patients is at risk for prolonged intensive care treatment. Timely closure of the ASD must be advised since older age emerged as a predictor for postoperative use of inotropic support. Since atrial fibrillation is a strong independent risk factor for prolonged intensive care unit stay the preservation of sinus rhythm must be aimed at.
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Affiliation(s)
- Jürgen Hörer
- Department of Cardiovascular Surgery, German Heart Center Munich at Technical University, Lazarettstrasse. 36, D-80636 Munich, Germany.
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156
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Affiliation(s)
- Jason B Lindsey
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - L David Hillis
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
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157
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Marie Valente A, Rhodes JF. Current indications and contraindications for transcatheter atrial septal defect and patent foramen ovale device closure. Am Heart J 2007; 153:81-4. [PMID: 17394907 DOI: 10.1016/j.ahj.2007.01.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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158
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Ruiz Lera M, de la Torre-Hernández JM, Zueco J, Francisco Nistal J. Perforación cardiaca tardía tras cierre percutáneo de un defecto septal interauricular con dispositivo Amplatzer. Rev Esp Cardiol 2007. [DOI: 10.1157/13101652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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159
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Spies C, Timmermanns I, Schräder R. Transcatheter closure of secundum atrial septal defects in adults with the Amplatzer septal occluder: Intermediate and long-term results. Clin Res Cardiol 2007; 96:340-6. [PMID: 17323009 DOI: 10.1007/s00392-007-0502-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 01/10/2007] [Indexed: 10/23/2022]
Abstract
AIMS Transcatheter closure of secundum atrial septal defects (ASD) with the Amplatzer septal occluder (ASO) has become a standard procedure in most pediatric and adult patients. However, data addressing success rates and outcome in adults is limited. We sought to define the safety profile of the ASO in the community setting and identify the percentage of adults with ASD amenable to percutaneous closure with the ASO. METHODS We performed a retrospective analysis of patients' records referred for transcatheter ASD closure from 1999 through 2005 at a single institution. Patients were evaluated with right heart catheterization and underwent closure of the ASD according to standard indications under transesophageal and fluoroscopic guidance. RESULTS Two hundred and seven consecutive patients were taken to the catheterization laboratory for hemodynamic evaluation and possible interventional closure of an ASD. Of those patients, 18 were excluded because the defect and the left-to-right shunt were hemodynamically insignificant (n = 7) or because there was no distinct defect, but instead a multi-perforated septum (n = 11). Nineteen cases were excluded for anatomic reasons. Of the remaining 170 patients, ASO implantation was attempted and successfully performed in 166 (83% of 200 patients with hemodynamically significant ASD). Complications occurred in 11 cases (6.5%) (device dislocation = 4, transient ST-segment elevation = 4, TIA = 1, hemoptysis = 1, pericardial effusion = 1); none of these events were associated with long-term sequelae. During a median follow-up period of 13 months (range 6-80) there were no major clinical events. CONCLUSIONS More than 80% of adults with a distinct, hemodynamically significant secundum ASD can be successfully treated with the ASO. The immediate success rates are excellent and follow-up data suggest that the ASO is a safe device well suited for transcatheter ASD closure.
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Affiliation(s)
- Christian Spies
- Rush University Medical Center, Section of Cardiology, 1653 W Congress Parkway, Chicago, IL 60612, USA.
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160
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Sigler M, Jux C, Ewert P. Histopathological workup of an Amplatzer atrial septal defect occluder after surgical removal. Pediatr Cardiol 2006; 27:775-6. [PMID: 17031717 DOI: 10.1007/s00246-006-1413-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Accepted: 05/26/2006] [Indexed: 11/27/2022]
Abstract
We present results of the histopathological work-up of an atrial septal defect occluder that was explanted 15 months after interventional implantation due to a significant residual shunt. Complete endothelialization of the surface and a mild inflammatory reaction was demonstrated.
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Affiliation(s)
- Matthias Sigler
- Pediatric Cardiology and Intensive Care Medicine, Georg-August-University, Robert-Koch-Strasse 40, D - 37075, Goettingen, Germany.
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161
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Affiliation(s)
- Leon Morgenstern
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
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162
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Perich Duran RM, Subirana Domènech MT, Malo Concepción P. [Progress in pediatric cardiology and congenital heart defects]. Rev Esp Cardiol 2006; 59 Suppl 1:87-98. [PMID: 16540024 DOI: 10.1157/13084452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We present a review of progress reported in the fields of pediatric cardiology and congenital heart disease between July 2004 and July 2005. The review covers diagnosis, medical treatment, interventional cardiology, and surgery. Among advances in diagnosis, we highlight new diagnostic imaging methods such as three-dimensional echocardiography, magnetic resonance imaging, CT angiography, and tissue Doppler imaging. In the area of fetal cardiology, we focus on advances in fetal interventions, such as percutaneous aortic valvuloplasty, percutaneous pulmonary valvuloplasty, and intact or restrictive atrial balloon septostomy. In interventional cardiology, we highlight advances in the application of percutaneous techniques to adult congenital heart disease to help solve problems resulting from previous surgery, and we review new devices for enabling the percutaneous closure of muscular and membranous ventricular septal defects. In cardiac surgery, a number of developments in valved conduits and in aortic translocation in patients with complex transposition of the great arteries are of particular interest.
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Affiliation(s)
- Rosa M Perich Duran
- Unidad de Cardiología Pediátrica, Hospital Sabadell, Corporació Parc Taulí, Sabadell, Barcelona, Spain.
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163
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Russell IA, Rouine-Rapp K, Stratmann G, Miller-Hance WC. Congenital Heart Disease in the Adult: A Review with Internet-Accessible Transesophageal Echocardiographic Images. Anesth Analg 2006; 102:694-723. [PMID: 16492817 DOI: 10.1213/01.ane.0000197871.30775.2a] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Isobel A Russell
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA.
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164
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Affiliation(s)
- Zahid Amin
- Joint Division of Pediatric Cardiology, University of Nebraska/Creighton University, Children's Hospital of Omaha, Nebraska, USA.
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165
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Choi JY. Recent advances in transcatheter treatment of congenital heart disease. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.9.917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jae Young Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
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166
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Goy JJ, Stauffer JC, Yusoff Z, Wong AR, Owlya R, Perret F, Siegenthaler M, Savcic M, Ménétrey R, Seydoux C. Percutaneous closure of atrial septal defect type ostium secundum using the new Intrasept occluder: Initial experience. Catheter Cardiovasc Interv 2006; 67:265-7. [PMID: 16416474 DOI: 10.1002/ccd.20607] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report the first experience obtained with the new Intrasept device. We attempted to treat 35 patients with a mean age of 43 +/- 21 years. The mean size of the defect was 17/15 mm. It was successfully closed in 31 patients. In the remaining four the device could not be stabilized because of excessive defect size. A small residual shunt was present immediately following implantation in three patients. No complications occurred during the procedure and at 6 months, 31 patients had an uneventful outcome. Only one patient had a small residual shunt. No thrombus, embolization, or device fracture was documented during a mean follow-up of 17 +/- 11 months. Percutaneous closure of ASD ostium secundum is feasible with the Intrasept device with a high success rate and very good medium-term outcome. Our initial experience and results were excellent with small to medium size defects, however, large defects (>20 mm) remain challenging.
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Affiliation(s)
- J J Goy
- Cardiology Service, Clinique Cecil, Lausanne, Switzerland.
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167
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Demaria AN, Ben-Yehuda O, Berman D, Feld GK, Ginsberg J, Greenberg BH, Lew WYW, Sahn D, Tsimikas S. Highlights of the Year in JACC2005. J Am Coll Cardiol 2006; 47:184-202. [PMID: 16386685 DOI: 10.1016/j.jacc.2005.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Accepted: 11/11/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Anthony N Demaria
- Cardiology Division, University of California-San Diego, San Diego, California
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168
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Hein R, Büscheck F, Fischer E, Leetz M, Bayard MTY, Ostermayer S, Reschke M, Lang K, Römer A, Wilson N, Sievert H. Atrial and Ventricular Septal Defects Can Safely Be Closed by Percutaneous Intervention. J Interv Cardiol 2005; 18:515-22. [PMID: 16336434 DOI: 10.1111/j.1540-8183.2005.00094.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Various transcatheter devices and methods to close congenital heart defects are currently available. Devices have been designed specifically for atrial septal defect (ASD), patent foramen ovale (PFO), and ventricular septal defect (VSD) closure. The trend in interventional treatment of intracardiac shunts shows toward defect-specific systems. The PFO is a tunnel defect requiring occluders that adapt to its length while common ASD strongly vary in their diameter, making a large scale of device sizes indispensable. VSDs are predominantly sealed by coils or tissue-adapted devices like muscular or perimembranous occluders. Since VSDs may occur with an aneurysm (VSA), a multi-perforated septum, an instable myocardial situation (postinfarction) or a high interventricular pressure gradient, closure of these defects is regarded sometimes as complicated. But during the last 30 years (since King and Mills implanted the first double-umbrella occluding system) several studies have proven procedure efficacy and safety of both ASD and VSD closure. This article reviews a large scale of studies and includes our single center data on 1,609 PFO, ASD, and VSD patients.
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Affiliation(s)
- Ralph Hein
- The CardioVascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany
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169
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Abstract
PURPOSE OF THE REVIEW The fields of pediatric and congenital cardiac interventions continue to expand at a rapid pace. The last few years have witnessed a tremendous explosion in procedures such as the transcatheter closure of secundum atrial septal defects, patent foramen ovale, patent ductus arteriosus, stent placement for pulmonary artery stenosis, and coarctation of the aorta. The purpose of this review is to highlight important publications in the last year and the direction the field is taking. RECENT FINDINGS Research data over the last year has concentrated on six main themes: (a) mid-to-long-term data for device closure of atrial septal defects, the incidence of late cardiac erosions, thrombus formation and heart block; (b) the transcatheter closure of muscular ventricular septal defects; (c) the transcatheter closure of perimembranous ventricular septal defects; (d) the placement of bioprosthetic valves in the pulmonary and aortic positions; (e) the 'hybrid' approach that combines surgical and interventional techniques in the management of various congenital cardiac defects; and (f) fetal interventions. SUMMARY This review outlines the key data presented in the literature involving interventional cardiology for pediatric and congenital cardiac defects over the last year. It illustrates that in close collaboration with industry, together with bioengineers and cardiothoracic surgeons, adult cardiac interventionists and perinatologists should continue to expand the role of pediatric catheter interventions. Fetal interventions have the potential to alter the natural history of abnormal cardiac development.
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Affiliation(s)
- Hitendra T Patel
- Children's Hospital and Research Center at Oakland, Oakland, California, USA
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