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Das S, Roy M, Chattopadhya A, Ganguly D. Intervention Challenges in Patients with Congenital Heart Disease with Coexisting Interruption of the Inferior Vena Cava - A Case Series. Heart Views 2021; 22:224-230. [PMID: 34760057 PMCID: PMC8574097 DOI: 10.4103/heartviews.heartviews_197_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/12/2021] [Indexed: 11/04/2022] Open
Abstract
Interruption of the inferior vena cava with azygos continuation is a rare congenital anomaly. This anomaly becomes clinically important during cardiac interventions.
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Affiliation(s)
- Saurabhi Das
- Department of Paediatric Cardiology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Mahua Roy
- Department of Paediatric Cardiology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Amitabh Chattopadhya
- Department of Paediatric Cardiology, Narayana Super Speciality Hospital, Howrah, West Bengal, India
| | - Debasree Ganguly
- Department of Paediatric Cardiology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
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Hoetama E, Prakoso R, Roebiono PS, Sakidjan I, Kurniawati Y, Siagian SN, Lelya O, Rahajoe AU, Harimurti GM, Lilyasari O. Balloon pulmonary valvuloplasty in neonates with critical pulmonary stenosis: Jugular or femoral. Ann Pediatr Cardiol 2019; 13:11-15. [PMID: 32030030 PMCID: PMC6979020 DOI: 10.4103/apc.apc_14_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/18/2019] [Accepted: 08/12/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Critical pulmonary stenosis (PS) is one of the life-threatening congenital heart diseases which present during the neonatal period with cyanosis. Surgical valvotomy was once the procedure of choice for critical PS; however, balloon pulmonary valvuloplasty (BPV) has now become the standard treatment. Although the procedure is usually simple, crossing the pulmonary valve from the femoral vein can be difficult, especially when severe tricuspid regurgitation and right atrium dilatation are present. In such patients, the maneuver can be simplified by using the right internal jugular vein approach. However, many operators are reluctant to use this approach because of unfamiliarity with the technique, potential complications, and paucity of reports. Until now, there is no literature describing BPV using the transjugular approach in neonates, also none directly comparing the transfemoral and transjugular approaches. Objective: We compared transjugular with the transfemoral approach in terms of procedure time and complications. Materials and Methods: This was a retrospective cohort study. Participants were neonates with critical PS undergoing BPV in the National Cardiovascular Center Harapan Kita from 2013 to 2018. Results: Of 15 neonates undergoing BPV, eight were done using the transjugular approach and seven using the femoral approach. Mean age and weight in both groups was similar. In all eight patients using transjugular approach, crossing the pulmonary valve was consistently quick and easy. The total procedural time, pulmonary crossing time, and fluoro time was significantly shorter using the transjugular approach (65 ± 8 vs. 108 ± 17.8 min, P < 0.05; 22 ± 3.1 vs. 45 ± 14.8 min, P < 0.01; 29 ± 13 vs. 67 ± 35 min, P < 0.05). There were no complications relating to vascular access. Moreover, the BPV procedure itself demonstrated comparable results in both groups. Conclusion: BPV using the transjugular approach is safe and effective to relieve critical PS in neonates compared to the transfemoral approach.
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Affiliation(s)
- Erick Hoetama
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Radityo Prakoso
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Poppy Surwianti Roebiono
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Indriwanto Sakidjan
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Yovi Kurniawati
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Sisca Natalia Siagian
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Olfi Lelya
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anna Ulfah Rahajoe
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ganesja Moelia Harimurti
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Oktavia Lilyasari
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Nath R, Rajvanshi S, Gupta A, Pandit N. An unconventional valvuloplasty: severe pulmonary stenosis with 'candy cane' inferior vena cava. BMJ Case Rep 2017; 2017:bcr-2017-221087. [PMID: 28705851 DOI: 10.1136/bcr-2017-221087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Femoral vein is the usual approach to balloon pulmonary valvuloplasty (BPV). However, alternative access may be mandated in some peculiar situations. We hereby report a 10-year-old patient with symptomatic severe valvular pulmonary stenosis with interrupted inferior vena cava which was successfully treated with transjugular BPV. Technical considerations for this approach as well as other possible options for such patients are discussed.
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Affiliation(s)
- Ranjit Nath
- Department of Cardiology, Ram Manohar Lohia Hospital, New Delhi, India
| | - Satyam Rajvanshi
- Department of Cardiology, Ram Manohar Lohia Hospital, New Delhi, India
| | - Ankit Gupta
- Department of Cardiology, Ram Manohar Lohia Hospital, New Delhi, India
| | - Neeraj Pandit
- Department of Cardiology, Ram Manohar Lohia Hospital, New Delhi, India
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Lee ML. Transjugular Balloon Pulmonary Valvuloplasty Through a Bidirectional Glenn Shunt for Dysplastic Pulmonary Valve Stenosis in an 8.7-Year-Old Boy with Inaccessible Femoral Veins. Pediatr Neonatol 2016; 57:145-8. [PMID: 24103403 DOI: 10.1016/j.pedneo.2013.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 06/10/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022] Open
Abstract
An 8.7-year-old boy was affected by exertional dyspnea with cyanosis of the lip at 6 years old. Oxygen saturation (SpO2) was 66%. A bidirectional Glenn shunt (BGS) was constructed to successfully elevate SpO2 to 88%. Unfortunately, he again experienced exertional dyspnea with flagrant cyanosis of the lip at 8.5 years old. SpO2 decreased to 65%. Echocardiography revealed a dysplastic pulmonary valve with severe stenosis. Considering the potential growth of the right ventricle and the branch pulmonary arteries, transjugular balloon pulmonary valvuloplasty (BPV) through a BGS was performed as a palliative treatment for cyanosis in this boy because of inaccessible femoral veins. After gradational BPV, the opening of the pulmonary valve was dilated from 2.59 mm to 6.65 mm, the pressure gradient decreased from 60 mmHg to 25 mmHg, and the SpO2 increased to 85%. He became physically active and was free of exertional dyspnea at the 12-month follow-up. BGS is irrefutably an alternative vascular access through which transjugular BPV could be performed to ameliorate cyanosis due to dysplastic pulmonary valve stenosis in patients with inaccessible femoral vessels.
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Affiliation(s)
- Meng-Luen Lee
- Division of Pediatric Cardiology, Department of Pediatrics, Changhua Christian Hospital, Changhua 50050, Taiwan.
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Margey R, Inglessis-Azuaje I. Percutaneous Therapies in the Treatment of Valvular Pulmonary Stenosis. Interv Cardiol Clin 2012; 1:101-119. [PMID: 28582060 DOI: 10.1016/j.iccl.2011.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Transcatheter balloon pulmonary valvuloplasty (BPV) is the standard of care in managing symptomatic patients with moderate-to-severe pulmonary valvular stenosis, or asymptomatic patients with severe pulmonary valvular stenosis or with moderate pulmonary stenosis and evidence of objective exercise intolerance or right ventricular dysfunction. This article discusses the incidence, causes, and pathophysiology of valvular pulmonary stenosis in adolescents and adults; its natural history and noninvasive evaluation; the current guideline-recommended indications for BPV; the technical aspects of performing BPV; the immediate and long-term outcomes after valvuloplasty; and the complications and safety of the procedure. Also discussed is the role of this procedure in neonatal critical pulmonary stenosis and in percutaneous pulmonary valve replacement for patients with prior pulmonic valve interventions or degenerated right ventricular pulmonary artery conduits.
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Affiliation(s)
- Ronan Margey
- Structural Heart Disease and Interventional Cardiology, Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | - Ignacio Inglessis-Azuaje
- Adult Congenital Heart Disease Intervention, Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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Abstract
A transjugular approach was successfully used for concurrent mitral-aortic and mitral-tricuspid valvuloplasty in one patient each. This approach simplifies antegrade transvenous aortic valve dilatation in rheumatic aortic stenosis. Advantages obtained by transjugular tricuspid valvuloplasty are easy crossing of the tricuspid valve and stable balloon position, co-axial with the tricuspid orifice.
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Affiliation(s)
- G Joseph
- Department of Cardiology, Christian Medical College Hospital, Vellore, India.
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