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Yan C. Is combined use of radiofrequency ablation and balloon dilation the future of interatrial communications? Expert Rev Cardiovasc Ther 2022; 20:895-903. [PMID: 36329641 DOI: 10.1080/14779072.2022.2144233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Personalized and stable interatrial communication is an important palliative therapy for patients with heart failure. However, this remains a technically challenging task. AREAS COVERED In the past decades, substantial advancements in atrial septostomy for the creation of controllable and durable interatrial communication have been made, and numerous novel devices and techniques are in various stages of development. In this review, we discuss the evolving indications for atrial septostomy, current approaches with or without device implantation, and indicators for optimal interatrial communication. The combined use of radiofrequency ablation and balloon dilation (CURB) is an individualized management approach based on underlying hemodynamics, which demonstrates unique advantages in creating a sufficient interatrial communication with satisfactory stability. The advantages and disadvantages of this implant-free procedure are analyzed and its clinical prospects are assessed. EXPERT OPINION With ready availability, high safety, and efficacy, CURB is a promising procedure for creating personalized and stable interatrial communication without device implantation. Further research is required to simplify the procedure, screen optimal reference parameters for personalized therapy, and evaluate the long-term outcome in a large population of patients.
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Affiliation(s)
- Chaowu Yan
- Department of Structural Heart Disease, Fuwai Hospital, 100037, Beijing, China
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2
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Retrograde Pulmonary Vein Recanalization Using Transcatheter Electrosurgery. JACC Case Rep 2022; 4:592-595. [PMID: 35615218 PMCID: PMC9125525 DOI: 10.1016/j.jaccas.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/24/2022] [Accepted: 03/28/2022] [Indexed: 11/20/2022]
Abstract
Transcatheter electrosurgery is a wire-based technique used to traverse or cut tissue within blood-filled spaces using alternating current delivered by guidewires or catheters. The use of transcatheter electrosurgical techniques in the pediatric population has been limited. We are reporting the first case of retrograde pulmonary vein recanalization using transcatheter electrosurgery. (Level of Difficulty: Advanced.)
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Mishra J. Atrial Septostomy and Atrial Septal Stenting: Role of Echocardiography. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2022. [DOI: 10.4103/jiae.jiae_9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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4
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Khan JM, Rogers T, Greenbaum AB, Babaliaros VC, Yildirim DK, Bruce CG, Herzka DA, Schenke WH, Ratnayaka K, Lederman RJ. Transcatheter Electrosurgery: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75:1455-1470. [PMID: 32216915 PMCID: PMC7184929 DOI: 10.1016/j.jacc.2020.01.035] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 01/28/2023]
Abstract
Transcatheter electrosurgery refers to a family of procedures using radiofrequency energy to vaporize and traverse or lacerate tissue despite flowing blood. The authors review theory, simulations, and benchtop demonstrations of how guidewires, insulation, adjunctive catheters, and dielectric medium interact. For tissue traversal, all but the tip of traversing guidewires is insulated to concentrate current. For leaflet laceration, the "Flying V" configuration concentrates current at the inner lacerating surface of a kinked guidewire. Flooding the field with non-ionic dextrose eliminates alternative current paths. Clinical applications include traversing occlusions (pulmonary atresia, arterial and venous occlusion, and iatrogenic graft occlusion), traversing tissue planes (atrial and ventricular septal puncture, radiofrequency valve repair, transcaval access, Potts and Glenn shunts), and leaflet laceration (BASILICA, LAMPOON, ELASTA-Clip, and others). Tips are provided for optimizing these techniques. Transcatheter electrosurgery already enables a range of novel therapeutic procedures for structural heart disease, and represents a promising advance toward transcatheter surgery.
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Affiliation(s)
- Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Medstar Washington Hospital Center, Washington, DC
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Medstar Washington Hospital Center, Washington, DC
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia
| | | | - Dursun Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - William H Schenke
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Kanishka Ratnayaka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; UCSD Rady Children's Hospital, San Diego, California
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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Cardiac Catheterization and Intervention in Pediatric Cardiac Disease: A Narrative Review of Current Indications, Techniques, and Complications. JOURNAL OF PEDIATRICS REVIEW 2017. [DOI: 10.5812/jpr.10815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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6
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Sandoval JP, Chaturvedi RR. A simple and fast technique for radiofrequency-assisted perforation of the atrial septum in congenital heart disease. Ann Pediatr Cardiol 2016; 9:39-41. [PMID: 27011690 PMCID: PMC4782466 DOI: 10.4103/0974-2069.171405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Radiofrequency (RF) assisted perforation of the atrial septum was performed successfully in three infants using a 0.035” RF wire deployed through a Williams right posterior catheter. Balloon atrial septoplasty was performed over the 0.035” RF wire in two of them, shortening the procedural time.
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Affiliation(s)
- Juan Pablo Sandoval
- Department of Pediatrics, Cardiac Diagnostic and Interventional Unit, The Hospital for Sick Children, The Labatt Family Heart Centre, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Rajiv R Chaturvedi
- Department of Pediatrics, Cardiac Diagnostic and Interventional Unit, The Hospital for Sick Children, The Labatt Family Heart Centre, University of Toronto School of Medicine, Toronto, Ontario, Canada
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Yoshida S, Suzuki T, Yoshida Y, Watanabe S, Nakamura K, Sasaki T, Kawasaki Y, Ehara E, Murakami Y, Kato T, Nakamura Y. Feasibility and safety of transseptal puncture procedures for radiofrequency catheter ablation in small children weighing below 30 kg: single-centre experience. Europace 2015; 18:1581-1586. [PMID: 26705553 DOI: 10.1093/europace/euv383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/26/2015] [Indexed: 12/22/2022] Open
Abstract
AIMS Transseptal puncture (TSP) has become a common approach in catheter ablation of arrhythmia originating from the left atrium. In paediatric patients, however, TSP can be a challenge due to narrower access vessels and small left atrial size, and the safety of TSP in smaller children is yet to be understood. The purpose of this study was to retrospectively evaluate the feasibility and safety of TSP in children weighing below 30 kg. METHODS AND RESULTS Among 655 paediatric patients who underwent catheter ablation of arrhythmia between July 2009 and April 2015, 43 cases having structurally normal hearts, weighing <30 kg and requiring TSP were included in the study. Age, height, body weight, diagnosis, and complications during TSP and catheter ablation were evaluated. The median age, height, and body weight (range) were 7.0 years (0.3-11.1), 116.8 cm (54.0-138.4 cm) and 21.5 kg (4.3-29.6 kg), respectively. Diagnosis included manifest (n = 27; 62.8%) and concealed accessory pathway (n = 14; 32.6%) and atrial tachycardia (n = 2; 4.6%). In 10 cases (23.2%), TSP using radiofrequency energy was performed. None of the patients had major complications. Pericardial effusion was recorded as a minor complication in one patient (2.3%). CONCLUSION TSP was feasible, safe, and of low risk of complications in children weighing <30 kg.
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Affiliation(s)
- Shuichiro Yoshida
- Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan .,Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Tsugutoshi Suzuki
- Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
| | - Yoko Yoshida
- Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
| | - Shigeo Watanabe
- Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
| | - Kae Nakamura
- Department of Pediatric Cardiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
| | - Takeshi Sasaki
- Department of Pediatric Cardiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
| | - Yuki Kawasaki
- Department of Pediatric Cardiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
| | - Eiji Ehara
- Department of Pediatric Cardiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
| | - Yosuke Murakami
- Department of Pediatric Cardiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
| | - Taichi Kato
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yoshihide Nakamura
- Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
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Moszura T, Góreczny S, Dryżek P. Hypoplastic left heart syndrome - a review of supportive percutaneous treatment. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 10:201-8. [PMID: 25489307 PMCID: PMC4252312 DOI: 10.5114/pwki.2014.45148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/18/2014] [Accepted: 09/01/2014] [Indexed: 12/01/2022] Open
Abstract
Due to the complex anatomical and haemodynamic consequences of hypoplastic left heart syndrome (HLHS), patients with the condition require multistage surgical and supportive interventional treatment. Percutaneous interventions may be required between each stage of surgical palliation, sometimes simultaneously with surgery as hybrid interventions, or after completion of multistage treatment. Recent advances in the field of interventional cardiology, including new devices and techniques, have significantly contributed to improving results of multistage HLHS palliation. Knowledge of the potential interventional options as well as the limitation of percutaneous interventions will enable the creation of safe and effective treatment protocols in this highly challenging group of patients. In this comprehensive review we discuss the types, goals, and potential complications of transcatheter interventions in patients with HLHS.
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Affiliation(s)
- Tomasz Moszura
- Department of Cardiology, Polish Mothers Memorial Hospital, Research Institute, Lodz, Poland
- Department of Paediatric Cardiology and Nephrology, Poznan University of Medical Sciences, Poland
| | - Sebastian Góreczny
- Department of Cardiology, Polish Mothers Memorial Hospital, Research Institute, Lodz, Poland
| | - Paweł Dryżek
- Department of Cardiology, Polish Mothers Memorial Hospital, Research Institute, Lodz, Poland
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Tapping CR, Uri IF, Dixon S, Bratby MJ, Anthony S, Uberoi R. Successful Recanalization of a Longstanding Right Common Iliac Artery Occlusion with a Radiofrequency Guidewire. Cardiovasc Intervent Radiol 2011; 35:1221-5. [DOI: 10.1007/s00270-011-0327-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 11/20/2011] [Indexed: 11/27/2022]
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Crystal MA, Mirza MA, Benson LN. A radiofrequency transseptal needle: Initial animal studies. Catheter Cardiovasc Interv 2010; 76:769-73. [DOI: 10.1002/ccd.22600] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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11
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Hijazi ZM, Awad SM. Pediatric cardiac interventions. JACC Cardiovasc Interv 2009; 1:603-11. [PMID: 19463373 DOI: 10.1016/j.jcin.2008.07.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 06/24/2008] [Accepted: 07/27/2008] [Indexed: 11/18/2022]
Abstract
The field of pediatric cardiac interventions has witnessed a dramatic increase in the number and type of procedures performed. We review the most common procedures performed in the catheter laboratory. Lesions are divided according to their physiological characteristics into left-to-right shunting lesions (atrial septal defect, patent ductus arteriosus, ventricular septal defect), right-to-left shunting lesions (pulmonary stenosis, pulmonary atresia/intact ventricular septum), right heart obstructive lesions (peripheral arterial pulmonic stenosis, right ventricular outflow tract obstruction), and left heart obstructive lesions (aortic valve stenosis, coarctation of the aorta). In addition, a miscellaneous group of lesions is discussed.
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Affiliation(s)
- Ziyad M Hijazi
- Department of Pediatrics, Section of Cardiology, Rush University Medical Center, Rush Center for Congenital and Structural Heart Disease, Chicago, Illinois 60637, USA.
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Peters B, Ewert P, Berger F. The role of stents in the treatment of congenital heart disease: Current status and future perspectives. Ann Pediatr Cardiol 2009; 2:3-23. [PMID: 20300265 PMCID: PMC2840765 DOI: 10.4103/0974-2069.52802] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Intravascular or intracardiac stenoses occur in many forms of congenital heart disease (CHD). Therefore, the implantation of stents has become an accepted interventional procedure for stenotic lesions in pediatric cardiology. Furthermore, stents are know to be used to exclude vessel aneurysm or to ensure patency of existing or newly created intracardiac communications. With the further refinement of the first generation of devices, a variety of "modern" stents with different design characteristics have evolved. Despite the tremendous technical improvement over the last 20 years, the "ideal stent" has not yet been developed. Therefore, the pediatric interventionalist has to decide which stent is suitable for each lesion. On this basis, currently available stents are discussed in regard to their advantages and disadvantages for common application in CHD. New concepts and designs developed to overcome some of the existing problems, like the failure of adaptation to somatic growth, are presented. Thus, in the future, biodegradable or growth stents might replace the currently used generation of stents. This might truly lead to widening indications for the use of stents in the treatment of CHD.
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Affiliation(s)
- Bjoern Peters
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany
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Gordon BM, Levi DS, Shannon KM. Electrosurgical energy in combination with a transseptal needle: A novel method for the creation of an atrial communication in hypoplastic left heart syndrome with intact atrial septum. Catheter Cardiovasc Interv 2009; 73:113-6. [DOI: 10.1002/ccd.21754] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kim E, Sobczyk WL, Yang S, Mascio C, Austin EH, Recto M. Restrictive tunnel patent foramen ovale and left atrial hypertension in single-ventricle physiology: implications for stent placement across the atrial septum. Pediatr Cardiol 2008; 29:1087-94. [PMID: 18685803 DOI: 10.1007/s00246-008-9262-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 03/29/2008] [Accepted: 06/06/2008] [Indexed: 11/25/2022]
Abstract
Our objective is to describe our approach to the management of patients with single-ventricle physiology and restrictive tunnel patent foramen ovale (TPFO) with unfavorable atrial septal morphology. We describe a series of five patients with single-ventricle physiology and restrictive TPFO and our experience with radiofrequency perforation (RFP), static balloon atrial septostomy (BAS), and stent implantation to create an alternative pathway for left atrial decompression. Between July 4, 2006, and July 10, 2007, five patients with single-ventricle physiology and restrictive TPFO were brought to the cardiac catheterization laboratory for decompression of a hypertensive left atrium. Four of five patients underwent RFP followed by static BAS and stent implantation across the newly created atrial communication. One patient had a stent placed across an existing TPFO. Unfortunately, stable stent position was not achieved in this case, and the patient required open atrial septectomy. In patients with single-ventricle physiology and a restrictive TPFO associated with left atrial hypertension, stent placement across the existing defect can result in unstable stent position. Using a RFP wire to create a new defect in the septum primum allows stable stent deployment across the atrial septum and achieves left atrial decompression.
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Affiliation(s)
- Edward Kim
- Division of Pediatric Cardiology, University of Louisville and Kosair Children's Hospital, KY 40202, USA.
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Almashham Y, Dahdah N, Miro J. Use of radiofrequency then stent implantation for recanalization of complete aorta coarctation. Pediatr Cardiol 2008; 29:207-9. [PMID: 17885781 DOI: 10.1007/s00246-007-9090-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 06/26/2007] [Accepted: 06/26/2007] [Indexed: 10/22/2022]
Abstract
Recanalization of a complete coarctation with isthmus occlusion was successfully accomplished in a 16-year-old patient using radiofrequency. This allowed the insertion and deployment of a covered stent to reestablish flow continuity across the isthmus. No complications were encountered. To the authors' knowledge this is the first case of radiofrequency use for complete coarctation, and among the rare cases of complete coarctation addressed primarily percutaneously to be reported.
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Affiliation(s)
- Y Almashham
- Pediatric Cardiology, Sainte-Justine Hospital, 3175 Cote Sainte-Catherine, Qc H3T 1C5 Montreal, Canada
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Cuenca Peiró V, Zabala Argüelles JI, Tejero Hernández A, Conejo Muñoz L. [Rashkind atrioseptostomy with cutting balloon catheter]. An Pediatr (Barc) 2007; 67:275-6. [PMID: 17785166 DOI: 10.1016/s1695-4033(07)70619-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Pedra CAC, Neves JR, Pedra SRF, Ferreiro CR, Jatene I, Cortez TM, Jatene M, Souza LCB, Assad R, Fontes VF. New transcatheter techniques for creation or enlargement of atrial septal defects in infants with complex congenital heart disease. Catheter Cardiovasc Interv 2007; 70:731-9. [PMID: 17621660 DOI: 10.1002/ccd.21260] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To describe a series of 8 consecutive infants (5 with transposition of the great arteries [TGA] and 3 with hypoplastic left heart syndrome [HLHS]) who underwent nonconventional septostomy techniques. BACKGROUND For some complex congenital heart defects, an unrestrictive atrial septal defect (ASD) is essential to achieve an adequate cardiac output and/or systemic saturation. In some scenarios, the use of conventional septostomy techniques may be technically difficult, hazardous, and/or ineffective. METHODS Use of transhepatic approach, cutting balloons, and radiofrequency perforation with stenting of the atrial septum. RESULTS The size of the ASD and the oxygen saturation increased in all patients with no major complications. In those with TGA, the ASDs were considered to be of good size at the arterial switch operation. Two of the 3 patients with hybrid palliation for HLHS have developed some degree of obstruction within the interatrial stent over 2-3 months. At surgery, the stents were found to be secured within the septum with one showing significant fibrous ingrowth after uneventful removal. The other had some nonobstructive ingrowth. CONCLUSIONS Creation or enlargement of ASDs in infants using new nonconventional transcatheter techniques is feasible, safe, and effective, at least in the short-to-mid-term follow-up. Infants with TGA seem to benefit the most because the procedure results in satisfactory clinical stability for subsequent early surgical intervention. In infants with HLHS palliated by a hybrid approach, stent implantation to the atrial septum seems to buy enough time to bring them to the phase II safely despite progressive in-stent obstruction.
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Affiliation(s)
- Carlos A C Pedra
- Pediatric Cardiology Division, Hospital do Coração da Associação Sanatório Sírio, São Paulo, SP, Brazil.
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Eicken A, Gildein HP, Schreiber C, Balling G, Hess J. Stenting of a restrictive foramen ovale in a patient with hypoplastic left heart syndrome. Int J Cardiol 2006; 113:254-6. [PMID: 16309763 DOI: 10.1016/j.ijcard.2005.08.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Accepted: 08/29/2005] [Indexed: 11/24/2022]
Abstract
Neonates with a severely restrictive foramen ovale and hypoplastic left heart syndrome (HLHS) present as an emergency. We report the case of a newborn in whom left atrial decompression was successfully achieved by stent implantation into the foramen ovale on the first day of life.
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Baerlocher MO, Asch MR, Myers A. Successful Recanalization of a Longstanding Complete Left Subclavian Vein Occlusion by Radiofrequency Perforation with Use of a Radiofrequency Guide Wire. J Vasc Interv Radiol 2006; 17:1703-6. [PMID: 17057015 DOI: 10.1097/01.rvi.0000243637.23923.a7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Treatment with radiofrequency (RF) energy can be used to ablate or perforate tissues. The latter involves lower power, higher voltage, and much shorter treatment time, and it is thought to induce much less collateral tissue damage. To date, RF perforation has been successfully used for various cardiac interventions; however, to our knowledge, there has not been a report of its use for peripheral vascular disease. This report describes the successful recanalization of a longstanding occlusion of a left subclavian vein in a 73-year-old woman with polycystic kidney disease and end-stage renal disease undergoing chronic hemodialysis treatment via an upper-extremity arteriovenous fistula. Multiple previous attempts at mechanical recanalization were unsuccessful. Recanalization was achieved by RF perforation with use of a PowerWire RF guide wire.
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Affiliation(s)
- Mark O Baerlocher
- Department of Interventional Radiology, University Health Network and Mount Sinai Hospital, University of Toronto, Ontario, Canada.
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Wilson N. A whole new way to make a hole-or a whole new wheel? Catheter Cardiovasc Interv 2005; 65:564. [PMID: 16010687 DOI: 10.1002/ccd.20418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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