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Piccinelli E, Frazzetto F, Pilati M, Butera G. Stent Implantation Across the Atrial Flow Regulator Device. Pediatr Cardiol 2024; 45:695-698. [PMID: 38308059 DOI: 10.1007/s00246-024-03405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/04/2024] [Indexed: 02/04/2024]
Abstract
The Atrial Flow Regulator (AFR) is a self-expandable double-disc device with a central fenestration, intended to maintain a calibrated communication across the interatrial septum. We reported for the first time a stent implantation across an AFR device in an adolescent born with complex congenital heart disease with duct-dependent systemic circulation and severe combined pulmonary hypertension.
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Affiliation(s)
- Enrico Piccinelli
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
- Polito BIO Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Fausto Frazzetto
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Mara Pilati
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
| | - Gianfranco Butera
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy.
- Pediatric Cardiology Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy.
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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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Yan C, Wan L, Li H, Wang C, Guo T, Niu H, Li S, Yundan P, Wang L, Fang W. First in-human modified atrial septostomy combining radiofrequency ablation and balloon dilation. Heart 2022; 108:1690-1698. [PMID: 35676068 DOI: 10.1136/heartjnl-2022-321212] [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] [Received: 04/05/2022] [Accepted: 05/18/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Preclinical research suggests that the combined use of radiofrequency ablation and balloon dilation (CURB) could create stable interatrial communications without device implantation. This study examined the first in-human use of CURB for modified atrial septostomy in patients with severe pulmonary arterial hypertension (PAH). METHODS Between July 2018 and October 2021, CURB was performed in 19 patients with severe PAH (age: 31.5±9.1 years; mean pulmonary artery pressure: 73 mm Hg (IQR: 66-92); pulmonary vascular resistance: 18.7 Wood units (IQR: 17.8-23.3)). Under guidance of intracardiac echocardiography and three-dimensional location system, (1) fossae ovalis was reconstructed and ablated point-by-point with radiofrequency; (2) then graded balloon dilation was performed after transseptal puncture and the optimal size was determined according to the level of arterial oxygen saturation (SatO2); (3) radiofrequency ablation was repeated around the rims of the created fenestration. The interatrial fenestrations were followed-up serially. RESULTS After CURB, the immediate fenestration size was 4.4 mm (IQR: 4.1-5.1) with intracardiac echocardiography, systolic aortic pressure increased by 10.2±6.9 mm Hg, cardiac index increased by 0.7±0.3 L/min/m2 and room-air resting SatO2 decreased by 6.2±1.9% (p<0.001). One patient experienced increased pericardiac effusion postoperatively; the others had no complications. On follow-up (median: 15.5 months), all interatrial communications were patent with stable size (intraclass correlation coefficient=0.96, 95%CI:0.89 to 0.99). The WHO functional class increased by 1 (IQR: 1-2) (p<0.001) with improvement of exercise capacity (+159.5 m, P<0.001). CONCLUSION The interatrial communications created with CURB in patients with severe PAH were stable and the mid-term outcomes were satisfactory. TRIAL REGISTRATION NUMBER NCT03554330.
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Affiliation(s)
- Chaowu Yan
- Department of Structural Heart Disease, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Linyuan Wan
- Department of Echocardiography, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Hua Li
- Department of Cardiology, Beijing Tongren Hospital, Beijing, China
| | - Cheng Wang
- Department of Cardiology, Xuzhou Medical University Affiliated Hospital, Xuzhou, Jiangsu, China
| | - Tingting Guo
- Center for Respiratory and Pulmonary Vascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Hanxu Niu
- Johnson and Johnson Medical China Ltd, Shanghai, China
| | - Shiguo Li
- Department of Structural Heart Disease, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Pingcuo Yundan
- Department of Structural Heart Disease, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Lei Wang
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Wei Fang
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
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Morgan KRS, Stauthammer CD, Gruenstein D. Transmembrane stent placement for cor triatriatum dexter in 6 dogs. J Vet Cardiol 2022; 41:79-87. [DOI: 10.1016/j.jvc.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
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5
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Nishibata M, Kitano M, Sato S. Radiofrequency Energy-Assisted Wire Atrial Septostomy to Easily Create a Large Atrial Septal Defect. World J Pediatr Congenit Heart Surg 2021; 12:778-782. [PMID: 34846963 PMCID: PMC8637369 DOI: 10.1177/21501351211037640] [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] [Indexed: 11/16/2022]
Abstract
Wire atrial septostomy, a new transcatheter technique, combines 2 atrial septal defects
(ASDs) into a large one in a thickened atrial septum. Although the thin-wire-looped atrial
septum between ASDs needs to be pulled deeply into a hard catheter to tear the septum,
this action might harm the surrounding cardiac structures. We utilized radiofrequency wire
energy to facilitate the tearing of the septum, making the procedure easier and safer.
This technical article presents the modified procedure in detail; the procedure was
performed in a 6-month-old boy with double outlet right ventricle and intact ventricular
septum.
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Affiliation(s)
- Masahiro Nishibata
- 156978Okinawa Prefectural13875Nanbu Medical Center & Children's Medical Center, Shimaziri, Japan
| | - Masataka Kitano
- 156978Okinawa Prefectural13875Nanbu Medical Center & Children's Medical Center, Shimaziri, Japan
| | - Seiich Sato
- 156978Okinawa Prefectural13875Nanbu Medical Center & Children's Medical Center, Shimaziri, Japan
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Nagatomo Y, Nagata H, Yamamura K, Ohga S. Modified wire atrial septostomy with a reverse transseptal puncture in an infant: Case report. Catheter Cardiovasc Interv 2021; 97:865-868. [PMID: 33539042 DOI: 10.1002/ccd.29514] [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] [Received: 10/19/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 11/08/2022]
Abstract
We report a modified technique of wire atrial septostomy (WAS) with a reverse transseptal puncture (TSP) in an infant case of pulmonary atresia with intact ventricular septum. A radiofrequency (RF) wire was advanced to the septum through a 4 Fr pigtail catheter hooked on the left side of atrial septum and RF energy was applied while advancing the wire across the septum. Following that reverse TSP, WAS was performed to cut the septal tissue using a 0.010 microwire and RF wire. The atrial septum defect (ASD) was enlarged to a size of 15 mm. WAS with a reverse TSP could be a useful and safe method to enlarge ASD in infants with congenital heart diseases.
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Affiliation(s)
- Yusaku Nagatomo
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University Hospital, Fukuoka, Japan
| | - Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University Hospital, Fukuoka, Japan
| | - Kenichiro Yamamura
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University Hospital, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University Hospital, Fukuoka, Japan
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8
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Mainzer G, Goreczny S, Morgan GJ, Qureshi S, Krasemann T, Dryzek P, Moll JA, Moszura T, Rosenthal E. Stenting of the inter-atrial septum in infants and small children: Indications, techniques and outcomes. Catheter Cardiovasc Interv 2018; 91:1294-1300. [DOI: 10.1002/ccd.27462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 11/04/2017] [Accepted: 11/29/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Gur Mainzer
- Department of Paediatric Cardiology; Evelina London Children's Hospital, Guy's and St. Thomas' Hospital; London United Kingdom
- Paediatric Cardiology Unit, Padeh-Poriya Medical Center; Tiberias Israel
| | - Sebastian Goreczny
- Cardiology Department; Polish Mother's Memorial Hospital, Research Institute; Lodz Poland
| | - Gareth J. Morgan
- Department of Paediatric Cardiology; Evelina London Children's Hospital, Guy's and St. Thomas' Hospital; London United Kingdom
- Department of Congenital Cardiology; University of Colorado; Denver Colorado
| | - Shakeel Qureshi
- Department of Paediatric Cardiology; Evelina London Children's Hospital, Guy's and St. Thomas' Hospital; London United Kingdom
| | - Thomas Krasemann
- Department of Paediatric Cardiology; Evelina London Children's Hospital, Guy's and St. Thomas' Hospital; London United Kingdom
- Department of Pediatric Cardiology; Erasmus Medical Centre; Rotterdam Netherlands
| | - Pawel Dryzek
- Cardiology Department; Polish Mother's Memorial Hospital, Research Institute; Lodz Poland
| | - Jadwiga A Moll
- Cardiology Department; Polish Mother's Memorial Hospital, Research Institute; Lodz Poland
| | - Tomasz Moszura
- Cardiology Department; Polish Mother's Memorial Hospital, Research Institute; Lodz Poland
| | - Eric Rosenthal
- Department of Paediatric Cardiology; Evelina London Children's Hospital, Guy's and St. Thomas' Hospital; London United Kingdom
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9
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Kitano M, Tsukada M, Fujino M. Wire Atrial Septostomy: A New Technique to Create a Large Defect in a Thickened Atrial Septum. World J Pediatr Congenit Heart Surg 2017; 11:NP18-NP21. [PMID: 28415904 DOI: 10.1177/2150135116686929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Both balloon atrial septostomy and static balloon dilation are often ineffective in creating a large atrial septal defect in patients with a thickened atrial septum. In such situations, blade atrial septostomy and atrial septal stenting are alternative treatments. We have devised and performed a new technique, called wire atrial septostomy, which uses a thin soft wire to create a large defect. The details of the procedure are presented.
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Affiliation(s)
- Masataka Kitano
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Fujishirodai, Suita, Osaka, Japan
| | - Masanori Tsukada
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Fujishirodai, Suita, Osaka, Japan
| | - Mistuhiro Fujino
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Fujishirodai, Suita, Osaka, Japan
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Abraham BP, Gilliam E, Kim DW, Wolf MJ, Vincent RN, Petit CJ. Early catheterization after initiation of extracorporeal membrane oxygenation support in children is associated with improved survival. Catheter Cardiovasc Interv 2016; 88:592-599. [PMID: 27037743 DOI: 10.1002/ccd.26526] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/20/2015] [Accepted: 02/27/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The study evaluated the institutional experience with cardiac catheterization on extracorporeal membrane oxygenation (ECMO) support. BACKGROUND There is scant literature on the outcomes of catheterization on ECMO. METHODS A retrospective review was performed of all children who underwent catheterization on ECMO from 2003 to 2013. Patients were categorized as cardiomyopathy (CM) or congenital heart disease (CHD). RESULTS During the study period, 215 children were placed on cardiac ECMO. Of these, 29.8% underwent 75 catheterization procedures while on ECMO support. The median age of the cohort was 1.5 months (range 0 days -16.7 years) and the median weight was 3.9 kg (2.2-63.1 kg). CM patients constituted 18.8% of the cohort and all of them underwent atrial septoplasty (an atrial septal stent in 7/12 and balloon atrial septoplasty or septostomy in 5). The survival to hospital discharge rate was 83% and the transplant-free survival rate was 58.3%. CHD patients constituted 81.2% of the cohort. In this group, transcatheter interventions were performed in 40.4% and subsequent surgical interventions in 40.4%. Survival to hospital discharge rate was 34.6% and transplant free survival rate was 32.7%. Overall, 76.7% underwent transcatheter or surgical interventions. The major catheterization complication rate was 6.7%. The mean ECMO-to-catheterization time was 1.6 days for survivors and 3.5 days for non-survivors (P = 0.034). Survival to discharge was better for the CM group compared to the CHD group (P = 0.01). Among CHD, survival was better with transcatheter interventions compared to no interventions or surgical interventions (P < 0.001). CONCLUSIONS Cardiac catheterization and transcatheter interventions on ECMO can be performed with low rate of complications. Catheterization was associated with high rate of interventions. Better survival to hospital discharge was associated with transcatheter interventions, earlier performance of catheterization after ECMO and diagnosis of CM. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Boban P Abraham
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Erikka Gilliam
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Dennis W Kim
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Michael J Wolf
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Robert N Vincent
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Christopher J Petit
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
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Amat-Santos IJ, Cabau JR, López J. Left-to-right interatrial shunt percutaneously implanted devices: a new avenue in the treatment of heart failure. Interv Cardiol 2015. [DOI: 10.2217/ica.15.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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12
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Amat-Santos IJ, Bergeron S, Bernier M, Allende R, Barbosa Ribeiro H, Urena M, Pibarot P, Verheye S, Keren G, Yaacoby M, Nitzan Y, Abraham WT, Rodés-Cabau J. Left atrial decompression through unidirectional left-to-right interatrial shunt for the treatment of left heart failure: first-in-man experience with the V-Wave device. EUROINTERVENTION 2015; 10:1127-31. [PMID: 24832489 DOI: 10.4244/eijy14m05_07] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS Elevated filling pressures of the left atrium (LA) are associated with poorer outcomes in patients with chronic heart failure. The V-Wave is a new percutaneously implanted device intended to decrease the LA pressure by the shunting of blood from the LA to the right atrium. This report describes the first-in-man experience with the V-Wave device. METHODS AND RESULTS A 70-year-old man with a history of heart failure of ischaemic origin, left ventricular dysfunction (LVEF: 35%, pulmonary wedge: 19 mmHg), no right heart dysfunction, NYHA Class III and orthopnoea despite optimal treatment, was accepted for V-Wave device implantation. The device consists of an ePTFE encapsulated nitinol frame that is implanted at the level of the interatrial septum and contains a trileaflet pericardium tissue valve sutured inside which allows a unidirectional LA to right atrium shunt. The procedure was performed through a transfemoral venous approach under fluoroscopic and TEE guidance. The device was successfully implanted and the patient was discharged 24 hours after the procedure with no complications. At three-month follow-up a left-to-right shunt through the device was confirmed by TEE. The patient was in NYHA Class II, without orthopnoea, the Kansas City Cardiomyopathy index was 77.6 (from 39.1 at baseline) and NT-proBNP was 322 ng/mL (from 502 ng/mL at baseline). The QP/QS was 1.17 and the pulmonary wedge was 8 mmHg, with no changes in pulmonary pressure or right ventricular function. CONCLUSIONS Left atrial decompression through a unidirectional left-to-right interatrial shunt represents a new concept for the treatment of patients with left ventricular failure. The present report shows the feasibility of applying this new therapy with the successful and uneventful implantation of the V-Wave device, which was associated with significant improvement in functional, quality of life and haemodynamic parameters at 90 days.
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Affiliation(s)
- Ignacio J Amat-Santos
- Department of Cardiology, Quebec Heart & Lung Institute, Quebec City, Quebec, Canada
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Amat-Santos IJ, Nombela-Franco L, García B, Tobar J, Rodés-Cabau J, San Román JA. The V-Wave Device for the Treatment of Heart Failure. Initial Experience in Europe. ACTA ACUST UNITED AC 2015; 68:808-10. [DOI: 10.1016/j.rec.2015.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/20/2015] [Indexed: 11/16/2022]
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Dispositivo V-Wave para el tratamiento de la insuficiencia cardiaca. Experiencia inicial en Europa. Rev Esp Cardiol (Engl Ed) 2015. [DOI: 10.1016/j.recesp.2015.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Yi LY, Liang X, Liu DM, Sun B, Ying S, Yang DB, Li QB, Jiang CL, Han Y. Disrupted topological organization of resting-state functional brain network in subcortical vascular mild cognitive impairment. CNS Neurosci Ther 2015; 21:846-54. [PMID: 26257386 DOI: 10.1111/cns.12424] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 01/21/2023] Open
Abstract
AIMS Neuroimaging studies have demonstrated both structural and functional abnormalities in widespread brain regions in patients with subcortical vascular mild cognitive impairment (svMCI). However, whether and how these changes alter functional brain network organization remains largely unknown. METHODS We recruited 21 patients with svMCI and 26 healthy control (HC) subjects who underwent resting-state functional magnetic resonance imaging scans. Graph theory-based network analyses were used to investigate alterations in the topological organization of functional brain networks. RESULTS Compared with the HC individuals, the patients with svMCI showed disrupted global network topology with significantly increased path length and modularity. Modular structure was also impaired in the svMCI patients with a notable rearrangement of the executive control module, where the parietal regions were split out and grouped as a separate module. The svMCI patients also revealed deficits in the intra- and/or intermodule connectivity of several brain regions. Specifically, the within-module degree was decreased in the middle cingulate gyrus while it was increased in the left anterior insula, medial prefrontal cortex and cuneus. Additionally, increased intermodule connectivity was observed in the inferior and superior parietal gyrus, which was associated with worse cognitive performance in the svMCI patients. CONCLUSION Together, our results indicate that svMCI patients exhibit dysregulation of the topological organization of functional brain networks, which has important implications for understanding the pathophysiological mechanism of svMCI.
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Affiliation(s)
- Li-Ye Yi
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xia Liang
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Da-Ming Liu
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bo Sun
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Sun Ying
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dong-Bo Yang
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qing-Bin Li
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chuan-Lu Jiang
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ying Han
- Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China.,Department of Neurology, XuanWu Hospital, Capital Medical University, Beijing, China
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Abstract
A wide atrial communication is important to maintain hemodynamics in certain forms of congenital and acquired heart defects. In comparison to balloon septostomy or blade septostomy, atrial septal stenting provides a controlled, predictable, and long-lasting atrial communication. It often needs a prior Brockenbrough needle septal puncture to obtain a stable stent position. A stent deployed across a previously dilated and stretched oval foramen or tunnel form of oval foramen carries higher risk of embolization. This review provides technical tips to achieve a safe atrial septal stenting. Even though this is a “How to do it article,” an initial discussion about the indications for atrial septal stenting is vital as the resultant size of the atrial septal communication should be tailored for each indication.
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Affiliation(s)
- Kothandam Sivakumar
- Department of Pediatric Cardiology, The Madras Medical Mission, Chennai, Tamil Nadu, India
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17
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Veeram Reddy SR, Guleserian KJ, Nugent AW. Transcatheter removal of atrial septal stent placed to decompress left atrium with VA ECMO. Catheter Cardiovasc Interv 2015; 85:1021-5. [PMID: 25573324 DOI: 10.1002/ccd.25817] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/17/2014] [Accepted: 01/03/2015] [Indexed: 11/10/2022]
Abstract
Left atrial (LA) decompression in infants with thick atrial septum placed on veno-arterial extracorporeal membrane oxygenation (ECMO) can be reliably achieved with transcatheter atrial septal (AS) stent placement. However, with myocardial recovery and ECMO decannulation the stent causes a permanent left to right shunt and surgical removal of the AS stent is usually accomplished. Transcatheter removal of AS stent is an attractive option as the advantages of LA decompression would then be coupled with the advantage of avoiding a sternotomy for surgical removal of the stent. To our knowledge, this is the first reported case of successful transcatheter retrieval of AS stent used for LA decompression in a 13-month-old child.
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Pushparajah K, Hayes N, Durward A, Qureshi S, Austin CB, Rosenthal E. Stenting the Atrial Septum: A Hybrid Approach Guided Solely by Echocardiography. J Card Surg 2014; 29:561-3. [DOI: 10.1111/jocs.12310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kuberan Pushparajah
- Department of Congenital Heart Disease; Evelina London Children's Hospital; London United Kingdom
| | - Nicholas Hayes
- Department of Congenital Heart Disease; Evelina London Children's Hospital; London United Kingdom
| | - Andrew Durward
- Paediatric Intensive Care Unit; Evelina London Children's Hospital; London United Kingdom
| | - Shakeel Qureshi
- Department of Congenital Heart Disease; Evelina London Children's Hospital; London United Kingdom
| | - Conal B. Austin
- Department of Congenital Heart Disease; Evelina London Children's Hospital; London United Kingdom
| | - Eric Rosenthal
- Department of Congenital Heart Disease; Evelina London Children's Hospital; London United Kingdom
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Feltes TF, Bacha E, Beekman RH, Cheatham JP, Feinstein JA, Gomes AS, Hijazi ZM, Ing FF, de Moor M, Morrow WR, Mullins CE, Taubert KA, Zahn EM. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 2011; 123:2607-52. [PMID: 21536996 DOI: 10.1161/cir.0b013e31821b1f10] [Citation(s) in RCA: 484] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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20
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Rupp S, Michel-Behnke I, Valeske K, Akintürk H, Schranz D. Implantation of stents to ensure an adequate interatrial communication in patients with hypoplastic left heart syndrome. Cardiol Young 2007; 17:535-40. [PMID: 17612414 DOI: 10.1017/s104795110700090x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS To assess the feasibility of interatrial stenting for left atrial decompression in infants with hypoplastic left heart syndrome treated by a "hybrid-approach", with bilateral surgical banding of the pulmonary arteries and percutaneous stenting of the arterial duct. PATIENTS AND METHODS We stented the atrial septum in 5 infants aged from 21 to 77 days, making the intervention as an elective procedure in 4, but as a rescue procedure in the fifth patient, who had a restrictive foramen. The stents, comprising 2 Jo-stents of 17 millimetres hand-crimped on a balloon catheter with dimensions of 10 by 20 millimetres, and 3 premounted Genesis stents with dimensions of 10 by 19 millimetres, were placed using a 6 French long or short sheath by femoral venous access. The stents were expanded under fluoroscopic guidance to create a slightly diabolo-shaped form that fitted the septum. RESULTS The percutaneous interventions were successfully performed in all cases, producing significant improvement in clinical condition after placement. The saturations of oxygen increased from an average of 64% plus or minus 18% to 88% plus or minus 7%, (p < 0.05). During a mean follow up of 2.5 months, without any anticoagulant therapy, there were no complications related to the stenting. Surgical removal of the stents was uneventful during reconstruction of the aortic arch and creation of a bidirectional cavopulmonary connection in 4 patients, and during cardiac transplantation in one. CONCLUSION In the context of the hybrid approach, definitive decompression of the left atrium can be achieved by stenting the atrial septum in infants with hypoplastic left heart syndrome. Placement of the stents is safe and effective, with insertion in the form of a diabolo reducing the risk of dislocation, as well as embolisation of the stent.
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Affiliation(s)
- Stefan Rupp
- Paediatric Heart Centre, University Clinic Giessen-Marburg, Germany
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Abstract
Graded balloon septostomy, bladed atrial septostomy, fenestrated Amplatzer devices and stent placement have been reported to obtain stable interatrial communications. We expose our favorable experience creating an interatrial septal defect, by the use of two stents concentrically placed. We think it can be a procedure to be taken into account whenever a wide interauricular septal orifice must be achieved.
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Affiliation(s)
- Josep Girona
- Pediatric Cardiology Unit and Adult Cardiology Service, Vall d'Hebron Hospital, 08035 Barcelona, Spain.
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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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Williams RJ, Levi DS, Moore JW, Boechat MI. Radiographic appearance of pediatric cardiovascular transcatheter devices. Pediatr Radiol 2006; 36:1231-41; quiz 1332-3. [PMID: 16896694 DOI: 10.1007/s00247-006-0254-7] [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: 01/17/2006] [Revised: 05/04/2006] [Accepted: 05/23/2006] [Indexed: 10/24/2022]
Abstract
The treatment of congenital heart disease has been revolutionized by the availability of transcatheter devices. These advances in interventional pediatric cardiology require that both treating physicians and radiologists develop a more thorough understanding of the appearance of these devices on chest radiographs. Furthermore, recognition of appropriate versus inappropriate placement of transcatheter devices is essential to the care of patients with congenital heart disease. Knowledge of the radiographic appearance of devices used by interventional pediatric cardiologists can allow a radiologist to make better clinical assessments and detect possible complications given a limited clinical history.
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Affiliation(s)
- Ryan J Williams
- Division of Pediatric Cardiology, Mattel Children's Hospital at UCLA, Los Angeles, CA, USA
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Fraisse A, Chetaille P, Amin Z, Rouault F, Humbert M. Use of Amplatzer fenestrated atrial septal defect device in a child with familial pulmonary hypertension. Pediatr Cardiol 2006; 27:759-62. [PMID: 17111292 DOI: 10.1007/s00246-006-1325-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Accepted: 06/09/2006] [Indexed: 10/23/2022]
Abstract
In a 4.5-year-old child with refractory pulmonary arterial hypertension, we performed atrial septostomy with the application of an Amplatzer fenestrated device designed to maintain patency. Continuous intravenous epoprostenol infusion was started concomitantly. Forty-two months after the procedure, the patient had no recurrent syncope and remained in New York Heart Association functional class II. Fenestration of the atrial septum is feasible in children with pulmonary artery hypertension. No conclusion regarding the patient's need for an atrial septal defect can be drawn since concomitant prostanoid therapy was administered. The long-term patency of the atrial communication needs further confirmation and the optimal timing for its application has to be determined.
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Affiliation(s)
- Alain Fraisse
- Cardiologie Pédiatrique, Département de cardiologie, Hôpital de la Timone, 264 rue St Pierre, 13385, Cedex 05, Marseille, France.
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Leonard GT, Justino H, Carlson KM, Rossano JW, Neish SR, Mullins CE, Grifka RG. Atrial Septal Stent Implant: Atrial Septal Defect Creation in the Management of Complex Congenital Heart Defects in Infants. CONGENIT HEART DIS 2006; 1:129-35. [DOI: 10.1111/j.1747-0803.2006.00022.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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