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Yeh MJ, Gauvreau K, Armstrong AK, Batlivala SP, Callahan R, Gudausky TM, Hainstock MR, Hasan B, Nicholson GT, O'Byrne ML, Shahanavaz S, Trucco S, Zampi JD, Bergersen L. Early Postoperative Congenital Cardiac Catheterization Outcomes: A Multicenter Study. Ann Thorac Surg 2022:S0003-4975(22)01528-4. [PMID: 36481325 DOI: 10.1016/j.athoracsur.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND Early postoperative catheterizations (EPOCs) within 6 weeks after a congenital heart surgical procedure can treat residual lesions and provide important clinical information. However, EPOCs are often assumed to impose additional risk on a vulnerable patient population. This study aimed to describe the EPOC population, evaluate procedural safety, compare EPOC patients with procedure-matched non-EPOC patients, and determine risk factors for poor outcomes using data from the Congenital Cardiac Catheterization Project on Outcomes registry. METHODS In a retrospective cohort, demographic, clinical, and procedural characteristics were analyzed for diagnostic and interventional catheterizations performed in 13 participating institutions from January 2014 to December 2017, excluding patients after heart transplant. The primary outcome was a high-severity adverse event (AE). Three distinct analyses included (1) describing the full cohort and EPOC patients, (2) comparing EPOC patients with and without a high-severity AE, and (3) comparing EPOC patients with controls matched on case type. RESULTS This study included 17,776 catheterizations, with 1399 EPOCs. The high-severity AE rate was 6.4% overall, 8.9% in the EPOC cohort, and 8.4% in matched controls (P = .74). The association between EPOC status and high-severity AE was not significant in a multivariable model (P = .17). In EPOCs with a high-severity AE, median procedure duration was 30 minutes longer (P < .001), and median time from surgical procedure to catheterization was 3 days longer (P = .05). CONCLUSIONS EPOC was not associated with additional risk. Individual patient characteristics of size and hemodynamic vulnerability may serve as informative predictors. Timely catheterization may preempt further clinical deterioration, and intraprocedure duration optimization may correlate with improved outcomes.
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Affiliation(s)
- Mary J Yeh
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | | | - Sarosh P Batlivala
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ryan Callahan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Todd M Gudausky
- Division of Pediatric Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin; Herma Heart Institute, Children's Wisconsin, Milwaukee, Wisconsin
| | - Michael R Hainstock
- Division of Pediatric Cardiology, University of Virginia Children's Heart Center, Charlottesville, Virginia
| | - Babar Hasan
- Department of Pediatric and Child Health, The Aga Khan University, Karachi, Pakistan
| | - George T Nicholson
- Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael L O'Byrne
- Division of Cardiology and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shabana Shahanavaz
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sara Trucco
- Division of Pediatric Cardiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jeffrey D Zampi
- Division of Pediatric Cardiology, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Lisa Bergersen
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
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Haddad RN, Lange JM, Raisky O, Gaudin R, Barbanti C, Bonnet D, Malekzadeh-Milani S. Indications and outcomes of cardiac catheterization following congenital heart surgery in children. Eur J Cardiothorac Surg 2022; 61:1056-1065. [PMID: 35076064 DOI: 10.1093/ejcts/ezac026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/20/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Our goal was to evaluate the indications for postoperative cardiac catheterizations after paediatric cardiac surgeries and their impact on outcomes. METHODS Non-planned cardiac catheterizations performed after congenital heart surgeries and before discharge between January 2013 and July 2019 were reviewed. Hybrid procedures were excluded. Heart defects, illness course, surgeries and catheter procedures were classified. Indications and findings were comprehensively regrouped. Outcomes were analysed. RESULTS Cardiac catheterizations were performed on 192 patients (median age 2.3 months, weight 4.2 kg) on median postoperative day 7 (interquartile range, 2-17 days). Patients had defects of great complexity (79.9%), high disease severity index (46.4%), high Aristotle level of surgical complexity (75%) and a high Catheterization RISk Score for Pediatrics category of catheterizations (61%). Catheterizations confirmed 66% of suspected diagnoses. Confirmed diagnoses were more likely to be haemodynamic anomalies than anatomical lesions (81.3% > 53.7%, P < 0.001). Confirmed anatomical lesions were more likely to be residual than new lesions created by surgery (88.5% > 40.4%, P < 0.001). New diagnoses were identified in 36.5% of patients. Catheterization findings led to catheter-based or surgical interventions in 120 (62.5%) patients. Transcatheter interventions were successful (97.7%), immediate (89.5%) and performed across fresh suture lines (27.8%). Repeat catheterizations (76% interventional) were necessary in 25 (13%) patients. A high index of disease severity [odds ratio (OR): 16.26, 95% confidence interval (CI): 3.72-71.17], extracorporeal membrane oxygenation support (OR: 10.35, 95% CI: 2.78-38.56), delayed sternal closure (OR: 4.66, 95% CI: 1.25-17.32) and surgically acquired lesions (OR: 3.70, 95% CI: 1.22-11.16) were significant risk factors of 12-month mortality. CONCLUSIONS Postoperative cardiac catheterizations answer both anatomical and haemodynamic questions in high-risk patients with complicated courses and guide subsequent treatment with satisfactory outcomes.
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Affiliation(s)
- Raymond N Haddad
- Department of Congenital and Pediatric Cardiology, M3C-Necker, Necker-Enfants malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Juan Manuel Lange
- Department of Congenital and Pediatric Cardiology, M3C-Necker, Necker-Enfants malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Olivier Raisky
- Department of Pediatric Cardiac Surgery, Necker-Enfants malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,University of Paris, Paris, France
| | - Regis Gaudin
- Department of Pediatric Cardiac Surgery, Necker-Enfants malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Claudio Barbanti
- Division of Pediatric Cardiac Anesthesia, Department of Pediatric Cardiac Surgery, Necker-Enfants malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Damien Bonnet
- Department of Congenital and Pediatric Cardiology, M3C-Necker, Necker-Enfants malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,University of Paris, Paris, France
| | - Sophie Malekzadeh-Milani
- Department of Congenital and Pediatric Cardiology, M3C-Necker, Necker-Enfants malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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Abstract
BACKGROUND Catheter interventions for residual lesions in the early postoperative period after CHD operations are still not established as a reliable treatment option. METHODS We retrospectively reviewed our institutional experience of cardiac catheterisations and catheter interventions performed in the early postoperative period. We classified our patients into two groups. The "hyper" acute phase group - operation to cardiac catheterisation of ⩽7 days - and acute phase group - operation to cardiac catheterisation from 7 to 30 days. RESULTS Of the 47 patients, catheter interventions were performed in 38 patients (81%). The success rate of the intervention was 96% in the acute phase group and 90% in the "hyper" acute phase group. The overall success rate was 95%. There were two self-limited complications in the acute phase group, but not in the "hyper" acute phase group. There were four cases of catheter interventions performed for a newly reconstructed aortic arch, and those procedures were also safe and effective. CONCLUSIONS Cardiac catheterisations and catheter interventions were safe and effective not only in the early postoperative period but also in the very early postoperative period. Catheter interventions for the left-sided heart in the early postoperative period were also safe and effective.
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Mowers K, Rockefeller T, Balzer D, Nicolas R, Shahanavaz S. Post-operative Catheterization Interventions at the Site of Surgery: An Application of the CRISP Scoring System. Pediatr Cardiol 2018; 39:674-681. [PMID: 29327147 DOI: 10.1007/s00246-018-1805-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
Abstract
Catheter-based interventions in the early post-operative period are performed with caution due to concerns for increased procedural risk, particularly across fresh suture lines. The recently published CRISP scoring system provides prospective risk stratification based on pre-procedural criterion. In an effort to refine the assessment of risk in patients undergoing post-operative catheter-based interventions, the predicted risk of an adverse event based on CRISP scores was compared to actual adverse event rates. A single-center, retrospective review of patients undergoing catheterization interventions within 6 weeks of cardiac surgery was conducted between Jan 2004 and Dec 2014. Patients who underwent dilation interventions across fresh suture lines (group 1) were compared to patients who underwent interventional procedures at other sites (group 2), and a CRISP score was calculated for all patients. Patients receiving only surveillance biopsies were excluded. Sixty-eight patients underwent 100 interventional procedures. Group 1 was composed of 44 patients receiving 64 interventions, while group 2 had 24 patients who underwent 36 interventions. Group 1 was comprised significantly more single ventricles and patients were smaller/younger. Group 1 had a significantly higher median CRISP score, but both groups were within Category 4. The rates of adverse events were similar between groups and comparable to predicted rates with the CRISP scoring system. Catheter-based interventions in the early post-operative period can be performed with no significant increase in the risk of serious adverse events when intervening across fresh suture lines. The CRISP scoring system can be a valuable tool in pre-procedural counseling of high-risk post-operative patients.
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Affiliation(s)
- Katie Mowers
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, 1 Children's Place, Saint Louis, MO, 63108, USA
| | - Toby Rockefeller
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, 1 Children's Place, Saint Louis, MO, 63108, USA
| | - David Balzer
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, 1 Children's Place, Saint Louis, MO, 63108, USA
| | - Ramzi Nicolas
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, 1 Children's Place, Saint Louis, MO, 63108, USA
| | - Shabana Shahanavaz
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, 1 Children's Place, Saint Louis, MO, 63108, USA.
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Nicholson GT, Kim DW, Vincent RN, Kogon BE, Miller BE, Petit CJ. Cardiac catheterization in the early post-operative period after congenital cardiac surgery. JACC Cardiovasc Interv 2014; 7:1437-43. [PMID: 25523535 DOI: 10.1016/j.jcin.2014.06.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 05/20/2014] [Accepted: 06/13/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study sought to demonstrate that early cardiac catheterization, whether used solely as a diagnostic modality or for the use of transcatheter interventional techniques, can be used effectively and with an acceptable risk in the post-operative period. BACKGROUND Cardiac catheterization offers important treatment for patients with congenital heart disease. Early post-operative cardiac catheterization is often necessary to diagnose and treat residual anatomic defects. Experience with interventional catheterization to address post-operative concerns is limited. METHODS This was a retrospective cohort study. The medical and catheterization data of pediatric patients who underwent a cardiac catheterization ≤30 days after congenital heart surgery between November 2004 and July 2013 were reviewed. Patients who underwent right heart catheterization and endomyocardial biopsy after heart transplantation were excluded. RESULTS A total of 219 catheterizations (91 interventional procedures, 128 noninterventional catheterizations) were performed on 193 patients. Sixty-five interventions (71.43%) were dilations, either balloon angioplasty or stent implantation. There was no difference in survival to hospital discharge between those who underwent an interventional versus noninterventional catheterization (p = 0.93). One-year post-operative survival was comparable between those who underwent an intervention (66%) versus diagnostic (71%) catheterization (p = 0.58). There was no difference in the incidence of major or minor complications between the interventional and diagnostic catheterization cohorts (p = 0.21). CONCLUSIONS Cardiac catheterization, including transcatheter interventions, can be performed safely in the immediate post-operative period after congenital heart surgery.
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Affiliation(s)
- George T Nicholson
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, Georgia
| | - Dennis W Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, Georgia
| | - Robert N Vincent
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, Georgia
| | - Brian E Kogon
- Division of Cardiothoracic Surgery, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, Georgia
| | - Bruce E Miller
- Division of Pediatric Cardiac Anesthesia, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, Georgia
| | - Christopher J Petit
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, Georgia.
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Siehr SL, Martin MH, Axelrod D, Efron B, Peng L, Roth SJ, Perry S, Shin AY. Outcomes following cardiac catheterization after congenital heart surgery. Catheter Cardiovasc Interv 2014; 84:622-8. [DOI: 10.1002/ccd.25490] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 03/06/2014] [Accepted: 03/12/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Stephanie L. Siehr
- Department of Pediatrics; Cardiovascular Institute, Stanford University School of Medicine; Palo Alto California
| | - Mary Hunt Martin
- Department of Pediatrics, Division of Pediatric Cardiology; Primary Children's Medical Center; Salt Lake City Utah
| | - David Axelrod
- Department of Pediatrics; Cardiovascular Institute, Stanford University School of Medicine; Palo Alto California
| | - Bradley Efron
- Department of Health Research and Policy, Division of Biostatistics; Stanford University Medical Center; Palo Alto California
| | - Lynn Peng
- Department of Pediatrics; Cardiovascular Institute, Stanford University School of Medicine; Palo Alto California
| | - Stephen J. Roth
- Department of Pediatrics; Cardiovascular Institute, Stanford University School of Medicine; Palo Alto California
| | - Stanton Perry
- Department of Pediatrics; Cardiovascular Institute, Stanford University School of Medicine; Palo Alto California
| | - Andrew Y. Shin
- Department of Pediatrics; Cardiovascular Institute, Stanford University School of Medicine; Palo Alto California
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Stumper O, Bhole V, Anderson B, Reinhardt Z, Noonan P, Mehta C. A novel technique for stenting pulmonary artery and conduit bifurcation stenosis. Catheter Cardiovasc Interv 2011; 78:419-24. [PMID: 21452244 DOI: 10.1002/ccd.23025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 01/29/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Distal conduit obstruction is a recognized complication after surgery for congenital heart disease requiring implantation of a conduit from the right ventricle to the pulmonary arteries. Endovascular stenting of distal conduit obstruction can be challenging due to the proximity to the pulmonary artery bifurcation. OBJECTIVE A technique is described, whereby a single stent is mounted onto two balloon angioplasty catheters in tandem. This ensemble was delivered to the distal conduit/pulmonary artery via a large Mullins sheath on two guidewires, one placed in each of the branch pulmonary arteries. The aim was to assess safety and efficacy of this novel technique. MATERIALS AND RESULTS Seven patients (mean age 13.4 (6.7-23.4) years, mean weight 44.2 (23-69) kg were treated with this method. The pressure gradient was reduced from 36 (26-52) mm Hg to 11 (8-15) mm Hg [P< 0.05]. RV/LV pressure ratio decreased from 0.85 (0.6-0.95) to 0.42 (0.35-0.5) [P < 0.05]. There were no significant complications. During follow-up over a median of 2.6 (0.3-6.7) years no patient required re-intervention or surgery. CONCLUSION This novel technique appears to be safe and effective for stenting stenoses just proximal to pulmonary artery bifurcation.
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Affiliation(s)
- Oliver Stumper
- Heart Unit, Birmingham Children's Hospital, United Kingdom.
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Latson LA, Qureshi AM. Techniques for transcatheter recanalization of completely occluded vessels and pathways in patients with congenital heart disease. Ann Pediatr Cardiol 2011; 3:140-6. [PMID: 21234193 PMCID: PMC3017918 DOI: 10.4103/0974-2069.74044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Occlusions of major vessels in patients with congenital heart disease may occur due to a variety of factors. These occlusions are often felt to be best addressed surgically; however, we and others have been successful in recanalizing most of these vessels in the catheterization laboratory. Most of these patients will require multiple procedures in the catheterization laboratory to ensure vessel patency and to facilitate vessel growth. Physicians performing the procedure should have a thorough understanding of the anatomic considerations for the intended procedure and have access to a variety of devices and equipment to optimize the result of the procedure. In this article, we review some of the technical aspects that are vital for the success of the procedure.
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Affiliation(s)
- Larry A Latson
- Center for Pediatric and Congenital Heart Disease, Children's Hospital, Cleveland Clinic, Cleveland, Ohio, USA
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Bhole V, Wright JG, De Giovanni JV, Dhillon R, Miller PA, Desai T, Chikermane A, Jones T, Barron DJ, Brawn WJ, Stumper O. Transcatheter interventions in the early postoperative period after the Fontan procedure. Catheter Cardiovasc Interv 2010; 77:92-8. [DOI: 10.1002/ccd.22667] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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[Modern therapy of congenital heart defects]. Radiologe 2010; 51:10-4. [PMID: 21104224 DOI: 10.1007/s00117-010-1994-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Modern therapy of congenital heart defects consists of interventional and surgical procedures. The following report provides information about the most common congenital heart defects and the corresponding therapeutic options. Furthermore, the combined application of interventional and surgical procedures, so-called hybrid procedures, is described in detail as well as the latest developments in percutaneous valve replacement therapy.
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Asoh K, Hickey E, Dorostkar PC, Chaturvedi R, van Arsdell G, Humpl T, Benson LN. Outcomes of emergent cardiac catheterization following pediatric cardiac surgery. Catheter Cardiovasc Interv 2009; 73:933-40. [DOI: 10.1002/ccd.21919] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Field ML, Sammut J, Kuduvalli M, Oo A, Rashid A. Hybrid theatres: nicety or necessity? J R Soc Med 2009; 102:92-7. [PMID: 19297649 DOI: 10.1258/jrsm.2009.080390] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Mark L Field
- Liverpool Heart and Chest Hospital Thomas Drive, Liverpool L14 3PE, UK.
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Bouzas-Mosquera A, Rueda F, Aldama G, Medrano C, Portela F, Zavanella C, Castro-Beiras A. Perventricular pulmonary valvuloplasty under echocardiographic guidance. Int J Cardiol 2008; 130:e102-4. [PMID: 17764769 DOI: 10.1016/j.ijcard.2007.06.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 06/23/2007] [Indexed: 10/22/2022]
Abstract
We report the case of a small neonate with a complex congenital heart disease who successfully underwent a perventricular pulmonary valvuloplasty during the early postoperative period, using echocardiographic guidance alone without fluoroscopy. We describe the technique and the advantages of this novel procedure.
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Gudausky TM, Pearl J, Dent CL, Kim E, Divanovic A, Spicer RL, Beekman RH. Open-chest epicardial approach to transcatheter pulmonary artery stenting following heart transplantation in an infant. CONGENIT HEART DIS 2008; 2:64-9. [PMID: 18377519 DOI: 10.1111/j.1747-0803.2007.00074.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe an open-chest epicardial approach to transcatheter pulmonary artery stenting in a critically ill infant following heart transplantation. Technical considerations, indications, and feasibility are discussed. This case provides another example of the value of a "hybrid" approach (combining surgery and interventional cardiology) to complex congenital heart disease.
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Affiliation(s)
- Todd M Gudausky
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA
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