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Vernemmen I, Buschmann E, Van Steenkiste G, Demeyere M, Verhaeghe LM, De Somer F, Devreese KMJ, Schauvliege S, Decloedt A, van Loon G. Intracardiac ultrasound-guided transseptal puncture in horses: Outcome, follow-up, and perioperative anticoagulant treatment. J Vet Intern Med 2024; 38:2707-2717. [PMID: 39086137 PMCID: PMC11423474 DOI: 10.1111/jvim.17158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 07/18/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Cardiac catheterizations in horses are mainly performed in the right heart, as access to the left heart traditionally requires an arterial approach. Transseptal puncture (TSP) has been adapted for horses but data on follow-up and closure of the iatrogenic atrial septal defect (iASD) are lacking. HYPOTHESIS/OBJECTIVES To perform TSP and assess postoperative complications and iASD closure over a minimum of 4 weeks. ANIMALS Eleven healthy adult horses. METHODS Transseptal puncture was performed under general anesthesia. Serum cardiac troponin I concentrations were measured before and after puncture. Weekly, iASD closure was monitored using transthoracic and intracardiac echocardiography. Relationship between activated clotting time and anti-factor Xa activity during postoperative enoxaparin treatment was assessed in vitro and in vivo. RESULTS Transseptal puncture was successfully achieved in all horses within a median duration of 22 (range, 10-104) minutes. Balloon dilatation of the puncture site for sheath advancement was needed in 4 horses. Atrial arrhythmias occurred in 9/11 horses, including atrial premature depolarizations (N = 1), atrial tachycardia (N = 5), and fibrillation (N = 3). Serum cardiac troponin I concentrations increased after TSP, but remained under the reference value in 10/11 horses. Median time to iASD closure was 14 (1-35) days. Activated clotting time correlated with anti-factor Xa activity in vitro but not in vivo. CONCLUSIONS AND CLINICAL IMPORTANCE Transseptal puncture was successfully performed in all horses. The technique was safe and spontaneous iASD closure occurred in all horses. Clinical application of TSP will allow characterization and treatment of left-sided arrhythmias in horses.
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Affiliation(s)
- Ingrid Vernemmen
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Eva Buschmann
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Glenn Van Steenkiste
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Marie Demeyere
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Lize-Maria Verhaeghe
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Filip De Somer
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Katrien M J Devreese
- Coagulation Laboratory, Ghent University Hospital, Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Stijn Schauvliege
- Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Annelies Decloedt
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Gunther van Loon
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
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Vernemmen I, Van Steenkiste G, Buschmann E, Cornelis K, Schauvliege S, Ibrahim L, Decloedt A, van Loon G. Development of an atrial transseptal puncture procedure in horses to access the left heart: An ultrasound-guided jugular vein and transhepatic approach. Equine Vet J 2024. [PMID: 38522423 DOI: 10.1111/evj.14084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/25/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Radiofrequency ablation has been successfully applied to treat right atrial arrhythmias in horses. Ablation of left-sided arrhythmias requires a retrograde transarterial approach which is complicated. In human medicine, the left atrium is accessed through transseptal puncture (TSP) of the fossa ovalis (FO) using a caudal approach via the femoral vein. OBJECTIVES To develop a zero fluoroscopy TSP technique for horses using a jugular vein (cranial) and transhepatic (caudal) approach. STUDY DESIGN In vivo experimental study. METHODS Transseptal puncture was performed in 18 horses admitted for euthanasia and donated for scientific research under general anaesthesia: using a jugular vein approach (10 horses), a transhepatic approach (2 horses) or both (6 horses). Radiofrequency energy was applied on a guidewire to perforate the FO and allow sheath advancement under intracardiac and transthoracic echocardiographic guidance. Puncture lesions were inspected post-mortem. RESULTS Transseptal puncture was successful in 17/18 horses, of which 15/16 jugular vein approaches and 5/8 transhepatic approaches. Failure was due to technical malfunction, inability to advance the guidewire toward the heart and inability to advance the sheath through the FO. Intracardiac echocardiography was essential to safely guide the puncture process. Atrial arrhythmias caused by the TSP occurred in 13/18 horses. Puncture lesions were found in the right atrium in the FO region, and left atrium ventral to pulmonary vein ostium III. MAIN LIMITATIONS Because in several horses two approaches were tested consecutively, it cannot be excluded that the second TSP was performed at the previous puncture site. Due to the developmental nature of the study the approaches were not randomised and did not allow comparison. CONCLUSION Transseptal puncture is feasible in horses using ultrasound guidance and allows for electrophysiological exploration of the left heart. Further studies are needed to evaluate post-operative follow-up.
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Affiliation(s)
- Ingrid Vernemmen
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Glenn Van Steenkiste
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Eva Buschmann
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Kristoff Cornelis
- Cardiology Department, Maria Middelares Heart Centre, Ghent, Belgium
| | - Stijn Schauvliege
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Lara Ibrahim
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Annelies Decloedt
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Gunther van Loon
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
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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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4
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Meliota G, Vairo U. Transcatheter Interventions for Neonates with Congenital Heart Disease: A Review. Diagnostics (Basel) 2023; 13:2673. [PMID: 37627932 PMCID: PMC10453781 DOI: 10.3390/diagnostics13162673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/28/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Newborns with congenital heart disease often require interventions linked to high morbidity and mortality rates. In the last few decades, many transcatheter interventions have become the first-line treatments for some critical conditions in the neonatal period. A catheter-based approach provides several advantages in terms of procedural time, length of hospitalization, repeatability and neurodevelopmental issues (usually related to cardiopulmonary bypass). The main transcatheter procedures will be reviewed, as they are now valid alternatives to conventional surgical management.
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Affiliation(s)
- Giovanni Meliota
- Pediatric Cardiology, Giovanni XXIII Pediatric Hospital, 70126 Bari, Italy;
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5
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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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6
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Barry OM, Bouhout I, Turner ME, Petit CJ, Kalfa DM. Transcatheter Cardiac Interventions in the Newborn: JACC Focus Seminar. J Am Coll Cardiol 2022; 79:2270-2283. [PMID: 35654498 DOI: 10.1016/j.jacc.2022.03.374] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
For neonates with critical congenital heart disease requiring intervention, transcatheter approaches for many conditions have been established over the past decades. These interventions may serve to stabilize or palliate to surgical next steps or effectively primarily treat the condition. Many transcatheter interventions have evidence-based records of effectiveness and safety, which have led to widespread acceptance as first-line therapies. Other techniques continue to innovatively push the envelope and challenge the optimal strategies for high-risk neonates with right ventricular outflow tract obstruction or ductal-dependent pulmonary blood flow. In this review, the most commonly performed neonatal transcatheter interventions will be described to illustrate the current state of the field and highlight areas of future opportunity.
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Affiliation(s)
- Oliver M Barry
- Division of Pediatric Cardiology, NewYork-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA
| | - Ismail Bouhout
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic and Vascular Surgery, NewYork-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA
| | - Mariel E Turner
- Division of Pediatric Cardiology, NewYork-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA
| | - Christopher J Petit
- Division of Pediatric Cardiology, NewYork-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA.
| | - David M Kalfa
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic and Vascular Surgery, NewYork-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA.
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7
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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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Haynes S, Kerber RE, Johnson FL, Lynch WR, Divekar A. Left heart decompression by atrial stenting during extracorporeal membrane oxygenation. Int J Artif Organs 2018; 32:240-2. [DOI: 10.1177/039139880903200408] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Persistent severe left ventricular dysfunction during extracorporeal membrane oxygenation (ECMO) requires left heart decompression. We describe stenting of the atrial septum as an alternative emergency approach for left heart decompression during ECMO in addition to the already published surgical and transcatheter approaches.
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Affiliation(s)
- Susan Haynes
- Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Children's Hospital, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Richard E. Kerber
- Division of Cardiology, Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Frances L Johnson
- Division of Cardiology, Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - William R. Lynch
- Department of Cardiothoracic Surgery, University of Iowa Children's Hospital, University of Iowa Hospitals and Clinics, Iowa City, Iowa - USA
| | - Abhay Divekar
- Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Children's Hospital, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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10
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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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11
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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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12
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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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13
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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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14
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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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15
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A 10-year single-centre experience in percutaneous interventions for multi-stage treatment of hypoplastic left heart syndrome. Cardiol Young 2014; 24:54-63. [PMID: 23402359 DOI: 10.1017/s104795111200220x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The purpose of this paper is to report our 10 years of experience of interventional treatment of patients with hypoplastic left heart syndrome and to focus on the frequency, type, and results of percutaneous interventions during all the stages of palliation, considering the different techniques, devices, and complications. BACKGROUND Constant progress in surgical treatment of congenital heart defects in the last decade has significantly improved the prognosis for children with hypoplastic left heart syndrome. However, morbidity and mortality remain relatively high. Modern interventional procedures complement or occasionally replace surgical treatment. METHODS Between January, 2001 and December, 2010, 161 percutaneous interventions were performed in 88 patients with hypoplastic left heart syndrome. Patients were divided into four groups: (a) before the first surgical treatment including hybrid approach, (b) after first-stage Norwood operation, (c) after second-stage bidirectional Glenn operation, and (d) after third-stage Fontan operation. RESULTS Percutaneous interventions resulted in statistically significant changes in pulmonary artery pressures, vessel diameters, and O2 saturation. Complications occurred in 4.3% of interventions and were related mainly to stent implantation in stenosed pulmonary arteries. CONCLUSIONS Percutaneous interventions may result in haemodynamic stability and reduction in the number of operations. They may result in significant changes in pulmonary artery pressures, vessel diameters, O2 saturation, with a low rate of complications, which are mainly related to stent implantation in the pulmonary arteries.
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Hoque T, Richmond M, Vincent JA, Bacha E, Torres A. Current outcomes of hypoplastic left heart syndrome with restrictive atrial septum: a single-center experience. Pediatr Cardiol 2013; 34:1181-9. [PMID: 23392623 DOI: 10.1007/s00246-012-0625-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 12/26/2012] [Indexed: 11/28/2022]
Abstract
Advances in the management of hypoplastic left heart syndrome (HLHS) have resulted in improved survival. However, short and long-term mortality in patients with a restrictive atrial septum remains high. All neonates diagnosed with HLHS from 2003 to 2010 at our institution were evaluated. Patients who underwent atrial septostomy within the first 72 h conformed the restrictive atrial septum group (HLHS-RS). Patients with a non-restrictive communication (HLHS-NRS) formed the control group. Outcomes and survival status were determined from review of medical records. Of the 141 newborns diagnosed with HLHS, 20 (14 %) required intervention for a restrictive atrial septum. Procedural success was achieved in 17/20 (85 %) patients. Complications occurred in ten procedures, two of which were life threatening. No procedural deaths occurred. Overall median follow up was 35.5 months (0.4-104). Initial hospitalization survival was 16/20 (80 %) for the HLHS-RS group and 114/121(94 %) for the HLHS-NRS (p = 0.028). Twenty (14 %) patients were lost to follow up and 9 (6 %) underwent heart transplant. Overall survival was 10/16 (62 %) for HLHSRS patients and 77/95 (81 %) for HLHS-NRS (p = 0.1). Survival after initial discharge was 10/12 (83 %) for the HLHS-RS group and 77/88 (87 %) for the HLHS-NRS (p = 0.67). No predictors for HLHS-RS outcome were identified. Mortality at first-stage palliation in HLHS neonates with a restrictive atrial septum remains higher than in those with an unrestrictive communication. However, survival after initial hospital discharge is similar.
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Affiliation(s)
- Tasneem Hoque
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York-Presbyterian, 3959 Broadway, 2North, New York, NY, USA
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Padilla T, Zapata M, Díaz LH, Lince R, Ruz M, Guzmán M, Donado J, Franco G. Results of Balloon Atrial Septostomy as Preparation for Surgical Correction in Transposition of Great Arteries. World J Pediatr Congenit Heart Surg 2011; 2:249-52. [DOI: 10.1177/2150135110395409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Balloon atrial septostomy (BAS) is a palliative procedure performed in the preoperative management of patients with transposition of great arteries (TGA), to improve the mixing of blood between the 2 systems. This report describes experience at the Clínica Cardiovascular Santa Maria in Medellin, Colombia. Between 2002 and 2010, 22 patients with TGA underwent BAS. Patient age at the time of the procedure was 21 days on average; 68% of patients were male. Average weight was 2.96 kg and interatrial gradient was between 4 and 12 mm Hg. The average systemic oxygen saturation at the beginning of the procedure was 60%, with a final saturation of 90%. Z5 atrioseptostomy balloons were used in 18 patients (81%), using Rashkind technique; Tyshak balloon catheters were used in 3 patients (13%) with the Shrivastava technique; and static high-pressure peripheral angioplasty balloons were used in 3 patients (13%). Two patients underwent BAS with 2 types of balloons. Although there were no complications clearly attributable to the procedure, 14% of patients had evidence of focal brain injury on the postoperative magnetic resonance image. Six patients died (27%), 5 of them because of postoperative complications and 1 because of infectious complications at another institution. All postoperative deaths occurred before 2006. The BAS is a safe technique for preoperative stabilization of patients with TGA.
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Affiliation(s)
- Tatiana Padilla
- Paediatric Cardiology Division, Clínica Cardiovascular Santa María, Medellín, Colombia
- Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Margarita Zapata
- Paediatric Cardiology Division, Clínica Cardiovascular Santa María, Medellín, Colombia
- Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Luis Horacio Díaz
- Paediatric Cardiology Division, Clínica Cardiovascular Santa María, Medellín, Colombia
- Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Rafael Lince
- Paediatric Cardiology Division, Clínica Cardiovascular Santa María, Medellín, Colombia
- Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Miguel Ruz
- Paediatric Cardiology Division, Clínica Cardiovascular Santa María, Medellín, Colombia
- Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Mónica Guzmán
- Paediatric Cardiology Division, Clínica Cardiovascular Santa María, Medellín, Colombia
- Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Juan Donado
- Paediatric Cardiology Division, Clínica Cardiovascular Santa María, Medellín, Colombia
- Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Gloria Franco
- Medical Investigations Division, Clínica Cardiovascular Santa María, Medellín, Colombia
- Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellín, Colombia
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ELAYI CLAUDESAMY, GURLEY JOHNCARL, DI SESSA THOMASGERALD, KAKAVAND BAHRAM. Surgical Electrocautery Facilitated Transseptal Puncture in Children. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:827-31. [DOI: 10.1111/j.1540-8159.2011.03056.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pedra SF, Jatene M, Pedra CA. Hybrid management of a large atrial septal defect and a patent ductus arteriosus in an infant with chronic lung disease. Ann Pediatr Cardiol 2010; 3:68-73. [PMID: 20814479 PMCID: PMC2921521 DOI: 10.4103/0974-2069.64358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We report a case wherein a dysmorphic four-month-old infant (weighing 4.5 kgs) with an 8 mm atrial septal defect (ASD), a 1.5 mm patent ductus arteriosus (PDA), a 2 mm mid-muscular ventricular septal defect (VSD) associated with chronic lung disease, and severe pulmonary hypertension, was successfully managed using a hybrid approach, without the use of cardiopulmonary bypass (CPB). Through a median sternotomy, the PDA was ligated and the ASD was closed with a 9 mm Amplatzer septal occluder implanted through peratrial access. The VSD was left untouched. Serial echocardiograms showed complete closure of the ASD and PDA, with progressive normalization of the pulmonary artery (PA) pressures within three months. The child rapidly gained weight and was weaned from sildenafil and oxygen administration. After 12 months, the VSD closed spontaneously and the child remained well, with normal PA pressures. A hybrid approach without the use of CPB should be considered in the management of infants with congenital heart disease, associated with chronic lung disease and pulmonary hypertension.
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Affiliation(s)
- Simone F Pedra
- Hospital do Coração da Associação Sanatório Sírio, São Paulo, Brazil
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Novel transatrial septoplasty technique for neonates with hypoplastic left heart syndrome and an intact or highly restrictive atrial septum. Pediatr Cardiol 2010; 31:545-9. [PMID: 20049426 DOI: 10.1007/s00246-009-9627-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 12/15/2009] [Indexed: 11/27/2022]
Abstract
Two patients born with hypoplastic left heart syndrome and an intact or highly restrictive atrial septum requiring emergent intervention are presented. For both patients, rapid septoplasty was performed using a hybrid approach involving direct atrial puncture and transatrial cutting balloon dilation of the atrial septum. This technique facilitates safe and rapid procedural completion and minimizes the risk of procedural complications in this very-high-risk patient population.
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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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Xu Z, Owens G, Gordon D, Cain C, Ludomirsky A. Noninvasive creation of an atrial septal defect by histotripsy in a canine model. Circulation 2010; 121:742-9. [PMID: 20124126 DOI: 10.1161/circulationaha.109.889071] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The primary objective of this study was to develop an image-guided, noninvasive procedure to create or enlarge an atrial septal defect for the treatment of neonates with hypoplastic left heart syndrome and an intact or restrictive atrial septum. Histotripsy is an innovative ultrasonic technique that produces nonthermal, mechanical tissue fractionation through the use of high-intensity ultrasound pulses. This article reports the pilot in vivo study to create an atrial septal defect through the use of extracardiac application of histotripsy in an open-chest canine model. METHODS AND RESULTS In 10 canines, the atrial septum was exposed to histotripsy by an ultrasound transducer positioned outside the heart. Ultrasound pulses of 6-microsecond duration at a peak negative pressure of 15 MPa and a pulse repetition frequency of 3.3 kHz were generated by a 1-MHz focused transducer. The procedure was guided and monitored by real-time ultrasound imaging. In 9 of 10 canines, an atrial septal defect was produced, and shunting across the atrial septum was visualized. Pathology of the hearts showed atrial septal defects with minimal damage to surrounding tissue. No damage was found on the epicardial surface of the heart or other structures. CONCLUSIONS Under real-time ultrasound guidance, atrial septal defects were successfully created with extracardiac histotripsy in a live canine model. Although further studies in an intact animal model are needed, these results provide promise of histotripsy becoming a valuable clinical tool.
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Affiliation(s)
- Zhen Xu
- Departments of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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Medrano López C, Guía Torrent JM, Rueda Núñez F, Moruno Tirado A. [Update on pediatric cardiology and congenital heart disease]. Rev Esp Cardiol 2009; 62 Suppl 1:39-52. [PMID: 19174049 DOI: 10.1016/s0300-8932(09)70040-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The fields of pediatric cardiology and congenital heart disease have experienced considerable progress in the last few years, with advances in new diagnostic and therapeutic techniques that can be applied at all stages of life from the fetus to the adult. This article reviews scientific publications in a number of areas that appeared between August 2007 and September 2008. In developed countries, congenital heart disease is becoming increasingly prevalent in nonpediatric patients, including pregnant women. Actions aimed at preventing coronary heart disease must be started early in infancy and should involve the promotion of a healthy diet and lifestyle. Recent developments in echocardiography include the introduction of three-dimensional echocardiography and of new techniques such as two-dimensional speckle tracking imaging, which can be used for both anatomical and functional investigations in patients with complex heart disease, including a univentricular heart. Progress has also occurred in fetal cardiology, with new data on prognosis and prognostic factors and developments in intrauterine interventions, though indications for these interventions have still to be established. Heart transplantation has become a routine procedure, supplemented in some cases by circulatory support devices. In catheter interventions, new devices have become available for the closure of atrial or ventricular septal defects and patent ductus arteriosus as well as for percutaneous pulmonary valve implantation. Surgery is also advancing, in some cases with hybrid techniques, particularly for the treatment of hypoplastic left heart syndrome. The article ends with a review of publications on cardiomyopathy, myocarditis and the treatment of bacterial endocarditis.
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Affiliation(s)
- Constancio Medrano López
- Cardiología Pediátrica, Hospital Infantil, Hospital General Universitario Gregorio Marañón, Madrid, España.
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Moszura T, Mazurek-Kula A, Dryzek P, Moll JJ, Moll JA, Sysa A, Qureshi SA. Interventions complementing surgery as part of multistage treatment for hypoplastic left heart syndrome: one center's experience. Pediatr Cardiol 2009; 30:106-13. [PMID: 18726645 DOI: 10.1007/s00246-008-9283-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 07/10/2008] [Accepted: 07/11/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Interventional procedures often are used as part of multistage treatment for hypoplastic left heart syndrome (HLHS). This study aimed to evaluate the efficacy of interventions in multistage treatment of HLHS. METHODS AND RESULTS Between 1999 and 2007, 78 interventions were performed for 58 children with HLHS at different stages of surgical treatment. Group 1, involving 30 interventions for 22 patients with postoperative pulmonary arterial stenosis, showed reduced pulmonary artery pressure and increased vessel diameter. Group 2, involving 15 interventions after the Norwood operation for 12 patients with aortic arch obstruction, showed success for 11 patients. Group 3, involving eight balloon angioplasties of narrowed Glenn anastomosis for seven patients, showed abolition of the pressure gradient between the superior vena cava and the right pulmonary artery. Group 4, involving eight interventional closures of a fenestration for eight patients after a Fontan operation, showed increased oxygen saturation for all eight patients. Group 5, involving seven interventions for six patients in whom venovenous collaterals were closed percutaneously, showed improved oxygen saturation. For Group 6, uncommon miscellaneous interventions were used to stabilize the patients' condition before the next surgical treatment. CONCLUSIONS Interventional procedures play an important role during multistage treatment of HLHS. They allow for a reduction in the number of operations or stabilization of the patients' condition before the next surgical treatment.
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Affiliation(s)
- T Moszura
- Department of Cardiology, Polish Mother's Memorial Hospital Research Institute, 93-338 Lodz, Rzgowska, 281/289, Poland.
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Kutty S, Zahn EM. Interventional therapy for neonates with critical congenital heart disease. Catheter Cardiovasc Interv 2009; 72:663-74. [PMID: 18942127 DOI: 10.1002/ccd.21705] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transcatheter interventional therapies for children continue to evolve at a remarkable rate. Perhaps no where are these procedures more important than in the critically ill newborn. In this core curriculum review article several of the most commonly performed interventions performed in critically ill newborns are discussed with regards to technique and outcomes.
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Affiliation(s)
- Shelby Kutty
- Joint Division of Pediatric Cardiology, University of Nebraska/Creighton University, Children's Hospital of Omaha, Omaha, Nebraska, 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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