1
|
Gunasekaran V, Natarajan RK, Mahmood B, Ibrahim J. An unusual case of hypoxemic respiratory failure in a preterm neonate. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
2
|
Novel use of a mechanical suction thrombectomy system for interposition graft occlusion in complex congenital heart disease. Cardiol Young 2022; 32:1181-1183. [PMID: 34819202 DOI: 10.1017/s1047951121004704] [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
Complete thrombosis of a pulmonary artery interposition graft in an adolescent with complex repaired CHD was treated successfully with a combination of a novel mechanical thrombectomy system, stent implantation, and thrombolysis. This thrombectomy system used a flexible catheter with a built-in mechanism to attenuate blood loss, while providing effective recanalisation of a foreign graft.
Collapse
|
3
|
Cohen CT, Sartain SE, Sangi-Haghpeykar H, Kukreja KU, Desai SB. Clinical characteristics and outcomes of combined thrombolysis and anticoagulation for pediatric and young adult lower extremity and inferior vena cava thrombosis. Pediatr Hematol Oncol 2021; 38:528-542. [PMID: 33646916 DOI: 10.1080/08880018.2021.1889729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Effective treatment for acute, extensive, symptomatic lower extremity (LE) thrombosis involves thrombolysis in addition to anticoagulation. There is limited available data on the outcomes and safety of thrombolysis to help guide its use in pediatrics and young adults. A retrospective study of children and young adults (<21 years of age) that received catheter directed thrombolysis (CDT) for LE and inferior vena cava (IVC) thrombosis was performed over a 5-year span at a pediatric tertiary care center. A total of 29 patients were identified for inclusion in the study, 76% (n = 22) received overnight CDT while 24% (n = 7) received tissue plasminogen activator as a bolus dose during a single interventional procedure. The median age of the cohort was 15.8 years (range 0-19.1). All patients were treated with a course of therapeutic anticoagulation. The thromboses represented were extensive, with 93% (n = 27) being occlusive and affecting multiple venous segments. Thrombus resolution occurred in 35% (n = 10) of patients. Rivaroxaban use (p < 0.01) during the course of anticoagulation and estrogen-containing hormonal therapy (p = 0.01) use prior to diagnosis were associated with thrombus resolution, while Hispanic ethnicity (p = 0.06) had a trend toward thrombus persistence. There were one major and 3 minor bleeding events that occurred as complications of thrombolysis and no treatment related deaths. This study provides baseline information that can be used to help guide clinicians treating similar patients and suggests the need to develop an improved, uniform treatment approach for superior resolution rates.
Collapse
Affiliation(s)
- Clay T Cohen
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas, USA
| | - Sarah E Sartain
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas, USA
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Kamlesh U Kukreja
- Department of Radiology, Section of Interventional Radiology, Texas, Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Sudhen B Desai
- Department of Radiology, Section of Interventional Radiology, Texas, Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
4
|
Muraji S, Kobayashi T, Oka S, Kojima T, Yoshiba S, Kanai M, Ishido H, Masutani S, Hosoda R, Masuoka A, Suzuki T, Sumitomo N. Successful Percutaneous Thrombectomy of the Left Pulmonary Artery in a Neonate After a Patent Ductus Arteriosus Clipping. Int Heart J 2021; 62:706-709. [PMID: 33994502 DOI: 10.1536/ihj.20-533] [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: 11/18/2022]
Abstract
We report a neonate with a successful percutaneous thrombectomy of a total thrombotic occlusion of the left pulmonary artery (LPA) after a surgical clipping for a patent ductus arteriosus (PDA). We suspected the compression of the LPA by the clipping and postoperative hemodynamic instability caused the LPA obstruction. After the surgical removal of the PDA clip and division of the PDA, we could safely retrieve the LPA thrombus with a non-hydrodynamic thrombectomy catheter for coronary arteries.
Collapse
Affiliation(s)
- Shota Muraji
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Toshiki Kobayashi
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Shuntaro Oka
- Department of Pediatrics, Saitama Medical University Saitama Medical Center
| | - Takuro Kojima
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Shigeki Yoshiba
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Masayo Kanai
- Department of Pediatrics, Saitama Medical University Saitama Medical Center
| | - Hirotaka Ishido
- Department of Pediatrics, Saitama Medical University Saitama Medical Center
| | - Satoshi Masutani
- Department of Pediatrics, Saitama Medical University Saitama Medical Center
| | - Ryusuke Hosoda
- Department of Pediatric Cardiac Surgery, Saitama Medical University International Medical Center
| | - Ayumu Masuoka
- Department of Pediatric Cardiac Surgery, Saitama Medical University International Medical Center
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University International Medical Center
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| |
Collapse
|
5
|
Post-natal diagnosis and catheter-based management of premature fetal ductal closure presenting as unilateral pulmonary artery thrombosis and right ventricular failure. Cardiol Young 2021; 31:833-835. [PMID: 33345766 DOI: 10.1017/s1047951120004564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
6
|
Gutierrez ME, Alten JA, Law MA. Successful Angiojet ® aortic thrombectomy of extracorporeal membrane oxygenation-related thrombus in a newborn. Ann Pediatr Cardiol 2018; 11:300-303. [PMID: 30271021 PMCID: PMC6146852 DOI: 10.4103/apc.apc_26_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Thrombosis and systemic embolization are important complications of extracorporeal membrane oxygenation (ECMO). We present a 2.5 kg neonate born at 37.4 weeks with hypoplastic left heart supported on ECMO that developed an acute, occlusive distal aortic thrombus that was emergently managed by transcatheter Angiojet® (Boston Scientific, Boston, MA) thrombectomy. The procedure successfully restored perfusion to the lower extremities with sustained result upon 1-week follow-up. This case highlights the Angiojet® thrombectomy as a treatment option for limb- or organ-threatening acute thrombus in even the most complex ECMO patients.
Collapse
Affiliation(s)
- Maria Elena Gutierrez
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey A Alten
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, Division of Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mark A Law
- Department of Pediatrics, Division of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
7
|
Rajpurkar M, Biss TT, Amankwah EK, Martinez D, Williams S, van Ommen CH, Goldenberg NA. Pulmonary embolism and in situ pulmonary artery thrombosis in paediatrics. Thromb Haemost 2017; 117:1199-1207. [DOI: 10.1160/th16-07-0529] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 03/01/2017] [Indexed: 11/05/2022]
Abstract
SummaryData on paediatric pulmonary embolism (PE) are scarce. We sought to systematically review the current literature on childhood PE and conducted a search on paediatric PE via PubMed (1946–2013) and Embase (1980–2013). There was significant heterogeneity in reported data. Two patterns were noted: classic thromboembolic PE (TE-PE) and in situ pulmonary artery thrombosis (ISPAT). Mean age of presentation for TE-PE was 14.86 years, and 51% of cases were males. The commonest method for diagnosis of TE-PE was contrast CT with angiography (74% of patients). The diagnosis of TE-PE was often delayed. Although 85% of children with TE-PE had an elevated D-dimer at presentation, it was non-discriminatory for the diagnosis. In paediatric TE-PE, the prevalence of central venous catheters was 23%, immobilisation 38%, systemic infection 31% and obesity 13%, elevated Factor VIII or von Willebrand factor levels 27%, Protein C deficiency 17%, Factor V Leiden 14% and Protein S deficiency 7%. In patients with TE-PE, pharmacologic thrombolysis was used in 29%; unfractionated heparin was the most common initial anticoagulant treatment in 64% and low-molecular-weight heparins the most common follow-up treatment in 83%. Duration of anticoagulant therapy was variable and death was reported in 26% of TE-PE patients. In contrast to TE-PE, patients with ISPAT were not investigated systematically for presence of thrombophilia, had more surgical interventions as the initial management and were often treated with anti-platelet medications. This review summarises important data and identifies gaps in the knowledge of paediatric PE, which may help to design future studies.
Collapse
|
8
|
Sessions KL, Anderson JH, Johnson JN, Taggart NW. AngioJet ™ thrombolysis of SVC thrombosis after orthotopic heart transplantation: A case report. Pediatr Transplant 2016; 20:723-726. [PMID: 27090499 DOI: 10.1111/petr.12715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/28/2022]
Abstract
SVC obstruction is a rare acute complication after bicaval cardiac transplantation and can be catastrophic for the patient. Herein, we report the case of a child who developed SVC thrombosis causing acute SVC syndrome nine days after heart transplantation. Thrombolysis was successfully performed using the AngioJet™ system and subsequent balloon angioplasty with re-establishment of flow. This procedure allowed for revascularization without repeat sternotomy or stent implantation. The patient is well without recurrence at last follow-up.
Collapse
Affiliation(s)
- Kristen L Sessions
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Jason H Anderson
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Jonathan N Johnson
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Nathaniel W Taggart
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
9
|
Qureshi AM, Petit CJ, Crystal MA, Liou A, Khan A, Justino H. Efficacy and safety of catheter-based rheolytic and aspiration thrombectomy in children. Catheter Cardiovasc Interv 2016; 87:1273-80. [DOI: 10.1002/ccd.26399] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/21/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Athar M. Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, CE Mullins Cardiac Catheterization Laboratories, Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Christopher J. Petit
- The Lillie Frank Abercrombie Section of Cardiology, CE Mullins Cardiac Catheterization Laboratories, Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Matthew A. Crystal
- The Lillie Frank Abercrombie Section of Cardiology, CE Mullins Cardiac Catheterization Laboratories, Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Aimee Liou
- The Lillie Frank Abercrombie Section of Cardiology, CE Mullins Cardiac Catheterization Laboratories, Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Asra Khan
- The Lillie Frank Abercrombie Section of Cardiology, CE Mullins Cardiac Catheterization Laboratories, Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Henri Justino
- The Lillie Frank Abercrombie Section of Cardiology, CE Mullins Cardiac Catheterization Laboratories, Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| |
Collapse
|
10
|
Law MA, McMahon WS, Hock KM, Zaccagni HJ, Borasino S, Alten JA. Balloon Angioplasty for the Treatment of Left Innominate Vein Obstruction Related Chylothorax after Congenital Heart Surgery. CONGENIT HEART DIS 2015; 10:E155-63. [PMID: 25600286 DOI: 10.1111/chd.12246] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Chylothorax complicates the postoperative course of patients after congenital heart surgery. Innominate vein thrombosis and stenosis have been associated with postoperative chylothorax. Revascularization and angioplasty can be accomplished using transcatheter techniques. We report our experience with this procedure for the management of postoperative chylothorax. DESIGN This is a retrospective case series of patients who underwent catheter revascularization and/or angioplasty of the innominate vein following cardiac surgery at our institution from January 1, 2008 through April 9, 2014. SETTING The cardiovascular intensive care unit and cardiac catheterization laboratory at the University of Alabama at Birmingham and Benjamin Russell Hospital for Children in Birmingham, Alabama were used as settings for the study. PATIENTS Out of 112 patients with postoperative chylothorax, 7 (6.3%) underwent transcatheter dilation of the innominate vein for occlusion/stenosis. The median age of the cohort was 1 month (15 days-6 years); median weight was 3 kg (2.7-22.2). Diagnosis was made a median 8 days (2-20) and persisted for a median of 24 days (9-44). Most patients failed medical management (low fat diet, nothing by mouth, and/or octreotide). RESULTS Cardiac catheterization occurred at a median 9 days (2-29) after chylothorax diagnosis. Median chest tube output on the day prior to procedure was 63 (12-149) cc/kg/day and decreased to 23 (0-64) cc/kg/day 2 days postprocedure (P = .01). Effusions resolved in a median of 5 days (1-16). There were no clinical complications postcatheterization. All patients who have undergone repeat angiography have maintained patency of the innominate vein. There was no mortality. Complications from chylothorax included prolong hospitalization, hyponatremia, hypoproteinemia, coagulopathy, lymphopenia, and infection. CONCLUSIONS Innominate vein occlusion and stenosis associated with chylous effusion are amenable to transcatheter revascularization and/or angioplasty, consistently leading to improvement, if not full resolution of chylothorax.
Collapse
Affiliation(s)
- Mark A Law
- Department of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Ala, USA
| | - William S McMahon
- Department of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Ala, USA
| | - Kristal M Hock
- Department of Pediatric Cardiac Critical Care, University of Alabama at Birmingham, Birmingham, Ala, USA
| | - Hayden J Zaccagni
- Department of Pediatric Cardiac Critical Care, University of Alabama at Birmingham, Birmingham, Ala, USA
| | - Santiago Borasino
- Department of Pediatric Cardiac Critical Care, University of Alabama at Birmingham, Birmingham, Ala, USA
| | - Jeffrey A Alten
- Department of Pediatric Cardiac Critical Care, University of Alabama at Birmingham, Birmingham, Ala, USA
| |
Collapse
|
11
|
Wehman B, Pasrija C, Kaushal S, Pham PP. Angiojet thrombectomy for Blalock-Taussig shunt and pulmonary artery thrombus in an infant with tetralogy of fallot. Ann Pediatr Cardiol 2014; 7:213-6. [PMID: 25298699 PMCID: PMC4189241 DOI: 10.4103/0974-2069.140855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We describe a new technique for treatment of shunt thrombosis in infants with complex anatomical defects. A 2-month-old girl with Tetralogy of Fallot underwent placement of a modified Blalock-Taussig shunt (MBTS) at day of life (DOL) 6 with revision at DOL 20. Following this surgery, the patient became hypotensive and hypoxic with new evidence of lack of flow through the MBTS on echocardiography. Angiography showed an occluded MBTS and right pulmonary artery with patent distal branches with normal pulmonary venous return. Balloon angioplasty was attempted but failed to fully recanalize the right pulmonary artery (RPA) and MBTS. An AngioJet catheter was then passed through the shunt and RPA to perform rheolyticthrombectomy. Subsequent angiogram showed a widely patent RPA and MBTS. An echocardiogram at 1-month post-thrombectomy showed a widely patent MBTS with continuous flow seen entering both branch pulmonary arteries. The AngioJet system for thrombectomy provides a viable option for complex thrombus removal in patients refractory to other methods.
Collapse
Affiliation(s)
- Brody Wehman
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sunjay Kaushal
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Phat P Pham
- Department of Pediatrics, Division of Pediatric Cardiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
12
|
Nicholson GT, Kogon B, Vincent R. AngioJet rheolytic thrombectomy in a neonate with pulmonary artery thrombus. Catheter Cardiovasc Interv 2013; 82:E704-7. [PMID: 23420640 DOI: 10.1002/ccd.24740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 10/29/2012] [Indexed: 11/08/2022]
Abstract
A newborn infant with obstructed supracardiac total anomalous pulmonary venous return underwent emergent surgical correction on day of life 0. A surgically placed transthoracic pulmonary artery catheter was used to monitor pulmonary artery pressure and removed on postoperative day 3. Following acute deterioration in respiratory status requiring reintubation, echocardiographic assessment demonstrated findings consistent with pulmonary hypertension and diminished flow to the left lung. Cardiac catheterization confirmed elevated pulmonary artery pressure and near complete occlusion of his left pulmonary artery due to a thrombus. He underwent successful percutaneous catheter-based thrombectomy using the AngioJet rheolytic catheter, recovered fully, and was discharged home on postoperative day 30. Although thrombotic events resulting in respiratory and hemodynamic compromise are rare in infants, recognition is important and treatment using mechanical thrombectomy can be life saving.
Collapse
Affiliation(s)
- George T Nicholson
- Division of Pediatric Cardiology and Department of Pediatrics, Emory University, Atlanta, Georgia
| | | | | |
Collapse
|
13
|
Giglia TM, DiNardo J, Ghanayem NS, Ichord R, Niebler RA, Odegard KC, Massicotte MP, Yates AR, Laussen PC, Tweddell JS. Bleeding and Thrombotic Emergencies in Pediatric Cardiac Intensive Care. World J Pediatr Congenit Heart Surg 2012; 3:470-91. [DOI: 10.1177/2150135112460866] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Children in the cardiac intensive care unit (CICU) with congenital or acquired heart disease are at risk for hematologic complications, both hemorrhage and thrombosis. The overall incidence of hematologic complications in the CICU is unknown, but risk factors and target groups have been identified where the essential physiologic balance between bleeding and clotting has been disrupted. Although the best management of life-threatening bleeding and clotting is prevention, the cardiac intensivist is often faced with managing life-threatening hematologic events involving patients from within the unit or those who present from outside. Part I of this review deals with the propensity of children with congenital and acquired heart disease to complications of both bleeding and clotting, and includes discussions of perioperative bleeding, thromboses in single-ventricle patients, clotting of Blalock-Taussig shunts and thrombotic complications of mechanical valves. Part II deals with the subject of stroke in children with heart disease. Part III reviews monitoring the effectiveness of anticoagulation and thrombolysis in the CICU. Currently available diagnostics modalities, medications and management strategies are reviewed and future directions discussed.
Collapse
Affiliation(s)
- Therese M. Giglia
- Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - James DiNardo
- Division of Cardiac Anesthesia, Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nancy S. Ghanayem
- Division of Critical Care, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Rebecca Ichord
- Division of Neurology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Robert A. Niebler
- Division of Critical Care, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Kirsten C. Odegard
- Division of Cardiovascular Critical Care, Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - M. Patricia Massicotte
- Department of Pediatrics, Stoller Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew R. Yates
- Sections of Cardiology and Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Peter C. Laussen
- Division of Cardiovascular Critical Care, Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - James S. Tweddell
- Division of Critical Care, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
14
|
Gerardin JF, Anderson CS, Armstrong AK, Grifka RG. Descending aorta thrombus in a neonate mimicking coarctation of the aorta: Mechanical thrombectomy using the AngioJet®catheter. Catheter Cardiovasc Interv 2012; 81:E134-8. [DOI: 10.1002/ccd.24435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 03/18/2012] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Aimee K. Armstrong
- C.S. Mott Children's Hospital; University of Michigan Congenital Heart Center; Ann Arbor; Michigan
| | - Ronald G. Grifka
- C.S. Mott Children's Hospital; University of Michigan Congenital Heart Center; Ann Arbor; Michigan
| |
Collapse
|
15
|
An institutional approach to interventional strategies for complete vascular occlusions. Pediatr Cardiol 2011; 32:713-23. [PMID: 21479825 DOI: 10.1007/s00246-011-9968-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 03/20/2011] [Indexed: 10/18/2022]
Abstract
Complete vascular occlusions are rare but potentially lethal. Reports on transcatheter therapy are limited to solitary case reports. The study was conducted as a single-center retrospective chart review. Between January 2003 and December 2009, 26 patients underwent cardiac catheterizations for either a known complete thoracic vascular occlusion or for incidental complete vascular occlusion that was noted during cardiac catheterization. Procedural technique, risk factors, and outcomes are reviewed. Median age at the time of diagnosis was 13.3 years (range 2 months to 54 years). In 6 of 26 (23%) patients, the vascular occlusion was of acute onset. Ninety-two percent of patients had at least 1 known risk factor for vascular occlusion, whereas 54% of patients had ≥ 2 risk factors. Successful rehabilitation was achieved in 19 patients, with direct catheter and/or wire manipulation being used to cross the occluded vessel in 15 (75%) patients, radiofrequency (RF) perforation in 3 patients, and perforation with Brockenbrough needle in 1 patient. Subsequent techniques included AngioJet (n = 2), balloon angioplasty and/or stent implantation (n = 18), and adjuvant local administration of recombinant tissue-plasminogen activator (n = 3). Reinterventions were required in 5 patients, and 8 patients died during the study period from causes unrelated to the catheterization procedure(s). Median follow-up of patients after successful recanalization was 12.6 months (range 1 day to 64 months), and the median duration of survival free from reintervention was 11.8 months (range 1 day to 64 months). In most patients, risk factors can be identified that are associated with the occurrence of a complete vascular occlusion. Different treatment strategies are used in patients having chronic compared with acute occlusions. Residual vascular lesions (hypoplasia or stenosis) are often associated with occurrence of reobstructions and should therefore be treated to prevent such an occurrence. Postprocedural anticoagulation is important in maintaining vascular patency.
Collapse
|