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Hasan BS, Barry OM, Ali F, Armstrong AK, Batlivala SP, Crystal MA, Divekar A, Gudausky T, Holzer R, Kreutzer J, Nicholson G, O’Byrne ML, Quinn BP, Boe BA. Evaluating Procedural Performance: A Composite Outcome for Aortic and Pulmonary Valvuloplasty in Congenital Cardiac Catheterization. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101119. [PMID: 39129900 PMCID: PMC11308845 DOI: 10.1016/j.jscai.2023.101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/05/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2024]
Abstract
Background Safety events and technical success (TS) have been previously reported for aortic and pulmonary valvuloplasty, but a composite performance measure as a novel, patient-centered strategy has neither been developed nor been studied. This study aims to refine a procedural performance (PP) variable, a composite of TS and procedural safety, for isolated, standard-risk aortic and pulmonary valvuloplasty. Methods A multicenter review was performed using data from the Congenital Cardiac Catheterization Project on Outcomes registry. Data were collected for all cases of isolated balloon aortic and pulmonary valvuloplasty from 2014 through 2017. Patients were excluded if they were aged <1 month, were inpatient at the time of the procedure, or had significant comorbidities, such as Williams or Noonan syndrome. Criteria for TS were developed and categorized (optimal, satisfactory, and unsatisfactory) by expert consensus based on previous outcome research. Adverse events (AE) were categorized by severity (level 1-5) using established criteria. Level 4 and 5 severity AE were considered high-severity AE. Using criteria of TS and AE severity, PP was divided into 3 composite outcome classes. Factors correlating with class III (suboptimal) PP were analyzed. Results There were 169 cases of aortic and 270 cases of pulmonary valvuloplasty in the cohorts. In the aortic valvuloplasty cohort, a suboptimal PP (class III) occurred in 14% of cases, mostly due to high-severity AE (7%). No significant correlation between patient or case characteristics and PP was demonstrated. In the pulmonary valvuloplasty cohort, class III PP occurred in 9% of cases, predominantly due to residual valve gradient, which correlated with lower weight (P = .02). Conclusions We designed a composite variable of PP consisting of TS and safety as a comprehensive measure of outcome. Incorporating both TS and AE may better reflect patient outcome than each metric measured separately. PP indices may identify areas for further investigation and quality improvement.
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Affiliation(s)
- Babar S. Hasan
- Division of Cardio-thoracic Sciences, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Oliver M. Barry
- Division of Cardiology, Morgan Stanley Children’s Hospital of New York and Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Fatima Ali
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | - Aimee K. Armstrong
- The Heart Center, Nationwide Children’s Hospital and Department of Pediatrics Ohio State University School of Medicine, Columbus, Ohio
| | - Sarosh P. Batlivala
- Department of Pediatrics, University of Cincinnati College of Medicine and Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Matthew A. Crystal
- Division of Cardiology, Morgan Stanley Children’s Hospital of New York and Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Abhay Divekar
- Division of Pediatric Cardiology, UT Southwestern Medical Center, Dallas Children’s Hospital, Dallas, Texas
| | - Todd Gudausky
- Division of Pediatric Cardiology, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ralf Holzer
- Department of Pediatrics, UC Davis Medical Center, UC Davis Children’s Hospital, Sacramento, California
| | - Jacqueline Kreutzer
- Division of Cardiology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - George Nicholson
- Division of Cardiology, Monroe Carell Jr. Children’s Hospital and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Michael L. O’Byrne
- Division of Cardiology and Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian P. Quinn
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Brian A. Boe
- Department of Cardiology, Joe DiMaggio Children’s Hospital, Hollywood, Florida
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2
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Jiang Y, Luo F, Bu H. Percutaneous closure of simple congenital heart diseases under echocardiographic guidance. Eur J Med Res 2023; 28:408. [PMID: 37805534 PMCID: PMC10559656 DOI: 10.1186/s40001-023-01398-8] [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: 07/08/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023] Open
Abstract
Congenital heart disease (CHD), birth defect with the highest incidence rates worldwide, and is mainly characterized by the abnormal internal structure of the heart or/and the anatomical structure of great vessels. In the past few decades, CHD repair surgery through standard median sternotomy incision combined with cardiopulmonary bypass (CPB) technology has been considered the gold standard for surgical correction of heart and great vessels. With the promotion and clinical application of interventional catheterization technology, transcatheter closure of CHD under radioactive radiation has gradually been recognized and applied. However, its radiation exposure and potential complications related to arteriovenous vessels still face challenges. In recent years, an increasing number of surgeons have explored new surgical procedures, for the safe and effective treatment of CHD, as far as possible to reduce surgical trauma, avoid radiation exposure, and improve the cosmetic effect. Therefore, on the premise of satisfactory exposure or guidance, how to integrate ultrasound and percutaneous interventional technology remained the focus of the exploration. This mini-review highlights and summarizes the signs of progress of ultrasound intervention in the last decade that have proven the effectiveness and operability of a well-established procedure for percutaneous closure of congenital heart diseases under echocardiographic guidance only. We discuss potential diseases that will benefit from this emerging procedure based on this progress. Owing to the crucial advantages played by this strategy in the treatment of CHD, better understanding and promotion of this less exploited field may contribute to the development of therapeutics targeting CHD, improve medical utilization rate, promote the optimization of medical resources, and ultimately achieve precise and efficient medical treatment.
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Affiliation(s)
- Ying Jiang
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Fanyan Luo
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Haisong Bu
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
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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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Sirico D, Spigariol G, Mahmoud HT, Basso A, Cuppini E, Avesani M, Sabatino J, Castaldi B, Di Salvo G. Acute Changes in Right Ventricular Function in Pediatric Patients with Pulmonary Valve Stenosis Undergoing Percutaneous Valvuloplasty: A Speckle-Tracking Study. J Clin Med 2023; 12:4344. [PMID: 37445378 DOI: 10.3390/jcm12134344] [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: 05/13/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Pulmonary valve stenosis determines multiple effects on the right ventricular dimension and function. Percutaneous balloon valvuloplasty is the treatment of choice in severe pulmonary valve stenosis in patients of all ages. However, little is known regarding right ventricular function immediate changes after percutaneous balloon dilation. Pediatric patients with isolated pulmonary valve stenosis represent a pure clinical model of chronic RV pressure overload not affected by other confounders or comorbidities. AIM OF THE STUDY This study seeks to explore right ventricle (RV) mechanics in pediatric patients early after percutaneous balloon pulmonary valvuloplasty (BPV) for valvar pulmonary stenosis (PS). MATERIALS AND METHODS Forty-three pediatric patients (19 males), mean age 3.2 ± 4.9 years old, with severe pulmonary valve stenosis and indication for percutaneous balloon valvuloplasty were recruited. All patients underwent standard transthoracic echocardiography (TTE), and speckle-tracking echocardiography (STE) with an analysis of right ventricle free-wall longitudinal strain (RVFWLS) one day before and one day after the procedure. For each patient, we collected invasive parameters during the interventional procedure before and after BPV. RESULTS After the procedure, there was an immediate significant reduction in both peak-to-peak transpulmonary gradient (peak-to-peak PG) and ratio between the right ventricle and aortic systolic pressure (RV/AoP) with a drop of ∆29.3 ± 14.67 mmHg and ∆0.43 ± 0.03, respectively. Post-procedural echocardiography showed peak and mean transvalvar pressure gradient drop (∆50 ± 32.23 and ∆31 ± 17.97, respectively). The degree of pulmonary valve regurgitation was mild in 8% of patients before the procedure, affecting 29% of our patients post-BPV (p = 0.007). The analysis of right ventricular mechanics showed a significant improvement of fractional area change (FAC) immediately after BPV (40.11% vs. 44.42%, p = 0.01). On the other hand, right ventricular longitudinal systolic function parameters, TAPSE and global RVFWLS, did not improve significantly after intervention. The segmental analysis of the RVFWLS showed a significant regional increase in the myocardial deformation of the apical segments. CONCLUSIONS Percutaneous BPV represents an efficient and safe procedure to relieve severe pulmonary valve stenosis. The analysis of the right ventricular function on echocardiography demonstrated an immediate global systolic function improvement, while longitudinal systolic function was persistently impaired 24 h after intervention, possibly due to the necessity of a longer recovery time.
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Affiliation(s)
- Domenico Sirico
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Giulia Spigariol
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Heba Talat Mahmoud
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Alessia Basso
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Elena Cuppini
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Martina Avesani
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Jolanda Sabatino
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
- Experimental Cardiology, Paediatric Research Institute (IRP), Città della Speranza, University of Padova, 35122 Padua, Italy
| | - Biagio Castaldi
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Giovanni Di Salvo
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
- Experimental Cardiology, Paediatric Research Institute (IRP), Città della Speranza, University of Padova, 35122 Padua, Italy
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Ali F, Yeh MJ, Bergersen L, Gauvreau K, Polivenok I, Ronderos M, De Decker R, Kumar RK, Jenkins K, Hasan BS. Congenital Cardiac Catheterization in Low- and Middle-Income Countries: The International Quality Improvement Collaborative Catheterization Registry. JACC. ADVANCES 2023; 2:100344. [PMID: 38938241 PMCID: PMC11198277 DOI: 10.1016/j.jacadv.2023.100344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/27/2023] [Accepted: 03/14/2023] [Indexed: 06/29/2024]
Abstract
Background No published data are available on the patient, procedural characteristics, and outcomes of congenital heart disease (CHD) cardiac catheterization performed in low- and middle-income countries (LMICs). Objectives The objective of this study was to describe procedural characteristics and patient outcomes of CHD cardiac catheterizations in LMICs. Methods Cases performed between January 2019 and December 2020 from 15 centers in the International Quality Improvement Collaborative Congenital Heart Disease Catheterization Registry (IQIC-CHDCR) data were included. The Procedural Risk in Congenital Cardiac Catheterization (PREDIC3T) classification was used to stratify risk. Outcomes of interest included mortality, severe adverse events (SAEs), and procedural efficacy. Procedural efficacy, based on technical and safety endpoints, was categorized into optimal, adequate, and inadequate for 5 common interventional procedures. Results There were 3,287 cases, of which 60% (n = 1,973) were interventional cases. Most of the cases (66%) were in patients between the ages of 1 to 18 years with a median patient age of 4 years. PREDIC3T risk class 1 and 2 were most common in 37% and 38% of cases, respectively. SAEs occurred in 2.8% while the death was reported within <72 hours post catheterization 1%. The majority of device implantation procedures patent ductus arteriosus (67%) and atrial septal defect (60%) had optimal procedure efficacy outcomes. Conclusions This study demonstrates that congenital cardiac catheterization is safely performed in LMICs. Future work addressing predictors of SAEs and adverse procedural outcomes may help future quality improvement initiatives.
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Affiliation(s)
- Fatima Ali
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | - Mary J. Yeh
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Lisa Bergersen
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Igor Polivenok
- Zaitcev Institute for General and Urgent Surgery in Kharkov, Ukraine/Novick Cardiac Alliance, Kharkov, Sloboda, Ukraine
| | - Miguel Ronderos
- Fundación Cardioinfantil de Bogota, Institut of Congnitas Heart Disease, Bogota, Colombia
| | - Rik De Decker
- Division of Cardiology, Red Cross War Memorial Children’s Hospital in Cape Town, Cape Town, South Africa
| | - Raman Krishna Kumar
- Amrita Institute for Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Kathy Jenkins
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Babar Sultan Hasan
- Division of Cardio-thoracic Sciences, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Sindh, Pakistan
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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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Lu X, Wen P, Liu Y, Zhu Q, Wang N. Simultaneous Percutaneous Interventional Treatment of Atrial Septal Defects and Pulmonary Valve Stenosis in Children Under the Guidance of Transoesophageal Echocardiography Alone: Preliminary Experiences. Front Cardiovasc Med 2022; 9:771281. [PMID: 35141301 PMCID: PMC8818781 DOI: 10.3389/fcvm.2022.771281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To investigate the efficacy and safety of simultaneous percutaneous interventional treatment of atrial septal defects (ASDs) and pulmonary valve stenosis (PS) in children under the guidance of transoesophageal echocardiography (TEE) alone. Methods Eleven children with ASD combined with PS who were treated at our hospital between March 2015 and March 2019 were recruited, including 4 males and 7 females. Preoperative transthoracic echocardiography showed that all patients had type II ASDs of the foramen ovale subtype, with a maximum diameter of 12.9 ± 2.7 mm (9.0–18.0 mm). The guiding principle of septal occluder selection is that the diameter of the occluder should be 2–4 mm larger than the maximum diameter of the ASD. The pressure gradient across the pulmonary valve in patients with PS was 54.7 ± 5.8 mmHg (47.0–64.0 mmHg), and a balloon with a diameter 1.2–1.4 times the diameter of the pulmonary valve annulus was used for dilatation. Effective dilatation was repeated 2–3 times. All children underwent ASD occlusion and PS balloon dilatation through the femoral vein under TEE guidance without radiation or contrast agents. The patients underwent PS balloon dilatation first, followed by ASD occlusion. The treatment effect was evaluated by TEE immediately after the procedure, and the patients were followed up regularly. Results All patients underwent successful simultaneous ASD occlusion and PS balloon dilatation through the femoral vein under the guidance of TEE alone. The pressure gradient across the pulmonary valve immediately after the procedure was 21.3 ± 1.8 mmHg (19.0–25.0 mmHg) (P < 0.01). No shunt was detected at the atrial septum level. The patients were followed for 3.0 ± 1.4 years (1.0–5.0 years) after the procedure. The atrial septal occluders were in the normal position in all of the patients, and there was no arrhythmia, hemolysis, or residual shunting. The pressure gradient across the pulmonary valve at 1 month after the procedure was 18.5 ± 3.3 mmHg (P < 0.01). Conclusion Simultaneous percutaneous interventional treatment of ASD and PS in children under the guidance of TEE alone is not only safe and effective but also prevents trauma caused by extracorporeal circulation and surgical incision and damage caused by X-ray and contrast agents. The surgical sequence included first performing PS balloon dilatation, followed by ASD occlusion.
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Barry OM, Ali F, Ronderos M, Sudhaker A, Kumar RK, Mood MC, Corona-Villalobos C, Nguyen DT, Doherty-Schmeck K, Bergersen L, Gauvreau K, Jenkins KJ, Hasan BS. Pilot phase experience of the International Quality Improvement Collaborative catheterization registry. Catheter Cardiovasc Interv 2021; 97:127-134. [PMID: 32294315 DOI: 10.1002/ccd.28908] [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] [Received: 09/23/2019] [Revised: 01/23/2020] [Accepted: 03/31/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To describe the development of a quality collaborative for congenital cardiac catheterization centers in low and middle-income countries (LMICs) including pilot study data and a novel procedural efficacy measure. BACKGROUND Absence of congenital cardiac catheterization registries in LMICs led to the development of the International Quality Improvement Collaborative Congenital Heart Disease Catheterization Registry (IQIC-CHDCR). As a foundation for this initiative, the IQIC is a collaboration of pediatric cardiac surgical programs from LMICs. Participation in IQIC has been associated with improved patient outcomes. METHODS A web-based registry was designed through a collaborative process. A pilot study was conducted from October through December 2017 at seven existing IQIC sites. Demographic, hemodynamic, and adverse event data were obtained and a novel tool to assess procedural efficacy was applied to five specific procedures. Procedural efficacy was categorized using ideal, adequate, and inadequate. RESULTS A total of 429 cases were entered. Twenty-five adverse events were reported. The five procedures for which procedural efficacy was measured represented 48% of cases (n = 208) and 71% had complete data for analysis (n = 146). Procedure efficacy was ideal most frequently in patent ductus arteriosus (95%) and atrial septal defect (90%) device closure, and inadequate most frequently in coarctation procedures (100%), and aortic and pulmonary valvuloplasties (50%). CONCLUSIONS The IQIC-CHDCR has designed a feasible collaborative to capture catheterization data in LMICs. The novel tool for procedural efficacy will provide valuable means to identify areas for quality improvement. This pilot study and lessons learned culminated in the full launch of the IQIC-CHDCR.
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Affiliation(s)
- Oliver M Barry
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Fatima Ali
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | | | - Abish Sudhaker
- Amrita Institute for Medical Sciences and Research Centre, Kochi, Kerala, India
| | - R Krishna Kumar
- Amrita Institute for Medical Sciences and Research Centre, Kochi, Kerala, India
| | | | - Carlos Corona-Villalobos
- American British Cowdray Medical Center, I.A.P. and Instituto Nacional de Pediatria, Mexico City, Mexico
| | | | | | - Lisa Bergersen
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kathy J Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Babar S Hasan
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
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Abstract
BACKGROUND Balloon pulmonary valvuloplasty is the treatment of choice for patients with moderate to severe pulmonary valve stenosis. METHODS An observational retrospective cross-sectional study including neonates, small infants, and children who underwent balloon pulmonary valvuloplasty in the period from 2007 to 2016 in the cardiac catheterisation unit of the paediatric cardiology department in Cairo University. Multivariable models were built to report the predictors of the outcome of balloon pulmonary valvuloplasty and its complications. RESULTS A total of 1200 patients were included in the study and divided according to age into 3 groups: neonates and early infants (n = 282), infants (n = 362), and children (n = 556). Procedural success, defined as a drop pressure gradient across the pulmonary valve to less than or equal to 50% of the baseline measurements, was achieved in 82.7% of the patients. Multivariate analysis revealed that only infundibular pulmonary stenosis (p value 0.032), supravalvular in association with valvular pulmonary stenosis (p value <0.001), and pulmonary valve diameter by angiogram (p value <0.001) were significant predictors of success. The presence of supravalvular in association with valvular pulmonary stenosis (p value <0.001) was associated with a lower weight (p value 0.007) and higher right ventricular pressure before the intervention (p value <0.001), and a minor immediate drop in the pressure gradient post-intervention (p value <0.001) was found to be the most significant predictor of the occurrence of complications. CONCLUSION The absence of infundibular and supravalvular stenosis and a large pulmonary valve diameter were the most significant predictors of success.
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Holzer RJ, Dayton JD. Registries, Risk Calculators, and Risk-Adjusted Outcomes: Current Usage, Limitations, and Future Prospects. Pediatr Cardiol 2020; 41:443-458. [PMID: 32198591 DOI: 10.1007/s00246-020-02300-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/17/2020] [Indexed: 11/26/2022]
Abstract
Small study sizes are a limiting factor in assessing outcome measures in pediatric cardiology. It is even more difficult to assess the outcomes of congenital catheterizations where the sample sizes are even smaller, particularly on a individual institutional level. The creation of multicenter registries is a method by which investigators can pool data to better assess quality and outcome measures of these procedures. No registry is perfect with several being available today, each with its own strengths and weaknesses. In addition, there are a multitude of methods currently used to assess quality and outcomes from the data contained in these registries, each having its own limitations as well. Nonetheless, multicenter registrities remain one of the best available options to improve the quality of care for pediatric interventional cardiac catheterization. Below, we provide an overview of the current state of quality assessment/improvement in pediatric interventional cardiology including a review of the available registrities and the metrics used to measure quality of care and outcomes.
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Affiliation(s)
- Ralf J Holzer
- NewYork-Presbyterian Komansky Children's Hospital, New York, USA.
- Weill Cornell Medicine, New York, USA.
- David Wallace - Starr Foundation, Division of Pediatric Cardiology, Pediatric Cardiac Catheterization, NewYork-Presbyterian Komansky Children's Hospital, New york, USA.
| | - Jeffrey D Dayton
- NewYork-Presbyterian Komansky Children's Hospital, New York, USA
- Weill Cornell Medicine, New York, USA
- Department of Pediatrics, 525 East 68th Street, Room F-677, New York, NY, 10065, USA
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Interventional Treatment of Cardiac Emergencies in Children with Congenital Heart Diseases. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2019. [DOI: 10.2478/jce-2019-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Abstract
Cardiac emergencies in children represent an extremely important issue in medical practice. In general, interventional treatment could be optional in many situations, however it can be indicated in emergency conditions. There are many diseases at pediatric age that can benefit from interventional treatment, thus reducing the surgical risks and subsequent complications. Balloon atrioseptostomy, patent ductus arteriosus (PDA) closure, percutaneous or hybrid closure of a ventricular septal defect, pulmonary or aortic valvuloplasty, balloon angioplasty for aortic coarctation, implantation of a stent for coarctation of the aorta, for severe stenosis of the infundibulum of the right ventricle, or for PDA correction are among the procedures that can be performed in emergency situations. This review aims to present the current state of the art in the field of pediatric interventional cardiology.
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12
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Congenital Heart Disease Classification, Epidemiology, Diagnosis, Treatment, and Outcome. CONGENIT HEART DIS 2019. [DOI: 10.1007/978-3-319-78423-6_1] [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: 10/27/2022]
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Atik E, Barreto AC, Binotto MA, Kajita LJ. Case 5/2018 - Severe Pulmonary Valve Stenosis (PVS), Relieved by a Double-balloon Catheter, in a 68-year-old Woman. Arq Bras Cardiol 2018; 111:427-429. [PMID: 30379261 PMCID: PMC6173339 DOI: 10.5935/abc.20180151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Edmar Atik
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina, USP/, São Paulo, SP - Brazil
| | - Alessandra Costa Barreto
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina, USP/, São Paulo, SP - Brazil
| | - Maria Angélica Binotto
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina, USP/, São Paulo, SP - Brazil
| | - Luiz Junya Kajita
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina, USP/, São Paulo, SP - Brazil
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Hong D, Qian MY, Zhang ZW, Wang SS, Li JJ, Li YF, Liu T. Immediate Therapeutic Outcomes and Medium-term Follow-up of Percutaneous Balloon Pulmonary Valvuloplasty in Infants with Pulmonary Valve Stenosis: A Single-center Retrospective Study. Chin Med J (Engl) 2017; 130:2785-2792. [PMID: 29176137 PMCID: PMC5717856 DOI: 10.4103/0366-6999.219155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Percutaneous balloon pulmonary valvuloplasty (PBPV) is the preferred therapy for pulmonary valve stenosis (PVS). This study retrospectively reviewed recent PBPV outcomes in infants with PVS. The aim of this study was to evaluate factors associated with immediate therapeutic outcomes and restenosis during medium-term follow-up. METHODS The study included 158 infants with PVS who underwent PBPV from January 2009 to July 2015. Demographic characteristics and patient records were reviewed, including detailed hospitalization parameters, hemodynamic data before and immediately after balloon dilation, cineangiograms, and echocardiograms before PBPV and at each follow-up. All procedures were performed by more than two experienced operators. RESULTS Immediately after balloon dilation, the pressure gradient across the pulmonary valve decreased from 73.09 ± 21.89 mmHg (range: 43-151 mmHg) to 24.49 ± 17.00 mmHg (range: 3-92 mmHg; P < 0.001) and the right ventricular systolic pressure decreased from 95.34 ± 23.44 mmHg (range: 60-174 mmHg) to 52.07 ± 18.89 mmHg (range: 22-134 mmHg; P < 0.001). Residual transvalvular pressure gradients of 67.31 ± 15.19 mmHg (range: 50-92 mmHg) were found in 8.2% of patients, indicating poor therapeutic effects; 6.4% of patients had variable-staged restenosis at follow-up and 3.8% underwent reintervention by balloon dilation or surgical repairs. Further analysis demonstrated that the balloon/annulus ratio showed statistically significant differences (P < 0.05) among groups with different therapeutic effects and between the restenosis and no-stenosis groups. Binary logistic regression analysis further revealed that higher balloon/annulus ratio (odds ratio: 0.005, 95% confidence interval: 0-0.39) was an independent protective factor for restenosis. The rate of severe complications was 1.9%. CONCLUSIONS PBPV is a definitive therapy for infants with PVS based on its effectiveness, feasibility, and safety. Restenosis upon medium-term follow-up is relatively rare.
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Affiliation(s)
- Dian Hong
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong 510100, China
- Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Ming-Yang Qian
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong 510100, China
- Address for correspondence: Dr. Ming-Yang Qian, Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong 510100, China E-Mail:
| | - Zhi-Wei Zhang
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong 510100, China
| | - Shu-Shui Wang
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong 510100, China
| | - Jun-Jie Li
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong 510100, China
| | - Yi-Fan Li
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong 510100, China
| | - Tian Liu
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong 510100, China
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Safety, Feasibility, Results, and Economic Impact of Common Interventional Procedures in a Low-Volume Region of the United States. Pediatr Cardiol 2017. [PMID: 28639149 DOI: 10.1007/s00246-017-1664-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of the study was to evaluate the safety, feasibility, and economic benefit of a high-volume operator performing common interventional procedures in a rural region of the United States (U.S.). Rural areas of the U.S., even with well-equipped cardiac catheterization laboratories, may not have a full-time pediatric interventional cardiologist (PIC); this requires patients to travel out of state even for simple interventions. Since 2005, we have adopted a policy of performing cardiac catheterizations and common interventional procedures with a visiting PIC. We reviewed data of all patients who underwent cardiac catheterizations from May 2005 through March 2015 at our center. Variables analyzed were type of procedure, results, and follow-up six months after procedure. 197 catheterizations were performed, of which 80 were for single atrial septal defect (ASD), 29 for fenestrated ASD, 49 for patent ductus arteriosus (PDA), and 39 for other procedures. Device closure of single ASD was successful in 75 of 79 attempts and in 27 of 28 attempts for fenestrated ASD. PDA closure was successful in 45 of 46 attempts. Follow-up data of 6 months or more were available for 127 patients. All but two patients had no cardiovascular symptoms at 6 months. There were four minor complications and no major complications. With a technical success rate of 94.9% for single ASD closure, 97.8% for PDA closure, and results comparable to those of multi-institutional registries, cardiac catheterization and interventions can be performed safely with excellent results. Performing procedures in such an arrangement is safe, feasible, and economically beneficial.
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Long-term results of percutaneous balloon valvuloplasty in neonatal critical pulmonary valve stenosis: a 20-year, single-centre experience. Cardiol Young 2017; 27:1314-1322. [PMID: 28619122 DOI: 10.1017/s1047951117000178] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Introduction Percutaneous balloon valvuloplasty is the primary treatment for critical pulmonary valve stenosis in neonates. Thus far, a few studies have reported long-term results of this technique in neonatal critical pulmonary valve stenosis. METHODS We carried out a retrospective study of all consecutive newborns with critical pulmonary valve stenosis subjected to percutaneous balloon valvuloplasty at a single centre, between 1994 and 2014, to assess its immediate and long-term safety and efficacy. RESULTS A total of 24 neonates presented with critical pulmonary valve stenosis. The mean diameter of the pulmonary annulus was 7 mm (±1.19); 33.3% had a dysplastic pulmonary valve, and 92% were started on prostaglandin E1 treatment. Percutaneous balloon valvuloplasty was performed at a mean age of 4.0±4.3 days using, on average, a balloon-to-pulmonary annulus ratio of 1.18 mm (with a range from 0.9 to 1.43). Immediate success was achieved in 22/24 patients (92%) with a reduction in the pulmonary transvalvular peak gradient (p<0.05) and in the right ventricle/systemic pressure ratio (p<0.05). There was one death (4%) 6 days after the procedure, and 29.2% of them had transient rhythm complications. For a mean follow-up time of 8.4 years, the re-intervention rate was 42.9%. In total, 14 re-interventions were performed in nine neonates, including surgery in six. Freedom from re-intervention was 50% at 8 years and 43% at 10 and 15 years. CONCLUSION This series, to the best of our knowledge, has had the longest follow-up of neonates with critical pulmonary valve stenosis. Percutaneous balloon valvuloplasty is a safe and effective treatment, and in our study 75% of the patients were exclusively treated using this technique.
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Application of new balloon catheters in the treatment of congenital heart defects. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:231-7. [PMID: 27625686 PMCID: PMC5011539 DOI: 10.5114/aic.2016.61645] [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: 09/15/2015] [Accepted: 01/13/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Balloon angioplasty (BAP) and aortic or pulmonary balloon valvuloplasty (BAV, BPV) are well-established treatment options in congenital heart defects. Recently, significant technological progress has been made and new catheters have been implemented in clinical practice. AIM To analyze the results of BAP, BAV and BPV with the new balloon catheter Valver and its second generation Valver II, which the company Balton (Poland) launched and developed. These catheters have not been clinically evaluated yet. MATERIAL AND METHODS We performed 64 interventions with Valver I and Valver II. With Valver I the following procedures were performed: 17 BPV (including 9 in tetralogy of Fallot - TOF), 10 BAV and 27 BAP in coarctations of the aorta (CoA) - including 9 native and 18 after surgery. With Valver II ten interventions were done - 3 BPV, 2 pulmonary supravalvular BAP (after switch operations), 2 BAP of recoarctations and 3 other BAP. Age of the patients ranged from a few days to 40 years. RESULTS All procedures were completed successfully, without rupture of any balloon catheters. The pressure gradient drop was statistically significant in all groups: BPV in isolated pulmonary valvular stenosis 28.1 mm Hg (mean), BPV in TOF 18.7 mm Hg, BAV 32.8 mm Hg, BAP in native CoA 15.4 mm Hg and in recoarctations 18.6 mm Hg. In 3 cases during rapid deflation of Valver I, wrinkles of the balloons made it impossible to insert the whole balloon into the vascular sheath (all were removed surgically from the groin). No such complication occured with Valver II. CONCLUSIONS Valver balloon catheters are an effective treatment modality in different valvular and vascular stenoses.
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Wang SZ, Ou-Yang WB, Hu SS, Pang KJ, Liu Y, Zhang FW, Zhang DW, Pan XB. First-in-Human Percutaneous Balloon Pulmonary Valvuloplasty Under Echocardiographic Guidance Only. CONGENIT HEART DIS 2016; 11:716-720. [PMID: 27346469 DOI: 10.1111/chd.12380] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to assess the feasibility of percutaneous balloon pulmonary valvuloplasty (PBPV) under echocardiographic guidance only. SETTING PBPV has become the preferred choice for pulmonary valve stenosis (PS). We report the first-in-human successful PBPV under only echocardiography guidance for isolated PS. METHODS From March 2013 to December 2014, 34 patients with congenital PS underwent PBPV with echocardiography as the only imaging modality in the ordinary operation room or catheter lab. Outpatient follow-up including chest radiography, electrocardiography, and transthoracic echocardiography (TTE) was conducted at 1, 3, 6, and 12 months. RESULTS All 34 patients successfully underwent PBPV under echocardiography guidance without radiation and contrast agent. The pulmonic transvalvular pressure gradient dropped from 62.8 ± 10.1 mm Hg to 14.7 ± 4.2 mm Hg measured on catheterization (P < .05). The balloon diameter/pulmonary annulus diameter ratio was 1.34 ± 0.07. Slight regurgitation of the pulmonary valve occurred in five patients and mild pulmonary regurgitation occurred in one patients. The pulmonic transvalvular pressure gradient measured on TTE 12 months after the procedure was 14.1 ± 4.6 mm Hg. No pericardial effusion and peripheral vascular complications occurred. CONCLUSION This study demonstrated that PBPV can be successfully performed under only echocardiography guidance and appears safe and effective while avoiding radiation and contrast agent use.
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Affiliation(s)
- Shou-Zheng Wang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Wen-Bin Ou-Yang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Sheng-Shou Hu
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Kun-Jing Pang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Yao Liu
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Feng-Wen Zhang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Da-Wei Zhang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Xiang-Bin Pan
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
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Promphan W, Qureshi SA. What Interventional Cardiologists Are Still Leaving to the Surgeons? Front Pediatr 2016; 4:59. [PMID: 27379218 PMCID: PMC4904017 DOI: 10.3389/fped.2016.00059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/25/2016] [Indexed: 12/17/2022] Open
Abstract
Nowadays, development of new technologies is still ongoing with the ultimate goal of maximizing treatment outcomes with less invasiveness and reduced procedural risk. This review is intended to update on when interventionalists need surgical support in common or emerging problems in congenital heart disease.
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Affiliation(s)
- Worakan Promphan
- Queen Sirikit National Institute of Child Health, Bangkok, Thailand
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20
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Chaudhry-Waterman N, Coombs S, Porras D, Holzer R, Bergersen L. Developing tools to measure quality in congenital catheterization and interventions: the congenital cardiac catheterization project on outcomes (C3PO). Methodist Debakey Cardiovasc J 2015; 10:63-7. [PMID: 25114756 DOI: 10.14797/mdcj-10-2-63] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The broad range of relatively rare procedures performed in pediatric cardiac catheterization laboratories has made the standardization of care and risk assessment in the field statistically quite problematic. However, with the growing number of patients who undergo cardiac catheterization, it has become imperative that the cardiology community overcomes these challenges to study patient outcomes. The Congenital Cardiac Catheterization Project on Outcomes was able to develop benchmarks, tools for measurement, and risk adjustment methods while exploring procedural efficacy. Based on the success of these efforts, the collaborative is pursuing a follow-up project, the Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement, aimed at improving the outcomes for all patients undergoing catheterization for congenital heart disease by reducing radiation exposure.
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Affiliation(s)
| | | | - Diego Porras
- Boston Children's Hospital, Boston, Massachusetts
| | - Ralf Holzer
- Nationwide Children's Hospital, Columbus, Ohio
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21
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Goldstein BH, Holzer RJ, Trucco SM, Porras D, Murphy J, Foerster SR, El-Said HG, Beekman RH, Bergersen L. Practice Variation in Single-Ventricle Patients Undergoing Elective Cardiac Catheterization: A Report from the Congenital Cardiac Catheterization Project on Outcomes (C3PO). CONGENIT HEART DIS 2015; 11:122-35. [DOI: 10.1111/chd.12299] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Bryan H. Goldstein
- The Heart Institute; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio USA
| | - Ralf J. Holzer
- The Heart Center; Nationwide Children's Hospital; Columbus Ohio USA
| | - Sara M. Trucco
- Heart Institute; Children's Hospital of Pittsburgh; Pittsburgh Pa USA
| | - Diego Porras
- Department of Cardiology; Children's Hospital Boston; Boston Mass USA
| | - Joshua Murphy
- Division of Pediatric Cardiology; Washington University; St. Louis Mo USA
| | - Susan R. Foerster
- Herma Heart Center; Children's Hospital of Wisconsin; Milwaukee Wis USA
| | | | - Robert H. Beekman
- The Heart Institute; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio USA
| | - Lisa Bergersen
- Division of Pediatric Cardiology; Washington University; St. Louis Mo USA
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Rahkonen OP, Lee KJ, Chaturvedi RC, Benson LN. The First Ten of Everything: A Review of Past and Current Practice in Pediatric Cardiac Percutaneous Interventions. CONGENIT HEART DIS 2015; 10:292-301. [PMID: 25597863 DOI: 10.1111/chd.12247] [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] [Accepted: 12/03/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study was designed to compare outcomes of the most common pediatric cardiac interventions from the time of implementation with the current era. BACKGROUND Since the introduction of semilunar valve balloon dilation and device closure of the arterial duct and septal defects, development of interventional techniques and devices has been rapid. However, few studies have compared outcomes between those initial interventions and those in the current era. METHODS Five validated common catheter-based therapies were chosen for analysis, including atrial and duct device closure, balloon dilation of the aortic and pulmonary valves, and native coarctation of the aorta. A retrospective review of the first and most recent 10 consecutive patients in each group was performed. RESULTS There was a high mortality (30%) among neonates who underwent aortic valve (AV) dilation in the early era, but no mortality noted in other groups. In the early era, transcatheter atrial defect closure and AV dilations were associated with a low success rate (60% for both lesions) and a high complication rate (40% for atrial septal defect, 30% for AV dilations). Among the last 10 children, the atrial defect occlusion was successful in 100% without complications and AV dilations where successful in all children with a 30% complication rate (one major, two minor). CONCLUSIONS A learning curve with device development plays a significant role in the evolution of transcatheter techniques. These data provide baseline estimates of success and may be used as a template in the future when new techniques are adapted into practice.
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Affiliation(s)
- Otto P Rahkonen
- The Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic and Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Kyong-Jin Lee
- The Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic and Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Rajiv C Chaturvedi
- The Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic and Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Lee N Benson
- The Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic and Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada
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Moore JW, Vincent RN, Beekman RH, Benson L, Bergersen L, Holzer R, Jayaram N, Jenkins K, Li Y, Ringel R, Rome J, Martin GR. Procedural Results and Safety of Common Interventional Procedures in Congenital Heart Disease. J Am Coll Cardiol 2014; 64:2439-51. [DOI: 10.1016/j.jacc.2014.09.045] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 09/08/2014] [Accepted: 09/16/2014] [Indexed: 11/16/2022]
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Merino-Ingelmo R, Santos-de Soto J, Coserria-Sánchez F, Descalzo-Señoran A, Valverde-Pérez I. Resultados a largo plazo de la valvuloplastia transluminal percutánea en la estenosis valvular pulmonar en población pediátrica. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Merino-Ingelmo R, Santos-de Soto J, Coserria-Sánchez F, Descalzo-Señoran A, Valverde-Pérez I. Long-term results of percutaneous balloon valvuloplasty in pulmonary valve stenosis in the pediatric population. ACTA ACUST UNITED AC 2014; 67:374-9. [PMID: 24774730 DOI: 10.1016/j.rec.2013.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 08/29/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Percutaneous pulmonary valvuloplasty is the preferred interventional procedure for pulmonary valve stenosis. The aim of this study was to evaluate the effectiveness of this technique, assess the factors leading to its success, and determine the long-term results in the pediatric population. METHODS The study included 53 patients with pulmonary valve stenosis undergoing percutaneous balloon valvuloplasty between December 1985 and December 2000. Right ventricular size and functional echocardiographic parameters, such as pulmonary regurgitation and residual transvalvular gradient, were assessed during long-term follow-up. RESULTS Peak-to-peak transvalvular gradient decreased from 74 mmHg [interquartile range, 65-100 mmHg] to 20 mmHg [interquartile range, 14-34 mmHg]. The procedure was unsuccessful in 2 patients (3.77%). The immediate success rate was 73.58%. Follow-up ranged from 10 years to 24 years (median, 15 years). During follow-up, all patients developed late pulmonary regurgitation which was assessed as grade II in 58.4% and grade III in 31.2%. There was only 1 case of long-term restenosis (2.1%). Severe right ventricular dilatation was observed in 27.1% of the patients. None of the patients developed significant right ventricular dysfunction. Pulmonary valve replacement was not required in any of the patients. CONCLUSIONS Percutaneous balloon valvuloplasty is an effective technique in the treatment of pulmonary valve stenosis with good long-term results.
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Affiliation(s)
- Raquel Merino-Ingelmo
- Unidad de Cardiología y Hemodinámica Infantil, Hospital Virgen del Rocío, Seville, Spain.
| | - José Santos-de Soto
- Unidad de Cardiología y Hemodinámica Infantil, Hospital Virgen del Rocío, Seville, Spain
| | - Félix Coserria-Sánchez
- Unidad de Cardiología y Hemodinámica Infantil, Hospital Virgen del Rocío, Seville, Spain
| | | | - Israel Valverde-Pérez
- Unidad de Cardiología y Hemodinámica Infantil, Hospital Virgen del Rocío, Seville, Spain
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Kim DH, Park SJ, Jung JW, Kim NK, Choi JY. The Comparison between the Echocardiographic Data to the Cardiac Catheterization Data on the Diagnosis, Treatment, and Follow-Up in Patients Diagnosed as Pulmonary Valve Stenosis. J Cardiovasc Ultrasound 2013; 21:18-22. [PMID: 23560138 PMCID: PMC3611114 DOI: 10.4250/jcu.2013.21.1.18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 02/26/2013] [Accepted: 02/27/2013] [Indexed: 11/22/2022] Open
Abstract
Background Isolated pulmonary valve stenosis (PS) makes up 6-9% of all congenital heart defects among children. The initial gold standard for diagnosis, follow-up of PS is by echocardiography. However, the most accurate diagnosis still remains to be measurement of the pressure gradient through transcatheterization. The purpose of this study is to compare the difference between the echocardiographic data to the cardiac catheterization data on the diagnosis, treatment, and follow-up in patients diagnosed as PS, and to see what parameters should be closely monitored. Methods A total of 112 patients (Male : Female = 46 : 66) who underwent balloon pulmonary valvuloplasty (BPV) at Severance Cardiovascular Hospital, between December, 2002 to August, 2012 were retrospectively analyzed. The patients were all under 16 years of age and critical PS patients who underwent BPV were excluded from this study. Results The pre-BPV right ventricle (RV)-pulmonary artery (PA) systolic pressure gradient and post-BPV systolic pressure gradient showed statistically significant decrease. The pre-BPV RV-PA systolic pressure gradient and 3 month post-BPV systolic pressure gradient showed statistically significant decrease. The consistency between the echocardiographic data and cardiac catheterization data shows statistically significant consistency. The mean pressure gradient and systolic pressure gradient on the echocardiography shows high consistency when comparing with the cardiac catheterization data. Conclusion Our study shows that BPV in PS is a safe and effective procedure in children and adolescent. The standard echocardiographic evaluation of PS, during diagnosis and follow-up, should include mean transpulmonic pressure gradient, as well as the peak systolic pressure gradient. The success of the procedure should be held off until at least 3 months, only if the patients do not show any symptoms.
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Affiliation(s)
- Do Hoon Kim
- Division of Pediatric Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
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