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Zampi JD, Sower CT, Lancaster TS, Sood V, Romano JC. Hybrid Interventions in Congenital Heart Disease: A Review of Current Practice and Rationale for Use. Ann Thorac Surg 2024; 118:329-337. [PMID: 38462049 DOI: 10.1016/j.athoracsur.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/14/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Hybrid interventions have become a common option in the management for a variety of patients with congenital heart disease. In this review, we discuss the data that have driven decision making about hybrid interventions to date. METHODS The existing literature on various hybrid approaches was reviewed and summarized. In addition, the key tenants to creating a successful hybrid program within a congenital heart center are elucidated. RESULTS Hybrid strategies for single-ventricle patients, pulmonary atresia with intact ventricular septum, branch pulmonary artery stenosis, and muscular ventricular septal defect closure have important benefits and limitations compared with traditional approaches. CONCLUSION A growing body of evidence supports the use of hybrid interventions in congenital heart disease. But important questions remain regarding improved survival and other long-term outcomes, such as neurocognition, that might impact widespread adoption as a primary treatment strategy.
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Affiliation(s)
- Jeffrey D Zampi
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
| | - C Todd Sower
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Timothy S Lancaster
- Section of Pediatric Cardiovascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Vikram Sood
- Section of Pediatric Cardiovascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jennifer C Romano
- Section of Pediatric Cardiovascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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2
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Wood KP, Fleming GA, Chamberlain RC. Update on Transcatheter Device Closure of Congenital Septal Defects. Curr Cardiol Rep 2023; 25:1083-1093. [PMID: 37523002 DOI: 10.1007/s11886-023-01925-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE OF REVIEW The goal of this paper is to review currently available devices for closure of atrial septal defects (ASDs) and ventricular septal defects (VSDs). RECENT FINDINGS Favorable results from the ASSURED trial resulted in FDA approval for the most recently developed device for transcatheter ASD closure in the United States. Further studies are required to assist in the development or approval of safe devices for transcatheter perimembranous VSD closure in pediatric patients. Device closure is the less invasive and preferred management option for many ASDs, with multiple studies demonstrating lower complication rates, shorter hospital stays, and lower mortality than surgical repair. Complex ASDs that make device closure more difficult include large defects, rim deficiencies, fenestrated defects, multiple defects, and the presence of pulmonary arterial hypertension. Device closure has also become an accepted alternative to surgery for some types of ventricular septal defects VSDs, though challenges and limitations remain. Future innovations including novel devices and techniques are needed to further expand on the types of defects that can be safely closed via transcatheter approach.
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Affiliation(s)
- Kathleen P Wood
- Division of Pediatric Cardiology, Duke University, Durham, USA
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3
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Lozier JS, Sati M, Cheifetz IM, Bocks ML. Update on percutaneous and perventricular device closure of congenital ventricular septal defect. Expert Rev Cardiovasc Ther 2023; 21:337-345. [PMID: 37096558 DOI: 10.1080/14779072.2023.2206566] [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: 04/26/2023]
Abstract
INTRODUCTION Ventricular septal defect is the most common congenital heart defect. Surgical repair has been standard therapy for symptomatic ventricular septal defects since the 1950's. Catheter-based device closure of ventricular septal defects emerged in the 1980's and has become a safe and effective alternative in select patients. AREAS COVERED This review focuses on patient selection and procedural techniques for device closure of ventricular septal defects, including percutaneous and hybrid perventricular approaches. The available devices used for these procedures, and outcomes of their use, are reviewed. EXPERT OPINION Percutaneous and perventricular device closure of ventricular septal defects is safe and effective in select patients. However, the majority of ventricular septal defects requiring closure continue to be managed with conventional surgery. Further development and investigation of transcatheter and hybrid surgical approaches for closing ventricular septal defects is required.
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Affiliation(s)
- John S Lozier
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Maram Sati
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ira M Cheifetz
- Divisions of Pediatric Cardiac Critical Care and Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Martin L Bocks
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
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Turner ME, Bouhout I, Petit CJ, Kalfa D. Transcatheter Closure of Atrial and Ventricular Septal Defects: JACC Focus Seminar. J Am Coll Cardiol 2022; 79:2247-2258. [PMID: 35654496 DOI: 10.1016/j.jacc.2021.08.082] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
The field of congenital interventional cardiology has experienced tremendous growth in recent years. Beginning with the development of early devices for transcatheter closure of septal defects in the 1970s and 1980s, such technologies have evolved to become a mainstay of treatment for many atrial septal defects (ASDs) and ventricular septal defects (VSDs). Percutaneous device closure is now the preferred approach for the majority of secundum ASDs. It is also a viable treatment option for selected VSDs, though limitations still exist. In this review, the authors describe the current state of transcatheter closure of ASDs and VSDs in children and adults, including patient selection, procedural approach, and outcomes. Potential areas for future evolution and innovation are also discussed.
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Affiliation(s)
- Mariel E Turner
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA.
| | - Ismail Bouhout
- Division of Cardiothoracic Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA
| | - Christopher J Petit
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA
| | - David Kalfa
- Division of Cardiothoracic Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA
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Diab KA, Boujemline Y, Hijazi ZM. Update on shunt closure in neonates and infants. Expert Rev Cardiovasc Ther 2021; 19:475-492. [PMID: 33899641 DOI: 10.1080/14779072.2021.1922079] [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: 10/21/2022]
Abstract
Introduction: Cardiac defects that result in shunting are the most common types of congenital heart anomalies. Although these lesions can be simple, they can cause significant hemodynamic changes and can be challenging to manage in neonates and infants. Over the recent decades, the development of new transcatheter techniques and devices has made it safe and feasible to manage such defects when indicated, even in the smallest of patients. Understanding these interventional procedures is essential in order to manage those patients.Areas covered: In this article, we review the techniques and experience for closure of atrial septal defects, ventricular septal defects, patent ductus aarteriosus,as well as coronary arteriovenous malformations and fistulas in neonates and infants. Literature review of PubMed articles was performed through January 2021, with focus on the latest data and results of the usage of interventional techniques in treating these lesions specifically in this age-group.Expert opinion: Significant shunting lesions can be particularly challenging to manage in neonates and infants. Newer lower profile devices will likely continue to be developed in the future, allowing their use for transcatheter interventions in even smaller patients and those with more complex anatomy.
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Affiliation(s)
- Karim A Diab
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar
| | - Younes Boujemline
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar
| | - Ziyad M Hijazi
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar.,Weill Cornell Medical College, Doha, Qatar.,Weill Cornell Medical College, New York, NY, USA
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Longinotti L, Castaldi B, Bertelli F, Vida VL, Padalino MA. Three-Dimensional printing for hybrid closure of complex muscular ventricular septal defects. Ann Thorac Surg 2021; 113:e129-e132. [PMID: 33957097 DOI: 10.1016/j.athoracsur.2021.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022]
Abstract
The identification and surgical closure of apical complex muscular ventricular septal defects (CMVSD) remains a difficult problem because of their location in the ventricular septum distal to the moderating band.
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Affiliation(s)
- Lorenzo Longinotti
- Pediatric Cardiac and Congenital Cardiac Surgery, Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padova, Italy.
| | - Biagio Castaldi
- Pediatric Cardiology, Department of Woman and Child's Health, University of Padova, Italy
| | - Francesco Bertelli
- Pediatric Cardiac and Congenital Cardiac Surgery, Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Vladimiro L Vida
- Pediatric Cardiac and Congenital Cardiac Surgery, Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Massimo A Padalino
- Pediatric Cardiac and Congenital Cardiac Surgery, Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
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Staying connected during the COVID-19 pandemic: highlights from the Paediatric and Congenital Interventional Cardiology Early-Career Society (PICES) 2020 activities. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:1-5. [PMID: 33868412 PMCID: PMC8039930 DOI: 10.5114/aic.2021.104762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022] Open
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8
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Alsaad AA, Russell HM, Tokarczyk AJ, Ricciardi MJ. Hybrid approach to postmyocardial infarction ventricular septal defect repair. Catheter Cardiovasc Interv 2021; 97:E731-E735. [PMID: 32473072 DOI: 10.1002/ccd.29000] [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: 04/15/2020] [Revised: 05/01/2020] [Accepted: 05/12/2020] [Indexed: 11/07/2022]
Abstract
Postinfarction ventricular septal rupture is a rare and devastating complication of myocardial infarction. Despite attempts at acute surgical and percutaneous defect closure, morbidity and mortality remain high. Herein, we describe a hybrid surgical and catheter-based approach to defect closure in a 63-year-old woman with postinfarction ventricular septal rupture and cardiogenic shock.
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Affiliation(s)
- Ali A Alsaad
- Department of Medicine/Cardiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Hyde M Russell
- Department of Cardiothoracic Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Arthur J Tokarczyk
- Department of Anesthesiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Mark J Ricciardi
- Department of Medicine/Cardiology, NorthShore University HealthSystem, Evanston, Illinois, USA
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Wu L, Tanidir IC, Ye D, Zhang X, Li B, Zhu D, Deng G, Chen H. Hybrid Transthoracic Periventricular Device Closure of Ventricular Septal Defects: Single- Center Experience. Braz J Cardiovasc Surg 2021; 36:48-56. [PMID: 33118345 PMCID: PMC7918382 DOI: 10.21470/1678-9741-2020-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of hybrid transthoracic periventricular device closure of ventricular septal defects (VSDs) in a single center. METHODS All patients who underwent hybrid transthoracic periventricular device closure of VSDs between January 2018 and December 2019 were retrospectively analyzed. The preoperative, operative and postoperative findings and clinical follow-ups were reviewed. RESULTS A total of 59 patients underwent the procedure. Transesophageal echocardiographic guidance was used in all procedures. The procedure was successful in 57 procedures (97%). The procedures of two patients were changed to openheart surgery during the same intervention due to severe aortic insufficiency (the device was not deployed) and significant residual shunt after device deployment. One major complication (1.7%) was observed after the procedure. The patient's device was dislodged within 12 hours after the procedure, and this patient underwent device extraction and VSD patch closure due to significant residual shunt. Eight (14%) minor complications were observed after the procedure, and three of them persisted during follow-up. Three of these eight complications were incomplete right bundle branch block, one of which resolved during followup; two were mild residual shunts, one of which resolved during follow-up; two were mild new-onset tricuspid valve insufficiencies; and one was mild new-onset mitral valve insufficiency; all valvular insufficiencies were resolved during follow-up. CONCLUSION Hybrid transthoracic periventricular device closure of VSD seems to be a good alternative approach due to its procedural success and low risk rates. The best advantage of the procedure is the possibility of switching to open-heart surgery, if necessary.
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Affiliation(s)
- Liying Wu
- Department of Cardiovascular Surgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.,The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ibrahim Cansaran Tanidir
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - DongTing Ye
- Department of Cardiovascular Surgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Xiong Zhang
- Department of Cardiovascular Surgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Bin Li
- Department of Cardiovascular Surgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Daliang Zhu
- Department of Cardiovascular Surgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Gaopi Deng
- Department of Gynecology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haisheng Chen
- Department of Cardiovascular Surgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
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10
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Escobar AJ, Levi DS, Van Arsdell GS, Perens GS, Mohan UR. Apical muscular ventricular septal defect closure via hybrid approach using a right ventricular stay suture. Catheter Cardiovasc Interv 2020; 97:E514-E517. [PMID: 33197132 DOI: 10.1002/ccd.29370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/04/2020] [Accepted: 10/24/2020] [Indexed: 11/08/2022]
Abstract
Transcatheter closure of large apical muscular ventricular septal defects (VSDs) can be performed via transfemoral or hybrid approach. A very large apical muscular VSD was closed via a hybrid approach. A strategy for deployment of a right ventricular stay suture was utilized to minimize the risk of device embolization without the use of bypass and without externalization of a portion of the device.
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Affiliation(s)
- Antonio J Escobar
- Division of Pediatric Cardiology, Ronald Reagan Medical Center, University of California, Los Angeles, California, USA
| | - Daniel S Levi
- Division of Pediatric Cardiology, Ronald Reagan Medical Center, University of California, Los Angeles, California, USA
| | - Glen S Van Arsdell
- Division of Pediatric Cardiothoracic Surgery, Ronald Reagan Medical Center, University of California, Los Angeles, California
| | - Gregory S Perens
- Division of Pediatric Cardiology, Ronald Reagan Medical Center, University of California, Los Angeles, California, USA
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Hybrid perventricular muscular ventricular septal defect closure using the new multi-functional occluder. Cardiol Young 2020; 30:1517-1520. [PMID: 32787993 DOI: 10.1017/s1047951120002401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The hybrid perventricular approach for the closure of trabecular ventricular septal defects is an attractive treatment modality for small children. Worldwide experience has shown that procedure success is influenced by the defect anatomical accessibility, operators' expertise, and device technical features. In May 2018, a new promising device, the KONAR-Multi-functional™ ventricular septal defect occluder (Lifetech, Shenzhen, China), obtained CE-marking for septal defect transcatheter closure after the first-in-man implantation in 2013. Herein, this is the first report of successful perventricular closure of ventricular septal defect using this new device in a child with significant co-morbidities.
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12
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Highlights from the Paediatric and Congenital Interventional Cardiology Early-Career Society (PICES) 2019 Activities. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:15-18. [PMID: 32368232 PMCID: PMC7189140 DOI: 10.5114/aic.2020.93908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 11/17/2022] Open
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Beyond atrial septal defect closure, it is time to start seriously considering closing ventricular septal defects with devices. Curr Opin Cardiol 2019; 35:58-62. [PMID: 31652133 DOI: 10.1097/hco.0000000000000695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the history and current state of transcutaneous device closure of ventricular septal defects. RECENT FINDINGS Newer devices and techniques have expanded the role of transcutaneous device closure of ventricular septal defects. Device closure of ventricular septal defects is a mainstay of therapy in many parts of the world. Device closure in smaller infants has relatively higher risks than larger infants and older children. The potential for the development of complete heart block remains a concern with this procedure. SUMMARY Transcutaneous device closure of ventricular septal defects is a safe alternative to surgical repair in many patients.
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Kalfa D, Torres AJ. Indications and results for hybrid interventions in patients with congenital heart disease. Arch Cardiovasc Dis 2019; 113:96-103. [PMID: 31492537 DOI: 10.1016/j.acvd.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 11/28/2022]
Abstract
A hybrid therapy or procedure is a new treatment modality that develops by combining therapies from different subspecialties. In congenital heart disease, a growing number of such procedures have been described in recent decades, as a result of increasing collaboration between surgeons and interventionalists. The ideas behind these therapies include enabling the performance of procedures of different complexity in a less invasive manner, shortening procedural times, avoiding cardiopulmonary bypass, facilitating vascular access and decreasing the number of complications associated with more invasive approaches. Over the years, hybrid therapy has gained a place as a widely accepted therapeutic option for the management of several conditions in high-risk patients with congenital heart disease.
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Affiliation(s)
- David Kalfa
- Section of Congenital and Pediatric Cardiac Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Children's Hospital of NewYork-Presbyterian/Columbia University Medical Center, 10032 New York, NY, United States
| | - Alejandro J Torres
- Pediatric Cardiology Department, Children's Hospital of New York-Presbyterian/Columbia University Medical Center, 3959, Broadway BH2N, 10032 New York, NY, United States.
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15
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Martinez JJ, Verma AJ, Thankavel PP, Jaquiss RD. Ventricular Pseudoaneurysms After Perventricular Closure of Ventricular Septal Defect. Ann Thorac Surg 2018; 107:e397-e398. [PMID: 30414831 DOI: 10.1016/j.athoracsur.2018.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/08/2018] [Accepted: 09/16/2018] [Indexed: 11/29/2022]
Abstract
Perventricular ventricular septal defect closure has become an accepted method for treatment of some muscular and perimembranous ventricular septal defects. This report describes the case of a child who had left ventricular pseudoaneurysms after perventricular closure of a ventricular septal defect performed at 3 months of age. At 18 months, the ventricular pseudoaneurysms were closed surgically. Ventricular trauma from guidewire use during device placement was thought to be the cause. The potential for injury to the left ventricular free wall should be borne in mind and sought with serial imaging during and after perventricular septal defect closure.
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Affiliation(s)
- Joseph J Martinez
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | | | - Poonam P Thankavel
- Division of Cardiology, Department of Pediatrics, Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert D Jaquiss
- Pediatric Group, Department of Cardiothoracic Surgery, Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas, Texas
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Abstract
Transcatheter closure of ventricular septal defects (VSDs) was first documented in 1988. The early studies of VSD closure were successful but there were high complication rates, particularly early and late-onset complete heart block. However, the development and use of new vascular occlusion devices in an off-label fashion has improved the range of patients who can be treated and reduced the complication rates. In particular, the rate of complete heart block documented in contemporary studies of VSD closure has fallen to levels at or below those documented in the surgical VSD closure literature.
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Affiliation(s)
- Brian H Morray
- Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way Northeast, RC.2.820, Seattle, WA 98105, USA.
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Hybrid muscular ventricular septal defect closure in a 4.5 kg infant followed by sildenafil treatment and transcatheter atrial septal defect occlusion. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:112-114. [PMID: 29743916 PMCID: PMC5939557 DOI: 10.5114/aic.2018.74368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 12/10/2017] [Indexed: 11/17/2022] Open
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Kenny D. Interventional Cardiology for Congenital Heart Disease. Korean Circ J 2018; 48:350-364. [PMID: 29671282 PMCID: PMC5940641 DOI: 10.4070/kcj.2018.0064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/05/2018] [Indexed: 12/22/2022] Open
Abstract
Congenital heart interventions are now replacing surgical palliation and correction in an evolving number of congenital heart defects. Right ventricular outflow tract and ductus arteriosus stenting have demonstrated favorable outcomes compared to surgical systemic to pulmonary artery shunting, and it is likely surgical pulmonary valve replacement will become an uncommon procedure within the next decade, mirroring current practices in the treatment of atrial septal defects. Challenges remain, including the lack of device design focused on smaller infants and the inevitable consequences of somatic growth. Increasing parental and physician expectancy has inevitably lead to higher risk interventions on smaller infants and appreciation of the consequences of these interventions on departmental outcome data needs to be considered. Registry data evaluating congenital heart interventions remain less robust than surgical registries, leading to a lack of insight into the longer-term consequences of our interventions. Increasing collaboration with surgical colleagues has not been met with necessary development of dedicated equipment for hybrid interventions aimed at minimizing the longer-term consequences of scar to the heart. Therefore, great challenges remain to ensure children and adults with congenital heart disease continue to benefit from an exponential growth in minimally invasive interventions and technology. This can only be achieved through a concerted collaborative approach from physicians, industry, academia and regulatory bodies supporting great innovators to continue the philosophy of thinking beyond the limits that has been the foundation of our specialty for the past 50 years.
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Affiliation(s)
- Damien Kenny
- Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
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