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Price K, Ryan JR, El-Said H. Stenting of the Patent Ductus Arteriosus. Interv Cardiol Clin 2024; 13:421-430. [PMID: 38839174 DOI: 10.1016/j.iccl.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Since PDA stenting was first attempted in the early 1990s, significant technical advancements have improved outcomes and some centers have even transitioned to exclusive PDA stenting for all infants with duct-dependent pulmonary circulation. In addition to its use in infants with duct-dependent pulmonary circulation, PDA stenting has also been adapted as a percutaneous palliative option for suprasystemic pulmonary arterial hypertension and as a component of the hybrid procedure. In this article, the authors aim to review indications and outcomes for PDA stenting, describe the procedure, and discuss future directions.
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Affiliation(s)
- Katherine Price
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, USA
| | - Justin R Ryan
- Webster Foundation 3D Innovations Lab, Rady Children's Hospital, 3020 Children's way, San Diego, CA 92123, USA
| | - Howaida El-Said
- Department of Pediatric Cardiology, Rady Children's Hospital, 3020 Children's way, San Diego, CA 92123, USA.
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2
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Flores-Umanzor E, Alshehri B, Keshvara R, Wilson W, Osten M, Benson L, Abrahamyan L, Horlick E. Transcatheter-Based Interventions for Tetralogy of Fallot Across All Age Groups. JACC Cardiovasc Interv 2024; 17:1079-1090. [PMID: 38749587 DOI: 10.1016/j.jcin.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 05/26/2024]
Abstract
Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease. Palliative procedures, either surgical or transcatheter, aim to improve oxygen saturation, affording definitive procedures at a later stage. Transcatheter interventions have been used before and after surgical palliative or definitive repair in children and adults. This review aims to provide an overview of the different catheter-based interventions for TOF across all age groups, with an emphasis on palliative interventions, such as patent arterial duct stenting, right ventricular outflow tract stenting, or balloon pulmonary valvuloplasty in infants and children and transcatheter pulmonary valve replacement in adults with repaired TOF, including the available options for a large, dilated native right ventricular outflow tract.
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Affiliation(s)
- Eduardo Flores-Umanzor
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Cardiology Department, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Bandar Alshehri
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Rajesh Keshvara
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - William Wilson
- Royal Melbourne Hospital Cardiology, Parkville, Victoria, Australia
| | - Mark Osten
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Lee Benson
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; The Labatt Family Heart Centre, Division of Cardiology, The Hospital for Sick Children, The Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
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3
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Takajo D, Newkirk B, Shahanavaz S. Incidence, risk factors, and management following cardiac catheterization via carotid and axillary artery approaches: A single-center experience on pseudoaneurysms in young infants. Catheter Cardiovasc Interv 2024; 103:580-586. [PMID: 38353500 DOI: 10.1002/ccd.30966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Use of alternate access for complex neonatal interventions has gained acceptance with carotid and axillary artery access being used for ductal and aortic interventions. METHODS This study was a retrospective, single-center study at Cincinnati Children's Hospital Medical Center. The study included infants, aged ≤90 days, who underwent cardiac catheterization with either carotid or axillary artery access between 2013 and 2022. Data encompassing demographics, clinical information, catheterization data, and the incidence of pseudoaneurysm as a procedural complication were collected. RESULTS Among 29 young infants (20 males, 69%), 4 out of 15 patients (27%) who underwent the carotid approach developed pseudoaneurysms, while 1 out of 14 patients (7.1%) who underwent the axillary approach developed one. Two patients required transcatheter intervention due to enlargement of pseudoaneurysms, involving the placement of transarterial flow-diverting stent and occlusion of left common carotid artery. Longer sheath in-to-out time (135 vs. 77 min, p = 0.001), and higher closing activated clotting times (ACT) (268 vs. 197 s, p = 0.021) were observed among patients with pseudoaneurysms compared to those without. CONCLUSIONS Young infants with alternative access via the carotid and axillary arteries may be at risk of pseudoaneurysm formation during longer procedures and with higher ACTs for closure. Ultrasound-guided compression can be employed to prevent the progression and in resolution of these lesions.
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Affiliation(s)
- Daiji Takajo
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Betsy Newkirk
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shabana Shahanavaz
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Flores S, Su E, Moher JM, Adler AC, Riley AF. Point-of-Care-Ultrasound in Pediatrics: A Review and Update. Semin Ultrasound CT MR 2024; 45:3-10. [PMID: 38056790 DOI: 10.1053/j.sult.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Point-of-Care-Ultrasound (POCUS) has encountered a tremendous expansion in patient care. POCUS has taken a central role during invasive procedures. POCUS has expanded to most subspecialties from adult to pediatric and neonatal health care. POCUS in pediatrics has also become part of specific critical situations such as myocardial function assessment during cardiac arrest, extracorporeal membrane oxygenation deployment and neurological evaluation. In this review we will go over the most important historical aspects of POCUS. We will also review important aspects of POCUS in the intensive care unit, cardiologist evaluation and in the emergency department among others.
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Affiliation(s)
- Saul Flores
- Department of Pediatrics, Division of Critical Care and Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
| | - Erik Su
- Department of Pediatrics, Division of Critical Care, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Justin M Moher
- Department of Pediatrics, Division of Emergency Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Adam C Adler
- Department of Anesthesiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Alan F Riley
- Department of Pediatrics, Division of Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
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5
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Haddad RN, Karmustaji F, Alloush R, Al Soufi M, Kasem M. Systematic approach to obtain axillary arterial access for pediatric heart catheterizations. Front Cardiovasc Med 2024; 11:1332152. [PMID: 38357517 PMCID: PMC10864575 DOI: 10.3389/fcvm.2024.1332152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Background Axillary arterial access (AAA) in pediatric heart catheterizations is undervalued. Methods We retrospectively reviewed children with congenital heart diseases (CHDs) who received trans-axillary arterial catheterizations between January 2019 and February 2023. We aimed ultrasound-guided punctures in the proximal two-thirds of axillary arteries with diameters ≥2 mm to insert 7 cm/4 Fr short introducers. We administrated intra-arterial verapamil (1.25 mg) and heparin (100 UI/kg). We infiltrated per-operatively 2% lignocaine (10 mg) for arterial spasms, long sheaths use (≥5 Fr), and ≥60 min procedures in <3 kg patients. Results We identified 30 patients (66.7% males) with a median age of 1.1 months (IQR, 0.3-5.4), and a median weight of 3.1 kg (IQR, 2.7-3.7). 5/30 patients had six redo interventions after a median of 3.9 months (IQR, 1.7-5.1). Overall, 27/36 procedures were interventional, including 6 aortic valvuloplasties, 6 balloon angioplasties, and 15 stenting procedures. The median arterial axillary angiographic diameter was 2.6 mm (IQR, 2.4-3). Access was right-sided in 23/36 (63.9%) procedures and obtained using 21G/2.5 cm bevel needles in 25/36 (69.4%) procedures. No hemodynamical change occurred after introducing spasmolytic drugs. The median fluoroscopy time was 26.1 min (IQR, 19.2-34.8). There were two self-resolving arterial dissections, one sub-occlusive arterial thrombosis (resolved with 6 weeks of enoxaparin), and one occlusive arterial thrombosis (resolved with alteplase thrombolysis and 6 weeks of enoxaparin). Median follow-up was 11.7 months (IQR, 8-17.5). Four patients with complex univentricular hearts died from non-procedural causes at a median of 40 days (IQR, 31-161) postoperative. Conclusion Systematic approach for AAA is the key to success and unlocks the many potentials of trans-axillary pediatric cardiology interventions.
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Affiliation(s)
- Raymond N. Haddad
- M3C-Necker, Necker-Enfants Malades University Hospital, Assistance Publique—Hôpitaux de Paris (AP-HP), Paris, France
| | - Fatema Karmustaji
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Rasha Alloush
- Department of Pediatric Cardiology, Heart Centre of Excellence, Al Jalila Children’s Speciality Hospital, Dubai, United Arab Emirates
| | - Mahmoud Al Soufi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Mohamed Kasem
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JACC Cardiovasc Interv 2024; 17:115-216. [PMID: 38099915 DOI: 10.1016/j.jcin.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California.
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101181. [PMID: 39131968 PMCID: PMC11307799 DOI: 10.1016/j.jscai.2023.101181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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Mejia E, McLennan D, Zablah J, Soszyn N, Shibbani K, Morgan GJ. Establishing Carotid Seldinger as Routine Access in Infants; Planning, Performance, and Follow-Up Protocols. Pediatr Cardiol 2023; 44:1815-1820. [PMID: 37603081 DOI: 10.1007/s00246-023-03267-x] [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] [Received: 03/13/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023]
Abstract
Percutaneous carotid access (PCA) in infants has been reported in small multicenter cohorts, case reports and wider studies over the last 20 years. Compare outcomes after implementation of a systematic approach to PCA in a single center including an imaging follow-up protocol. Retrospective case-control study of PCA at Children's Hospital Colorado was performed from January 2013 to December 2022. Seventy-four patients underwent 82 PCAs for cardiac catheterization. The median age (range) was 14 days (1-359), and weight was 3.25-kg (1.9-7.9). Median sheath size was 4-Fr (3.3-6). Seventy-seven interventions performed included PDA stenting, aortic valvoplasty, BTT shunt stenting, and coarctation stenting. Vascular access was performed using a modified 21 g butterfly needle. A protocolized approach was implemented in 2020 reversing the patient head-to-toe orientation on the catheterization table, maintaining intubation and sedation for 4-h during recovery and routine use of a specific vascular ultrasound protocol. Following these changes, time to access significantly improved with no major complications. Before 2020, two access related complications occurred. One requiring surgical vascular repair and one occlusive thrombus. A significant increase in sheath time in post-era was associated with increased case complexity. Longer sheath times were not associated with increased risk of vessel injury or thrombus. No neurological insults were reported. Our experience confirms that PCA is safe and achievable with preserved vessel patency regardless of patient weight or sheath size. A protocolized planning, recovery, and follow-up regimen is recommended to establish safe practice and identify and treat complications as necessary.
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Affiliation(s)
- Ernesto Mejia
- Department of Pediatric Cardiology, University of Colorado, Children's Hospital Colorado, The Heart Center, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA
| | - Daniel McLennan
- Department of Pediatric Cardiology, Children's Wisconsin, Milwaukee, WI, USA
- Department of Pediatric Cardiology, University of Iowa, Stead Family Children's Hospital, Iowa City, IA, USA
| | - Jenny Zablah
- Department of Pediatric Cardiology, University of Colorado, Children's Hospital Colorado, The Heart Center, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA
| | - Natalie Soszyn
- Department of Pediatric Cardiology, University of Colorado, Children's Hospital Colorado, The Heart Center, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA
| | - Kamel Shibbani
- Department of Pediatric Cardiology, University of Iowa, Stead Family Children's Hospital, Iowa City, IA, USA
| | - Gareth J Morgan
- Department of Pediatric Cardiology, University of Colorado, Children's Hospital Colorado, The Heart Center, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA.
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Wong N, Shorofsky M, Lim DS. Catheter-based Interventions in Tetralogy of Fallot Across the Lifespan. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:339-351. [PMID: 38161670 PMCID: PMC10755836 DOI: 10.1016/j.cjcpc.2023.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/07/2023] [Indexed: 01/03/2024]
Abstract
Surgical treatment of tetralogy of Fallot (TOF) involves surgical relief of right ventricular outflow tract (RVOT) obstruction and closure of ventricular septal defect. However, some patients may require staged palliation before surgical repair. This traditionally was achieved only with surgery but recently evolved to include catheter-based techniques. RVOT dysfunction occurs inevitably after the surgical repair of TOF and, depending on the surgical approach, manifests as either progressive stenosis, regurgitation, or a combination of both. This predisposes the individual to repeated RVOT interventions with the attendant risks of multiple open-heart surgeries. The advent of transcatheter pulmonary valve replacement has reduced the operative burden, and the expansion of transcatheter pulmonary valve replacement device platforms has widened the type and size of RVOT anatomies that can be treated. This review will discuss the transcatheter therapies available throughout the lifespan of the patient with TOF.
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Affiliation(s)
- Ningyan Wong
- Department of Cardiology, National Heart Centre Singapore, Singapore
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Michael Shorofsky
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - D. Scott Lim
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
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Abdul Latiff H, Gopal AR, Hidayat ZF, Haranal M, Borhanuddin BK, Alwi M, Samion H. Ductus arteriosus morphology in duct-dependent pulmonary circulation: CT classification and pattern in different ventricular morphology. Cardiol Young 2023; 33:2243-2251. [PMID: 36651340 DOI: 10.1017/s1047951122004218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The objective was to study the ductus arteriosus morphology in duct-dependent pulmonary circulation and its pattern in different ventricle morphology using CT angiography. METHOD From January 2013 to December 2015, patients aged 6 months and below with duct-dependent pulmonary circulation underwent CT angiography to delineate the ductus arteriosus origin, tortuosity, site of insertion, and pulmonary artery anatomy. The ductus arteriosus were classified into type I, IIa, IIb, and III based on its site of origin, either from descending aorta, distal arch, proximal arch, or subclavian artery, respectively. RESULTS A total of 114 patients and 116 ductus arteriosus (two had bilateral ductus arteriosus) were analysed. Type I, IIa, IIb, and III ductus arteriosus were seen in 13 (11.2 %), 71 (61.2%), 21 (18.1%), and 11 (9.5%), respectively. Tortuous ductus arteriosus was found in 38 (32.7%), which was commonly seen in single ventricular lesions. Ipsilateral and bilateral branch pulmonary artery stenosis was seen in 68 (59.6%) and 6 (5.3%) patients, respectively. The majority of patients with pulmonary atresia intact ventricular septum had type I (54.4%) and non-tortuous ductus arteriosus, while those with single and biventricular lesions had type II ductus arteriosus (84.9% and 89.7%, respectively). Type III ductus arteriosus was more common in biventricular lesions (77.8%). CONCLUSIONS Ductus arteriosus in duct-dependent pulmonary circulation has a diverse morphology with a distinct origin and tortuosity pattern in different types of ventricular morphology. CT may serve as an important tool in case selection and pre-procedural planning for ductal stenting.
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Affiliation(s)
- Haifa Abdul Latiff
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Anu Ratha Gopal
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Zul Febrianti Hidayat
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Maruti Haranal
- Department of Cardiac Surgery, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Boekren K Borhanuddin
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Mazeni Alwi
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Hasri Samion
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
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Bauser-Heaton H, Price K, Weber R, El-Said H. Erratum: Stenting of the Patent Ductus Arteriosus: A Meta-analysis and Literature Review. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101052. [PMID: 39131650 PMCID: PMC11307754 DOI: 10.1016/j.jscai.2023.101052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/18/2022] [Accepted: 06/01/2022] [Indexed: 08/13/2024]
Abstract
[This corrects the article DOI: 10.1016/j.jscai.2022.100392.][This corrects the article DOI: 10.1016/j.jscai.2023.101051.].
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Affiliation(s)
- Holly Bauser-Heaton
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Katherine Price
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California
| | - Rachel Weber
- Division of Pediatric Cardiology, Rady Children’s Hospital and University of California San Diego School of Medicine, San Diego, California
| | - Howaida El-Said
- Division of Pediatric Cardiology, Rady Children’s Hospital and University of California San Diego School of Medicine, San Diego, California
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12
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Basgoze S, Odemis E, Onalan A, Temur B, Aydın S, Guzelmeric F, Cevik A, Erek E. Carotid artery cut-down technique for ductus arteriosus stenting. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:317-324. [PMID: 37664774 PMCID: PMC10472473 DOI: 10.5606/tgkdc.dergisi.2023.24598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/03/2023] [Indexed: 09/05/2023]
Abstract
Background This study aims to evaluate early and mid-term outcomes of ductal stenting via carotid artery surgical cut-down technique in neonates. Methods Between January 2015 and January 2022, a total of 17 neonates (12 males, 5 females; median age: 14 days, range, 5 to 34 days) who underwent carotid artery surgical cut-down technique for ductal stenting were retrospectively analyzed. Diagnoses of the patients, demographics, procedural success/failure, access-related complications, and neuroimaging findings were recorded. Results The primary indication for ductal stenting was pulmonary atresia in all patients. All patients who underwent carotid cut-down had vertical anatomy, with or without tortuous ductal anatomy, and they were not suitable for the femoral approach. The median body weight was 3 (range, 2 to 3.4) kg. Fifteen of the 17 interventions (88.2%) were successful. Two patients whose stenting failed underwent a systemic-to-pulmonary shunt operation. The early in-hospital mortality rate was 17.6% (n=3). No neurological or accessrelated complications were observed in any of the patients. Conclusion Stenting the ductus arteriosus with challenging anatomy is feasible and safe with carotid artery cut-down, particularly in small neonates. Based on our study findings, this technique may offer an effective and less invasive alternative to the systemic-to-pulmonary shunt operation.
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Affiliation(s)
- Serdar Basgoze
- Department of Pediatric Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University Atakent Hospital, Istanbul, Türkiye
| | - Ender Odemis
- Department of Pediatric Cardiology, Koç University Faculty of Medicine, Istanbul, Türkiye
| | - Akif Onalan
- Department of Pediatric Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University Atakent Hospital, Istanbul, Türkiye
| | - Bahar Temur
- Department of Pediatric Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University Atakent Hospital, Istanbul, Türkiye
| | - Selim Aydın
- Department of Pediatric Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University Atakent Hospital, Istanbul, Türkiye
| | - Fusun Guzelmeric
- Department of Anesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University Atakent Hospital, Istanbul, Türkiye
| | - Ayhan Cevik
- Department of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University Atakent Hospital, Istanbul, Türkiye
| | - Ersin Erek
- Department of Pediatric Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University Atakent Hospital, Istanbul, Türkiye
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Dewangga MSY, Prakoso R, Rahajoe AU, Lilyasari O. Efficacy and safety of transcarotid compared to transfemoral approach of patent ductus arteriosus stenting in duct-dependent cyanotic heart disease. Egypt Heart J 2023; 75:47. [PMID: 37306786 DOI: 10.1186/s43044-023-00371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/20/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Minimally invasive transcatheter approaches were usually done for patent ductus arteriosus (PDA) with duct-dependent pulmonary circulation. There are two ways to establish vascular access, by using transfemoral either femoral vein (FV) or femoral artery (FA) and transcarotid artery (CA) with surgical cutdown approach to access the PDA and then provide good support for the balloon and the stent to be safely deployed. This study aims to compare the efficacy and safety of transcarotid with surgical cutdown compared to the transfemoral approach of patent ductus arteriosus stenting in duct-dependent cyanotic heart disease. RESULTS Overall procedural complication rates were higher in the FA/FV approach than in the CA approach (51% vs. 30%). The incidence of acute limb ischemia in the FA approach is significantly higher than in the CA approach (P < 0.05). No acute thrombosis/occlusion of the carotid artery was assessed by carotid vascular ultrasound in 2-day series. CONCLUSIONS The transcarotid approach with surgical cutdown may offer a secure and more efficient means of accessing the PDA, particularly for those emerging from the underside of the aortic arch.
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Affiliation(s)
- Made Satria Yudha Dewangga
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita Jakarta, University of Indonesia, Jakarta, Indonesia.
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Udayana-Prof. I.G.N.G Ngoerah Hospital, Bali, Indonesia.
| | - Radityo Prakoso
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita Jakarta, University of Indonesia, Jakarta, Indonesia
| | - Anna Ulfah Rahajoe
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita Jakarta, University of Indonesia, Jakarta, Indonesia
| | - Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita Jakarta, University of Indonesia, Jakarta, Indonesia
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14
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Prakoso R, Sembiring AA, Hernisa L, Mendel B, Lelya O, Lilyasari O. Case report: Right atrial appendage hybrid access to bailout a stuck stent from the inferior vena cava of a small child. Front Cardiovasc Med 2023; 9:1084170. [PMID: 36776945 PMCID: PMC9912932 DOI: 10.3389/fcvm.2022.1084170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/20/2022] [Indexed: 01/26/2023] Open
Abstract
A three-month-old baby boy (5. 4 Kg) with pulmonary atresia, subaortic ventricular septal defect (VSD), and patent ductus arteriosus (PDA) was sent for ductal stenting from the femoral vein. The route to the PDA was extremely tortuous and the procedure was complicated with a stent stuck in the abdominal inferior vena cava (IVC). Transfemoral stent recapture was technically laborious and the stent was successfully recaptured across a 10-Fr right atrial appendage (RAA) hybrid access avoiding a cardiopulmonary bypass (CBP). The PDA was subsequently stented for the femoral artery with satisfactory clinical outcomes.
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Affiliation(s)
- Radityo Prakoso
- Department of Cardiology and Vascular Medicine, Division of Pediatric Cardiology and Congenital Heart Disease, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia,*Correspondence: Radityo Prakoso ✉
| | - Aditya Agita Sembiring
- Department of Cardiology and Vascular Medicine, Division of Pediatric Cardiology and Congenital Heart Disease, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Latifa Hernisa
- Division of Pediatric and Congenital Heart Surgery, National Cardiovascular Centre of Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Brian Mendel
- Department of Cardiology and Vascular Medicine, Division of Pediatric Cardiology and Congenital Heart Disease, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia,Department of Cardiology and Vascular Medicine, Sultan Sulaiman Government Hospital, Serdang Bedagai, Sei Rampah, Indonesia
| | - Olfi Lelya
- Department of Cardiology and Vascular Medicine, Division of Pediatric Cardiology and Congenital Heart Disease, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, Division of Pediatric Cardiology and Congenital Heart Disease, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
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15
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Bauser-Heaton H, Price K, Weber R, El-Said H. Stenting of the Patent Ductus Arteriosus: A Meta-analysis and Literature Review. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100392. [PMID: 39132356 PMCID: PMC11308046 DOI: 10.1016/j.jscai.2022.100392] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/18/2022] [Accepted: 06/01/2022] [Indexed: 08/13/2024]
Abstract
Background Patent ductus arteriosus (PDA) stent placement and systemic-pulmonary surgical shunt procedure can both be performed as palliation for infants with duct-dependent pulmonary circulation. The aim of this meta-analysis and literature review was to compare outcomes and study populations between the 2 methods as well as review the technical considerations and complications of PDA stenting. Methods A systematic search was conducted using the PubMed database and meta-analysis was performed. Risk ratio and mean difference were used to compare the reported outcomes of studies across patients receiving PDA stent and surgical shunt. Results In total, 1094 patients from 8 comparative observational studies were included. The PDA stent group had a lower mortality rate and a shorter hospital length of stay than the systemic-pulmonary surgical shunt group, although at the expense of increased reintervention rates. There were higher proportions of patients with single-ventricle physiology and single-source pulmonary blood flow in the surgical shunt group. Conclusions PDA stenting appears to be a noninferior or possibly superior method of palliation for duct-dependent pulmonary circulation compared with systemic-pulmonary surgical shunt, recognizing, however, that patients receiving surgical shunt more often had single-ventricle physiology or single-source pulmonary blood flow in this meta-analysis.
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Affiliation(s)
- Holly Bauser-Heaton
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Katherine Price
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California
| | - Rachel Weber
- Division of Pediatric Cardiology, Rady Children’s Hospital and University of California San Diego School of Medicine, San Diego, California
| | - Howaida El-Said
- Division of Pediatric Cardiology, Rady Children’s Hospital and University of California San Diego School of Medicine, San Diego, California
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16
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Wespi R, Callegari A, Quandt D, Logoteta J, von Rhein M, Kretschmar O, Knirsch W. Favourable Short- to Mid-Term Outcome after PDA-Stenting in Duct-Dependent Pulmonary Circulation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12794. [PMID: 36232092 PMCID: PMC9566406 DOI: 10.3390/ijerph191912794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Stenting of patent ductus arteriosus (PDA) is a minimally invasive catheter-based temporary palliative procedure that is an alternative to a surgical shunt in neonates with duct-dependent pulmonary perfusion. METHODS An observational, single-centre, cross-sectional study of patients with duct-dependent pulmonary perfusion undergoing PDA-stenting as a stage I procedure and an analysis of short- to mid-term follow-up until a subsequent surgical procedure (stage II), with a focus on the interstage course. RESULTS Twenty-six patients were treated with PDA-stenting at a median (IQR) age of 7 (4-10) days; 10/26 patients (38.5%) (6/10 single pulmonary perfusion) were intended for later univentricular palliation, 16/26 patients (61.5%) (13/16 single pulmonary perfusion) for biventricular repair. PDA diameter was 2.7 (1.8-3.2) mm, stent diameter 3.5 (3.5-4.0) mm. Immediate procedural success was 88.5%. The procedure was aborted, switching to immediate surgery after stent embolisation, malposition or pulmonary coarctation in three patients (each n = 1). During mid-term follow-up, one patient needed an additional surgical shunt due to severe cyanosis, while five patients underwent successful catheter re-intervention 27 (17-30) days after PDA-stenting due to pulmonary hypo- (n = 4) or hyperperfusion (n = 1). Interstage mortality was 8.6% (2/23), both in-hospital and non-procedure-related. LPA grew significantly (p = 0.06) between PDA-stenting and last follow-up prior to subsequent surgical procedure (p = 0.06). RPA Z-scores remained similar (p = 0.22). The subsequent surgical procedure was performed at a median age of 106 (76.5-125) days. CONCLUSIONS PDA-stenting is a feasible, safe treatment option, with the need for interdisciplinary decision-making beforehand and surgical backup afterwards. It allows adequate body and pulmonary vessel growth for subsequent surgical procedures. Factors determining the individual patient's course should be identified in larger prospective studies.
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Affiliation(s)
- Regina Wespi
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
| | - Alessia Callegari
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
| | - Daniel Quandt
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
| | - Jana Logoteta
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
| | - Michael von Rhein
- University of Zurich, 8006 Zurich, Switzerland
- Child Development Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Oliver Kretschmar
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
| | - Walter Knirsch
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
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17
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Nasef MA, Shahbah DA, Batlivala SP, Darwish R, Qureshi AM, Breatnach CR, Linnane N, Walsh KP, Oslizlok P, McCrossan B, Momenah T, Alshahri A, Abdulhamed J, Arafat A, Tamimi OA, Diraneyya OM, Goldestein BH, Kenny D. Short- and medium-term outcomes for patent ductus arteriosus stenting in neonates ≤2.5 kg with duct-dependent pulmonary circulation. Catheter Cardiovasc Interv 2022; 100:596-605. [PMID: 35904221 DOI: 10.1002/ccd.30351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/29/2022] [Accepted: 07/16/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Morbidity with surgical systemic-to-pulmonary artery shunting (SPS) in infants ≤2.5 kg has remained high. Patent ductus arteriosus (PDA) stenting may be a valid alternative. The objective of this study is to evaluate outcomes following PDA stenting in patients ≤2.5 kg from four large tertiary centers. METHODS Retrospective review of all neonates ≤2.5 kg with duct-dependent pulmonary circulation who underwent PDA stenting. Procedural details, pulmonary arterial growth, reinterventions, surgery type, and outcomes were assessed. RESULTS PDA stents were implanted in 37 of 38 patients attempted (18 female) at a median procedural weight of 2.2 kg (interquartile range [IQR], 2-2.4 kg). Seven patients (18%) had a genetic abnormality and 16 (42%) had associated comorbidities. The median intensive care unit stay was 4 days (IQR, 2-6.75 days), and the median hospital stay was 20 days (IQR, 16-57.25). One patient required a rescue shunt procedure, with three others requiring early SPS (<30 days postprocedure). Twenty patients (54%) required reintervention with either balloon angioplasty, restenting, or both. At 6-month follow-up, right pulmonary artery growth (median z-score -1.16 to 0.01, p = 0.05) was greater than the left pulmonary artery (median z-score -0.9 to -0.64, p = 0.35). Serious adverse effects (SAEs) were seen in 18% (N = 7) of our cohort. One patient developed an SAE during planned reintervention There were no intraprocedural deaths, with one early procedure-related mortality, and three interstage mortalities not directly related to PDA stenting. CONCLUSIONS PDA stenting in infants ≤2.5 kg is feasible and effective, promoting pulmonary artery growth. Reintervention rates are relatively high, though many are planned to allow for optimal growth before a definitive operation.
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Affiliation(s)
- Mohamed Al Nasef
- Children Health Ireland at Crumlin, Dublin, Ireland.,Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Doaa A Shahbah
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.,Department of Pediatric Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sarosh P Batlivala
- Department of Pediatric Cardiology Department, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Reem Darwish
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | | | | | | | | | | | - Tarek Momenah
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Atif Alshahri
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | | | - Amr Arafat
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Omar Al Tamimi
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | | | | | - Damien Kenny
- Children Health Ireland at Crumlin, Dublin, Ireland
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18
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Qureshi AM, Caldarone CA, Wilder TJ. Transcatheter Approaches to Palliation for Tetralogy of Fallot. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2022; 25:48-57. [PMID: 35835516 DOI: 10.1053/j.pcsu.2022.05.001] [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: 02/12/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 11/11/2022]
Abstract
To this day, controversy still exists regarding the optimal method to treat symptomatic neonates and infants with Tetralogy of Fallot (TOF). Symptomatic (severely cyanotic or ductal dependent) infants with TOF can undergo either a staged repair approach (consisting of initial palliation followed by complete repair) or primary repair. Traditionally, initial palliative procedures have been surgical, for example placement of a Blalock-Taussig-Thomas (BTT) shunt. Recent advances in technology have facilitated the introduction of catheter-based procedures as palliative techniques, for example, patent ductus arteriosus (PDA) stenting and right ventricular outflow tract (RVOT) stenting as more durable solutions than balloon pulmonary valvuloplasty (BPV). In this article, we discuss the rationale for these procedures, technical aspects of these procedures and outcomes data compared to traditional surgical procedures. Recent data have suggested that RVOT and PDA stenting procedures offer many advantages over traditional surgical palliative procedures as palliative methods in this patient population. This comes at a cost of increased reintervention burden, which may be considered part of the overall treatment strategy in smaller neonates and can be minimized with a focus on technical aspects and overall treatment strategies. Advanced surgical techniques are required at the eventual complete repair to negotiate removal of stent material and pulmonary artery reconstruction in some instances. Further adoption of catheter based palliative procedures for infants with symptomatic TOF has the potential to tip the outcomes towards favoring a staged approach, particularly in high-risk infants.
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Affiliation(s)
- Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
| | - Christopher A Caldarone
- Congenital Heart Surgery, Texas Children's Hospital and Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Travis J Wilder
- Division of Congenital Heart Surgery, University Hospitals, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
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19
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Shahanavaz S, Qureshi AM, Petit CJ, Goldstein BH, Glatz AC, Bauser-Heaton HD, McCracken CE, Kelleman MS, Law MA, Nicholson GT, Zampi JD, Pettus J, Meadows J. Factors Influencing Reintervention Following Ductal Artery Stent Implantation for Ductal-Dependent Pulmonary Blood Flow: Results From the Congenital Cardiac Research Collaborative. Circ Cardiovasc Interv 2021; 14:e010086. [PMID: 34789017 DOI: 10.1161/circinterventions.120.010086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Stenting of the patent ductus arteriosus (PDA) is an established palliative option for infants with ductal-dependent pulmonary blood flow. Following initial palliation, reintervention on the PDA stent is common, but risk factors have not been characterized. METHODS Infants with ductal-dependent pulmonary blood flow palliated with PDA stent between 2008 and 2015 were reviewed within the Congenital Cardiac Research Collaborative. Rates and risk factors for reintervention were analyzed. RESULTS Among 105 infants who underwent successful PDA stenting, 41 patients (39%) underwent a total of 53 reinterventions on the PDA stent, with all but one occurring within 6 months of the initial intervention. Stent redilation constituted the majority of reintervention (n=35; 66%) followed by additional stent placement (n=11; 21%) and surgical shunt placement (n=7; 13%). The majority of reintervention was nonurgent, and there were no deaths during the reintervention procedure. All but one reintervention occurred within 6 months of the initial procedure. On univariate analysis, risk factors for reintervention included anticipated single-ventricle physiology, lack of prior balloon pulmonary valvuloplasty, use of drug-eluting stent, and increased ductal tortuosity. CONCLUSIONS In infants with ductal-dependent pulmonary blood flow palliated with PDA stent implantation, reintervention is common, can be performed safely, and is associated with both anatomic/procedural factors and anticipated final physiology.
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Affiliation(s)
- Shabana Shahanavaz
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, MO (S.S.).,The Heart Institute, Cincinnati Children's Hospital Medical Center, OH (S.S., B.H.G.)
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston (A.M.Q.)
| | - Christopher J Petit
- Emory University School of Medicine, Children's Healthcare of Atlanta, GA (C.J.P., H.D.B.-H., J.P.).,Division of Pediatric Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Hospital (C.J.P.)
| | - Bryan H Goldstein
- The Heart Institute, Cincinnati Children's Hospital Medical Center, OH (S.S., B.H.G.).,Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, PA (B.H.G.)
| | - Andrew C Glatz
- Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia (A.C.G.)
| | - Holly D Bauser-Heaton
- Emory University School of Medicine, Children's Healthcare of Atlanta, GA (C.J.P., H.D.B.-H., J.P.)
| | - Courtney E McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (C.E.M., M.S.K.)
| | - Michael S Kelleman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (C.E.M., M.S.K.)
| | - Mark A Law
- Department of Pediatrics, Division of Pediatric Cardiology, University of Alabama at Birmingham (M.A.L.)
| | - George T Nicholson
- Division of Pediatric Cardiology, Department of Pediatrics at the Ann and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN (G.T.N.)
| | - Jeffrey D Zampi
- Department of Pediatrics, Division of Cardiology, University of Michigan, Ann Arbor (J.D.Z.)
| | - Joelle Pettus
- Emory University School of Medicine, Children's Healthcare of Atlanta, GA (C.J.P., H.D.B.-H., J.P.)
| | - Jeffery Meadows
- Division of Pediatric Cardiology, University of California, San Francisco (J.M.)
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20
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Evaluation of carotid artery access in comparison with femoral artery access in neonatal percutaneous stenting of ductus arteriosus. Cardiol Young 2021; 31:1465-1471. [PMID: 33597066 DOI: 10.1017/s1047951121000469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patent ductus arteriosus stenting in duct-dependent pulmonary circulation is a challenging procedure. Percutaneous carotid artery access for ductal stenting has proven to be feasible; however, comparison with femoral artery access in terms of procedure details and complications either immediate or late is scarce. Therefore, we evaluated carotid artery access in comparison with femoral artery for stenting of patent ductus arteriosus. METHODS Forty neonates were reviewed, 20 were stented via carotid artery access, and 20 via the traditional femoral artery access. Comparison variables were neonatal demographics at the procedure, angiographic ductal anatomy, procedure details, and immediate complications. Follow-up Doppler ultrasound on access site was performed to document late complications. RESULTS Median age of included cases was 10.5 (3-28) days with complex ductal anatomy more frequently accessed via carotid artery than femoral. Immediate access-related complications were significantly higher with femoral than carotid artery access; 9 (45%) versus 3 (15%) respectively, p = 0.038. With carotid access, we had only one case with small pseudoaneurysm and acute hemiparesis 3 days after the procedure. Delayed local complications were more common with femoral access (15%) than carotid access (5%), mild stenosis in one case, and severe in another with femoral access; while with transcarotid arterial access, only one case had mild narrowing. CONCLUSION Percutaneous carotid artery access in neonates is a more convenient approach for patent ductus arteriosus stenting especially with complex ductal anatomy. Moreover, local complications are limited and vascular patency is better preserved, in comparison with trans-femoral arterial access. However, the potential for neurological adverse events should not be overlooked.
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21
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Qasim A, Qureshi AM. Patent ductus arteriosus stenting for ductal dependent pulmonary blood flow. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Ratnayaka K, Nageotte SJ, Moore JW, Guyon PW, Bhandari K, Weber RL, Lee JW, You H, Griffin DA, Rao RP, Nigro JJ, El-Said HG. Patent Ductus Arteriosus Stenting for All Ductal-Dependent Cyanotic Infants: Waning Use of Blalock-Taussig Shunts. Circ Cardiovasc Interv 2021; 14:e009520. [PMID: 33685211 DOI: 10.1161/circinterventions.120.009520] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Kanishka Ratnayaka
- Division of Pediatric Cardiology (K.R., J.W.M., P.W.G., K.B., R.L.W., D.A.G., R.P.R., H.G.E.-S.), Rady Children's Hospital and UC San Diego School of Medicine, CA
| | - Stephen J Nageotte
- Division of Pediatric Cardiology, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, MO (S.J.N.)
| | - John W Moore
- Division of Pediatric Cardiology (K.R., J.W.M., P.W.G., K.B., R.L.W., D.A.G., R.P.R., H.G.E.-S.), Rady Children's Hospital and UC San Diego School of Medicine, CA
| | - Peter W Guyon
- Division of Pediatric Cardiology (K.R., J.W.M., P.W.G., K.B., R.L.W., D.A.G., R.P.R., H.G.E.-S.), Rady Children's Hospital and UC San Diego School of Medicine, CA
| | - Krishna Bhandari
- Division of Pediatric Cardiology (K.R., J.W.M., P.W.G., K.B., R.L.W., D.A.G., R.P.R., H.G.E.-S.), Rady Children's Hospital and UC San Diego School of Medicine, CA
| | - Rachel L Weber
- Division of Pediatric Cardiology (K.R., J.W.M., P.W.G., K.B., R.L.W., D.A.G., R.P.R., H.G.E.-S.), Rady Children's Hospital and UC San Diego School of Medicine, CA
| | - Jesse W Lee
- Division of Pediatric Cardiology, Baylor College of Medicine, The Children's Hospital of San Antonio, TX (J.W.L.)
| | - Hyeri You
- Biostatistics Unit, Altman Clinical and Translational Research Institute, University of California San Diego, CA (H.Y.)
| | - Danica A Griffin
- Division of Pediatric Cardiology (K.R., J.W.M., P.W.G., K.B., R.L.W., D.A.G., R.P.R., H.G.E.-S.), Rady Children's Hospital and UC San Diego School of Medicine, CA
| | - Rohit P Rao
- Division of Pediatric Cardiology (K.R., J.W.M., P.W.G., K.B., R.L.W., D.A.G., R.P.R., H.G.E.-S.), Rady Children's Hospital and UC San Diego School of Medicine, CA
| | - John J Nigro
- Division of Cardiovascular Surgery (J.J.N.), Rady Children's Hospital and UC San Diego School of Medicine, CA
| | - Howaida G El-Said
- Division of Pediatric Cardiology (K.R., J.W.M., P.W.G., K.B., R.L.W., D.A.G., R.P.R., H.G.E.-S.), Rady Children's Hospital and UC San Diego School of Medicine, CA
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23
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Hummel J, Kubicki R, Pingpoh C, Stiller B, Sigler M, Siepe M, Grohmann J. Surgically placed radiopaque markers: Proof-of-concept of a novel technique to facilitate percutaneous interventions in neonates and infants. Catheter Cardiovasc Interv 2020; 96:E303-E309. [PMID: 32267611 DOI: 10.1002/ccd.28891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Aim of this study was to evaluate feasibility and benefit of self-designed, radiopaque markers as a novel technique in neonates and infants with shunt- or duct-dependent lesions. BACKGROUND Surgically placed radiopaque markers have the potential to facilitate postoperative percutaneous interventions. METHODS All consecutive children with surgically placed radiopaque markers involving systemic-to-pulmonary artery connections or arterial ducts in the context of hybrid palliation and subsequent cardiac catheterization between January 2013 and March 2019 were included in this analysis. Our primary endpoint was our concept's feasibility, which we defined as a combination of surgical feasibility and the percutaneous intervention's success. Secondary endpoint was the rate of complications resulting from the surgical procedure or during catheterization. RESULTS Radiopaque markers that reveal the proximal entry of a surgical shunt or the arterial duct proved to be a feasible and beneficial approach in 25 postoperative catheterizations. The markers' high accuracy enabled easy probing and proper stent positioning in 13 neonates with a median age and weight of 121 days (range 9-356) and 4.7 kg (1.6-9.4) at the intervention. No procedural complications or unanticipated events associated with the radiopaque marker occurred. The markers were never lost, never migrated, and caused no local obstructive lesion. Surgical removal was straightforward in all patients. CONCLUSIONS Radiopaque markers are a promising and refined technique to substantially facilitate target vessel access and enabling the accurate positioning of stents during postoperative percutaneous procedures.
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Affiliation(s)
- Johanna Hummel
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rouven Kubicki
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Clarence Pingpoh
- Department of Cardiac and Vascular Surgery, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Sigler
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University, Göttingen, Germany
| | - Matthias Siepe
- Department of Cardiac and Vascular Surgery, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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