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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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Ryan JR, Ghosh R, Sturgeon G, Ali A, Arribas E, Braden E, Chadalavada S, Chepelev L, Decker S, Huang YH, Ionita C, Lee J, Liacouras P, Parthasarathy J, Ravi P, Sandelier M, Sommer K, Wake N, Rybicki F, Ballard D. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: pediatric congenital heart disease conditions. 3D Print Med 2024; 10:3. [PMID: 38282094 PMCID: PMC10823658 DOI: 10.1186/s41205-023-00199-3] [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: 11/21/2023] [Accepted: 12/11/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND The use of medical 3D printing (focusing on anatomical modeling) has continued to grow since the Radiological Society of North America's (RSNA) 3D Printing Special Interest Group (3DPSIG) released its initial guideline and appropriateness rating document in 2018. The 3DPSIG formed a focused writing group to provide updated appropriateness ratings for 3D printing anatomical models across a variety of congenital heart disease. Evidence-based- (where available) and expert-consensus-driven appropriateness ratings are provided for twenty-eight congenital heart lesion categories. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with pediatric congenital heart disease indications. Each study was vetted by the authors and strength of evidence was assessed according to published appropriateness ratings. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for pediatric congenital heart lesions. Recommendations are provided in accordance with strength of evidence of publications corresponding to each cardiac clinical scenario combined with expert opinion from members of the 3DPSIG. CONCLUSIONS This consensus appropriateness ratings document, created by the members of the RSNA 3DPSIG, provides a reference for clinical standards of 3D printing for pediatric congenital heart disease clinical scenarios.
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Affiliation(s)
- Justin R Ryan
- Webster Foundation 3D Innovations Lab, Rady Children's Hospital-San Diego, San Diego, CA, USA.
- Department of Neurological Surgery, UC San Diego Health, La Jolla, CA, USA.
| | - Reena Ghosh
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Greg Sturgeon
- Duke Children's Pediatric & Congenital Heart Center, Durham, NC, USA
| | - Arafat Ali
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Elsa Arribas
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric Braden
- Arkansas Children's Hospital, Little Rock, AR, USA
| | - Seetharam Chadalavada
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Leonid Chepelev
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Summer Decker
- Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, USA
- Tampa General Hospital, Tampa, FL, USA
| | - Yu-Hui Huang
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Ciprian Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
| | - Joonhyuk Lee
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Peter Liacouras
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | - Prashanth Ravi
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael Sandelier
- Department of Radiology - Advanced Reality Lab, James A. Haley VA Hospital, Tampa, FL, USA
| | | | - Nicole Wake
- Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene, Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Frank Rybicki
- Department of Radiology, University of Arizona, Phoenix, AZ, USA
| | - David Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
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3
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Vasquez Choy AL, Zonana Amkie R, Adebo DA. Role of Cardiac CTA to Evaluate Branch Pulmonary Artery Stenosis and Ductal Insertion Pattern in Right-Sided Congenital Heart Defects. Pediatr Cardiol 2023:10.1007/s00246-023-03234-6. [PMID: 37477698 DOI: 10.1007/s00246-023-03234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Abstract
There is limited experience in evaluating abnormal ductus arteriosus (DA) insertion pattern by contrast-enhanced cardiac computed tomography (cardiac CT) in patients with right-sided obstructive cardiac defects. Retrospective review of 38 infants with right-sided obstructive cardiac defects who underwent a preoperative cardiac CT between 2016 and 2021. We reviewed the types of cardiac lesions, patterns of ductal insertion, frequency of pulmonary artery (PA) stenosis requiring intervention, total dose length product (DLP), and effective radiation dose. Of 38 infants, 45% were female, the median gestational age and weight were 37 (range 34-40) weeks and 2.95 (range 2-4) kg. The most common pathologies were pulmonary atresia with ventricular septal defect (24%) and tetralogy of Fallot (24%). The abnormal ductal insertion patterns were DA inserting into the left PA in 39%, DA bifurcating into branch PA in 32%, and DA inserting into the right PA in 13%. Of the 38 infants, 76% developed branch PA stenosis requiring intervention. Among patients with abnormal DA insertion, 44% required branch PA arterioplasty during their index surgery compared to 17% without abnormal DA insertion. Regardless of the type of abnormal DA insertion, 67% developed bilateral branch PA stenosis over time. The mean DLP was 8 mGy-cm and the mean calculated effective radiation dose was 0.312 mSv. The utilization of contrast-enhanced cardiac CT in infants with right-sided obstructive heart defects can offer crucial insights into abnormal ductus arteriosus insertion patterns. This information is valuable for effective procedure planning and for monitoring the development of branch pulmonary artery stenosis.
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Affiliation(s)
- Ana L Vasquez Choy
- Division of Pediatric Cardiology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, 6410 Fannin Street, UTPB Suite 425, Houston, TX, 77030, USA.
| | - Rafael Zonana Amkie
- Division of Pediatric Cardiology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, 6410 Fannin Street, UTPB Suite 425, Houston, TX, 77030, USA
| | - Dilachew A Adebo
- Section of Pediatric Cardiac MRI And Pediatric Cardiac CT, Division of Pediatric Cardiology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
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4
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Computed tomography for aortic assessment in children. Pediatr Radiol 2022; 52:2470-2484. [PMID: 36151220 DOI: 10.1007/s00247-022-05501-9] [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: 05/23/2022] [Revised: 07/19/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
Because the aorta is the major vessel of the body, basic knowledge of aortic pathology is essential to the pediatric imager. This review divides aortic pathology into anatomical (e.g., congenital abnormalities) and acquired (e.g., vasculitis, trauma) entities, providing a brief description of pathology, technical considerations in CT acquisition and processing, and some pearls and pitfalls of interpretation. The objective of this paper is to familiarize general pediatric imagers with imaging features of common as well as high-impact aortic pathology on CT and prepare them for acquisition and reporting.
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5
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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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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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7
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Baspinar O. How should the tortuosity index and curvature ratio be used correctly in the ductal stenting procedure? Transl Pediatr 2022; 11:1065-1067. [PMID: 35800268 PMCID: PMC9253960 DOI: 10.21037/tp-22-107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/29/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Osman Baspinar
- Department of Pediatric Cardiology, Gaziantep University Medical Faculty, Gaziantep, Turkey
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8
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Parker LE, Sturgeon GM, Andersen ND, Turek JW. Commentary: It’s all about perspective: 3D visualization and surgical repair planning for complex congenital heart defects. JTCVS Tech 2022; 14:196-197. [PMID: 35967243 PMCID: PMC9366528 DOI: 10.1016/j.xjtc.2022.04.015] [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: 04/15/2022] [Accepted: 04/15/2022] [Indexed: 11/05/2022] Open
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9
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Arar Y, Divekar A, Clark S, Hussain T, Sebastian R, Hoda M, King J, Zellers TM, Reddy SRV. Role of Cross-Sectional Imaging in Pediatric Interventional Cardiac Catheterization. CHILDREN 2022; 9:children9030300. [PMID: 35327672 PMCID: PMC8947056 DOI: 10.3390/children9030300] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
Management of congenital heart disease (CHD) has recently increased utilization of cross-sectional imaging to plan percutaneous interventions. Cardiac computed tomography (CT) and cardiac magnetic resonance (CMR) imaging have become indispensable tools for pre-procedural planning prior to intervention in the pediatric cardiac catheterization lab. In this article, we review several common indications for referral and the impact of cross-sectional imaging on procedural planning, success, and patient surveillance.
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Affiliation(s)
- Yousef Arar
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
- Correspondence:
| | - Abhay Divekar
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
| | - Stephen Clark
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
| | - Tarique Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Roby Sebastian
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
- Department of Anesthesia and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Mehar Hoda
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
| | - Jamie King
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
| | - Thomas M. Zellers
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
| | - Surendranath R. Veeram Reddy
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
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10
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Sturgeon GM, Andersen ND, Campbell MJ, Barker PCA. Three-dimensional modeling of the mitral valve for surgical planning in a pediatric patient: A case-based discussion of the technical challenges of segmentation and printing from 3D transthoracic echocardiographic datasets. Echocardiography 2021; 38:1978-1983. [PMID: 34719050 DOI: 10.1111/echo.15239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/20/2021] [Accepted: 10/16/2021] [Indexed: 12/22/2022] Open
Abstract
Abnormal atrioventricular valve present great challenges to the surgeon in achieving a successful repair, and thus present a great opportunity for enhanced 3D imaging to guide pre- and intra-operative management. Spatial and temporal resolution of 3D echocardiography enables 3D printing of valve morphology. However, non-linearity, angle dependence, speckle, blur, and resampling complicate segmentation compared to computed tomography (CT) and magnetic resonance imaging (MRI). A case of complex mitral valve disease in a pediatric patient is therefore presented to illustrate the technical challenges of segmentation and 3D printing from echocardiographic data.
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Affiliation(s)
- Gregory M Sturgeon
- Duke Children's Pediatric & Congenital Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Nicholas D Andersen
- Duke Children's Pediatric & Congenital Heart Center, Duke University Medical Center, Durham, North Carolina, USA.,Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael J Campbell
- Duke Children's Pediatric & Congenital Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Piers C A Barker
- Duke Children's Pediatric & Congenital Heart Center, Duke University Medical Center, Durham, North Carolina, USA
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11
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Arar Y, Dimas VV, Nugent AW, Hussain T, Kasraie N, Reddy SRV, Zellers TM, Herbert C. Pre-procedural CT imaging aids neonatal PDA stenting for ductal-dependent pulmonary blood flow with reduction in overall procedural morbidity. Cardiol Young 2021; 32:1-6. [PMID: 34663483 DOI: 10.1017/s1047951121004133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patent ductus arteriosus stenting for ductal-dependent pulmonary blood flow is a technically challenging neonatal procedure to maintain a stable pulmonary circulation. Pre-procedural computed tomography imaging aids in outlining ductal origin, insertion, size, course and curvature. Computed tomography imaging may add value to procedural outcomes and reduce overall procedural morbidity in neonatal patent ductus arteriosus stenting. We conducted a single centre retrospective chart review of neonates with ductal-dependent pulmonary blood flow who underwent patent ductus arteriosus stenting between January 1, 2014 and June 31, 2020. We compared patients variables between patients who underwent pre-procedural computed tomography imaging to those who did not. A total of 64 patients were referred for patent ductus arteriosus stenting with 33 (52%) obtaining pre-procedural computed tomography imaging. Average age [19 days; range 1-242 days (p = 0.85)] and weight [3.3 kg (range 2.2-6.0 kg; p = 0.19)] was not significantly different between the groups. A diagnosis of pulmonary atresia was made in 42 out of 64 (66%) patients prior to patent ductus arteriosus stenting. The cohort with pre-intervention computed tomography imaging had a significant reduction in the total number of access sites (1.2 versus 1.5; p = 0.03), contrast needed (5.9 versus 8.2 ml/kg; p = 0.008), fluoroscopy (20.7 versus 38.8 minutes; p = 0.02) and procedural time (83.4-128.4 minutes; p = 0.002) for the intervention. There was no significant difference in radiation burden between the groups (p = 0.35). Pre-procedural computed tomography imaging adds value by aiding interventional planning for neonatal patent ductus arteriosus stenting. A statistically significant reduction in the number of access sites, contrast exposure, as well as fluoroscopic and procedural time was noted without significantly increasing the cumulative radiation burden.
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Affiliation(s)
- Yousef Arar
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
| | - V Vivian Dimas
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
| | - Alan W Nugent
- Department of Pediatrics, Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Tarique Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
| | - Nima Kasraie
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Surendranath R Veeram Reddy
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
| | - Thomas M Zellers
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
| | - Carrie Herbert
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
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12
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Technical Modifications for Ductal Stenting in Neonates with Duct-Dependent Pulmonary Circulation. HEARTS 2021. [DOI: 10.3390/hearts2020015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The ductal stenting (DS) is currently an acceptable palliative treatment in newborns suffering with duct-dependent pulmonary circulation. However, this procedure remains technically a challenge in complex ductal morphology, which may eventually lead to detrimental outcomes. This review is mainly focused on pre-procedural planning, essential instruments and practical approaches for DS, and post-procedural care.
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13
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Meza JM, Prabhu N, Chamberlain RC, Turek JW, Andersen ND. Commentary: Ductal stenting for ductal-dependent pulmonary blood flow: Time for an exclusive club to expand its membership? J Thorac Cardiovasc Surg 2020; 161:392-393. [PMID: 33268124 DOI: 10.1016/j.jtcvs.2020.07.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Affiliation(s)
- James M Meza
- Duke Congenital Heart Surgery Research and Training Laboratory, Durham, NC; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
| | - Neel Prabhu
- Duke Congenital Heart Surgery Research and Training Laboratory, Durham, NC; Duke University School of Medicine, Durham, NC
| | - Reid C Chamberlain
- Duke Congenital Heart Surgery Research and Training Laboratory, Durham, NC; Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC; Duke Children's Pediatric & Congenital Heart Center, Durham, NC
| | - Joseph W Turek
- Duke Congenital Heart Surgery Research and Training Laboratory, Durham, NC; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC; Duke Children's Pediatric & Congenital Heart Center, Durham, NC
| | - Nicholas D Andersen
- Duke Congenital Heart Surgery Research and Training Laboratory, Durham, NC; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC; Duke Children's Pediatric & Congenital Heart Center, Durham, NC
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