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Bélanger P, David LP, Garceau P, Bouchard D, Asgar AW. Transcatheter Edge-to-Edge Repair for Acute Papillary Muscle Rupture After Transvenous Lead Extraction in a d-TGA. JACC Case Rep 2024; 29:102213. [PMID: 38379645 PMCID: PMC10874963 DOI: 10.1016/j.jaccas.2023.102213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/13/2023] [Accepted: 11/24/2023] [Indexed: 02/22/2024]
Abstract
We present a case of a patient known for dextrotransposition of the great arteries corrected with a Mustard procedure, in whom severe mitral valve regurgitation secondary to transvenous lead extraction was successfully repaired with transcatheter edge-to-edge repair using the TriClip device (Abbott Vascular).
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Jolley MA, Sulentic A, Amin S, Gupta M, Ching S, Cianciulli A, Wang Y, Sabin P, Zelonis C, Daemer M, Silvestro E, Coleman K, Ford LK, Edelson JB, Ruckdeschel ES, Cohen MS, Nicolson SC, Gillespie MJ. Introduction of transcatheter edge-to-edge repair in patients with congenital heart disease at a children's hospital. Catheter Cardiovasc Interv 2024; 103:326-334. [PMID: 38149722 PMCID: PMC10911413 DOI: 10.1002/ccd.30935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/19/2023] [Accepted: 12/03/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Atrioventricular valve regurgitation (AVVR) is a devastating complication in children and young adults with congenital heart disease (CHD), particularly in patients with single ventricle physiology. Transcatheter edge-to-edge repair (TEER) is a rapidly expanding, minimally invasive option for the treatment of AVVR in adults that avoids the morbidity and mortality associated with open heart surgery. However, application of TEER in in CHD and in children is quite novel. We describe the development of a peri-procedural protocol including image-derived pre-intervention simulation, with successful application to four patients. AIMS To describe the initial experience using the MitraClip system for TEER of dysfunctional systemic atrioventricular valves in patients with congential heart disease within a pediatric hospital. METHODS A standardized screening and planning process was developed using cardiac magnetic resonance imaging, three dimensional echocardiography and both virtual and physical simulation. Procedures were performed using the MitraClip G4 system and patients were clinically followed post-intervention. RESULTS A series of four CHD patients with at least severe AVVR were screened for suitability for TEER with the MitraClip system: three patients had single ventricle physiology and Fontan palliation, and one had repair of a common atrioventricular canal defect. Each patient had at least severe systemic AVVR and was considered at prohibitively high risk for surgical repair. Each patient underwent a standardized preprocedural screening protocol and image-derived modeling followed by the TEER procedure with successful clip placement at the intended location in all cases. CONCLUSIONS The early results of our protocolized efforts to introduce TEER repair of severe AV valve regurgitation with MitraClip into the CHD population within our institution are encouraging. Further investigations of the use of TEER in this challenging population are warranted.
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Affiliation(s)
- Matthew A. Jolley
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Analise Sulentic
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Silvani Amin
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Mudit Gupta
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Stephen Ching
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Alana Cianciulli
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Yan Wang
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Patricia Sabin
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Christopher Zelonis
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Matthew Daemer
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Elizabeth Silvestro
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Keith Coleman
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Lauren K. Ford
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Jonathan B. Edelson
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | - Meryl S. Cohen
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Susan C. Nicolson
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
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Tedla BA, Kim YY, Vaikunth S. Novel Approaches to the Failing Congenital Heart. Curr Cardiol Rep 2023; 25:1633-1647. [PMID: 37889420 DOI: 10.1007/s11886-023-01979-3] [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] [Accepted: 10/04/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE OF REVIEW Heart failure is the leading cause of morbidity and mortality in adults with congenital heart disease and is characterized by a variety of underlying mechanisms. Here, we aim to elaborate on the medical and technological advancements in the management of heart failure in adult patients with congenital heart disease and highlight the use of imaging modalities to guide therapy. RECENT FINDINGS There have been several advances over the past decade with angiotensin receptor neprilysin and sodium-glucose cotransporter-2 inhibitors, atrioventricular valve clips, transcatheter pulmonary valves, catheter ablation, and cardiac resynchronization therapy, as well as the introduction of lymphatic interventions. Expanded use of echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography has guided many of these therapies. Significant innovations in the management of heart failure in adults with congenital heart disease have evolved with advancements in imaging modalities playing a critical role in guiding treatment therapies.
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Affiliation(s)
- Bruke A Tedla
- Philadelphia Adult Congenital Heart Center, Penn Medicine & Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Yuli Y Kim
- Philadelphia Adult Congenital Heart Center, Penn Medicine & Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Sumeet Vaikunth
- Philadelphia Adult Congenital Heart Center, Penn Medicine & Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
- Perelman Center for Advanced Medicine, 11th Floor, South Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA, 19104-5127, USA.
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Vaikunth S, Sundaravel S, Saef J, Ortega-Legaspi J. Novel Therapeutic Strategies in Heart Failure in Adult Congenital Heart Disease: of Medicines and Devices. Curr Heart Fail Rep 2023; 20:401-416. [PMID: 37582901 DOI: 10.1007/s11897-023-00621-1] [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] [Accepted: 07/18/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE OF REVIEW This paper reviews the latest literature on the growing field of heart failure in the adult congenital heart disease population. RECENT FINDINGS After highlighting the increasing prevalence and a few of the unique potential causes, including the concept of early senescence, this review begins with novel medical management strategies such as the angiotensin II receptor blocker and neprilysin inhibitors and sodium glucose cotransporter-2 inhibitors. Then, it addresses the latest applications of percutaneous techniques like implantable hemodynamic monitoring, transcatheter pulmonary and aortic valve replacement, and mitral clips. Cardiac resynchronization therapy and novel lymphatic system imaging and intervention are then described. Finally, the use of mechanical support devices, temporary and durable, is discussed as well as heart and combined heart and liver transplantation. There have been recent exciting advances in the strategies used to manage adult congenital heart disease patients with heart failure. As this population continues to grow, it is likely we will see further rapid evolution in this field.
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Affiliation(s)
- Sumeet Vaikunth
- Philadelphia Adult Congenital Heart Center, Penn Medicine & Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
| | - Swethika Sundaravel
- Advanced Heart Failure Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua Saef
- Philadelphia Adult Congenital Heart Center, Penn Medicine & Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Juan Ortega-Legaspi
- Advanced Heart Failure Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Schamroth Pravda N, Vaknin Assa H, Sondergaard L, Bajoras V, Sievert H, Piayda K, Levi A, Witberg G, Shapira Y, Hamdan A, Perl L, Vig S, Blieden L, Kornowski R, Hirsch R, Codner P. Transcatheter Interventions for Atrioventricular Dysfunction in Patients with Adult Congenital Heart Disease: An International Case Series. J Clin Med 2023; 12:521. [PMID: 36675450 PMCID: PMC9864755 DOI: 10.3390/jcm12020521] [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: 12/12/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION A substantial proportion of patients with adult congenital heart disease (ACHD) suffer from worsening valvular dysfunction in adulthood. Transcatheter valve interventions can offer a therapeutic alternative to surgery for those at high surgical risk. There is emerging but limited data on transcatheter interventions for atrioventricular (AV) valve dysfunction in patients with ACHD. METHODS We compiled an international collaborative multi-center registry focusing on adult patients with congenital heart disease undergoing transcatheter AV valve interventions (repair or replacement). Included were patients from three international centers who underwent procedures between 2016 and 2022. Demographic, clinical, and procedural data were compiled. RESULTS Nine patients with ACHD underwent AV valve interventions. The median age was 48 years (IQR (37; 56), 55% women). At baseline, seven patients (78%) were in NYHA functional class III and two (22%) were in NYHA functional class II. The diagnosis of ACHD varied. Three valve interventions were performed on the subpulmonary AV valve and six on the systemic AV valve. The primary valvular pathology was regurgitation (six patients, 78%). Five procedures were valve-in-valve interventions, and four procedures were transcatheter edge-to-edge repair procedures. There were no major complications or peri-procedural complications or peri-procedural mortality. One patient developed a suspected non-obstructive thrombus on the valve that was medically treated. One patient did not improve clinically following the procedure and underwent a heart transplant, one patient died 6 months following the procedure due to a cardiovascular implantable electronic device infection. At one year, six patients were in NYHA functional class I, and one patient was in NYHA functional class III. In conclusion, transcatheter AV heart valve interventions are feasible and safe procedures in carefully selected ACHD patients. These procedures can offer an effective treatment option in these younger patients with high surgical risk.
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Affiliation(s)
- Nili Schamroth Pravda
- Department of Cardiology, Rabin Medical Center, Petah Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hana Vaknin Assa
- Department of Cardiology, Rabin Medical Center, Petah Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Lars Sondergaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Vilhelmas Bajoras
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Horst Sievert
- CardioVascular Center Frankfurt CVC, 60389 Frankfurt am Main, Germany
| | - Kerstin Piayda
- CardioVascular Center Frankfurt CVC, 60389 Frankfurt am Main, Germany
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center, Petah Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petah Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yaron Shapira
- Department of Cardiology, Rabin Medical Center, Petah Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, Petah Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Leor Perl
- Department of Cardiology, Rabin Medical Center, Petah Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shahar Vig
- Department of Cardiology, Rabin Medical Center, Petah Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Leonard Blieden
- Department of Cardiology, Rabin Medical Center, Petah Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Rafael Hirsch
- Department of Cardiology, Rabin Medical Center, Petah Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petah Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Haeffele CL, Lui GK, Peng L, Chan F, Sharma RP. First described mitral clip in an adult extracardiac Fontan patient: a case report. Eur Heart J Case Rep 2022; 7:ytac479. [PMID: 36733686 PMCID: PMC9887705 DOI: 10.1093/ehjcr/ytac479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/11/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Background The use of transcatheter edge-to-edge repair (TEER) in patients with advanced heart failure has been shown to reduce hospitalizations and increase survival. As patients with Fontan circulations grow older, a significant proportion of them will develop severe atrioventricular (AV) valve regurgitation in the systemic ventricle. Conventional surgical repair and transplant carry high mortality risk for the adult Fontan patient with progressive heart failure. Case summary A 51-year-old female extracardiac Fontan patient developed severe AV valve regurgitation and progressive functional decline. Based on her operative risk for conventional surgical intervention or transplant, TEER using the Abbott MitraClip device was performed. The degree of mitral regurgitation was decreased from severe to moderate regurgitation. Discussion This is the first known case describing the use of a successful TEER in an adult patient with an extracardiac Fontan. Given the increasing numbers of patients surviving into adulthood with a Fontan circulation, transcatheter interventions may provide an alternative treatment option to conventional surgeries and medical therapies.
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Affiliation(s)
| | - George K Lui
- Department of Medicine, Division of Cardiovascular Medicine, CV Medicine Division 870 Quarry Rd, Palo Alto, CA 94304, USA,Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, CV Medicine Division 870 Quarry Rd, Palo Alto, CA 94304, USA
| | - Lynn Peng
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, CV Medicine Division 870 Quarry Rd, Palo Alto, CA 94304, USA
| | - Frandics Chan
- Division of Radiology, Stanford University, CV Medicine Division 870 Quarry Rd, Palo Alto, CA 94304, USA
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Tan W, Stefanescu Schmidt AC, Horlick E, Aboulhosn J. Transcatheter Interventions in Patients With Adult Congenital Heart Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100438. [PMID: 39132367 PMCID: PMC11307551 DOI: 10.1016/j.jscai.2022.100438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/17/2022] [Accepted: 08/01/2022] [Indexed: 08/13/2024]
Abstract
Patients with congenital heart disease now live well into adulthood because of advances in surgical techniques, improvements in medical management, and the development of novel therapeutic agents. As patients grow older into adults with congenital heart disease, many require catheter-based interventions for the treatment of residual defects, sequelae of their initial repair or palliation, or acquired heart disease. The past 3 decades have witnessed an exponential growth in both the type and number of transcatheter interventions in patients with congenital heart disease. With improvements in medical technology and device design, including the use of devices designed for the treatment of acquired valve stenosis or regurgitation, patients who previously would have required open-heart surgery for various conditions can now undergo percutaneous cardiac catheter-based procedures. Many of these procedures are complex and occur in complex patients who are best served by a multidisciplinary team. This review aims to highlight some of the currently available transcatheter interventional procedures for adults with congenital heart disease, the clinical outcomes of each intervention, and any special considerations so that the reader may better understand both the procedure and patients with adult congenital heart disease.
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Affiliation(s)
- Weiyi Tan
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ada C. Stefanescu Schmidt
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric Horlick
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jamil Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine, University of California, Los Angeles, California
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8
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Chaudhry A, Selwyn J, Adams E, Bradley EA. Heart Failure in Complex Congenital Heart Disease of the Adult. Curr Cardiol Rep 2022; 24:1727-1735. [PMID: 36197543 PMCID: PMC9901216 DOI: 10.1007/s11886-022-01788-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Adult congenital heart disease (ACHD) patients have demonstrated improved survival, especially those with severely complex disease, mainly single-ventricle/Fontan physiology and those with a systemic right ventricle. We describe the heart failure phenotypes of complex CHD, reversible causes for heart failure, and considerations for advanced therapy. RECENT FINDINGS While initially marketed for application to patients with acquired causes for heart failure, newer devices and technologies have started to be used in the ACHD population. After reversible causes for heart failure in CHD are addressed, it is reasonable to consider use of new device-based technologies and orthotopic heart transplant (OHT) for end-stage disease. New heart failure technology and organ transplant should carefully be considered and applied in complex ACHD, where there may be significant improvement in morbidity and mortality.
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Affiliation(s)
- Anisa Chaudhry
- Division of Cardiovascular Medicine, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Julia Selwyn
- Department of Internal Medicine, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Elizabeth Adams
- Division of Cardiovascular Medicine, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Elisa A. Bradley
- Division of Cardiovascular Medicine, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA,Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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9
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The pivotal role of tricuspid regurgitation in the failing systemic right ventricle: The “chicken and egg story‿. Arch Cardiovasc Dis 2022; 115:476-486. [DOI: 10.1016/j.acvd.2022.05.004] [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: 04/02/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 11/18/2022]
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Barry OM, Bouhout I, Kodali SK, George I, Rosenbaum MS, Petit CJ, Kalfa D. Interventions for Congenital Atrioventricular Valve Dysfunction: JACC Focus Seminar. J Am Coll Cardiol 2022; 79:2259-2269. [PMID: 35654497 DOI: 10.1016/j.jacc.2021.08.083] [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: 04/30/2021] [Revised: 07/27/2021] [Accepted: 08/24/2021] [Indexed: 11/27/2022]
Abstract
Innovation and creativity have led to tremendous advancements in the care and management of patients with congenital heart disease (CHD) that have resulted in considerably increased survival. Catheter-based interventions have contributed significantly to these advancements. However, catheter-based interventions for congenital lesions of the atrioventricular (AV) valves have been limited in scope and effectiveness mainly because of patient size and anatomical challenges. Thus, surgical repair and replacement for congenital AV valve lesions have remained the preferred therapy. However, the ongoing transcatheter heart valve revolution has led to techniques and technologies that are changing the landscape, particularly for adult CHD patients. Many devices for AV valve repair and replacement are being studied in adult patients without CHD, and translation of select practices to CHD patients has begun, with many more to come. Transcatheter AV valve interventions represent exciting opportunities for the growing numbers of adult CHD patients.
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Affiliation(s)
- Oliver M Barry
- Division of Pediatric Cardiology, New York-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA
| | - Ismail Bouhout
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, New York-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA
| | - Susheel K Kodali
- Division of Cardiology, New York-Presbyterian-Columbia University Medical Center, New York, New York, USA
| | - Isaac George
- Division of Cardiac, Thoracic, and Vascular Surgery, New York-Presbyterian-Columbia University Medical Center, New York, New York, USA
| | - Marlon S Rosenbaum
- Division of Cardiology, New York-Presbyterian-Columbia University Medical Center, New York, New York, USA
| | - Christopher J Petit
- Division of Pediatric Cardiology, New York-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA.
| | - David Kalfa
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, New York-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA.
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Guerin P, Jalal Z, Le Ruz R, Cueff C, Hascoet S, Bouvaist H, Ladouceur M, Levy F, Hugues N, Malekzadeh‐Milani S, Leroux L, Modine T, Silini A, Gallet J, Saunier C, Warin Fresse K, Karam N, Vouhe P, Iserin L, Ghostine S, Iriart X, Le Gloan L, Thambo JB. Percutaneous Edge‐to‐Edge Repair for Systemic Atrioventricular Valve Regurgitation in Patients With Congenital Heart Disease: The First Descriptive Cohort. J Am Heart Assoc 2022; 11:e025628. [PMID: 35574967 PMCID: PMC9238561 DOI: 10.1161/jaha.122.025628] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Patrice Guerin
- Congenital Cardiology Unit Institut du Thorax Inserm UMRS 791 University Hospital of Nantes France
| | - Zakaria Jalal
- Department of Pediatric and Adult Congenital Cardiology University Hospital of Bordeaux Bordeaux France
- LIRYC Electrophysiology and Heart Modeling Institute Fondation Bordeaux Université Bordeaux France
- INSERM Centre de Recherche Cardio‐Thoracique de Bordeaux Pessac France
| | - Robin Le Ruz
- Congenital Cardiology Unit Institut du Thorax Inserm UMRS 791 University Hospital of Nantes France
| | | | - Sebastien Hascoet
- Paediatric and Congenital Cardiac Surgery Department M3C Marie‐Lannelongue Hospital National Reference Centre Groupe Hospitalier Saint‐JosephParis Saclay University Plessis‐Robinson France
| | - Hélène Bouvaist
- Department of Cardiology University Hospital of Grenoble France
| | - Magalie Ladouceur
- Adult Congenital Heart Disease Unit Department of Cardiology Centre de référence des Malformations Cardiaques Congénitales Complexes M3C Hôpitaux de ParisHôpital Européen Georges Pompidou Paris France
| | | | | | | | | | | | - Alexandre Silini
- Department of Pediatric and Adult Congenital Cardiology University Hospital of Bordeaux Bordeaux France
- LIRYC Electrophysiology and Heart Modeling Institute Fondation Bordeaux Université Bordeaux France
- INSERM Centre de Recherche Cardio‐Thoracique de Bordeaux Pessac France
| | - Jean Gallet
- Congenital Cardiology Unit Institut du Thorax Inserm UMRS 791 University Hospital of Nantes France
| | - Carole Saunier
- Department of Cardiology University Hospital of Grenoble France
| | - Karine Warin Fresse
- Non‐Invasive Imaging Unit Institut du Thorax University Hospital of Nantes Nantes France
| | - Nicole Karam
- European Hospital Georges Pompidou (Cardiology Department) Paris University Paris France
- Paris Cardiovascular Research Center (INSERMU970) Paris France
| | - Pascal Vouhe
- M3C‐Necker Hôpital Universitaire Necker‐Enfants MaladesAPHP Paris France
| | - Laurence Iserin
- Adult Congenital Heart Disease Unit Department of Cardiology Centre de référence des Malformations Cardiaques Congénitales Complexes M3C Hôpitaux de ParisHôpital Européen Georges Pompidou Paris France
| | - Said Ghostine
- Paediatric and Congenital Cardiac Surgery Department M3C Marie‐Lannelongue Hospital National Reference Centre Groupe Hospitalier Saint‐JosephParis Saclay University Plessis‐Robinson France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology University Hospital of Bordeaux Bordeaux France
- LIRYC Electrophysiology and Heart Modeling Institute Fondation Bordeaux Université Bordeaux France
- INSERM Centre de Recherche Cardio‐Thoracique de Bordeaux Pessac France
| | - Laurianne Le Gloan
- Congenital Cardiology Unit Institut du Thorax Inserm UMRS 791 University Hospital of Nantes France
| | - Jean Benoit Thambo
- Department of Pediatric and Adult Congenital Cardiology University Hospital of Bordeaux Bordeaux France
- LIRYC Electrophysiology and Heart Modeling Institute Fondation Bordeaux Université Bordeaux France
- INSERM Centre de Recherche Cardio‐Thoracique de Bordeaux Pessac France
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12
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Silini A, Iriart X. Percutaneous edge-to-edge repair in congenital heart disease: Preliminary results of a promising new technique. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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13
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Jalal Z, Gewillig M, Boudjemline Y, Guérin P, Pilati M, Butera G, Malekzadeh-Milani S, Avesani M, Thambo JB. Transcatheter interventions in patients with a Fontan circulation: Current practice and future developments. Front Pediatr 2022; 10:965989. [PMID: 36110107 PMCID: PMC9468446 DOI: 10.3389/fped.2022.965989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022] Open
Abstract
The Fontan operation represents the last of multiple steps that are offered a wide range of congenital cardiac lesions with a single ventricle (SV) physiology. Nowadays this surgical program consists of a total cavopulmonary connection (TCPC), by anastomosing systemic veins to the pulmonary arteries (PAs), excluding the right-sided circulation from the heart. As a result of imaging, surgical, percutaneous, and critical care improvements, survival in this population has steadily increased. However, the Fontan physiology chronically increases systemic venous pressure causing systemic venous congestion and decreased cardiac output, exposing patients to the failure of the Fontan circulation (FC), which is associated with a wide variety of clinical complications such as liver disease, cyanosis, thromboembolism, protein-losing enteropathy (PLE), plastic bronchitis (PB), and renal dysfunction, ultimately resulting in an increased risk of exercise intolerance, arrhythmias, and premature death. The pathophysiology of the failing Fontan is complex and multifactorial; i.e., caused by the single ventricle dysfunction (diastolic/systolic failure, arrhythmias, AV valve regurgitation, etc.) or caused by the specific circulation (conduits, pulmonary vessels, etc.). The treatment is still challenging and may include multiple options and tools. Among the possible options, today, interventional catheterization is a reliable option, through which different procedures can target various failing elements of the FC. In this review, we aim to provide an overview of indications, techniques, and results of transcatheter options to treat cavopulmonary stenosis, collaterals, impaired lymphatic drainage, and the management of the fenestration, as well as to explore the recent advancements and clinical applications of transcatheter cavopulmonary connections, percutaneous valvular treatments, and to discuss the future perspectives of percutaneous therapies in the Fontan population.
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Affiliation(s)
- Zakaria Jalal
- University Hospital of Bordeaux - Department of Pediatric and Adult Congenital Cardiology, Pessac, France.,IHU LIRYC Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France
| | - Marc Gewillig
- Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Patrice Guérin
- Interventional Cardiology Unit, Inserm UMR 1229, L'Institut du Thorax, University Hospital of Nantes, Nantes, France
| | - Mara Pilati
- Medical and Surgical Department of Pediatric Cardiology, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Gianfranco Butera
- Medical and Surgical Department of Pediatric Cardiology, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Sophie Malekzadeh-Milani
- Department of Congenital and Pediatric Cardiology, Centre de Reference Malformations Cardiaques Congenitales Complexes-M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Pediatric Cardiology, Paris, France
| | - Martina Avesani
- University Hospital of Bordeaux - Department of Pediatric and Adult Congenital Cardiology, Pessac, France.,IHU LIRYC Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France
| | - Jean-Benoit Thambo
- University Hospital of Bordeaux - Department of Pediatric and Adult Congenital Cardiology, Pessac, France.,IHU LIRYC Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France
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14
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Avesani M, Kang SL, Jalal Z, Thambo JB, Iriart X. Renaissance of Cardiac Imaging to Assist Percutaneous Interventions in Congenital Heart Diseases:The Role of Three-Dimensional Echocardiography and Multimodality Imaging. Front Pediatr 2022; 10:894472. [PMID: 35664875 PMCID: PMC9160663 DOI: 10.3389/fped.2022.894472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022] Open
Abstract
Percutaneous interventions have completely refashioned the management of children with congenital heart diseases (CHD) and the use of non-invasive imaging has become the gold standard to plan and guide these procedures in the modern era. We are now facing a dual challenge to improve the standard of care in low-risk patients, and to shift our strategies from the classic open chest surgery to imaging-guided percutaneous interventions in high-risk patients. Such rapid evolution of ultrasound technologies over the last 20 years have permitted the integration of transthoracic, transesophageal and intracardiac echocardiography into the interventional workflow to improve image guidance and reduce radiation burden from fluoroscopy and angiography. Specifically, miniaturization of transesophageal probe and advances in three-dimensional (3D) imaging techniques have enabled real-time 3D image guidance during complex interventional procedure, In addition, multimodality and fusion imaging techniques harness the strengths of different modalities to enhance understanding of anatomical and spatial relationship between different structures, improving communication and coordination between interventionalists and imaging specialists. In this review, we aim to provide an overview of 3D imaging modalities and multimodal fusion in procedural planning and live guidance of percutaneous interventions. At the present times, 3D imaging can no longer be considered a luxury but a routine clinical tool to improve procedural success and patient outcomes.
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Affiliation(s)
- Martina Avesani
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
| | - Sok-Leng Kang
- Department of Pediatric Cardiology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Zakaria Jalal
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France.,Institut Hospitalo-Universitaire (IHU) Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Foundation, Pessac, France
| | - Jean-Benoit Thambo
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France.,Institut Hospitalo-Universitaire (IHU) Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Foundation, Pessac, France
| | - Xavier Iriart
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France.,Institut Hospitalo-Universitaire (IHU) Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Foundation, Pessac, France
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15
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Iriart X, Guérin P, Jalal Z, Thambo JB. Edge to edge repair using a MitraClip for severe tricuspid valve regurgitation after a Mustard operation. Catheter Cardiovasc Interv 2021; 98:E108-E114. [PMID: 33793055 DOI: 10.1002/ccd.29681] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 11/11/2022]
Abstract
A 48-year-old who underwent a Mustard operation in 1972 followed by a second cardiac intervention in 1996 for pulmonary venous baffle enlargement and residual baffle leak closure, complicated by recurrent atrial flutter, was admitted to our institution for severe systemic atrio-ventricular valve regurgitation (SAVVR) associated with severely impaired systemic right ventricular (RV) function. After careful preoperative anatomic assessment including three-dimensional transesophageal echocardiography (3DTEE) to define the clipping strategy and computed tomography to optimize the transvenous baffle puncture site, the intervention was performed under general anesthesia, fluoroscopic, and 3DTEE guidance. One XTR MitraClip was successfully implanted, achieving a significant reduction in regurgitation and immediate clinical improvement. The transbaffle puncture was closed using an 8 mm atrial septal defect (ASD) device without residual shunt or obstruction of the venous baffle. Post-operative clinical evaluation showed immediate improvement in the NYHA functional class (from III to II), but the patient presented with recurrent flutter at 1 week after the procedure, which was successfully treated by catheter ablation with another transbaffle approach next to the ASD device. Clinical improvement was maintained at 1- and 6-month follow-up with significant reduction in SAVVR, reduced systemic RV volumes and improved RV ejection fraction. This case demonstrates the feasibility of percutaneous treatment of systemic SAVV in patients with systemic RV after atrial redirection.
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Affiliation(s)
- Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Patrice Guérin
- Department of congenital heart disease, University hospital of Nantes, Nantes, France
| | - Zakaria Jalal
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Jean-Benoit Thambo
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
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