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Inuzuka R, Tachimori H, Kim SH, Matsui H, Kobayashi T, Kato A, Fujii T, Ho M, Morikawa H, Takahashi S, Shirato H, Haishima Y, Okamoto Y, Sakoda H, Tomita H. Practice and Safety of Static Balloon Atrial Septostomy Based on a Nationwide Registry Data. Circ J 2022; 86:1990-1997. [DOI: 10.1253/circj.cj-22-0185] [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: 11/09/2022]
Affiliation(s)
- Ryo Inuzuka
- Department of Pediatrics, The University of Tokyo Hospital
| | - Hisateru Tachimori
- Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry
| | - Sung-Hae Kim
- Department of Cardiology, Shizuoka Children’s Hospital
| | - Hikoro Matsui
- Department of Pediatrics, The University of Tokyo Hospital
| | - Tohru Kobayashi
- Department of Data Science, National Center for Child Health and Development
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Takanari Fujii
- Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital
| | - Mami Ho
- Office of Medical Devices I, Pharmaceuticals and Medical Devices Agency
| | - Hanako Morikawa
- Office of Medical Devices II, Pharmaceuticals and Medical Devices Agency
| | - Sara Takahashi
- Office of Manufacturing Quality and Vigilance for Medical Devices, Pharmaceuticals and Medical Devices Agency
| | - Haruki Shirato
- Office of Manufacturing Quality and Vigilance for Medical Devices, Pharmaceuticals and Medical Devices Agency
| | - Yuji Haishima
- Division of Medical Devices, National Institute of Health Sciences
| | | | - Hideyuki Sakoda
- Division of Medical Devices, National Institute of Health Sciences
| | - Hideshi Tomita
- Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital
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Mishra J. Atrial Septostomy and Atrial Septal Stenting: Role of Echocardiography. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2022. [DOI: 10.4103/jiae.jiae_9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Baba K, Suda K, Takamuro M, Takahashi S, Sugiyama H, Fujimoto K, Kitano M, Fujii T, Kise H, Ohtsuki S, Tomita H. Static balloon atrial septostomy in Japan in shortage of standard balloon septostomy catheter. J Cardiol 2021; 78:219-223. [PMID: 33994264 DOI: 10.1016/j.jjcc.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/24/2021] [Accepted: 04/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The supply of Rashkind balloon atrial septostomy (BAS) catheters (Medtronic, Minneapolis, MN, USA) has suddenly been discontinued in the world due to its recall. Consequently, Japan fell into a critical shortage of standard BAS catheters. Although the use of static BAS is off-label in Japan, its importance is increasing in such a situation. A nationwide survey of static BAS is needed in such a critical period. METHODS A questionnaire survey was conducted among centers in Japan regarding BAS performed between October 1, 2020, and December 15, 2020, while the supply of Rashkind BAS catheter was discontinued. RESULTS We received answers from 70 of the 90 centers, for a response rate of 78%. In this survey, 25 patients who underwent static BAS were enrolled, and a total of 47 BAS procedures were performed. Median age and weight at static BAS were 10 days of life and 3001 g, respectively. The most common diagnosis was transposition of the great arteries without pulmonary stenosis and hypoplastic left heart syndrome and its variants, with 8 cases each. The most frequently used balloon diameter was 10 mm (13 balloons), followed by 12 mm (10 balloons), and 3 cases required double-balloon techniques. The 3-point scale of the efficacy of static BAS rated by physicians were 10 excellent, 15 good, and 0 poor, respectively. Complications included cardiac tamponade during the procedure in 1 patient and the need for Rashkind BAS later in 2 patients. Comparing the share of static BAS in all transcatheter atrial septostomy, its share in the current survey (28/53) is significantly higher compared to the annual registry data in 2018 (86/304) (p < 0.01). CONCLUSIONS This survey shows that static BAS is widely performed in Japan and is effective and safe. Static BAS cases have increased significantly due to a shortage of standard BAS catheters.
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Affiliation(s)
- Kenji Baba
- Working Group on Balloon Atrial Septostomy Catheter, Japanese Society of Congenital Interventional Cardiology; Division of Pediatric Cardiology, Interventional Radiology Center, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Kenji Suda
- Working Group on Balloon Atrial Septostomy Catheter, Japanese Society of Congenital Interventional Cardiology; Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Motoki Takamuro
- Working Group on Balloon Atrial Septostomy Catheter, Japanese Society of Congenital Interventional Cardiology; Department of Pediatric Cardiology, Hokkaido Medical Center for Child Health and Rehabilitation, Hokkaido, Japan
| | - Shin Takahashi
- Working Group on Balloon Atrial Septostomy Catheter, Japanese Society of Congenital Interventional Cardiology; Department of Pediatric Cardiology, Iwate Medical University, Iwate, Japan
| | - Hisashi Sugiyama
- Working Group on Balloon Atrial Septostomy Catheter, Japanese Society of Congenital Interventional Cardiology; Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Kazuto Fujimoto
- Working Group on Balloon Atrial Septostomy Catheter, Japanese Society of Congenital Interventional Cardiology; Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masataka Kitano
- Working Group on Balloon Atrial Septostomy Catheter, Japanese Society of Congenital Interventional Cardiology; Department of Pediatric Cardiology, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
| | - Takanari Fujii
- Working Group on Balloon Atrial Septostomy Catheter, Japanese Society of Congenital Interventional Cardiology; Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital, Tokyo, Japan
| | - Hiroaki Kise
- Working Group on Balloon Atrial Septostomy Catheter, Japanese Society of Congenital Interventional Cardiology; Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital, Tokyo, Japan
| | - Sinichi Ohtsuki
- Working Group on Balloon Atrial Septostomy Catheter, Japanese Society of Congenital Interventional Cardiology; Department of Pediatric Cardiology, Okayama University Hospital, Okayama, Japan
| | - Hideshi Tomita
- Working Group on Balloon Atrial Septostomy Catheter, Japanese Society of Congenital Interventional Cardiology; Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital, Tokyo, Japan
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Allen JW, Phipps KL, Llamas AA, Barrett KA. Left atrial decompression as a palliative minimally invasive treatment for congestive heart failure caused by myxomatous mitral valve disease in dogs: 17 cases (2018-2019). J Am Vet Med Assoc 2021; 258:638-647. [PMID: 33683957 DOI: 10.2460/javma.258.6.638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether left atrial decompression (LAD) would reduce left atrial pressure (LAP) in dogs with advanced myxomatous mitral valve disease (MMVD) and left-sided congestive heart failure (CHF) and to describe the LAD procedure and hemodynamic alterations and complications. ANIMALS 17 dogs with advanced MMVD and left-sided CHF that underwent LAD. PROCEDURES The medical record database was retrospectively reviewed for all LAD procedures attempted in dogs with MMVD and left-sided CHF between October 2018 and June 2019. Data were collected regarding signalment (age, breed, weight, and sex), clinical signs, treatment, physical examination findings, and diagnostic testing before and after LAD. Procedural data were also collected including approach, technique, hemodynamic data, complications, and outcome. RESULTS 18 LAD procedures performed in 17 patients were identified. Dogs ranged in age from 7.5 to 16 years old (median, 11 years) and ranged in body weight from 2.9 to 11.6 kg (6.4 to 25.5 lb) with a median body weight of 7.0 kg (15.4 lb). Minimally invasive creation of an atrial septal defect for the purpose of LAD was successful in all dogs without any intraoperative deaths. Before LAD, mean LAP was elevated and ranged from 8 to 32 mm Hg with a median value of 14 mm Hg (reference value, < 10 mm Hg). Following LAD, there was a significant decrease in mean LAP (median decrease of 6 mm Hg [range, 1 to 15 mm Hg]). Survival time following LAD ranged from 0 to 478 days (median, 195 days). CONCLUSIONS AND CLINICAL RELEVANCE For dogs with advanced MMVD and left-sided CHF, LAD resulted in an immediate and substantial reduction in LAP.
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Allen J, Peterson N, Barrett K, Llamas A. Graded balloon atrial septostomy for palliation of congenital pulmonary hypertension in a dog: A case report. J Vet Intern Med 2019; 34:283-288. [PMID: 31769097 PMCID: PMC6979104 DOI: 10.1111/jvim.15666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 11/10/2019] [Indexed: 12/29/2022] Open
Abstract
CASE DESCRIPTION A 6-month-old intact female Maltese dog was presented for acute onset of syncope. CLINICAL FINDINGS The dog was presented for collapse upon excitement and exercise. It collapsed at discharge and suffered cardiopulmonary arrest. Echocardiography after resuscitation indicated severe pulmonary hypertension without evidence of intracardiac or extracardiac shunting. A presumptive diagnosis of congenital pulmonary hypertension was made. TREATMENT AND OUTCOME Initial treatment with sildenafil was effective at relieving syncope, but the extent of pulmonary hypertension as determined by serial echocardiography was unchanged. Graded balloon atrial septostomy was performed as a palliative procedure. Follow-up echocardiography identified a patent interatrial communication with bidirectional shunting. The dog remained asymptomatic 18 months after treatment. CLINICAL RELEVANCE To the best of our knowledge, this study is the first report in the veterinary literature of graded balloon atrial septostomy performed for therapeutic purposes. Further studies are required to determine if this palliative procedure is a beneficial treatment option for dogs with congenital or severe refractory pulmonary hypertension.
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Amat-Santos IJ, Cabau JR, López J. Left-to-right interatrial shunt percutaneously implanted devices: a new avenue in the treatment of heart failure. Interv Cardiol 2015. [DOI: 10.2217/ica.15.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Amat-Santos IJ, Bergeron S, Bernier M, Allende R, Barbosa Ribeiro H, Urena M, Pibarot P, Verheye S, Keren G, Yaacoby M, Nitzan Y, Abraham WT, Rodés-Cabau J. Left atrial decompression through unidirectional left-to-right interatrial shunt for the treatment of left heart failure: first-in-man experience with the V-Wave device. EUROINTERVENTION 2015; 10:1127-31. [PMID: 24832489 DOI: 10.4244/eijy14m05_07] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS Elevated filling pressures of the left atrium (LA) are associated with poorer outcomes in patients with chronic heart failure. The V-Wave is a new percutaneously implanted device intended to decrease the LA pressure by the shunting of blood from the LA to the right atrium. This report describes the first-in-man experience with the V-Wave device. METHODS AND RESULTS A 70-year-old man with a history of heart failure of ischaemic origin, left ventricular dysfunction (LVEF: 35%, pulmonary wedge: 19 mmHg), no right heart dysfunction, NYHA Class III and orthopnoea despite optimal treatment, was accepted for V-Wave device implantation. The device consists of an ePTFE encapsulated nitinol frame that is implanted at the level of the interatrial septum and contains a trileaflet pericardium tissue valve sutured inside which allows a unidirectional LA to right atrium shunt. The procedure was performed through a transfemoral venous approach under fluoroscopic and TEE guidance. The device was successfully implanted and the patient was discharged 24 hours after the procedure with no complications. At three-month follow-up a left-to-right shunt through the device was confirmed by TEE. The patient was in NYHA Class II, without orthopnoea, the Kansas City Cardiomyopathy index was 77.6 (from 39.1 at baseline) and NT-proBNP was 322 ng/mL (from 502 ng/mL at baseline). The QP/QS was 1.17 and the pulmonary wedge was 8 mmHg, with no changes in pulmonary pressure or right ventricular function. CONCLUSIONS Left atrial decompression through a unidirectional left-to-right interatrial shunt represents a new concept for the treatment of patients with left ventricular failure. The present report shows the feasibility of applying this new therapy with the successful and uneventful implantation of the V-Wave device, which was associated with significant improvement in functional, quality of life and haemodynamic parameters at 90 days.
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Affiliation(s)
- Ignacio J Amat-Santos
- Department of Cardiology, Quebec Heart & Lung Institute, Quebec City, Quebec, Canada
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Sugiyama H, Fujimoto K, Ishii T, Nakanishi T, Tomita H. Impact of Novel Balloon Catheter on Static Balloon Atrial Septostomy With Double Balloon Technique in Infants With Congenital Heart Disease. Circ J 2015; 79:2367-71. [DOI: 10.1253/circj.cj-15-0480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Kazuto Fujimoto
- Cardiovascular Center, Showa University Northern Yokohama Hospital
| | - Tetsuko Ishii
- Pediatric Cardiology, Tokyo Women’s Medical University
| | | | - Hideshi Tomita
- Cardiovascular Center, Showa University Northern Yokohama Hospital
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DeSena HC, Veeram Reddy SR, Welch T, Wang J, Forbess J, Nugent AW. Morphology of interatrial defects created by interventional techniques in a neonatal animal model. Pediatr Cardiol 2014; 35:381-5. [PMID: 24013176 DOI: 10.1007/s00246-013-0786-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 08/21/2013] [Indexed: 11/30/2022]
Abstract
Pathological details are lacking of various techniques used for interatrial defect (IAD) creation in lesions requiring mixing or with left atrial hypertension. Therefore, the morphology of the IAD created by different interventional techniques is described. The atrial septa of ten euthanized piglets (seven at <3 days and three at 2 weeks of age) were surgically exposed. In pigs of both ages, a needle-created communication was dilated with angioplasty, cutting, and cryoplasty balloons. A stent was also implanted in a newborn pig. By way of a patent foramen ovale (PFO) in newborns, angioplasty and septostomy balloons and a stent created IADs. The morphology of the IAD was directly imaged and the size measured. Newborn piglets had noticeably thinner atrial septa, and a PFO was still present. Static balloon dilation created a circular IAD equivalent to the balloon diameter (3 and 6 mm) in both the created defects of pigs of both ages and the neonatal PFO. A 3-mm cutting balloon (CB) produced a 2-mm triangular IAD (corresponding to atherotomes) in pigs of both ages. Premounted stents, by way of a created defect or PFO, led to circular IADs equivalent to balloon diameter. The 3-mm cryoplasty balloon created a large 5 × 4-mm IAD in the newborn pig; however, the IAD measured only 2 × 1-mm at 2 weeks. By way of a neonatal PFO, a septostomy balloon (inflated to 2 cc) created a 3-mm circular IAD. In neonatal piglet hearts, static balloon angioplasty, CBs, and stents created a predictable IAD. Cryoplasty balloons created highly variable defects.
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Affiliation(s)
- Holly C DeSena
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA,
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Kan JS. Jean S. Kan, MD: a conversation with Colin K.L. Phoon, MPhil, MD. Am J Cardiol 2008; 101:129-38. [PMID: 18157980 DOI: 10.1016/j.amjcard.2007.07.074] [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: 05/07/2007] [Revised: 07/05/2007] [Accepted: 07/05/2007] [Indexed: 10/22/2022]
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Pedra CAC, Neves JR, Pedra SRF, Ferreiro CR, Jatene I, Cortez TM, Jatene M, Souza LCB, Assad R, Fontes VF. New transcatheter techniques for creation or enlargement of atrial septal defects in infants with complex congenital heart disease. Catheter Cardiovasc Interv 2007; 70:731-9. [PMID: 17621660 DOI: 10.1002/ccd.21260] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To describe a series of 8 consecutive infants (5 with transposition of the great arteries [TGA] and 3 with hypoplastic left heart syndrome [HLHS]) who underwent nonconventional septostomy techniques. BACKGROUND For some complex congenital heart defects, an unrestrictive atrial septal defect (ASD) is essential to achieve an adequate cardiac output and/or systemic saturation. In some scenarios, the use of conventional septostomy techniques may be technically difficult, hazardous, and/or ineffective. METHODS Use of transhepatic approach, cutting balloons, and radiofrequency perforation with stenting of the atrial septum. RESULTS The size of the ASD and the oxygen saturation increased in all patients with no major complications. In those with TGA, the ASDs were considered to be of good size at the arterial switch operation. Two of the 3 patients with hybrid palliation for HLHS have developed some degree of obstruction within the interatrial stent over 2-3 months. At surgery, the stents were found to be secured within the septum with one showing significant fibrous ingrowth after uneventful removal. The other had some nonobstructive ingrowth. CONCLUSIONS Creation or enlargement of ASDs in infants using new nonconventional transcatheter techniques is feasible, safe, and effective, at least in the short-to-mid-term follow-up. Infants with TGA seem to benefit the most because the procedure results in satisfactory clinical stability for subsequent early surgical intervention. In infants with HLHS palliated by a hybrid approach, stent implantation to the atrial septum seems to buy enough time to bring them to the phase II safely despite progressive in-stent obstruction.
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Affiliation(s)
- Carlos A C Pedra
- Pediatric Cardiology Division, Hospital do Coração da Associação Sanatório Sírio, São Paulo, SP, Brazil.
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Leonard GT, Justino H, Carlson KM, Rossano JW, Neish SR, Mullins CE, Grifka RG. Atrial Septal Stent Implant: Atrial Septal Defect Creation in the Management of Complex Congenital Heart Defects in Infants. CONGENIT HEART DIS 2006; 1:129-35. [DOI: 10.1111/j.1747-0803.2006.00022.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McQuillen PS, Hamrick SEG, Perez MJ, Barkovich AJ, Glidden DV, Karl TR, Teitel D, Miller SP. Balloon Atrial Septostomy Is Associated With Preoperative Stroke in Neonates With Transposition of the Great Arteries. Circulation 2006; 113:280-5. [PMID: 16401771 DOI: 10.1161/circulationaha.105.566752] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Preoperative brain injury is common in neonates with transposition of the great arteries (TGA). The objective of this study is to determine risk factors for preoperative brain injury in neonates with TGA. METHODS AND RESULTS Twenty-nine term neonates with TGA were studied with MRI before cardiac surgery in a prospective cohort study. Twelve patients (41%) had brain injury on preoperative MRI, and all injuries were focal or multifocal. None of the patients had birth asphyxia. Nineteen patients (66%) required preoperative balloon atrial septostomy (BAS). All patients with brain injury had BAS (12 of 19; risk difference, 63%; 95% confidence interval, 41 to 85; P=0.001). As expected on the basis of the need for BAS, these neonates had lower systemic arterial hemoglobin saturation (Sao2) (P=0.05). The risk of injury was not modified by the cannulation site for septostomy (umbilical versus femoral, P=0.8) or by the presence of a central venous catheter (P=0.4). CONCLUSIONS BAS is a major identifiable risk factor for preoperative focal brain injury in neonates with TGA. Imaging characteristics of identified brain injuries were consistent with embolism; however, the mechanism is more complex than site of vascular access for BAS or exposure to central venous catheters. These findings have implications for the indications for BAS, timing of surgical repair, and use of anticoagulation in TGA.
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Bar-Cohen Y, Perry SB, Keane JF, Lock JE. Use of Stents to Maintain Atrial Defects and Fontan Fenestrations in Congenital Heart Disease. J Interv Cardiol 2005; 18:111-8. [PMID: 15882157 DOI: 10.1111/j.1540-8183.2005.04049.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Maintaining patent atrial septal communications or fenestrations can be vital in conditions requiring adequate decompression of the atria or Fontan baffle. We have recently deployed stents for this purpose, and the aim of this retrospective analysis is to describe our experience. All 26 patients undergoing such stent placement were retrospectively studied and for neonates with hypoplastic left heart syndrome (HLHS) and patients with Fontan fenestrations, their data were compared to controls undergoing transseptal static balloon dilation during the same time period. All 7 stented neonates with HLHS survived to their Norwood procedure and 57% survived to hospital discharge, similar to those who had static balloon dilation. Complications occurred in both HLHS groups but transient complete heart block was only seen in the control group, which also had larger balloons used (10.3 mm vs 7 mm, P=0.002). The success rate for patients undergoing stent placement in Fontan fenestrations was 64% compared to 76% with dilation alone. Complications were seen in 64% of the Fontan stented group compared to 39% for controls. There were 5 other patients with complex lesions (3 of whom were on the Extracorporeal Membrane Oxygenator) in whom stent placement successfully maintained atrial communication patency. Atrial septal stent placement in neonates with HLHS with restrictive defects is effective and appears at least as safe as static balloon dilation. On the other hand, initial fenestration stent placement is indicated only after extracardiac Fontan procedures in which the previous fenestration location cannot be found.
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Affiliation(s)
- Yaniv Bar-Cohen
- Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115, USA.
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Veldtman GR, Norgard G, Wåhlander H, Garty Y, Thabit O, McCrindle BW, Lee KJ, Benson LN. Creation and enlargement of atrial defects in congenital heart disease. Pediatr Cardiol 2005; 26:162-8. [PMID: 15868326 DOI: 10.1007/s00246-004-0953-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Transcatheter creation and enlargement of interatrial defects (IAD) may improve hemodynamics; however, procedural outcomes have not been well defined. Hospital records were reviewed for children who underwent percutaneous procedures to create and enlarge an IAD and were grouped as follows: (1) right and (2) left heart obstructive lesions, (3) left atrial (LA) decompression during left heart assist, (4) failing Fontan circulation, and (5) miscellaneous. Forty-five children (mean age, 3.4 +/- 4.7 years; 30 (67%) male) were identified. In group 1 (n = 6), all achieved endpoints of right atrial (RA) decompression (n = 2), improved left ventricular filling (n = 3), or improved arterial saturations (n = 1). In group 2 (n = 18), mean LA pressure decreased (21 +/- 6 to 13 +/- 5 mmHg, p < 0.001) and arterial saturations increased (61 +/- 13% to 78 +/- 11%, p < 0.001). All except 2 patients achieved definitive repair, further palliation (n = 9), or heart transplantation (HTX) (n = 7). In group 3 (n = 5), the LA was decompressed (21 to 13 mmHg, p = 0.03) in all, and all except 1 patient survived to HTX (n = 2) or full recovery (n = 2). In group 4 (n = 11), of 7 patients with a low cardiac output syndrome after surgery, despite improved atrial shunting, 3 died and 1 required a HTX. In group 5 (n = 5), RA decompression (n = 1) or improved arterial saturation (n = 4) was achieved in all. Overall, 5-year HTX free survival was 75%. Mechanical ventilation before the procedure (p < 0.001), the need for a blade septostomy (p = 0.002), and higher LA pressures after the procedure (p = 0.04) independently predicted mortality or the requirement for HTX. Transcatheter optimization of an atrial communication can help optimize treatment strategies and has a low procedural risk.
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Affiliation(s)
- G R Veldtman
- Department of Pediatrics, Division of Cardiology, Hospital for Sick Children, The University of Toronto School of Medicine, 555 University Avenue, M5G 1X8, Toronto, Canada
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Abstract
A new technique is presented to create percutaneously an unrestrictive and lasting atrial communication in small children. In 2 infants, a stent was deployed in a restrictive atrial communication and first inflated with an 8 mm balloon. The stent was then further expanded up to 10 or 12 mm. The gradient and turbulent flow between the two atriums disappeared completely. The stent retained a very stable position without embolisation. Other complications, such as formation of thrombus or arrhythmia, were not observed until elective explantation after 2 and 11 months. We conclude that, in infants, dilation of the atrial septum with a stent can provide a safe, lasting, and unrestrictive atrial communication.
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Justino H, Benson LN, Nykanen DG. Transcatheter creation of an atrial septal defect using radiofrequency perforation. Catheter Cardiovasc Interv 2001; 54:83-7. [PMID: 11553955 DOI: 10.1002/ccd.1244] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transseptal perforation using radiofrequency energy was performed successfully in a patient with congenital heart disease and a thickened interatrial septum. This was followed by balloon dilatation of the atrial septal defect. Radiofrequency is presented as a alternative to standard transseptal needle puncture. Cathet Cardiovasc Intervent 2001;54:83-87.
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Affiliation(s)
- H Justino
- Department of Pediatrics, Division of Cardiology, the Variety Club Cardiac Catheterization Laboratories, the Hospital for Sick Children, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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Schneider MB, Zartner PA, Magee AG. Transseptal approach in children after patch occlusion of atrial septal defect: first experience with the cutting balloon. Catheter Cardiovasc Interv 1999; 48:378-81. [PMID: 10559818 DOI: 10.1002/(sici)1522-726x(199912)48:4<378::aid-ccd11>3.0.co;2-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Two children required a transseptal approach to the left heart for endovascular stent redilation late after pericardial patch closure of atrial septal defects performed at the time of their initial surgical intervention. Following perforation of thickened interatrial patches in both patients, cutting balloons were used to create adequate interatrial communications. Cathet. Cardiovasc. Intervent. 48:378-381, 1999.
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Affiliation(s)
- M B Schneider
- Department of Pediatric Cardiology, Humboldt University, Berlin, Germany
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Seib PM, Faulkner SC, Erickson CC, Van Devanter SH, Harrell JE, Fasules JW, Frazier EA, Morrow WR. Blade and balloon atrial septostomy for left heart decompression in patients with severe ventricular dysfunction on extracorporeal membrane oxygenation. Catheter Cardiovasc Interv 1999; 46:179-86. [PMID: 10348539 DOI: 10.1002/(sici)1522-726x(199902)46:2<179::aid-ccd13>3.0.co;2-w] [Citation(s) in RCA: 144] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is used as circulatory support or bridge to transplantation in patients with severe left ventricular (LV) dysfunction. Left heart decompression is needed to reduce pulmonary edema, prevent pulmonary hemorrhage, and reduce ventricular distention that may aid in recovery of function. We reviewed our experience from November 1993 to December 1997 with 10 patients having severe LV dysfunction (7 myocarditis, 3 dilated cardiomyopathy) who required circulatory support with ECMO and who underwent left heart decompression with blade and balloon atrial septostomy (BBAS). Patients ranged in age from 1 to 24 years (median, 3 years). Indications for BBAS included left atrial/left ventricular distension (10), pulmonary edema/hemorrhage (9), or severe mitral regurgitation (2). BBAS was performed electively in eight patients and urgently in two patients. BBAS was performed while on ECMO in seven patients and pre-ECMO in three. A femoral venous approach was used in all patients. ECMO patients were fully heparinized. Transseptal puncture was required in nine patients while one patient had a patent foramen ovale. Blade septostomy was performed in all patients. Enlargement of the defect was then performed by stationary balloon dilation in nine and Rashkind balloon atrial septostomy in one. Balloon diameters ranged from 10 to 20 mm. Sequential balloon inflations were performed in some patients. Adequacy of the atrial septal defect (ASD) was confirmed by pressure measurement and echocardiography. Adequate left heart decompression was achieved in all patients. Pulmonary edema improved in nine of nine patients. Left atrial mean pressure fell from a mean of 30.5 mm Hg, (range, 12-50 mm Hg) to 16 mm Hg (range, 9-24 mm Hg). Left atrial to right atrial pressure gradient fell from a mean of 20 mm Hg pre-BBAS to 3 mm Hg post-BBAS. ASDs ranged in size from 2.5 to 8 mm (mean, 5.9 mm). Complications included needle perforation of the left atrium without hemodynamic compromise (one), ventricular fibrillation requiring defibrillation (one), and hypotension following BBAS which responded to volume infusion (two). Duration of ECMO ranged from 41 hr to 704 hr (mean, 294 hr). Seven patients survived and four patients had recovery of normal LV function. Of those who recovered, two had no ASD at follow-up while two ASDs are patent 14 days and 3 months post-BBAS. Three patients underwent successful cardiac transplantation. Three patients died, all of whom had multisystem organ failure with or without sepsis. A patent ASD was noted at transplant (three) or autopsy (two). No patient required a second BBAS. BBAS alleviates severe left atrial hypertension and pulmonary edema. In addition, BBAS avoids the potential bleeding complications of surgical left heart decompression. Stationary balloon dilation of the atrial septum is an effective alternative to Rashkind balloon septostomy in older patients. BBAS achieves left heart decompression that may permit recovery of LV function or allow extended ECMO support as a bridge to transplant.
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Affiliation(s)
- P M Seib
- Department of Pediatric Cardiology, David M. Clark Cardiovascular Center, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock 72202, USA.
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Frazier EA, Faulkner SC, Seib PM, Harrell JE, Van Devanter SH, Fasules JW. Prolonged extracorporeal life support for bridging to transplant: technical and mechanical considerations. Perfusion 1997; 12:93-8. [PMID: 9160359 DOI: 10.1177/026765919701200203] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Through July 1995, the Extracorporeal Life Support Organization (ELSO) registry listed 87 patients who received extracorporeal life support (ECLS) as a bridge to cardiac transplantation with a survival rate of 41%. At Arkansas Children's Hospital, 17 patients (aged between two days and 24 years) with diagnoses of dilated cardiomyopathy (seven), postcardiotomy (seven) and acute viral myocarditis (three) were bridged with ECLS. Mechanical complications only occurred in two patients, neither of which necessitated withdrawal of ECLS. Decompression of the left heart was performed in 11 patients, six via a surgically placed vent and five with a blade/balloon artial septostomy. Documented infection occurred in 11/17 patients, but only one patient died from infection. Fifteen of 17 patients (88%) recovered or were transplanted, of which 13 (76%) were discharged home. With left-heart decompression and appropriate treatment of infection, ECLS may be used as a bridge to cardiac transplantation or until the return of cardiac function.
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Affiliation(s)
- E A Frazier
- Department of Pediatric Cardiology, Arkansas Children's Hospital, Little Rock 72202-3591, USA
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Grabitz RG, Handt S, Vanopbroeke HJ, Seghaye MC, Franke A, Osypka P, von Bernuth G. Interventional atrioseptostomy by application of monopolar high-frequency alternating current. In vitro evaluation of a new device. Invest Radiol 1997; 32:90-3. [PMID: 9039580 DOI: 10.1097/00004424-199702000-00003] [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: 02/03/2023]
Abstract
RATIONALE AND OBJECTIVES The authors evaluate the use of a new device for interventional creation of atrial septal defects (ASD) working with high-frequency alternating current in an in vitro study with porcine atria. METHODS The device consists of a symmetrical cage of six superelastic monofile wires, including a microthermistor that is placed via a catheter into a punctured hole in the porcine foramen ovale. The device is used as a differential electrode for monopolar, temperature-controlled application of high-frequency alternating current for thermal modelling of ASD. RESULTS Application of current for 60 seconds caused temperature-dependent, sized ASDs. CONCLUSION In vivo animal studies to evaluate possible side effects and long term patency of the ASDs are justified and warranted.
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Affiliation(s)
- R G Grabitz
- Department of Pediatric Cardiology, Aachen University of Technology, Germany
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Affiliation(s)
- P S Rao
- St. Louis University, School of Medicine, 1465 South Grand Boulevard, St. Louis, MO 63104-1095, USA
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Swindle MM, Smith AC, Laber-Laird K, Dungan L. Swine in Biomedical Research: Management and Models. ILAR J 1994. [DOI: 10.1093/ilar.36.1.1] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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