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Arfi AM, Alata J, Baho H, Ahmad Z, Badawy N, Bekheet S, Baatya W, Helal A, Kouatli A. Cardiac Catheterization Post Congenital Cardiac Surgery: Analysis of Risk Factors for Mortality and Literature Review. Cureus 2024; 16:e67020. [PMID: 39280470 PMCID: PMC11402465 DOI: 10.7759/cureus.67020] [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] [Accepted: 08/16/2024] [Indexed: 09/18/2024] Open
Abstract
Background Diagnostic and interventional cardiac catheterization plays a significant role in the management of congenital heart defects with acceptable risks. Its role has also evolved in sick children but is associated with higher risks due to technical difficulties and co-morbidity factors. Some of the post-cardiac surgery children who show resistance to conventional management during the early postoperative period usually have residual defects or obstructions. Trans-catheter intervention (TCI) in such high-risk circumstances and relatively sick children is challenging, demands much expertise, and should be backed up by a competent multidisciplinary team. Some cases improve clinically, while others may require surgical or transcatheter re-intervention for a positive outcome. There is minimal data so far regarding the major complications after interventional cardiac catheterization during the immediate postoperative period after cardiac surgery. We analyzed multiple factors, including age, sex, weight, the initial diagnosis, and the time interval between surgery and TCI, to stratify the possible risks for mortality after TCI during the immediate postoperative period after cardiac surgery. Results Thirty-five patients fulfilled the inclusion criteria and underwent 43 interventional procedures. Five patients could not survive. Four had stent angioplasties on natural vasculature and one patient had in synthetic conduit. None of the mortality was related to the procedure. Multivariable risk factor analysis confirmed a moderate positive correlation coefficient (r) of 0.8017 between the variables. Still, it was not statistically significant if compared among subgroups or among the mortality and survival groups. Conclusion Interventional cardiac catheterization in sick children during the immediate postoperative period can be carried out without much-added risks in expert hands and under the supervision of a multi-disciplinary team. Though no conclusions could be drawn, our study adds to the limited existing data that could inspire others to perform such procedures on sick children. Moreover, the trend in our results indicated a large sample size could have identified a possible risk factor for mortality.
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Affiliation(s)
- Amin M Arfi
- Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
| | - Jameel Alata
- Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
| | - Haysam Baho
- Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
| | - Zaheer Ahmad
- Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
| | - Nashwa Badawy
- Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
| | | | - Wejdan Baatya
- Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
| | - Abdelmonen Helal
- Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
| | - Amjad Kouatli
- Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
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2
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Steinberg ZL, Singh HS. How to plan and perform a diagnostic catheterisation in adult patients with congenital heart disease. Heart 2022; 109:151-157. [PMID: 36261281 DOI: 10.1136/heartjnl-2022-321005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
| | - Harsimran S Singh
- Department of Internal Medicine, Weill Cornell Medical College, New York, New York, USA
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John S, Schoeneberg L, Greenleaf CE, Salazar JD, Adebo DA. Pre- and post-operative cardiovascular CT in Stage I single ventricle palliation. J Card Surg 2021; 37:322-328. [PMID: 34845746 DOI: 10.1111/jocs.16162] [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: 10/23/2021] [Accepted: 11/18/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study is to describe clinical utility of low dose cardiac computed tomography (CT) in the evaluation of single ventricle physiology before and after Stage I palliation. BACKGROUND Despite the increased utilization of CT imaging and advancement of CT technology, there are limited studies describing the routine clinical use of cardiac CT and radiation dose parameters in the single ventricle Stage I palliation. METHODS This single center, retrospective study included 57 infants with single ventricle physiology who underwent cardiac CT scans between January 1, 2016 and November 30, 2020. Patients' demographic information, diagnosis, indication, total dose length product (DLP), computed tomographic dose index volume (CTDIvol), cardiac CT findings and intraoperative or intraprocedural findings were reviewed. Estimated effective radiation dose was calculated using a previously published conversion rate. RESULTS The studies were performed using different generations of CT scanners over the 4 years period: Somatom AS 128, Somatom definition edge, Somatom Force (Siemens Medical Solutions). The studies performed with dual source scanner with prospective gated technique have lower radiation dose exposure with median effective radiation dose of 0.32 mSv. CONCLUSION Pre- and post-operative cardiovascular CT in Stage I single ventricle palliation using newer generation scanners with prospective gated technique can be done with minimal radiation exposure and good image quality. Cardiac CT is a powerful imaging modality for better management planning in this group of patients.
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Affiliation(s)
- Sheba John
- Division of Pediatric Cardiology, Children's Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Laura Schoeneberg
- Division of Pediatric Cardiology, Children's Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Christopher E Greenleaf
- Division of Cardiothoracic Surgery, Children's Heart Institute, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, Texas, USA
| | - Jorge D Salazar
- Division of Cardiothoracic Surgery, Children's Heart Institute, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, Texas, USA
| | - Dilachew A Adebo
- Division of Pediatric Cardiology, Children's Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
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Yamasaki Y, Kamitani T, Sagiyama K, Matsuura Y, Hida T, Nagata H. Model-based iterative reconstruction for 320-detector row CT angiography reduces radiation exposure in infants with complex congenital heart disease. ACTA ACUST UNITED AC 2021; 27:42-49. [PMID: 33290239 DOI: 10.5152/dir.2020.19633] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE We investigated the impact of model-based iterative reconstruction (MBIR) on 320-detector row computed tomography angiography (CTA) in infants with complex congenital heart disease (CHD). METHODS Seventy infants with complex CHD who underwent 320-detector row CTA (40 boys and 30 girls; age range, 0-22 months; median age, 60 days) were retrospectively evaluated. First, the images were reconstructed by filtered back projection (FBP), hybrid iterative reconstruction (HIR), or MBIR in 20 cases, and variables were compared among the three iterative reconstruction methods (IR test). Second, the variables were compared between 25 cases scanned using HIR and 25 cases scanned using MBIR, with a 20 standard deviation noise level for both. Attenuation values and contrast-to-noise ratios (CNRs) of the great vessels and heart chambers were calculated. Total dose-length products were recorded for all patients (radiation dose: RD test). RESULTS In the IR test, the mean CNR values were 4.8±1.3 for FBP, 6.9±1.4 for HIR, and 8.2±1.7 for MBIR (P < 0.0001). The best subjective image qualities in the great vessels and heart chambers were obtained with MBIR. In RD testing, no significant differences between HIR and MBIR in image quality (CNR: HIR, 8.4±2.4; MBIR, 8.3±2.4) were observed. The effective dose was significantly lower for MBIR than for HIR (0.7±0.2 vs. 1.1±0.3 mSv; P < 0.001). CONCLUSION The MBIR algorithm significantly improved image quality and decreased radiation exposure in 320-row CTA of infants with complex CHD, providing an alternative to FBP or HIR that is both safer and produces better results.
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Affiliation(s)
- Yuzo Yamasaki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Sagiyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuko Matsuura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyuki Hida
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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5
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The effect of the duration of the procedure on the risk of complications during pediatric cardiac catheterization. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:467-473. [PMID: 32953209 DOI: 10.5606/tgkdc.dergisi.2020.19057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/23/2020] [Indexed: 11/21/2022]
Abstract
Background This study aims to evaluate the frequency of and associated risk factors for adverse events caused by cardiac catheterization procedures in pediatric patients. Methods Between January 2009 and January 2012, a total of 599 pediatric patients (320 males, 279 females; mean age 5.4±4.7 years; range, 1 day to 21 years) who underwent cardiac catheterization in our cardiac catheterization laboratory were retrospectively analyzed. Demographic and clinical data of the patients including the duration of the procedure, management of anesthesia, the American Society of Anesthesiologists class, and Catheterization Risk Score for Pediatrics, and procedure-related serious adverse events were recorded. Results The incidence of procedure-related serious adverse events was 9.18%. Potential risk factors associated with serious adverse events were identified as interventional heart catheterization, high scores obtained from the Catheterization Risk Score for Pediatrics, the use of endotracheal tube in airway control, and prolonged procedural duration. Conclusion Our study results suggest that prolonged duration of catheterization is a potential risk factor for procedure-related adverse events and the duration of the procedure needs to be included as a variable in the Catheterization Risk Score for Pediatrics scoring system for predicting procedure-related adverse events.
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6
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Brida M, Diller GP, Nashat H, Barracano R, Kempny A, Uebing A, Rigby ML, Gatzoulis MA. Cardiac catheter intervention complexity and safety outcomes in adult congenital heart disease. Heart 2020; 106:1432-1437. [PMID: 32205313 DOI: 10.1136/heartjnl-2019-316148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the intervention spectrum, complexity, and safety outcomes of catheter-based interventions in a contemporary adult congenital heart disease (ACHD) tertiary cohort. METHODS All patients over 16 years who underwent a catheter-based intervention for ACHD in our centre between 2000 and 2016 were included. Baseline demographics, clinical characteristics, indications for and complexity of intervention, procedural complications and early and mid-term mortality were analysed. RESULTS Overall, 1644 catheter-based interventions were performed. Intervention complexity ranged from simple (67.5%) to intermediate (26.4%) and to high (6.1%). Commonly performed procedures were atrial septal defect (33.4%) and patent foramen ovale closure (26.1%) followed by coarctation of the aorta (11.1%) and pulmonary artery interventions (7.0%). Age at index intervention was 40±16 years, 758 (46.1%) patients were male, 73.2% in New York Heart Association (NYHA) class I, 20.2% in NYHA class II, whereas 6.6% in NYHA class III/IV. In-hospital mortality was 0.7%. Median postinterventional length of stay was 1 day. Complications occurred in 129 (7.9%) with major adverse events in 21 (1.3%). One-year postintervention survival rates were 98.7% (95% CI 98.2 to 99.2). Over the study period, there was a notable shift in intervention complexity, with a predominance of simple procedures performed in early years and more complex procedures in later years. Furthermore, the case mix during the study broadened (p<0.001) with new catheter-based interventions and a more individualised approach to therapy. CONCLUSION This study shows an increasing complexity and expanding variability of ACHD catheter-based interventions, associated with low major complications, short hospital stays and low early and mid-term mortality. Ongoing investment in ACHD catheter interventions is warranted.
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Affiliation(s)
- Margarita Brida
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK .,Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre, Zagreb, Croatia.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Gerhard Paul Diller
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital Muenster, Muenster, Germany
| | - Heba Nashat
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Rosaria Barracano
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Aleksander Kempny
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Anselm Uebing
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Michael L Rigby
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
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Abstract
OBJECTIVES Cardiac catheterisation is commonly used for diagnosis and therapeutic interventions in paediatric cardiology. The inherent risk of the procedure can result in unanticipated admissions to critical care. Our goals were to provide a qualitative description of characteristics and evaluation of children admitted unexpectedly to the cardiac critical care unit (CCCU). METHODS A retrospective single centre review of cardiac catheterisation procedures was done between 1 January, 2003 and 30 April, 2013. RESULTS Of 9336 cardiac catheterisations performed, 146 (1.6%) were admitted from the catheterisation laboratory to the CCCU and met inclusion criteria. Of these 146 patients, 117 (1.3%) met criteria for unexpected admission and 29 (0.3%) were planned admissions. The majority admitted unexpectedly were below 1 year of age without co-morbidity aside from heart disease. Patients with planned admissions were significantly more likely to have single ventricle physiology, undergoing angiography or transferred for observation. Most unplanned admissions were triggered by interventional catheterisations or procedure-related complications. Patients received mechanical ventilation as the main CCCU management. Eighteen patients needed either cardiopulmonary resuscitation and/or extracorporeal membrane oxygenation during their catheterisation. About 106/117 (90.6%) patients survived to hospital discharge with no deaths in the planned admission group. CONCLUSIONS Admission to CCCU following cardiac catheterisation was uncommon and tended to occur in younger children undergoing interventional procedures. Outcomes did not differ between patients experiencing planned and unplanned CCCU admission. Ongoing development of risk stratification tools may help to decrease unplanned CCCU admissions. Further studies are needed to determine whether unplanned admission following paediatric cardiac catheterisation should be utilised as a quality indicator.
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Fujimoto K, Fujii T, Hata Y, Tarui S, Miyahara Y, Ishino K, Tomita H. Stent unzipping using an ultra-high-pressure balloon: in vitro and animal experiments. Heart Vessels 2017; 33:239-245. [PMID: 29032492 DOI: 10.1007/s00380-017-1060-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 10/06/2017] [Indexed: 01/15/2023]
Abstract
As a child grows, limitations to the maximum dilatable stent diameter (MDD) will result in stenosis associated with size mismatch. If an implanted stent can be intentionally fractured along its length, a process called "unzipping," it may eventually be redilated to adult vessel size. Few studies have addressed how a stent can be unzipped using an ultra-high-pressure balloon (UHB) with the smallest balloon diameter. Eleven commercially available stents, three Liberté stents (LS), six genesis renal stents (GS), and two express vascular SD stents (ES), were tested for in vitro unzipping. In addition, using eight stents, we investigated whether a balloon that had unzipped the stent in vitro would work similarly in the vessel of a pig. Finally, we assessed the histological influence of the unzipped stent on the surrounding tissue. In a bench test, LS, GS, and ES were consistently unzipped by a balloon whose diameter was ≥ 1.5, 2.18, and 1.66 times that of MDD, respectively. In animal experiments, LS, GS, and ES were predictably unzipped with balloons of 1.50, 1.81, and 1.66 times the MDD, respectively. After unzipping, the unzipped strut did not damage the surrounding tissue histologically. Use of a UHB enabled unzipping of the stent with a balloon diameter less than two times the MDD enables implantation of a larger stent in the unzipped small stent by incremental steps.
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Affiliation(s)
- Kazuto Fujimoto
- Cardiovascular Center, Showa University, Northern Yokohama Hospital, 35-1 Chigasakichuo, Tsuzuki-ku, Yokohama, Kanagawa, 224-8503, Japan. .,Department of Perinatal and Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan.
| | - Takanari Fujii
- Cardiovascular Center, Showa University, Northern Yokohama Hospital, 35-1 Chigasakichuo, Tsuzuki-ku, Yokohama, Kanagawa, 224-8503, Japan
| | - Yoshihito Hata
- Cardiovascular Center, Showa University, Northern Yokohama Hospital, 35-1 Chigasakichuo, Tsuzuki-ku, Yokohama, Kanagawa, 224-8503, Japan
| | - Suguru Tarui
- Cardiovascular Center, Showa University, Northern Yokohama Hospital, 35-1 Chigasakichuo, Tsuzuki-ku, Yokohama, Kanagawa, 224-8503, Japan
| | - Yoshinori Miyahara
- Cardiovascular Center, Showa University, Northern Yokohama Hospital, 35-1 Chigasakichuo, Tsuzuki-ku, Yokohama, Kanagawa, 224-8503, Japan
| | - Kozo Ishino
- Cardiovascular Center, Showa University, Northern Yokohama Hospital, 35-1 Chigasakichuo, Tsuzuki-ku, Yokohama, Kanagawa, 224-8503, Japan
| | - Hideshi Tomita
- Cardiovascular Center, Showa University, Northern Yokohama Hospital, 35-1 Chigasakichuo, Tsuzuki-ku, Yokohama, Kanagawa, 224-8503, Japan
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9
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Abstract
We determined the incidence, type, and severity of complications after cardiac catheterisation in children with heart disease in Norway, and we present the results in terms of the International Paediatric and Congenital Cardiac Code (IPCCC) nomenclature for complications. All paediatric cardiac catheterisations in Norway are performed in one clinical centre. All procedures performed during a 5-year period beginning in 2010 were prospectively registered, and medical records for cases with complications were reviewed to confirm the event and to re-classify the type, severity, and attributability of the complication according to the IPCCC nomenclature. Univariate and multivariate analyses were performed to identify possible risk predictors. A total of 1318 catheterisations performed on 941 patients were included in the present study, of which 68% were interventional. The complication and major complication rates were 5.5 and 1.4%, respectively. Trauma to the vessels or the myocardium, haemodynamic adverse events, and arrhythmias were the most common types of complications. In the multivariate model, weight <4 kg (odds ratios, 3.0; 95% confidence intervals: 1.6-5.8) and risk category 5 (odds ratios, 5.1; 95% confidence intervals: 2.1-12.3) were significant risk predictors for any complication. In spite of a high rate of interventions, the complication rates in this study were similar to older studies, but diverging methods and terminology limit the comparability. We strongly suggest general use of the proposed IPCCC classification system for registration and reports of complications for paediatric cardiac catheterisations.
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10
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Stefanescu Schmidt AC, Armstrong A, Kennedy KF, Nykanen D, Aboulhosn J, Bhatt AB. Prediction of adverse events after catheter-based procedures in adolescents and adults with congenital heart disease in the IMPACT registry. Eur Heart J 2017; 38:2070-2077. [PMID: 28430913 PMCID: PMC5837532 DOI: 10.1093/eurheartj/ehx200] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/23/2017] [Accepted: 04/05/2017] [Indexed: 12/17/2022] Open
Abstract
AIMS We sought to identify factors associated with major adverse events (MAE) after cardiac catheterization in adolescents and adults with congenital heart disease (CHD), and create the first model to individualize risk discussions in this growing population. METHODS AND RESULTS Improving Pediatric and Adult Congenital Treatment (IMPACT), a National Cardiovascular Data Registry, contains congenital catheterization data from over 87 hospitals in the United States. Demographics, pre-procedure, and procedural variables were collected for patients over age 10. Multivariable logistic regression was used to identify significant predictors of MAE, a composite of death, urgent surgery or procedure due to a catheterization complication, transfusion, embolic stroke, tamponade, extracorporeal membrane oxygenation or ventricular assist device placement, and device embolization, malposition or thrombosis requiring surgical intervention. A risk score was built based on the effect sizes of each predictor and validated in a split sample. A MAE occurred in 686 (2.5%) of the 27 293 index procedures meeting inclusion criteria. The independent multivariate predictors of MAE were older age, pre-procedural anticoagulation use, renal disease, lower haemoglobin, lower oxygen saturation, non-elective procedure, higher index procedure risk and having had no prior cardiac procedures. Being underweight or overweight had borderline significance and was added to the model. The C-statistic for the model was robust at 0.787 in the derivation and 0.773 in the validation cohort. CONCLUSION The factors predicting adverse events after cardiac catheterization in adolescents and adults with CHD are different than in the general population. Validation of this model in other national or multi-institutional datasets is the next step.
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Affiliation(s)
| | - Aimee Armstrong
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Kevin F. Kennedy
- Saint Luke's Hospital, 4401 Wornall Road, Kansas City, MO 64111, USA
| | - David Nykanen
- Heart Center, Arnold Palmer Hospital for Children, 1222 South Orange Avenue, Orlando, FL 32806, USA
| | - Jamil Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, 100 Medical Plaza, Los Angeles, CA 90095, USA
| | - Ami B. Bhatt
- Heart Center, Massachusetts General Hospital, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, USA
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Moustafa GA, Kolokythas A, Charitakis K, Avgerinos DV. Therapeutic Utilities of Pediatric Cardiac Catheterization. Curr Cardiol Rev 2016; 12:258-269. [PMID: 26926291 PMCID: PMC5304250 DOI: 10.2174/1573403x12666160301121253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 12/17/2015] [Accepted: 12/27/2015] [Indexed: 11/29/2022] Open
Abstract
In an era when less invasive techniques are favored, therapeutic cardiac catheterization constantly evolves and widens its spectrum of usage in the pediatric population. The advent of sophisticated devices and well-designed equipment has made the management of many congenital cardiac lesions more efficient and safer, while providing more comfort to the patient. Nowadays, a large variety of heart diseases are managed with transcatheter techniques, such as patent foramen ovale, atrial and ventricular septal defects, valve stenosis, patent ductus arteriosus, aortic coarctation, pulmonary artery and vein stenosis and arteriovenous malformations. Moreover, hybrid procedures and catheter ablation have opened new paths in the treatment of complex cardiac lesions and arrhythmias, respectively. In this article, the main therapeutic utilities of cardiac catheterization in children are discussed.
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Affiliation(s)
| | | | | | - Dimitrios V Avgerinos
- Department of Cardiothoracic Surgery, Athens Medical Center & Center for Percutaneous Valves and Aortic Diseases, 5-7 Distomou Street, 15125, Marousi, Attica, Greece.
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12
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Fuchigami T, Nagata N, Nishioka M, Akashige T, Higa S, Nakayashiro M, Nabeshima T, Takahashi K. Partial Anomalous Pulmonary Venous Connection With Left Atrial Drainage of the Superior Vena Cava. Circ J 2016; 80:2050-2. [PMID: 27452201 DOI: 10.1253/circj.cj-16-0376] [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)
- Tai Fuchigami
- Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center
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13
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Liu Y, Li J, Zhao H, Jia Y, Ren J, Xu J, Hao Y, Zheng M. Image quality and radiation dose of dual-source CT cardiac angiography using prospective ECG-triggering technique in pediatric patients with congenital heart disease. J Cardiothorac Surg 2016; 11:47. [PMID: 27059600 PMCID: PMC4826524 DOI: 10.1186/s13019-016-0460-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 04/05/2016] [Indexed: 11/30/2022] Open
Abstract
Background All studies involving use of ionizing radiation should be performed in accordance with the ALARA (As Low As Reasonably Achievable) principle, especially in children. In this study, the prospective ECG triggering technique with low voltage was used in dual-source computed tomography (DSCT) angiography to investigate if image quality with low radiation dose could be satisfactory in pediatric patients with congenital heart disease. Methods Sixty pediatric patients with suspected congenital cardiovascular anomalies were enrolled prospectively in the study. They were randomly assigned to two groups for DSCT angiography. Group A were scanned by prospective ECG-triggering computed tomography angiography (CTA) with 80 kV tube voltage, while group B by used non-ECG-gated CTA with the same tube voltage. The anomaly accuracy was evaluated based on the surgical and/or conventional cardiac angiography findings. The overall image quality was assessed on a five-point scale. And the diagnostic accuracy and radiation dose was evaluated in both groups. Results There were 127 cardiovascular anomalies in Group A and 108 in Group B. The mean subjective image quality and diagnostic accuracy between these two groups were significantly different (P = 0.007 and 0.011, respectively). The mean effective dose in Group A and Group B was 0.38 ± 0.13 mSv and 0.35 ± 0.17 mSv, respectively. But there was no significant difference between two groups (P = 0.197). Conclusions The prospective ECG triggering technique in DSCT scan can offer better image quality and diagnostic accuracy with low radiation exposure in pediatric patients with congenital heart diseases. This technique has potential to become a new clinical routine in pediatric cardiac computed tomography (CT) imaging.
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Affiliation(s)
- Ying Liu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 169 West Changle Road, Xi'an, 710032, China
| | - Jian Li
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 169 West Changle Road, Xi'an, 710032, China
| | - Hongliang Zhao
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 169 West Changle Road, Xi'an, 710032, China
| | - Yan Jia
- Siemens China Ltd., Shang Hai, China
| | - Jing Ren
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 169 West Changle Road, Xi'an, 710032, China
| | - Jian Xu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 169 West Changle Road, Xi'an, 710032, China
| | - Yuewen Hao
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 169 West Changle Road, Xi'an, 710032, China
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 169 West Changle Road, Xi'an, 710032, China.
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14
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Zhang Y, Zhang ZW, Xie YM, Wang SS, Qiu QH, Zhou YL, Zeng GH. Toxicity of nickel ions and comprehensive analysis of nickel ion-associated gene expression profiles in THP-1 cells. Mol Med Rep 2015; 12:3273-3278. [PMID: 26044615 PMCID: PMC4526064 DOI: 10.3892/mmr.2015.3878] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 04/08/2015] [Indexed: 12/27/2022] Open
Abstract
The aim of the present study was to explore the toxic effects and underlying mechanisms of nickel ions during therapeutic nickel‑based alloy‑treatment in congenital heart disease by investigating the metal‑induced cytotoxicity to the human monocyte‑derived macrophage cell line THP‑1. THP‑1 cells were treated with NiCl2·6H2O (25, 50, 100, 200, 400 and 800 µM) for 24, 48 and 72 h, respectively. MTT was applied to detect THP‑1 cell proliferation following NiCl2 treatment. Apoptosis of THP‑1 cells was quantified using flow cytometry. Illumina sequencing was used for screening the associated genes, whose mRNA expression levels were further confirmed by quantitative real‑time polymerase chain reaction. High concentrations of nickel ions had a significant suppressive effect on cell proliferation at the three concentrations investigated (200, 400 and 800 µM). Treatment with nickel ions (25‑400 µM) for 48 h reduced cell viability in a dose‑dependent manner. The mRNA expression levels of RELB, FIGF, SPI‑1, CXCL16 and CRLF2 were significantly increased following nickel treatment. The results of the present study suggested that nickel ions exert toxic effects on THP‑1 cell growth, which may indicate toxicity of the nickel ion during treatment of congenital heart disease. The identification of genes modified by the toxic effects of nickel on THP‑1 cells (EPOR, RELB, FIGF, SPI‑1, TGF‑β1, CXCL16 and CRLF2) may aid in the development of interventional measures for the treatment/prevention of nickel ion‑associated toxic effects during the treatment of congenital heart disease.
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Affiliation(s)
- Ying Zhang
- Department of Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510180, P.R. China
| | - Zhi-Wei Zhang
- Department of Pediatric Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510180, P.R. China
| | - Yu-Mei Xie
- Department of Pediatric Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510180, P.R. China
| | - Shu-Shui Wang
- Department of Pediatric Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510180, P.R. China
| | - Qing-Huan Qiu
- Department of Pediatric Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510180, P.R. China
| | - Ying-Ling Zhou
- Department of Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510180, P.R. China
| | - Guo-Hong Zeng
- Department of Pediatric Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510180, P.R. China
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15
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Maxwell BG, Steppan J, Cheng A. Complications of Catheter-Based Electrophysiology Procedures in Adults With Congenital Heart Disease: A National Analysis. J Cardiothorac Vasc Anesth 2015; 29:258-64. [DOI: 10.1053/j.jvca.2014.05.016] [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] [Received: 05/06/2014] [Indexed: 11/11/2022]
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16
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Association of a unique form of cor triatriatum with tetralogy of Fallot. Heart Vessels 2015; 31:628-30. [PMID: 25673496 DOI: 10.1007/s00380-015-0638-4] [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: 07/17/2014] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
Abstract
Cor triatriatum is a rare cardiac anomaly sometimes associated with tetralogy of Fallot (TOF) and persistent left superior vena cava (PLSVC). We present the case of a 2-year-old girl who was diagnosed with a unique form of cor triatriatum that was associated with TOF and PLSVC. In this case, the abnormal membrane that arose from the posterior wall of the left atrium encircled the left superior vena cava (LSVC) in the left atrial cavity. Here, we discuss this rare case as well as the imaging studies and surgical strategy adopted.
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17
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Tsukui H, Iwasa S, Yamazaki K. Left atrial dissection related to retrograde cardioplegia cannula insertion. Heart Vessels 2015; 31:819-21. [DOI: 10.1007/s00380-015-0634-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/16/2015] [Indexed: 11/28/2022]
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18
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Yoshimoto H, Suda K, Kishimoto S, Kudo Y. Intra-cardiac echocardiography-guided stent implantation into stenosed superior vena cava in a patient with a history of contrast anaphylaxis. Heart Vessels 2015; 31:631-4. [PMID: 25605657 DOI: 10.1007/s00380-015-0631-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/09/2015] [Indexed: 11/26/2022]
Abstract
A 37-year-old patient, who suffered from a repeated superior vena cava (SVC) syndrome, was scheduled for stent implantation into SVC, but suffered from contrast anaphylaxis. To monitor the procedure, we used intra-cardiac echocardiography and successfully implanted a stent. Placing an intra-cardiac echocardiographic catheter in the main pulmonary artery and facing towards the right, we could readily visualize stenosis in the SVC and inflation of the stent. Also looking up from right atrium, we noted proximal obstruction of the stent and confirmed the relief of obstruction after additional balloon dilation. This report leads to new application of intra-cardiac echocardiography for intervention of structural and vascular diseases other than inter-atrial septum.
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Affiliation(s)
- Hironaga Yoshimoto
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Asahi-Machi 67, Kurume, 830-0011, Japan
| | - Kenji Suda
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Asahi-Machi 67, Kurume, 830-0011, Japan.
| | - Shintaro Kishimoto
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Asahi-Machi 67, Kurume, 830-0011, Japan
| | - Yoshiyuki Kudo
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Asahi-Machi 67, Kurume, 830-0011, Japan
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19
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Phrenic nerve protection via packing of gauze into the pericardial space during ablation of cristal atrial tachycardia in a child. Heart Vessels 2014; 31:438-9. [PMID: 25430418 DOI: 10.1007/s00380-014-0603-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Abstract
The success of catheter ablation of focal atrial tachycardia is limited by possible collateral damage to the phrenic nerve. Protection of the phrenic nerve is required. Here we present a case of a 9-year-old girl having a history of an unsuccessful catheter ablation of a focal atrial tachycardia near the crista terminalis (because of proximity of the phrenic nerve) who underwent a successful ablation by means of a novel technique for phrenic nerve protection: packing of gauze into the pericardial space. This method is a viable approach for patients with a failed endocardial ablation due to the proximity of the phrenic nerve.
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20
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Larsen SH, Emmertsen K, Hjortdal VE, Nielsen-Kudsk JE. Adverse Events in Transcatheter Interventions for Congenital Heart Disease: A Population-based Long-term Study. CONGENIT HEART DIS 2014; 10:153-8. [DOI: 10.1111/chd.12218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Signe Holm Larsen
- Department of Cardiology; Aarhus University Hospital; Aarhus Denmark
- Department of Cardiothoracic Surgery; Aarhus University Hospital; Aarhus Denmark
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21
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Tanidir IC, Ozturk E, Ozyilmaz I, Saygi M, Kiplapinar N, Haydin S, Guzeltas A, Odemis E. Near Infrared Spectroscopy Monitoring in the Pediatric Cardiac Catheterization Laboratory. Artif Organs 2014; 38:838-44. [DOI: 10.1111/aor.12256] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ibrahim Cansaran Tanidir
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Istanbul Turkey
| | - Erkut Ozturk
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Istanbul Turkey
| | - Isa Ozyilmaz
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Istanbul Turkey
| | - Murat Saygi
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Istanbul Turkey
| | - Neslihan Kiplapinar
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Istanbul Turkey
| | - Sertac Haydin
- Department of Pediatric Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Istanbul Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Istanbul Turkey
| | - Ender Odemis
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Istanbul Turkey
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22
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Aneurysmal aorto-left ventricular tunnel causing right ventricular outflow tract obstruction, associated with bicuspid aortic valve. Heart Vessels 2013; 30:140-2. [DOI: 10.1007/s00380-013-0445-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/08/2013] [Indexed: 10/26/2022]
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