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Weeda JA, Bokenkamp-Gramann R, Straver BB, Rammeloo L, Hahurij ND, Bertels RA, Haak MC, Te Pas AB, Hazekamp MG, Blom NA, van der Palen RLF. Balloon atrial septostomy for transposition of the great arteries: Safety and experience with the Z-5 balloon catheter. Catheter Cardiovasc Interv 2024; 103:308-316. [PMID: 38091308 DOI: 10.1002/ccd.30932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/23/2023] [Accepted: 12/03/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Balloon atrial septostomy (BAS) is an emergent and essential cardiac intervention to enhance intercirculatory mixing at atrial level in deoxygenated patients diagnosed with transposition of the great arteries (TGA) and restrictive foramen ovale. The recent recall of several BAS catheters and the changes in the European legal framework for medical devices (MDR 2017/745), has led to an overall scarcity of BAS catheters and raised questions about the use, safety, and experience of the remaining NuMED Z-5 BAS catheter. AIMS To evaluate and describe the practice and safety of the Z-5 BAS catheter, and to compare it to the performance of other BAS catheters. METHODS A retrospective single-center cohort encompassing all BAS procedures performed with the Z-5 BAS catheter in TGA patients between 1999 and 2022. RESULTS A total of 182 BAS procedures were performed in 179 TGA-newborns at Day 1 (IQR 0-5) days after birth, with median weight of 3.4 (IQR 1.2-5.7) kg. The need for BAS was urgent in 90% of patients. The percentage of BAS procedures performed at bedside increased over time from 9.8% (before 2010) to 67% (2017-2022). Major complication rate was 2.2%, consisting of cerebral infarction (1.6%) and hypovolemic shock (0.5%). The rate of minor complications was 9.3%, including temporary periprocedural AV-block (3.8%), femoral vein thrombosis (2.7%), transient intracardiac thrombus (0.5%), and atrial flutter (2.2%). BAS procedures performed at bedside and in the cardiac catheterization laboratory had similar complication rates. CONCLUSIONS BAS using the Z-5 BAS catheter is both feasible and safe at bedside and at the cardiac catheterization laboratory with minimal major complications.
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Affiliation(s)
- Jesse A Weeda
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Department of Pediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
| | - Regina Bokenkamp-Gramann
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
| | - Bart B Straver
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
- Department of Pediatrics, Division of Pediatric Cardiology, Emma Children's Hospital, Amsterdam University Medical Center (Amsterdam UMC), Amsterdam, The Netherlands
| | - Lukas Rammeloo
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
- Department of Pediatrics, Division of Pediatric Cardiology, Emma Children's Hospital, Amsterdam University Medical Center (Amsterdam UMC), Amsterdam, The Netherlands
| | - Nathan D Hahurij
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
| | - Robin A Bertels
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
| | - Monique C Haak
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Arjan B Te Pas
- Department of Pediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Mark G Hazekamp
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Nico A Blom
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
| | - Roel L F van der Palen
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JACC Cardiovasc Interv 2024; 17:115-216. [PMID: 38099915 DOI: 10.1016/j.jcin.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California.
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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3
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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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4
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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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No difference found in safety or efficacy of balloon atrial septostomy performed at the bedside versus the catheterisation laboratory. Cardiol Young 2018; 28:1421-1425. [PMID: 30152306 DOI: 10.1017/s1047951118001439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Balloon atrial septostomy is performed in infants with dextro-transposition of the great arteries to improve oxygenation before surgery. It is performed in the catheterisation laboratory with fluoroscopy or at the bedside using echocardiography. It is unclear whether procedural safety and efficacy is superior in one location versus the other, although the bedside procedure may improve resource utilisation and present an opportunity for reducing cost. This study compares safety and efficacy of atrial septostomy performed at the patient's bedside versus the catheterisation laboratory. METHODS Neonates with dextro-transposition of the great arteries who underwent balloon atrial septostomy from October, 2000 to January, 2014 were included. Medical and procedural records, echocardiograms, and catheterisation data were reviewed. Comparisons between the two procedural locations included patient demographics, pre- and post-procedure oxygen saturations, and outcomes. Complications reviewed included bleeding, arrhythmia, cardiac trauma, stroke, and death. Coronary artery evaluations were recorded. T-tests were used for continuous variables, and Fisher's exact tests were used for all categorical variables. Wilcoxon rank sum and analysis of covariance modelling were used for time variables and oxygen saturation, respectively. RESULTS A total of 88 infants met the inclusion criteria. Among them, 53 underwent septostomy at the bedside and 35 underwent septostomy in the catheterisation laboratory. No safety or outcome benefit was identified between the two procedural locations. CONCLUSION Septostomy performed at the bedside and in the catheterisation laboratory had similar outcomes and efficacy. Further, bedside septostomy has the advantage of no radiation exposure, and obviating risks with patient transfer from the ICU to the catheterisation laboratory.
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Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum. Cardiol Young 2017; 27:530-569. [PMID: 28249633 DOI: 10.1017/s1047951117000014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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7
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Sarris GE, Balmer C, Bonou P, Comas JV, da Cruz E, Chiara LD, Di Donato RM, Fragata J, Jokinen TE, Kirvassilis G, Lytrivi I, Milojevic M, Sharland G, Siepe M, Stein J, Büchel EV, Vouhé PR. Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum. Eur J Cardiothorac Surg 2017; 51:e1-e32. [DOI: 10.1093/ejcts/ezw360] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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8
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Transcatheter Echocardiographic-Guided Closure of Patent Ductus Arteriosus in Extremely Premature Newborns. JACC Cardiovasc Interv 2016; 9:2438-2439. [DOI: 10.1016/j.jcin.2016.09.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 09/29/2016] [Indexed: 11/21/2022]
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9
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Krasemann T, Morgan GJ. Catheter interventions for congenital heart disease with less and less radiation. Interv Cardiol 2013. [DOI: 10.2217/ica.13.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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10
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Schranz D, Michel-Behnke I. Advances in interventional and hybrid therapy in neonatal congenital heart disease. Semin Fetal Neonatal Med 2013; 18:311-21. [PMID: 23759171 DOI: 10.1016/j.siny.2013.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In addition to the considerable surgical advances in treating congenital heart diseases, hybrid and transcatheter therapies have become a cornerstone of neonatal cardiology within the last decade. Approaches to the care of cyanotic newborns with congenital heart disease focused on manipulations of the inter-atrial septum, right ventricular outflow tract obstructions, and on the arterial duct as the source for pulmonary blood flow. Currently, fewer interventional procedures are used in newborns and small infants to treat excessive pulmonary blood flow caused by shunt lesions, but transcatheter techniques and hybrid strategies have been developed to treat newborns suffering from inadequate systemic perfusion. However, transcatheter techniques are still not available to treat failing systemic ventricles without obvious structural disorders of the myocardium or dilated cardiomyopathies in newborns and infancy, despite new surgical-interventional strategies are already developed to avoid or to delay early heart transplantation. In conclusion, material and technical improvements have enabled transcatheter techniques to replace medical-based therapies to solve structurally dependent cardiovascular diseases. However, evidence-based and long-term follow-up data are required.
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Affiliation(s)
- Dietmar Schranz
- Department of Pediatric Cardiology, Pediatric Heart Center, Justus-Liebig-University Giessen, Germany.
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11
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Intensive care management of neonates with d-transposition of the great arteries and common arterial trunk. Cardiol Young 2012; 22:755-60. [PMID: 23331599 DOI: 10.1017/s1047951112001965] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although mortality rates for patients with d-transposition of the great arteries remain quite low, these patients have a unique circulation that requires careful management in the peri-operative period. Despite the improved mortality for patients with common arterial trunk, the course in the intensive care unit is remarkable for significant morbidity and utilisation of significant resources. Pre-operative patient management focuses on balancing competing circulations, pulmonary and systemic, which exist in parallel rather than in series, as in the normal circulation. Post-operative patient management in both lesions focuses on optimising systemic output, respiratory status, and mitigating the effects of cardiopulmonary bypass. In this article, we review pre- and post-operative intensive care management in neonates with d-transposition of the great arteries and common arterial trunk.
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12
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Matter M, Almarsafawy H, Hafez M, Attia G, Elkhier MMA. Balloon atrial septostomy: The oldest cardiac interventional procedure in Mansoura. Egypt Heart J 2011. [DOI: 10.1016/j.ehj.2011.08.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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14
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Danon S, Levi DS, Alejos JC, Moore JW. Reliable atrial septostomy by stenting of the atrial septum. Catheter Cardiovasc Interv 2006; 66:408-13. [PMID: 16216026 DOI: 10.1002/ccd.20508] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of this report was to describe our experience with creating an interatrial communication by stenting the interatrial septum. In many forms of congenital heart disease, the presence of an appropriate interatrial shunt is critical. After the first several weeks of life, balloon atrial septostomy is not effective, and success with other methods is limited. Clinical records, echocardiograms, and catheterization data in patients who had an atrial septal stent placed between 2001 and 2004 at UCLA were reviewed. Changes in atrial pressures and systemic saturations were analyzed. Follow-up data and explant pathology were reviewed as available. Thirteen patients had stenting of the atrial septum (four restrictive, nine nonrestrictive). In patients with elevated right and left atrial pressures, there was a mean reduction of 2.4 and 7.4 mm Hg in right atrial and left atrial pressures, respectively. In patients with transposition physiology, there was a mean increase in oxygen saturation of 11.3%. Follow-up echocardiograms revealed patent stents with excellent position relative to the atrial septum. In six cases, the stents were removed during subsequent surgery and appeared endothelialized and patent. Stenting of the atrial septum is safe and effective in selected cases, allowing for a reliable, long-lasting, restrictive or nonrestrictive interatrial communication.
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Affiliation(s)
- Saar Danon
- Division of Pediatric Cardiology, Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Jaquiss RDB, Tweddell JS. The neonate with congenital heart disease: what the cardiac surgeon needs to know from the neonatologist and the cardiologist. Clin Perinatol 2005; 32:947-61, ix. [PMID: 16325671 DOI: 10.1016/j.clp.2005.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To plan and accomplish a successful operation for a neonate with congenital heart disease, the cardiac surgeon requires a complete anatomic description of the cardiovascular malformation. For optimum outcome, this information must be supplemented by a complete report of the prenatal and postnatal course of the newborn as well as by a thorough summary of any noncardiac congenital or acquired abnormalities. In the most favorable circumstance, the neonate arrives in the operating room completely diagnosed, fully resuscitated, well nourished, and with appropriate monitoring devices in place. Unique perioperative considerations attach to each cardiac anomaly and are briefly reviewed, and the importance of continuity of care for the patient and family is emphasized.
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Affiliation(s)
- Robert D B Jaquiss
- Medical College of Wisconsin, 9000 West Wisconsin Avenue, MS 715, Milwaukee, WI 53221, USA.
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Abstract
As a result of recent technological advances, more types of congenital heart disease are amenable to treatment in the cardiac catheter laboratory than ever before.1 Improved imaging techniques allow for better selection of patients, and the development of a wide range of devices specifically for use in children means that many patients can avoid surgery altogether, while those with complex congenital heart disease may require fewer or less complex surgical procedures.2 This allows for a quicker recovery and a shorter hospital stay, and gives many patients an improved quality of life in the short to medium term. However, the long term outcome for many of the newer forms of intervention is still unknown.
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Affiliation(s)
- R E Andrews
- Department of Congenital Heart Disease, Guy's and St Thomas' NHS Trust, Guy's Hospital, St Thomas' Street, London SE1 9RT, UK.
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