1
|
Linnane N, Kenny DP, Hijazi ZM. Congenital heart disease: addressing the need for novel lower-risk percutaneous interventional strategies. Expert Rev Cardiovasc Ther 2023; 21:329-336. [PMID: 37114439 DOI: 10.1080/14779072.2023.2208862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
INTRODUCTION With the advent of improved neonatal care, increasingly vulnerable higher-risk patients with complex congenital heart anomalies are presenting for intervention. This group of patients will always have a higher risk of an adverse event during a procedure but by recognising this risk and with the introduction risk scoring systems and thus the development of novel lower risk procedures, the rate of adverse events can be reduced. AREA COVERED This article reviews risk scoring systems for congenital catheterization and demonstrates how they can be used to reduce the rate of adverse events. Then novel low risk strategies are discussed for low weight infants e.g. patent ductus arteriosus (PDA) stent insertion; premature infants e.g. PDA device closure; and transcatheter pulmonary valve replacement. Finally, how risk is assessed and managed within the inherent bias of an institution is discussed. EXPERT OPINION There has been a remarkable improvement in the rate of adverse events in congenital cardiac interventions but now, as the benchmark of mortality rate is switched to morbidity and quality of life, continued innovation into lower risk strategies and understanding inherent bias when assessing risk will be key to continuing this improvement.
Collapse
Affiliation(s)
- N Linnane
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - D P Kenny
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
- Royal College of Surgeons, Dublin, Ireland
| | - Z M Hijazi
- Department of Cardiovascular Diseases, Sidra Medicine, Doha, Qatar
- Weill Cornell Medicine, New York, NY, USA
- Jordan University, Amman, Jordan
| |
Collapse
|
2
|
Zareef R, Hassan SA, Younis N, Tannoury T, Rassi IE, Bitar F, Arabi M. Pulmonary artery debanding in the cath lab: Lessons learned! Front Cardiovasc Med 2022; 9:950123. [PMID: 36588562 PMCID: PMC9797720 DOI: 10.3389/fcvm.2022.950123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Background Although primary definitive repair of congenital heart disease has become the preferred management approach, pulmonary artery banding (PAB) remains a valuable palliative procedure used to restrict pulmonary blood flow in certain conditions. However, when the band is to be removed, another surgical intervention is usually required. Methods To describe percutaneous removal of pulmonary artery band, the medical records of patients who underwent this procedure were reviewed. Results Between 2000 and 2020, 143 patients underwent PAB. Of these, we attempted balloon debanding of the pulmonary artery in four patients. At the time of the procedure, the average age of patients was 36 ± 6.24 months, and their average weight was 12.37 kg. Band removal via catheter was successful in three cases and was associated with an adequate reduction in pressure gradient across the pulmonary artery band site (average of 71.67 ± 12.58 to 23.67 ± 2.89 mm Hg). None of the patients experienced complications during or after the procedure. Follow-up data after discharge (3-10 years) provides reassuring and satisfactory results. Conclusion Based on our findings, we suggest that percutaneous removal of the pulmonary artery band might be a safe and effective alternative to surgical debanding. However, studies with a larger sample are required for further clinical implementation of the technique.
Collapse
Affiliation(s)
- Rana Zareef
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sally Al Hassan
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nour Younis
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Theresia Tannoury
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon,Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Issam El Rassi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon,Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon,Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon,Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon,*Correspondence: Mariam Arabi, ; orcid.org/0000-0001-6895-1580
| |
Collapse
|
3
|
Ligon RA, Latson LA, Ruzmetov MM, Chan KC, Turner II, Scholl FG, Bibevski S. Dilatable Pulmonary Artery Banding Palliation in Congenital Heart Disease. World J Pediatr Congenit Heart Surg 2021; 12:213-219. [PMID: 33684011 DOI: 10.1177/2150135120975763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Surgical pulmonary artery banding (PAB) has been limited in practice because of later requirement for surgical removal or adjustment. The aim of this study is to describe our experience creating a dilatable PAB via transcatheter balloon dilation (TCBD) in congenital heart disease (CHD) patients. METHODS Retrospective chart review of adjustable PAB-outline anatomical variants palliated and patient outcomes. RESULTS Sixteen patients underwent dilatable PAB-median age 52 days (range 4-215) and weight 3.12 kg (1.65-5.8). Seven (44%) of the patients were premature, 11 (69%) had ventricular septal defect(s) with pulmonary over-circulation, four (25%) atrioventricular septal defects, and four (25%) single ventricle physiology. Subsequent to the index procedure: five patients have undergone intracardiac complete repair, six patients remain well palliated with no additional intervention, and four single ventricles await their next palliation. One patient died from necrotizing enterocolitis (unrelated to PAB) and one patient required a pericardiocentesis postoperatively. Five patients underwent TCBD of the PAB without complication-Two had one TCBD, two had two TCBD, and another had three TCBD. The median change in saturation was 14% (complete range 6-22) and PAB diameter 1.7 mm (complete range 1.1-5.2). Median time from PAB to most recent outpatient follow-up was 868 days (interquartile range 190-1,079). CONCLUSIONS Our institution has standardized a PAB technique that allows for transcatheter incremental increases in pulmonary blood flow over time. This methodology has proven safe and effective enough to supplant other institutional techniques of limiting pulmonary blood flow in most patients-allowing for interval growth or even serving as the definitive palliation.
Collapse
Affiliation(s)
- R Allen Ligon
- Divisions of Pediatric Cardiology, The Pediatric Heart Institute, 23454Joe DiMaggio Children's Hospital, Hollywood, Florida, FL, USA
| | - Larry A Latson
- Divisions of Pediatric Cardiology, The Pediatric Heart Institute, 23454Joe DiMaggio Children's Hospital, Hollywood, Florida, FL, USA
| | - Mark M Ruzmetov
- Pediatric Cardiothoracic Surgery, The Pediatric Heart Institute, 23454Joe DiMaggio Children's Hospital, Hollywood, Florida, FL, USA
| | - Kak-Chen Chan
- Divisions of Pediatric Cardiology, The Pediatric Heart Institute, 23454Joe DiMaggio Children's Hospital, Hollywood, Florida, FL, USA
| | - Immanuel I Turner
- Pediatric Cardiothoracic Surgery, The Pediatric Heart Institute, 23454Joe DiMaggio Children's Hospital, Hollywood, Florida, FL, USA
| | - Frank G Scholl
- Pediatric Cardiothoracic Surgery, The Pediatric Heart Institute, 23454Joe DiMaggio Children's Hospital, Hollywood, Florida, FL, USA
| | - Steve Bibevski
- Pediatric Cardiothoracic Surgery, The Pediatric Heart Institute, 23454Joe DiMaggio Children's Hospital, Hollywood, Florida, FL, USA
| |
Collapse
|
4
|
Tomita H, Fujii T, Kise H, Oyama N, Shimizu T, Nagaoka K, Tarui S, Miyahara Y, Ishino K. Percutaneous pulmonary artery debanding. J Cardiol 2020; 77:307-312. [PMID: 33279375 DOI: 10.1016/j.jjcc.2020.10.021] [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: 06/03/2020] [Revised: 08/27/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a paucity of data on palliative or total percutaneous pulmonary artery debanding (p-debanding), particularly with use of a stent. METHODS Twelve p-debandings in eight patients were included in this study. Age at pulmonary artery banding (PAB) ranged from 3 days to 1 year (median, 13 days), while p-debanding was performed at 2-157 (7) months. The body weight at the p-debanding ranged from 3.2 to 22.2 (7.3) kg. We chose the balloon diameter of 30-50% to the circumference of the band for palliative, and larger than 50% for total p-debanding, respectively. In either way, the balloon diameter did not exceed 1.5 times the reference vessel diameter. Stent was implanted for palliative p-debanding in 2 patients. RESULTS 1. The circumference of the band ranged from 16 to 23 (20) mm, while the balloon diameter ranged from 20-60 (40)% to that, where larger than 50% was used for 2 procedures intended total p-debanding. 2. PAB diameter increased from 2.5-4.7 (3.0) mm to 2.8-9.5 (4.5) mm (p<0.01), however, there was no significant change in the diameter in 2 procedures. In one patient, p-debanding was the definitive treatment associated with spontaneous near closure of muscular ventricular septal defect, in another patient of congenitally corrected transposition of the great arteries, severely depressed left ventricular ejection fraction was recovered following p-debanding. 3. Arterial oxygen saturation (SaO2) increased from 64-97 (80)% to 66-95 (90)% (p<0.01), while in 10 procedures of 6 patients where the indication of p-debanding was hypoxia, SaO2 increased in 8 procedures. There was no significant pulmonary hypertension following p-debanding. CONCLUSION Palliative or total p-debanding using balloon and/or stenting is generally feasible and effective. A balloon diameter 35-50% to the band circumference in palliative, and more than 50% in total p-debanding, while in either way less than 1.5 times the reference vessel diameter, is safe.
Collapse
Affiliation(s)
- Hideshi Tomita
- Pediatric Heart Disease & Adult Congenital Heart Disease Center, Showa University, Tokyo, Japan.
| | - Takanari Fujii
- Pediatric Heart Disease & Adult Congenital Heart Disease Center, Showa University, Tokyo, Japan
| | - Hiroaki Kise
- Pediatric Heart Disease & Adult Congenital Heart Disease Center, Showa University, Tokyo, Japan
| | - Nobuo Oyama
- Pediatric Heart Disease & Adult Congenital Heart Disease Center, Showa University, Tokyo, Japan
| | - Takeshi Shimizu
- Pediatric Heart Disease & Adult Congenital Heart Disease Center, Showa University, Tokyo, Japan
| | - Kota Nagaoka
- Pediatric Heart Disease & Adult Congenital Heart Disease Center, Showa University, Tokyo, Japan
| | - Suguru Tarui
- Pediatric Heart Disease & Adult Congenital Heart Disease Center, Showa University, Tokyo, Japan
| | - Yoshinori Miyahara
- Pediatric Heart Disease & Adult Congenital Heart Disease Center, Showa University, Tokyo, Japan
| | - Kozo Ishino
- Pediatric Heart Disease & Adult Congenital Heart Disease Center, Showa University, Tokyo, Japan
| |
Collapse
|
5
|
Terazawa A, Fujii T, Sasaki T, Asada D, Tarui S, Miyahara Y, Ishino K, Soga T, Tomita H. Percutaneous pulmonary debanding for an infant complicated by spontaneously closing muscular ventricular septal defect: A case report and in vitro study. J Cardiol Cases 2017; 17:16-20. [PMID: 30279845 DOI: 10.1016/j.jccase.2017.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 07/22/2017] [Accepted: 08/16/2017] [Indexed: 11/29/2022] Open
Abstract
Pulmonary artery banding (PAB) is a standard operation for various congenital heart defects complicated by pulmonary hypertension (PH) and judged unsuitable for primary intracardiac repair. We report successful percutaneous pulmonary artery debanding in a baby complicated by muscular ventricular septal defect (VSD), that was initially large and multiple, but closed spontaneously later. The 5-month-old boy was referred to our hospital on day 3, diagnosed as having aortic coarctation (CoA), with multiple muscular VSDs and severe PH. On day 6, he underwent CoA repair and PAB using expanded polytetrafluoroethylene (ePTFE), while the muscular VSDs were left open. We planned percutaneous pulmonary debanding at the age of 5 months, as the muscular VSDs had become small. After dilation with a Mustang® (Boston Scientific, Marlborough, Massachusetts, United State) balloon (12 mm diameter) there was a persistent waist indicating a residual narrowing. Use of an extra-high pressure balloon, Conquest® (Medicon, Osaka, Japan) balloon of the same size, completely eliminated the waist. In in vitro experiments, the Mustang® partially tore the ePTFE, while a Conquest® of the same diameter completely opened the band. The mechanism of debanding was tearing of the ePTFE by the knot of the suture thread. Percutaneous pulmonary debanding to avoid unnecessary surgery is feasible in such a patient if the VSD becomes small. <Learning objective: Use of an extra-high pressure balloon, Conquest® (Medicon, Osaka, Japan) balloon could open the pulmonary artery banding made of expanded polytetrafluoroethylene (ePTFE). The mechanism of debanding was tearing of the ePTFE by the knot of the suture thread. Percutaneous pulmonary debanding to avoid unnecessary surgery is feasible in such a patient if the ventricular septal defect (VSD) becomes small.>.
Collapse
Affiliation(s)
- Atsushi Terazawa
- Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Takanari Fujii
- Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Takeshi Sasaki
- Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Dai Asada
- Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Suguru Tarui
- Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Yoshinori Miyahara
- Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Kozo Ishino
- Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Takashi Soga
- Children's Medical Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Hideshi Tomita
- Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| |
Collapse
|
6
|
Perez M, Kumar TS, Hoskoppal D, Akkhawattanangkul Y, Allen K, Knott-Craig CJ, Waller BR, Sathanandam S. Acute and long-term effects of endovascular debanding of pulmonary arteries in a swine model. CONGENIT HEART DIS 2017; 12:340-349. [DOI: 10.1111/chd.12449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/04/2016] [Accepted: 01/09/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Michael Perez
- Department of Pediatrics, Division of Pediatric Cardiology; University of Tennessee Health Science Center; Memphis Tennessee USA
| | - Tk Susheel Kumar
- Department of Surgery; University of Tennessee Health Science Center; Memphis Tennessee USA
| | - Deepthi Hoskoppal
- Department of Pathology; University of Tennessee Health Science Center; Memphis Tennessee USA
| | - Yada Akkhawattanangkul
- Department of Veterinary Medicine; University of Tennessee Health Science Center; Memphis Tennessee USA
| | | | | | - Benjamin Rush Waller
- Department of Pediatrics, Division of Pediatric Cardiology; University of Tennessee Health Science Center; Memphis Tennessee USA
| | - Shyam Sathanandam
- Department of Pediatrics, Division of Pediatric Cardiology; University of Tennessee Health Science Center; Memphis Tennessee USA
| |
Collapse
|
7
|
Hoshino S, Kitano M, Abe T, Yazaki S, Kagisaki K. Efficacy and safety of percutaneous transluminal balloon dilation to prevent progression of banding site stenosis after bilateral pulmonary artery banding. Catheter Cardiovasc Interv 2015; 85:E197-202. [DOI: 10.1002/ccd.25868] [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: 11/05/2014] [Accepted: 01/25/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Shinsuke Hoshino
- Department of Pediatric Cardiology; National Cerebral and Cardiovascular Center; Osaka Japan
| | - Masataka Kitano
- Department of Pediatric Cardiology; National Cerebral and Cardiovascular Center; Osaka Japan
| | - Tadaaki Abe
- Department of Pediatric Cardiology; National Cerebral and Cardiovascular Center; Osaka Japan
| | - Satoshi Yazaki
- Department of Pediatric Cardiology; National Cerebral and Cardiovascular Center; Osaka Japan
| | - Koji Kagisaki
- Department of Cardiovascular Surgery; National Cerebral and Cardiovascular Center; Osaka Japan
| |
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW Pediatric interventional cardiology has evolved quite dramatically over the past few decades and now, in 2009, the published literature continues to evolve new percutaneous strategies for managing patients with congenital heart disease, both simple and complex. Our goal for this review was to highlight new techniques and the new devices available to the pediatric interventional cardiologist, and to review the outcomes from past endeavors. RECENT FINDINGS Manuscripts published in the past year continue to demonstrate innovation; indicating an exciting and increasing experience of transcatheter treatment of septal communications using either new occluder devices or novel techniques. Bioabsorbable devices and percutaneously implanted valves are leading examples of technological improvements and creativity that will ultimately improve patient outcomes while minimizing invasiveness. Reports on procedural outcomes show technically safe early follow-up, with promising mid-term and long-term results for balloon valvuloplasty, balloon atrial septostomy and pulmonary artery stent implantation. As well, fetal and hybrid interventions have become important new arenas for the pediatric interventionist. SUMMARY Pediatric interventions have grown far beyond the early stages of the 1980s as mid-term and long-term outcome data are being reported, and many previously insurmountable hurdles have been overcome by developing new strategies and devices.
Collapse
|