1
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Stanley HM, Callahan R. Novel application of the Diabolo technique to restrict pulmonary blood flow in a single ventricle patient with a right ventricle to pulmonary artery conduit. Catheter Cardiovasc Interv 2024; 103:736-740. [PMID: 38488184 DOI: 10.1002/ccd.31008] [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: 12/01/2023] [Revised: 02/10/2024] [Accepted: 03/01/2024] [Indexed: 04/14/2024]
Abstract
Balancing pulmonary and systemic circulations in single ventricle patients with a conduit after Stage 1 palliation is challenging. A transcatheter intervention for excessive pulmonary blood flow would provide benefit. We report a case of a critically ill single ventricle patient with symptoms of excessive pulmonary blood flow after Stage 1 despite maximal medical therapy. The patient underwent percutaneous intraluminal downsizing of the right ventricle to pulmonary artery conduit using a novel application of the Diabolo-covered stent technique, with subsequent clinical improvement. A second catheterization was performed during the interstage period with successful dilation of the stent to achieve appropriate saturations. The Diabolo technique can be successfully employed in this population to restrict pulmonary blood flow and has the advantage of being adjusted during placement and in subsequent interventions.
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Affiliation(s)
- Helen M Stanley
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ryan Callahan
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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2
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Khan A, Qureshi AM, Bansal M, Stapleton G, Webb MK, Lam W, Eilers L, Singh HR, Gowda ST. Extra-cardiac and complex Fontan baffle fenestration using radio frequency current via surgical electrocautery. Cardiol Young 2023; 33:2621-2627. [PMID: 37092668 DOI: 10.1017/s1047951123000380] [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] [Indexed: 04/25/2023]
Abstract
BACKGROUND Fontan baffle punctures and creation of Fontan fenestration for cardiac catheterisation procedures remain challenging especially due to the heavy calcification of prosthetic material and complex anatomy. OBJECTIVES We sought to evaluate our experience using radiofrequency current via surgical electrocautery needle for Fontan baffle puncture to facilitate diagnostic, electrophysiology, and interventional procedures. METHODS A retrospective chart review of all Fontan patients (pts) who underwent Fontan baffle puncture using radiofrequency energy via surgical electrocautery from three centres were performed from January 2011 to July 2021. RESULTS A total of 19 pts underwent 22 successful Fontan baffle puncture. The median age and weight were 17 (3-36 years) and 55 (14-88) kg, respectively. The procedural indications for Fontan fenestration creation included: diagnostic study (n = 1), atrial septostomy and stenting (n = 1), electrophysiology study and ablation procedures (n = 8), Fontan baffle stenting for Fontan failure including protein-losing enteropathy (n = 7), and occlusion of veno-venous collaterals (n = 2) for cyanosis. The type of Fontan baffles included: extra-cardiac conduits (n = 12), lateral tunnel (n = 5), classic atrio-pulmonary connection (n = 1), and intra-cardiac baffle (n = 1). A Fontan baffle puncture was initially attempted using traditional method in 6 pts and Baylis radiofrequency trans-septal system in 2 pts unsuccessfully. In all pts, Fontan baffle puncture using radiofrequency energy via electrocautery needle was successful. The radiofrequency energy utilised was (10-50 W) and required 1-5 attempts for 2-5 seconds. There were no vascular or neurological complications. CONCLUSIONS Radiofrequency current delivery using surgical electrocautery facilitates Fontan baffle puncture in patients with complex and calcified Fontan baffles for diagnostic, interventional, and electrophysiology procedures.
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Affiliation(s)
- Asra Khan
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Athar M Qureshi
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Manish Bansal
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Gary Stapleton
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Melissa K Webb
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Wilson Lam
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Lindsay Eilers
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Harinder R Singh
- The Children's Hospital of San Antonio, 333 N. Santa Rosa Street, San Antonio, TX 78207, USA
| | - Srinath T Gowda
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
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3
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Mendel B, Kohar K, Amirah S, Vidya AP, Utama KE, Prakoso R, Siagian SN. The outcomes of fetal aortic valvuloplasty in critical aortic stenosis: A systematic review and meta-analysis. Int J Cardiol 2023; 382:106-111. [PMID: 36996909 DOI: 10.1016/j.ijcard.2023.03.050] [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: 12/06/2022] [Revised: 03/08/2023] [Accepted: 03/21/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Critical aortic stenosis that appears in mid-gestation tends to develop to growth retardation of left ventricle, known as hypoplastic left heart syndrome (HLHS). Despite better clinical management of HLHS, the morbidity and mortality rates of univentricular circulation patients remain high. In this paper, we sought to perform a systematic review and meta-analysis to know the outcomes of fetal aortic valvuloplasty in critical aortic stenosis patients. METHODS This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. A systematic search on fetal aortic valvuloplasty procedure for critical aortic stenosis was performed through PubMed, Scopus, EBSCOhost, ProQuest, and Google Scholar. The primary endpoint of each group was overall mortality. We used R software (version 4.1.3) to estimate the overall proportion of each outcome using random-effects model of proportional meta-analysis. RESULTS A total of 389 fetal subjects from 10 cohort studies were included in this systematic review and meta-analysis. Fetal aortic valvuloplasty (FAV) was successfully performed in 84% of patients. It revealed a successful conversion to biventricular circulation rate of 33% with a mortality rate of 20%. Bradycardia and pleural effusion requiring treatment were two most common fetal complications, whereas maternal complication reported was only placental abruption in one patient. CONCLUSIONS FAV has a high technical success rate with the ability to achieve biventricular circulation and a low rate of procedure-related mortality if carried out by experienced operators.
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Affiliation(s)
- Brian Mendel
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia; Department of Cardiology and Vascular Medicine, Sultan Sulaiman Government Hospital, Serdang Bedagai, North Sumatera, Indonesia.
| | - Kelvin Kohar
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Shakira Amirah
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | | | - Radityo Prakoso
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Sisca Natalia Siagian
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
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4
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Barry OM, Bouhout I, Turner ME, Petit CJ, Kalfa DM. Transcatheter Cardiac Interventions in the Newborn: JACC Focus Seminar. J Am Coll Cardiol 2022; 79:2270-2283. [PMID: 35654498 DOI: 10.1016/j.jacc.2022.03.374] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
For neonates with critical congenital heart disease requiring intervention, transcatheter approaches for many conditions have been established over the past decades. These interventions may serve to stabilize or palliate to surgical next steps or effectively primarily treat the condition. Many transcatheter interventions have evidence-based records of effectiveness and safety, which have led to widespread acceptance as first-line therapies. Other techniques continue to innovatively push the envelope and challenge the optimal strategies for high-risk neonates with right ventricular outflow tract obstruction or ductal-dependent pulmonary blood flow. In this review, the most commonly performed neonatal transcatheter interventions will be described to illustrate the current state of the field and highlight areas of future opportunity.
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Affiliation(s)
- Oliver M Barry
- Division of Pediatric Cardiology, NewYork-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA
| | - Ismail Bouhout
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic and Vascular Surgery, NewYork-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA
| | - Mariel E Turner
- Division of Pediatric Cardiology, NewYork-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA
| | - Christopher J Petit
- Division of Pediatric Cardiology, NewYork-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA.
| | - David M Kalfa
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic and Vascular Surgery, NewYork-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA.
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5
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Van Praagh R. Interatrial Communications. CONGENIT HEART DIS 2022. [DOI: 10.1016/b978-1-56053-368-9.00009-3] [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: 11/29/2022]
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6
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Jalal Z, Gewillig M, Boudjemline Y, Guérin P, Pilati M, Butera G, Malekzadeh-Milani S, Avesani M, Thambo JB. Transcatheter interventions in patients with a Fontan circulation: Current practice and future developments. Front Pediatr 2022; 10:965989. [PMID: 36110107 PMCID: PMC9468446 DOI: 10.3389/fped.2022.965989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022] Open
Abstract
The Fontan operation represents the last of multiple steps that are offered a wide range of congenital cardiac lesions with a single ventricle (SV) physiology. Nowadays this surgical program consists of a total cavopulmonary connection (TCPC), by anastomosing systemic veins to the pulmonary arteries (PAs), excluding the right-sided circulation from the heart. As a result of imaging, surgical, percutaneous, and critical care improvements, survival in this population has steadily increased. However, the Fontan physiology chronically increases systemic venous pressure causing systemic venous congestion and decreased cardiac output, exposing patients to the failure of the Fontan circulation (FC), which is associated with a wide variety of clinical complications such as liver disease, cyanosis, thromboembolism, protein-losing enteropathy (PLE), plastic bronchitis (PB), and renal dysfunction, ultimately resulting in an increased risk of exercise intolerance, arrhythmias, and premature death. The pathophysiology of the failing Fontan is complex and multifactorial; i.e., caused by the single ventricle dysfunction (diastolic/systolic failure, arrhythmias, AV valve regurgitation, etc.) or caused by the specific circulation (conduits, pulmonary vessels, etc.). The treatment is still challenging and may include multiple options and tools. Among the possible options, today, interventional catheterization is a reliable option, through which different procedures can target various failing elements of the FC. In this review, we aim to provide an overview of indications, techniques, and results of transcatheter options to treat cavopulmonary stenosis, collaterals, impaired lymphatic drainage, and the management of the fenestration, as well as to explore the recent advancements and clinical applications of transcatheter cavopulmonary connections, percutaneous valvular treatments, and to discuss the future perspectives of percutaneous therapies in the Fontan population.
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Affiliation(s)
- Zakaria Jalal
- University Hospital of Bordeaux - Department of Pediatric and Adult Congenital Cardiology, Pessac, France.,IHU LIRYC Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France
| | - Marc Gewillig
- Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Patrice Guérin
- Interventional Cardiology Unit, Inserm UMR 1229, L'Institut du Thorax, University Hospital of Nantes, Nantes, France
| | - Mara Pilati
- Medical and Surgical Department of Pediatric Cardiology, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Gianfranco Butera
- Medical and Surgical Department of Pediatric Cardiology, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Sophie Malekzadeh-Milani
- Department of Congenital and Pediatric Cardiology, Centre de Reference Malformations Cardiaques Congenitales Complexes-M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Pediatric Cardiology, Paris, France
| | - Martina Avesani
- University Hospital of Bordeaux - Department of Pediatric and Adult Congenital Cardiology, Pessac, France.,IHU LIRYC Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France
| | - Jean-Benoit Thambo
- University Hospital of Bordeaux - Department of Pediatric and Adult Congenital Cardiology, Pessac, France.,IHU LIRYC Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France
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7
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Evolving Paradigms in the Treatment of Atrial Septal Defects With Pulmonary Arterial Hypertension. Cardiol Rev 2020; 29:305-309. [PMID: 32956165 DOI: 10.1097/crd.0000000000000331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Atrial septal defects are one of the most frequently diagnosed congenital heart defects in adulthood. The presence of concurrent moderate or severe pulmonary arterial hypertension without Eisenmenger syndrome at the time of diagnosis can make for a challenging clinical scenario. There is continually evolving literature to determine the ideal approach to this subset of patients. Here we aim to review the clinical presentation, history, medical therapy, and closure options for atrial septal defects-pulmonary arterial hypertension with predominant left-to-right shunting, in the absence of Eisenmenger syndrome.
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8
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Outcomes of Atrioseptostomy with Stenting in Patients with Pulmonary Arterial Hypertension from a Large Single-Institution Cohort. Diagnostics (Basel) 2020; 10:diagnostics10090725. [PMID: 32967148 PMCID: PMC7555652 DOI: 10.3390/diagnostics10090725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 01/30/2023] Open
Abstract
The aim of this study was to analyze results of stenting atrioseptostomy in patients with pulmonary arterial hypertension and a different level of risk for one-year mortality that is not well described. Patients that underwent atrioseptostomy with stenting were retrospectively divided in two groups: "intermediate" (n = 55) or "high" risk (n = 13), according to the 2015 ESC/ESR guideline. Results of atrioseptostomy were assessed during hospital period and at follow-up. Patients from "intermediate" risk group demonstrated lower mortality rate (10/55, vs. 6/13) during the course of the study period, as well as higher freedom from lung transplantation or Potts shunt. At discharge, patients of both groups presented improvement in functional class and mobility. Patients from "intermediate" risk group showed longer 6-min walking distance, and lower levels of brain natriuretic peptide. At the latest follow-up, stable position and full patency of stents with right-to-left or bidirectional shunt at atrial level and absence of syncope was confirmed in patients of both groups. Patients from the "intermediate" risk group demonstrated higher functional class, better performance of walking test, and lower levels of brain natriuretic peptide. Stenting atrioseptostomy reliably secured interatrial communication and improved clinical condition in patients with idiopathic pulmonary arterial hypertension. Mid-term results were better in "intermediate" risk group.
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9
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Maschietto N, Baird C, Porras D. Percutaneous intraluminal downsizing of systemic‐to‐pulmonary artery shunts: a novel application of the Diabolo stent technique—Case series and description of the technique. Catheter Cardiovasc Interv 2019; 95:471-476. [DOI: 10.1002/ccd.28598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 10/27/2019] [Accepted: 11/06/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Nicola Maschietto
- Department of CardiologyBoston Children's Hospital and Harvard Medical School Boston Massachusetts
| | - Christopher Baird
- Department of Cardiovascular SurgeryBoston Children's Hospital and Harvard Medical School Boston Massachusetts
| | - Diego Porras
- Department of CardiologyBoston Children's Hospital and Harvard Medical School Boston Massachusetts
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10
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A word of caution: diabolic behaviour of AndraStents®: inflation of supporting balloon leads to "diabolo"-misconfiguration of the stent. Cardiol Young 2019; 29:972-976. [PMID: 31218985 DOI: 10.1017/s1047951119001264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS Transcatheter implantation of pulmonary balloon-expandable stent-valves requires pre-stenting of the right ventricular outflow tract with large calibre stents. To increase awareness of the associated risks of this part of transcatheter pulmonary valve replacement therapy, we report potential fatal complications during the implantation of AndraStents® in the right ventricular outflow tract in six cases from five different European institutions and their management. METHOD AND RESULT We present a retrospective case series analysis looking at the time period from 2013 to 2018. Of 127 AndraStents® implanted in the right ventricular outflow tract, in six patients, age from 13 to 71 years, a misconfiguration of the AndraStent® occurred forming a "diabolo"-configuration. During inflation of the balloon, the stent showed extreme "dog-boning", an expansion of the stent at both ends with the middle part remaining unexpanded. This led to rupture of the balloon and loss of manoeuvrability in four patients. Out of the total six cases, in four patients the stent was eventually expanded with high-pressure balloons, and in one case the stent was surgically retrieved. In one patient, in whom a percutaneous retrieval of the embolised stent was attempted, a fatal bleeding occurred. CONCLUSIONS Pre-stenting of the right ventricular outflow tract by AndraStents® can lead to misconfiguration of the stent with potentially fatal complications. Rescue strategies of misconfigured stents include stent inflation and placement with high pressure non-compliant balloons or surgical backup. Interventional retrieval measures of AndraStents® cannot be advised.
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11
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Guimaraes L, Lindenfeld J, Sandoval J, Bayés-Genis A, Bernier M, Provencher S, Rodés-Cabau J. Interatrial shunting for heart failure: current evidence and future perspectives. EUROINTERVENTION 2019; 15:164-171. [DOI: 10.4244/eij-d-18-01211] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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The Creation of an Interatrial Right-To-Left Shunt in Patients with Severe, Irreversible Pulmonary Hypertension: Rationale, Devices, Outcomes. Curr Cardiol Rep 2019; 21:31. [DOI: 10.1007/s11886-019-1118-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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13
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Nowroozpoor A, Malekmohammad M, Seyyedi SR, Hashemian SM. Pulmonary Hypertension in Intensive Care Units: An Updated Review. TANAFFOS 2019; 18:180-207. [PMID: 32411259 PMCID: PMC7210574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pulmonary hypertension (PH) is a condition associated with high morbidity and mortality. Patients with PH who require critical care usually have severe right ventricular (RV) dysfunction. Although different groups of PH have different etiologies, pulmonary vascular dysfunction is common in these groups. PH can lead to increased pulmonary artery pressure, which can ultimately cause RV failure. Clinicians should be familiar with the presentations of this disease and diagnostic tools. The contributing factors, if present (e.g., sepsis), and coexisting conditions (e.g., arrhythmias) should be identified and addressed accordingly. The preload should be optimized by fluid administration, diuretics, and dialysis, if necessary. On the other hand, the RV afterload should be reduced to improve the RV function with pulmonary vasodilators, such as prostacyclins, inhaled nitric oxide, and phosphodiesterase type 5 inhibitors, especially in group 1 PH. Inotropes are also used to improve RV contractility, and if inadequate, use of ventricular assist devices and extracorporeal life support should be considered in suitable candidates. Moreover, vasopressors should be used to maintain systemic blood pressure, albeit cautiously, as they increase the RV afterload. Measures should be also taken to ensure adequate oxygenation. However, mechanical ventilation is avoided in RV failure. In this study, we reviewed the pathophysiology, manifestations, diagnosis, monitoring, and management strategies of PH, especially in intensive care units.
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Affiliation(s)
- Armin Nowroozpoor
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Malekmohammad
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed Reza Seyyedi
- Lung Transplantation Research Center, Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammadreza Hashemian
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran,,Correspondence to: Hashemian SMR, Address: Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Email address:
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Kaley V, Dahdah N, El-Sisi A, Grohmann J, Rosenthal E, Jones M, Morgan G, Hayes N, Shah A, Karakurt C, Sadiq M, Sigler M, Figulla H, Becker M, Haas N, Onorato E, Rico AP, Roymanee S, Uebing A, Wiebe W, Samuel B, Hijazi Z, Vettukattil J. Atrial Septal Defect–Associated Pulmonary Hypertension: Outcomes of Closure With a Fenestrated Device. ACTA ACUST UNITED AC 2019. [DOI: 10.21693/1933-088x-18.1.4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Vishal Kaley
- Spectrum Health Helen DeVos Children's Hospital, USA
| | | | | | - Jochen Grohmann
- University Heart Center Freiburg - Bad Krozingen, Mathildenstrasse, Germany
| | | | | | | | | | - Ashish Shah
- Central Manchester University Hospitals, NHS Foundation Trust, United Kingdom
| | | | - Masood Sadiq
- The Children's Hospital Lahore and Punjab Institute of Cardiology, Pakistan
| | | | - Hans Figulla
- Universitätsklinikum Jena, Friedrich Schiller Universität Jena, Germany
| | | | - Nikolaus Haas
- Medical Hospital of the University of Munich, Germany
| | | | | | | | | | - Walter Wiebe
- Deutsches Kinderherzzentrum Sankt Augustin, Germany
| | | | - Ziyad Hijazi
- Weill Cornell Medicine, USA
- Sidra Medicine, Doha, Qatar
| | - Joseph Vettukattil
- Spectrum Health Helen DeVos Children's Hospital, USA
- Michigan State University, USA
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15
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Tufaro V, Butera G. Fenestrated ASD device "angioplasty": How to adjust a "pop-off" mechanism when needed. Catheter Cardiovasc Interv 2018; 92:1329-1333. [PMID: 30196540 DOI: 10.1002/ccd.27788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/29/2018] [Accepted: 06/20/2018] [Indexed: 11/07/2022]
Abstract
We report on three cases of atrial septal defect (ASD) closure where a handmade fenestration had to be modified after device implantation. Two patients suffered from left ventricular diastolic dysfunction and one had severe pulmonary arterial hypertension. Amplatzer ASD occluder fenestration was created in all patients. Devices were implanted using an "over-the-wire" implantation technique. Due to a sub-optimal hemodynamic result, fenestration was upsized by using a new technique.
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Affiliation(s)
- Vincenzo Tufaro
- Department of Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gianfranco Butera
- Department of Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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16
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Man W, Xinxin M, Yueli Z, Feng L. Percutaneous closure of residual shunting in a patient with a fenestrated atrial septal defect occluder: A case report. Medicine (Baltimore) 2018; 97:e11612. [PMID: 30075536 PMCID: PMC6081157 DOI: 10.1097/md.0000000000011612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 06/28/2018] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Fenestrated atrial septal defect (ASD) occlusion has been performed in patients complicated with severe pulmonary hypertension (PH). Nevertheless, the persistent interatrial residual shunting in the fenestration might increase the risk of paradoxical embolism. Percutaneous closure of fenestrated ASD occluder (ASO) has not yet been reported. PATIENT CONCERNS A 26-year-old patient with a 25-mm ASD and severe PH underwent ASD closure using a Memory ASO with a waist of 32 and 6-mm custom-made fenestration. Echocardiography revealed the fenestration remained 6 mm and the pulmonary artery pressure decreased to the normal range at the 6-month follow-up. DIAGNOSES Persistent interatrial residual shunting in ASO. INTERVENTIONS Percutaneous closure of residual interatrial shunting was performed using a waist of 8-mm ASO under guidance of TEE. OUTCOMES The fenestration was successfully closed. Neither thromboembolism nor infection events were noted during the 12-month follow-up after the procedure. LESSONS This case illustrates that percutaneous closure of the residual shunting in fenestrated ASO was feasible and safe for short- and long-term.
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Affiliation(s)
- Wang Man
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Department of Ultrasound in Medicine
| | - Ma Xinxin
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Department of Ultrasound in Medicine
| | - Zhang Yueli
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Department of Ultrasound in Medicine
| | - Li Feng
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Heart Center, Shanghai, China
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Interventional Therapies in Pulmonary Hypertension. ACTA ACUST UNITED AC 2018; 71:565-574. [PMID: 29545075 DOI: 10.1016/j.rec.2018.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/13/2018] [Indexed: 01/20/2023]
Abstract
Despite advances in drug therapy, pulmonary hypertension-particularly arterial hypertension (PAH)-remains a fatal disease. Untreatable right heart failure (RHF) from PAH eventually ensues and remains a significant cause of death in these patients. Lowering pulmonary input impedance with different PAH-specific drugs is the obvious therapeutic target in RHF due to chronically increased afterload. However, potential clinical gain can also be expected from attempts to unload the right heart and increase systemic output. Atrial septostomy, Potts anastomosis, and pulmonary artery denervation are interventional procedures serving this purpose. Percutaneous balloon pulmonary angioplasty, another interventional therapy, has re-emerged in the last few years as a clear alternative for the management of patients with distal, inoperable, chronic thromboembolic pulmonary hypertension. The current review discusses the physiological background, experimental evidence, and potential clinical and hemodynamic benefits of all these interventional therapies regarding their use in the setting of RHF due to severe pulmonary hypertension.
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Mainzer G, Goreczny S, Morgan GJ, Qureshi S, Krasemann T, Dryzek P, Moll JA, Moszura T, Rosenthal E. Stenting of the inter-atrial septum in infants and small children: Indications, techniques and outcomes. Catheter Cardiovasc Interv 2018; 91:1294-1300. [DOI: 10.1002/ccd.27462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 11/04/2017] [Accepted: 11/29/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Gur Mainzer
- Department of Paediatric Cardiology; Evelina London Children's Hospital, Guy's and St. Thomas' Hospital; London United Kingdom
- Paediatric Cardiology Unit, Padeh-Poriya Medical Center; Tiberias Israel
| | - Sebastian Goreczny
- Cardiology Department; Polish Mother's Memorial Hospital, Research Institute; Lodz Poland
| | - Gareth J. Morgan
- Department of Paediatric Cardiology; Evelina London Children's Hospital, Guy's and St. Thomas' Hospital; London United Kingdom
- Department of Congenital Cardiology; University of Colorado; Denver Colorado
| | - Shakeel Qureshi
- Department of Paediatric Cardiology; Evelina London Children's Hospital, Guy's and St. Thomas' Hospital; London United Kingdom
| | - Thomas Krasemann
- Department of Paediatric Cardiology; Evelina London Children's Hospital, Guy's and St. Thomas' Hospital; London United Kingdom
- Department of Pediatric Cardiology; Erasmus Medical Centre; Rotterdam Netherlands
| | - Pawel Dryzek
- Cardiology Department; Polish Mother's Memorial Hospital, Research Institute; Lodz Poland
| | - Jadwiga A Moll
- Cardiology Department; Polish Mother's Memorial Hospital, Research Institute; Lodz Poland
| | - Tomasz Moszura
- Cardiology Department; Polish Mother's Memorial Hospital, Research Institute; Lodz Poland
| | - Eric Rosenthal
- Department of Paediatric Cardiology; Evelina London Children's Hospital, Guy's and St. Thomas' Hospital; London United Kingdom
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Nijenhuis VJ, Sanchis L, van der Heyden JAS, Klein P, Rensing BJWM, Latib A, Maisano F, Ten Berg JM, Agostoni P, Swaans MJ. The last frontier: transcatheter devices for percutaneous or minimally invasive treatment of chronic heart failure. Neth Heart J 2017; 25:536-544. [PMID: 28741245 PMCID: PMC5612866 DOI: 10.1007/s12471-017-1018-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Heart failure has a high prevalence in the general population. Morbidity and mortality of heart failure patients remain high, despite improvements in drug therapy, implantable cardioverter-defibrillators and cardiac resynchronisation therapy. New transcatheter implantable devices have been developed to improve the treatment of heart failure. There has been a rapid development of minimally invasive or transcatheter devices used in the treatment of heart failure associated with aortic and mitral valve disease and these devices are being incorporated into routine clinical practice at a fast rate. Several other new transcatheter structural heart interventions for chronic heart failure aimed at a variety of pathophysiologic approaches are currently being developed. In this review, we focus on devices used in the treatment of chronic heart failure by means of left ventricular remodelling, left atrial pressure reduction, tricuspid regurgitation reduction and neuromodulation. The clinical evaluations of these devices are early-stage evaluations of initial feasibility and safety studies and additional clinical evidence needs to be gathered in appropriately designed clinical trials.
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Affiliation(s)
- V J Nijenhuis
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - L Sanchis
- Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | | | - P Klein
- Department of Cardio-Thoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - B J W M Rensing
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - A Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - F Maisano
- University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - J M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - P Agostoni
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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Abdelkarim A, Levi DS, Tran B, Ghobrial J, Aboulhosn J. Fenestrated Transcatheter ASD Closure in Adults with Diastolic Dysfunction and/or Pulmonary Hypertension: Case Series and Review of the Literature. CONGENIT HEART DIS 2016; 11:663-671. [PMID: 27125263 DOI: 10.1111/chd.12367] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aims to evaluate the safety and efficacy of transcatheter fenestrated ASD closure and to summarize the literature regarding the published techniques and outcomes of transcatheter partial ASD closure. BACKGROUND Patients with left ventricular diastolic dysfunction (LVDD) or right ventricular (RV) dysfunction and/or pulmonary hypertension (PHT) may suffer untoward consequences of complete closure of an ostium secundum atrial septal defect (ASD). Therefore, for patients that fall under these categories we suggest partial occlusion of the defect, which may be better tolerated than complete defect closure. METHODS AND PATIENTS After obtaining IRB approval, a search for patients that have undergone percutaneous ASD closure was performed in the Ahmanson/UCLA Adult Congenital Heart Disease Center database to identify which patients received a fenestrated ASD closure device. RESULTS Eight consecutive patients ranging between 22 and 83 years of age (mean 48 years) with PHT and/or LVDD or RV dysfunction who underwent fenestrated transcatheter ASD closure at UCLA were identified. None of the subjects experienced complications related to the procedure. Postprocedure clinical evaluation showed improvement in symptoms and exercise capacity. Available follow-up transthoracic echocardiography data (mean 4 months, range 0-20 months) demonstrated patent fenestrations in four of eight patients. None of the patients had thromboembolic or infectious complications and there were no device migrations, erosions or embolizations. CONCLUSIONS Partial ASD occlusion in patients with diastolic dysfunction or RV dysfunction and/or PHT is safe and may be better tolerated than complete ASD closure in selected patients.
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Affiliation(s)
- Ayman Abdelkarim
- David Geffen School of Medicine at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, Calif, USA
| | - Daniel S Levi
- David Geffen School of Medicine at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, Calif, USA
| | - Bao Tran
- David Geffen School of Medicine at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, Calif, USA
| | - Joanna Ghobrial
- David Geffen School of Medicine at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, Calif, USA
| | - Jamil Aboulhosn
- David Geffen School of Medicine at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, Calif, USA
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Aldoss O, Divekar A. Modified Technique to Create Diabolo Stent Configuration. Pediatr Cardiol 2016; 37:728-33. [PMID: 26739005 DOI: 10.1007/s00246-015-1339-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
Diabolo stent configuration aids in stent positioning, stability, and creating a controlled defect with a predetermined size. A number of techniques to create the diabolo configuration have been previously described. The indications for creating a controlled "defect" are rapidly growing and include the Fontan circulation, patients with severe end-stage pulmonary hypertension, restrictive atrial communication in the setting of hypoplastic right or left heart syndrome, and diastolic left heart failure. We describe an alternative technique using a prefabricated readily available tool (gooseneck snare) to create a diabolo stent configuration. The chosen balloon expandable stent is mounted on a 5-mm gooseneck snare centered on an angioplasty catheter larger than 5 mm diameter. When deployed, the snare restricts the central waist to 5 mm and both ends expand to a larger diameter creating a dumbbell/diabolo configuration. A total of six diablo stent configurations were successfully implanted in four patients with failing Fontan physiology; five to create a transcatheter fenestration and one to relieve atrial septal restriction. Data expressed as median and IQR. Their weight was 24.8 kg (19.6-46.95), and age years was 9.2 (6.28-13.23). There were no complications and a consistent diabolo configuration with a 5-mm central waist was created in all patients. The snare serves as a sterile, preconfigured, radiopaque, readily available tool of adequate length and strength, to create consistent diabolo stent configuration without any modifications. This technique is a simple, reproducible, and easy to learn.
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Affiliation(s)
- Osamah Aldoss
- Stead Family Department of Pediatrics, Division of Pediatric Cardiology, University of Iowa Children's Hospital, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
| | - Abhay Divekar
- Stead Family Department of Pediatrics, Division of Pediatric Cardiology, University of Iowa Children's Hospital, 200 Hawkins Dr., Iowa City, IA, 52242, USA
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Aldoss O, Reinking BE, Divekar A. Native atrial septal restriction after Fontan palliation successfully treated with transcatheter Diabolo stent. Ann Pediatr Cardiol 2016; 9:49-52. [PMID: 27011693 PMCID: PMC4782469 DOI: 10.4103/0974-2069.171411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 6-year-old male child born with hypoplastic left heart syndrome (HLHS) was palliated with an extracardiac nonfenestrated Fontan procedure (18-mm Gore-Tex tube graft). He developed low-pressure (mean Fontan pressure 10 mmHg) protein-losing enteropathy 6 months after Fontan palliation. After initially responding to medical therapy and transcatheter pulmonary artery stent implantation, he developed medically refractory protein-losing enteropathy. At this time, his transthoracic echocardiogram showed new restriction across his native atrial septum with an 8 mmHg mean gradient. Cardiac catheterization now showed high-pressure (mean Fontan pressure 18-20 mmHg) protein-losing enteropathy and a new 6 mmHg mean gradient across the atrial septum. To avoid cardiopulmonary bypass, he underwent successful transcatheter relief of atrial septal restriction and creation of a fenestration with rapid clinical and biochemical improvement of his protein-losing enteropathy.
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Affiliation(s)
- Osamah Aldoss
- Department of Pediatrics, Division of Pediatric Cardiology, University of Iowa Children's Hospital, Iowa City, Iowa, USA
| | - Benjamin E Reinking
- Department of Pediatrics, Division of Pediatric Cardiology, University of Iowa Children's Hospital, Iowa City, Iowa, USA
| | - Abhay Divekar
- Department of Pediatrics, Division of Pediatric Cardiology, University of Iowa Children's Hospital, Iowa City, Iowa, USA
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Velázquez Martín M, Albarrán González-Trevilla A, Jiménez López-Guarch C, García Tejada J, Martín Asenjo R, Escribano Subías P. Septostomía auricular en el tratamiento de la hipertensión arterial pulmonar grave del adulto. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Velázquez Martín M, Albarrán González-Trevilla A, Jiménez López-Guarch C, García Tejada J, Martín Asenjo R, Escribano Subías P. Use of Atrial Septostomy to Treat Severe Pulmonary Arterial Hypertension in Adults. ACTA ACUST UNITED AC 2015; 69:78-81. [PMID: 26643769 DOI: 10.1016/j.rec.2015.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/10/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Maite Velázquez Martín
- Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Unidad Multidisciplinar de Hipertensión Pulmonar, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain.
| | - Agustín Albarrán González-Trevilla
- Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Unidad Multidisciplinar de Hipertensión Pulmonar, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Carmen Jiménez López-Guarch
- Servicio de Cardiología, Unidad Multidisciplinar de Hipertensión Pulmonar, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Julio García Tejada
- Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Unidad Multidisciplinar de Hipertensión Pulmonar, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Roberto Martín Asenjo
- Servicio de Cardiología, Unidad Multidisciplinar de Hipertensión Pulmonar, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Pilar Escribano Subías
- Servicio de Cardiología, Unidad Multidisciplinar de Hipertensión Pulmonar, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
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Patel MB, Samuel BP, Girgis RE, Parlmer MA, Vettukattil JJ. Implantable atrial flow regulator for severe, irreversible pulmonary arterial hypertension. EUROINTERVENTION 2015; 11:706-9. [DOI: 10.4244/eijy15m07_08] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Moszura T, Góreczny S, Dryżek P. Hypoplastic left heart syndrome - a review of supportive percutaneous treatment. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 10:201-8. [PMID: 25489307 PMCID: PMC4252312 DOI: 10.5114/pwki.2014.45148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/18/2014] [Accepted: 09/01/2014] [Indexed: 12/01/2022] Open
Abstract
Due to the complex anatomical and haemodynamic consequences of hypoplastic left heart syndrome (HLHS), patients with the condition require multistage surgical and supportive interventional treatment. Percutaneous interventions may be required between each stage of surgical palliation, sometimes simultaneously with surgery as hybrid interventions, or after completion of multistage treatment. Recent advances in the field of interventional cardiology, including new devices and techniques, have significantly contributed to improving results of multistage HLHS palliation. Knowledge of the potential interventional options as well as the limitation of percutaneous interventions will enable the creation of safe and effective treatment protocols in this highly challenging group of patients. In this comprehensive review we discuss the types, goals, and potential complications of transcatheter interventions in patients with HLHS.
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Affiliation(s)
- Tomasz Moszura
- Department of Cardiology, Polish Mothers Memorial Hospital, Research Institute, Lodz, Poland
- Department of Paediatric Cardiology and Nephrology, Poznan University of Medical Sciences, Poland
| | - Sebastian Góreczny
- Department of Cardiology, Polish Mothers Memorial Hospital, Research Institute, Lodz, Poland
| | - Paweł Dryżek
- Department of Cardiology, Polish Mothers Memorial Hospital, Research Institute, Lodz, Poland
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Non-invasive cardiac output monitoring during catheter interventions in patients with cavopulmonary circulations. Cardiol Young 2014; 24:417-21. [PMID: 23680531 DOI: 10.1017/s1047951113000486] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Functionally univentricular hearts palliated with superior or total cavopulmonary connection result in circulations in series. The absence of a pre-pulmonary pump means that cardiac output is more difficult to adjust and control. Continuous monitoring of cardiac output is crucial during cardiac catheter interventions and can provide new insights into the complex physiology of these lesions. MATERIALS AND METHODS The Icon cardiac output monitor was used to study the changes in cardiac output during catheter interventions in 15 patients (median age: 6.1 years, range: 4.8-15.3 years; median weight: 18.5 kg, range: 15-63 kg) with cavopulmonary circulations. A total of 19 interventions were undertaken in these patients and the observed changes in cardiac output were recorded and analysed. RESULTS Cardiac output was increased with creation of stent fenestrations after total cavopulmonary connection (median increase of 22.2, range: 6.7%-28.6%) and also with drainage of significant pleural effusions (16.7% increase). Cardiac output was decreased with complete or partial occlusion of fenestrations (median decrease of 10.6, range: 7.1%-13.4%). There was a consistent increase in cardiac output with stenting of obstructive left pulmonary artery lesions (median increase of 7.7, range: 5%-14.3%, p = 0.007). CONCLUSIONS Icon provides a novel technique for the continuous, non-invasive monitoring of cardiac output. It provides a further adjunct for monitoring of physiologically complex patients during catheter interventions. These results are consistent with previously reported series involving manipulation of fenestrations. This is the first report identifying an increase in cardiac output with stenting of obstructive pulmonary arterial lesions.
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Abstract
AIM To analyse the current practice and contribution of catheter interventions in the staged management of patients with hypoplastic left heart syndrome. METHODS This study is a retrospective case note review of 527 patients undergoing staged Norwood/Fontan palliation at a single centre between 1993 and 2010. Indications and type of catheter interventions were reviewed over a median follow-up period of 7.5 years. RESULTS A staged Norwood/Fontan palliation for hypoplastic left heart syndrome was performed in 527 patients. The 30-day survival rate after individual stages was 76.5% at Stage I, 96.3% at Stage II, and 99.4% at Stage III. A total of 348 interventions were performed in 189 out of 527 patients. Freedom from catheter intervention in survivors was 58.2% before Stage II and 46.7% before Stage III. Kaplan-Meier freedom from intervention post Fontan completion was 55% at 10.8 years of follow-up. Post-stage I interventions were mostly directed to relieve aortic arch obstruction--84 balloon angioplasties--and augment pulmonary blood flow--15 right ventricle-to-pulmonary conduit interventions; post-Stage II interventions centred on augmenting size of the left pulmonary artery--73 procedures and abolishing systemic venous collaterals--32 procedures. After Stage III, the focus was on manipulating the size of the fenestration--42 interventions--and the left pulmonary artery -31 procedures. CONCLUSION Interventional cardiac catheterisation constitutes an integral part in the staged palliative management of patients with hypoplastic left heart syndrome. Over one-third (37%) of patients undergoing staged palliation required catheter intervention over the follow-up period.
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Bhamra-Ariza P, Keogh AM, Muller DW. Percutaneous Interventional Therapies for the Treatment of Patients With Severe Pulmonary Hypertension. J Am Coll Cardiol 2014; 63:611-618. [DOI: 10.1016/j.jacc.2013.11.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/05/2013] [Accepted: 11/11/2013] [Indexed: 02/01/2023]
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A 10-year single-centre experience in percutaneous interventions for multi-stage treatment of hypoplastic left heart syndrome. Cardiol Young 2014; 24:54-63. [PMID: 23402359 DOI: 10.1017/s104795111200220x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The purpose of this paper is to report our 10 years of experience of interventional treatment of patients with hypoplastic left heart syndrome and to focus on the frequency, type, and results of percutaneous interventions during all the stages of palliation, considering the different techniques, devices, and complications. BACKGROUND Constant progress in surgical treatment of congenital heart defects in the last decade has significantly improved the prognosis for children with hypoplastic left heart syndrome. However, morbidity and mortality remain relatively high. Modern interventional procedures complement or occasionally replace surgical treatment. METHODS Between January, 2001 and December, 2010, 161 percutaneous interventions were performed in 88 patients with hypoplastic left heart syndrome. Patients were divided into four groups: (a) before the first surgical treatment including hybrid approach, (b) after first-stage Norwood operation, (c) after second-stage bidirectional Glenn operation, and (d) after third-stage Fontan operation. RESULTS Percutaneous interventions resulted in statistically significant changes in pulmonary artery pressures, vessel diameters, and O2 saturation. Complications occurred in 4.3% of interventions and were related mainly to stent implantation in stenosed pulmonary arteries. CONCLUSIONS Percutaneous interventions may result in haemodynamic stability and reduction in the number of operations. They may result in significant changes in pulmonary artery pressures, vessel diameters, O2 saturation, with a low rate of complications, which are mainly related to stent implantation in the pulmonary arteries.
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Abstract
For more than 10 years, balloon-expandable intravascular stents have become an integral part of treatment for obstructive vascular lesions in children and adults with congenital heart disease. The initial problems with stents, such as sharp edges, rigid frame and unacceptable shortening when over-expanded have been overcome to a large extent with the newer designs. The problems related to delivery of stents, such as stent migration, balloon rupture, flaring of the edges of the stent, rupture of vessels and milking of the stent off the balloon, have also been overcome by newer designs of balloons. The failure of growth of balloon-expandable stents with the growth of the child is managed by redilation with or without additional stenting and newer growth stents. Self-expanding stents are not appropriate for use in growing children due to the limitation of their maximum diameters. The development of biodegradable stents may overcome these disadvantages in the future. Various new developments have recently occurred. Covered stents are ideal for treating acute vessel rupture and in isolating vascular aneurysms. Drug-eluting stents may prevent restenosis, but have not been used in children. Valved stents are a recent innovation for the treatment of regurgitant pulmonary valves.
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Affiliation(s)
- Shakeel Ahmed Qureshi
- Department of Pediatric Cardiology, Guy's Hospital, 11th Floor Guy's Tower, St Thomas Street, London SE1 9RT, UK.
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Kaleschke G. Katheterinterventionelle Therapie bei Erwachsenen mit Herz- und Gefäßmissbildungen. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2012. [DOI: 10.1007/s00398-011-0885-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Anderson BW, Barron DJ, Jones TJ, Edwards L, Brawn W, Stumper O. Catheter takedown in the management of the acutely failing Fontan circulation. Ann Thorac Surg 2011; 92:346-8. [PMID: 21718874 DOI: 10.1016/j.athoracsur.2011.01.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 01/03/2011] [Accepted: 01/12/2011] [Indexed: 11/19/2022]
Abstract
The acutely failing Fontan circulation requires urgent management to decompress the systemic venous pressures and augment cardiac output. This may involve the use of extracorporeal membrane oxygenation support to preserve life. Catheter-based effective Fontan takedown is an alternative to surgery in these patients, who are acutely unstable, and offers the potential for an adjustable fenestration.
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Affiliation(s)
- Ben W Anderson
- The Heart Unit, Department of Pediatric Cardiology, Birmingham Children's Hospital, Birmingham, United Kingdom
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Feltes TF, Bacha E, Beekman RH, Cheatham JP, Feinstein JA, Gomes AS, Hijazi ZM, Ing FF, de Moor M, Morrow WR, Mullins CE, Taubert KA, Zahn EM. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 2011; 123:2607-52. [PMID: 21536996 DOI: 10.1161/cir.0b013e31821b1f10] [Citation(s) in RCA: 491] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Kenny D, McMahon C, Walsh KP. Transhepatic Approach for Extracardiac Inferior Cavopulmonary Connection Stent Fenestration. CONGENIT HEART DIS 2011; 6:276-9. [DOI: 10.1111/j.1747-0803.2011.00488.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bhole V, Wright JG, De Giovanni JV, Dhillon R, Miller PA, Desai T, Chikermane A, Jones T, Barron DJ, Brawn WJ, Stumper O. Transcatheter interventions in the early postoperative period after the Fontan procedure. Catheter Cardiovasc Interv 2010; 77:92-8. [DOI: 10.1002/ccd.22667] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Anderson B, Bhole V, Desai T, Mehta C, Stumper O. Novel technique to reduce the size of a Fontan Diabolo stent fenestration. Catheter Cardiovasc Interv 2010; 76:860-4. [DOI: 10.1002/ccd.22661] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
BACKGROUND Sildenafil is increasingly being used in the management of pulmonary arterial hypertension in the newborn. Its role in patients with congenital cardiac disease is less well defined and as yet has only been reported sporadically. AIM Present our experience with sildenafil treatment in patients with a failing Fontan circulation. PATIENTS AND METHODS Retrospective review of 13 symptomatic patients after Fontan palliation who received treatment with sildenafil between January, 2006 and July, 2008. RESULTS Three patients suffered from protein-losing enteropathy, four patients presented with bronchial casts, two had severe cyanosis after fenestrated Fontan procedure, two had prolonged chylous effusions, one had a previous failure of Fontan and take-down, and one patient had arrhythmias and end-stage cardiac failure requiring conversion to an extra-cardiac Fontan. Sildenafil was used in the dosage of 1-2 milligrams per kilogram 3-4 times per day. Protein-losing enteropathy and alpha-1-antitrypsin levels improved in all three patients on sildenafil treatment. One of these patients had a concomitant catheter creation of a fenestration, as did two patients presenting with bronchial casts and both patients with persistent chylous effusions. All four patients with bronchial casts and two patients with cyanosis improved significantly on sildenafil treatment. Chylous effusions decreased after sildenafil and stent enlargement of a fenestration. There were no significant side effects requiring sildenafil withdrawal over a treatment period ranging from 2 months to 2 years. CONCLUSIONS Sildenafil can be used safely and effectively in the treatment of patients with a failing Fontan circulation.
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Troost E, Delcroix M, Gewillig M, Van Deyk K, Budts W. A modified technique of stent fenestration of the interatrial septum improves patients with pulmonary hypertension. Catheter Cardiovasc Interv 2009; 73:173-9. [PMID: 19085938 DOI: 10.1002/ccd.21760] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS A significant number of patients with pulmonary hypertension are resistant to medical therapy. We wanted to evaluate whether the modified technique of stent fenestration of the interatrial septum would be feasible and safe, and offer clinical benefit. METHODS AND RESULTS The medical records of all patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension who underwent a stent fenestration of the interatrial septum between 2001 and 2008 were reviewed. In all fifteen patients (12 female, mean age 48.2 +/- 20.5 years) a successful fenestration procedure could be performed. Median follow-up time between diagnosis and fenestration was 2.3 years (range from 0.5 to 18.6 years). Mean event free survival since diagnosis and after septostomy was 9.8 +/- 2.9 and 3.2 +/- 0.8 years, respectively. When one extreme outlier was excluded, the 6 min walk distance improved significantly from 309 +/- 69 m immediately before fenestration to 374 +/- 84 m, 3-4 months after fenestration (n = 8, paired t-test, P = 0.03). No stent occlusion occurred. CONCLUSION The modified stent fenestration technique is feasible and safe in patients with severe pulmonary hypertension. In a selected group of patients, functional capacity might improve although disease progression continues.
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Affiliation(s)
- Els Troost
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
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Moszura T, Mazurek-Kula A, Dryzek P, Moll JJ, Moll JA, Sysa A, Qureshi SA. Interventions complementing surgery as part of multistage treatment for hypoplastic left heart syndrome: one center's experience. Pediatr Cardiol 2009; 30:106-13. [PMID: 18726645 DOI: 10.1007/s00246-008-9283-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 07/10/2008] [Accepted: 07/11/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Interventional procedures often are used as part of multistage treatment for hypoplastic left heart syndrome (HLHS). This study aimed to evaluate the efficacy of interventions in multistage treatment of HLHS. METHODS AND RESULTS Between 1999 and 2007, 78 interventions were performed for 58 children with HLHS at different stages of surgical treatment. Group 1, involving 30 interventions for 22 patients with postoperative pulmonary arterial stenosis, showed reduced pulmonary artery pressure and increased vessel diameter. Group 2, involving 15 interventions after the Norwood operation for 12 patients with aortic arch obstruction, showed success for 11 patients. Group 3, involving eight balloon angioplasties of narrowed Glenn anastomosis for seven patients, showed abolition of the pressure gradient between the superior vena cava and the right pulmonary artery. Group 4, involving eight interventional closures of a fenestration for eight patients after a Fontan operation, showed increased oxygen saturation for all eight patients. Group 5, involving seven interventions for six patients in whom venovenous collaterals were closed percutaneously, showed improved oxygen saturation. For Group 6, uncommon miscellaneous interventions were used to stabilize the patients' condition before the next surgical treatment. CONCLUSIONS Interventional procedures play an important role during multistage treatment of HLHS. They allow for a reduction in the number of operations or stabilization of the patients' condition before the next surgical treatment.
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Affiliation(s)
- T Moszura
- Department of Cardiology, Polish Mother's Memorial Hospital Research Institute, 93-338 Lodz, Rzgowska, 281/289, Poland.
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Lammers AE, Derrick G, Haworth SG, Bonhoeffer P, Yates R. Efficacy and long-term patency of fenestrated amplatzer devices in children. Catheter Cardiovasc Interv 2008; 70:578-84. [PMID: 17896406 DOI: 10.1002/ccd.21216] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Novel transcatheter techniques to control interatrial communications exist. Devices with restrictive fenestrations can be implanted to maintain patency of an atrial septostomy, or reduce an interatrial communication. Experience with these devices in children is limited. PATIENTS AND METHODS Fenestrated atrial septal devices were implanted into 10 children (5 male, age 1.5-15.5 years). Devices were modified by the manufacturer (MM, n = 6), or by a modification of an atrial septal occlusion device by the operator (OM, n = 4). Seven devices were implanted after atrial septal puncture and septostomy for severe symptomatic pulmonary hypertension (PHT) [4 heart failure, 3 syncope], according to World Health Organisation Guidelines. Two devices were implanted to reduce left to right shunting through large atrial septal defects with associated PHT. One device was implanted acutely to offload the left atrium during extracorporal circulatory support prior to heart transplantation. Warfarin (n = 5), aspirin (n = 4), or heparin (n = 1) were used for prevention of fenestration thrombosis. RESULTS Symptoms in all patients with PHT improved after implantation; syncope recurred with fenestration occlusion in one patient. Nine patients were followed up to a mean of 26 months. Five devices (all MM; warfarin n = 4, aspirin n = 1) remained patent on echocardiography. Fenestrations occluded in 4 children after median follow-up of 10 months (MM n = 1, OM n = 3, warfarin n = 1, aspirin n = 3). CONCLUSIONS Implantation of fenestrated atrial devices is feasible and effective; but the occlusion rate is high. Further research on fenestrated atrial septal devices with better long-term patency, and effective antithrombotic drug treatment is necessary.
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Affiliation(s)
- Astrid E Lammers
- Department of Pediatric Cardiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, United Kingdom
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Mehta C, Jones T, De Giovanni J. Percutaneous transcatheter communication between the pulmonary artery and atrium following an extra-cardiac Fontan. Catheter Cardiovasc Interv 2008; 71:936-9. [DOI: 10.1002/ccd.21453] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rupp S, Michel-Behnke I, Valeske K, Akintürk H, Schranz D. Implantation of stents to ensure an adequate interatrial communication in patients with hypoplastic left heart syndrome. Cardiol Young 2007; 17:535-40. [PMID: 17612414 DOI: 10.1017/s104795110700090x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS To assess the feasibility of interatrial stenting for left atrial decompression in infants with hypoplastic left heart syndrome treated by a "hybrid-approach", with bilateral surgical banding of the pulmonary arteries and percutaneous stenting of the arterial duct. PATIENTS AND METHODS We stented the atrial septum in 5 infants aged from 21 to 77 days, making the intervention as an elective procedure in 4, but as a rescue procedure in the fifth patient, who had a restrictive foramen. The stents, comprising 2 Jo-stents of 17 millimetres hand-crimped on a balloon catheter with dimensions of 10 by 20 millimetres, and 3 premounted Genesis stents with dimensions of 10 by 19 millimetres, were placed using a 6 French long or short sheath by femoral venous access. The stents were expanded under fluoroscopic guidance to create a slightly diabolo-shaped form that fitted the septum. RESULTS The percutaneous interventions were successfully performed in all cases, producing significant improvement in clinical condition after placement. The saturations of oxygen increased from an average of 64% plus or minus 18% to 88% plus or minus 7%, (p < 0.05). During a mean follow up of 2.5 months, without any anticoagulant therapy, there were no complications related to the stenting. Surgical removal of the stents was uneventful during reconstruction of the aortic arch and creation of a bidirectional cavopulmonary connection in 4 patients, and during cardiac transplantation in one. CONCLUSION In the context of the hybrid approach, definitive decompression of the left atrium can be achieved by stenting the atrial septum in infants with hypoplastic left heart syndrome. Placement of the stents is safe and effective, with insertion in the form of a diabolo reducing the risk of dislocation, as well as embolisation of the stent.
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Affiliation(s)
- Stefan Rupp
- Paediatric Heart Centre, University Clinic Giessen-Marburg, Germany
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Sivaprakasam M, Kiesewetter C, Veldtman GR, Salmon AP, Vettukattil J. New Technique for Fenestration of the Interatrial Septum. J Interv Cardiol 2006; 19:334-6. [PMID: 16881980 DOI: 10.1111/j.1540-8183.2006.00155.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Achieving controlled flow between the systemic and pulmonary venous circulations is desirable in many complex congenital heart diseases. This includes the Fontan circulation, primary pulmonary hypertension, double inlet ventricles, or hypoplastic left heart with obstruction to the atrioventricular valve. As no specific device is available for this purpose, we developed a balloon-mounted stent technique to achieve a predetermined-sized fenestration of an atrial baffle in a patient with Fontan circulation. The details of the technique are described.
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Affiliation(s)
- Muthukumaran Sivaprakasam
- Wessex Adult Congenital Heart Unit, Wessex Cardiothoracic Unit, Southampton General Hospital, Southampton, United Kingdom
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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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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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Weidenbach M, Caffier P, Harnisch T, Daehnert I. Hypoplastic left heart syndrome with intact atrial septum. Clin Res Cardiol 2006; 95:110-4. [PMID: 16598520 DOI: 10.1007/s00392-006-0327-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2005] [Accepted: 09/20/2005] [Indexed: 10/25/2022]
Abstract
In patients with hypoplastic left heart syndrome (HLHS) and intact atrial septum, the blood entering the left atrium cannot egress. Emergency treatment interventionally or surgically is mandatory immediately after birth. We describe a patient with HLHS and intact atrial septum who underwent successful transvenous atrial septostomy immediately after birth. When the interatrial communication became restrictive, stent implantation into the arterial duct and into the atrial septum was performed on the 7th day of life. Despite good hemodymanic response, the lung damage was severe and persistent, rendering staged surgical correction impossible. The child died on the 23rd day of life. Autopsy showed patent and correct placed stents in the duct and the atrial septum. There was severe dilatation of pulmonary lymphatic and venous vessels, suggestive of long-standing pulmonary venous hypertension. In conclusion, this form of HLHS has a poor prognosis despite early and aggressive interventional treatment.
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Affiliation(s)
- Michael Weidenbach
- Klinik für Kinderkardiologie, Herzzentrum Leipzig GmbH, Universität Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.
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Gewillig M, Boshoff D, Delhaas T. Late fenestration of the extracardiac conduit in a Fontan circuit by sequential stent flaring. Catheter Cardiovasc Interv 2006; 67:298-301. [PMID: 16400676 DOI: 10.1002/ccd.20604] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recent Fontan circuits frequently involve an extracardiac conduit. We report on a new technique to create a late fenestration in such an extracardiac circuit by sequential flaring of a stent in the fenestration.
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Affiliation(s)
- M Gewillig
- Pediatric Cardiology, University Hospitals Leuven, Belgium.
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