1
|
Rao PS. Balloon Dilatation in the Management of Congenital Obstructive Lesions of the Heart: Review of Author's Experiences and Observations-Part II. J Cardiovasc Dev Dis 2023; 10:288. [PMID: 37504544 PMCID: PMC10380511 DOI: 10.3390/jcdd10070288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
While investigating the outcomes of balloon dilatation procedures in patients with congenital obstructive lesions of the heart, several parallel observations were made. The purpose of this review is to present these observations/phenomena/innovations related to balloon dilatation of pulmonary stenosis (PS), aortic stenosis (AS), and aortic coarctation (AC). In subjects who had balloon pulmonary valvuloplasty (BPV), development of infundibular obstruction, electrocardiographic (ECG) changes, changes in right ventricular filling, role of balloon/annulus ratios on the results of BPV, and double balloon vs. single balloon BPV will be reviewed. In patients who had balloon aortic valvuloplasty (BAV), causes of aortic insufficiency and trans-umbilical venous approach for BAV are tackled. In children who had balloon angioplasty (BA) of AC, aortic remodeling and biophysical response after BA of AC are discussed.
Collapse
Affiliation(s)
- P Syamasundar Rao
- Children's Heart Institute, University of Texas-Houston McGovern Medical School, Children's Memorial Hermann Hospital, Houston, TX 77030, USA
| |
Collapse
|
2
|
Statistical Treatment of Clinical Investigations in Pediatric Cardiology. CHILDREN-BASEL 2021; 8:children8040296. [PMID: 33921399 PMCID: PMC8069261 DOI: 10.3390/children8040296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/17/2022]
Abstract
This paper describes various statistical methods used by the author during multiple studies conducted by the author. Initially, the data were scrutinized to ensure normal distribution, and expressed as mean ± standard deviation (SD) or standard error of mean (SEM) for normally distributed variables. Medians and ranges were given for the data with skewed distribution. Two tailed, paired t tests or independent sample t tests (analysis of variance) were used for normally distributed data, while non-parametric chi-square or similar other tests were utilized for data with skewed distribution. Statistical significance was set at a p value of < 0.05. Bonferroni correction was applied when the study involves multiple comparisons. A number of other statistical methods used during these studies were also discussed. Finally, special methods used in evaluating aortic remodeling subsequent to balloon angioplasty of native aortic coarctation were reviewed.
Collapse
|
3
|
Cohen CT, Anderson V, Desai SB, Arunachalam A, Ahmed M, Diaz R. Patient Characteristics and Treatment Outcomes of Symptomatic Catheter-Related Arterial Thrombosis in Infants: A Retrospective Cohort Study. J Pediatr 2021; 231:215-222. [PMID: 33359630 DOI: 10.1016/j.jpeds.2020.12.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/06/2020] [Accepted: 12/21/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe the clinical characteristics, outcomes, and adverse events of treatment for symptomatic infant catheter-related arterial thrombosis. STUDY DESIGN Single-center retrospective medical record review of 99 infants (age <365 days) with catheter-related arterial thrombosis, either following indwelling arterial catheter placement or cardiac catheterization, who were treated with anticoagulation over an 8-year span at a pediatric tertiary care center. Outcomes measured include thrombosis progression, bleeding events, and thrombus resolution following the treatment period. RESULTS Thromboses were secondary to indwelling arterial catheter placement in 51 (51.5%) and cardiac catheterization in 48 (48.5%). The median age at diagnosis of catheter-related arterial thrombosis was 52 days. All patients received therapeutic anticoagulation with either unfractionated heparin or low molecular weight heparin for a maximum of 28 days. Progression of catheter-related arterial thrombosis occurred in 8 (8.1%) patients. One (1%) major and 3 (3%) minor bleeding events occurred within the cohort. Complete thrombus resolution was observed in 60 (60.6%), partial resolution in 33 (33.3%), and no resolution in 6 (6.1%) following the treatment period. Factors associated with complete thrombus resolution included time from intervention to catheter-related arterial thrombosis diagnosis (median of 1 day vs 5 days in those who experienced thrombus resolution vs those who did not, P = .035), and iliac and/or femoral artery involvement (P = .015). CONCLUSIONS Our treatment approach to infant catheter-related arterial thrombosis is safe and effective. Limitations of the study are its retrospective nature with a limited number of patients from a single institution. Additional prospective studies are needed to determine the optimal treatment approach to catheter-related arterial thrombosis in infants.
Collapse
Affiliation(s)
- Clay T Cohen
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, TX
| | - Viia Anderson
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, TX
| | - Sudhen B Desai
- Department of Radiology, Section of Interventional Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Athis Arunachalam
- Department of Pediatrics, Section of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Mubbasheer Ahmed
- Department of Pediatrics, Section of Critical Care, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Rosa Diaz
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, TX
| |
Collapse
|
4
|
Syamasundar Rao P. The Journey of an Indian Pediatric Cardiologist : Dr. K. C. Chaudhuri Lifetime Achievement Award/Oration at AIIMS, New Delhi, September 2017. Indian J Pediatr 2017; 84:848-858. [PMID: 28956269 DOI: 10.1007/s12098-017-2452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 11/28/2022]
Abstract
The life journey of an Indian pediatric cardiologist, who bestowed considerable attention to the development of new knowledge and train/teach physicians around the world while providing care of patients with heart disease over a 45-y period, is reviewed. This appraisal focuses particular attention on the scientific contributions to the literature. These include spontaneous closure of physiologically advantageous ventricular septal defects, various issues related to a congenital heart defect namely, tricuspid atresia and transcatheter and, interventional pediatric cardiac procedures.
Collapse
Affiliation(s)
- P Syamasundar Rao
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas-Houston McGovern Medical School/Children's Memorial Hermann Hospital, 6410 Fannin Street, UTPB Suite # 425, Houston, TX, 77030, USA.
| |
Collapse
|
5
|
Abstract
BACKGROUND Previous studies have identified risk factors for femoral arterial thrombosis after paediatric cardiac catheterisation, but none of them have evaluated the clinical and economic significance of this complication at the population level. Therefore, we examined the national prevalence and economic impact of femoral arterial thrombosis after cardiac catheterisation in children. METHODS Patients⩽18 years of age who underwent cardiac catheterisation were identified in the 2003-2009 Kids' Inpatient Database. Patients were stratified by age as follows: <1 year of age or 1-18 years of age. The primary outcome was arterial thrombosis of the lower extremity during the same hospitalisation as cardiac catheterisation. Propensity score matching was used to determine the impact of femoral arterial thrombosis on hospital length of stay, cost, and mortality. RESULTS Among the 11,497 paediatric cardiac catheterisations identified, 4558 catheterisations (39.6%) were performed in children <1 year of age. This age group experienced a higher prevalence of reported femoral arterial thrombosis, compared with children aged 1-18 years (1.3 versus 0.3%, p<0.001). After matching, femoral arterial thrombosis in children <1 year of age was associated with similar mortality (5.4 versus 1.8%, p=0.28), length of stay (8 versus 5 days, p=0.11), and total hospital cost ($27,135 versus $28,311, p=0.61), compared with absence of thrombosis. CONCLUSIONS Femoral arterial thrombosis is especially prevalent in children <1 year of age undergoing cardiac catheterisation. Clinicians should be vigilant in monitoring femoral arterial patency in neonates and infants after cardiac catheterisation.
Collapse
|
6
|
Rizzi M, Kroiss S, Kretschmar O, Forster I, Brotschi B, Albisetti M. Long-Term Outcome of Catheter-Related Arterial Thrombosis in Infants with Congenital Heart Disease. J Pediatr 2016; 170:181-7.e1. [PMID: 26685072 DOI: 10.1016/j.jpeds.2015.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/30/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate the long-term outcome of catheter-related arterial thrombosis in children. STUDY DESIGN Data from clinical and radiologic long-term follow-up of infants with congenital heart disease developing arterial thrombosis following femoral catheterization are presented. RESULTS Ninety-five infants with radiologically proven arterial thrombosis because of cardiac catheter (n = 52; 55%) or indwelling arterial catheter (n = 43; 45%) were followed for a median time of 23.5 months (IQR 13.3-47.3). Overall, radiologic complete thrombus resolution was observed in 64 (67%), partial resolution in 8 (9%), and no resolution in 23 (24%) infants. Complete resolution was significantly more frequent in infants with indwelling arterial catheter-related thrombosis compared with cardiac catheter-related thrombosis (P = .001). Patients with complete resolution had a significantly lower blood pressure difference and increased ankle-ankle index compared with patients with partial or no resolution (P < .0001). However, symptoms of claudication were present only in 1 case and clinical significant legs growth retardation (≥ 15 mm) was present in 1%. CONCLUSIONS A significant percentage of persistent occlusion is present in children with arterial catheter-related thrombosis on long-term follow-up. In these children, the magnitude of leg growth retardation is small and possibly not clinically relevant. However, in children with congenital heart disease, the high prevalence of persistent arterial occlusion may hamper future diagnostic and/or interventional catheterization.
Collapse
Affiliation(s)
- Mattia Rizzi
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Hematology, University Children's Hospital, Zurich, Switzerland
| | - Sabine Kroiss
- Division of Hematology, University Children's Hospital, Zurich, Switzerland; Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Oliver Kretschmar
- Children's Research Center, University Children's Hospital, Zurich, Switzerland; Division of Cardiology, University Children's Hospital, Zurich, Switzerland
| | - Ishilde Forster
- Department of Radiology, University Children's Hospital, Zurich, Switzerland
| | - Barbara Brotschi
- Children's Research Center, University Children's Hospital, Zurich, Switzerland; Intensive Care Unit, University Children's Hospital, Zurich, Switzerland
| | - Manuela Albisetti
- Division of Hematology, University Children's Hospital, Zurich, Switzerland; Children's Research Center, University Children's Hospital, Zurich, Switzerland.
| |
Collapse
|
7
|
Glatz AC, Keashen R, Chang J, Balsama LA, Dori Y, Gillespie MJ, Giglia TM, Raffini L, Rome JJ. Outcomes using a clinical practice pathway for the management of pulse loss following pediatric cardiac catheterization. Catheter Cardiovasc Interv 2014; 85:111-7. [PMID: 25257828 DOI: 10.1002/ccd.25686] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/22/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Objectives To describe the results of a clinical practice pathway (CPP) for the management of postcatheterization pulse loss in a children's hospital. BACKGROUND Standardized approaches to the diagnosis and management of postcatheterization arterial thrombus are lacking. As a result, substantial practice variation exists. METHODS Data collected prospectively for quality improvement purposes were retrospectively reviewed. RESULTS Since initiation of the CPP, 93/1,672 (5.4%) catheterizations resulted in pulse loss at a median patient age and weight of 73 days (1 day-5.8 years) and 4.8 kg (2-14.1 kg). Arterial thrombus was documented by ultrasound (US) in 85. Of these, 66 resolved by 12 weeks of therapy, seven patients died, and four were lost to follow-up before completing treatment. Eight patients had persistent thrombus despite a full treatment course (89% success rate in those able to complete treatment). Of patients treated with unfractionated heparin as initial therapy, 46% (17/37) achieved a therapeutic partial thromboplastin time within 12 hr with 19% (67/343) of all levels therapeutic. As a result, the CPP was modified to use enoxaparin as first line agent, of which 57% (41/72) had a therapeutic anti-Xa level after the 2nd dose and 88% by the 4th dose. No bleeding complications were observed. A priori established process metrics were achieved. CONCLUSIONS A CPP utilizing early initiation of anticoagulation and US to aid diagnosis of postcatheterization arterial thrombus and response to therapy is feasible and effective. In those able to complete up to 12 weeks of treatment, resolution occurs in nearly 90%. © 2014 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Andrew C Glatz
- Division of Cardiology, Children's Hospital of Philadelphia; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
Lower limb ischaemia is the most frequent complication of cardiac catheterisation in children. It is often overlooked, but it can cause significant disability and may limit arterial access sites to repeat diagnostic or interventional catheterisations. A narrative review of the literature on arterial access site thrombosis in children was carried out with a special focus on current evidence that supports preventive and treatment strategies. Anticoagulation, thrombolysis, and thrombectomy have been used successfully to treat arterial access site thrombosis. However, it is not completely established which is the role of each treatment modality and what is the most appropriate timing to deliver it. Therefore, diagnostic and therapeutic strategies have to be prospectively investigated, particularly for clarifying the role of new pharmacologic interventions and of percutaneous and surgical thrombectomy in the current era.
Collapse
|
9
|
Prabhu SJ, Padia SA, Valji K, McNeeley MF, Vaidya S, Vo NJ. Arterial closure device to achieve hemostasis in children following percutaneous femoral arterial puncture. Pediatr Radiol 2013; 43:703-8. [PMID: 23321700 DOI: 10.1007/s00247-012-2606-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 11/06/2012] [Accepted: 11/15/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Percutaneous arterial closure devices have increasingly entered clinical practice to assist in achieving femoral arterial access site hemostasis. Prior studies have demonstrated the safety and efficacy of several arterial closure devices in adults. OBJECTIVE To evaluate the efficacy of using an arterial closure device in children. MATERIALS AND METHODS A retrospective review of all children (defined as younger than 18 years) undergoing device-assisted closure of their percutaneous femoral arterial access site was conducted. Patient demographics, the clinical indications for use of the arterial closure device and pre-procedural laboratory parameters were noted. The accessed common femoral artery diameter and largest procedural sheath size were recorded. The technical success rate for device deployment and rates of immediate and delayed complications including hemorrhage, access site or retroperitoneal hematoma, access site infection, arterial thromboembolism, pseudoaneurysm or arteriovenous fistulae were documented. RESULTS Between June 2009 and June 2011, an arterial closure device was deployed with intent to achieve hemostasis in percutaneous femoral arterial access punctures in 38 consecutive children. The mean common femoral artery diameter was 0.70 ± 0.13 cm. Device deployment was technically successful in 37/38 (97.4%) procedures. There was a single complication (2.6%), a small access site hematoma. No other immediate or delayed complications occurred. CONCLUSION The use of a percutaneous arterial closure device can be an efficacious method for achieving immediate femoral arterial access site hemostasis with few complications in children who have undergone percutaneous femoral arterial access procedures.
Collapse
Affiliation(s)
- Somnath J Prabhu
- Department of Radiology, Division of Interventional Radiology, University of Washington, Seattle, WA, USA
| | | | | | | | | | | |
Collapse
|
10
|
Glatz AC, Shah SS, McCarthy AL, Geisser D, Daniels K, Xie D, Hanna BD, Grundmeier RW, Gillespie MJ, Rome JJ. Prevalence of and risk factors for acute occlusive arterial injury following pediatric cardiac catheterization: A large single-center cohort study. Catheter Cardiovasc Interv 2013; 82:454-62. [DOI: 10.1002/ccd.24737] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 10/29/2012] [Indexed: 11/05/2022]
Affiliation(s)
| | - Samir S. Shah
- Divisions of Hospital Medicine and Infectious Diseases; Cincinnati Children's Hospital Medical Center
| | - Ann L. McCarthy
- Division of Cardiology; Children's Hospital of Philadelphia; Philadelphia
| | | | - Kaitlyn Daniels
- Division of Cardiology; Children's Hospital of Philadelphia; Philadelphia
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics; Perelman School of Medicine at the University of Pennsylvania; Pennsylvania
| | | | - Robert W. Grundmeier
- Center for Biomedical Informatics; Children's Hospital of Philadelphia; Philadelphia
| | | | | |
Collapse
|
11
|
Abstract
Background: In selected neonates and infants, primary palliative stent implantation may be indicated for coarctation of the aorta. We describe our experience with this approach in five consecutive patients. Methods: Five neonates and infants (age range 6 to 68 days, gestation 33 to 38 weeks, weight range at procedure of between 1650 to 4000 g) underwent palliative stent implantation as primary therapy for coarctation of the aorta. Indications for primary stent implantation were varied. All procedures were performed by elective surgical cut down of the axillary artery. Standard coronary stents (diameter 4.5 to 5 mm, length 12 to 16 mm) were delivered via a 4F sheath. The axillary artery was repaired after removal of the sheath. Results: All procedures were acutely successful, and without procedural complications. All patients survived to hospital discharge. Four patients have subsequently undergone elective stent removal and surgical repair of the arch, at between 38 and 83 days following stent implantation. Complete stent removal was achieved in three patients. Over a follow-up ranging between 8 weeks and 36 months, none of the patients has had any further complications. Conclusions: This palliative approach is warranted in carefully selected patients. Long-term follow-up is required.
Collapse
Affiliation(s)
- Isabel Sreeram
- Department of Paediatric Cardiology, University Hospital of Cologne, Germany
| | | | | |
Collapse
|
12
|
Viswanathan S, Arthur R, Evans J, Truscott J, Thomson J, Gibbs J. The early and mid-term fate of the axillary artery following axillary artery cut-down and cardiac catheterization in infants and young children. Catheter Cardiovasc Interv 2012; 80:1183-9. [DOI: 10.1002/ccd.23476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 10/06/2011] [Accepted: 10/29/2011] [Indexed: 11/07/2022]
|
13
|
Gorenflo M, Boshoff DE, Heying R, Eyskens B, Rega F, Meyns B, Gewillig M. Bailout stenting for critical coarctation in premature/critical/complex/early recoarcted neonates. Catheter Cardiovasc Interv 2010; 75:553-61. [PMID: 20146315 DOI: 10.1002/ccd.22328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Surgical repair of critical coarctation can be problematic in premature, critical, complex, or early postoperative neonates. OBJECTIVES We aimed to review our experience with stent implantation to defer urgent surgery to an elective time. METHODS Fifteen neonates with severe aortic coarctation: five premature-hypotrophic (1,400-2,000 g), six critical and complex cardiac malformation, four early (1 day [0-2 days]; median [range]) after surgical coarctectomy or complex arch reconstruction. Bare coronary stents (diameter 4.0 [3.5-5.0] mm; length 10 [8-16] mm) were used. Stents were removed surgically depending on clinical needs. RESULTS Adequate aortic flow was obtained in 15 patients. The femoral artery was preserved in 13/15 patients. Two deaths occurred before stent removal and were nonprocedure related. In patients with simple stented coarctation, the stent was removed after 2.8 [0.2-5.0] months. In complex cardiac malformation, stents were finally removed 3.0 [0.2-78] months after implantation. SURGICAL TECHNIQUE simple coarctectomy end-to-end in eight, extensive arch patch reconstruction in four. One patient is awaiting stent removal. The final maximum systolic velocity (cw-Doppler) across the aortic arch was 1.7 [1.2-2.5] m/sec. CONCLUSIONS In premature/critical/complex neonates with severe coarctation, bailout stenting followed by early or late surgical coarctectomy appears a promising concept.
Collapse
Affiliation(s)
- Matthias Gorenflo
- Paediatric Cardiology, University Clinic Leuven, Leuven B 3000, Belgium
| | | | | | | | | | | | | |
Collapse
|
14
|
Rao PS. Transcatheter interventions in critically ill neonates and infants with aortic coarctation. Ann Pediatr Cardiol 2009; 2:116-9. [PMID: 20808623 PMCID: PMC2922658 DOI: 10.4103/0974-2069.58312] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- P Syamasundar Rao
- Address for correspondence: Dr. P Syamasundar Rao, Division of Pediatric Cardiology, The University of Texas/Houston Medical School, 6410 Fannin Street, UTPB Suite # 425, Houston, TX 77030, USA. E-mail:
| |
Collapse
|
15
|
Garty Y, Benson L. Cutting balloon recanalization for femoral artery stenosis in a child: a case report. Catheter Cardiovasc Interv 2005; 65:66-8. [PMID: 15800895 DOI: 10.1002/ccd.20323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A chronic femoral artery stenosis associated with an ipsilateral leg length discrepancy was found resistant to high-pressure balloon angioplasty. Improvement in vessel caliber and relief of the stenosis were achieved after a cutting balloon.
Collapse
Affiliation(s)
- Yael Garty
- Department of Pediatrics, Division of Cardiology, Hospital for Sick Children, University of Toronto School of Medicine, Toronto M5G 1X8, Canada
| | | |
Collapse
|
16
|
Kröger K, Nettelrodt J, Müntsches C, Neudorf U, Feuersenger A, Rudofsky G, Schmalz AA. Impact of Age, Height, and Body Mass Index on Arterial Diameters in Infants and Children:A Model for Predicting Femoral Artery Diameters Prior to Cardiovascular Procedures. J Endovasc Ther 2004; 11:419-23. [PMID: 15298513 DOI: 10.1583/03-1163.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To measure common femoral artery (CFA) diameters in infants and children referred for cardiac catheterization and investigate if CFA diameters can be predicted upon the basis of age, body mass index (BMI), and height. METHODS CFA diameters were measured in 84 infants and children (50 boys; age range 1- 220 months) referred for diagnostic or therapeutic cardiac interventions. Sonographic measurements were made in a supine position utilizing a 7.5-MHz linear transducer; diameters were defined as the intima to intima distance. Age was described in months and height in centimeters. The Spearman correlation coefficient (rho) was used to test the similarity of diameters between sides; the Pearson correlation coefficient (r) was used to analyze the influence of age, height, and BMI on CFA diameter. RESULTS Diameters of the right and left CFA were similar (rho=0.951). Age and height were highly correlated (rho=0.956), but not BMI and height (rho=0.279). The best model was CFA diameter = -0.838 + 0.031 height + 0.046 BMI. Height was the most relevant determinant for CFA diameter (p<0.0001, 90% CI 0.027 to 0.036; BMI: p=0.093, 90% CI 0.001 to 0.090, and the intercept: p=0.032, 90% CI-1.475 to-0.200). CONCLUSIONS Common femoral artery diameter can be sufficiently predicted from height and BMI of infants and children prior to femoral catheterization or surgical reconstruction.
Collapse
Affiliation(s)
- Knut Kröger
- Department of Angiology, Biometry and Epidemiology, University of Essen, Germany.
| | | | | | | | | | | | | |
Collapse
|
17
|
Balaguru D, Dilawar M, Ruff P, Radtke WAK. Early and late results of thrombolytic therapy using tissue-type plasminogen activator to restore arterial pulse after cardiac catheterization in infants and small children. Am J Cardiol 2003; 91:908-10. [PMID: 12667589 DOI: 10.1016/s0002-9149(03)00037-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Duraisamy Balaguru
- Children's Heart Center, Medical University of South Carolina, Charleston 29425, USA
| | | | | | | |
Collapse
|
18
|
|
19
|
Affiliation(s)
- C Duke
- Department of Congenital Heart Disease, Guy's Hospital, St. Thomas Street, London SE1 9RT, United Kingdom
| | | |
Collapse
|
20
|
Alcibar J, Peña N, Oñate A, Cabrera A, Galdeano JM, Pastor E, Inguanzo R, Vitoria Y, Gómez S, Arana JI, Barrenechea JI. [Primary stent implantation in aortic coarctation: mid-term follow-up]. Rev Esp Cardiol 2000; 53:797-804. [PMID: 10944972 DOI: 10.1016/s0300-8932(00)75160-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The use of balloon-expandable stents provides an effective alternative therapy in patients with stenotic lesions in congenital heart disease. Stents implantation has served to improve the results and to reduce complications of balloon angioplasty for coarctation and recoarctation of the aorta. OBJECTIVE We report our results after primary stents implantation for coarctation and recoarctation of the aorta. PATIENTS AND METHODS Balloon-expandable stents were implanted in 14 patients (mean age 20 +/- 12 years) with coarctation of the aorta (11 native and 3 postoperative); 2 patients had associated malformations. The morphology varied: 10 resembled a located-diaphragm (one of them with moderate arch hypoplasia); 2 had distorted coarctation and 2 had a complete aortal obstruction. Five patients were hypertensive and 1 had cardiogenic shock and severe arrhythmias which did not respond to intensive medical therapy. In all cases 14 Palmaz stents (7 P308 and 7 P4014) were implanted with the primary technique through a Mullin's sheath. The balloon-to-descending aorta diameter ratio, measured at the level of the diaphragm, was 1. A special technique was carried out in the 2 cases with complete aortal obstruction. RESULTS The procedure was effective in all 14 cases. The coarctation diameter increased from 4 +/- 2 to 15 +/- 2 mm (p < 0.0001) and transcoarctation systolic pressure gradient decreased from 43 +/- 19 to 2 +/- 2 mmHg (p < 0.0001). The ratio of the coarctation to descending aorta diameter measured at the level of the diaphragma increased from 0.3 +/- 0.1 to 0.95 +/- 0.05 (p < 0.001). At 19 +/- 8 months follow up, all patients showed sustained clinical improvement. The patient with complete aortal obstruction experienced a dramatic improvement, but she died from a sudden cardiac event 22 months after the procedure. At angiographic follow up in 7 patients, 1 year after implantation, no recoarctation was observed with secondary vessels patent, and absence of restenosis. CONCLUSIONS a) Percutaneous endovascular stents implantation in coarctation and recoarctation of the aorta may become an effective treatment modality in the older child, adolescent and adults; b) stents are particularly attractive in those patients with a more complex anatomy and higher surgical risk; c) primary stenting is expected to have a lower rate of complications, and d) we describe a special technique with a right femoral-left humeral arterial circuit that is successfully applied to patients with complete aortal obstruction.
Collapse
Affiliation(s)
- J Alcibar
- Sección de Hemodinámica, Hospital de Cruces, Vizcaya
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Rao PS. Long-term follow-up results after balloon dilatation of pulmonic stenosis, aortic stenosis, and coarctation of the aorta: a review. Prog Cardiovasc Dis 1999; 42:59-74. [PMID: 10505493 DOI: 10.1016/s0033-0620(99)70009-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although immediate and intermediate-term results after balloon dilatation of congenital stenotic lesions of the heart in children are well studied, long-term results have not been documented. Therefore, we reviewed our experience along with the limited published data to address this issue. Late follow-up after balloon pulmonary and aortic valvuloplasty shows low-residual gradients, reintervention-free rates in the mid-80s for pulmonic and in the mid-50s for aortic stenosis, and an increase in degree and prevalence of similunar valve insufficiency. Balloon angioplasty of aortic coarctation results in low-residual gradients, residual hypertension in a minority of patients, low prevalence of aneurysms, and high rates of recurrence in the neonate and young infant. Overall, balloon dilatation is a useful technique in relieving congenital obstructive lesions of the heart in the pediatric patient, but continued study of (1) late pulmonary and aortic insufficiency after valvuloplasty, (2) recurrence and aneurysms after balloon angioplasty of coarctations and, (3) femoral artery compromise in lesions requiring transfemoral artery approach is warranted.
Collapse
Affiliation(s)
- P S Rao
- Division of Pediatric Cardiology, Saint Louis University School of Medicine/Cardinal Glennon Children's Hospital, MO 63104-1095, USA.
| |
Collapse
|
22
|
Rao PS, Jureidini SB. Transumbilical venous, anterograde, snare-assisted balloon aortic valvuloplasty in a neonate with critical aortic stenosis. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 45:144-8. [PMID: 9786391 DOI: 10.1002/(sici)1097-0304(199810)45:2<144::aid-ccd8>3.0.co;2-c] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Balloon aortic valvuloplasty is an acceptable alternative to surgery in the treatment of critical aortic stenosis in the neonate. In this report, we describe a 1-day-old infant with critical aortic stenosis who was successfully treated with an anterograde, transumbilical venous, snare-assisted balloon aortic valvuloplasty. Based on this experience, it is suggested that the anterograde transumbilical venous approach is a feasible and effective alternative to retrograde femoral, carotid, or umbilical arterial and transfemoral venous anterograde routes for performing balloon aortic valvuloplasty in the neonate.
Collapse
Affiliation(s)
- P S Rao
- Department of Pediatrics, Saint Louis University School of Medicine/Cardinal Glennon Children's Hospital, Missouri 63104-1095, USA.
| | | |
Collapse
|
23
|
|