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Nakata T, Tachi M, Yasuda K, Nakashima S, Minamoto T, Yamazaki K. Double-Outlet Right Ventricle With Intact Ventricular Septum and Left Atrioventricular Valve Regurgitation in a Patient With Right Atrial Isomerism. World J Pediatr Congenit Heart Surg 2024:21501351241269948. [PMID: 39234681 DOI: 10.1177/21501351241269948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
We present a very rare case of right atrial isomerism, double-outlet right ventricle, and incomplete atrioventricular septal defect (intact ventricular septum). In the neonatal period, the right ventricle was compressed by a "blind-ended" left ventricle with mild-to-moderate left atrioventricular valve regurgitation. The regurgitation gradually decreased from mild-to-moderate to mild with body weight gain. The patient underwent systemic-to-pulmonary shunt at three months of age and bilateral bidirectional Glenn at eight months of age. Although the echocardiogram demonstrated that the right ventricle was still compressed by the left ventricle, over time the size of the left ventricle reduced significantly and the left atrioventricular valve regurgitation became trivial.
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Affiliation(s)
- Tomohiro Nakata
- Department of Cardiovascular Surgery, Shimane University Faculty of Medicine, Shimane, Japan
| | - Maiko Tachi
- Department of Cardiovascular Surgery, Shimane University Faculty of Medicine, Shimane, Japan
| | - Kenji Yasuda
- Department of Pediatrics, Shimane University Faculty of Medicine, Shimane, Japan
| | - Shigeki Nakashima
- Department of Pediatrics, Shimane University Faculty of Medicine, Shimane, Japan
| | - Toshiko Minamoto
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Kazuhiro Yamazaki
- Department of Cardiovascular Surgery, Shimane University Faculty of Medicine, Shimane, Japan
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Wong-Siegel JR, Petit CJ, Glatz AC. Pulmonary Atresia and Ventricular Septal Defect Without Major Aortopulmonary Collateral Arteries: Diagnostic Evaluation and the Role of Ductal Stenting. World J Pediatr Congenit Heart Surg 2024:21501351241269953. [PMID: 39234694 DOI: 10.1177/21501351241269953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Patients with pulmonary atresia (PA) and a ventricular septal defect (VSD), similar to those with tetralogy of Fallot and PA without major aortopulmonary collateral arteries, lack antegrade pulmonary blood flow, and thus require a neonatal intervention for stabilization or augmentation of pulmonary blood flow. The role of ductal stenting in the management of these patients, and the current literature supporting it, will be reviewed.
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Affiliation(s)
- Jeannette R Wong-Siegel
- Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Christopher J Petit
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Andrew C Glatz
- Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
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Fitzgerald N, Adams P, Mervis J, Webb A, Roberts P, Ayer J. A Comparison of Ductal Stenting and Surgical Shunts for Infants with Duct-Dependent Pulmonary Blood Flow: The Impact of Single Versus Biventricular Repair Pathways on Outcomes. Pediatr Cardiol 2024:10.1007/s00246-024-03549-y. [PMID: 38953954 DOI: 10.1007/s00246-024-03549-y] [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: 03/13/2024] [Accepted: 06/10/2024] [Indexed: 07/04/2024]
Abstract
Ductal stenting (DS) is an alternative to the Blalock-Taussig-Thomas Shunt (BTTS) as initial palliation for congenital heart disease with duct-dependent pulmonary blood flow (DDBPF). We sought to analyze the impact of intended single ventricle (SV) and biventricular (BiV) repair pathways on the outcome of DS and BTTS in infants with DDPBF. A single-center, retrospective comparison of infants with DDPBF who underwent either DS (2012-2022) or BTTS procedures (2013-2017). Primary outcomes included all-cause mortality and risk of unplanned re-intervention. Participants were divided into four groups: 1.SV with DS, 2.SV with BTTS, 3.BiV with DS, and 4.BiV with BTTS. Fifty-one DS (SV 45%) and 86 BTTS (SV 49%) procedures were undertaken. For those who had DS, mortality was lower in the BiV compared to SV patients (BiV: 0/28, versus SV: 4/23, p = 0.04). Compared to BiV DS, BiV BTTS had a higher risk of combined death or unplanned re-intervention (HR 4.28; CI 1.25-14.60; p = 0.02). In SV participants, there was no difference for either primary outcome based on procedure type. DS was associated with shorter intensive care length of stay for SV participants (mean difference 5 days, p = 0.01) and shorter intensive care and hospital stay for BiV participants (mean difference 11 days for both outcomes, p = 0.001). There is a survival benefit for DS in BiV participants compared with DS in SV and BTTS in BiV participants. Ductal stenting is associated with a shorter intensive care and hospital length of stay.
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Affiliation(s)
- Nicholas Fitzgerald
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia.
- The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Westmead, NSW, 2145, Australia.
| | - Paul Adams
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Jonathan Mervis
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Faculty of Health Sciences, Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, NSW, Australia
| | - Annabel Webb
- Faculty of Health Sciences, Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, NSW, Australia
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
| | - Philip Roberts
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Julian Ayer
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Faculty of Health Sciences, Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, NSW, Australia
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Prakoso R, Simanjorang CNS, Kurniawati Y, Mendel B, Rahmat B, Zahara R, Rudiktyo E, Sakti DDA, Sukmawan R. Ductal stenting vs. surgical shunting in late presenting duct-dependent pulmonary circulation: a single-center experience. Front Cardiovasc Med 2024; 11:1382879. [PMID: 38707893 PMCID: PMC11066280 DOI: 10.3389/fcvm.2024.1382879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction PDA stenting is an option to mBTT shunt for younger patients; nevertheless, few reports of this palliative approach have been made for the late presenter population, especially for patients who are older than 30 days but under 5 years. This study aimed to evaluate the clinical result and intra-hospital costs of ductal stenting in late-presenting patients in comparison to surgical shunting. Methods A single-center, retrospective cohort study was conducted from August 2016 to August 2022. This study included patients with pulmonary duct dependent CHD who were hospitalized for palliative therapy. The extracted data were baseline characteristics, clinical findings, supportive examination findings, complications, outcomes, and length of stay of the patients. Monitoring was carried out during treatment up to 30 days after the procedure. Results A total of 143 patients were included in the analysis; 43 patients underwent PDA stent and 100 patients underwent mBTT shunt with median age of PDA stent group 110 (31-1,498) days and mBTT shunt group 174.5 (30-1,651) days. Primary outcome composite was not significant in both groups including 30 days mortality [6 (14%) vs. 14 (14%), p = 1.000], reintervention [1 (2.3%) vs. 7 (7%), p = 0.436], and 30 days rehospitalization [0 (0%) vs. 2 (2%), p = 0.319]. Secondary outcome analysis showed shorter ICU length of stay in the PDA stent group [2 (0-16) days vs. 4 (1-63) days, p = 0.002]. Conclusions PDA stent has an outcome that is non inferior from the mBTT shunt procedure in the composite outcome including 30 days mortality, reintervention, and 30 days rehospitalization but significantly lower in ICU length of stay.
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Affiliation(s)
- Radityo Prakoso
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | | | - Yovi Kurniawati
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Brian Mendel
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Sultan Sulaiman Government Hospital, Serdang Bedagai, Indonesia
| | - Budi Rahmat
- Division of Pediatric and Congenital Heart Surgery, Department of Surgery, National Cardiovascular Centre of Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Rita Zahara
- Division of Intensive and Cardiovascular Care, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Estu Rudiktyo
- Division of Non-Invasive Diagnostic and Cardiovacular Imaging, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Damba Dwisepto Aulia Sakti
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Renan Sukmawan
- Division of Non-Invasive Diagnostic and Cardiovacular Imaging, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
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Bauser-Heaton H, Price K, Weber R, El-Said H. Erratum: Stenting of the Patent Ductus Arteriosus: A Meta-analysis and Literature Review. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101052. [PMID: 39131650 PMCID: PMC11307754 DOI: 10.1016/j.jscai.2023.101052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/18/2022] [Accepted: 06/01/2022] [Indexed: 08/13/2024]
Abstract
[This corrects the article DOI: 10.1016/j.jscai.2022.100392.][This corrects the article DOI: 10.1016/j.jscai.2023.101051.].
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Affiliation(s)
- Holly Bauser-Heaton
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Katherine Price
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California
| | - Rachel Weber
- Division of Pediatric Cardiology, Rady Children’s Hospital and University of California San Diego School of Medicine, San Diego, California
| | - Howaida El-Said
- Division of Pediatric Cardiology, Rady Children’s Hospital and University of California San Diego School of Medicine, San Diego, California
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Bauser-Heaton H, Price K, Weber R, El-Said H. Stenting of the Patent Ductus Arteriosus: A Meta-analysis and Literature Review. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100392. [PMID: 39132356 PMCID: PMC11308046 DOI: 10.1016/j.jscai.2022.100392] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/18/2022] [Accepted: 06/01/2022] [Indexed: 08/13/2024]
Abstract
Background Patent ductus arteriosus (PDA) stent placement and systemic-pulmonary surgical shunt procedure can both be performed as palliation for infants with duct-dependent pulmonary circulation. The aim of this meta-analysis and literature review was to compare outcomes and study populations between the 2 methods as well as review the technical considerations and complications of PDA stenting. Methods A systematic search was conducted using the PubMed database and meta-analysis was performed. Risk ratio and mean difference were used to compare the reported outcomes of studies across patients receiving PDA stent and surgical shunt. Results In total, 1094 patients from 8 comparative observational studies were included. The PDA stent group had a lower mortality rate and a shorter hospital length of stay than the systemic-pulmonary surgical shunt group, although at the expense of increased reintervention rates. There were higher proportions of patients with single-ventricle physiology and single-source pulmonary blood flow in the surgical shunt group. Conclusions PDA stenting appears to be a noninferior or possibly superior method of palliation for duct-dependent pulmonary circulation compared with systemic-pulmonary surgical shunt, recognizing, however, that patients receiving surgical shunt more often had single-ventricle physiology or single-source pulmonary blood flow in this meta-analysis.
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Affiliation(s)
- Holly Bauser-Heaton
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Katherine Price
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California
| | - Rachel Weber
- Division of Pediatric Cardiology, Rady Children’s Hospital and University of California San Diego School of Medicine, San Diego, California
| | - Howaida El-Said
- Division of Pediatric Cardiology, Rady Children’s Hospital and University of California San Diego School of Medicine, San Diego, California
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Alsoufi B. The Challenges of Swimming Against the Tide. World J Pediatr Congenit Heart Surg 2021; 12:527-528. [PMID: 34278868 DOI: 10.1177/21501351211013707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bahaaldin Alsoufi
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, 24931Norton Children's Hospital, Louisville, KY, USA
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