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Liu L, Luo Y, Deng Y, Liang Y, Xie L. Echocardiographic findings and pregnancy outcomes for fetuses with complete closure of the ductus arteriosus. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:737-744. [PMID: 38662985 DOI: 10.1002/jcu.23701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE We aimed to analyze the echocardiographic characteristics and pregnancy outcomes for fetuses with premature complete closure of the fetal ductus arteriosus. METHODS A retrospective analysis was performed for eight cases of premature ductus arteriosus closure diagnosed by prenatal ultrasonography in the Hunan Maternal and Child Health Hospital from July 2019 to August 2022, and the characteristics of fetal echocardiography and pregnancy outcomes of the eight cases were analyzed and summarized. RESULTS In all cases, the intima of the ductus arteriosus was thickened and occluded, the ductus arteriosus could be seen with slightly hyperechogenic, and no blood flow signal was found in the ductus arteriosus by Doppler ultrasonography. The right heart was enlarged in seven cases, and the whole heart was enlarged in one case. Tricuspid valve regurgitation was observed to different degrees, of which seven cases were severe and one case was moderate. The pulmonary arteries of eight patients had varying degrees of widening. All eight cases were delivered by cesarean section, and one newborn died after follow-up. The prognosis of the other newborns was good. CONCLUSION The parameters of prenatal echocardiography are helpful for the prognosis of fetuses with premature closure of the ductus arteriosus. Early prenatal detection, close observation, and clinical guidance can be used to select the right time of delivery.
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Affiliation(s)
- Lixia Liu
- Department of Ultrasound, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Yingchun Luo
- Department of Ultrasound, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Ying Deng
- Department of Ultrasound, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Yanling Liang
- Department of Ultrasound, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Lulu Xie
- Department of Ultrasound, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
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Abdul Latiff H, Gopal AR, Hidayat ZF, Haranal M, Borhanuddin BK, Alwi M, Samion H. Ductus arteriosus morphology in duct-dependent pulmonary circulation: CT classification and pattern in different ventricular morphology. Cardiol Young 2023; 33:2243-2251. [PMID: 36651340 DOI: 10.1017/s1047951122004218] [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: 01/19/2023]
Abstract
BACKGROUND The objective was to study the ductus arteriosus morphology in duct-dependent pulmonary circulation and its pattern in different ventricle morphology using CT angiography. METHOD From January 2013 to December 2015, patients aged 6 months and below with duct-dependent pulmonary circulation underwent CT angiography to delineate the ductus arteriosus origin, tortuosity, site of insertion, and pulmonary artery anatomy. The ductus arteriosus were classified into type I, IIa, IIb, and III based on its site of origin, either from descending aorta, distal arch, proximal arch, or subclavian artery, respectively. RESULTS A total of 114 patients and 116 ductus arteriosus (two had bilateral ductus arteriosus) were analysed. Type I, IIa, IIb, and III ductus arteriosus were seen in 13 (11.2 %), 71 (61.2%), 21 (18.1%), and 11 (9.5%), respectively. Tortuous ductus arteriosus was found in 38 (32.7%), which was commonly seen in single ventricular lesions. Ipsilateral and bilateral branch pulmonary artery stenosis was seen in 68 (59.6%) and 6 (5.3%) patients, respectively. The majority of patients with pulmonary atresia intact ventricular septum had type I (54.4%) and non-tortuous ductus arteriosus, while those with single and biventricular lesions had type II ductus arteriosus (84.9% and 89.7%, respectively). Type III ductus arteriosus was more common in biventricular lesions (77.8%). CONCLUSIONS Ductus arteriosus in duct-dependent pulmonary circulation has a diverse morphology with a distinct origin and tortuosity pattern in different types of ventricular morphology. CT may serve as an important tool in case selection and pre-procedural planning for ductal stenting.
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Affiliation(s)
- Haifa Abdul Latiff
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Anu Ratha Gopal
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Zul Febrianti Hidayat
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Maruti Haranal
- Department of Cardiac Surgery, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Boekren K Borhanuddin
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Mazeni Alwi
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Hasri Samion
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
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3
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Meliota G, Vairo U. Transcatheter Interventions for Neonates with Congenital Heart Disease: A Review. Diagnostics (Basel) 2023; 13:2673. [PMID: 37627932 PMCID: PMC10453781 DOI: 10.3390/diagnostics13162673] [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: 05/25/2023] [Revised: 06/28/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Newborns with congenital heart disease often require interventions linked to high morbidity and mortality rates. In the last few decades, many transcatheter interventions have become the first-line treatments for some critical conditions in the neonatal period. A catheter-based approach provides several advantages in terms of procedural time, length of hospitalization, repeatability and neurodevelopmental issues (usually related to cardiopulmonary bypass). The main transcatheter procedures will be reviewed, as they are now valid alternatives to conventional surgical management.
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Affiliation(s)
- Giovanni Meliota
- Pediatric Cardiology, Giovanni XXIII Pediatric Hospital, 70126 Bari, Italy;
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Vasquez Choy AL, Zonana Amkie R, Adebo DA. Role of Cardiac CTA to Evaluate Branch Pulmonary Artery Stenosis and Ductal Insertion Pattern in Right-Sided Congenital Heart Defects. Pediatr Cardiol 2023:10.1007/s00246-023-03234-6. [PMID: 37477698 DOI: 10.1007/s00246-023-03234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Abstract
There is limited experience in evaluating abnormal ductus arteriosus (DA) insertion pattern by contrast-enhanced cardiac computed tomography (cardiac CT) in patients with right-sided obstructive cardiac defects. Retrospective review of 38 infants with right-sided obstructive cardiac defects who underwent a preoperative cardiac CT between 2016 and 2021. We reviewed the types of cardiac lesions, patterns of ductal insertion, frequency of pulmonary artery (PA) stenosis requiring intervention, total dose length product (DLP), and effective radiation dose. Of 38 infants, 45% were female, the median gestational age and weight were 37 (range 34-40) weeks and 2.95 (range 2-4) kg. The most common pathologies were pulmonary atresia with ventricular septal defect (24%) and tetralogy of Fallot (24%). The abnormal ductal insertion patterns were DA inserting into the left PA in 39%, DA bifurcating into branch PA in 32%, and DA inserting into the right PA in 13%. Of the 38 infants, 76% developed branch PA stenosis requiring intervention. Among patients with abnormal DA insertion, 44% required branch PA arterioplasty during their index surgery compared to 17% without abnormal DA insertion. Regardless of the type of abnormal DA insertion, 67% developed bilateral branch PA stenosis over time. The mean DLP was 8 mGy-cm and the mean calculated effective radiation dose was 0.312 mSv. The utilization of contrast-enhanced cardiac CT in infants with right-sided obstructive heart defects can offer crucial insights into abnormal ductus arteriosus insertion patterns. This information is valuable for effective procedure planning and for monitoring the development of branch pulmonary artery stenosis.
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Affiliation(s)
- Ana L Vasquez Choy
- Division of Pediatric Cardiology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, 6410 Fannin Street, UTPB Suite 425, Houston, TX, 77030, USA.
| | - Rafael Zonana Amkie
- Division of Pediatric Cardiology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, 6410 Fannin Street, UTPB Suite 425, Houston, TX, 77030, USA
| | - Dilachew A Adebo
- Section of Pediatric Cardiac MRI And Pediatric Cardiac CT, Division of Pediatric Cardiology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
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Hammett O, Griksaitis MJ. Management of tetralogy of Fallot in the pediatric intensive care unit. Front Pediatr 2023; 11:1104533. [PMID: 37360374 PMCID: PMC10285149 DOI: 10.3389/fped.2023.1104533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/26/2023] [Indexed: 06/28/2023] Open
Abstract
Tetralogy of Fallot (ToF) is one of the most common congenital cyanotic heart lesions and can present to a variety of health care professionals, including teams working in pediatric intensive care. Pediatric intensive care teams may care for a child with ToF pre-operatively, peri-operatively, and post-operatively. Each stage of management presents its own unique challenges. In this paper we discuss the role of pediatric intensive care in each stage of management.
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Affiliation(s)
- Owen Hammett
- Paediatric Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Dorset and Somerset Air Ambulance, South Western Ambulance Service NHS Foundation Trust, Exeter, United Kingdom
| | - Michael J. Griksaitis
- Paediatric Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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Kakucs Z, Heidenhoffer E, Pop M. Detection of Coronary Artery and Aortic Arch Anomalies in Patients with Tetralogy of Fallot Using CT Angiography. J Clin Med 2022; 11:jcm11195500. [PMID: 36233367 PMCID: PMC9570993 DOI: 10.3390/jcm11195500] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/17/2022] [Accepted: 09/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease (CHD). Furthermore, the prevalence of anomalous origin of a coronary artery is higher in patients with TOF than in the general population (6% vs. ≤1%). Preoperative assessment of cardiovascular anatomy using computed tomography (CT) angiography enables the adaptation of the surgical approach to avoid potentially overlooked anomalies. Our purpose was to determine the prevalence of coronary artery and aortic arch anomalies in a cohort of TOF patients. Methods: In this retrospective analysis, data were collected from CT reports (2015–2021) of 105 TOF patients. All images were acquired using a 64-slice multi-detector CT (MDCT) scanner. Results: The median age of the patients was 38.7 months, with a male-to-female ratio of 1.39. The overall prevalence of coronary artery anomalies (CAAs) was 7.61% (8 of 105 cases). The anomalous origin and course of coronary arteries across the right ventricular outflow tract (RVOT; prepulmonic course) were defined in 5.71% of cases (six patients). In four of these, the left anterior descending artery (LAD) originated from the right coronary artery (RCA), while in two cases, the RCA arose from the LAD. In the remaining two patients, the coronary arteries followed an interarterial course. The most frequent anomalous aortic arch pattern in the overall TOF population was the right aortic arch (RAA) with mirror image branching, seen in 20% of patients (21 cases). The most frequent anomaly of the supra-aortic trunks was bovine configuration, found in 17.14% (18 cases). Conclusions: The prevalence of CAAs and aortic arch anomalies detected by CT angiography was in line with the data reported in anatomical specimens. Therefore, this technique represents a powerful tool for the evaluation of congenital cardiovascular anomalies.
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Affiliation(s)
- Zsófia Kakucs
- Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania
- Correspondence: (Z.K.); (E.H.)
| | - Erhard Heidenhoffer
- Clinical County Hospital Mures, 540103 Targu Mures, Romania
- Correspondence: (Z.K.); (E.H.)
| | - Marian Pop
- ME1 Department, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
- Emergency Institute for Cardiovascular Disease and Transplant of Targu Mures, 540136 Targu Mures, Romania
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Sun L, Li JJ, Xu YK, Xie YM, Wang SS, Zhang ZW. Initial status and 3-month results relating to the use of biodegradable nitride iron stents in children and the evaluation of right ventricular function. Front Cardiovasc Med 2022; 9:914370. [PMID: 35979021 PMCID: PMC9376250 DOI: 10.3389/fcvm.2022.914370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/05/2022] [Indexed: 11/15/2022] Open
Abstract
Background Pulmonary artery stenosis is often associated with congenital heart disease. The aim of the study was to evaluate the efficacy and safety of stenting for branch pulmonary artery stenosis using a biodegradable nitride iron stent (IBS® Angel™) and right ventricular systolic and diastolic function. Methods From July 2021 to February 2022, a total of 11 cases (ages ranged from 36 to 86 months old) were included in this pre and post-intervention, prospective, cohort and preclinical study. All cases underwent transthoracic echocardiographic (TTE), chest radiography, along with computed tomography (256-slice scanner, multiple-detector) and right heart catheterization. Different types of biodegradable nitride iron stents were implanted. TTE was performed serially 1 day, 1 month and 3 months after the procedure to evaluate the rate of restenosis and right ventricular function. Results Stenting was successful in 11 patients. There were no major adverse cardiovascular events related to the device or to the procedure. Blood perfusion in the branch pulmonary artery was improved immediately. At follow-up, there was no significant restenosis that required re-intervention. None of the patients suffered from in-stent thrombosis, vascular embolism, stent displacement or heart failure. Compared with normal values, there were statistical with regards to FAC, E/A and E′/A′. Furthermore, we found that TAPSE correlated significantly with pulsed Doppler S wave (p = 0.008) and left ventricular ejection fraction (p < 0.01). The early trans-tricuspid inflow velocities E/E′ (tissue doppler at the lateral tricuspid annulus) correlated significantly with E′/A′ (p = 0.009). FAC and E′/A′ were statistically different from those prior to stenting (p = 0.041 and p = 0.035) when tested one month postoperatively. At three months postoperatively, only E/A showed a statistical difference (p = 0.015). Conclusion Our analysis suggests that biodegradable nitride iron stents are feasible, safe, and effective in children. Some small improvements were observed in right ventricular systolic and diastolic function after successful transcatheter intervention, although change was not statistically significant due to the small sample number. (A clinical Trial to Evaluate the Safety and Efficacy of IBS Angel in Patients With Pulmonary Artery Stenosis (IRIS); NCT04973540).
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8
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Nasef MA, Shahbah DA, Batlivala SP, Darwish R, Qureshi AM, Breatnach CR, Linnane N, Walsh KP, Oslizlok P, McCrossan B, Momenah T, Alshahri A, Abdulhamed J, Arafat A, Tamimi OA, Diraneyya OM, Goldestein BH, Kenny D. Short- and medium-term outcomes for patent ductus arteriosus stenting in neonates ≤2.5 kg with duct-dependent pulmonary circulation. Catheter Cardiovasc Interv 2022; 100:596-605. [PMID: 35904221 DOI: 10.1002/ccd.30351] [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: 01/07/2022] [Revised: 06/29/2022] [Accepted: 07/16/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Morbidity with surgical systemic-to-pulmonary artery shunting (SPS) in infants ≤2.5 kg has remained high. Patent ductus arteriosus (PDA) stenting may be a valid alternative. The objective of this study is to evaluate outcomes following PDA stenting in patients ≤2.5 kg from four large tertiary centers. METHODS Retrospective review of all neonates ≤2.5 kg with duct-dependent pulmonary circulation who underwent PDA stenting. Procedural details, pulmonary arterial growth, reinterventions, surgery type, and outcomes were assessed. RESULTS PDA stents were implanted in 37 of 38 patients attempted (18 female) at a median procedural weight of 2.2 kg (interquartile range [IQR], 2-2.4 kg). Seven patients (18%) had a genetic abnormality and 16 (42%) had associated comorbidities. The median intensive care unit stay was 4 days (IQR, 2-6.75 days), and the median hospital stay was 20 days (IQR, 16-57.25). One patient required a rescue shunt procedure, with three others requiring early SPS (<30 days postprocedure). Twenty patients (54%) required reintervention with either balloon angioplasty, restenting, or both. At 6-month follow-up, right pulmonary artery growth (median z-score -1.16 to 0.01, p = 0.05) was greater than the left pulmonary artery (median z-score -0.9 to -0.64, p = 0.35). Serious adverse effects (SAEs) were seen in 18% (N = 7) of our cohort. One patient developed an SAE during planned reintervention There were no intraprocedural deaths, with one early procedure-related mortality, and three interstage mortalities not directly related to PDA stenting. CONCLUSIONS PDA stenting in infants ≤2.5 kg is feasible and effective, promoting pulmonary artery growth. Reintervention rates are relatively high, though many are planned to allow for optimal growth before a definitive operation.
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Affiliation(s)
- Mohamed Al Nasef
- Children Health Ireland at Crumlin, Dublin, Ireland.,Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Doaa A Shahbah
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.,Department of Pediatric Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sarosh P Batlivala
- Department of Pediatric Cardiology Department, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Reem Darwish
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | | | | | | | | | | | - Tarek Momenah
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Atif Alshahri
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | | | - Amr Arafat
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Omar Al Tamimi
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | | | | | - Damien Kenny
- Children Health Ireland at Crumlin, Dublin, Ireland
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Cardiovascular Computed Tomography in Pediatric Congenital Heart Disease: A State of the Art Review. J Cardiovasc Comput Tomogr 2022; 16:467-482. [DOI: 10.1016/j.jcct.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 01/04/2023]
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10
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Agha HM, Abd -El Aziz O, Kamel O, Sheta SS, El-Sisi A, El-Saiedi S, Fatouh A, Esmat A, Abdelmohsen G, Hanna B, Hussien M, Sobhy R. Margin between success and failure of PDA stenting for duct-dependent pulmonary circulation. PLoS One 2022; 17:e0265031. [PMID: 35421117 PMCID: PMC9009684 DOI: 10.1371/journal.pone.0265031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/22/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives
Percutaneous patent ductus arteriosus (PDA) stenting is a therapeutic modality in patients with duct-dependent pulmonary circulation with reported success rates from 80–100%. The current study aims to assess the outcome and the indicators of success for PDA stenting in different ductal morphologies using various approaches.
Methods
A prospective cohort study from a single tertiary center presented from January 2018 to December 2019 that included 96 consecutive infants with ductal-dependent pulmonary circulation and palliated with PDA stenting. Patients were divided according to PDA origin into 4 groups: Group 1: PDA from proximal descending aorta, Group 2: from undersurface of aortic arch, Group 3: opposite the subclavian artery, Group 4: opposite the innominate/brachiocephalic artery.
Results
The median age of patients was 22 days and median weight was 3 kg. The procedure was successful in 78 patients (81.25%). PDA was tortuous in 70 out of 96 patients. Femoral artery was the preferred approach in Group 1 (63/67), while axillary artery access was preferred in the other groups (6/11 in Group 2, 11/17 in Group 3, 1/1 in Group 4, P <0.0001). The main cause of procedural failure was inadequate parked coronary wire inside one of the branch of pulmonary arteries (14 cases; 77.7%), while 2 cases (11.1%) were complicated by acute stent thrombosis, and another 2 cases with stent dislodgment. Other procedural complications comprised femoral artery thrombosis in 7 cases (7.2%). Patients with straight PDA, younger age at procedure and who had larger PDA at pulmonary end had higher odds for success (OR = 8.01, 2.94, 7.40, CI = 1.011–63.68, 0.960–0.99, 1.172–7.40,respectively, P = 0.048, 0.031,0.022 respectively).
Conclusions
The approach for PDA stenting and hence the outcome is markedly determined by the PDA origin and morphology. Patients with straight PDA, younger age at procedure and those who had relatively larger PDA at the pulmonary end had better opportunity for successful procedure.
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Affiliation(s)
- Hala Mounir Agha
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
- * E-mail:
| | - Osama Abd -El Aziz
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Ola Kamel
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Sahar S. Sheta
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Amal El-Sisi
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Sonia El-Saiedi
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Aya Fatouh
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Amira Esmat
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Gaser Abdelmohsen
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Baher Hanna
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Mai Hussien
- Pediatric Department, General Organization of Teaching Hospitals and Institues, Cairo, Egypt
| | - Rodina Sobhy
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
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11
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Moustafa SAEF, Hussein MM, Sultan AA, Bilal MMZ, El Gamal MAF, Sobh DM. Three steps approach for preoperative evaluation of tetralogy of Fallot patients: role of 128 MDCT. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021; 52:47. [DOI: 10.1186/s43055-021-00418-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/13/2021] [Indexed: 09/02/2023] Open
Abstract
Abstract
Background
Tetralogy of Fallot is the most common congenital cyanotic heart disease. Advances in surgical repair recently facilitate survival of the affected patients into adulthood with good quality of life. Despite imaging plays crucial role in diagnosis of TOF patients, no single diagnostic modality suffices for complete evaluation of TOF. Thus, different diagnostic tools should be used alone or in combination according to patient’s clinical question. This study aims to find out the agreement between the echocardiography and MDCT in evaluation of TOF patients prior to surgical repair.
Results
Three-step approach used in scanning TOF patients. Firstly, classic TOF findings, MDCT was comparable to echocardiography in overriding aorta (k = 0.6), VSD (k = 0.8), RVH (k = 0.4), and sub valvular pulmonary stenosis (k = 0.6). Echocardiography is superior to MDCT in evaluation of valvular stenosis (k = 0.4). MDCT was superior to echocardiography in supravalvular pulmonary stenosis. Secondary, surgical relevant findings, McGoon ratio calculated in 94.2%, small and major APCs in 45.5% and 28.5% respectively, PDA in 35% and anomalous coronary artery in 5.1%. Thirdly, other TOF-associated anomalies, common: ASD (34.3%) and RAA (28.3%), and persistent LSVC (10.3%). Uncommon: situs ambiguous (2.5 %), PAPVR (1.2%), and IVC anomalies (3.8%). MDCT was superior to echocardiography in surgical relevant findings and other TOF-associated anomalies.
Conclusion
MDCT is a crucial imaging tool for extra cardiac evaluation of TOF patients prior to surgical repair.
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12
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Shahanavaz S, Qureshi AM, Petit CJ, Goldstein BH, Glatz AC, Bauser-Heaton HD, McCracken CE, Kelleman MS, Law MA, Nicholson GT, Zampi JD, Pettus J, Meadows J. Factors Influencing Reintervention Following Ductal Artery Stent Implantation for Ductal-Dependent Pulmonary Blood Flow: Results From the Congenital Cardiac Research Collaborative. Circ Cardiovasc Interv 2021; 14:e010086. [PMID: 34789017 DOI: 10.1161/circinterventions.120.010086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Stenting of the patent ductus arteriosus (PDA) is an established palliative option for infants with ductal-dependent pulmonary blood flow. Following initial palliation, reintervention on the PDA stent is common, but risk factors have not been characterized. METHODS Infants with ductal-dependent pulmonary blood flow palliated with PDA stent between 2008 and 2015 were reviewed within the Congenital Cardiac Research Collaborative. Rates and risk factors for reintervention were analyzed. RESULTS Among 105 infants who underwent successful PDA stenting, 41 patients (39%) underwent a total of 53 reinterventions on the PDA stent, with all but one occurring within 6 months of the initial intervention. Stent redilation constituted the majority of reintervention (n=35; 66%) followed by additional stent placement (n=11; 21%) and surgical shunt placement (n=7; 13%). The majority of reintervention was nonurgent, and there were no deaths during the reintervention procedure. All but one reintervention occurred within 6 months of the initial procedure. On univariate analysis, risk factors for reintervention included anticipated single-ventricle physiology, lack of prior balloon pulmonary valvuloplasty, use of drug-eluting stent, and increased ductal tortuosity. CONCLUSIONS In infants with ductal-dependent pulmonary blood flow palliated with PDA stent implantation, reintervention is common, can be performed safely, and is associated with both anatomic/procedural factors and anticipated final physiology.
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Affiliation(s)
- Shabana Shahanavaz
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, MO (S.S.).,The Heart Institute, Cincinnati Children's Hospital Medical Center, OH (S.S., B.H.G.)
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston (A.M.Q.)
| | - Christopher J Petit
- Emory University School of Medicine, Children's Healthcare of Atlanta, GA (C.J.P., H.D.B.-H., J.P.).,Division of Pediatric Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Hospital (C.J.P.)
| | - Bryan H Goldstein
- The Heart Institute, Cincinnati Children's Hospital Medical Center, OH (S.S., B.H.G.).,Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, PA (B.H.G.)
| | - Andrew C Glatz
- Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia (A.C.G.)
| | - Holly D Bauser-Heaton
- Emory University School of Medicine, Children's Healthcare of Atlanta, GA (C.J.P., H.D.B.-H., J.P.)
| | - Courtney E McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (C.E.M., M.S.K.)
| | - Michael S Kelleman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (C.E.M., M.S.K.)
| | - Mark A Law
- Department of Pediatrics, Division of Pediatric Cardiology, University of Alabama at Birmingham (M.A.L.)
| | - George T Nicholson
- Division of Pediatric Cardiology, Department of Pediatrics at the Ann and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN (G.T.N.)
| | - Jeffrey D Zampi
- Department of Pediatrics, Division of Cardiology, University of Michigan, Ann Arbor (J.D.Z.)
| | - Joelle Pettus
- Emory University School of Medicine, Children's Healthcare of Atlanta, GA (C.J.P., H.D.B.-H., J.P.)
| | - Jeffery Meadows
- Division of Pediatric Cardiology, University of California, San Francisco (J.M.)
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13
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Tan JWY, Alwi M, Siew ELL, Samion H. Role of tenecteplase (rtPA) to re-establish flow in intraprocedural stent thrombosis in infants undergoing ductal stenting for duct-dependent pulmonary circulation-a case series. Catheter Cardiovasc Interv 2021; 98:738-742. [PMID: 34143549 DOI: 10.1002/ccd.29838] [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: 11/06/2020] [Revised: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 11/07/2022]
Abstract
Ductal stenting in patients with duct-dependent pulmonary circulation has allowed growth of pulmonary arteries prior to definitive surgical procedures. Intraprocedural stent thrombosis (IPST) of the arterial duct is a life-threatening complication as it leads to total circulatory collapse. Previous reports have described use of tissue plasminogen activators in infants for less emergent settings. We report three infants with IPST and the use of tenecteplase to overcome this. Also discussed are the predisposing mechanisms in each scenario and a possibility of direct catheter-guided tenecteplase administration. Judicious use of tenecteplase can be life-saving and rapid access to this drug may obviate the need for emergency extracorporeal life support.
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Affiliation(s)
- Jason Weng Yew Tan
- Paediatric and Congenital Heart Center, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Mazeni Alwi
- Paediatric and Congenital Heart Center, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Esther Lee Ling Siew
- Paediatric and Congenital Heart Center, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Hasri Samion
- Paediatric and Congenital Heart Center, Institut Jantung Negara, Kuala Lumpur, Malaysia
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14
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Goo HW, Siripornpitak S, Chen SJ, Lilyasari O, Zhong YM, Latiff HA, Maeda E, Kim YJ, Tsai IC, Seo DM. Pediatric Cardiothoracic CT Guideline Provided by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group: Part 2. Contemporary Clinical Applications. Korean J Radiol 2021; 22:1397-1415. [PMID: 33987995 PMCID: PMC8316776 DOI: 10.3348/kjr.2020.1332] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/27/2021] [Accepted: 01/31/2021] [Indexed: 12/14/2022] Open
Abstract
The use of pediatric cardiothoracic CT for congenital heart disease (CHD) was traditionally limited to the morphologic evaluation of the extracardiac thoracic vessels, lungs, and airways. Currently, the applications of CT have increased, owing to technological advancements in hardware and software as well as several dose-reduction measures. In the previously published part 1 of the guideline by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group, we reviewed the prerequisite technical knowledge for clinical applications in a user-friendly and vendor-specific manner. Herein, we present the second part of our guideline on contemporary clinical applications of pediatric cardiothoracic CT for CHD based on the consensus of experts from the Asian Society of Cardiovascular Imaging CHD Study Group. This guideline describes up-to-date clinical applications effectively in a systematic fashion.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Suvipaporn Siripornpitak
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Shyh Jye Chen
- Department of Medical Imaging, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Yu Min Zhong
- Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai, China
| | - Haifa Abdul Latiff
- Pediatric and Congenital Heart Centre, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Eriko Maeda
- Department of Radiology, The University of Tokyo, Tokyo, Japan
| | - Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - I Chen Tsai
- Congenital Heart Disease Study Group Member of the Asian Society of Cardiovascular Imaging, Taichung, Taiwan
| | - Dong Man Seo
- Department of Cardiothoracic Surgery, Ewha Womans University Seoul Hospital, Seoul, Korea
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15
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Chávez-Saldívar S, Mego JC, Tauma-Arrué A, Coronado J, Luis-Ybáñez O, Bravo-Jaimes K. [The adult with tetralogy of fallot: what the clinical cardiologist needs to know]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2021; 2:121-129. [PMID: 38274563 PMCID: PMC10809779 DOI: 10.47487/apcyccv.v2i2.138] [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: 05/31/2021] [Accepted: 06/26/2021] [Indexed: 01/27/2024]
Abstract
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. After more than seven decades of the first palliative surgery, TOF prognosis has changed dramatically. The prevalence of TOF is approximately 3 per 10 000 births, representing 7 to 10% of congenital heart disease. With a higher survival into adulthood, the clinical cardiologist faces challenges in the management of this population, from severe pulmonary regurgitation to heart failure and ventricular arrhythmias. Its prevalence is approximately 3 per 10 000 live births, representing 7 to 10% of congenital heart disease. This review will describe the most relevant aspects of the care of adult patients with this disease.
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Affiliation(s)
- Samantha Chávez-Saldívar
- Facultad de Medicina San Fernando. Universidad Nacional Mayor de San Marcos. Lima, Perú.Universidad Nacional Mayor de San MarcosFacultad de Medicina San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
- Sociedad Científica de San Fernando. Lima, Perú.Sociedad Científica de San FernandoLimaPerú
| | - Juan Carlos Mego
- Facultad de Medicina San Fernando. Universidad Nacional Mayor de San Marcos. Lima, Perú.Universidad Nacional Mayor de San MarcosFacultad de Medicina San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
- Sociedad Científica de San Fernando. Lima, Perú.Sociedad Científica de San FernandoLimaPerú
| | - Astrid Tauma-Arrué
- Facultad de Medicina San Fernando. Universidad Nacional Mayor de San Marcos. Lima, Perú.Universidad Nacional Mayor de San MarcosFacultad de Medicina San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
- Sociedad Científica de San Fernando. Lima, Perú.Sociedad Científica de San FernandoLimaPerú
| | - Joel Coronado
- Facultad de Medicina San Fernando. Universidad Nacional Mayor de San Marcos. Lima, Perú.Universidad Nacional Mayor de San MarcosFacultad de Medicina San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
- Sociedad Científica de San Fernando. Lima, Perú.Sociedad Científica de San FernandoLimaPerú
| | - Odalis Luis-Ybáñez
- Facultad de Medicina San Fernando. Universidad Nacional Mayor de San Marcos. Lima, Perú.Universidad Nacional Mayor de San MarcosFacultad de Medicina San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
- Sociedad Científica de San Fernando. Lima, Perú.Sociedad Científica de San FernandoLimaPerú
| | - Katia Bravo-Jaimes
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California. Los Angeles, Estados Unidos.University of CaliforniaAhmanson/UCLA Adult Congenital Heart Disease CenterUniversity of CaliforniaLos AngelesUSA
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16
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17
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Lenoir M, Desnous B, Rahmani B, El Gueddari N, Aries É, El Louali F, Aldebert P, Ovaert C, Metras D, Macé L, Fouilloux V. Anterograde blood flow associated with modified Blalock-Taussig shunt does not modify pulmonary artery growth compared with modified Blalock-Taussig shunt alone. Arch Cardiovasc Dis 2021; 114:268-276. [PMID: 33509744 DOI: 10.1016/j.acvd.2020.11.007] [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: 07/29/2020] [Revised: 11/08/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The main difference between extreme tetralogy of Fallot (TOF) and pulmonary atresia with ventricle septal defect (PA/VSD) is anterograde pulmonary blood flow (APBF). It is speculated that the association of modified Blalock-Taussig shunt (mBTS) with APBF favours shunt thrombosis, but promotes better pulmonary artery growth. AIM To compare pulmonary artery growth after mBTS between TOF and PA/VSD. METHODS From 1995 to 2018, 77 mBTS procedures were performed in infants (aged<1 year): 45 for TOF; 32 for PA/VSD. Using a 1/1 propensity score-matched analysis, 38 patients were included (19 per group). Delta Nakata was defined as the difference in the Nakata index before biventricular repair and before mBTS. RESULTS After matching, the preoperative Nakata index was similar in the two groups (TOF 101±34 vs. PA/VSD 106±35 mm2/m2; P=0.75). Age and weight were similar (TOF 24±20 days, 3.3±0.6kg vs. PA/VSD 24±33 days, 3.3±0.9kg; P=0.84 and P=0.77, respectively). There was no difference in rates of in-hospital mortality (TOF 0% vs. PA/VSD 10%; P=0.13) or mBTS thrombosis (TOF 15% vs. PA/VSD 10%; P=0.63). The left and right pulmonary artery diameters at time of biventricular repair were similar (TOF 7.5±2.2 and 6.7±2.1 vs. PA/VSD 8±2.7 and 7.1±2.5mm; P=0.43 and P=0.78, respectively), as were delta Nakata (TOF 112±102 vs. PA/VSD 107±66 mm2/m2; P=0.89), median age for biventricular repair (P=0.83) and reintervention rates (TOF 10% vs. PA/VSD 15%; P=0.67). CONCLUSIONS We found no difference in pulmonary artery growth between APBF with mBTS versus mBTS alone. Thus, we could not show an increase in mBTS thrombosis with APBF.
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Affiliation(s)
- Marien Lenoir
- Department of paediatric cardiac surgery, Timone hospital, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France.
| | - Beatrice Desnous
- Department of paediatric neurology, Timone hospital, AP-HM, 13005 Marseille, France
| | - Bilal Rahmani
- Department of paediatric cardiac surgery, Timone hospital, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - Nabila El Gueddari
- Department of paediatric cardiac surgery, Timone hospital, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - Édouard Aries
- Department of paediatric cardiology, Timone hospital, AP-HM, 13385 Marseille, France
| | - Fedoua El Louali
- Department of paediatric cardiology, Timone hospital, AP-HM, 13385 Marseille, France
| | - Philippe Aldebert
- Department of paediatric cardiology, Timone hospital, AP-HM, 13385 Marseille, France
| | - Caroline Ovaert
- Department of paediatric cardiology, Timone hospital, AP-HM, 13385 Marseille, France
| | - Dominique Metras
- Department of paediatric cardiac surgery, Timone hospital, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - Loic Macé
- Department of paediatric cardiac surgery, Timone hospital, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - Virginie Fouilloux
- Department of paediatric cardiac surgery, Timone hospital, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
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18
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Li D, Zhou X, Li M. Arterial duct stent versus surgical shunt for patients with duct-dependent pulmonary circulation: a meta-analysis. BMC Cardiovasc Disord 2021; 21:9. [PMID: 33407150 PMCID: PMC7789398 DOI: 10.1186/s12872-020-01817-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 12/08/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Both systemic-pulmonary shunt and arterial duct stent could be the palliation of duct-dependent pulmonary circulation. We aimed to compare the safety and efficacy of the two approaches. METHODS The PubMed, EMBASE, and Cochrane Library databases were searched through December 2019 for studies comparing stent implantation and surgical shunt in duct-dependent pulmonary circulation. The baseline characteristics included ventricle physiology and cardiac anomaly. The main outcomes were hospital stay and total mortality. Additional outcomes included procedural complications, intensive care unit (ICU) stay, pulmonary artery growth at follow-up, and other indexes. A random- or fixed-effects model was used to summarize the estimates of the mean difference (MD)/risk ratio (RR) with 95% confidence intervals (CIs). RESULTS In total, 757 patients with duct-dependent pulmonary circulation from six studies were included. Pooled estimates of hospital stay (MD, - 4.83; 95% CI - 7.92 to - 1.74; p < 0.05), total mortality (RR 0.44; 95% CI 0.28-0.70; p < 0.05), complications (RR 0.49; 95% CI 0.30-0.81; p < 0.05) and ICU stay (MD, - 4.00; 95% CI - 5.96 to - 2.04; p < 0.05) favored the stent group. Significant differences were found in the proportions of patients with a single ventricle (RR 0.82; 95% CI 0.68-0.98; p < 0.05) or a double ventricle (RR 1.23; 95% CI 1.07-1.41; p < 0.05) between the stent and shunt groups. Additionally, pulmonary artery growth showed no significant differences between the two groups. CONCLUSION Arterial duct stent appears to have not inferior outcomes of procedural complications, mortality, hospital and ICU stay, and pulmonary artery growth in selected patients compared with a surgical shunt. TRIAL REGISTRATION CRD42019147672.
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MESH Headings
- Blalock-Taussig Procedure/adverse effects
- Blalock-Taussig Procedure/mortality
- Cardiac Catheterization/adverse effects
- Cardiac Catheterization/instrumentation
- Cardiac Catheterization/mortality
- Child
- Child, Preschool
- Ductus Arteriosus, Patent/diagnostic imaging
- Ductus Arteriosus, Patent/mortality
- Ductus Arteriosus, Patent/physiopathology
- Ductus Arteriosus, Patent/therapy
- Female
- Heart Defects, Congenital/diagnostic imaging
- Heart Defects, Congenital/mortality
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/therapy
- Hemodynamics
- Humans
- Infant
- Infant, Newborn
- Length of Stay
- Male
- Palliative Care
- Pulmonary Artery/abnormalities
- Pulmonary Artery/diagnostic imaging
- Pulmonary Artery/growth & development
- Pulmonary Artery/surgery
- Pulmonary Circulation
- Recovery of Function
- Stents
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Dongxu Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Xu Zhou
- Evidence-Based Medicine Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang, People's Republic of China
| | - Mengsi Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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In vivo degradation and endothelialization of an iron bioresorbable scaffold. Bioact Mater 2020; 6:1028-1039. [PMID: 33102944 PMCID: PMC7566209 DOI: 10.1016/j.bioactmat.2020.09.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 12/18/2022] Open
Abstract
Detection of in vivo biodegradation is critical for development of next-generation medical devices such as bioresorbable stents or scaffolds (BRSs). In particular, it is urgent to establish a nondestructive approach to examine in vivo degradation of a new-generation coronary stent for interventional treatment based on mammal experiments; otherwise it is not available to semi-quantitatively monitor biodegradation in any clinical trial. Herein, we put forward a semi-quantitative approach to measure degradation of a sirolimus-eluting iron bioresorbable scaffold (IBS) based on optical coherence tomography (OCT) images; this approach was confirmed to be consistent with the present weight-loss measurements, which is, however, a destructive approach. The IBS was fabricated by a metal-polymer composite technique with a polylactide coating on an iron stent. The efficacy as a coronary stent of this new bioresorbable scaffold was compared with that of a permanent metal stent with the name of trade mark Xience, which has been widely used in clinic. The endothelial coverage on IBS was found to be greater than on Xience after implantation in a rabbit model; and our well-designed ultrathin stent exhibited less individual variation. We further examined degradation of the IBSs in both minipig coronary artery and rabbit abdominal aorta models. The present result indicated much faster iron degradation of IBS in the rabbit model than in the porcine model. The semi-quantitative approach to detect biodegradation of IBS and the finding of the species difference might be stimulating for fundamental investigation of biodegradable implants and clinical translation of the next-generation coronary stents. A semi-quantitative OCT method was suggested to evaluate in vivo biodegradation of an iron based coronary stent IBS in a nondestructive manner. The in vivo biodegradation of IBS exhibited dependence on animal species. The endothelial coverage on the biodegradable stent IBS was better than on the commercialized nonbiodegradable stent Xience in rabbits.
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20
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Current Trends and Critical Care Considerations for the Management of Single Ventricle Neonates. CURRENT PEDIATRICS REPORTS 2020. [DOI: 10.1007/s40124-020-00227-4] [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: 10/23/2022]
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21
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Abstract
PURPOSE OF REVIEW To review the most recent literature on pediatric transcatheter ductal intervention including ductus arteriosus occlusion and stenting. RECENT FINDINGS With the development and FDA approval of smaller ductal devices, including most recently the Amplatzer Piccolo Occluder (Abbott, Abbott Park, IL), transcatheter ductus arteriosus device closure is now being safely performed in premature infants and patients < 6 kg using a transvenous approach. In patients with ductus-dependent pulmonary blood flow, ductal stenting with pre-mounted coronary artery stents has been shown to be an acceptable alternative to the surgically placed Blalock-Taussig shunt. Centers with experience in ductal stenting have demonstrated success, even with the tortuous ductus. Innovation in transcatheter device technology and procedural practices have allowed for significant advances. Transcatheter ductal device closure is a reasonable alternative to surgical ligation even in premature, low-birthweight infants. Ductal stenting is also an accepted alternative to the modified Blalock-Taussig shunt. We anticipate continued advancement and procedural refinement over the next several years.
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22
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Chamberlain RC, Ezekian JE, Sturgeon GM, Barker PCA, Hill KD, Fleming GA. Preprocedural three-dimensional planning aids in transcatheter ductal stent placement: A single-center experience. Catheter Cardiovasc Interv 2019; 95:1141-1148. [PMID: 31854085 DOI: 10.1002/ccd.28669] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/05/2019] [Accepted: 12/07/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Describe the use of three-dimensional (3D) patent ductus arteriosus (PDA) modeling to better define ductal anatomy to improve preprocedural planning for ductal stent placement. BACKGROUND Ductal stenting is an alternative to surgical shunting in patients with ductal dependent pulmonary blood flow. Ductal anatomy is often complex with extreme tortuosity and risk of pulmonary artery isolation, thus increasing procedural risks. METHODS CT angiograms were segmented to produce 3D PDA models. Ductal morphology was characterized with attention to access approach, degree of pulmonary artery offset/risk of isolation and ductal tortuosity. 3D models were retrospectively compared with biplane angiography. RESULTS 3D modeling was performed in 12 patients with adequate image quality for complete analysis in 11; median (interquartile range) age/weight 17 days (8-20 days) and 3.1 kg (2.4-3.9 kg). The PDA was reverse oriented in nine with average length of 17.2 ± 2.5 mm and high tortuosity (mean tortuosity index 52, range 3-108). From 3D modeling, two patients were excluded from ductal stenting-extreme ductal tortuosity and threatened pulmonary artery discontinuity, respectively. Ductal stenting was successful in the remaining nine with no major procedural complications. 3D modeling predicted a successful access approach based on the aortic orientation of the ductus in all patients (five carotid, two axillary, two femoral). When comparing 2D angiography with 3D models, angiography consistently underestimated ductal length (-3.2 mm ± 1.6 mm) and tortuosity (-14.8 ± 7.2). CONCLUSIONS 3D modeling prior to ductal stent placement for ductal dependent pulmonary blood flow is useful in procedural planning, specifically for eligibility, access approach, and accurate ductal measurements. Further studies are needed to determine if 3D planning improves procedural outcomes.
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Affiliation(s)
- Reid C Chamberlain
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Jordan E Ezekian
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Gregory M Sturgeon
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Piers C A Barker
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Kevin D Hill
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Gregory A Fleming
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
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23
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Valdeomillos E, Jalal Z, Boudjemline Y, Thambo JB. Transcatheter ductus arteriosus stenting in paediatric cardiology: Indications, results and perspectives. Arch Cardiovasc Dis 2019; 113:129-141. [PMID: 31753586 DOI: 10.1016/j.acvd.2019.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 12/17/2022]
Abstract
Stenting the arterial duct emerged in the early 1990s as an alternative to a variety of surgical interventions in neonates with a duct-dependent pulmonary or systemic circulation complex defect. Furthermore, palliative ductal stenting has been applied in older children with severe suprasystemic pulmonary arterial hypertension, as an alternative to surgical shunts, such as Potts anastomosis. Early results of this technique were discouraging, but by learning from the failures of the past, ductal stenting has become a reliable palliative therapy. In this review, we aim to describe the historical evolution of ductal stenting, its different clinical applications and outcomes, and future perspectives for this strategy in congenital cardiac catheterization.
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Affiliation(s)
- Estibaliz Valdeomillos
- Department of Paediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), avenue Magellan, 33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, fondation Bordeaux université, 33600 Pessac, France; U1045, Inserm, centre de recherche cardio-thoracique de Bordeaux, 33000 Bordeaux, France.
| | - Zakaria Jalal
- Department of Paediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), avenue Magellan, 33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, fondation Bordeaux université, 33600 Pessac, France; U1045, Inserm, centre de recherche cardio-thoracique de Bordeaux, 33000 Bordeaux, France
| | | | - Jean-Benoit Thambo
- Department of Paediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), avenue Magellan, 33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, fondation Bordeaux université, 33600 Pessac, France; U1045, Inserm, centre de recherche cardio-thoracique de Bordeaux, 33000 Bordeaux, France
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- Department of Paediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), avenue Magellan, 33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, fondation Bordeaux université, 33600 Pessac, France; U1045, Inserm, centre de recherche cardio-thoracique de Bordeaux, 33000 Bordeaux, France; Heart Center, Sidra Medicine, Doha, Qatar
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24
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Aggarwal V, Petit CJ, Glatz AC, Goldstein BH, Qureshi AM. Stenting of the ductus arteriosus for ductal-dependent pulmonary blood flow-current techniques and procedural considerations. CONGENIT HEART DIS 2019; 14:110-115. [PMID: 30811792 DOI: 10.1111/chd.12709] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 10/19/2018] [Accepted: 10/20/2018] [Indexed: 12/14/2022]
Abstract
The use of prostaglandin-E1 immediately after birth and subsequent surgical creation of the modified Blalock-Taussig shunt (BTS) shunt have remarkably improved the prognosis and survival of children with congenital heart disease and ductal-dependent pulmonary blood flow (PBF). Despite the advancement in surgical techniques, bypass strategies, and postoperative management, significant morbidity and mortality after BTS still remain. Patent ductus arteriosus stenting has been shown to be as an acceptable alternative to BTS placement in select infants with ductal-dependent PBF. Newer procedural techniques and equipment, along with operator experience have all contributed to procedural refinement associated with improved outcomes over the recent years. In this article, we review the procedural and periprocedural details, with an emphasis on recent advances of this procedure.
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Affiliation(s)
- Varun Aggarwal
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Christopher J Petit
- Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Andrew C Glatz
- The Cardiac Center at the Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bryan H Goldstein
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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Breatnach CR, Aggarwal V, Al-Alawi K, McMahon CJ, Franklin O, Prendiville T, Oslizlok P, Walsh K, Qureshi AM, Kenny D. Percutaneous axillary artery approach for ductal stenting in critical right ventricular outflow tract lesions in the neonatal period. Catheter Cardiovasc Interv 2019; 93:1329-1335. [PMID: 31020799 DOI: 10.1002/ccd.28302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/25/2019] [Accepted: 04/05/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We aimed to assess the experience using a percutaneous axillary artery approach for insertion of arterial ductal stents in patients with critical right ventricular outflow tract lesions at two tertiary pediatric cardiology centers. BACKGROUND Patent ductus arteriosus stenting is an accepted palliative alternative to BT shunts for neonates with critical right heart lesions. Access to tortuous ductus' may be challenging via the femoral artery, whereas the carotid artery presents a low risk of stroke. Recently, the axillary artery has been utilized for access in these patients. METHODS We performed a retrospective review of neonates who underwent stent placement or angioplasty using percutaneous axillary artery approach at two tertiary care centers from October 2016 to November 2018. Medical records were reviewed to ascertain demographic, clinical, and outcome data. RESULTS Axillary artery access was performed in 20 patients (16 primary ductal stents and 4 re-interventions) at a median (IQR) procedural weight of 3.4 (3-3.9) kg. Median (IQR) procedural time was 110 (75-150) min. The median (IQR) ICU stay and intubation times were 14 (0-94) hr and 5 (0-40) hr, respectively. There were three access-related vascular complications which were managed conservatively with no long-term effects. Two patients subsequently died due to non-procedure related causes. CONCLUSIONS Ductal stenting via a percutaneous axillary artery approach is a viable option in neonates with critical right ventricular outflow tract lesions. This approach provides an additional access site for PDA stenting which may be utilized in patients with vertical duct morphology.
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Affiliation(s)
- Colm R Breatnach
- Department of cardiology, Our Lady's Children's Hospital, Dublin 8, Ireland
| | - Varun Aggarwal
- Department of cardiology, Texas Children's Hospital, Houston, Texas
| | - Khalid Al-Alawi
- Department of cardiology, Our Lady's Children's Hospital, Dublin 8, Ireland
| | - Colin J McMahon
- Department of cardiology, Our Lady's Children's Hospital, Dublin 8, Ireland
| | - Orla Franklin
- Department of cardiology, Our Lady's Children's Hospital, Dublin 8, Ireland
| | | | - Paul Oslizlok
- Department of cardiology, Our Lady's Children's Hospital, Dublin 8, Ireland
| | - Kevin Walsh
- Department of cardiology, Our Lady's Children's Hospital, Dublin 8, Ireland
| | - Athar M Qureshi
- Department of cardiology, Texas Children's Hospital, Houston, Texas
| | - Damien Kenny
- Department of cardiology, Our Lady's Children's Hospital, Dublin 8, Ireland
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