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Mbabazi N, Aliku T, Namuyonga J, Tumwebaze H, Ndagire E, Obongonyinge B, Khainza RE, Akech MT, Angelline K, Nakato A, Ssendagire C, Ssemogerere L, Oketcho M, Omagino J, Lwabi P, Lubega S. Congenital heart disease cardiac catheterization at Uganda Heart Institute, a 12-year retrospective study of immediate outcomes. BMC Cardiovasc Disord 2024; 24:463. [PMID: 39210275 PMCID: PMC11360719 DOI: 10.1186/s12872-024-04085-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Cardiac catheterization is an invasive diagnostic and treatment tool for congenital heart disease (CHD) with potential complications. OBJECTIVE To describe the immediate outcomes of patients who underwent cardiac catheterization for CHD at the Uganda Heart Institute (UHI). METHODS The study was a retrospective chart review of 857 patients who underwent cardiac catheterization for CHD at UHI from 1st February 2012 to 30th June 2023. Precardiac catheterization clinical data, procedure details, and post-procedure data were recorded. The statistical software SPSS was used for data analysis. RESULTS We studied 857 patients who underwent cardiac catheterization for CHD at UHI. Females comprised 62.8% (n = 528). The age range was 3 days to 64 years, with a mean of 5.1 years (SD 7.4). Advanced heart failure was present in 24(2.8%) of the study participants. The most common procedures were patent ductus arteriosus device closure (n = 500, 58.3%), diagnostic catheterization (n = 194, 22.5%), and balloon pulmonary valvuloplasty (n = 114, 13.0%). PDA device closure had 89.4% optimal results while BPV had 75.9% optimal performance outcome. Adverse events occurred in 52 out of 857 study participants (6.1%). Clinically meaningful adverse events (CMAES) occurred in 3.9%, (n = 33), high severity adverse events in 2.9% (n = 25) and mortality in 1.5% (n = 13). Advanced heart failure at the time of cardiac catheterization, was significantly associated with clinically meaningful adverse events (OR 52 p-value < 0.001) and mortality (OR 564, p value < 0.001). CONCLUSION Many patients with CHD have benefited from the cardiac catheterization program at UHI with high optimal procedure outcome results. Patients with advanced heart failure at the time of cardiac catheterization have less favorable outcomes emphasizing the need for early detection and early intervention.
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Affiliation(s)
- Nestor Mbabazi
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda.
- Mulago National Referral Hospital, Kampala, Uganda.
| | - Twalib Aliku
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
- Uganda Christian University School of Medicine, Mukono, Uganda
| | - Judith Namuyonga
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Emma Ndagire
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
| | | | - Rebecca Esther Khainza
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
- Mulago National Referral Hospital, Kampala, Uganda
| | | | - Killen Angelline
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
- John. Fitzgerald Kennedy Hospital, 22nd Street Sinkor, Monrovia, Liberia
| | - Aisha Nakato
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
- Bombo General Military Hospital, Bombo, Uganda
| | - Cornelius Ssendagire
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Lameck Ssemogerere
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - John Omagino
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
| | - Peter Lwabi
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
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Shen Z, Qin W, Zhu L, Lin Y, Ling H, Zhang Y. Construction of nursing-sensitive quality indicators for cardiac catheterisation: A Delphi study and an analytic hierarchy process. J Clin Nurs 2021; 31:2821-2838. [PMID: 34866256 DOI: 10.1111/jocn.16105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/22/2021] [Accepted: 10/05/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Nursing care can profoundly reduce the risk of emergencies related to cardiac catheterisation. Therefore, identifying nursing-sensitive quality indicators (NSQIs) to evaluate nursing quality is critical for optimal cardiac catheterisation. However, studies on NSQIs for cardiac catheterisation are scarce. OBJECTIVES This study was conducted to develop a set of NSQIs for cardiac catheterisation. METHODS Literature retrieval and expert group discussions were conducted to identify potential NSQIs and compile an inquiry questionnaire. Then, Delphi surveys were used to collect opinions from experts in the field of cardiac catheterisation. The consistency of the consultation results formed the basis on which we conducted the next rounds of consultation. Based on the importance given to each NSQI by the consulted experts in the previous round, we determined the weight coefficient of each indicator with the analytic hierarchy process. This study was performed according to the SRQR guidelines. RESULTS We conducted two rounds of expert inquiry. The recovery rates of the first and second questionnaires were 100% and 66.67%, respectively. The average authoritative coefficients were 0.86 and 0.91. The Kendall W values ranged from 0.214~0.361 (p < .001). Consensus was reached on 3 primary indicators, 8 secondary indicators and 20 tertiary indicators. CONCLUSIONS A set of NSQIs for cardiac catheterisation was developed. However, the effects of these NSQIs on the evaluation and continuous improvement of nursing quality in cardiac catheterisation need to be verified in clinical practice.
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Affiliation(s)
- Zhiyun Shen
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Qin
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li Zhu
- Cardiac catheterization laboratory, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ying Lin
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huaxing Ling
- Cardiac catheterization laboratory, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuxia Zhang
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
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Chen K, Dawkins D, Orbach DB, Aagaard-Kienitz B. Low profile sheaths in pediatric neurointervention: a multicenter experience. J Neurointerv Surg 2021; 14:1135-1138. [PMID: 34625510 DOI: 10.1136/neurintsurg-2021-017936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/03/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pediatric neurointervention is challenged by the appropriateness of adult catheters and devices. This multicenter report on the smallest groin access sheaths offers technical notes and clinical outcomes in the pediatric neurointerventional population. METHODS All pediatric neurointerventional cases from 2019 to 2021 were reviewed for use of a 3.3F Pediavascular or a 4F Merit Prelude Ideal low profile sheath. Hospital records were reviewed for complications and technical notes and compared with arterial groin access with the 4F Terumo Pinnacle in infants less than 1 year old, before the low profile sheaths at one author's institution were introduced. RESULTS From January 1, 2019 to March 31, 2021 there were 347 procedures performed at Boston Children's Hospital and University of Wisconsin. Forty-four procedures in 26 patients were identified in which a 3.3F (38 cases, 20 patients) or 4F (6 cases, 6 patients) sheath was used. The average age was 2.2 years (1.5 days to 18 years). Retinoblastoma intra-arterial chemotherapy infusion (18 of 44) was the most common indication. The remaining procedures comprised vein of Galen embolization (12), diagnostic cerebral angiography (13), and one preoperative tumor embolization. Morbidity included a groin hematoma and decreased pulses (4.5%). No major groin complications occurred. There was no statistically significant difference compared with the historical cohort (132 procedures), which had seven instances of decreased pulses (5.3%, p>0.05). CONCLUSION The 3.3F Pediavascular and 4F Merit Prelude Ideal sheaths are easily incorporated into the pediatric neurointerventionalist's armamentarium for infants and readily accommodate various microcatheters for distal embolization and catheterization.
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Affiliation(s)
- Karen Chen
- Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Demi Dawkins
- Neurosurgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Darren B Orbach
- Neurointerventional Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Beverly Aagaard-Kienitz
- Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Dönmez YN, Aykan HH, Sel K, Ertuğrul İ, Duman D, Aypar E, Alehan D, Karagöz T. Femoral venous haemostasis in children and young adults using the 'figure-of-eight' suture technique. Acta Cardiol 2021; 77:626-631. [PMID: 34493153 DOI: 10.1080/00015385.2021.1973769] [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: 10/20/2022]
Abstract
AIM The aim of our study was to evaluate the safety and efficiency of the 'figure-of-eight' suture among children and young adults with congenital heart defects who underwent interventional procedures, in patients with structurally normal hearts who underwent electrophysiological study and in haemodynamically impaired children and newborns. We also reported a novel femoral haemostasis method in patients with a central catheter by modifying the 'figure-of-eight' suture around the catheter for haemorrhage control. METHOD Between 2015 and 2018, a total of 100 'figure-of-eight' sutures were performed in 90 patients (48 males, 42 females) where the median age was 12.5 years (minimum 3 days, maximum 22 years). The procedures were diagnostic angiography (n = 6), radiofrequency and/or cryoablation (n = 7) and interventional procedures (n = 87). RESULT Haemostasis was achieved in 89 of 90 patients. Haemostasis could not be achieved in one malnourished patient due to lack of subcutaneous tissue. There were no major complications. A bullous skin lesion and minor bleeding were the only complications seen in two patients. A central catheter was inserted in eight patients using the modified 'figure-of-eight' suture technique. CONCLUSION The 'figure-of-eight' suture is a safe and effective method for femoral venous haemostasis in patients who require large sheaths for procedures, in those using high-dose heparin and in haemodynamically unstable children who need cardiac catheterisation.
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Affiliation(s)
- Yasemin N. Dönmez
- Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hayrettin Hakan Aykan
- Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kutay Sel
- Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlker Ertuğrul
- Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Derya Duman
- Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Aypar
- Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dursun Alehan
- Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tevfik Karagöz
- Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Kou L, Wang Q, Long WA, Tang F, Li L. Emerging predictors of femoral artery occlusion after pediatric cardiac catheterization. Sci Rep 2020; 10:14001. [PMID: 32814787 PMCID: PMC7438527 DOI: 10.1038/s41598-020-70891-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 08/04/2020] [Indexed: 11/14/2022] Open
Abstract
The Objective was to review the prevalence of femoral artery occlusion (FAO) after cardiac catheterization in children up to 12 years old from two centers in China and identify its related risk factors. After collecting clinical data from patients who had undergone pediatric cardiac catheterization, univariate and multivariate analysis were used to evaluate the correlations between FAO and clinical factors, including sex, age, height, weight, sheath size, operation time, therapeutic strategy, sheath/age, sheath/height and sheath/weight. The ROC curve was also used to assess the influence of risk factors to predict FAO. FAO occurred in 19 (0.9%) out of 2,084 children following cardiac catheterization. Patients with younger age, lower height, longer operation time, electrophysiological (EP) diagnosis or/and therapy for arrhythmias, higher Sheath/Age, higher Sheath/Height and higher Sheath/Weight ratios had higher risk for FAO compared to their respective control groups (p < 0.05). In the multivariate analysis, sheath/age and operation time were independent risk factors for FAO. Patients with operation time > 77.5 min or sheath/age > 0.5334 had a significantly higher risk for FAO. Operation time and sheath/age were confirmed as significant and independent risk factors associated with FAO. Operation time > 77.5 min and sheath/age > 0.5334 could effectively predict high risk of FAO after pediatric cardiac catheterization.
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Affiliation(s)
- Lei Kou
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Qian Wang
- Department of Vascular Surgery, First Hospital of Tsinghua University (Beijing Huaxin Hospital), No.6 1st Jiuxianqiao Street, Chaoyang District, Beijing, 100016, China
| | - Whitney Annie Long
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, China
| | - Feng Tang
- Department of Vascular Surgery, First Hospital of Tsinghua University (Beijing Huaxin Hospital), No.6 1st Jiuxianqiao Street, Chaoyang District, Beijing, 100016, China
| | - Lei Li
- Department of Vascular Surgery, First Hospital of Tsinghua University (Beijing Huaxin Hospital), No.6 1st Jiuxianqiao Street, Chaoyang District, Beijing, 100016, China.
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Claretti M, Lopez BS, Boz E, Martelli F, Pradelli D, Bussadori CM. Complications during catheter-mediated patent ductus arteriosus closure and pulmonary balloon valvuloplasty. J Small Anim Pract 2019; 60:607-615. [PMID: 31280488 DOI: 10.1111/jsap.13046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/29/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate and illustrate complications of cardiac catheterisation and the associated risk factors of the most common cardiac intervention procedures. MATERIALS AND METHODS Retrospective study of clinical records of client-owned dogs presented to a cardiology referral centre between January 2006 and December 2017. RESULTS Five hundred and twenty-four dogs were included, 62 of which had complications. Complications were divided into technical complications and those due to unexpected additional anatomical abnormalities. Seven procedures (1.33%) were interrupted; five dogs (0.95%) subsequently underwent surgery, and four dogs died during the interventional procedure, indicating a mortality rate of 0.76% CLINICAL SIGNIFICANCE: There is a low risk of complications following closure of patent ductus arteriosus or pulmonary balloon valvuloplasty when carried out by a trained team using standardised procedures in a referral centre.
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Affiliation(s)
- M Claretti
- Department of Cardiology, Clinica Veterinaria Gran Sasso, 20131, Milan, Italy
| | - B S Lopez
- Department of Cardiology, Clinica Veterinaria Gran Sasso, 20131, Milan, Italy
| | - E Boz
- Department of Cardiology, Clinica Veterinaria Gran Sasso, 20131, Milan, Italy
| | - F Martelli
- Department of Cardiology, Clinica Veterinaria Gran Sasso, 20131, Milan, Italy
| | - D Pradelli
- Department of Cardiology, Clinica Veterinaria Gran Sasso, 20131, Milan, Italy
| | - C M Bussadori
- Department of Cardiology, Clinica Veterinaria Gran Sasso, 20131, Milan, Italy
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Amaro E, Pophal S, Zoldos J. Vascular Reconstruction in a Neonate after Iatrogenic Injury during Cardiac Catheterization. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1600. [PMID: 29632779 PMCID: PMC5889463 DOI: 10.1097/gox.0000000000001600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/20/2017] [Indexed: 11/25/2022]
Abstract
As technology and interventional techniques continue to evolve, both the volume and complexity of cardiac catheterizations will increase, leading to a rise in the number of complications. One of the most morbid complications of cardiac catheterization is vascular injury. We report the case of a 31-day-old, 3.0-kg infant with hypoplastic left heart syndrome who experienced a left common iliac artery disruption during cardiac catheterization resulting in a retroperitoneal hemorrhage. The extent of the vascular injury combined with the vessel caliber posed a technically challenging surgical scenario. Ultimately, the vascular supply to the left lower extremity was reconstructed by the plastic surgery team with a reverse autologous vein graft. To our knowledge, this multidisciplinary approach with the involvement of plastic surgery represents a unique case.
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Affiliation(s)
- Emilie Amaro
- From the Vanderbilt School of Medicine, Nashville, Tenn.; Division of Cardiology, Phoenix Children’s Hospital Heart Center, Phoenix, Ariz.; College of Medicine, University of Arizona, Arizona Center for Hand Surgery, Phoenix, Ariz
| | - Stephen Pophal
- From the Vanderbilt School of Medicine, Nashville, Tenn.; Division of Cardiology, Phoenix Children’s Hospital Heart Center, Phoenix, Ariz.; College of Medicine, University of Arizona, Arizona Center for Hand Surgery, Phoenix, Ariz
| | - Jozef Zoldos
- From the Vanderbilt School of Medicine, Nashville, Tenn.; Division of Cardiology, Phoenix Children’s Hospital Heart Center, Phoenix, Ariz.; College of Medicine, University of Arizona, Arizona Center for Hand Surgery, Phoenix, Ariz
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Kong YH, Song J, Huh J, Kang IS. Outcomes Associated with the Off-label Use of Medical Devices in Congenital Heart Disease at a Single Institute. Korean Circ J 2017; 47:509-515. [PMID: 28765743 PMCID: PMC5537153 DOI: 10.4070/kcj.2016.0311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/28/2016] [Accepted: 12/29/2016] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives While the off-label use of implantable medical devices for treating congenital heart disease is not uncommon, the present conditions and outcomes of their off-label use have rarely been described. Therefore, this study evaluated the prevalence and results of using implantable devices off-label to treat congenital heart disease at a single institute. Subjects and Methods This was a retrospective study based on the medical records of catheter-based interventions for congenital heart disease performed from July 1, 1995 to June 1, 2015. The inclusion criterion was the off-label use of an implantable device. Patient demographic data, procedural success, and follow-up status regarding late complications were investigated, and the results of the off-label use of each device were compared. Results Off-label use occurred in 144 of 1730 interventions with device implantation, accounting for 8.3% of the interventions. The median patient age and mean body weight were 51.0 months and 16.3 kg, respectively. Immediate and late failures were found in 9 cases, and 3 cases of mortality were not directly related to the devices used. The overall success rate was 93.8%. There were no long-term complications of the off-label use of occlusion devices. No procedural failures resulted from stent implantation, but one case of stent malposition and two cases of stent fracture were identified after procedure completion. Conclusion In general, the off-label use of implantable devices for treating congenital heart disease is safe and effective.
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Affiliation(s)
- Young Hwa Kong
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - I-Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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