1
|
Hribernik I, Bentham J. Transcatheter recanalization of chronic total occlusion in congenital heart disease: case reports and lessons from percutaneous coronary interventions. Eur Heart J Case Rep 2023; 7:ytad403. [PMID: 37650077 PMCID: PMC10464570 DOI: 10.1093/ehjcr/ytad403] [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: 01/20/2023] [Revised: 04/03/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023]
Abstract
Background Chronic complete vascular occlusion causes significant morbidity and mortality in patients with congenital heart disease (CHD). The diversity of lesions, lack of dedicated equipment, and small number of procedures performed by individual operator continue to pose a challenge to congenital interventional cardiologists. Case summary We report two cases of percutaneous recanalization in CHD using percutaneous coronary intervention (PCI) equipment for chronic total occlusion (CTO). Discussion Careful pre-procedural planning, access site choice, use of catheter guiding systems for support, and selection of penetrating guidewires and techniques used in CTO-PCIs are key steps to a successful outcome.
Collapse
Affiliation(s)
- Ines Hribernik
- Department of Paediatric Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds LS13EX, UK
| | - James Bentham
- Department of Paediatric Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds LS13EX, UK
| |
Collapse
|
2
|
Patel JD, Mandhani M, Gray R, Pettus J, McCracken CE, Thomas A, Bauser-Heaton H, Kim DW, Petit CJ. Transcatheter Recanalization of Atretic Pulmonary Veins in Infants and Children. Circ Cardiovasc Interv 2022; 15:e011351. [PMID: 35727880 DOI: 10.1161/circinterventions.121.011351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary vein stenosis is a progressive disease associated with a high rate of mortality in children. If left untreated, myofibroblastic proliferation can lead to pulmonary vein atresia (PVA). In our experience, transcatheter recanalization has emerged as a favorable interventional option. We sought to determine the acute success rate of recanalization of atretic pulmonary veins and mid-term outcomes of individual veins after recanalization. METHODS We reviewed all patients with PVA at our institution between 2008 and 2020 diagnosed by either catheterization or cardiac computed tomography. All veins with successful recanalization were reviewed and procedural success rate and patency rate were noted. Competing risk analysis was performed to demonstrate outcomes of individual atretic veins longitudinally. RESULTS Between 2008 and 2020, our institution diagnosed and treated 131 patients with pulmonary vein stenosis. Of these, 61 patients developed atresia of at least one pulmonary vein. In total, there were 97 atretic pulmonary veins within this group. Successful recanalization was accomplished in 47/97 (48.5%) atretic veins. No atretic pulmonary veins were successfully recanalized before 2012. The majority of veins were recanalized between 2017 and 2020-39/56 (70%). The most common intervention after recanalization was drug-eluting stent placement. At 2-year follow-up 42.6% of recanalized veins (20.6% of all atretic veins) remained patent with a median of 4 reinterventions per person. CONCLUSIONS Transcatheter recanalization of PVA can result in successful reestablishment of flow to affected pulmonary veins in many cases. Drug-eluting stent implantation was the most common intervention performed immediately post-recanalization. Vein patency was maintained in 42.6% of patients at 2-year follow-up from recanalization with appropriate surveillance and reintervention. Overall, only a small portion of atretic pulmonary veins underwent successful recanalization with maintained vessel patency at follow-up. Irrespective of successful recanalization, there was no detectable survival difference between the more recently treated PVA cohort and non-PVA cohort.
Collapse
Affiliation(s)
- Jay D Patel
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
| | - Mansi Mandhani
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
| | - Rosemary Gray
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
| | - Joelle Pettus
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
| | - Courtney E McCracken
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
| | - Amanda Thomas
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
| | - Holly Bauser-Heaton
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
| | - Dennis W Kim
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
| | - Christopher J Petit
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Morgan Stanley Children's Hospital (C.J.P.)
| |
Collapse
|
3
|
Chessa M, Favoccia C, Jha N, Carminati M, Fernandez Gonzalez L, Eicken A, Butera G, Ferreira Martins J, Pinto F, Tofeig M, Khan M. Long-term follow-up after recanalisation of aortic arch atresia. EUROINTERVENTION 2021; 16:e1274-e1280. [PMID: 31235456 PMCID: PMC9724876 DOI: 10.4244/eij-d-18-00857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Aortic arch atresia (AAA) is one of the rarest obstructive defects. The presence of this anomaly in adult age is uncommon. The typical anatomic feature consists of a complete occlusion of the membranous obstruction resulting in an acquired atresia without flow continuity between the proximal and distal segments. This feature is important in determining the feasibility of percutaneous intervention. The aim of the present study was to share long-term follow-up data of adult patients with AAA requiring percutaneous interventions for the management of this rare anomaly involving five different centres. METHODS AND RESULTS Retrospective data of 19 patients (12 males, 63.2%, mean age 32.2±18.9 years) diagnosed with AAA treated in five different centres between 1999 and 2017 were collected. All patients underwent percutaneous recanalisation by (1) radiofrequency (RF) system (five patients, 26.3%), (2) extra-stiff guidewire (12 patients, 63.2%), and (3) transseptal needle (two patients, 10.5%). All procedures were subsequently followed by covered stent implantation. Two patients developed complications during the procedure and one of them died. Over a median follow-up of 4.94 years, four (21%) patients were able to be weaned from medications for hypertension. All the patients underwent reassessment for recurrence or restenosis during the follow-up. Seven (36.8%) patients underwent successful stent dilatation with a balloon. After the intervention, one patient experienced a late complication; however, one patient died due to an unknown cause believed to be unrelated to the previous recanalisation procedure. CONCLUSIONS Percutaneous treatment of AAA is feasible with good long-term survival. This study reports the largest case series so far available in the literature.
Collapse
Affiliation(s)
- Massimo Chessa
- Pediatric and Adult Congenital Heart Centre, IRCCS, Policlinico San Donato Hospital, Via Morandi, 30, 20097 San Donato Milanese, Milan, Italy
| | - Carla Favoccia
- Pediatric and Adult Congenital Heart Centre – IRCCS - Policlinico San Donato, Milan, Italy
| | - Neerod Jha
- Pediatric Cardiac Surgery Division, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Mario Carminati
- Pediatric and Adult Congenital Heart Centre – IRCCS - Policlinico San Donato, Milan, Italy
| | - Luis Fernandez Gonzalez
- Hospital Universitario de Cruces, Sección de Hemodinámica y Cardiología Intervencionista, Baracaldo, Vizcaya, Spain
| | - Andreas Eicken
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Gianfranco Butera
- Pediatric and Adult Congenital Heart Centre – IRCCS - Policlinico San Donato, Milan, Italy
| | | | - Fatima Pinto
- Pediatric Cardiology Department, Santa Marta Hospital, CHLC, Lisbon, Portugal
| | - Magdi Tofeig
- Paediatric Cardiology & Adult Congenital Heart Diseases Division, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Mohammad Khan
- Paediatric Cardiology & Adult Congenital Heart Diseases Division, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| |
Collapse
|
4
|
Menon PJ, Walsh K. A Case Series Describing Percutaneous Management of Aortic Isthmic Atresia. Vasc Endovascular Surg 2020; 54:463-466. [PMID: 32338186 DOI: 10.1177/1538574420921280] [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: 11/16/2022]
Abstract
Aortic isthmic atresia is a severe form of aortic coarctation where there is loss of luminal communication at the aortic isthmus. The primary approach for correcting aortic isthmic atresia has been surgical repair of the coarctation. A small number of case series have shown that percutaneous correction of aortic isthmic atresia is possible. We describe 3 cases of aortic isthmic atresia that was successfully treated using a percutaneous approach. Our cases ranged in age between 42 and 51 years, and they all had hypertension. In our case series, 2 patients were successfully treated with radiofrequency perforation and 1 patient had anterograde recanalization performed using a stiff wire. Our patients have been followed up for between 2 and 4 years post-procedure, and they continue to do well. The success of percutaneous management in this case series adds to the small but increasing amount of data available in support of endovascular management of aortic isthmic atresia in adult patients.
Collapse
Affiliation(s)
| | - Kevin Walsh
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| |
Collapse
|
5
|
Qureshi AM, Mullins CE, Latson LA. Recent advances in managing vascular occlusions in the cardiac catheterization laboratory. F1000Res 2018; 7. [PMID: 29770200 PMCID: PMC5931263 DOI: 10.12688/f1000research.13271.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 11/28/2022] Open
Abstract
Vascular occlusions continue to be a significant cause of morbidity and mortality. The management of vascular occlusions in patients is complex, requiring specialized expertise in the cardiac catheterization laboratory and from other disciplines. Knowledge of currently available tools at the operator’s disposal is important to optimize the success of these procedures. In this review, we discuss some of the recent advances in recanalization procedures of vascular occlusions and thrombotic lesions in the cardiac catheterization laboratory.
Collapse
Affiliation(s)
- Athar M. Qureshi
- CE Mullins Cardiac Catheterization Laboratories, The Lillie Frank Abercrombie Section, Texas Children’s Hospital of Cardiology, 6621 Fannin Street, Houston, TX 77030, USA
- Internal Medicine/Cardiology, Baylor St. Luke’s Medical Center, 6621 Fannin Street, West Tower, 19th Floor, MC 19345C, Houston, TX 77030, USA
| | - Charles E. Mullins
- CE Mullins Cardiac Catheterization Laboratories, The Lillie Frank Abercrombie Section, Texas Children’s Hospital of Cardiology, 6621 Fannin Street, Houston, TX 77030, USA
| | - Larry A. Latson
- Joe DiMaggio Children's Hospital and Center for Adult Congenital Heart Disease, Memorial Healthcare System, 1005 Joe Dimaggio Drive Pediatric Heart Station Hollywood, FL 33021, USA
| |
Collapse
|
6
|
Ligon RA, Kim DW, Vincent RN, Bauser-Heaton HD, Ooi YK, Petit CJ. Angiographic follow-up of infants and children undergoing percutaneous carotid artery interventions. Catheter Cardiovasc Interv 2018; 91:1301-1306. [DOI: 10.1002/ccd.27481] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/07/2017] [Accepted: 12/10/2017] [Indexed: 11/12/2022]
Affiliation(s)
- R. Allen Ligon
- Children's Healthcare of Atlanta, Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | - Dennis W. Kim
- Children's Healthcare of Atlanta, Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | - Robert N. Vincent
- Children's Healthcare of Atlanta, Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | - Holly D. Bauser-Heaton
- Children's Healthcare of Atlanta, Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | - Yinn K. Ooi
- Children's Healthcare of Atlanta, Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | - Christopher J. Petit
- Children's Healthcare of Atlanta, Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| |
Collapse
|
7
|
Ligon RA, Ooi YK, Kim DW, Vincent RN, Petit CJ. Intervention on Surgical Systemic-to-Pulmonary Artery Shunts: Carotid Versus Femoral Access. JACC Cardiovasc Interv 2017; 10:1738-1744. [PMID: 28823774 DOI: 10.1016/j.jcin.2017.05.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/03/2017] [Accepted: 05/04/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The purpose of this study was to compare results between the femoral arterial (FA) and carotid arterial (CA) approaches in catheter-based interventions on Blalock-Taussig shunts (BTS). BACKGROUND Transcatheter intervention on BTS is often performed in shunt-dependent, hypoxemic infants. The approach to BTS intervention likely has an impact on timeliness and overall success. METHODS The authors reviewed all cases of catheter intervention for BTS obstruction between 2012 and 2017 for their institution. They sought to compare procedural success rates and time, sheath time, time to arterial access, and time from access to stent implantation between FA and CA approaches. RESULTS There were 42 BTS interventions between 34 patients. BTS intervention was more successful from the CA approach (p = 0.035). Among the FA cohort, BTS intervention was unsuccessful in 8 cases (25%), 5 of which were converted to CA with subsequent success. The CA cohort had lower procedure time (62 min vs. 104 min; p = 0.01) and anesthesia time (119 min vs. 151 min; p = 0.01). Additionally, CA access was associated with shorter time to arterial access (4.0 min vs. 9.3 min; p < 0.01), time to placement of the guidewire through the BTS (6.5 min vs. 13 min; p < 0.01), and time from the final sheath to BTS stent implantation (9 min vs. 20 min; p < 0.01). CONCLUSIONS Operators should consider the route of access to the BTS deliberately. The authors' approach has been the carotid artery as an alternative access site-associated with greater procedural success, shorter procedural time, and shorter time to stent implantation.
Collapse
Affiliation(s)
- R Allen Ligon
- Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Yinn K Ooi
- Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Dennis W Kim
- Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Robert N Vincent
- Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Christopher J Petit
- Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
| |
Collapse
|
8
|
Elarabi AI, Leong MC, Alwi M. Recanalization of an occluded left pulmonary artery: A case report and review of the literature. Ann Pediatr Cardiol 2017; 10:203-205. [PMID: 28566832 PMCID: PMC5431036 DOI: 10.4103/0974-2069.205157] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report an 8-year-old male child with tetralogy of Fallot (TOF), who developed left pulmonary artery (LPA) atresia, following surgical repair of TOF and left pulmonary arterioplasty at the age of 6 years. He underwent successful radiofrequency recanalization and stenting of the LPA. The LPA exhibited satisfactory growth for 3 months, following recanalization and stenting.
Collapse
Affiliation(s)
- Ali Ibrahim Elarabi
- Paediatric and Congenital Heart Centre, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Ming Chern Leong
- Paediatric and Congenital Heart Centre, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Mazeni Alwi
- Paediatric and Congenital Heart Centre, Institut Jantung Negara, Kuala Lumpur, Malaysia
| |
Collapse
|
9
|
Qureshi AM, Petit CJ, Crystal MA, Liou A, Khan A, Justino H. Efficacy and safety of catheter-based rheolytic and aspiration thrombectomy in children. Catheter Cardiovasc Interv 2016; 87:1273-80. [DOI: 10.1002/ccd.26399] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/21/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Athar M. Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, CE Mullins Cardiac Catheterization Laboratories, Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Christopher J. Petit
- The Lillie Frank Abercrombie Section of Cardiology, CE Mullins Cardiac Catheterization Laboratories, Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Matthew A. Crystal
- The Lillie Frank Abercrombie Section of Cardiology, CE Mullins Cardiac Catheterization Laboratories, Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Aimee Liou
- The Lillie Frank Abercrombie Section of Cardiology, CE Mullins Cardiac Catheterization Laboratories, Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Asra Khan
- The Lillie Frank Abercrombie Section of Cardiology, CE Mullins Cardiac Catheterization Laboratories, Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Henri Justino
- The Lillie Frank Abercrombie Section of Cardiology, CE Mullins Cardiac Catheterization Laboratories, Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| |
Collapse
|
10
|
Goel PK, Syal SK. Percutaneous reconstruction of aortic isthmus atresia using coronary total occlusion technique. J Cardiol Cases 2014; 10:121-124. [PMID: 30534221 DOI: 10.1016/j.jccase.2014.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/10/2014] [Accepted: 06/11/2014] [Indexed: 02/08/2023] Open
Abstract
Aortic isthmus atresia is an extreme form of coarctation presenting in adults and usually calls for surgical correction. In this report, we present our initial experience with the first four cases successfully treated percutaneously using dedicated coronary total occlusion wires and techniques. <Learning objective: This case series shows a technique to cross totally occluded coarctation using the coronary chronic total occlusion technique which has not been described in the literature till date. Further, these cases although not common are not as rare either as is evident by our experience of four consecutive cases observed over a period of 6 years in a large tertiary care centre. The readers could benefit from applying the same principles for similar cases that they would see in their clinical practice.>.
Collapse
Affiliation(s)
- Pravin K Goel
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sanjeev K Syal
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
11
|
Qureshi AM, Hill JA, Prieto LR, Arruda J, Morrison S, Worley S, Latson LA. Transcatheter recanalization of totally occluded proximal pulmonary arteries and major systemic veins in patients with congenital heart disease. Am J Cardiol 2013. [PMID: 23178055 DOI: 10.1016/j.amjcard.2012.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of the present study was to assess the results and technical aspects of attempted transcatheter recanalization of occluded pulmonary arteries or major systemic veins from our center. Occluded pulmonary arteries or major systemic veins are often not considered amenable to transcatheter treatment and can be a cause of significant hemodynamic compromise for patients. The records of patients with occluded pulmonary arteries or major systemic veins who underwent cardiac catheterization from April 1997 to February 2011 were reviewed. We identified 18 patients, of whom, 9 had occluded pulmonary arteries and 9 occluded systemic veins. Recanalization was achieved in 17 of the 18 patients (94%). At a median follow-up of 35 months (range 6 months to 12 years), all vessels remained patent. The freedom from reintervention rate in the entire cohort was 61% at 6 months, 35% at 1 year, and 35% at 5 years. Freedom from an unplanned reintervention was 67% at 6 months. Procedural adverse events occurred in 2 patients. One death occurred within 24 hours of the catheterization procedure and 2 late deaths occurred, all unrelated to the procedure. In conclusion, both acute and chronic success at recanalizing the occluded pulmonary arteries and major systemic veins can be achieved using percutaneous techniques. Careful follow-up is needed, because reintervention can be necessary to maintain long-term vessel patency without stenosis.
Collapse
Affiliation(s)
- Athar M Qureshi
- Center of Pediatric and Congenital Heart Disease, Cleveland Clinic, Ohio, USA.
| | | | | | | | | | | | | |
Collapse
|