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Joseph SP, Mirza SU, Krupa J, Varghese SI, Kartha GB, George OK, George PV, Jose J, Thomson VS. Original Article--Clinical and Procedural Characteristics of Successful Transcatheter Device Closure of Ostium Secundum Atrial Septal Defect in Symptomatic Children Weighing <15 kg: A Retrospective Study Spanning One Decade From South India. J Saudi Heart Assoc 2024; 36:14-22. [PMID: 38566902 PMCID: PMC10984675 DOI: 10.37616/2212-5043.1365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/07/2024] [Accepted: 01/30/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives This retrospective study sought to determine the feasibility of transcatheter atrial septal defect device closure in patients less than 15 kg, as well as to assess complication rates and the reasons for unsuccessful device closure. Background In general, the risks associated with transcatheter atrial septal defect device closure are believed and reported to be relatively low, but the evidence stems from trials involving adults and older children. Current guidelines do not recommend atrial defect closure in device closure in children <15 kg, due to limited data available for feasibility and safety of device closure in this group of patients. Methods Retrospective review of all patients who underwent elective transcatheter closure of ostium secundum atrial septal defect between September 2013 to February 2022. We excluded all children above 15 kg, as well as those with complex congenital heart defects. Major and minor complications were predefined and indications for referral were evaluated. Results We identified 81 patients meeting criteria with a median procedural age of 3 years (1 year-8 years), and median weight of 12 kg (4-15 kg). Successful device closure was achieved in 95.1% (77/81) and in 4.9% (4/81), the procedure was aborted. There was 1 major (1.2%) and 1 minor (1.2%) complication, total complication rate (2.4%). 100% of the referrals had right heart enlargement and exertional dyspnoea, 18.5% had recurrent lower respiratory tract infection and 9.9% had failure to thrive. Rate of resolution of residual shunt was 95.1%. at post-procedure day 1 and 98.8% at post-procedure 3 and 6 months respectively. Conclusions Percutaneous atrial septal defect closure can be done effectively and safely in symptomatic children weighing less than 15 kg in experienced centres. However, deferral for closure until the historically established timeline of around 4-5 years of age should be strongly considered in asymptomatic children.
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Affiliation(s)
- Shobhit P. Joseph
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Shohiab U.R. Mirza
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Jesu Krupa
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Shruti I. Varghese
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Gayathri B. Kartha
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Oommen K. George
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Paul V. George
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - John Jose
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Viji S. Thomson
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
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Cinteza E, Vasile CM, Busnatu S, Armat I, Spinu AD, Vatasescu R, Duica G, Nicolescu A. Can Artificial Intelligence Revolutionize the Diagnosis and Management of the Atrial Septal Defect in Children? Diagnostics (Basel) 2024; 14:132. [PMID: 38248009 PMCID: PMC10814919 DOI: 10.3390/diagnostics14020132] [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: 12/04/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Atrial septal defects (ASDs) present a significant healthcare challenge, demanding accurate and timely diagnosis and precise management to ensure optimal patient outcomes. Artificial intelligence (AI) applications in healthcare are rapidly evolving, offering promise for enhanced medical decision-making and patient care. In the context of cardiology, the integration of AI promises to provide more efficient and accurate diagnosis and personalized treatment strategies for ASD patients. In interventional cardiology, sometimes the lack of precise measurement of the cardiac rims evaluated by transthoracic echocardiography combined with the floppy aspect of the rims can mislead and result in complications. AI software can be created to generate responses for difficult tasks, like which device is the most suitable for different shapes and dimensions to prevent embolization or erosion. This paper reviews the current state of AI in healthcare and its applications in cardiology, emphasizing the specific opportunities and challenges in applying AI to ASD diagnosis and management. By exploring the capabilities and limitations of AI in ASD diagnosis and management. This paper highlights the evolution of medical practice towards a more AI-augmented future, demonstrating the capacity of AI to unlock new possibilities for healthcare professionals and patients alike.
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Affiliation(s)
- Eliza Cinteza
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.)
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
| | - Corina Maria Vasile
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, F-33600 Bordeaux, France;
| | - Stefan Busnatu
- Cardio-Thoracic Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Cardiology Department, “Prof. Dr. Bagdasar Arseni” Clinical Hospital, 041915 Bucharest, Romania
| | - Ionel Armat
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
| | - Arsenie Dan Spinu
- “Dr. Carol Davila” Central Emergency University Military Hospital, 010825 Bucharest, Romania;
- Department 3, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Radu Vatasescu
- Cardio-Thoracic Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Emergency Clinical Hospital, 014461 Bucharest, Romania
| | - Gabriela Duica
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.)
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
| | - Alin Nicolescu
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
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Xu Q, Fa H, Yang P, Wang Q, Xing Q. Progress of biodegradable polymer application in cardiac occluders. J Biomed Mater Res B Appl Biomater 2024; 112:e35351. [PMID: 37974558 DOI: 10.1002/jbm.b.35351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/08/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
Cardiac septal defect is the most prevalent congenital heart disease and is typically treated with open-heart surgery under cardiopulmonary bypass. Since the 1990s, with the advancement of interventional techniques and minimally invasive transthoracic closure techniques, cardiac occluder implantation represented by the Amplazter products has been the preferred treatment option. Currently, most occlusion devices used in clinical settings are primarily composed of Nitinol as the skeleton. Nevertheless, long-term follow-up studies have revealed various complications related to metal skeletons, including hemolysis, thrombus, metal allergy, cardiac erosion, and even severe atrioventricular block. Thus, occlusion devices made of biodegradable materials have become the focus of research. Over the past two decades, several bioabsorbable cardiac occluders for ventricular septal defect and atrial septal defect have been designed and trialed on animals or humans. This review summarizes the research progress of bioabsorbable cardiac occluders, the advantages and disadvantages of different biodegradable polymers used to fabricate occluders, and discusses future research directions concerning the structures and materials of bioabsorbable cardiac occluders.
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Affiliation(s)
- Qiteng Xu
- Medical College, Qingdao University, Qingdao, China
| | - Hongge Fa
- Qingdao Women and Children's Hospital, QingdaoUniversity, Qingdao, China
| | - Ping Yang
- Medical College, Qingdao University, Qingdao, China
| | | | - Quansheng Xing
- Qingdao Women and Children's Hospital, QingdaoUniversity, Qingdao, China
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Naseem JA, Riyaz MSU, Joseph SP, Krupa J, Agarwal M, Mathen PG, George OK, George PV, Jose J, Thomson VS. Transcatheter closure of large ostium secundum atrial septal defects in symptomatic small children: A single-center retrospective study. Ann Pediatr Cardiol 2023; 16:393-398. [PMID: 38817268 PMCID: PMC11135894 DOI: 10.4103/apc.apc_163_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 06/01/2024] Open
Abstract
Background In general, the risks associated with transcatheter atrial septal defect (ASD) device closure are reported to be relatively low, but the evidence stems from trials involving adults and older children. Current guidelines do not recommend ASD device closure in children with defect sizes >20 mm due to limited data available in this group of patients. This retrospective study sought to determine the clinical and procedural characteristics of successful transcatheter ASD device closure in small children with large defects and assess the complication rates and reasons for unsuccessful device closure. Methods We retrospectively reviewed the data of all patients who underwent elective transcatheter closure of ostium secundum ASD in our department between September 2013 and February 2022. All children weighing <20 kg, requiring a device of size 20 mm or greater, were included. Major and minor complications were predefined and indications for referral were evaluated. Echocardiogram reports were reviewed from the time of referral, postcatheterization day 1, and at 1-year follow-up. Results We identified 40 patients meeting inclusion criteria with a median (interquartile range [IQR]) procedural age of 5 (4-7) years and median (IQR) weight of 14 (12-18) kg. Successful device closure was achieved in 39 patients with a success rate of 97.5%. The total complication rate was 2.5% (95% confidence interval: 0.44%- I2.8%) with only 1 major complication. All children had right heart enlargement and exertional dyspnea, 30% of patients had recurrent lower respiratory tract infections, and 10% had failure to thrive. At 1-year follow-up, a transthoracic echocardiogram showed a well-endothelialized device in a stable position in all the patients, and none of the patients had a residual shunt. Conclusion In experienced centers, percutaneous ASD closure of large defects in symptomatic small children can be done effectively and safely with a great degree of predictability and a low complication rate.
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Affiliation(s)
| | | | | | - Jesu Krupa
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mayank Agarwal
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Oommen K. George
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Paul V. George
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - John Jose
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Viji Samuel Thomson
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
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Ditkivskyy IO, Voloshyn DL, Yermolovych YV, Perepeka IA, Lazoryshynets VV. Endovascular Closure of Secondary Septal Defect in Children with Low Body Weight. UKRAINIAN JOURNAL OF CARDIOVASCULAR SURGERY 2022. [DOI: 10.30702/ujcvs/22.30(04)/dv061-5358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The aim. To assess the effectiveness and safety of transcatheter closure of a secondary atrial septal defect (ASD) using an occluder in symptomatic children weighing ≤10 kg.
Materials and methods. In the period from November 2014 to June 2021, on the basis of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, closure of secondary ASD using an occluder was performed in 18 patients, among them 13 women (72.2%) and 5 men (27.8%). Th e mean age of the patients was 18.94±9.44 months (the youngest patient was 12 months, the oldest was 4 years). The mean weight was 9.294±1.170 kg (6.4 kg to 10 kg), the mean Z-score was -1.7±1.5 (-4.6 to 0.46), the mean height was 80 cm (71 cm to 88 cm). According to the measurements by transesophageal echocardiography (TEE), the average size of the defects was 13.7 mm±3.6mm (the largest 18.0 mm, the smallest 6.0 mm).
Results and discussion. In our publication, the effectiveness of the method was 100% (18/18), while the world statistics show 94-95%. Th e frequency of complications was 5.6% (n=1). We suggest that this is associated with the use of a sizing balloon and careful selection of the device.
When choosing treatment tactics for symptomatic children weighing ≤10 kg, the decisive factor was the determination of the presence of edges and the size of the defect. Defects were considered suitable for closure, according to TEE data, when all margins of the defect were ≥4 mm, except for the aortic margin. Although the total length of the interatrial membrane was taken into account, it was not of decisive importance, since for most occluders with the presence of all edges, the fields of the implant could not interfere with the work of the anatomical structures of the heart. To determine the real size of the defect, we recommend a measuring balloon under TEE control.
The following devices were used to close the defect: MemoPart ASD occluder, Amplatzer Septal Occluder, LifeTech HeartR Occluder, LifeTech HeartR Multi-Fenestrated Atrial Septal Defect (MF-ASD) Occluder.
Conclusion. After the study, we are convinced that the endovascular method of closing a hemodynamically significant secondary ASD for the treatment of children with a body weight of ≤10 kg has proven to be an effective method, with successful implantation of the occluder in 100% of cases.
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Kumar A, Ramamurthy HR, Tiwari N, Joshi S, Kumar G, Kumar V, Sharma V. Fast-tracking with continuous thoracic epidural analgesia in paediatric congenital heart surgeries: an institutional experience. Indian J Thorac Cardiovasc Surg 2022; 38:469-480. [PMID: 36050967 PMCID: PMC9424455 DOI: 10.1007/s12055-022-01373-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To assess the success of fast-tracking in infants and small children undergoing paediatric cardiac surgery under general anaesthesia with continuous thoracic epidural analgesia (TEA). Methodology It is a retrospective study at a tertiary care hospital. A total of 461 children, aged 12 years or younger, were operated for congenital heart disease over a 2-year period from January 2018 to December 2019. After the exclusion of 71 patients, data from the remaining 390 patients were analysed. Measurements and main results The median time for extubation after intensive care unit admission was 2 h and 25 min (0-20 h). Extubation within 6 h was achieved in 215 patients (~ 55%). Patients in the early extubation group had significantly shorter hospital stay (4.1 ± 2.3 vs 6.9 ± 3.9 days, p = 0.004) than patients in the ventilated group. Reintubation was required in 27 (6.9%) patients. Thirteen patients died postoperatively on ventilator. Patients with low nadir temperature intraoperatively and cardiopulmonary bypass time > 90 min significantly predicted failure in fast-tracking with an odds ratio (OR) = 1.27; CI: 1.18-1.38 and OR = 2.3; CI: 1.8-2.96 respectively. The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery mortality score, younger age, Down syndrome and high vasopressor inotropic score did not adversely affect early extubation, contrary to contemporary concerns. Conclusions A multimodal approach for perioperative pain relief and sedation consisting of propofol and dexmedetomidine infusion along with TEA ensures early extubation in 59% of the cases undergoing paediatric cardiac surgery. Our data suggests that fast-tracking is feasible with safe and superior outcomes in a subset of appropriate patients undergoing paediatric cardiac surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-022-01373-8.
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Affiliation(s)
- Alok Kumar
- Department of Anaesthesia & Critical Care, Army Hospital (Research & Referral), Delhi Cantt, New Delhi 110010 India
| | - H. R. Ramamurthy
- Department of Paediatrics, Army Hospital (Research & Referral), Delhi Cantt, New Delhi 110010 India
| | - Nikhil Tiwari
- Department of Cardiothoracic Surgery, Army Hospital (Research & Referral), Delhi Cantt, New Delhi 110010 India
| | - Saajan Joshi
- Department of Anaesthesia & Critical Care, Army Hospital (Research & Referral), Delhi Cantt, New Delhi 110010 India
| | - Gaurav Kumar
- Department of Cardiothoracic Surgery, Army Hospital (Research & Referral), Delhi Cantt, New Delhi 110010 India
| | - Vivek Kumar
- Department of Paediatrics, Army Hospital (Research & Referral), Delhi Cantt, New Delhi 110010 India
| | - Vipul Sharma
- Department of Anaesthesia & Critical Care, Dr. DY Patil Medical College, Pune, India
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Kashyap T, Sanusi M, Momin ES, Khan AA, Mannan V, Pervaiz MA, Akram A, Elshaikh AO. Transcatheter Occluder Devices for the Closure of Atrial Septal Defect in Children: How Safe and Effective Are They? A Systematic Review. Cureus 2022; 14:e25402. [PMID: 35765405 PMCID: PMC9233908 DOI: 10.7759/cureus.25402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/27/2022] [Indexed: 11/27/2022] Open
Abstract
Atrial septal defect (ASD) is a hole in the interatrial septum (IAS) of the heart that is one of the most common congenital heart diseases (CHD). Percutaneous transcatheter device occlusion is one of the techniques that have been developed for the closure of atrial septal defects. The primary objective of this study is to assess the safety and efficacy of septal occluder devices in the management of atrial septal defect in children. We searched PubMed, Science Direct, and Google Scholar databases to collect relevant articles according to a predetermined eligibility criteria and included 21 papers of different study designs in this systematic review. We found that transcatheter closure is safe and effective in most children with ASD. The major complications reported could be avoided by comprehensive clinical assessment and echocardiographic evaluation to determine appropriate device size and implantation strategy per individual child. Further research involving more clinical trials with larger sample size and longer duration of followup is required to improve the safety of existing devices for their use in all children with ASD despite their weight and defect size, and also the efficacy of newer devices such as biodegradable septal occluders.
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Affiliation(s)
- Tejasvi Kashyap
- General Practice, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Muhammad Sanusi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Elina S Momin
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Asma A Khan
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Vijayalakshmi Mannan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Muhammad Ahad Pervaiz
- Urology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aqsa Akram
- Internal medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Abeer O Elshaikh
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Arvind B, Ramakrishnan S. Pediatric interventional cardiology: Breaking new grounds. Ann Pediatr Cardiol 2022; 15:109-113. [PMID: 36246752 PMCID: PMC9564413 DOI: 10.4103/apc.apc_91_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Balaji Arvind
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Said SM, Sainathan S, Miranda C, Aggarwal V, Bass J. Sinus Node Recovery after Explantation of Amplatzer Septal Occluder: A Word of Caution. JTCVS Tech 2022; 12:166-169. [PMID: 35403052 PMCID: PMC8987339 DOI: 10.1016/j.xjtc.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/04/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sameh M. Said
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minn
- Address for reprints: Sameh M. Said, MBBCh, MD, FACS, Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave S, Academic Office Building, 521, Minneapolis, MN 55454.
| | - Sandeep Sainathan
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minn
| | | | - Varun Aggarwal
- Division of Pediatric Cardiology, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minn
| | - John Bass
- Division of Pediatric Cardiology, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minn
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Jang SI. The Use of Diuretics on Atrial Septal Defect: To Use or Not to Use. Korean Circ J 2021; 51:1030-1032. [PMID: 34854582 PMCID: PMC8636756 DOI: 10.4070/kcj.2021.0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/02/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- So-Ick Jang
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea.
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Aristizabal-Villa G, Plata-Marriaga A, Escobar-Modesto J. Percutaneous closure of atrial septal defect in patients under 15 kilograms using balloon assisted technique. Case report. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2020; 91:261-263. [PMID: 33079076 PMCID: PMC8295860 DOI: 10.24875/acm.20000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/21/2020] [Indexed: 11/17/2022] Open
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