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Rodriguez J, Cortez D. Aveir retrievable, 38-mm length, leadless pacemaker implantation in a 23-kg pediatric patient with congenital heart disease. Pacing Clin Electrophysiol 2024; 47:398-400. [PMID: 38341644 DOI: 10.1111/pace.14934] [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] [Received: 10/27/2023] [Revised: 12/31/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Complications are more prevalent in pediatric patients receiving pacemaker implants. METHODS We performed a retrospective review of a retrievable, 38 mm leadless pacemaker implantation in a 23-kg pediatric patient. CASE/DISCUSSION An active 9-year-old, 23 kg male patient with tetralogy of Fallot with intermittent pacing need presented with a fractured lead and pacing need. He underwent implant of a retrievable leadless pacemaker (Abbott Aveir) via internal jugular vein access, without complication, and with echocardiographic guidance. His threshold was stable at 1.25 V @0.4 ms, with stable impedance and sensing at 5-month follow-up. CONCLUSION Aveir retrievable leadless pacemakers can be implanted safely in a child with tetralogy of Fallot, as small as 23 kilograms.
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Affiliation(s)
- Jacob Rodriguez
- Department of Pediatric Cardiology, UC Davis Medical Center, Sacramento, USA
- Santa Clara University, Santa Clara, USA
| | - Daniel Cortez
- Department of Pediatric Cardiology, UC Davis Medical Center, Sacramento, USA
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2
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Hugo E, Doubell A, Steyn J, Moses J. A retrospective audit of young adults who received permanent pacemakers at a teaching hospital in the Western Cape, South Africa. Front Cardiovasc Med 2023; 10:1235197. [PMID: 37840958 PMCID: PMC10570724 DOI: 10.3389/fcvm.2023.1235197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction While most pacemaker implantations occur in older individuals, younger patients also receive pacemakers. In these, degenerative conduction system disease is less likely to be the cause of atrioventricular block (AVB), with other diseases being more common. There is, however, a paucity of data on this group as well as on younger pacemaker recipients that have undergone pacemaker implantation for reasons other than AVB. The aim of this study was to perform an audit of young adult permanent pacemaker recipients. Method This was a retrospective record review, conducted in the Division of Cardiology at Tygerberg Hospital, Cape Town, South Africa. We included 169 adult patients between the ages of 18 and 60, who received permanent pacemakers between 2010 and 2020. A subgroup analysis of patients 55 years and younger was also performed. Results Third degree AVB was the most common indication for pacemaker implantation (n = 115; 68%), followed by high degree AVB (n = 23; 13.6%) and sick sinus syndrome (SSS; n = 14; 8.3%). A specific underlying cause for conduction system abnormalities was found in only 25.4% of patients (n = 43), with most of them being 55 years or younger (n = 32; 30.8% of patients ≤ 55 years). Specific causes that were identified included prosthetic valve implantation and/or valve repair (n = 14; 8.3%), myocardial infarction (n = 6; 3.6%), cardiac sarcoidosis (n = 5; 3.0%), coronary artery bypass grafting (n = 3; 1.8%), cardiomyopathy (n = 2; 1.2%), muscular dystrophy (n = 2; 1.2%), congenital heart disease (ventricular septal defect; atrioventricular septal defect; Tetralogy of Fallot; bicuspid aortic valve; n = 6; 3.6%), acute myocarditis (n = 1; 0.6%), atrial myxoma removal (n = 1; 0.6%), planned AV node ablation (n = 2; 1.2%), and following a previous stab in the chest (n = 1; 0.6%). Conclusion Given that the mean age of our study population was high, the low number of identified underlying causes in the whole cohort (≤60 years) may reflect some AVB due to age related degeneration of the conductions system in the patients 56 to 60 years age, but also raises the possibility that these patients may be less likely to be extensively investigated for an underlying cause than those ≤55 years, where diseases such as sarcoidosis were more readily confirmed. As access to advanced diagnostic tools improves, the percentage of young pacemaker recipients with an underlying cause identified may increase.
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Affiliation(s)
- Elrike Hugo
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
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3
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Karev E, Stovpyuk OF. Double outlet right ventricle in adults: Anatomic variability, surgical treatment, and late postoperative complications. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1151-1165. [PMID: 36218204 DOI: 10.1002/jcu.23319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/08/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
Double outlet right ventricle (DORV) is a highly complex congenital heart disease (CHD) entity, gaining increasing interest due to the rapid progress of cardiac surgery. The number of patients operated for this congenital defect has been growing since 1980s and over following decades with active transitioning of this cohort into the adult medicine. However, the diversity of initial anomaly and performed interventions makes challenging the management of these patients. This is particularly important in the regions where specialized adult CHD cardiology still remains underdeveloped. In this review, we observe the basic principles of DORV nomenclature, main types of the operations and possible late complications. The article focuses on adult patients and offers illustrations from clinical practice.
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Affiliation(s)
- Egor Karev
- The aorta and aortic valve pathology research laboratory, Federal State Budgetary Institution "V. A. Almazov National Medical Research Center" of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - Oksana F Stovpyuk
- The aorta and aortic valve pathology research laboratory, Federal State Budgetary Institution "V. A. Almazov National Medical Research Center" of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
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Bergmann M, Germann CP, Nordmeyer J, Peters B, Berger F, Schubert S. Short- and Long-term Outcome After Interventional VSD Closure: A Single-Center Experience in Pediatric and Adult Patients. Pediatr Cardiol 2021; 42:78-88. [PMID: 33009919 PMCID: PMC7864847 DOI: 10.1007/s00246-020-02456-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022]
Abstract
Interventional closure of congenital ventricular septal defects (VSD) is recording a continuous rise in acceptance. Complete atrioventricular block (cAVB) and residual shunting are major concerns during follow-up, but long-term data for both are still limited. We retrospectively evaluated the outcome of patients with interventional VSD closure and focused on long-term results (> 1 year follow-up). Transcatheter VSD closures were performed between 1993 and 2015, in 149 patients requiring 155 procedures (104 perimembranous, 29 muscular, 19 residual post-surgical VSDs, and 3 with multiple defects). The following devices were used: 65 × Amplatzer™ Membranous VSD Occluder, 33 × Duct Occluder II, 27 × Muscular VSD Occluder, 3 × Duct Occluder I, 24 × PFM-Nit-Occlud®, and 3 × Rashkind-Occluder. The median age at time of implantation was 6.2 (0.01-66.1) years, median height 117 (49-188) cm, and median weight 20.9 (3.2-117) kg. Median follow-up time was 6.2 (1.1-21.3) years and closure rate was 86.2% at last follow-up. Complications resulting in device explantation include one case of cAVB with a Membranous VSD occluder 7 days after implantation and four cases due to residual shunt/malposition. Six (4%) deaths occurred during follow-up with only one procedural related death from a hybrid VSD closure. Overall, our reported results of interventional VSD closure show favorable outcomes with only one (0.7%) episode of cAVB. Interventional closure offers a good alternative to surgical closure and shows improved performance by using softer devices. However, prospective long-term data in the current era with different devices are still mandatory to assess the effectiveness and safety of this procedure.
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Affiliation(s)
- M. Bergmann
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - C. P. Germann
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - J. Nordmeyer
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - B. Peters
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - F. Berger
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - S. Schubert
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.418457.b0000 0001 0723 8327Clinic for Pediatric Cardiology and Congenital Heart Defects, Herz- Und Diabeteszentrum NRW, Ruhr University of Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
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Ebrahim MA, Ashkanani HK, Alramzi RS, Malhas ZI, Al-Bahrani M, Sadek AA, Elsayed MA, Lyubomudrov VG. Pacemaker implantation post congenital heart disease surgical repair: tertiary center experience. Eur J Pediatr 2020; 179:1867-1872. [PMID: 32676720 DOI: 10.1007/s00431-020-03739-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
This was a retrospective study documenting all pacemaker implantations (PMIs) secondary to postoperative atrioventricular block. A total of 26 patients were included between 2011 and 2020. The incidence rate was 1.8%, with a median follow-up time of 4.5 years. At the time of the initial PMI, the median weight was 5 kg, and the median generator longevity was 45 months. Mean cardiopulmonary bypass and aortic clamp times were significantly longer among surgeries complicated with PMI (P≤ 0.05). Trisomy 21 patients were 4 times more likely to need a PMI (95% CI 1.8-9, P < 0.001). The mean Risk Adjustment in Congenital Heart Surgery and Society of Thoracic Surgery scores were higher in patients with PMI. All initial PMIs were epicardial (18 single chamber). Most patients underwent ventricular septal defect closure (isolated or complex), except for 5 patients who underwent left-sided surgery. Pacing-induced dilated cardiomyopathy occurred in 3 patients. All implanted leads were functional except for 2 leads with high thresholds and another biventricular system infection. There was a 31% rate of pacing reintervention.Conclusion: PMI resulted in significant morbidity but without mortality. The highest risk for PMI was left ventricular outflow tract repair, trisomy 21, prolonged cardiopulmonary bypass, and aortic cross times. What is Known: •Incidence rate for postoperative atrioventricular block requiring pacemaker was at 1.8%, similar to previously published reports. •Longer cardiopulmonary bypass and aortic cross-clamp times were associated with higher risk for developing postoperative persistent atrioventricular block. What is New: •Incidence for persistent atrioventricular block requiring pacemaker was highest among left ventricular outflow tract surgery at 8.6%. •Following all intracardiac repair, Down syndrome patients were 4 times more likely to need a pacemaker implantation compared to the non-syndromic group.
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Affiliation(s)
- Mohammad A Ebrahim
- Department of Pediatrics, Faculty of Medicine, affiliated with Chest Diseases Hospital, Kuwait University, Block 4, Street 102, Postal Office 46300, Jabriya, Kuwait.
| | | | | | | | - Mariam Al-Bahrani
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University, Jabriya, Kuwait
| | - Ali A Sadek
- Division of Health and Vital Statistics, National Center for Health Information at Ministry of Health, Kuwait City, Kuwait
| | - Moustafa A Elsayed
- Department of Pediatric Cardiac Surgery, Ministry of Health, Chest Diseases Hospital, Kuwait City, Kuwait
| | - Vadim G Lyubomudrov
- Department of Pediatric Cardiac Surgery, Ministry of Health, Chest Diseases Hospital, Kuwait City, Kuwait
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Haddad RN, Daou L, Saliba Z. Device Closure of Perimembranous Ventricular Septal Defect: Choosing Between Amplatzer Occluders. Front Pediatr 2019; 7:300. [PMID: 31475122 PMCID: PMC6707042 DOI: 10.3389/fped.2019.00300] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/08/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Off-label device closure of perimembranous ventricular septal defect (pmVSD) is well reported in the literature with encouraging results. However, technical challenges may be encountered. Objectives: To evaluate and compare feasibility, technical aspects, procedural outcomes, and mid-term follow-up of pmVSD closure using Amplatzer™ occluders. Patients and Methods: From July 2015 to July 2018, patients in whom pmVSD closure was attempted using an Amplatzer occluder were retrospectively identified from our institution's database. Device selection was made according to the defect anatomy that was obtained via ventriculography and trans-esophageal echocardiography. Follow-up evaluations were done at discharge, then at 1, 3, 6, and 12 months and yearly thereafter with transthoracic echocardiography and electrocardiogram. Results: In total, 8 Amplatzer Duct Occluder (ADO), 27 ADO II, and 17 Amplatzer Muscular VSD Occluder (AMO) were used in 51 patients with a mean age of 7.4 ± 6.9 years and a mean weight of 25.4 ± 19.8 kg. Implantation was successful in 50/51 patients (98.0%). There was no procedure related mortality. One ADO accidentally embolized to the aorta after release and was surgically recaptured from the iliac artery. All ADO II were delivered retrogradely with the least amount of time (p = 0.002) and the lowest radiation exposure (p < 0.001). Minor valvular disturbances occurred in 8/49 patients (16.3%), including five tricuspid regurgitation (three with ADOII and two with AMO) and three trivial aortic regurgitations (two with ADO and one with ADOII). On a median follow-up of 194 days (range, 60-895 days), no surgical device removal was necessary. At 6 months of follow-up, trivial residual shunt was present in 5/49 patients (10.2%), among which none occurred with ADO. One complete atrioventricular block was detected 18 months after ADO implantation and required permanent pacing. Conclusions: Transcatheter closure of PmVSD using Amplatzer occluders is feasible, safe and efficacious in properly selected patients. The major key factor behind high procedural success rate is proper device selection. ADOII is remarkably superior in terms of device softness, flexibility and faster implantation process. Yet, its use is limited to small defects with particular anatomy.
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Affiliation(s)
- Raymond N Haddad
- Department of Pediatrics, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon
| | - Linda Daou
- Department of Pediatric Cardiology, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon
| | - Zakhia Saliba
- Department of Pediatric Cardiology, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon
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7
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Altaweel H, Kabbani MS, Hijazi O, Hammadah HM, Al Ghamdi S. Late presenting complete heart block after surgical repair of ventricular septal defect. Egypt Heart J 2018; 70:455-459. [PMID: 30591772 PMCID: PMC6303357 DOI: 10.1016/j.ehj.2018.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 10/23/2018] [Indexed: 11/26/2022] Open
Abstract
Late onset of complete heart block is a life-threatening uncommon complication after surgical repair of congenital heart diseases. In this report, we discuss two cases of Perimembranous ventricular septal defect (VSD) that had late presentation of complete heart block after surgical repair. We are aiming to highlight this unusual complication for more awareness, better understanding and management of this unusual complication after pediatric cardiac surgery.
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Affiliation(s)
- Hayan Altaweel
- Division of Pediatric Cardiac Intensive Care, Cardiac Science Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohamed S Kabbani
- Division of Pediatric Cardiac Intensive Care, Cardiac Science Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Omar Hijazi
- Division of Pediatric Cardiac Intensive Care, Cardiac Science Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hussam M Hammadah
- Division of Pediatric Cardiac Intensive Care, Cardiac Science Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Saleh Al Ghamdi
- Division of Pediatric Cardiology, Cardiac Science Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Nguyen HL, Phan QT, Doan DD, Dinh LH, Tran HB, Sharmin S, Thottian JJ, Won H, Lee WS, Shin SY, Nguyen TQ, Kim SW. Percutaneous closure of perimembranous ventricular septal defect using patent ductus arteriosus occluders. PLoS One 2018; 13:e0206535. [PMID: 30439981 PMCID: PMC6237304 DOI: 10.1371/journal.pone.0206535] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 10/15/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To assess the safety and efficacy of percutaneous closure of perimembranous ventricular septal defect (PmVSD) using patent ductus arteriosus (PDA) occluders. BACKGROUND Widespread use of conventional PmVSD closure devices has been limited by unacceptable high rate of complete heart block (CHB). The elegant design of PDA occluders is supposed to ease implantation, increase closure rate and minimize damage to adjacent structures. Thus, PDA occluders may reduce complications, especially the CHB, and offer a good alternative for PmVSD closure. METHOD From September 2008 to October 2015, patients who underwent attempted percutaneous VSD closure using PDA occluders were included in the study. Patient demographics, echocardiography measurements, procedure details and follow-up data until October 2017 were collected. RESULTS In total, 321 patients with a mean age of 15.5±12.6 years and mean a weight of 33.3±20.5 kg were included in this study. The mean defect size was 4.8±2.1 mm. Implantation was successful in 307 (95.6%) patients. The median follow-up time was 63 months (24 to 108 months). The closure rates were 89.5%, 91.5%, and 99.3% after the procedure 24 hours, 6 months and 2 years, respectively. Major complications occurred in 5 (1.7%) patients during the procedure and follow-up, including persistent CHB in 2 (0.7%) patients and device embolization in 3 (1.0%) patients. No death, disability, or other major complication was detected. CONCLUSION Percutaneous closure of PmVSD using PDA occluders is feasible, safe and efficacious in selected patients.
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Affiliation(s)
- Hieu Lan Nguyen
- Intervention Center, Vietnam National Heart Institute, Ha Noi, Vietnam
- Intervention Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Quang Tan Phan
- Intervention Center, Quang Nam Central General Hospital, Quang Nam, Vietnam
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
- * E-mail:
| | - Dung Duc Doan
- Intervention Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Linh Huynh Dinh
- Intervention Center, Vietnam National Heart Institute, Ha Noi, Vietnam
| | - Hieu Ba Tran
- Intervention Center, Vietnam National Heart Institute, Ha Noi, Vietnam
| | - Saima Sharmin
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Julian Johny Thottian
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
- Intervention Center, Westfort Group Hospital, Kerala, India
| | - Hoyoun Won
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Wang Soo Lee
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Seung Yong Shin
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
| | | | - Sang Wook Kim
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
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Nguyen HL, Phan QT, Dinh LH, Tran HB, Won H, Thottian JJ, Duc DD, Quang TN, Kim SW. Nit-Occlud Lê VSD coil versus Duct Occluders for percutaneous perimembranous ventricular septal defect closure. CONGENIT HEART DIS 2018; 13:584-593. [PMID: 30019378 DOI: 10.1111/chd.12613] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/06/2018] [Accepted: 04/19/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of Nit-Occlud Lê VSD Coil versus Duct Occluders for percutaneous closure of perimembranous ventricular septal defect (pmVSD). INTRODUCTION VSD closure using conventional pmVSD occluders has been largely abandoned because of an unacceptable high rate of complete heart block (CHB). The advantages of Duct Occluders and VSD Coil are supposed to reduce the drawbacks of previous devices, especially CHB complications. METHOD Patients underwent percutaneous pmVSD closure were divided into Coil group (using VSD Coil, n = 71) and DO group (using Duct Occluders, n = 315). Patient demographics, clinical presentations, echocardiography measurements, procedure details and follow-up data were collected. RESULT The procedure success rate was high in both DO group (95.6%) and Coil group (97.2%, P = .53). The closure rate immediately after procedure in the DO group was higher than that in the Coil group (76.8% vs. 58.0%, P < .01). After 6 months, the closure rate was not significantly different between the 2 groups (DO group 91.3% vs. Coil group 84.1%, P = .07). The mean follow-up time was 61.4 ± 24.1 months. The major complication rate was low in both groups (DO group 1.9% vs. Coil group 1.4%, P = .78). Two patients (0.7%) in the DO group and one patient (1.4%) in the Coil group with CHB needed permanent pacemaker (P = .5). Device embolization (3 patients, 1.0%) and endocarditis (1 patient, 0.3%) occurred only in the DO group. There was no death, disability or other major complications detected in either group. CONCLUSION Percutaneous pmVSD closure using either Nit-Occlud Lê VSD Coil or Duct Occluders is feasible, safe and efficacious in selected patients. The main problems of Duct Occluders are unsuitable defect anatomy and device embolization while VSD Coil disadvantages are residual shunt and hemolysis.
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Affiliation(s)
- Hieu Lan Nguyen
- Intervention Center, Hanoi Medical University Hospital, Hanoi, Vietnam.,Intervention Center, Vietnam National Heart Institute, Hanoi, Vietnam
| | - Quang Tan Phan
- Intervention Center, Quang Nam Central General Hospital, Quang Nam, Vietnam.,Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Linh Huynh Dinh
- Intervention Center, Vietnam National Heart Institute, Hanoi, Vietnam
| | - Hieu Ba Tran
- Intervention Center, Vietnam National Heart Institute, Hanoi, Vietnam
| | - Hoyoun Won
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Julian Johny Thottian
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea.,Westfort Group Hospital, Intervention Center, Kerala, India
| | - Dung Doan Duc
- Intervention Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | | | - Sang Wook Kim
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
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Abstract
Ghana is one of the few low-to-middle-income countries in sub-Saharan Africa able to consistently sustain a cardiothoracic program with locally trained staff for more than two decades. Cardiothoracic surgery practice in Ghana started in 1964 but faltered from a combination of political and the economic problems. In 1989, Dr. Kwabena Frimpong-Boateng, a Ghanaian cardiothoracic surgeon trained in Hannover, rekindled interest in cardiothoracic surgery and in establishing a National Cardiothoracic Centre. His vision and leadership has brought cardiothoracic surgery practice in Ghana to its current high level. As a result, the medical landscape of what is achievable locally in both pediatric and adult patients has changed substantially: outbound medical travel that used to be common among Ghanaian cardiovascular patients has been reduced drastically. Ghana's National Cardiothoracic Center (NCTC), the only tertiary center in the country for cardiothoracic surgical pathology manages all such patients that were previously referred abroad. The NCTC has become a medical/surgical hub in the West African sub-region providing service, training, and research opportunities to neighboring countries. The Centre is accredited by the West African College of Surgeons as a center of excellence for training specialists in cardiothoracic surgery. Expectedly, practicing cardiothoracic surgery in such a resource-poor setting has peculiar challenges. This review focuses on the history, practice, successes, and challenges of cardiovascular and thoracic surgery in Ghana.
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Affiliation(s)
- Mark Tettey
- National Cardiothoracic Center, Korle Bu Teaching Hospital, Accra, Ghana; ; School of Medicine and Dentistry, University of Ghana, Legon, Accra, Ghana
| | - Martin Tamatey
- National Cardiothoracic Center, Korle Bu Teaching Hospital, Accra, Ghana
| | - Frank Edwin
- National Cardiothoracic Center, Korle Bu Teaching Hospital, Accra, Ghana
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Valenzuela DM, Ordovas KG. Radiologic evaluation of coronary artery disease in adults with congenital heart disease. Int J Cardiovasc Imaging 2015; 32:13-8. [PMID: 26342712 DOI: 10.1007/s10554-015-0760-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 08/29/2015] [Indexed: 12/31/2022]
Abstract
Improved surgical and medical therapy have prolonged survival in patients with congenital heart disease (CHD) such that general medical conditions like coronary artery disease (CAD) are now the main determinants of mortality. A summary of the association of CAD with CHD, as well as a discussion of the radiologic evaluation of the coronary arteries in adults with CHD is described herein. Cross sectional imaging to evaluate CAD in adults with CHD should follow the same appropriateness criteria as gender and aged matched patients without CHD. Coronary CT imaging may be particularly valuable in evaluating the coronary arteries in this patient population as invasive coronary angiography may prove challenging secondary to complicated or unconventional anatomy of the coronary arteries. Further, typical methods for evaluating CAD such as stress or echocardiography may be impractical in adults with CHD. Finally, delineating the anatomic relationship of the coronary arteries and their relationship with the sternum, chest wall, conduits, grafts, and valves is highly recommended in patients with CHD prior to reintervention to avoid iatrogenic complications.
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Affiliation(s)
- David M Valenzuela
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA
| | - Karen G Ordovas
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA.
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12
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Khanna P, Arora S, Aravindan A, Prasad G. Anesthetic management of a 2-day-old with complete congenital heart block. Saudi J Anaesth 2014; 8:134-7. [PMID: 24665257 PMCID: PMC3950440 DOI: 10.4103/1658-354x.125977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Maternal connective tissue disorders such as Systemic Lupus Erythematosus (most common), Sjogren's syndrome, mixed connective tissue disorders may lead to the rare condition of complete congenital heart block in the neonate. Rare fetal syndromes such as myocarditis, 18p syndrome, mucopolysaccharidoses and mitochondrial diseases are other causes. The mortality rate of this condition is inversely propotional to the age of presentation being 6 % in the neonatal age group. As the cardiac output in the neonate is heart rate dependent, it is crucial to maintain the heart rate in these patients. Pharamacological interventions with dopamine, isoprenaline, epinephrine and atropine are known for their variable response. Although permanent pacing is the most reliable mode of management, the access to it is often not readily available, especially in the developing countries. In such cases temporary pacing methods become lifesaving. Of all the modalities of temporary pacing (transcutaneous, transesophageal and transvenous) transcutaneous pacing is the most readily available and immediate mode. In this case report we present a two day old neonate with isolated complete congenital heart block and a resting heart rate of 50-55/min in immediate need of palliative surgery for trachea-esophageal fistula (TEF). With pharmacological intervention the heart rate could only be raised to 75-80/min. The surgery was successfully carried out using transcutaneous pacing to maintain a heart rate of 100/min.
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Affiliation(s)
- Puneet Khanna
- Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - Shubhangi Arora
- Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ajisha Aravindan
- Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ganga Prasad
- Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
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Edwin F, Tettey M, Aniteye E, Tamatey M, Sereboe L, Entsua-Mensah K, Kotei D, Baffoe-Gyan K. The development of cardiac surgery in West Africa--the case of Ghana. Pan Afr Med J 2011; 9:15. [PMID: 22355425 PMCID: PMC3215537 DOI: 10.4314/pamj.v9i1.71190] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 06/04/2011] [Indexed: 01/08/2023] Open
Abstract
West Africa is one of the poorest regions of the world. The sixteen nations listed by the United Nations in this sub-region have some of the lowest gross domestic products in the world. Health care infrastructure is deficient in most of these countries. Cardiac surgery, with its heavy financial outlay is unavailable in many West African countries. These facts notwithstanding, some West African countries have a proud history of open heart surgery not very well known even in African health care circles. Many African health care givers are under the erroneous impression that the cardiovascular surgical landscape of West Africa is blank. However, documented reports of open-heart surgery in Ghana dates as far back as 1964 when surface cooling was used by Ghanaian surgeons to close atrial septal defects. Ghana's National Cardiothoracic Center is still very active and is accredited by the West African College of Surgeons for the training of cardiothoracic surgeons. Reports from Nigeria indicate open-heart surgery taking place from 1974. Cote D'Ivoire had reported on its first 300 open-heart cases by 1983. Senegal reported open-heart surgery from 1995 and still runs an active center. Cameroon started out in 2009 with work done by an Italian group that ultimately aims to train indigenous surgeons to run the program. This review traces the development and current state of cardiothoracic surgery in West Africa with Ghana's National Cardiothoracic Center as the reference. It aims to dispel the notion that there are no major active cardiothoracic centers in the West African sub-region.
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Affiliation(s)
- Frank Edwin
- National Cardiothoracic Center, Korle Bu Teaching Hospital, P.O. Box KB 846, Accra, Ghana
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