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McElhinney DB, Gillespie MJ, Aboulhosn JA, Cabalka AK, Morray BH, Balzer DT, Qureshi AM, Hoskoppal AK, Goldstein BH. Transcatheter Pulmonary Valve Replacement With the Harmony Valve in Patients Who Do Not Meet Recommended Oversizing Criteria on the Screening Perimeter Plot. Circ Cardiovasc Interv 2024:e013889. [PMID: 38606564 DOI: 10.1161/circinterventions.123.013889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/22/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Anatomic selection for Harmony valve implant is determined with the aid of a screening report and perimeter plot (PP) that depicts the perimeter-derived radius along the right ventricular outflow tract (RVOT) and projects device oversizing. The PP provides an estimation of suitability for implant, but its sensitivity as a screening method is unknown. This study was performed to describe anatomic features and outcomes in patients who underwent Harmony TPV25 implant despite a PP that predicted inadequate oversizing. METHODS We reviewed RVOT anatomic features and measurements in patients who underwent transcatheter pulmonary valve replacement with the Harmony TPV25 device despite a PP that predicted inadequate oversizing. RESULTS This study included 22 patients. There were no unsuccessful implants or adverse valve-related events. Anatomic features varied, but all patients fit into 1 of 3 anatomic types characterized by differences in RVOT dimensions. Type 1 patients (n=9) had a long RVOT with a choke point and a wide main pulmonary artery. Type 2 patients (n=6) had a short RVOT that was pyramidal in shape, with no choke point, and extensive main pulmonary artery lengthening/expansion during systole. Type 3 patients (n=7) had a short, bulbous main pulmonary artery with a choke point and an open pulmonary artery bifurcation. CONCLUSIONS Transcatheter pulmonary valve replacement with the Harmony valve is feasible in some patients whose PP fit analysis predicts inadequate oversizing. All cases in this series fit into 1 of 3 anatomic patterns, which are not identified in the screening report. Implanters must review cases individually to assess the feasibility of the implant.
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Affiliation(s)
- Doff B McElhinney
- Departments of Cardiothoracic Surgery and Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA (D.B.M.E.)
| | - Matthew J Gillespie
- Division of Pediatric Cardiology, University of Pennsylvania School of Medicine and The Children's Hospital of Philadelphia (M.J.G.)
| | - Jamil A Aboulhosn
- Division of Cardiology, UCLA Medical Center, Los Angeles, CA (J.A.A.)
| | - Allison K Cabalka
- Divisions of Pediatric Cardiology and Structural Heart Diseases, Mayo Clinic, Rochester, MN (A.K.C.)
| | - Brian H Morray
- Seattle Children's Hospital, University of Washington (B.H.M.)
| | - David T Balzer
- Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, MO (D.T.B.)
| | - Athar M Qureshi
- Division of Cardiology, Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston (A.M.Q.)
| | - Arvind K Hoskoppal
- Heart Institute, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh School of Medicine, PA (A.K.H., B.H.G.)
| | - Bryan H Goldstein
- Heart Institute, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh School of Medicine, PA (A.K.H., B.H.G.)
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Donahue CL, Westman CL, Faanes BL, Qureshi AM, Barocas VH, Aggarwal V. Finite element modeling with patient-specific geometry to assess clinical risks of percutaneous pulmonary valve implantation. Catheter Cardiovasc Interv 2024. [PMID: 38597297 DOI: 10.1002/ccd.31016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 03/10/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Percutaneous pulmonary valve implantation (PPVI) is a non-surgical treatment for right ventricular outflow tract (RVOT) dysfunction. During PPVI, a stented valve, delivered via catheter, replaces the dysfunctional pulmonary valve. Stent oversizing allows valve anchoring within the RVOT, but overexpansion can intrude on the surrounding structures. Potentially dangerous outcomes include aortic valve insufficiency (AVI) from aortic root (AR) distortion and myocardial ischemia from coronary artery (CA) compression. Currently, risks are evaluated via balloon angioplasty/sizing before stent deployment. Patient-specific finite element (FE) analysis frameworks can improve pre-procedural risk assessment, but current methods require hundreds of hours of high-performance computation. METHODS We created a simplified method to simulate the procedure using patient-specific FE models for accurate, efficient pre-procedural PPVI (using balloon expandable valves) risk assessment. The methodology was tested by retrospectively evaluating the clinical outcome of 12 PPVI candidates. RESULTS Of 12 patients (median age 14.5 years) with dysfunctional RVOT, 7 had native RVOT and 5 had RV-PA conduits. Seven patients had undergone successful RVOT stent/valve placement, three had significant AVI on balloon testing, one had left CA compression, and one had both AVI and left CA compression. A model-calculated change of more than 20% in lumen diameter of the AR or coronary arteries correctly predicted aortic valve sufficiency and/or CA compression in all the patients. CONCLUSION Agreement between FE results and clinical outcomes is excellent. Additionally, these models run in 2-6 min on a desktop computer, demonstrating potential use of FE analysis for pre-procedural risk assessment of PPVI in a clinically relevant timeframe.
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Affiliation(s)
- Carly L Donahue
- Department of Biomedical Engineering, University of Minnesota, Twin Cities, Minnesota, USA
| | - Claire L Westman
- Department of Biomedical Engineering, University of Minnesota, Twin Cities, Minnesota, USA
| | - Brittany L Faanes
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Athar M Qureshi
- Department of Pediatrics, The Lillei Frank Abercombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Victor H Barocas
- Department of Biomedical Engineering, University of Minnesota, Twin Cities, Minnesota, USA
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
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Goldstein BH, McElhinney DB, Gillespie MJ, Aboulhosn JA, Levi DS, Morray BH, Cabalka AK, Love BA, Zampi JD, Balzer DT, Law MA, Schiff MD, Hoskoppal A, Qureshi AM. Early Outcomes From a Multicenter Transcatheter Self-Expanding Pulmonary Valve Replacement Registry. J Am Coll Cardiol 2024; 83:1310-1321. [PMID: 38569760 DOI: 10.1016/j.jacc.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/31/2024] [Accepted: 02/08/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Transcatheter pulmonary valve replacement (TPVR) with the self-expanding Harmony valve (Medtronic) is an emerging treatment for patients with native or surgically repaired right ventricular outflow tract (RVOT) pulmonary regurgitation (PR). Limited data are available since U.S. Food and Drug Administration approval in 2021. OBJECTIVES In this study, the authors sought to evaluate the safety and short-term effectiveness of self-expanding TPVR in a real-world experience. METHODS This was a multicenter registry study of consecutive patients with native RVOT PR who underwent TPVR through April 30, 2022, at 11 U.S. CENTERS The primary outcome was a composite of hemodynamic dysfunction (PR greater than mild and RVOT mean gradient >30 mm Hg) and RVOT reintervention. RESULTS A total of 243 patients underwent TPVR at a median age of 31 years (Q1-Q3: 19-45 years). Cardiac diagnoses were tetralogy of Fallot (71%), valvular pulmonary stenosis (21%), and other (8%). Acute technical success was achieved in all but 1 case. Procedural serious adverse events occurred in 4% of cases, with no device embolization or death. Hospital length of stay was 1 day in 86% of patients. Ventricular arrhythmia prompting treatment occurred in 19% of cases. At a median follow-up of 13 months (Q1-Q3: 8-19 months), 98% of patients had acceptable hemodynamic function. Estimated freedom from the composite clinical outcome was 99% at 1 year and 96% at 2 years. Freedom from TPVR-related endocarditis was 98% at 1 year. Five patients died from COVID-19 (n = 1), unknown causes (n = 2), and bloodstream infection (n = 2). CONCLUSIONS In this large multicenter real-world experience, short-term clinical and hemodynamic outcomes of self-expanding TPVR therapy were excellent. Ongoing follow-up of this cohort will provide important insights into long-term outcomes.
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Affiliation(s)
- Bryan H Goldstein
- Division of Pediatric Cardiology, University of Pittsburgh School of Medicine and Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Doff B McElhinney
- Departments of Cardiothoracic Surgery and Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, California, USA
| | - Matthew J Gillespie
- Division of Pediatric Cardiology, University of Pennsylvania School of Medicine and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jamil A Aboulhosn
- Division of Pediatric Cardiology, Mattel Children's Hospital at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA
| | - Daniel S Levi
- Division of Pediatric Cardiology, Mattel Children's Hospital at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA
| | - Brian H Morray
- Department of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Allison K Cabalka
- Divisions of Pediatric Cardiology and Structural Heart Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Barry A Love
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey D Zampi
- Department of Pediatrics, University of Michigan Congenital Heart Center, Michigan Medicine, Ann Arbor, Michigan, USA
| | - David T Balzer
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Mark A Law
- Department of Pediatrics, University of Alabama, Birmingham, Alabama, USA
| | - Mary D Schiff
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Arvind Hoskoppal
- Division of Pediatric Cardiology, University of Pittsburgh School of Medicine and Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Athar M Qureshi
- Section of Cardiology, Texas Children's Hospital, Houston, Texas, USA
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Hermann D, Khan Z, Khan Z, Abreu J, Loyalka P, Qureshi AM. First-in-Human Percutaneous Removal of Left Atrial Appendage Occlusion Devices With a Novel Retrieval System. JACC Clin Electrophysiol 2024:S2405-500X(24)00085-9. [PMID: 38456857 DOI: 10.1016/j.jacep.2024.102328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Daniel Hermann
- Division of Cardiology, Memorial Herman Health System, Houston, Texas, USA
| | - Zahoor Khan
- Houston Heart, Hospital Corporation of America, Houston Healthcare, Houston, Texas, USA
| | - Zaka Khan
- Division of Cardiology, Memorial Herman Health System, Houston, Texas, USA
| | - Juan Abreu
- Division of Cardiovascular Surgery, Memorial Herman Health System, Houston, Texas, USA
| | - Pranav Loyalka
- Houston Heart, Hospital Corporation of America, Houston Healthcare, Houston, Texas, USA
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Division of Cardiology, Texas Children's Hospital, Houston, Texas, USA; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
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Doan TT, Bonilla-Ramirez C, Eilers L, Reaves-O'Neal D, Sachdeva S, Dolgner SJ, Masand PM, Gowda S, Qureshi AM, Binsalamah Z, Molossi S. Myocardial bridges in a pediatric population: Outcomes following a standardized approach. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00003-5. [PMID: 38199293 DOI: 10.1016/j.jtcvs.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/15/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To describe clinical, functional, surgical, and outcomes data in pediatric patients with a myocardial bridge (MB) evaluated and managed following a standardized approach. METHODS Prospective observational study included patients evaluated in the Coronary Artery Anomalies Program. Anatomy was determined by computed tomography angiography, myocardial perfusion by stress perfusion imaging, and coronary hemodynamic assessment by cardiac catheterization. RESULTS In total, 39 of 42 patients with a complete evaluation for MB were included (December 2012 to June 2022) at a median age of 14.1 years (interquartile range, 12.2-16.4). Sudden cardiac arrest occurred in 3 of 39 (8%), exertional symptoms in 14 (36%), and no/nonspecific symptoms in 7 (18%) patients. Exercise stress test was abnormal in 3 of 34 (9%), stress perfusion imaging in 8 of 34 (24%), and resting instantaneous wave-free ratio ≤0.89 or diastolic dobutamine fractional flow reserve ≤0.80 in 11 of 21 (52%) patients. As a result, 15 of 39 (38%) patients were determined to have hemodynamically significant MB, 1 of 15 patients started beta-blocker, and 14 of 15 were referred for surgery. Myotomy (n = 11) and coronary bypass (n = 1) were performed successfully, resulting in improved symptoms and stress testing results. One patient required pericardiocentesis postoperatively, and all were discharged without other complications. At median follow-up time of 2.9 (1.8-5.8) years, all (except 2 pending surgery) were doing well without exercise restriction. CONCLUSIONS Pediatric patients with MB can present with myocardial ischemia and sudden cardiac arrest. Provocative stress test and intracoronary hemodynamic tests helped risk-stratify symptomatic patients with MB and concern for ischemia. Surgical repair was safe and effective in mitigating exertional symptoms and stress test results, allowing patients to return to exercise without restriction.
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Affiliation(s)
- Tam T Doan
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
| | - Carlos Bonilla-Ramirez
- General Surgery Residency Program, Department of Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
| | - Lindsay Eilers
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Dana Reaves-O'Neal
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Shagun Sachdeva
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Stephen J Dolgner
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Prakash M Masand
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Pediatric Radiology, Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Srinath Gowda
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Athar M Qureshi
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Ziyad Binsalamah
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Silvana Molossi
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
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6
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Bashir DA, Cargill JC, Gowda S, Musick M, Coleman R, Chartan CA, Hensch L, Pezeshkmehr A, Qureshi AM, Sartain SE. Implementing a Pediatric Pulmonary Embolism Response Team Model: An Institutional Experience. Chest 2024; 165:192-201. [PMID: 38199732 DOI: 10.1016/j.chest.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 01/12/2024] Open
Abstract
Pulmonary embolism is increasing in prevalence among pediatric patients; although still rare, it can create a significant risk for morbidity and death within the pediatric patient population. Pulmonary embolism presents in various ways depending on the patient, the size of the embolism, and the comorbidities. Treatment decisions are often driven by the severity of the presentation and hemodynamic effects; severe presentations require more invasive and aggressive treatment. We describe the development and implementation of a pediatric pulmonary embolism response team designed to facilitate rapid, multidisciplinary, data-driven treatment decisions and management.
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Affiliation(s)
- Dalia A Bashir
- Department of Pediatrics, Division of Critical Care Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
| | - Jamie C Cargill
- Department of Pediatrics, Division of Critical Care Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Srinath Gowda
- Division of Cardiology- Interventional Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Matthew Musick
- Department of Pediatrics, Division of Critical Care Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Ryan Coleman
- Department of Pediatrics, Division of Critical Care Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Corey A Chartan
- Department of Pediatrics, Division of Critical Care Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Lisa Hensch
- Department of Pathology & Immunology and Anesthesia, Division of Transfusion Medicine & Coagulation, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Amir Pezeshkmehr
- Department of Radiology, Division of Interventional Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Athar M Qureshi
- Division of Cardiology- Interventional Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Sarah E Sartain
- Division of Hematology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
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Lemley BA, Wu L, Roberts AL, Shinohara RT, Quarshie WO, Qureshi AM, Smith CL, Dori Y, Gillespie MJ, Rome JJ, Glatz AC, Amaral S, O'Byrne ML. Trends in Ductus Arteriosus Stent Versus Blalock-Taussig-Thomas Shunt Use and Comparison of Cost, Length of Stay, and Short-Term Outcomes in Neonates With Ductal-Dependent Pulmonary Blood Flow: An Observational Study Using the Pediatric Health Information Systems Database. J Am Heart Assoc 2023; 12:e030575. [PMID: 38038172 PMCID: PMC10727347 DOI: 10.1161/jaha.123.030575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/09/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The modified Blalock-Taussig-Thomas shunt is the gold standard palliation for securing pulmonary blood flow in infants with ductal-dependent pulmonary blood flow. Recently, the ductus arteriosus stent (DAS) has become a viable alternative. METHODS AND RESULTS This was a retrospective multicenter study of neonates ≤30 days undergoing DAS or Blalock-Taussig-Thomas shunt placement between January 1, 2017 and December 31, 2020 at hospitals reporting to the Pediatric Health Information Systems database. We performed generalized linear mixed-effects modeling to evaluate trends in intervention and intercenter variation, propensity score adjustment and inverse probability weighting with linear mixed-effects modeling to analyze length of stay and cost of hospitalization, and generalized linear mixed modeling to analyze differences in 30-day outcomes. There were 1874 subjects (58% male, 61% White) from 45 centers (29% DAS). Odds of DAS increased with time (odds ratio [OR] 1.23, annually, P<0.01 [95% CI, 1.10-1.38]) with significant intercenter variation (median OR, 3.81 [95% CI, 2.74-5.91]). DAS was associated with shorter hospital length of stay (ratio of geometric means, 0.76 [95% CI, 0.63-0.91]), shorter intensive care unit length of stay (ratio of geometric means, 0.77 [95% CI, 0.61-0.97]), and less expensive hospitalization (ratio of geometric means, 0.70 [95% CI, 0.56-0.87]). Intervention was not significantly associated with odds of 30-day transplant-free survival (OR,1.18 [95% CI, 0.70-1.99]) or freedom from catheter reintervention (OR, 1.02 [95% CI, 0.65-1.58]), but DAS was associated with 30-day freedom from composite adverse outcome (OR, 1.51 [95% CI, 1.11-2.05]). CONCLUSIONS Use of DAS is increasing, but there is variability across centers. Though odds of transplant-free survival and reintervention were not significantly different after DAS, and DAS was associated with shorter length of stay and lower in-hospital costs.
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Affiliation(s)
- Bethan A. Lemley
- Division of CardiologyLurie Children’s HospitalChicagoILUSA
- Department of PediatricsFeinberg School of Medicine Northwestern UniversityChicagoILUSA
| | - Lezhou Wu
- Department of Biomedical and Health InformaticsChildren’s Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Amy L. Roberts
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Russell T. Shinohara
- Department of Biostatistics, Epidemiology, and InformaticsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - William O. Quarshie
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Athar M. Qureshi
- Division of CardiologyTexas Children’s HospitalHoustonTXUSA
- Department of Pediatrics Baylor College of MedicineHoustonTXUSA
| | - Christopher L. Smith
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Yoav Dori
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Matthew J. Gillespie
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Jonathan J. Rome
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Andrew C. Glatz
- Division of CardiologySt. Louis Children’s HospitalSt. LouisMOUSA
- Department of PediatricsWashington University School of MedicineSt. LouisMOUSA
| | - Sandra Amaral
- Division of NephrologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of PediatricsPerelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Michael L. O'Byrne
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
- Clinical Futures, The Children’s Hospital of Philadelphia and Leonard Davis Institute and Cardiovascular Outcomes, Quality, and Evaluative Research CenterPerelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
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8
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Khan A, Qureshi AM, Bansal M, Stapleton G, Webb MK, Lam W, Eilers L, Singh HR, Gowda ST. Extra-cardiac and complex Fontan baffle fenestration using radio frequency current via surgical electrocautery. Cardiol Young 2023; 33:2621-2627. [PMID: 37092668 DOI: 10.1017/s1047951123000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Fontan baffle punctures and creation of Fontan fenestration for cardiac catheterisation procedures remain challenging especially due to the heavy calcification of prosthetic material and complex anatomy. OBJECTIVES We sought to evaluate our experience using radiofrequency current via surgical electrocautery needle for Fontan baffle puncture to facilitate diagnostic, electrophysiology, and interventional procedures. METHODS A retrospective chart review of all Fontan patients (pts) who underwent Fontan baffle puncture using radiofrequency energy via surgical electrocautery from three centres were performed from January 2011 to July 2021. RESULTS A total of 19 pts underwent 22 successful Fontan baffle puncture. The median age and weight were 17 (3-36 years) and 55 (14-88) kg, respectively. The procedural indications for Fontan fenestration creation included: diagnostic study (n = 1), atrial septostomy and stenting (n = 1), electrophysiology study and ablation procedures (n = 8), Fontan baffle stenting for Fontan failure including protein-losing enteropathy (n = 7), and occlusion of veno-venous collaterals (n = 2) for cyanosis. The type of Fontan baffles included: extra-cardiac conduits (n = 12), lateral tunnel (n = 5), classic atrio-pulmonary connection (n = 1), and intra-cardiac baffle (n = 1). A Fontan baffle puncture was initially attempted using traditional method in 6 pts and Baylis radiofrequency trans-septal system in 2 pts unsuccessfully. In all pts, Fontan baffle puncture using radiofrequency energy via electrocautery needle was successful. The radiofrequency energy utilised was (10-50 W) and required 1-5 attempts for 2-5 seconds. There were no vascular or neurological complications. CONCLUSIONS Radiofrequency current delivery using surgical electrocautery facilitates Fontan baffle puncture in patients with complex and calcified Fontan baffles for diagnostic, interventional, and electrophysiology procedures.
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Affiliation(s)
- Asra Khan
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Athar M Qureshi
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Manish Bansal
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Gary Stapleton
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Melissa K Webb
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Wilson Lam
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Lindsay Eilers
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Harinder R Singh
- The Children's Hospital of San Antonio, 333 N. Santa Rosa Street, San Antonio, TX 78207, USA
| | - Srinath T Gowda
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
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Tume SC, Fuentes-Baldemar AA, Anders M, Spinner JA, Tunuguntla H, Imamura M, Razavi A, Hickey E, Stapleton G, Qureshi AM, Adachi I. Temporary ventricular assist device support with a catheter-based axial pump: Changing the paradigm at a pediatric heart center. J Thorac Cardiovasc Surg 2023; 166:1756-1763.e2. [PMID: 36681561 DOI: 10.1016/j.jtcvs.2022.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We report the largest pediatric single-center experience with an Impella (Abiomed Inc) catheter-based axial pump support. METHODS We conducted a retrospective cohort study of all patients with acute decompensated heart failure or cardiogenic shock requiring catheter-based axial pump support between October 2014 and February 2022. The primary outcome per individual encounter (hospital admission) was defined as bridge-to-recovery, bridge-to-durable ventricular assist device support, bridge-to-cardiac transplantation, or death at 6 months after catheter-based axial pump explantation. Adverse events were defined according to the Pediatric Interagency Registry for Mechanical Circulatory Support criteria. RESULTS Our final study cohort included 37 encounters with 43 catheter-based axial pump implantations. A single catheter-based axial pump device was used for support in 33 encounters (89%), with 2 catheter-based axial pump devices used in 3 (8%) separate encounters and 3 catheter-based axial pump devices used in 1 (3%) encounter. The median [range] age, weight, and body surface area at implantation were 16.8 [6.9-42.8] years, 61.1 [23.1-123.8] kg, and 1.7 [0.8-2.5] m2, respectively. The predominant causes of circulatory failure were graft failure/rejection in 16 patients (43%), followed by cardiomyopathy in 7 patients (19%), arrhythmia refractory to medical therapies in 6 patients (16%), myocarditis/endocarditis in 4 patients (11%), and heart failure due to congenital heart disease in 4 patients (11%). Competing outcomes analysis showed a positive outcome with bridge-to-recovery in 58%, bridge-to-durable VAD support in 14%, and bridge-to-cardiac transplantation in 14% at 6 months. Fourteen percent of encounters resulted in death at 6 months. CONCLUSIONS We demonstrate that catheter-based axial pump support in children results in excellent 1- and 6-month survival with an acceptable adverse event profile.
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Affiliation(s)
- Sebastian C Tume
- Division of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
| | - Andres A Fuentes-Baldemar
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Marc Anders
- Division of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Joseph A Spinner
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Hari Tunuguntla
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Michiaki Imamura
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Asma Razavi
- Division of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Edward Hickey
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Gary Stapleton
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Athar M Qureshi
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex; The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Iki Adachi
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
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Bansal M, Stapleton GE, Gowda ST, Qureshi AM. Wire Snare Close Loop: A Novel Technique to Retrieve Embolized Devices. JACC Cardiovasc Interv 2023; 16:2673-2674. [PMID: 37804286 DOI: 10.1016/j.jcin.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/11/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Manish Bansal
- Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
| | - Gary E Stapleton
- Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Srinath T Gowda
- Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Athar M Qureshi
- Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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11
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Boucek DM, Qureshi AM, Aggarwal V, Spigel ZA, Johnson J, Gray RG, Martin MH. Over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement. Cardiol Young 2023; 33:2282-2290. [PMID: 36705001 DOI: 10.1017/s104795112200405x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To determine the safety and feasibility of over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement. BACKGROUND Transcatheter pulmonary valve placement is an alternative to surgical pulmonary valve replacement. Traditionally, it was thought to be unsafe to expand a conduit to >110% of its original size. METHODS This retrospective cohort study from two centers includes patients with right ventricle to pulmonary artery conduits with attempted transcatheter pulmonary valve placement from 2010 to 2017. Demographic, procedural, echocardiographic and follow-up data, and complications were evaluated in control and overdilation (to >110% original conduit size) groups. RESULTS One hundred and seventy-two patients (51 overdilation and 121 control) had attempted transcatheter pulmonary valve placement (98% successful). The overdilation group was younger (11.2 versus 16.7 years, p < 0.001) with smaller conduits (15 versus 22 mm, p < 0.001); however, the final valve size was not significantly different (19.7 versus 20.2 mm, p = 0.2). Baseline peak echocardiographic gradient was no different (51.8 versus 55.6 mmHg, p = 0.3). Procedural complications were more frequent in overdilation (18%) than control (7%) groups (most successfully addressed during the procedure). One patient from each group required urgent surgical intervention, with no procedural mortality. Follow-up echocardiographic peak gradients were similar (24.1 versus 26 mmHg, p = 0.5). CONCLUSIONS Over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement can be performed successfully. Procedural complications are more frequent with conduit overdilation, but there was no difference in the rate of life-threatening complications. There was no difference in valve function at most recent follow-up, and no difference in rate of reintervention. The long-term outcomes of transcatheter pulmonary valve placement with conduit over-expansion requires further study.
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Affiliation(s)
- Dana M Boucek
- Department of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota, Masonic Children's Hospital, Minneapolis, MN, USA
| | - Zachary A Spigel
- Department of Surgery, Allegheny Health Network Medical Education Consortium, Pittsburgh, PA, USA
| | - Joyce Johnson
- Department of Pediatric Cardiology, John's Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Robert G Gray
- Department of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Mary Hunt Martin
- Department of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
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12
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Kalustian AB, Doan TT, Masand P, Gowda ST, Eilers LF, Reaves-O'Neal DL, Sachdeva S, Qureshi AM, Heinle J, Molossi SM, Binsalamah ZM. Evolution of surgical repair of intraseptal anomalous left coronary artery with myocardial ischaemia. Cardiol Young 2023; 33:2342-2349. [PMID: 36861393 DOI: 10.1017/s1047951123000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND Anomalous aortic origin of the left coronary artery with intraseptal course is a rare coronary anomaly associated with an increased risk of myocardial ischaemia. The role and techniques for surgical intervention are evolving, with numerous novel surgical techniques for this challenging anatomy reported in the last 5 years. We report our single-centre experience with surgical repair of intraseptal anomalous left coronary artery in the paediatric population, including clinical presentation, evaluation, and short- to mid-term outcomes. METHODS All patients with coronary anomalies presenting to our institution undergo standardised clinical evaluation. Five patients aged 4 to 17 years underwent surgical intervention for intraseptal anomalous aortic origin of the left coronary artery between 2012 and 2022. Surgical techniques included coronary artery bypass grafting (n = 1), direct reimplantation with limited supra-arterial myotomy via right ventriculotomy (n = 1), and transconal supra-arterial myotomy with right ventricular outflow tract patch reconstruction (n = 3). RESULTS All patients had evidence of haemodynamically significant coronary compression, and three had evidence of inducible myocardial ischaemia pre-operatively. There were no deaths or major complications. Median follow-up was 6.1 months (range 3.1-33.4 months). Patients who underwent supra-arterial myotomy (with or without reimplantation) had improved coronary flow and perfusion based on stress imaging and catheterisation data. CONCLUSIONS Surgical approaches to intraseptal anomalous left coronary artery with evidence of myocardial ischaemia continue to evolve, with new techniques demonstrating promising improvement in coronary perfusion. Further studies are warranted to determine long-term outcomes and refine indications for repair.
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Affiliation(s)
- Alyssa B Kalustian
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Tam T Doan
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Prakash Masand
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Srinath T Gowda
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Lindsay F Eilers
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Dana L Reaves-O'Neal
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Shagun Sachdeva
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Athar M Qureshi
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey Heinle
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Silvana M Molossi
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Ziyad M Binsalamah
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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13
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Qureshi AM, Qureshi SA. Stenting of coarctation of the aorta-"Once and for all?". Catheter Cardiovasc Interv 2023; 102:966-967. [PMID: 37904668 DOI: 10.1002/ccd.30884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/30/2023] [Indexed: 11/01/2023]
Abstract
Key Points
Long term hemodynamic benefit and survival are sustained in patients undergoing stenting of coarctation of the aorta with bare metal and covered Cheatham‐Platinum (CP) stents.
Reintervention and complication rates are similar with both bare metal and covered CP stents.
Routine advanced imaging should be performed periodically in the long‐term to assess for stent integrity and aortic wall injury, and to guide treatment/reintervention, when necessary.
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Affiliation(s)
- Athar M Qureshi
- Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Shakeel A Qureshi
- Department of Paediatric and Adult Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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14
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Przybycien TS, Doan TT, Qureshi AM, Reaves-O'Neal D, Binsalamah Z, Molossi S. Invasive Coronary Assessment in a 9-Year-Old With Anomalous Aortic Origin of the Left Coronary Artery. World J Pediatr Congenit Heart Surg 2023; 14:746-748. [PMID: 37691340 DOI: 10.1177/21501351231185579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
A previously healthy nine-year-old boy with anomalous aortic origin of the left coronary artery (AAOLCA) with high-risk anatomy demonstrated negative stress on magnetic resonance imaging. Invasive cardiac catheterization for intracoronary flow measurement was performed and demonstrated compromised coronary flow during pharmacologic stress and significant stenosis on angiography. The patient underwent surgical intervention with normalization of coronary flow upon postoperative evaluation. Invasive intracoronary flow determination with angiography under provocative stress is emerging as a critical data point for risk stratification and management decision-making in high-risk AAOLCA patients with negative noninvasive perfusion studies.
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Affiliation(s)
- Thomas S Przybycien
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Tam T Doan
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, TX, USA
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Athar M Qureshi
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, TX, USA
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Dana Reaves-O'Neal
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, TX, USA
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Ziyad Binsalamah
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, TX, USA
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Silvana Molossi
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, TX, USA
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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15
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Lahiri S, Qureshi AM, Pignatelli RH, Eilers L, Khan A, Bansal M, Webb MK, Stapleton G, Gowda ST. Single tertiary center experience using Gore Cardioform Atrial Septal Defect Occluder for secundum atrial septal defect closure with a focus on deficient rims. J Invasive Cardiol 2023; 35. [PMID: 37992333 DOI: 10.25270/jic/23.00119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND The data on the use of Gore Cardioform Septal Occluder (GCA; W. L. Gore and Associates, Inc.) for atrial septal defect (ASD) with deficient rims is limited. METHODS All patients evaluated by transesophageal echocardiogram (TEE) for ASD occlusion were included. TEE planes at 35°, 0°, and 90° were assessed for anterior-superior (AS) and posterior (P), anterior-inferior (AI) and posterior-superior (PS), as well as superior (S) and inferior (I) rims. ASD size >20 mm, and rims less than 5 mm were defined as large and deficient, respectively. We included patients who had a procedural failure along with the patients in whom the procedure was not attempted after echocardiogram in the unsuccessful group. RESULTS In 148 patients, the median weight, age, and ASD size were 36 kg (range, 8-60 kg), 11.8 years (range, 1-60 years), and 14.2 ± 8.28 mm, respectively. One or more deficient rims were noted in 112 of 148 (75.7%): 99 (67%) AS, 36 (24%) P, 17 (11%) AI, 30 (20%) PS, 26 (18%) S, and 33 (22%) I. ASD closure was performed in 115 (78%) patients. The procedure was successful in 111 (96.5%) patients with procedural failure in 4 (3.4%) patients. Multiple deficient rims were associated with reduced procedural success (OR 0.36, 95% CI, 0.25-0.56). On multivariate analysis deficient P, PS, and I rims were associated with an unsuccessful group (P = .001, .046, and .005, respectively). Complications included 1 device embolization, 1 vascular injury, and 5 arrhythmias. CONCLUSIONS Transcatheter closure of ASDs with deficient rims is feasible using GCA. Large ASDs with deficient P, PS, and I rims were associated with unsuccessful closure. Risk stratification and comprehensive evaluation of ASD rims is vital for the use of GCA.
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Affiliation(s)
- Subhrajit Lahiri
- Children's Hospital of Illinois, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Ricardo H Pignatelli
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Lindsay Eilers
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Asra Khan
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Manish Bansal
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Melissa K Webb
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Gary Stapleton
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Srinath T Gowda
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
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Meadows JJ, Bauser-Heaton H, Petit CJ, Goldstein BH, Qureshi AM, McCracken CE, Kelleman MS, Nicholson GT, Law MA, Zampi JD, Shahanavaz S, Chai PJ, Romano JC, Batlivala SP, Maskatia SA, Asztalos IB, Eilers L, Kamsheh AM, Healan SJ, Smith JD, Ligon RA, Dailey-Schwartz A, Pettus JA, Pajk AL, Glatz AC, Mascio CE. Comparison of treatment strategies for neonates with tetralogy of Fallot and pulmonary atresia. J Thorac Cardiovasc Surg 2023; 166:916-925.e6. [PMID: 36828672 DOI: 10.1016/j.jtcvs.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Neonates with tetralogy of Fallot and pulmonary atresia (TOF/PA) but no major aorta-pulmonary collaterals are dependent on the arterial duct for pulmonary blood flow and require early intervention, either by primary (PR) or staged repair (SR) with initial palliation (IP) followed by complete repair (CR). The optimal approach has not been established. METHODS Neonates with TOF/PA who underwent PR or SR were retrospectively reviewed from the Congenital Cardiac Research Collaborative. Outcomes were compared between PR and SR (IP + CR) strategies. Propensity scoring was used to adjust for baseline differences. The primary outcome was mortality. Secondary outcomes included complications, length of stay, cardiopulmonary bypass and anesthesia times, reintervention (RI), and pulmonary artery (PA) growth. RESULTS Of 282 neonates, 106 underwent PR and 176 underwent SR (IP: 144 surgical, 32 transcatheter). Patients who underwent SR were more likely to have DiGeorge syndrome and greater rates of mechanical ventilation before the initial intervention. Mortality was not significantly different. Duration of mechanical ventilation, inotrope use, and complication rates were similar. Cumulative length of stay, cardiopulmonary bypass, and anesthesia times favored PR (P ≤ .001). Early RI was more common in patients who underwent SR (rate ratio, 1.42; P = .003) but was similar after CR (P = .837). Conduit size at the time of CR was larger with SR. Right PA growth was greater with PR. CONCLUSIONS In neonates with TOF/PA, SR is more common in greater-risk patients. Accounting for this, SR and PR strategies have similar mortality. Perioperative morbidities, RI, and right PA growth generally favor PR, whereas SR allows for larger initial conduit implantation.
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Affiliation(s)
- Jeffery J Meadows
- Department of Pediatrics, University of California, San Francisco, San Francisco, Calif; Benioff Children's Hospital, San Francisco, Calif.
| | - Holly Bauser-Heaton
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga; Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Christopher J Petit
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga; Division of Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Bryan H Goldstein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati School of Medicine, Cincinnati, Ohio; Department of Pediatrics, Heart Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Athar M Qureshi
- Lillie Frank Abercrombie Section on Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Courtney E McCracken
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Michael S Kelleman
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - George T Nicholson
- Division of Cardiology, Monroe Carrell Jr. Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Mark A Law
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala
| | - Jeffrey D Zampi
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Mich
| | - Shabana Shahanavaz
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Paul J Chai
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Jennifer C Romano
- Section of Pediatric Cardiothoracic Surgery, Department of Cardiac Surgery, CS Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, Mich
| | - Sarosh P Batlivala
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Shiraz A Maskatia
- Moore Children's Heart Center, Lucille Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, Calif
| | - Ivor B Asztalos
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Lindsay Eilers
- Lillie Frank Abercrombie Section on Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Alicia M Kamsheh
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Steven J Healan
- Division of Cardiology, Monroe Carrell Jr. Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Justin D Smith
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Mich
| | - R Allen Ligon
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Andrew Dailey-Schwartz
- Lillie Frank Abercrombie Section on Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Joelle A Pettus
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Amy L Pajk
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Andrew C Glatz
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Washington University Heart Center at St Louis Children's Hospital, St. Louis, Mo
| | - Christopher E Mascio
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Department of Cardiovascular and Thoracic Surgery, West Virginia University School of Medicine, Morgantown, WVa
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17
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Petit CJ, Glatz AC, Goldstone AB, Law MA, Romano JC, Maskatia SA, Chai PJ, Zampi JD, Meadows JJ, Nicholson GT, Shahanavaz S, Qureshi AM, McCracken CE, Mascio CE, Batlivala SP, Asztalos IB, Healan SJ, Smith JD, Pettus JA, Beshish A, Raulston JEB, Hock KM, Pajk AL, Goldstein BH. Pulmonary Artery Hypoplasia in Neonates With Tetralogy of Fallot. J Am Coll Cardiol 2023; 82:615-627. [PMID: 37558375 DOI: 10.1016/j.jacc.2023.05.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/27/2023] [Accepted: 05/22/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Neonates with symptomatic tetralogy of Fallot (sTOF) with hypoplastic pulmonary arteries (hPA) are considered high risk. Data are needed to inform the impact of hPA on outcomes, and the ideal management strategy. OBJECTIVES The objectives of this study were to quantify the impact of hPA on outcomes in neonates with sTOF and measure the impact of strategy on pulmonary artery (PA) growth in this population. METHODS Neonates with sTOF from 2005 to 2017 were reviewed from the Congenital Cardiac Research Collaborative. Criteria for hPA included a unilateral PA z score <-2.0 and contralateral PA z score <0. Primary outcome was mortality. Secondary outcomes included reintervention and PA growth. RESULTS We included 542 neonates with sTOF, including 188 (35%) with hPA and 354 (65%) with normal PA, with median follow-up of 4.1 years. Median right and left hPA z scores were -2.19 (25th-75th percentile: -2.55 to -1.94) and -2.23 (25th-75th percentile: -2.64 to -1.91), respectively. Staged repair (vs primary TOF repair) was less common in the hPA cohort (36 vs 44%; P = 0.07). Survival was similar between groups (unadjusted P = 0.16; adjusted P = 0.25). Reintervention was more common in the hPA group (HR: 1.28; 95% CI: 1.01-1.63; P = 0.044); there was no difference after definitive repair (HR: 1.21; 95% CI: 0.93-1.58; P = 0.16). PA growth at 1 year was greater in the hPA cohort, particularly for the right PA (P < 0.001). CONCLUSIONS Despite perception, the presence of hPA in neonates with sTOF conferred no increase in overall hazard of mortality or reintervention after definitive repair. PA growth was superior in the hPA cohort. These findings suggest that the presence of hPA does not adversely impact outcomes in sTOF.
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Affiliation(s)
- Christopher J Petit
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA; Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
| | - Andrew C Glatz
- Division of Pediatric Cardiology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Division of Pediatric Cardiology, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Missouri, USA
| | - Andrew B Goldstone
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Mark A Law
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Jennifer C Romano
- University of Michigan School of Medicine, Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Shiraz A Maskatia
- University of California San Francisco School of Medicine, Benioff Children's Hospital, San Francisco, California, USA
| | - Paul J Chai
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jeffrey D Zampi
- University of Michigan School of Medicine, Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Jeffery J Meadows
- University of California San Francisco School of Medicine, Benioff Children's Hospital, San Francisco, California, USA
| | - George T Nicholson
- Division of Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shabana Shahanavaz
- Division of Pediatric Cardiology, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Missouri, USA; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Athar M Qureshi
- Baylor College of Medicine, Texas Children's Hospital, Waco, Texas, USA
| | - Courtney E McCracken
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Christopher E Mascio
- Division of Pediatric Cardiology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; University of West Virginia School of Medicine, Morgantown, West Virginia, USA
| | | | - Ivor B Asztalos
- Division of Pediatric Cardiology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Steven J Healan
- Division of Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin D Smith
- University of Michigan School of Medicine, Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Joelle A Pettus
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Asaad Beshish
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - James E B Raulston
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Krissie M Hock
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Amy L Pajk
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bryan H Goldstein
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Gillespie MJ, McElhinney DB, Jones TK, Levi DS, Asnes J, Gray RG, Cabalka AK, Fujimoto K, Qureshi AM, Justino H, Bergersen L, Benson LN, Haugan D, Boe BA, Cheatham JP. 1-Year Outcomes in a Pooled Cohort of Harmony Transcatheter Pulmonary Valve Clinical Trial Participants. JACC Cardiovasc Interv 2023; 16:1917-1928. [PMID: 37278682 DOI: 10.1016/j.jcin.2023.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND The Harmony transcatheter pulmonary valve (TPV) is the first U.S. Food and Drug Administration-approved device for severe pulmonary regurgitation (PR) in the native or surgically repaired right ventricular outflow tract (RVOT). OBJECTIVES One-year safety and effectiveness of the Harmony TPV were evaluated in patients from the Harmony Native Outflow Tract Early Feasibility Study, Harmony TPV Pivotal Study, and Continued Access Study, representing the largest cohort to date of Harmony TPV recipients. METHODS Eligible patients had severe PR by echocardiography or PR fraction ≥ 30% by cardiac magnetic resonance imaging and clinical indications for pulmonary valve replacement. The primary analysis included 87 patients who received a commercially available TPV22 (n = 42) or TPV25 (n = 45) device; 19 patients who received an early device iteration prior to its discontinuation were evaluated separately. RESULTS In the primary analysis, median patient age at treatment was 26 years (IQR: 18-37 years) in the TPV22 group and 29 years (IQR: 19-42 years) in the TPV25 group. At 1 year, there were no deaths; 98% of TPV22 and 91% of TPV25 patients were free from the composite of PR, stenosis, and reintervention (moderate or worse PR, mean RVOT gradient >40 mmHg, device-related RVOT reoperation, and catheter reintervention). Nonsustained ventricular tachycardia occurred in 16% of patients. Most patients had none/trace or mild PR (98% of TPV22 patients, 97% of TPV25 patients). Outcomes with the discontinued device are reported separately. CONCLUSIONS The Harmony TPV device demonstrated favorable clinical and hemodynamic outcomes across studies and valve types through 1 year. Further follow-up will continue to assess long-term valve performance and durability.
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Affiliation(s)
- Matthew J Gillespie
- Division of Cardiology, Children's Hospital of Philadelphia, Pennsylvania, USA.
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Thomas K Jones
- Department of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Daniel S Levi
- Department of Interventional Pediatric Cardiology, David Geffen School of Medicine at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA
| | - Jeremy Asnes
- Section of Pediatric Cardiology, Yale University, New Haven, Connecticut, USA
| | - Robert G Gray
- Division of Pediatric Cardiology, University of Utah at Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Allison K Cabalka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Athar M Qureshi
- Section of Cardiology, Texas Children's Hospital, Houston, Texas, USA
| | - Henri Justino
- Section on Cardiology, Rady Children's Hospital, San Diego, California, USA
| | - Lisa Bergersen
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lee N Benson
- Labatt Family Heart Center, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Brian A Boe
- Department of Cardiology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - John P Cheatham
- Department of Cardiology, Nationwide Children's Hospital, Columbus, Ohio, USA
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19
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Ansah DA, Lawrence EJ, Kearney DL, Qureshi AM. In Utero Presentation of Left Ventricular Aneurysm. Neoreviews 2023; 24:e530-e537. [PMID: 37525319 DOI: 10.1542/neo.24-8-e530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Congenital left ventricular aneurysm, pseudoaneurysm, and diverticulum are rare entities. These diagnoses can be made pre- and/or postnatally. Although these entities overlap clinically and morphologically, important distinctions can allow for accurate diagnoses. Appropriate diagnosis can be imperative for risk stratification and guidance of prenatal and postnatal management. The case described in the present report highlights a challenging case of a fetal left ventricular aneurysm, management during the prenatal and postnatal periods, and important differentiating features from a ventricular diverticulum and pseudoaneurysm.
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Affiliation(s)
- Deidra A Ansah
- The Lillie Frank Abercrombie Division of Cardiology, Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Emily J Lawrence
- The Lillie Frank Abercrombie Division of Cardiology, Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Debra L Kearney
- Departments of Pathology and Immunology, Texas Children's Hospital and Department of Pathology, Baylor College of Medicine, Houston, TX
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Division of Cardiology, Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, TX
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20
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Grewing A, Jujjavarapu H, Price C, Eilers LF, Zimmerman S, Hiermandi N, Qureshi AM, Kellermayer R, Britt JJ. Esophageal Lesion Reveals an Aortic Pseudoaneurysm in the Setting of Actinomyces odontolyticus Bacteremia. JACC Case Rep 2023; 15:101867. [PMID: 37283823 PMCID: PMC10240280 DOI: 10.1016/j.jaccas.2023.101867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 06/08/2023]
Abstract
A toddler presented with hematemesis a few weeks after ingesting a penny. Workup revealed an esophageal lesion communicating with an aortic pseudoaneurysm in the setting of Actinomyces odontolyticus bacteremia. A. odontolytica is an oropharyngeal bacteria known to cause fistulas when introduced into tissue planes. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Anneliese Grewing
- Address for correspondence: Dr Anneliese Grewing, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, 1 Baylor Plaza #32, Houston, Texas 77030, USA.
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21
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Qureshi AM, Gowda ST. A tale of two ASDs-Compliance matters. Catheter Cardiovasc Interv 2023; 101:1241-1242. [PMID: 37125612 DOI: 10.1002/ccd.30669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 05/02/2023]
Abstract
Key Points
Patients with secundum atrial septal defects (ASDs) who have pulmonary atresia with intact ventricular septum or critical pulmonary stenosis, exhibit different ASD physiology compared to patients with isolated secundum ASDs.
The indication and timing of secundum ASD closure in these patients should be made on a case‐by‐case basis.
Long‐term assessment of the physiological consequences of secundum ASD closure in this group of patients should be kept in mind, as these patients have right ventricles that represent a spectrum ranging from significantly restrictive right ventricles, to right ventricles with normal compliance.
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Affiliation(s)
- Athar M Qureshi
- Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Srinath T Gowda
- Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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22
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Eilers LF, Britt JJ, Weigand J, Penny DJ, Gowda ST, Qureshi AM, Stapleton GE, Khan A, Webb MK, Bansal M. Pre-Fontan Assessment Utilizing Combined Cardiac Catheterization and Cardiac MRI: Comparison to the Pre-Fontan Catheterization. Pediatr Cardiol 2023:10.1007/s00246-023-03178-x. [PMID: 37210685 DOI: 10.1007/s00246-023-03178-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/10/2023] [Indexed: 05/22/2023]
Abstract
Single ventricle patients eligible for Fontan completion undergo pre-Fontan catheterization for hemodynamic and anatomic assessment prior to surgery. Cardiac magnetic resonance imaging may be used to evaluate pre-Fontan anatomy, physiology, and collateral burden. We describe our center's outcomes in patients undergoing pre-Fontan catheterization combined with cardiac magnetic resonance imaging. A retrospective review of patients undergoing pre-Fontan catheterization from 10/2018 to 04/2022 at Texas Children's Hospital was performed. Patients were divided into 2 groups: combined cardiac magnetic resonance imaging and catheterization (combined group) and those who underwent catheterization only (catheterization only group). There were 37 patients in the combined group and 40 in the catheterization only group. Both groups were similar in age and weight. Patients undergoing combined procedures received less contrast, and experienced less in-lab time, fluoroscopy time and catheterization procedure time. Median radiation exposure was lower in the combined procedure group but was not statistically significant. Intubation and total anesthesia times were higher in the combined procedure group. Patients undergoing a combined procedure were less likely to have collateral occlusion performed than in the catheterization only group. Bypass time, intensive care unit length of stay, and chest tube duration were similar in both groups at the time of Fontan completion. Combined pre-Fontan assessment decreases catheterization procedure and fluoroscopy time associated with cardiac catheterization at the expense of longer anesthetic times, and results in similar Fontan outcomes compared to when cardiac catheterization alone is utilized.
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Affiliation(s)
- Lindsay F Eilers
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Jolie J Britt
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Justin Weigand
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Daniel J Penny
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Srinath T Gowda
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Gary E Stapleton
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Asra Khan
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Melissa K Webb
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Manish Bansal
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA.
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23
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Broda CR, Frankel WC, Nair AP, Dreyer WJ, Tunuguntla HP, Frazier OH, Dolgner SJ, Anders MM, Tume SC, Qureshi AM, Parekh DR, Hickey EJ, Adachi I, Civitello AB. Continuous-Flow Ventricular Assist Device Support in Adult Congenital Heart Disease: A 15-Year, Multicenter Experience of Temporary and Durable Support. ASAIO J 2023; 69:429-437. [PMID: 36730653 DOI: 10.1097/mat.0000000000001853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Heart failure (HF) is common in adult congenital heart disease (ACHD) patients; however, use of continuous-flow ventricular assist devices (CF-VADs) remains rare. We reviewed outcomes of patients with congenital heart disease greater than or equal to 18 years of age at the time of CF-VAD implant at the affiliated pediatric and adult institutions between 2006 and 2020. In total, 18 ACHD patients (15 with great anatomical complexity) received 21 CF-VADs. Six patients (median age 34 years) received seven percutaneous CF-VADs with a median duration of support of 20 days (3-44 days) with all patients survived to hospital discharge and two patients were bridged to durable CF-VADs. Fourteen patients (median age 38 years) received durable CF-VADs. Thirteen patients (93%) survived to hospital discharge and the median duration of support was 25.8 months (6.4-52.1 months). Estimated survival on durable CF-VAD at 1, 3, and 5 years was 84%, 72%, and 36%, respectively. Three patients were successfully bridged to transplantation. Device-related complications include cerebrovascular accident (n = 5), driveline infection (n = 3), device infection requiring chronic antibiotic therapy (n = 4), gastrointestinal bleeding (n = 6), and presumed pump thrombosis (n = 5). These results show percutaneous and durable CF-VADs can support ACHD patients with advanced HF.
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Affiliation(s)
- Christopher R Broda
- From the Section of Pediatric and Adult Congenital Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - William C Frankel
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ajith P Nair
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Texas
| | - W Jeffrey Dreyer
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Hari P Tunuguntla
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - O Howard Frazier
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Texas
| | - Stephen J Dolgner
- From the Section of Pediatric and Adult Congenital Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Marc M Anders
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Sebastian C Tume
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Athar M Qureshi
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Dhaval R Parekh
- From the Section of Pediatric and Adult Congenital Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Edward J Hickey
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Iki Adachi
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Andrew B Civitello
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Texas
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24
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Bishop T, Kostelyna S, Weyland C, Dolgner S, Lam WW, Qureshi AM, Parekh DR, Salciccioli KB. UTILITY OF SURVEILLANCE ECHOCARDIOGRAMS FOLLOWING TRANSCATHETER PULMONARY VALVE REPLACEMENT IN ADULTS WITH CONGENITAL HEART DISEASE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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25
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Wong-Siegel J, Glatz AC, McCracken C, Downing TE, Goldstein BH, Petit CJ, Qureshi AM, Nicholson GT, Law MA, Meadows J, Shahanavaz S, O'Byrne ML, Batlivala SP, Beshish A, Mascio CE, Romano JC, Stack KO, Asztalos I, Zampi J. CUMULATIVE RADIATION EXPOSURE IN NEONATES WITH SYMPTOMATIC TETRALOGY OF FALLOT REQUIRING EARLY INTERVENTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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26
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Aggarwal V, Stapleton GE, Eilers LF, Gowda S, Bansal M, Qureshi AM, Webb MK, Khan A, Justino H. Pulmonary Vein Atresia: Feasibility of Initial Recanalization Attempts with Subsequent Follow-up. Curr Probl Cardiol 2023; 48:101463. [PMID: 36261100 DOI: 10.1016/j.cpcardiol.2022.101463] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 01/04/2023]
Abstract
Pulmonary vein atresia (PVA) may lead to pulmonary hypertension, cardiac failure, and death. Transcatheter or surgical treatments have rarely been offered to this population because of perceived poor outcomes. We describe single center outcomes of transcatheter management of PVA. Retrospective chart review of PVA patients who underwent cardiac catheterization at a single tertiary center. Sixty patients underwent catheterization for evaluation of PVA from 1995 to 2019. The age at the initial catheterization was 1.6 (0.7, 5.97) years. Two thirds of PVA patients had associated congenital heart disease (n=40). PVA recanalization was attempted in 34 patients, successful in 23/34 (68%) of the initial attempts. 3/23 (13%) underwent balloon angioplasty alone, and 20/23 (87%) received drug-eluting stents, with no procedural mortalities. 22/23 patients had transcatheter reinterventions during an interval of 2.1 (0.3, 5.1) years. Right ventricular systolic to aortic systolic pressure ratio (in biventricular patients) at the index catheterization was 0.45 (0.34, 0.68) in survivors versus 0.69 (0.54, 0.83) in those who died; P = 0.012 (n=45). The baseline right ventricular or pulmonary artery systolic to aortic systolic pressure ratio of ≥0.54 at the initial catheterization was predictive of mortality. We hereby demonstrate that transcatheter recanalization of PVA with placement of drug-eluting stents can be performed safely with acceptable success rate. With appropriate use of re-interventions for restenosis as indicated, PVA can be successfully palliated with good long-term patency and distal growth of the affected veins. Pulmonary hypertension is a risk factor for mortality in patients with PVA and biventricular circulation. Percutaneous recanalization of PVA is safe and feasible, and with placement of drug-eluting stents, carries a high acute success rate and results in growth of the distal pulmonary veins. However, close vigilance and reinterventions are required due to restenosis.
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Affiliation(s)
- Varun Aggarwal
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Gary E Stapleton
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Lindsay F Eilers
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Srinath Gowda
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Manish Bansal
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Athar M Qureshi
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Melissa K Webb
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Asra Khan
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Henri Justino
- CE Mullins Cardiac Catheterization Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
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Nicholson GT, Goldstein BH, Petit CJ, Qureshi AM, Glatz AC, McCracken CE, Kelleman MS, Meadows JJ, Zampi JD, Shahanavaz S, Mascio CE, Chai PJ, Romano JC, Healan SJ, Pettus JA, Batlivala SP, Raulston JEB, Hock KM, Maskatia SA, Beshish A, Law MA. Impact of Management Strategy on Feeding and Somatic Growth in Neonates with Symptomatic Tetralogy of Fallot: Results from the Congenital Cardiac Research Collaborative. J Pediatr 2022; 250:22-28.e4. [PMID: 35772511 DOI: 10.1016/j.jpeds.2022.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate early growth following primary or staged repair of neonatal symptomatic tetralogy of Fallot (sTOF). STUDY DESIGN We performed a retrospective, multicenter cohort study of consecutive infants with sTOF who underwent initial intervention at age ≤30 days, from 2005 to 2017. Management strategies were either primary repair or staged repair (ie, initial palliation followed by complete repair). The primary outcome was change in weight-for-age z-score (ΔWAZ) from the initial intervention to age 6 ± 2 months. Secondary outcomes included method and mode of feeding, feeding-related medications, and feeding-related readmissions. Propensity score adjustment was used to account for baseline differences between groups. A secondary analysis was performed comparing patients stratified by the presence of adequate growth (6-month ΔWAZ > -0.5) or inadequate growth (6-month ΔWAZ ≤ -0.5), independent of treatment strategy. RESULTS The study cohort included 143 primary repair subjects and 240 staged repair subjects. Prematurity was more common in the staged repair group. After adjustment, median ΔWAZ did not differ between treatment groups over the first 6 months of life (primary: -0.43 [IQR, -1.17 to 0.50]; staged: -0.31 [IQR, -1.31 to 0.71]; P = .55). For the entire cohort, ΔWAZ was negative (-0.36; IQR, -1.21 to 0.63). There were no between-group differences in the secondary outcomes. Secondary analysis revealed that the subjects with adequate growth were more likely to be orally fed at initial hospital discharge (P = .04). CONCLUSIONS In neonates with sTOF, growth trajectory over the first 6 months of life was substandard, irrespective of treatment strategy. Those patients with adequate growth were more likely to be discharged from the index procedure on oral feeds.
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Affiliation(s)
- George T Nicholson
- Division of Cardiology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
| | - Bryan H Goldstein
- The Heart Institute, Cincinnati Children's Hospital Medical Center and Division of Pediatric Cardiology, University of Cincinnati College of Medicine, Cincinnati, OH; Heart Institute, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Christopher J Petit
- Children's Heart Center Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Morgan Stanley Children's Hospital, Columbia University Vagelos College of Physicians & Surgeons, New York, NY
| | - Athar M Qureshi
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Andrew C Glatz
- The Cardiac Center, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Courtney E McCracken
- Children's Heart Center Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Michael S Kelleman
- Children's Heart Center Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Jeffery J Meadows
- Division of Cardiology, Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, CA
| | - Jeffrey D Zampi
- Division of Cardiology, Department of Pediatrics, CS Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI
| | - Shabana Shahanavaz
- The Heart Institute, Cincinnati Children's Hospital Medical Center and Division of Pediatric Cardiology, University of Cincinnati College of Medicine, Cincinnati, OH; Section of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, MO
| | - Christopher E Mascio
- The Cardiac Center, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Pediatric Cardiothoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - Paul J Chai
- Children's Heart Center Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Jennifer C Romano
- Section of Pediatric Cardiothoracic Surgery, Department of Cardiac Surgery, CS Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI
| | - Steven J Healan
- Division of Cardiology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Joelle A Pettus
- Children's Heart Center Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Sarosh P Batlivala
- The Heart Institute, Cincinnati Children's Hospital Medical Center and Division of Pediatric Cardiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - James E B Raulston
- Division of Pediatric Cardiology, Department of Pediatrics, Children's of Alabama, University of Alabama Birmingham School of Medicine, Birmingham, AL
| | - Kristal M Hock
- Division of Pediatric Cardiology, Department of Pediatrics, Children's of Alabama, University of Alabama Birmingham School of Medicine, Birmingham, AL
| | - Shiraz A Maskatia
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Asaad Beshish
- Children's Heart Center Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Mark A Law
- Division of Pediatric Cardiology, Department of Pediatrics, Children's of Alabama, University of Alabama Birmingham School of Medicine, Birmingham, AL
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Law MA, Glatz AC, Romano JC, Chai PJ, Mascio CE, Petit CJ, McCracken CE, Kelleman MS, Nicholson GT, Meadows JJ, Zampi JD, Shahanavaz S, Batlivala SP, Pettus J, Pajk AL, Hock KM, Goldstein BH, Qureshi AM. Palliation Strategy to Achieve Complete Repair in Symptomatic Neonates with Tetralogy of Fallot. Pediatr Cardiol 2022; 43:1587-1598. [PMID: 35381860 DOI: 10.1007/s00246-022-02886-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
Abstract
Neonates with symptomatic tetralogy of Fallot (sTOF) may undergo palliations with varying physiology, namely systemic to pulmonary artery connections (SPC) or right ventricular outflow tract interventions (RVOTI). A comparison of palliative strategies based on the physiology created is lacking. Consecutive sTOF neonates undergoing SPC or RVOTI from 2005-2017 were reviewed from the Congenital Cardiac Research Collaborative. The primary outcome was survival with successful complete repair (CR) by 18 months. A variety of secondary outcomes were assessed including overall survival, hospitalization-related comorbidities, and interstage reinterventions. Propensity score adjustment was utilized to compare treatment strategies. The cohort included 252 SPC (surgical shunt = 226, ductus arteriosus stent = 26) and 68 RVOTI (balloon pulmonary valvuloplasty = 48, RVOT stent = 11, RVOT patch = 9) patients. Genetic syndrome (29 [42.6%] v 75 [29.8%], p = 0.04), weight < 2.5 kg (28 [41.2%] v 68 [27.0%], p = 0.023), bilateral pulmonary artery Z-score < - 2 (19 [28.0%] v 36 [14.3%], p = 0.008), and pre-intervention antegrade flow (48 [70.6%] v 104 [41.3%], p < 0.001) were more common in RVOTI. Significant center differences were noted (p < 0.001). Adjusted survival to CR by 18 months (HR = 0.87, 95% CI = 0.63-1.21, p = 0.41) and overall survival (HR = 2.08, 95% CI = 0.93-4.65, p = 0.074) were similar. RVOTI had increased interstage reintervention (HR = 2.15, 95% CI = 1.36-3.99, p = 0.001). Total anesthesia (243 [213, 277] v 328 [308, 351] minutes, p < 0.001) and cardiopulmonary bypass times (117 [103, 132] v 151 [143, 160] minutes, p < 0.001) favored RVOTI. In this multicenter comparison of physiologic palliation strategies for sTOF, survival to successful CR and overall survival were similar; however, reintervention burden was significantly higher in RVOTI.
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Affiliation(s)
- Mark A Law
- Department of Pediatrics, University of Alabama at Birmingham, 1700 6th Ave S, Suite 9100, Birmingham, AL, 35233, USA.
| | - Andrew C Glatz
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer C Romano
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, Atlanta, USA
| | - Paul J Chai
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Christopher E Mascio
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Courtney E McCracken
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael S Kelleman
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - George T Nicholson
- Division of Cardiology, Monroe Carrell Jr. Children's Hospital, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jeffery J Meadows
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey D Zampi
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, Atlanta, USA
| | - Shabana Shahanavaz
- Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Sarosh P Batlivala
- Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Joelle Pettus
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Amy L Pajk
- Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Kristal M Hock
- Department of Pediatrics, University of Alabama at Birmingham, 1700 6th Ave S, Suite 9100, Birmingham, AL, 35233, USA
| | - Bryan H Goldstein
- Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA.,Department of Pediatrics, The Heart Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburg School of Medicine, Pittsburgh, PA, USA
| | - Athar M Qureshi
- Department of Pediatrics, Lillie Frank Abercrombie Section on Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Cortes MS, Bechtold H, Qureshi AM, Justino H, Espinoza J, Nassr AA, Donepudi R, Castro E, Furtun BY, Ayres N, Belfort M, Shamshirsaz A. INNOVATION IN FETAL SURGERY: USE OF VASCULAR PLUGS IN PLACENTAL CHORIOANGIOMA WITH FETAL HYDROPS. Prenat Diagn 2022; 42:1471-1474. [DOI: 10.1002/pd.6226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/19/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Magdalena Sanz Cortes
- Department of Obstetrics and Gynecology Baylor College of Medicine. Texas Children’s Hospital Houston TX United States
| | - Hunter Bechtold
- Department of Obstetrics and Gynecology Baylor College of Medicine. Texas Children’s Hospital Houston TX United States
| | - Athar M. Qureshi
- The Lillie Frank Abercrombie Section of Cardiology Baylor College of Medicine. Texas Children’s Hospital Houston TX United States
| | - Henri Justino
- The Lillie Frank Abercrombie Section of Cardiology Baylor College of Medicine. Texas Children’s Hospital Houston TX United States
- Cardiovascular innovation Rady Children’s Hospital University of California San Diego CA United States
| | - Jimmy Espinoza
- Department of Obstetrics and Gynecology Baylor College of Medicine. Texas Children’s Hospital Houston TX United States
| | - Ahmed A. Nassr
- Department of Obstetrics and Gynecology Baylor College of Medicine. Texas Children’s Hospital Houston TX United States
| | - Roopali Donepudi
- Department of Obstetrics and Gynecology Baylor College of Medicine. Texas Children’s Hospital Houston TX United States
| | - Eumenia Castro
- Department of Pathology and Immunology Baylor College of Medicine. Texas Children’s Hospital Houston TX United States
| | - Betul Yilmaz Furtun
- Department of Pediatric Cardiology Baylor College of Medicine. Texas Children’s Hospital Houston TX United States
| | - Nancy Ayres
- Department of Pediatric Cardiology Baylor College of Medicine. Texas Children’s Hospital Houston TX United States
| | - Michael Belfort
- Department of Obstetrics and Gynecology Baylor College of Medicine. Texas Children’s Hospital Houston TX United States
| | - Alireza Shamshirsaz
- Department of Obstetrics and Gynecology Baylor College of Medicine. Texas Children’s Hospital Houston TX United States
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Qureshi AM, Adachi I. Survival Disparities in Pediatric Out-of-Hospital Cardiac Arrest. JACC: Asia 2022; 2:444-445. [PMID: 36339353 PMCID: PMC9627807 DOI: 10.1016/j.jacasi.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Nasef MA, Shahbah DA, Batlivala SP, Darwish R, Qureshi AM, Breatnach CR, Linnane N, Walsh KP, Oslizlok P, McCrossan B, Momenah T, Alshahri A, Abdulhamed J, Arafat A, Tamimi OA, Diraneyya OM, Goldestein BH, Kenny D. Short- and medium-term outcomes for patent ductus arteriosus stenting in neonates ≤2.5 kg with duct-dependent pulmonary circulation. Catheter Cardiovasc Interv 2022; 100:596-605. [PMID: 35904221 DOI: 10.1002/ccd.30351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/29/2022] [Accepted: 07/16/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Morbidity with surgical systemic-to-pulmonary artery shunting (SPS) in infants ≤2.5 kg has remained high. Patent ductus arteriosus (PDA) stenting may be a valid alternative. The objective of this study is to evaluate outcomes following PDA stenting in patients ≤2.5 kg from four large tertiary centers. METHODS Retrospective review of all neonates ≤2.5 kg with duct-dependent pulmonary circulation who underwent PDA stenting. Procedural details, pulmonary arterial growth, reinterventions, surgery type, and outcomes were assessed. RESULTS PDA stents were implanted in 37 of 38 patients attempted (18 female) at a median procedural weight of 2.2 kg (interquartile range [IQR], 2-2.4 kg). Seven patients (18%) had a genetic abnormality and 16 (42%) had associated comorbidities. The median intensive care unit stay was 4 days (IQR, 2-6.75 days), and the median hospital stay was 20 days (IQR, 16-57.25). One patient required a rescue shunt procedure, with three others requiring early SPS (<30 days postprocedure). Twenty patients (54%) required reintervention with either balloon angioplasty, restenting, or both. At 6-month follow-up, right pulmonary artery growth (median z-score -1.16 to 0.01, p = 0.05) was greater than the left pulmonary artery (median z-score -0.9 to -0.64, p = 0.35). Serious adverse effects (SAEs) were seen in 18% (N = 7) of our cohort. One patient developed an SAE during planned reintervention There were no intraprocedural deaths, with one early procedure-related mortality, and three interstage mortalities not directly related to PDA stenting. CONCLUSIONS PDA stenting in infants ≤2.5 kg is feasible and effective, promoting pulmonary artery growth. Reintervention rates are relatively high, though many are planned to allow for optimal growth before a definitive operation.
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Affiliation(s)
- Mohamed Al Nasef
- Children Health Ireland at Crumlin, Dublin, Ireland.,Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Doaa A Shahbah
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.,Department of Pediatric Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sarosh P Batlivala
- Department of Pediatric Cardiology Department, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Reem Darwish
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | | | | | | | | | | | - Tarek Momenah
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Atif Alshahri
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | | | - Amr Arafat
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Omar Al Tamimi
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | | | | | - Damien Kenny
- Children Health Ireland at Crumlin, Dublin, Ireland
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Bonilla-Ramirez C, Aggarwal V, Atyam M, Qureshi AM, Heinle JS, McKenzie ED. Decellularized vs Non-decellularized Allogeneic Pulmonary Artery Patches for Pulmonary Arterioplasty. Semin Thorac Cardiovasc Surg 2022; 35:722-730. [PMID: 35878741 DOI: 10.1053/j.semtcvs.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/11/2022]
Abstract
We studied pulmonary artery size, reinterventions, and panel reactive antibodies in patients with single-ventricle physiology who underwent a pulmonary arterioplasty with decellularized (DAPAP) and non-decellularized allogeneic pulmonary artery patches (non-DAPAP). Retrospective review identified 59 patients with single-ventricle physiology who underwent pulmonary arterioplasty from 2008 to 2017: 28 patients underwent arterioplasty with DAPAP and 31 patients with non-DAPAP. Demographic and operative variables were similar between groups. Among patients who underwent a Norwood procedure, a right ventricle to pulmonary artery shunt was more commonly used in the DAPAP group (12/20, 60%) and a modified Blalock-Taussig shunt was more commonly used in the non-DAPAP group (17/22, 77%). On multivariable analysis, the use of DAPAP was associated with higher pre-Fontan angiography Z-scores in right (estimate = 0.17, standard error = 0.04, P = 0.0005) and left pulmonary arteries (estimate = 0.12, standard error = 0.05, P = 0.01). No areas of calcification, discrete coarctation, or pulmonary dilation were noted in any of the pulmonary arteries. On multivariable analysis, the use of DAPAP was associated with higher freedom from pulmonary artery reinterventions (Hazard ratio = 0.36, 95% confidence interval = 0.13-0.9, P = 0.04). The median value for Class I panel reactive antibodies was 0% (IQR 0, 4) in the DAPAP and 23% (IQR 14, 36) in the non-DAPAP group. The median value for Class II panel reactive antibodies was 15% (IQR 0, 17) in the DAPAP and 21% (IQR 10, 22) in the non-DAPAP group. Pulmonary arterioplasty with DAPAP was associated with higher pre-Fontan pulmonary artery Z-scores and higher freedom from pulmonary artery reinterventions.
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Affiliation(s)
- Carlos Bonilla-Ramirez
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Manasa Atyam
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX
| | - E Dean McKenzie
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX.
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Qureshi AM, Caldarone CA, Wilder TJ. Transcatheter Approaches to Palliation for Tetralogy of Fallot. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2022; 25:48-57. [PMID: 35835516 DOI: 10.1053/j.pcsu.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 11/11/2022]
Abstract
To this day, controversy still exists regarding the optimal method to treat symptomatic neonates and infants with Tetralogy of Fallot (TOF). Symptomatic (severely cyanotic or ductal dependent) infants with TOF can undergo either a staged repair approach (consisting of initial palliation followed by complete repair) or primary repair. Traditionally, initial palliative procedures have been surgical, for example placement of a Blalock-Taussig-Thomas (BTT) shunt. Recent advances in technology have facilitated the introduction of catheter-based procedures as palliative techniques, for example, patent ductus arteriosus (PDA) stenting and right ventricular outflow tract (RVOT) stenting as more durable solutions than balloon pulmonary valvuloplasty (BPV). In this article, we discuss the rationale for these procedures, technical aspects of these procedures and outcomes data compared to traditional surgical procedures. Recent data have suggested that RVOT and PDA stenting procedures offer many advantages over traditional surgical palliative procedures as palliative methods in this patient population. This comes at a cost of increased reintervention burden, which may be considered part of the overall treatment strategy in smaller neonates and can be minimized with a focus on technical aspects and overall treatment strategies. Advanced surgical techniques are required at the eventual complete repair to negotiate removal of stent material and pulmonary artery reconstruction in some instances. Further adoption of catheter based palliative procedures for infants with symptomatic TOF has the potential to tip the outcomes towards favoring a staged approach, particularly in high-risk infants.
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Affiliation(s)
- Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
| | - Christopher A Caldarone
- Congenital Heart Surgery, Texas Children's Hospital and Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Travis J Wilder
- Division of Congenital Heart Surgery, University Hospitals, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
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Brown N, Bhatt H, Salunke A, Chinnakotla S, Qureshi AM, Aggarwal V. Stenting of ductus venosus as a palliation for portal hypertension because of neonatal cirrhosis. Liver Int 2022; 42:879-883. [PMID: 35129262 DOI: 10.1111/liv.15190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/04/2022] [Accepted: 01/24/2022] [Indexed: 02/13/2023]
Abstract
Portal hypertension because of liver cirrhosis is a significant cause of morbidity and mortality. Treatment options in these patients include liver transplant, symptomatic treatment of oesophageal varices via endoscopic treatment and symptomatic management of ascites. Portosystemic shunt creation can be challenging in newborns and infants. We present a newborn with Trisomy 21, severe portal hypertension secondary to neonatal cirrhosis, oesophageal varices and upper GI bleeding, severe ascites refractory to medical management who underwent ductus venosus stenting as a palliative procedure. He demonstrated remarkable clinical improvement with no subsequent upper GI bleed and resolution of ascites till his last follow-up at 12 months of age. To the best of our knowledge, stenting of the patent ductus venosus to create a portosystemic shunt to relieve portal hypertension has not been reported in English literature.
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Affiliation(s)
- Nicholas Brown
- Division of Pediatric Critical Care, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Heli Bhatt
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Amrita Salunke
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Srinath Chinnakotla
- Division of Transplant Surgery, Department of Surgery, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Athar M Qureshi
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
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O'Byrne ML, Glatz AC, Huang YSV, Kelleman MS, Petit CJ, Qureshi AM, Shahanavaz S, Nicholson GT, Batlivala S, Meadows JJ, Zampi JD, Law MA, Romano JC, Mascio CE, Chai PJ, Maskatia S, Asztalos IB, Beshish A, Pettus J, Pajk AL, Healan SJ, Eilers LF, Merritt T, McCracken CE, Goldstein BH. Comparative Costs of Management Strategies for Neonates With Symptomatic Tetralogy of Fallot. J Am Coll Cardiol 2022; 79:1170-1180. [PMID: 35331412 DOI: 10.1016/j.jacc.2021.12.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/22/2021] [Accepted: 12/23/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Recent data have demonstrated that overall mortality and adverse events are not significantly different for primary repair (PR) and staged repair (SR) approaches to management of neonates with symptomatic tetralogy of Fallot (sTOF). Cost data can be used to compare the relative value (cost for similar outcomes) of these approaches and are a potentially more sensitive measure of morbidity. OBJECTIVES This study sought to compare the economic costs associated with PR and SR in neonates with sTOF. METHODS Data from a multicenter retrospective cohort study of neonates with sTOF were merged with administrative data to compare total costs and cost per day alive over the first 18 months of life in a propensity score-adjusted analysis. A secondary analysis evaluated differences in department-level costs. RESULTS In total, 324 subjects from 6 centers from January 2011 to November 2017 were studied (40% PR). The 18-month cumulative mortality (P = 0.18), procedural complications (P = 0.10), hospital complications (P = 0.94), and reinterventions (P = 0.22) did not differ between PR and SR. Total 18-month costs for PR (median $179,494 [IQR: $121,760-$310,721]) were less than for SR (median: $222,799 [IQR: $167,581-$327,113]) (P < 0.001). Cost per day alive (P = 0.005) and department-level costs were also all lower for PR. In propensity score-adjusted analyses, PR was associated with lower total cost (cost ratio: 0.73; P < 0.001) and lower department-level costs. CONCLUSIONS In this multicenter study of neonates with sTOF, PR was associated with lower costs. Given similar overall mortality between treatment strategies, this finding suggests that PR provides superior value.
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Affiliation(s)
- Michael L O'Byrne
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center For Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Cardiovascular Outcomes, Quality, and Evaluative Research Center, Leonard Davis Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Andrew C Glatz
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center For Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yuan-Shung V Huang
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael S Kelleman
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christopher J Petit
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA; Division of Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Athar M Qureshi
- Lillie Frank Abercrombie Section on Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Shabana Shahanavaz
- Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA; Heart Center, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - George T Nicholson
- Division of Cardiology, Monroe Carrell Jr. Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Shawn Batlivala
- Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Jeffery J Meadows
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey D Zampi
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark A Law
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer C Romano
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher E Mascio
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul J Chai
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shiraz Maskatia
- Betty Irene Moore Children's Heart Center, Lucille Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ivor B Asztalos
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Asaad Beshish
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joelle Pettus
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amy L Pajk
- Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Steven J Healan
- Division of Cardiology, Monroe Carrell Jr. Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Lindsay F Eilers
- Lillie Frank Abercrombie Section on Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Taylor Merritt
- Heart Center, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Courtney E McCracken
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bryan H Goldstein
- Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA; Heart Institute, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Spigel ZA, Qureshi AM, Kalustian A, Binsalamah ZM, Imamura M, Caldarone CA. Shunt resistance is associated with clinically important outcomes after the Norwood operation. JTCVS Open 2022; 9:206-214. [PMID: 36003462 PMCID: PMC9390403 DOI: 10.1016/j.xjon.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Zachary A. Spigel
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Athar M. Qureshi
- Division of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Alyssa Kalustian
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Ziyad M. Binsalamah
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Michiaki Imamura
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Christopher A. Caldarone
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
- Address for reprints: Christopher A. Caldarone, MD, Division of Congenital Heart Surgery, Texas Children's Hospital, 6651 Main St, LT19345H, Houston, TX 77030.
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McElhinney DB, Zhang Y, Levi DS, Georgiev S, Biernacka EK, Goldstein BH, Shahanavaz S, Qureshi AM, Cabalka AK, Bauser-Heaton H, Torres AJ, Morray BH, Armstrong AK, Millan-Iturbe O, Peng LF, Aboulhosn JA, Rużyłło W, Berger F, Sondergaard L, Schranz D, Cheatham JP, Jones TK, Ewert P, Schubert S. Reintervention and Survival After Transcatheter Pulmonary Valve Replacement. J Am Coll Cardiol 2022; 79:18-32. [PMID: 34991785 DOI: 10.1016/j.jacc.2021.10.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Transcatheter pulmonary valve (TPV) replacement (TPVR) has become the standard therapy for postoperative pulmonary outflow tract dysfunction in patients with a prosthetic conduit/valve, but there is limited information about risk factors for death or reintervention after this procedure. OBJECTIVES This study sought to evaluate mid- and long-term outcomes after TPVR in a large multicenter cohort. METHODS International registry focused on time-related outcomes after TPVR. RESULTS Investigators submitted data for 2,476 patients who underwent TPVR and were followed up for 8,475 patient-years. A total of 95 patients died after TPVR, most commonly from heart failure (n = 24). The cumulative incidence of death was 8.9% (95% CI: 6.9%-11.5%) 8 years after TPVR. On multivariable analysis, age at TPVR (HR: 1.04 per year; 95% CI: 1.03-1.06 per year; P < 0.001), a prosthetic valve in other positions (HR: 2.1; 95% CI: 1.2-3.7; P = 0.014), and an existing transvenous pacemaker/implantable cardioverter-defibrillator (HR: 2.1; 95% CI: 1.3-3.4; P = 0.004) were associated with death. A total of 258 patients underwent TPV reintervention. At 8 years, the cumulative incidence of any TPV reintervention was 25.1% (95% CI: 21.8%-28.5%) and of surgical TPV reintervention was 14.4% (95% CI: 11.9%-17.2%). Risk factors for surgical reintervention included age (0.95 per year [95% CI: 0.93-0.97 per year]; P < 0.001), prior endocarditis (2.5 [95% CI: 1.4-4.3]; P = 0.001), TPVR into a stented bioprosthetic valve (1.7 [95% CI: 1.2-2.5]; P = 0.007), and postimplant gradient (1.4 per 10 mm Hg [95% CI: 1.2-1.7 per 10 mm Hg]: P < 0.001). CONCLUSIONS These findings support the conclusion that survival and freedom from reintervention or surgery after TPVR are generally comparable to outcomes of surgical conduit/valve replacement across a wide age range.
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Affiliation(s)
| | - Yulin Zhang
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Daniel S Levi
- Mattel Children's Hospital at UCLA, Los Angeles, California, USA
| | | | | | - Bryan H Goldstein
- Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Shabana Shahanavaz
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | | | | | - Holly Bauser-Heaton
- Sibley Heart Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Alejandro J Torres
- New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA
| | - Brian H Morray
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | | | | | - Lynn F Peng
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Jamil A Aboulhosn
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Witold Rużyłło
- The Cardinal Stefan Wyszyński Institute of Cardiology, Warsaw, Poland
| | | | - Lars Sondergaard
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Thomas K Jones
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
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Lahiri S, Qureshi AM, Justino H, Mossad EB. Percutaneous Common Carotid Artery Access for Cardiac Interventions in Infants Does Not Acutely Change Cerebral Perfusion. Pediatr Cardiol 2022; 43:104-109. [PMID: 34363498 DOI: 10.1007/s00246-021-02697-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
Pediatric cardiac interventions via percutaneous common carotid artery (CCA) access have been shown to be safe and effective. However, the impact of placement of a sheath in the carotid artery for interventions on cerebral perfusion is unknown. In this study we used cerebral near-infrared spectroscopy (NIRS) to analyze the effects of percutaneous CCA access for cardiac interventions on cerebral perfusion. This study is a retrospective chart review carried out at a tertiary care center on all pediatric patients who underwent percutaneous cardiac catheterization via carotid artery access from January 2010 to January 2020. All patients who had ipsilateral NIRS recorded on the side of carotid artery access were included. Patients with only partial or no ipsilateral NIRS data were excluded. The primary outcome measure was the change in NIRS upon CCA access; the mean NIRS for 15 min before obtaining access was compared to the mean NIRS during the procedure and to the mean NIRS 15 min after removal of the CCA sheath. We hypothesized that there would be a significant drop in NIRS values on the side of CCA access. There were 48 catheterizations in the study period where percutaneous CCA was accessed. Of those, 21 catheterizations had complete data and were included in the study. 13 (62%) were of males. The median age was 23 days (IQR 7-79). The indications for CCA access were patent ductus arteriosus stent implantation (n = 13; 62%), aortic valvuloplasty (n = 5; 24%), balloon angioplasty of coarctation of aorta (n = 2; 10%), and renal artery angioplasty (n = 1; 4%). In 16 patients (72%), the left common carotid artery was accessed. The median weight of the patients was 3.3 kg (IQR 2.8-2.9). The most common sheath size used was 4F, in 16 patients (72%). The mean NIRS prior to the procedure was 67 ± 15%, during the procedure was 68 ± 20%, and after removal of sheath was 68 ± 21%. Paired t test of cerebral NIRS before, during, and after the procedure showed no significant change with CCA access (P = 0.08). No patient in the series had a documented neurologic deficit following the procedure. Percutaneous CCA access was not associated with a decrease in NIRS on the side of the access during the procedure, suggesting there was no significant acute change in cerebral perfusion with CCA access.
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Affiliation(s)
- Subhrajit Lahiri
- Department of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, E1920, Houston, TX, 77030, USA.
| | - Athar M Qureshi
- Department of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, E1920, Houston, TX, 77030, USA
| | - Henri Justino
- Department of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, E1920, Houston, TX, 77030, USA
| | - Emad B Mossad
- Division of Pediatric Cardiac Anesthesia, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, 77030, USA
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Spigel ZA, Qureshi AM, Adachi I. Stratification of the Right Ventricle Dependent Coronary Circulation: Relevance to Treatment Strategy. J Thorac Cardiovasc Surg 2022; 164:765-769. [DOI: 10.1016/j.jtcvs.2022.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/08/2022] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
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Gowda ST, Latson L, Sivakumar K, Hiremath G, Crystal M, Law M, Shahanavaz S, Asnes J, Veeram Reddy S, Kobayashi D, Alwi M, Ichida F, Hirono K, Tahara M, Takeda A, Minami T, Kutty S, Nugent AW, Forbes T, Prieto LR, Qureshi AM. Anatomical Classification and Posttreatment Remodeling Characteristics to Guide Management and Follow-Up of Neonates and Infants With Coronary Artery Fistula: A Multicenter Study From the Coronary Artery Fistula Registry. Circ Cardiovasc Interv 2021; 14:e009750. [PMID: 34903033 DOI: 10.1161/circinterventions.120.009750] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary artery fistulas (CAFs) presenting in infancy are rare, and data regarding postclosure sequelae and follow-up are limited. METHODS A retrospective review of all the neonates and infants (<1 year) was conducted from the CAF registry for CAF treatment. The CAF type (proximal or distal), size, treatment method, and follow-up angiography were reviewed to assess outcomes and coronary remodeling. RESULTS Forty-eight patients were included from 20 centers. Of these, 30 were proximal and 18 had distal CAF; 39 were large, 7 medium, and 2 had small CAF. The median age and weight was 0.16 years (0.01-1) and 4.2 kg (1.7-10.6). Heart failure was noted in 28 of 48 (58%) patients. Transcatheter closure was performed in 24, surgical closure in 18, and 6 were observed medically. Procedural success was 92% and 94 % for transcatheter closure and surgical closure, respectively. Follow-up data were obtained in 34 of 48 (70%) at a median of 2.9 (0.1-18) years. Angiography to assess remodeling was available in 20 of 48 (41%). I. Optimal remodeling (n=10, 7 proximal and 3 distal CAF). II. Suboptimal remodeling (n=7) included (A) symptomatic coronary thrombosis (n=2, distal CAF), (B) asymptomatic coronary thrombosis (n=3, 1 proximal and 2 distal CAF), and (C) partial thrombosis with residual cul-de-sac (n=1, proximal CAF) and vessel irregularity with stenosis (n=1, distal CAF). Finally, (III) persistent coronary artery dilation (n=4). Antiplatelets and anticoagulation were used in 31 and 7 patients post-closure, respectively. Overall, 7 of 10 (70%) with proximal CAF had optimal remodeling, but 5 of 11 (45%) with distal CAF had suboptimal remodeling. Only 1 of 7 patients with suboptimal remodeling were on anticoagulation. CONCLUSIONS Neonates/infants with hemodynamically significant CAF can be treated by transcatheter or surgical closure with excellent procedural success. Patients with distal CAF are at higher risk for suboptimal remodeling. Postclosure anticoagulation and follow-up coronary anatomic evaluation are warranted.
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Affiliation(s)
- Srinath T Gowda
- Department of Pediatrics, Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston (S.T.G., A.M.Q.)
| | - Larry Latson
- Pediatric Cardiology, Joe DiMaggio Children's Hospital, Hollywood, FL (L.L.)
| | | | - Gurumurthy Hiremath
- Department of Pediatrics, University of Minnesota, Masonic Children's Hospital, Minneapolis (G.H.)
| | - Matthew Crystal
- Pediatric Cardiology, Irving Medical Center, Columbia University, New York, NY (M.C.)
| | - Mark Law
- Pediatric Cardiology, Children's of Alabama, University of Alabama at Birmingham (M.L.)
| | | | - Jeremy Asnes
- Pediatric Cardiology, Yale New Haven Children's Hospital, CT (J.A.)
| | | | - Daisuke Kobayashi
- Pediatric Cardiology, Children's Hospital of Michigan, Detroit, MI (D.K., T.F.)
| | - Mazeni Alwi
- Pediatric Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (M.A.)
| | - Fukiko Ichida
- Department of Pediatrics, University of Toyoma, Japan (F.I., K.H.)
| | - Keiichi Hirono
- Department of Pediatrics, University of Toyoma, Japan (F.I., K.H.)
| | - Masahiro Tahara
- Department of Pediatrics, Tsuchiya General Hospital, Hiroshima, Japan (M.T.)
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Japan (A.T.)
| | - Takaomi Minami
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan (T.M.)
| | - Shelby Kutty
- Pediatric Cardiology, Helen B. Taussig Heart Center, The Johns Hopkins Hospital, Baltimore, MD (S.K.)
| | - Alan W Nugent
- Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL (A.W.N.)
| | - Thomas Forbes
- Pediatric Cardiology, Children's Hospital of Michigan, Detroit, MI (D.K., T.F.)
| | - Lourdes R Prieto
- Pediatric Cardiology, Nicklaus Children's Hospital, Miami, FL (L.R.P.)
| | - Athar M Qureshi
- Department of Pediatrics, Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston (S.T.G., A.M.Q.)
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Headrick AT, Qureshi AM, Ghanayem NS, Heinle J, Anders M. In-hospital Morbidity and Mortality Following Modified Blalock-Taussig-Thomas Shunts. Ann Thorac Surg 2021; 114:168-175. [PMID: 34838515 DOI: 10.1016/j.athoracsur.2021.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/20/2021] [Accepted: 11/02/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The modified Blalock-Taussig-Thomas shunt (mBTTs) is a critically important palliation for patients with insufficient pulmonary blood flow associated with congenital heart disease. Following creation of a mBTTs, patients experience high rates of early postoperative morbidity and mortality. METHODS This is a single-institution retrospective cohort study. A query of the Society of Thoracic Surgeons database identified relevant patients whose health records were manually queried for echocardiography and operative reports. Patients with ductal-dependent systemic circulation were excluded. Primary outcomes were early serious adverse events and in-hospital mortality. Secondary outcomes were time to primary outcomes and postoperative lengths of stay. We investigated the correlation of demographics, presence of competitive pulmonary blood flow, and surgical and anatomic factors on outcomes. RESULTS After exclusions, our cohort resulted in 155 patients. 33 (21.3%) patients experienced an early serious adverse event, ten (6.5%) early shunt malfunction, and 11 (7.1%) in-hospital mortality. Smaller shunt size, smaller shunted pulmonary artery size, surgical approach, and site of proximal shunt anastomosis were independently associated with morbidity and mortality. CONCLUSIONS Anatomical elements imparting increased resistance along the mBTTs predispose to increased morbidity and mortality, particularly in the early postoperative period. Despite the significant heterogeneity of patients receiving such shunts, similar risk profiles are observed regardless of lesion or presence of competitive flow. Surgical approach via thoracotomy with shunt anastomosis to the subclavian artery, where feasible, results in the subclavian artery as the point of natural resistance allowing for placement of larger shunts, yielding lower morbidity and mortality.
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Affiliation(s)
- Andrew T Headrick
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
| | - Athar M Qureshi
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Nancy S Ghanayem
- Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas; Department of Pediatrics, Section of Critical Care Medicine, University of Chicago, Chicago, Illinois
| | - Jeffrey Heinle
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas
| | - Marc Anders
- Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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42
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Shahanavaz S, Qureshi AM, Petit CJ, Goldstein BH, Glatz AC, Bauser-Heaton HD, McCracken CE, Kelleman MS, Law MA, Nicholson GT, Zampi JD, Pettus J, Meadows J. Factors Influencing Reintervention Following Ductal Artery Stent Implantation for Ductal-Dependent Pulmonary Blood Flow: Results From the Congenital Cardiac Research Collaborative. Circ Cardiovasc Interv 2021; 14:e010086. [PMID: 34789017 DOI: 10.1161/circinterventions.120.010086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Stenting of the patent ductus arteriosus (PDA) is an established palliative option for infants with ductal-dependent pulmonary blood flow. Following initial palliation, reintervention on the PDA stent is common, but risk factors have not been characterized. METHODS Infants with ductal-dependent pulmonary blood flow palliated with PDA stent between 2008 and 2015 were reviewed within the Congenital Cardiac Research Collaborative. Rates and risk factors for reintervention were analyzed. RESULTS Among 105 infants who underwent successful PDA stenting, 41 patients (39%) underwent a total of 53 reinterventions on the PDA stent, with all but one occurring within 6 months of the initial intervention. Stent redilation constituted the majority of reintervention (n=35; 66%) followed by additional stent placement (n=11; 21%) and surgical shunt placement (n=7; 13%). The majority of reintervention was nonurgent, and there were no deaths during the reintervention procedure. All but one reintervention occurred within 6 months of the initial procedure. On univariate analysis, risk factors for reintervention included anticipated single-ventricle physiology, lack of prior balloon pulmonary valvuloplasty, use of drug-eluting stent, and increased ductal tortuosity. CONCLUSIONS In infants with ductal-dependent pulmonary blood flow palliated with PDA stent implantation, reintervention is common, can be performed safely, and is associated with both anatomic/procedural factors and anticipated final physiology.
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Affiliation(s)
- Shabana Shahanavaz
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, MO (S.S.).,The Heart Institute, Cincinnati Children's Hospital Medical Center, OH (S.S., B.H.G.)
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston (A.M.Q.)
| | - Christopher J Petit
- Emory University School of Medicine, Children's Healthcare of Atlanta, GA (C.J.P., H.D.B.-H., J.P.).,Division of Pediatric Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Hospital (C.J.P.)
| | - Bryan H Goldstein
- The Heart Institute, Cincinnati Children's Hospital Medical Center, OH (S.S., B.H.G.).,Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, PA (B.H.G.)
| | - Andrew C Glatz
- Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia (A.C.G.)
| | - Holly D Bauser-Heaton
- Emory University School of Medicine, Children's Healthcare of Atlanta, GA (C.J.P., H.D.B.-H., J.P.)
| | - Courtney E McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (C.E.M., M.S.K.)
| | - Michael S Kelleman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (C.E.M., M.S.K.)
| | - Mark A Law
- Department of Pediatrics, Division of Pediatric Cardiology, University of Alabama at Birmingham (M.A.L.)
| | - George T Nicholson
- Division of Pediatric Cardiology, Department of Pediatrics at the Ann and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN (G.T.N.)
| | - Jeffrey D Zampi
- Department of Pediatrics, Division of Cardiology, University of Michigan, Ann Arbor (J.D.Z.)
| | - Joelle Pettus
- Emory University School of Medicine, Children's Healthcare of Atlanta, GA (C.J.P., H.D.B.-H., J.P.)
| | - Jeffery Meadows
- Division of Pediatric Cardiology, University of California, San Francisco (J.M.)
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Spigel ZA, Adachi I, Binsalamah ZM, Parekh D, Qureshi AM. Transcatheter pulmonic valve implantation in adult patients with prior congenital heart surgery. Ann Cardiothorac Surg 2021; 10:658-666. [PMID: 34733693 DOI: 10.21037/acs-2021-tviv-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/09/2021] [Indexed: 11/06/2022]
Abstract
Background Transcatheter pulmonary valve replacement (TPVR) is now an established modality for pulmonary valve replacement in suitable candidates. We aim to describe our experience with TPVR in adults. Methods This is a descriptive study of all TPVR performed in adults with congenital heart disease at a single institution from 2010-2020. All adult patients (defined as 18 years old or older at TPVR) were included. Time-to-event outcomes were described using Kaplan-Meier estimates with 95% confidence intervals (CIs). Results Out of a total of 200 patients that had undergone TPVR, 81 patients (57% male) met the inclusion criteria, with a median age and weight of 26 years (IQR 21-37) and 71.0 kg (IQR 54.6-89.0), respectively. In the cohort, 45 (56%) patients had tetralogy of Fallot. While 53 (65%) patients received a Melody valve, a Sapien valve (S3 in 20, XT in eight) was implanted in the rest. Pre-stenting was performed in 49 (52%) patients. One patient died of severe heart failure a year following TPVR. One patient had a second TPVR performed 2.2 years following initial TPVR for severe pulmonary regurgitation. Valve survival at 2.2 years was 94% (95% CI: 87-100%). Four patients developed endocarditis. Endocarditis-free survival was 89% (95% CI: 80-100%) at three years. Conclusions Our experience suggests favorable results of TPVR in adults with congenital heart disease. Additional research would be warranted with a focus on total valve longevity and patient reported outcomes, in order to improve the understanding of TPVR in this population and further refine this technology.
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Affiliation(s)
- Zachary A Spigel
- Department of Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Iki Adachi
- Department of Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Ziyad M Binsalamah
- Department of Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Dhaval Parekh
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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44
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Parekh DR, Qureshi AM. Transcatheter pulmonary valve in failed bioprosthesis. Ann Cardiothorac Surg 2021; 10:720-722. [PMID: 34733707 DOI: 10.21037/acs-2021-tviv-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/02/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Dhaval R Parekh
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Houston, TX, USA.,Texas Heart Institute, Houston, TX, USA
| | - Athar M Qureshi
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Houston, TX, USA
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45
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Affiliation(s)
- Lindsay F Eilers
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - William B Kyle
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Hugh D Allen
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
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46
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McElhinney DB, Zhang Y, Aboulhosn JA, Morray BH, Biernacka EK, Qureshi AM, Torres AJ, Shahanavaz S, Goldstein BH, Cabalka AK, Bauser-Heaton H, Georgiev S, Berger F, Millan-Iturbe O, Peng LF, Armstrong AK, Levi DS, Fronczak-Jakubczyk A, Sondergaard L, Anderson JH, Schranz D, Jones TK, Cheatham JP, Schubert S, Ewert P. Multicenter Study of Endocarditis After Transcatheter Pulmonary Valve Replacement. J Am Coll Cardiol 2021; 78:575-589. [PMID: 34353535 DOI: 10.1016/j.jacc.2021.05.044] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/02/2021] [Accepted: 05/18/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Endocarditis has emerged as one of the most impactful adverse events after transcatheter pulmonary valve replacement (TPVR), but there is limited information about risk factors for and outcomes of this complication. OBJECTIVES The purpose of this study was to evaluate risk factors for and outcomes of endocarditis in a large multicenter cohort. METHODS The authors established an international registry focused on characterizing endocarditis after TPVR, including the incidence, risk factors, characteristics, and outcomes. RESULTS Investigators submitted data for 2,476 patients who underwent TPVR between July 2005 and March 2020 and were followed for 8,475 patient-years. In total, 182 patients were diagnosed with endocarditis a median of 2.7 years after TPVR, for a cumulative incidence of 9.5% (95% CI: 7.9%-11.1%) at 5 years and 16.9% (95% CI: 14.2%-19.8%) at 8 years (accounting for competing risks: death, heart transplant, and explant) and an annualized incidence of 2.2 per 100 patient-years. Staphylococcus aureus and Viridans group Streptococcus species together accounted for 56% of cases. Multivariable analysis confirmed that younger age, a previous history of endocarditis, and a higher residual gradient were risk factors for endocarditis, but transcatheter pulmonary valve type was not. Overall, right ventricular outflow tract (RVOT) reintervention was less often to treat endocarditis than for other reasons, but valve explant was more often caused by endocarditis. Endocarditis was severe in 44% of patients, and 12 patients (6.6%) died, nearly all of whom were infected with Staphylococcus aureus. CONCLUSIONS The incidence of endocarditis in this multicenter registry was constant over time and consistent with prior smaller studies. The findings of this study, along with ongoing efforts to understand and mitigate risk, will be critical to improve the lifetime management of patients with heart disease involving the RVOT. Although endocarditis can be a serious adverse outcome, TPVR remains an important tool in the management of RVOT dysfunction.
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Affiliation(s)
| | - Yulin Zhang
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Jamil A Aboulhosn
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Brian H Morray
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | | | | | - Alejandro J Torres
- New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA
| | - Shabana Shahanavaz
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Bryan H Goldstein
- Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Holly Bauser-Heaton
- Sibley Heart Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | - Oscar Millan-Iturbe
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Centro Medico Nacional Siglo XXI, Mexico City, Mexico
| | - Lynn F Peng
- Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Daniel S Levi
- Mattel Children's Hospital at UCLA, Los Angeles, California, USA
| | | | - Lars Sondergaard
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Thomas K Jones
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | | | - Stephan Schubert
- Deutsches Herzzentrum Berlin, Berlin, Germany; Ruhr University of Bochum, Bad Oeynhausen, Germany
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47
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Goldstein BH, Petit CJ, Qureshi AM, McCracken CE, Glatz AC. Reply: Neonates With Symptomatic TOF: The Shorter Path Need Not Always Be the Desirable Path. J Am Coll Cardiol 2021; 77:2984-2985. [PMID: 34112329 DOI: 10.1016/j.jacc.2021.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
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48
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Eilers LF, Gowda ST, Gowda S, Lahiri S, Aggarwal V, Stapleton GE, Gillespie MJ, Qureshi AM. Mullins-Sheath Facilitated Delivery of Gore Cardioform ASD Occluder Devices for Closure of Large or Challenging Secundum Atrial Septal Defects. J Invasive Cardiol 2021; 33:E425-E430. [PMID: 33893794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To describe a deployment technique of the Gore Cardioform atrial septal defect (ASD) occluder (W.L. Gore and Associates) for large secundum ASDs and ASDs with challenging anatomy. BACKGROUND The Gore Cardioform ASD occluder has recently been approved for closure of secundum ASDs; however, there are limitations to its delivery system. METHODS A retrospective study was conducted on the use of a Mullins sheath (Cook Medical) to facilitate Gore Cardioform ASD occluder delivery for secundum ASD closure in the cardiac catheterization laboratory from June, 2017 to December, 2019 at Texas Children's Hospital/Baylor College of Medicine. RESULTS Out of 98 patients who underwent an attempt at ASD closure using the Gore Cardioform ASD occluder, a Mullins sheath was used in 52 patients (median age, 8 years [interquartile range, 4-13 years] and weight 27.2 kg [interquartile range, 17.9-51.2 kg]), with a successful implant in 46/52 patients (88%). The Mullins sheath was primarily used to deliver large devices (>32 mm) in 38/46 successful implants (83%). There were 2 major adverse events (atrial fibrillation requiring cardioversion). At a median follow-up of 43 days (interquartile range, 1-374 days), no patient had more than a mild residual shunt. The ASD size, maximum sheath size, and device size were larger in patients in whom the Mullins sheath was used as compared with those patients in whom a Mullins sheath was not used. CONCLUSIONS The Mullins sheath-facilitated delivery of the Gore Cardioform ASD occluder device may be a useful adjunct technique for closure of large secundum ASDs and secundum ASDs with challenging anatomy.
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Affiliation(s)
| | | | | | | | | | | | | | - Athar M Qureshi
- CE Mullins Cardiac Catheterization Laboratories, The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Associate Professor of Pediatrics, Baylor College of Medicine, Attending Physician, Internal Medicine/Cardiology, Baylor St. Luke's Medical Center, 6651 Main Street, E 1920, Houston, TX 77030.
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49
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Qasim A, Qureshi AM. Patent ductus arteriosus stenting for ductal dependent pulmonary blood flow. Progress in Pediatric Cardiology 2021. [DOI: 10.1016/j.ppedcard.2021.101367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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50
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Agrawal H, Qureshi AM, Molossi S. Response to "Wolf in Sheep's Clothing - The False Sense of Security in Patients With Anomalous Aortic Origin of a Coronary Artery Undergoing Submaximal Stress Testing". J Invasive Cardiol 2021; 33:E397-E398. [PMID: 33932284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
| | | | - Silvana Molossi
- Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030 USA.
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