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Bruhs J, Sandica E, Laser K, Grohmann J, Goerg R, Hummel J, Molatta S, Schubert S. Long-Term Experience with Heart Transplantation in Patients with Congenital Heart Disease - Focus on Single Ventricle Patients and Vad. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1322] [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] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Stiller B, Zartner P, Dähnert I, Haas NA, Schubert S, Kanaan M, Berger F, Ewert P, Schmoor C, Grohmann J. Prospective multicenter study of the breakable babystent for treatment of aortic coarctation in newborns and infants. Catheter Cardiovasc Interv 2022; 99:1529-1537. [PMID: 35170186 DOI: 10.1002/ccd.30133] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 12/22/2022]
Abstract
To assess the efficacy and safety of a breakable BabyStent to treat complex aortic coarctation (CoA) in early childhood. Although recommended in several guidelines, there is no approved aortic stent for young infants, because of the dilemma between two mandatory requirements: expandable up to adult size on the one hand, and small enough to fit through a baby's femoral artery on the other. Prospective interventional, multi-center clinical trial with the breakable Osypka BabyStent® (OBS). The OBS is a low-profile, 15-mm long cobalt-chromium stent, pre-mounted on a 6 mm balloon and inserted via a 4 Fr sheath. After implantation, its diameter is adjustable from 6 to 12 mm by balloon dilation. Further dilation opens predefined joints enabling unrestricted growth. Nineteen patients (9 male), median age 112 days (range: 7-539), median body weight 5.6 kg (range: 2.4-8.4) were deemed high risk and underwent stent implantation. Of those, 74% suffered from re-CoA following surgery, 53% had additional cardiac and 21% noncardiac malformations. Our primary combined endpoint was fulfilled: All stents were implanted in the desired region, and a >50% intrastenotic diameter-extension was achieved in 15 patients (78.9%, 80% confidence interval [62.2; 90.5], 95% confidence interval [54.4; 93.9]). Secondary endpoint confirmed that the OBS fits the baby's femoral vessel diameter. All children survived the procedure and 12-month follow-up. This stent enables percutaneous stenting of complex aortic coarctation to treat high-risk newborns and infants.
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Affiliation(s)
- Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Centre Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Zartner
- Department of Pediatric Cardiology, Kinderherzzentrum am Universitätsklinikum, Bonn, Germany
| | - Ingo Dähnert
- Department of Pediatric Cardiology, Heart Centre Leipzig, Helios Klinik GmbH, Leipzig, Germany
| | - Nikolaus A Haas
- Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.,Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stephan Schubert
- Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.,Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Majed Kanaan
- Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.,Department of Pediatric Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Felix Berger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Centre Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Berlin, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre of the State of Bavaria and the Technical University, Munich, Germany.,German Center for Cardiovascular Research, Munich, Germany
| | - Claudia Schmoor
- Clinical Trials Unit, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Centre Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
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Glonnegger H, Zieger B, Grohmann J, Freund G, Zeller T, Uhl M, Stiller B. Successful Secondary Endovascular Intervention in Pediatric Patients with Venous Thromboembolic Events. Hamostaseologie 2022; 43:102-109. [PMID: 35026859 DOI: 10.1055/a-1701-2098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND In the past, pediatric patients with venous thromboembolic events (VTE) were treated with low-molecular-weight heparin (LMWH) which was successful in around 70% of the cases. However, anticoagulation alone might not restore patency in all patients, and advanced therapeutic options to prevent postthrombotic syndrome are needed. During recent years, endovascular interventions have become a treatment option for pediatric patients with persistent thrombotic occlusion, not only in life- or limb-threatening VTE. METHODS We evaluated 12 consecutive patients (11-17 years) with newly diagnosed VTE being treated at our department during the last 4 years (2017-2020). In case follow-up examination showed persistent venoocclusion under anticoagulation, patients received secondary interventional therapy like recanalization, percutaneous transluminal angioplasty with or without catheter-directed thrombolysis, and stenting. Patients with no clinical signs of venoocclusion or regredient thrombosis in imaging examination received anticoagulation alone. RESULTS Six of 12 (50%) patients underwent catheter intervention. Median time from diagnosis to intervention was 4 months (0-12 months). Reintervention was necessary in one (8%) case and complete recanalization failed in one (8%) case. There were no major bleeding events or other major postinterventional complications, no acute or late local recurrence, and all patients reported clinical improvement after the procedure. CONCLUSION If endovascular intervention is used in teenage patients with persistent symptomatic VTE, reduction of postthrombotic symptoms is possible, even if intervention is performed secondary to failure of anticoagulation. Multidisciplinary treatment decisions can be based on the clinical course and follow-up imaging.
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Affiliation(s)
- Hannah Glonnegger
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center - University of Freiburg, Germany
| | - Barbara Zieger
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center - University of Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany.,Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Gabriele Freund
- Department of Angiology, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Thomas Zeller
- Department of Angiology, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Markus Uhl
- Division of Pediatric Radiology, Department of Radiology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Defects and Pediatric Cardiology, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
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Fritz C, Engelhardt A, Grohmann J, Dähnert I, Hummel J, Tanase D, Ewert P, Eicken A. A multi-center trial on efficacy and safety of the LifeTech CeraFlexTM ASD occluder for transcatheter closure in patients with secundum atrial septal defects. Cardiovasc Diagn Ther 2022; 12:475-484. [PMID: 36033225 PMCID: PMC9412214 DOI: 10.21037/cdt-21-798] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/23/2022] [Indexed: 11/06/2022]
Abstract
Background The last decades have brought remarkable improvements in treatment strategy and occluder modification of secundum atrial septal defect (ASD) closure. Approval, efficacy and safety of ASD closure devices have previously been demonstrated. This study investigated the clinical efficacy and safety of the LifeTech CeraFlexTM ASD occluder for interventional closure of secundum ASD with a 6-month follow-up (FU). Methods Procedure specific data was collected on patients considered for ASD closure with the CeraFlexTM occluder between April 2016 and December 2019 in three German centers. Efficacy and safety were assessed after device closure, at discharge, and at 6-month FU. Results The primary endpoint (successful ASD closure without severe complications) was reached by 102/103 patients (99%). Device embolization occurred in two patients (one early and one late embolization). After early snare-retrieval of an embolized device, this ASD was closed surgically and in the other patient with late device embolization the defect was closed with a larger CeraFlexTM occluder. The secondary endpoint (clincal efficacy after 6 months) was reached by 94/98 patients since new onset of arrhythmia occurred in four patients. Three patients had withdrawn their study-participation and one patient had moderate residual shunt, but not related to the occluder. Incomplete right bundle branch block (iRBBB) was seen in 31 patients. At last FU only 17 patients had remaining iRBBB documenting effective volume unloading of the right ventricle. Conclusions Catheter interventional closure of secundum ASDs with the CeraFlexTM ASD occluder was feasible, safe and effective in this study.
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Affiliation(s)
- Celina Fritz
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Andrea Engelhardt
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ingo Dähnert
- Heart Center, University of Leipzig, Clinic for Pediatric Cardiology, Leipzig, Germany
| | - Johanna Hummel
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Tanase
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Andreas Eicken
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
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Kubicki R, Hummel J, Höhn R, Müller K, Stiller B, Grohmann J. Catheter strategy to ease the procedure and reduce radiation exposure when requiring neck access. Open Heart 2020; 7:openhrt-2020-001267. [PMID: 32595140 PMCID: PMC7322512 DOI: 10.1136/openhrt-2020-001267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/30/2020] [Accepted: 05/11/2020] [Indexed: 01/14/2023] Open
Abstract
Objectives To assess the potential occupational radiation reduction and technical feasibility in patients rotated 180° (upside-down) when requiring neck access for transcervical or trans-subclavian catheterisation. Methods Upside-down positioning is defined as rotating patients in supine position by 180°, so that the feet come to rest where the head would otherwise be. We retrospectively evaluated all these procedures performed between March 2016 and May 2019. Furthermore, two different phantoms (paediatric and adult) were used prospectively to quantify the occupational dose between conventional or upside-down positioning. In this context, ambient dose equivalents were measured using real-time dosimeters. Three different projection angles were applied. Results 44 patients with median age and body weight of 1.0 year (range 0–56) and 9.5 kg (range 1.3–74.3) underwent 63 procedures positioned upside-down. This position proved advantageous for practical reasons, since the length of the examination table could be optimally used. Additionally, it resulted in a significantly lower overall ambient dose equivalent for the primary operator (PO) of 94.8% (mean: 2569±807 vs 135±23 nSv; p<0.01) in the adult, and of 65.5% (mean: 351±104 vs 121±56 nSv; p<0.01) in the paediatric phantom, respectively. Conclusion Upside-down positioning facilitates handling in a straightforward manner when access from the neck is required. Moreover, it significantly reduces local radiation exposure for the PO in the paediatric and, most impressively, in the adult phantom.
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Affiliation(s)
- Rouven Kubicki
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - Johanna Hummel
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - René Höhn
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - Kevin Müller
- Department of Occupational Safety, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
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Kubicki R, Grohmann J, Kunz KG, Stiller B, Schwab KO, van der Werf-Grohmann N. Frequency of thyroid dysfunction in pediatric patients with congenital heart disease exposed to iodinated contrast media - a long-term observational study. J Pediatr Endocrinol Metab 2020; 33:1409-1415. [PMID: 33001853 DOI: 10.1515/jpem-2020-0032] [Citation(s) in RCA: 5] [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] [Received: 01/23/2020] [Accepted: 08/06/2020] [Indexed: 12/19/2022]
Abstract
Background The thyroid gland of patients with congenital heart disease may be exposed to large doses of iodine from various sources. We assessed the thyroid response after iodine exposure during conventional angiography in cardiac catheterization and angiographic computer tomography in childhood. Methods Retrospective mid- to long-term follow-up of 104 individuals (24% neonates, 51% infants, 25% children) with a median age and body weight of 104 days [0-8 years] and 5.3 kg [1.6-20]. Serum levels of thyroid-stimulating hormone, free triiodthyronine and free thyroxine were evaluated at baseline and after excess iodine. We also assessed risk factors that may affect thyroid dysfunction. Results Baseline thyroidal levels were within normal range in all patients. The mean cumulative iodinate contrast load was 6.6 ± 1.6 mL/kg. In fact, 75% had experienced more than one event involving iodine exposure, whose median frequency was three times per patient [1-12]. During the median three years follow-up period [0.5-10], the incidence of thyroid dysfunction was 15.4% (n=16). Those patients developed acquired hypothyroidism (transient n=14, long-lasting n=2 [both died]) with 10 of them requiring temporary replacement therapy for transient thyroid dysfunction, while four patients recovered spontaneously. 88 individuals (84.6%) remained euthyroid. Repeated cardiac interventions, use of drugs that interfere with the thyroid and treatment in the intensive care unit at the index date were strong predictors for acquired thyroid dysfunction. Conclusions The incidence of acquired hypothyroidism after iodine excess was 15.4%. However, most patients developed only transient hypothyroidism. Systemic iodine exposure seems to be clinically and metabolically well tolerated during long-term follow-up.
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Affiliation(s)
- Rouven Kubicki
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus-Georg Kunz
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Karl Otfried Schwab
- Department of Pediatrics and Adolescent Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Natascha van der Werf-Grohmann
- Department of Pediatrics and Adolescent Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Kubicki R, Stiller B, Kroll J, Siepe M, Beyersdorf F, Benk C, Höhn R, Grohmann J, Fleck T, Zieger B. Acquired von Willebrand syndrome in paediatric patients during mechanical circulatory support. Eur J Cardiothorac Surg 2020; 55:1194-1201. [PMID: 30590475 DOI: 10.1093/ejcts/ezy408] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 07/23/2018] [Revised: 10/15/2018] [Accepted: 11/01/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Bleeding signs can become life-threatening complications in patients on mechanical circulatory support (MCS). Clinical phenotyping and comprehensive analyses of the cause of bleeding are, therefore, essential, especially when risk-stratifying patients during MCS workup. We conducted coagulation analyses and determined von Willebrand factor (VWF) parameters in a paediatric cohort on temporary extracorporeal life support, extracorporeal membrane oxygenation or long-term ventricular assist device support. METHODS We carried out an observational single-centre study including 30 children with MCS (extracorporeal life support, n = 13; extracorporeal membrane oxygenation, n = 5; and ventricular assist device, n = 12). We also assessed the acquired von Willebrand parameters of each study participant: collagen binding capacity (VWF:CB), the ratio of collagen-binding capacity to VWF antigen (VWF:CB/VWF:Ag) and high-molecular-weight VWF multimers. We also documented bleeding events, transfusion requirement, haemolysis parameters and surgical interventions. RESULTS All children developed AVWS (acquired von Willebrand syndrome) during MCS, usually during the early postoperative course. They presented no AVWS after device explantation. We detected a loss of high-molecular-weight VWF multimers, decreased VWF:CB/VWF:Ag ratios and reduced VWF:CB levels. Twenty of the 30 patients experienced bleeding complications; approximately 53% of them required surgical revision. There were no deaths due to bleeding during support. CONCLUSIONS The AVWS prevalence in paediatric patients on MCS is 100% regardless of the types of devices tested in this study. The bleeding propensity of AVWS patients widely varies.
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Affiliation(s)
- Rouven Kubicki
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Kroll
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Benk
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - René Höhn
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thilo Fleck
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Barbara Zieger
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Hummel J, Kubicki R, Pingpoh C, Stiller B, Sigler M, Siepe M, Grohmann J. Surgically placed radiopaque markers: Proof-of-concept of a novel technique to facilitate percutaneous interventions in neonates and infants. Catheter Cardiovasc Interv 2020; 96:E303-E309. [PMID: 32267611 DOI: 10.1002/ccd.28891] [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: 12/14/2019] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Aim of this study was to evaluate feasibility and benefit of self-designed, radiopaque markers as a novel technique in neonates and infants with shunt- or duct-dependent lesions. BACKGROUND Surgically placed radiopaque markers have the potential to facilitate postoperative percutaneous interventions. METHODS All consecutive children with surgically placed radiopaque markers involving systemic-to-pulmonary artery connections or arterial ducts in the context of hybrid palliation and subsequent cardiac catheterization between January 2013 and March 2019 were included in this analysis. Our primary endpoint was our concept's feasibility, which we defined as a combination of surgical feasibility and the percutaneous intervention's success. Secondary endpoint was the rate of complications resulting from the surgical procedure or during catheterization. RESULTS Radiopaque markers that reveal the proximal entry of a surgical shunt or the arterial duct proved to be a feasible and beneficial approach in 25 postoperative catheterizations. The markers' high accuracy enabled easy probing and proper stent positioning in 13 neonates with a median age and weight of 121 days (range 9-356) and 4.7 kg (1.6-9.4) at the intervention. No procedural complications or unanticipated events associated with the radiopaque marker occurred. The markers were never lost, never migrated, and caused no local obstructive lesion. Surgical removal was straightforward in all patients. CONCLUSIONS Radiopaque markers are a promising and refined technique to substantially facilitate target vessel access and enabling the accurate positioning of stents during postoperative percutaneous procedures.
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Affiliation(s)
- Johanna Hummel
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rouven Kubicki
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Clarence Pingpoh
- Department of Cardiac and Vascular Surgery, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Sigler
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University, Göttingen, Germany
| | - Matthias Siepe
- Department of Cardiac and Vascular Surgery, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Stavropoulou D, Hentschel R, Rädecke J, Kunze M, Niemeyer C, Uhl M, Grohmann J. Preoperative selective embolization with vascular coiling of giant sacrococcygeal teratoma. J Neonatal Perinatal Med 2020; 12:345-349. [PMID: 30932896 DOI: 10.3233/npm-180066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Sacrococcygeal teratoma is one of the most common congenital tumors. Its optimal management requires interdisciplinary care by obstetricians, radiologists, pediatric surgeons, and neonatologists. Early surgery entailing complete tumor excision is the main therapy aim, but a substantial risk of life-threatening complications remains, especially uncontrollable intraoperative hemorrhage. To reduce the risk of bleeding in a female neonate with a giant sacrococcygeal teratoma, we successfully coil-embolized the tumor's main feeding arteries. Her subsequent complete surgical resection was uneventful, and the child is well with favorable reconstructive and functional status of all involved and adjacent organ systems.
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Affiliation(s)
- D Stavropoulou
- Department of General Pediatrics, Adolescent Medicine, Division of Neonatology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R Hentschel
- Department of General Pediatrics, Adolescent Medicine, Division of Neonatology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J Rädecke
- Department of Pediatric Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Kunze
- Department of Obstetrics and Gynecology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Niemeyer
- Department of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Uhl
- Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Kruckenberg J, Kubicki R, Höhn R, Siepe M, Stiller B, Grohmann J. Recanalization and Stenting of the Occluded Vertical Vein as Rescue and Bridging Strategy in a Critically Ill Neonate with Supracardiac Total Anomalous Pulmonary Venous Connection. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705522] [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] [Indexed: 10/24/2022]
Affiliation(s)
| | | | - R. Höhn
- Freiburg Bad Krozingen, Germany
| | - M. Siepe
- Freiburg / Bad Krozingen, Germany
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11
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Glonnegger H, Schulze M, Kathemann S, Berg S, Füllgraf H, Tannapfel A, Gerner P, Grohmann J, Niemeyer C, Hettmer S. Case Report: Hepatic Adenoma in a Child With a Congenital Extrahepatic Portosystemic Shunt. Front Pediatr 2020; 8:501. [PMID: 32984213 PMCID: PMC7477041 DOI: 10.3389/fped.2020.00501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/15/2020] [Indexed: 12/19/2022] Open
Abstract
Congenital extrahepatic portosystemic shunts (CEPS), previously also described as Abernethy malformations, are rare malformations in which the extrahepatic portal system directly communicates with the vena cava inferior, thereby bypassing the liver. A hypoplastic portal vein (PV) exists in most cases. CEPS have been associated with the development of liver nodules, ranging from mostly focal nodular hyperplasia (FNH) to hepatic adenoma (HA) and even hepatocellular carcinoma (HCC). Tumor development in CEPS may be due to changes in perfusion pressures, oxygen supply or endocrine imbalances. It is important to rule out CEPS in children with liver tumors, because resection could impede future shunt occlusion procedures, and benign masses may regress after shunt occlusion. Here, we review the case of a 9-years-old male with CEPS and hepatic nuclear Factor 1-alpha (HNF-1-alpha) inactivated HA to raise awareness of this condition and review histopathological changes in the liver of CEPS.
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Affiliation(s)
- Hannah Glonnegger
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
| | - Maren Schulze
- Department of Transplant and General Surgery, University Hospital Essen, Essen, Germany
| | - Simone Kathemann
- Department of Transplant and General Surgery, University Hospital Essen, Essen, Germany
| | - Sebastian Berg
- Division of Pediatric Radiology, Department of Radiology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
| | - Hannah Füllgraf
- Department of Pathology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
| | - Andrea Tannapfel
- Faculty of Medicine, Medical Center, Institute for Pathology, Ruhr-University Bochum, Bochum, Germany
| | - Patrick Gerner
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Charlotte Niemeyer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
| | - Simone Hettmer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
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12
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Schwendt M, Fleck T, Kubicki R, Höhn R, Kroll J, Siepe M, Maier S, Grohmann J, Reineker K, Stiller B. A Rare Case of Alström Syndrome, Berlin Heart EXCOR, Heart Transplantation and 1-Year Follow-up. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705518] [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] [Indexed: 10/24/2022]
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13
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Fürniss HE, Hummel J, Stiller B, Grohmann J. Left recurrent laryngeal nerve palsy following aortic arch stenting: A case report. World J Cardiol 2019; 11:316-321. [PMID: 31908731 PMCID: PMC6937415 DOI: 10.4330/wjc.v11.i12.316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/13/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aortic arch stenting is continuously emerging as a safe and effective option to alleviate aortic arch stenosis and arterial hypertension.
CASE SUMMARY We present a 15-year-old girl with aortic arch hypoplasia who had undergone implantation of an uncovered 22 mm Cheatham-Platinum stent due to severe (native) aortic arch stenosis. On follow-up seven months later, she presented a significant re-stenosis of the aortic arch. A second stent (LD Max 26 mm) was implanted and both stents were dilated up to 16 mm. After an initially unremarkable post-interventional course, the patient presented with hoarseness five days after the intervention. MRI and CT scans ruled out an intracranial pathology, as well as thoracic hematoma, arterial dissection, and aneurysm around the intervention site. Laryngoscopy confirmed left vocal fold paresis attributable to an injury to the left recurrent laryngeal nerve (LRLN) during aortic arch stenting, as the nerve loops around the aortic arch in close proximity to the area of the implanted stents. Following a non-invasive therapeutic approach entailing regular speech therapy, the patient recovered and demonstrated no residual clinical symptoms of LRLN palsy after six months.
CONCLUSION Left recurrent laryngeal nerve palsy is a rare complication of aortic arch stenting not previously reported.
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Affiliation(s)
- Hannah Elisabeth Fürniss
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Centre Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79106, Germany
| | - Johanna Hummel
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Centre Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79106, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Centre Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79106, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Centre Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79106, Germany
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14
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Udi J, Köhler TC, Grohmann J, Bäuml M, Grundmann S, Bode C, Biever P, Duerschmied D. A challenging case of severe pulmonary bleeding in a patient with congenital ventricular septal defect (VSD) and Eisenmenger syndrome: extracorporeal membrane oxygenation (ECMO) support and weaning strategies. Clin Res Cardiol 2019; 109:403-407. [PMID: 31501999 DOI: 10.1007/s00392-019-01544-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/28/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Josefina Udi
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany. .,Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, Freiburg, Germany.
| | | | - Jochen Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology, Heart Center, University of Freiburg, Freiburg, Germany
| | - Marina Bäuml
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, Freiburg, Germany
| | - Sebastian Grundmann
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, Freiburg, Germany
| | - Paul Biever
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, Freiburg, Germany
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15
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Shahanavaz S, Asnes JD, Grohmann J, Qureshi AM, Rome JJ, Tanase D, Crystal MA, Latson LA, Morray BH, Hellenbrand W, Balzer DT, Gewillig M, Love JC, Berdjis F, Gillespie MJ, McElhinney DB. Intentional Fracture of Bioprosthetic Valve Frames in Patients Undergoing Valve-in-Valve Transcatheter Pulmonary Valve Replacement. Circ Cardiovasc Interv 2019; 11:e006453. [PMID: 30354783 DOI: 10.1161/circinterventions.118.006453] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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] [Indexed: 12/31/2022]
Abstract
BACKGROUND Percutaneous transcatheter pulmonary valve replacement (TPVR) has good clinical and hemodynamic outcomes in treating dysfunctional bioprosthetic valves (BPV) in the pulmonary position. Valve-in-valve therapy can further decrease the inner diameter (ID), potentially resulting in patient-prosthesis mismatch in patients with smaller BPVs. METHODS AND RESULTS To evaluate feasibility and outcomes of intentional BPV fracture to enlarge the pulmonary valve orifice with TPVR, 37 patients from 13 centers who underwent TPVR with intended BPV fracture were evaluated. A control cohort (n=70) who underwent valve-in-valve TPVR without attempted fracture was evaluated. BPV was successfully fractured in 28 patients and stretched in 5 while fracture was unsuccessful in 4. A Melody valve was implanted in 25 patients with fractured/stretched frame and a Sapien (XT 3) valve in 8. Among patients whose BPV was fractured/stretched, the final ID was a median of 2 mm larger (0-6.5 mm) than the valve's true ID. The narrowest diameter after TPVR in controls was a median of 2 mm smaller ( P<0.001) than true ID. Right ventricular outflow tract gradient decreased from median 40 to 8 mm Hg in the fracture group. Cases with fracture/stretching were matched 1:1 (weight, true ID) to controls. Post-TPVR peak gradient was lower but not significant (8.3±5.2 versus 11.8±9.2 mm Hg; P=0.070). There were no fracture-related adverse events. CONCLUSIONS Preliminary experience shows intentional fracture of BPV frame can be useful for achieving larger ID and better hemodynamics after valve-in-valve TPVR.
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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., D.T.B.)
| | | | - Jochen Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology, Heart Center, University of Freiburg, Germany (J.G.)
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston (A.M.Q.)
| | - Jonathan J Rome
- The Children's Hospital of Philadelphia, PA (J.J.R., M.J.G.)
| | - Daniel Tanase
- Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre, Munich (D.T.)
| | - Matthew A Crystal
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY (M.A.C.)
| | - Larry A Latson
- Department of Cardiology, Joe DiMaggio Children's Hospital, Hollywood, FL (L.A.L.)
| | - Brian H Morray
- Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington School of Medicine (B.H.M.)
| | | | - David T Balzer
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, MO (S.S., D.T.B.)
| | - Marc Gewillig
- Department of Pediatric Cardiology, University Hospitals Leuven, Belgium (M.G.)
| | - Jon C Love
- Division of Pediatric Cardiology, University of New Mexico, Albuquerque (J.C.L.)
| | | | | | - Doff B McElhinney
- Departments of Pediatrics and Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center, Stanford University School of Medicine, Palo Alto, CA (D.B.M.)
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16
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Fürniss HE, Kubicki R, Stiller B, Reineker K, Siepe M, Grohmann J. Retrograde transcatheter aortic valve closure in an infant with failing Norwood stage I palliation: a case report. J Med Case Rep 2019; 13:217. [PMID: 31311582 PMCID: PMC6635989 DOI: 10.1186/s13256-019-2141-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/16/2019] [Accepted: 05/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aortic valve regurgitation leading to coronary steal phenomenon can severely impair cardiac function in hypoplastic left heart syndrome, thus worsening long-term outcome. CASE PRESENTATION A German infant with borderline aortic and mitral valve, hypoplastic left ventricle, ventricular septal defect, and hypoplastic aortic arch with critical coarctation initially underwent aortic arch reconstruction and aortic valve dilation with the aim of biventricular correction later on. Unfortunately, severe cardiac dysfunction necessitated a change in strategy entailing modified stage I Norwood palliation. Increasing aortic regurgitation with coronary steal was revealed postoperatively, which required redo surgery to oversew the valve. However, pronounced aortic regurgitation recurred, causing severe cardiac decompensation with repeated resuscitation. As a bailout strategy, we performed aortic valve closure via transfemoral retrograde implantation of an Amplatzer Duct Occluder II device. This led to the patient's rapid stabilization while circumventing highly risky renewed surgery in such a critically ill infant. CONCLUSIONS Retrograde transcatheter aortic valve closure may be considered a feasible alternative in infants with a failing single ventricle due to aortic regurgitation, with critical device evaluation being crucial for successful device implantation in this young age group.
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Affiliation(s)
- Hannah E Fürniss
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Faculty of Medicine, Mathildenstrasse 1, 79106, Freiburg, Germany
| | - Rouven Kubicki
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Faculty of Medicine, Mathildenstrasse 1, 79106, Freiburg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Faculty of Medicine, Mathildenstrasse 1, 79106, Freiburg, Germany
| | - Katja Reineker
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Faculty of Medicine, Mathildenstrasse 1, 79106, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Faculty of Medicine, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Faculty of Medicine, Mathildenstrasse 1, 79106, Freiburg, Germany.
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17
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Kaley V, Dahdah N, El-Sisi A, Grohmann J, Rosenthal E, Jones M, Morgan G, Hayes N, Shah A, Karakurt C, Sadiq M, Sigler M, Figulla H, Becker M, Haas N, Onorato E, Rico AP, Roymanee S, Uebing A, Wiebe W, Samuel B, Hijazi Z, Vettukattil J. Atrial Septal Defect–Associated Pulmonary Hypertension: Outcomes of Closure With a Fenestrated Device. ACTA ACUST UNITED AC 2019. [DOI: 10.21693/1933-088x-18.1.4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Vishal Kaley
- Spectrum Health Helen DeVos Children's Hospital, USA
| | | | | | - Jochen Grohmann
- University Heart Center Freiburg - Bad Krozingen, Mathildenstrasse, Germany
| | | | | | | | | | - Ashish Shah
- Central Manchester University Hospitals, NHS Foundation Trust, United Kingdom
| | | | - Masood Sadiq
- The Children's Hospital Lahore and Punjab Institute of Cardiology, Pakistan
| | | | - Hans Figulla
- Universitätsklinikum Jena, Friedrich Schiller Universität Jena, Germany
| | | | - Nikolaus Haas
- Medical Hospital of the University of Munich, Germany
| | | | | | | | | | - Walter Wiebe
- Deutsches Kinderherzzentrum Sankt Augustin, Germany
| | | | - Ziyad Hijazi
- Weill Cornell Medicine, USA
- Sidra Medicine, Doha, Qatar
| | - Joseph Vettukattil
- Spectrum Health Helen DeVos Children's Hospital, USA
- Michigan State University, USA
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18
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Kubicki R, Fingerhut K, Uhl M, Hummel J, Höhn R, Reineker K, Fleck T, Stiller B, Grohmann J. Wire‐frame integrity of patch‐like Gore devices following atrial septal defect closure. Catheter Cardiovasc Interv 2019; 93:E238-E243. [DOI: 10.1002/ccd.28103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/31/2018] [Accepted: 01/02/2019] [Indexed: 11/10/2022]
Affiliation(s)
- R. Kubicki
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg – Bad Krozingen, Medical Center‐University of Freiburg, Faculty of MedicineUniversity of Freiburg Freiburg Germany
| | - K. Fingerhut
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg – Bad Krozingen, Medical Center‐University of Freiburg, Faculty of MedicineUniversity of Freiburg Freiburg Germany
| | - M. Uhl
- Department of Diagnostic and Therapeutic RadiologySt. Josef's Hospital Freiburg Germany
| | - J. Hummel
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg – Bad Krozingen, Medical Center‐University of Freiburg, Faculty of MedicineUniversity of Freiburg Freiburg Germany
| | - R. Höhn
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg – Bad Krozingen, Medical Center‐University of Freiburg, Faculty of MedicineUniversity of Freiburg Freiburg Germany
| | - K. Reineker
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg – Bad Krozingen, Medical Center‐University of Freiburg, Faculty of MedicineUniversity of Freiburg Freiburg Germany
| | - T. Fleck
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg – Bad Krozingen, Medical Center‐University of Freiburg, Faculty of MedicineUniversity of Freiburg Freiburg Germany
| | - B. Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg – Bad Krozingen, Medical Center‐University of Freiburg, Faculty of MedicineUniversity of Freiburg Freiburg Germany
| | - J. Grohmann
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg – Bad Krozingen, Medical Center‐University of Freiburg, Faculty of MedicineUniversity of Freiburg Freiburg Germany
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19
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Kubicki R, Stiller B, Kroll J, Siepe M, Beyersdorf F, Benk C, Höhn R, Grohmann J, Fleck T, Zieger B. Acquired von Willebrand Syndrome in Pediatric Patients during Mechanical Circulatory Support. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678862] [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] [Indexed: 10/27/2022]
Affiliation(s)
- R. Kubicki
- University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Congenital Heart Disease and Pediatric Cardiology, Freiburg, Germany
| | - B. Stiller
- University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Congenital Heart Disease and Pediatric Cardiology, Freiburg, Germany
| | - J. Kroll
- University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Cardiovascular Surgery, Freiburg, Germany
| | - M. Siepe
- University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Cardiovascular Surgery, Freiburg, Germany
| | - F. Beyersdorf
- University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Cardiovascular Surgery, Freiburg, Germany
| | - C. Benk
- University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Cardiovascular Surgery, Freiburg, Germany
| | - R. Höhn
- University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Congenital Heart Disease and Pediatric Cardiology, Freiburg, Germany
| | - J. Grohmann
- University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Congenital Heart Disease and Pediatric Cardiology, Freiburg, Germany
| | - T. Fleck
- University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Congenital Heart Disease and Pediatric Cardiology, Freiburg, Germany
| | - B. Zieger
- Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Freiburg, Germany
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20
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Kubicki R, Stiller B, Hummel J, Höhn R, Fleck T, Grohmann J. Collateral closure in congenital heart defects with Amplatzer vascular plugs: single-center experience and a simplified delivery technique for exceptional cases. Heart Vessels 2018; 34:134-140. [PMID: 30043154 DOI: 10.1007/s00380-018-1232-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/02/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
The study describes our experience with Amplatzer Vascular Plugs (AVP2 and 4) and highlights a more refindes telescopic technique for AVP2 delivery. AVPs are well-established occlusion devices for vascular anomalies in congenital heart disease (CHD). The AVP2 is sometimes preferred to the AVP4 due to its shorter length, flat-profiled retention disks, and the availability of larger diameters, but its profile requires a larger inner lumen for safe delivery. The latter may actually hamper access to target lesions. This is a retrospective analysis of all CHD patients treated with the AVP2 and AVP4 between 12/2012 and 12/2015. Target vessels were characterized, measured, and the device-to-vessel diameter ratio calculated. A modified pigtail technique for AVP2 delivery was frequently used: a floppy wire was simply reinforced by the curved tip of a pigtail catheter (instead of the long sheath's dilator) to guide the required delivery sheath towards the desired landing zone. 59 patients with a median age and bodyweight of 3.0 years (range 0.1-75) and 13.8 kg (range 2.5-80) underwent the implantation of 106 plug-devices (30 AVP2, 76 AVP4) in 91 target vessels. Indications for their use were ductus arteriosus (19%), aortopulmonary (43%) as well as venovenous collaterals (34%) and other miscellaneous lesions (4%). The pigtail-supported AVP2 delivery in six patients proved very convenient. No complications occurred. AVPs are excellent devices for embolizing shunt vessels in CHD patients. Here, we describe a simplified telescoping technique for AVP2 delivery to enter curvy target lesions gently and efficiently.
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Affiliation(s)
- Rouven Kubicki
- Department of Congenital Heart Disease and Pediatric Cardiology, Faculty of Medicine, Medical Center, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Mathildenstraße 1, 79106, Freiburg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, Faculty of Medicine, Medical Center, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Mathildenstraße 1, 79106, Freiburg, Germany
| | - Johanna Hummel
- Department of Congenital Heart Disease and Pediatric Cardiology, Faculty of Medicine, Medical Center, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Mathildenstraße 1, 79106, Freiburg, Germany
| | - Rene Höhn
- Department of Congenital Heart Disease and Pediatric Cardiology, Faculty of Medicine, Medical Center, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Mathildenstraße 1, 79106, Freiburg, Germany
| | - Thilo Fleck
- Department of Congenital Heart Disease and Pediatric Cardiology, Faculty of Medicine, Medical Center, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Mathildenstraße 1, 79106, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Pediatric Cardiology, Faculty of Medicine, Medical Center, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Mathildenstraße 1, 79106, Freiburg, Germany.
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21
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Kubicki R, Höhn R, Grohmann J, Fleck T, Reineker K, Kroll J, Siepe M, Benk C, Klemm R, Humburger F, Stiller B. Implementing and Assessing a Standardized Protocol for Weaning Children Successfully From Extracorporeal Life Support. Artif Organs 2018; 42:394-400. [PMID: 29423912 DOI: 10.1111/aor.13069] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 11/29/2022]
Abstract
Extracorporeal life support (ECLS) weaning is a complex interdisciplinary process with no clear guidelines. To assess ventricular and pulmonary function as well as hemodynamics including end-organ recovery during ECLS weaning, we developed a standardized weaning protocol. We reviewed our experience 2 years later to assess its feasibility and efficacy. In 2015 we established an inter-professional, standardized, stepwise protocol for weaning from ECLS. If the patient did not require further surgery, weaning was conducted bedside in the intensive care unit (ICU). Most of the weaning procedures are guided via echocardiography. Data acquisition began at baseline level, followed by four-step course (each step lasting 10 min), entailing flow-reduction and ending 30 min after decannulation. Moreover, data from the preprotocol era are presented. Between May 2015 and 2017, 26 consecutive patients (18 male), median age 177 days (2 days-20 years) required ECLS with median support of 4 (2-11) days. Excluding eight not weanable patients, 21 standardized weaning procedures were protocolled in the remaining 18 children. Our generally successful protocol-guided weaning rate (with at least 24-h survival) was 89%, with a discharge home rate of 58%. Practical application of the novel standard protocol seems to facilitate ECLS weaning and to improve its success rate. The protocol can be administered as part of standard bedside ICU assessment.
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Affiliation(s)
- Rouven Kubicki
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany
| | - René Höhn
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany
| | - Thilo Fleck
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany
| | - Katja Reineker
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany
| | - Johannes Kroll
- Department of Cardiovascular Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Christoph Benk
- Department of Cardiovascular Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Rolf Klemm
- Department of Cardiovascular Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Frank Humburger
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany
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Langenbach J, Stiller B, Kroll J, Grohmann J. Bilateral Arterial Ducts Causing Airway Compression by a Vascular Ring. Ann Thorac Surg 2018; 105:e89. [PMID: 29362201 DOI: 10.1016/j.athoracsur.2017.09.014] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/06/2017] [Accepted: 09/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Julia Langenbach
- Department of Congenital Heart Defects/Pediatric Cardiology, Heart Center, University of Freiburg, Freiburg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Defects/Pediatric Cardiology, Heart Center, University of Freiburg, Freiburg, Germany
| | - Johannes Kroll
- Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Defects/Pediatric Cardiology, Heart Center, University of Freiburg, Freiburg, Germany.
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Hummel J, Stiller B, Kroll J, Siepe M, Grohmann J. Right Ventricular Coiling to Limit Right Ventricle to Coronary Artery Connections in Pulmonary Atresia with Intact Ventricular Septum following Stage 2 Palliation. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628337] [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] [Indexed: 10/28/2022]
Affiliation(s)
- J. Hummel
- Universitäts Herzzentrum Freiburg Bad Krozingen, Klinik für Angeborene Herzfehler und Pädiatrische Kardiologie, Freiburg, Germany
| | - B. Stiller
- Universitäts Herzzentrum Freiburg Bad Krozingen, Klinik für Angeborene Herzfehler und Pädiatrische Kardiologie, Freiburg, Germany
| | - J. Kroll
- Universitäts Herzzentrum Freiburg Bad Krozingen, Klinik für Herz- und Gefäßchirurgie, Freiburg, Germany
| | - M. Siepe
- Universitäts Herzzentrum Freiburg Bad Krozingen, Klinik für Herz- und Gefäßchirurgie, Freiburg, Germany
| | - J. Grohmann
- Universitäts Herzzentrum Freiburg Bad Krozingen, Klinik für Angeborene Herzfehler und Pädiatrische Kardiologie, Freiburg, Germany
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Kretschmar O, Grohmann J, Bertram H, Jux C, Wiegand G, Tarusinov G, Dittrich S, Dähnert I, Bangen U, Fakler U, Moysich A, Schubert S, Knirsch W. New-Onset of Migraine and Nonmigraine Headache Attacks after Percutaneous Device-Closure of Atrial Septal Defect in Children: A Prospective Multicenter Trial. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628126] [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] [Indexed: 10/28/2022]
Affiliation(s)
- O. Kretschmar
- Klinik für Kinderkardiologie und angeborene Herzfehler, Universitätskinderklinik Zürich, Zürich, Switzerland
| | - J. Grohmann
- Klinik für Angeborene Herzfehler und Pädiatrische Kardiologie, Universitätsklinik Freiburg, Freiburg, Germany
| | - H. Bertram
- Klinik für Pädiatrische Kardiologie und, Medizinische Hochschule Hannover, Hannover, Germany
| | - C. Jux
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Münster, Münster, Germany
| | - G. Wiegand
- Universitätskinderklinik Tübingen, Tübingen, Germany
| | - G. Tarusinov
- Klinik für Kinderkardiologie und angeborene Herzfehler, Herzzentrum Duisburg, Duisburg, Germany
| | - S. Dittrich
- Kinderkardiologie, Universitätsklinikum Erlangen, Erlangen, Germany
| | - I. Dähnert
- Klinik für Kinderkardiologie, Herzzentrum Leipzig, Leipzig, Germany
| | - U. Bangen
- Klinik und Poliklinik für Kinderkardiologie, Univers. Herzzentrum Köln, Köln, Germany
| | - U. Fakler
- Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum München, München, Germany
| | - A. Moysich
- Klinik für Kinderkardiologie und angeborene Herzfehler, Universitätsklinikum Giessen, Giessen, Germany
| | - S. Schubert
- Klinik für Kinderkardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - W. Knirsch
- Klinik für Kinderkardiologie und angeborene Herzfehler, Universitätskinderklinik Zürich, Zürich, Switzerland
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Kubicki R, Siepe M, Kroll J, Kari F, Stiller B, Grohmann J. Tagging the Arterial Duct to Facilitate Stenting in Low-birthweight Infants. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628121] [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] [Indexed: 10/28/2022]
Affiliation(s)
- R. Kubicki
- Department of Congenital Heart Disease and Pediatric Cardiology, Medical Center - University of Freiburg, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany
| | - M. Siepe
- Department of Cardiovascular Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany
| | - J. Kroll
- Department of Cardiovascular Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany
| | - F. Kari
- Department of Cardiovascular Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany
| | - B. Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, Medical Center - University of Freiburg, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany
| | - J. Grohmann
- Department of Congenital Heart Disease and Pediatric Cardiology, Medical Center - University of Freiburg, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany
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Du Bois F, Stiller B, Borth-Bruhns T, Unseld B, Kubicki R, Hoehn R, Reineker K, Grohmann J, Fleck T. Echocardiographic characteristics in Fontan patients before the onset of protein-losing enteropathy or plastic bronchitis. Echocardiography 2017; 35:79-84. [PMID: 29082544 DOI: 10.1111/echo.13737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND It was this study's objective to evaluate the echocardiographic characteristics and flow patterns in abdominal arteries of Fontan patients before the onset of protein-losing enteropathy (PLE) or plastic bronchitis (PB). DESIGN In this retrospective cohort investigation, we examined 170 Fontan patients from 32 different centers who had undergone echocardiographic and Doppler ultrasound examinations between June 2006 and May 2013. Follow-up questionnaires were completed by 105 patients a median of 5.3 (1.5-8.5) years later to evaluate whether one of the complications had occurred since the examinations. RESULTS A total of 91 patients never developed PLE or PB ("non-PLE/PB"); they were compared to 14 affected patients. Eight of the 14 patients had already been diagnosed with "present PLE/PB" when examined. Six "future PLE/PB" patients developed those complications later on and were identified on follow-up. The "future PLE/PB" patients presented significantly slower diastolic flow velocities in the celiac artery (0.1 (0.1-0.5) m/s vs 0.3 (0.1-1.0) m/s (P = .04) and in the superior mesenteric artery (0.0 (0.0-0.2) m/s vs 0.2 (0.0-0.6) m/s, P = .02) than the "non-PLE/PB" group. Median resistance indices in the celiac artery were significantly higher (0.9 (0.8-0.9) m/s vs 0.8 (0.6-0.9) m/s, (P = .01)) even before the onset of PLE or PB. CONCLUSION An elevated flow resistance in the celiac artery may prevail in Fontan patients before the clinical manifestation of PLE or PB.
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Affiliation(s)
- Florian Du Bois
- University Heart Center Freiburg-Bad Krozingen, Department of Congenital Heart Disease and Pediatric Cardiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Brigitte Stiller
- University Heart Center Freiburg-Bad Krozingen, Department of Congenital Heart Disease and Pediatric Cardiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Bettina Unseld
- University Heart Center Freiburg-Bad Krozingen, Department of Congenital Heart Disease and Pediatric Cardiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rouven Kubicki
- University Heart Center Freiburg-Bad Krozingen, Department of Congenital Heart Disease and Pediatric Cardiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - René Hoehn
- University Heart Center Freiburg-Bad Krozingen, Department of Congenital Heart Disease and Pediatric Cardiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katja Reineker
- University Heart Center Freiburg-Bad Krozingen, Department of Congenital Heart Disease and Pediatric Cardiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jochen Grohmann
- University Heart Center Freiburg-Bad Krozingen, Department of Congenital Heart Disease and Pediatric Cardiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thilo Fleck
- University Heart Center Freiburg-Bad Krozingen, Department of Congenital Heart Disease and Pediatric Cardiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Unseld B, Stiller B, Borth-Bruhns T, du Bois F, Kroll J, Grohmann J, Fleck T. An Early Glenn Operation May be Associated with the Later Occurrence of Protein-Losing Enteropathy in Fontan Patients : Association of Early Glenn and Failing Fontan. Pediatr Cardiol 2017; 38:1155-1161. [PMID: 28534240 DOI: 10.1007/s00246-017-1632-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 02/02/2017] [Accepted: 05/10/2017] [Indexed: 11/26/2022]
Abstract
Protein-losing enteropathy (PLE) and plastic bronchitis (PB) are major causes of long-term mortality after Fontan operation. The objective of this study was to determine early clinical risk factors before the onset of PLE and PB. In a cohort study, 106 Fontan patients between 2005 and 2013 were examined. A median of 5.3 (1.5-8.5) years later, follow-up questionnaires were used to group the patients in a PLE or PB group (n = 14) and a non-PLE/PB group (n = 92). Prevalence of PLE was 9.4% (n = 10) and of PB 3.8% (n = 4). At follow-up, five patients (4.7%) died of PLE or PB. Median age at death was 6.2 years (IQR 10.5, 95% CI 5.3-23.4). We observed no significant group differences in gender distribution (p = 0.73), ventricular morphology (p = 0.87), surgical technique (p = 0.64), conduit fenestration (p = 0.34), age at Fontan operation (p = 0.54), and need for diuretics (p = 0.56). Hypoplastic left heart syndrome was more frequent in the PLE/PB group 50 vs. 22.8% (p = 0.03) OR 3.4 (95% CI 1.1-10.8). The modified Glenn procedure was performed at a median age of 4 months (IQR 4.0) in the PLE/PB group versus 8 months (IQR 8.0) in the non-PLE/PB group (p = 0.01). The early Glenn procedure and hypoplastic left heart syndrome may be associated with the development of PLE and PB.
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Affiliation(s)
- Bettina Unseld
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Centre Freiburg, Mathildenstrasse 1, 79106, Freiburg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Centre Freiburg, Mathildenstrasse 1, 79106, Freiburg, Germany
| | | | - Florian du Bois
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Centre Freiburg, Mathildenstrasse 1, 79106, Freiburg, Germany
| | - Johannes Kroll
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Centre Freiburg, Mathildenstrasse 1, 79106, Freiburg, Germany
| | - Thilo Fleck
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Centre Freiburg, Mathildenstrasse 1, 79106, Freiburg, Germany.
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Hummel J, Stiller B, Kroll J, Grohmann J. Primary Coiling of the Left Ventricle in Hypoplastic Left Heart With Ventriculo-Coronary Connections. Ann Thorac Surg 2017; 103:e559. [PMID: 28528069 DOI: 10.1016/j.athoracsur.2017.01.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 12/29/2016] [Accepted: 01/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Johanna Hummel
- Department of Congenital Heart Defects and Pediatric Cardiology, Heart Center, University of Freiburg, Freiburg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Defects and Pediatric Cardiology, Heart Center, University of Freiburg, Freiburg, Germany
| | - Johannes Kroll
- Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology, Heart Center, University of Freiburg, Freiburg, Germany.
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Abstract
OBJECTIVE Azygos vein aneurysms (AVAs) are uncommon and infrequently diagnosed. When confronted with a patient presenting with an AVA, physicians can rely on only a few case reports after an extensive literature search. To date, no guideline, no rule, and no review on the optimal treatment strategy for these patients exist. METHODS A PubMed and MEDLINE database search for papers and case reports describing AVA was performed. Cases from our own institutions were also reviewed. RESULTS The literature search identified 57 published case reports that were reviewed for inclusion. Of those published cases, etiologic factors can be classified into idiopathic, acquired, and traumatic causes. Most AVAs are limited to the azygos arch, a congenital anatomic weak point. Clinical symptoms generally remain nonspecific. Computed or magnetic resonance tomography scans are effective diagnostic tools, although the optimal therapeutic plan remains unclear. Complications include rupture, thromboembolism, mediastinal mass effects, and pulmonary artery hypertension. CONCLUSIONS Conservative treatment along with oral anticoagulation may be reasonable for some AVAs, but to date, there is no clear guideline or evidence-based threshold for surgical or interventional therapy. In review of the existing data and from our clinical and scientific knowledge, interventional or surgical treatment should strongly be considered in cases with clinical symptoms, pulmonary embolism or pulmonary arterial hypertension, thrombus formation within the AVA in patients with oral anticoagulation or for patients with a contraindication to oral anticoagulants, considerable increase in diameter or compression of adjacent structures, saccular AVA, or an underlying connective tissue disease. The most common procedure is surgical ligation of the AVA, although endovascular occlusion of the aneurysms is becoming more frequent.
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Affiliation(s)
- Maximilian Kreibich
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, Freiburg, Germany.
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Centre Freiburg, Freiburg, Germany
| | - Gregor Pache
- Section of Cardiovascular Radiology, Department of Radiology, University Hospital, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, Freiburg, Germany
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Hardt SE, Eicken A, Berger F, Schubert S, Carminati M, Butera G, Grohmann J, Höhn R, Nielsen-Kudsk JE, Hildick-Smith D, Settergren M, Thomson JD, Geis N, Søndergaard L. Closure of patent foramen ovale defects using GORE® CARDIOFORM septal occluder: Results from a prospective European multicenter study. Catheter Cardiovasc Interv 2017; 90:824-829. [PMID: 28296023 DOI: 10.1002/ccd.26993] [Citation(s) in RCA: 16] [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] [Received: 07/25/2016] [Revised: 01/15/2017] [Accepted: 01/28/2017] [Indexed: 01/24/2023]
Abstract
AIMS The GORE® CARDIOFORM Septal Occluder (GSO) is a novel device designed for rapid and effective closure of patent foramen ovale (PFO) which has distinctive features making it suitable for a broad spectrum of anatomical variations. We report the procedural and 6 months follow-up results of the first prospective, multicenter study using GSO. METHODS AND RESULTS This single-arm study included 150 subjects undergoing closure of PFO in 10 European centers. In 149 out of 150 patients implantation of a GSO device was successful. One patient had a different PFO-closure device implanted. Periprocedural complications were few including one patient with suspected transient ischemic attack, two access site bleedings, and one patient with AV-fistula. No device embolization occurred. During the 6-month follow-up period one patient had a transient asymptomatic thrombus on the device and four patients (2.6%) were diagnosed new onset paroxysmal atrial fibrillation, which were successfully treated. No thrombembolic events occurred. Closure was successful in 94.2% of subjects at discharge evaluation and 96.9% at 6 months follow-up. CONCLUSION This prospective, multicenter study adds to previous published data and suggests that GSO is a versatile device for PFO closure with high procedural and closure success rates and low complication rates through mid-term follow-up. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Stefan E Hardt
- Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Heidelberg, Germany.,Center for Cardiac and Circulatory Diseases, Bruchsal, Germany
| | - Andreas Eicken
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Felix Berger
- Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Stephan Schubert
- Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Mario Carminati
- Department of Paediatric Cardiology and Cardiac Surgery and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, Milan, 20097, Italy
| | - Gianfranco Butera
- Department of Paediatric Cardiology and Cardiac Surgery and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, Milan, 20097, Italy
| | - Jochen Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology, Heart Center, University of Freiburg, Freiburg, Germany
| | - Rene Höhn
- Department of Congenital Heart Defects and Pediatric Cardiology, Heart Center, University of Freiburg, Freiburg, Germany
| | - Jens Erik Nielsen-Kudsk
- Department of Cardiology-Research, Institute of Clinical Medicine, Aarhus University Hospital Skejby, Aarhus N, DK-8200, Denmark
| | | | - Magnus Settergren
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - John D Thomson
- Department of Congenital Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Nicolas Geis
- Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Heidelberg, Germany
| | - Lars Søndergaard
- The Heart Centre, Rigshospitalet University Hospital, Copenhagen, 2100, Denmark
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Mayer J, van der Werf-Grohmann N, Kroll J, Spiekerkoetter U, Stiller B, Grohmann J. Dysphagia after arteria lusoria dextra surgery: Anatomical considerations before redo-surgery. World J Cardiol 2017; 9:191-195. [PMID: 28289534 PMCID: PMC5329747 DOI: 10.4330/wjc.v9.i2.191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/28/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
Aberrant right subclavian artery (arteria lusoria) is the most common congenital root anomaly, remaining asymptomatic in most cases. Nevertheless, some of the 20%-40% of those affected present tracheo-esophageal symptoms. We report on a 6-year-old previously healthy girl presenting with progressive dysphagia over 4 wk. Diagnostics including barium swallow, echocardiography and magnetic resonance angiography (MRA) revealed a retro-esophageal compression by an aberrant right subclavian artery. Despite the successful, uneventful transposition of this arteria lusoria to the right common carotid via right-sided thoracotomy, the girl was suffering from persisting dysphagia. Another barium swallow showed the persistent compression of the esophagus on the level where the arteria lusoria had originated. As MRA showed no evidence of a significant re-obstruction by the transected vascular stump, we suspected a persisting ligamentum arteriosum. After a second surgical intervention via left-sided thoracotomy consisting of transecting the obviously persisting ligamentum and shortening the remaining arterial stump of the aberrant right subclavian artery, the patient recovered fully. In this case report we discuss the potential relevance of a persisting ligamentum arteriosum for patients with left aortic arch suffering from dysphagia lusoria and rational means of diagnosing, as well as the surgical options to prevent re-do surgery.
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Kubicki R, Stiller B, Grohmann J. Dysfunctional pulmonary artery conduit and co-existing large pseudoaneurysm: well-suited for a percutaneous approach with the Melody valve? SpringerPlus 2016; 5:1575. [PMID: 27652148 PMCID: PMC5025400 DOI: 10.1186/s40064-016-3273-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 09/08/2016] [Indexed: 11/18/2022]
Abstract
Pseudoaneurysm formation is a rare but potentially life-threatening complication after surgical repair of congenital heart disease. We present a boy with truncus arteriosus communis 14 years after homograft placement in pulmonary position. On follow-up, he presented progressive chronic homograft degeneration. Moreover, a large pseudoaneurysm in the right ventricular outflow tract was surprisingly depicted. We opted for a two-stage interventional approach.
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Grohmann J, Wildberg C, Zartner P, Abu-Tair T, Tarusinov G, Kitzmüller E, Schmoor C, Stiller B, Kampmann C. Multicenter midterm follow-up results using the gore septal occluder for atrial septal defect closure in pediatric patients. Catheter Cardiovasc Interv 2016; 89:E226-E232. [DOI: 10.1002/ccd.26881] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/14/2016] [Accepted: 11/13/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Jochen Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology; Heart Center, University of Freiburg; Freiburg Germany
| | - Christian Wildberg
- Department of Congenital Heart Defects and Pediatric Cardiology; Heart Center, University of Freiburg; Freiburg Germany
| | - Peter Zartner
- Department of Cardiology; German Pediatric Heart Center; Sankt Augustin Germany
| | - Tariq Abu-Tair
- Department of Pediatric Cardiology and Congenital Heart Disease; University Children's Hospital, University Medicine Mainz; Mainz Germany
| | - Gleb Tarusinov
- Department for Pediatric Cardiology and Congenital Heart Disease; Heart Center Duisburg; Duisburg Germany
| | - Erwin Kitzmüller
- Department of Pediatric Cardiology; Medical University of Vienna; Vienna Austria
| | - Claudia Schmoor
- Faculty of Medicine; Clinical Trials Unit, Medical Center - University of Freiburg; Freiburg Germany
| | - Brigitte Stiller
- Department of Congenital Heart Defects and Pediatric Cardiology; Heart Center, University of Freiburg; Freiburg Germany
| | - Christoph Kampmann
- Department of Pediatric Cardiology and Congenital Heart Disease; University Children's Hospital, University Medicine Mainz; Mainz Germany
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34
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Kubicki R, Kroll J, Stiller B, Grohmann J. Overstepping anatomical hurdles when opening an extremely rudimentary right ventricular outflow tract - greater safety via a hybrid strategy? EUROINTERVENTION 2016; 12:1311. [PMID: 27866142 DOI: 10.4244/eijv12i10a215] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Rouven Kubicki
- Department of Congenital Heart Defects and Pediatric Cardiology, Heart Center, University of Freiburg, Freiburg, Germany
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Grundmann S, Hoehn R, Kroll J, Grohmann J. Percutaneous Pulmonary Valve Implantation in the Patched Right Ventricular Outflow Tract 51 Years after Surgical Repair for Tetralogy of Fallot. J Heart Valve Dis 2016; 25:648-650. [PMID: 28238251] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Percutaneous pulmonary valve implantation (PPVI) has become a widely practiced treatment option for patients with right ventricular outflow tract (RVOT) dysfunction. For this procedure, the Melody transcatheter pulmonary valve has become the most widely used system. On-label indications are limited to the treatment of failing circumferential conduits. However, there is growing but still limited experience with the off-label treatment of native or patched RVOTs. Here, the case is reported of a 57-year-old patient in whom redo-surgery for a dysfunctional pulmonary valve could be avoided by PPVI into the patched RVOT at 51 years after tetralogy of Fallot repair.
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Affiliation(s)
- Sebastian Grundmann
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany
| | - René Hoehn
- Department of Congenital Heart Defects and Pediatric Cardiology
| | - Johannes Kroll
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology, . Electronic correspondence:
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Nozynska J, Stiller B, Grohmann J. Management of a dissection of matrix P right ventricular-to-pulmonary artery conduit by implanting two pre-stents and a melody valve. Catheter Cardiovasc Interv 2016; 91:E64-E67. [PMID: 27246262 DOI: 10.1002/ccd.26581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/25/2015] [Accepted: 04/21/2016] [Indexed: 11/05/2022]
Abstract
Reconstructing the right ventricular outflow tract and pulmonary valve via a bovine-derived valve conduit such as Matrix-P-Xenograft is a common surgical repair technique for pulmonary atresia and ventricular septal defect. After conduit degeneration due to calcification or aneurysmal dilatation, percutaneous transvenous stenting of the right ventricular outflow tract followed by pulmonary valve implantation has become the standard interventional treatment. Applied to stenotic conduits, the method is considered safe and effective. An important but seldom-reported problem is graft failure related to the formation of a Matrix membrane due to inflammation and fibrosis inside the xenograft, which can cause serious problems when dissection and rupture occur during transcatheter intervention. The torn pseudomembrane may cause the complete obstruction of both pulmonary arteries, resulting in a life-threatening situation requiring rapid intervention, as in this case presentation. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Joanna Nozynska
- Department of Congenital Heart Defects and Pediatric Cardiology, Heart Centre, University of Freiburg, Freiburg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Defects and Pediatric Cardiology, Heart Centre, University of Freiburg, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology, Heart Centre, University of Freiburg, Freiburg, Germany
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du Bois F, Stiller B, Borth-Bruhns T, Unseld B, Grohmann J, Höhn R, Fleck T. Hemodynamic Characteristics in Fontan Patients before the Onset of Protein-Losing Enteropathy or Plastic Bronchitis. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571938] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Unseld B, Stiller B, Both-Bruhns T, Du Bois F, Grohmann J, Höhn R, Fleck T. Early Glenn Operation May Be an Independent Risk Factor in Fontan Patients for the Development of Protein-Losing Enteropathy or Plastic Bronchitis. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571878] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Grohmann J, Stiller B, Neumann E, Jakob A, Reineker K, Fleck T, Pache G, Siepe M, Kroll J, Höhn R. Bronchial Compression by Mass Effect following Pulmonary Artery Stenting: Its Prevention and Decompression. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571883] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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40
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Siepe M, Höhn R, Fleck T, Stiller B, Neumann E, Sigler M, Kroll J, Beyersdorf F, Grohmann J. No-React® Injectable BioPulmonic™ Valves Re-evaluated: Discouraging Follow-up Results. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571636] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Grohmann J, Sigler M, Siepe M, Stiller B. A new breakable stent for recoarctation in early infancy: Preliminary Clinical Experience. Catheter Cardiovasc Interv 2016; 87:E143-50. [DOI: 10.1002/ccd.26393] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/14/2015] [Accepted: 12/13/2015] [Indexed: 12/27/2022]
Affiliation(s)
- Jochen Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology; Heart Center, University of Freiburg; Freiburg Germany
| | - Matthias Sigler
- Department of Pediatric Cardiology and Intensive Care; University Hospital Göttingen; Göttingen Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery; Heart Center, University of Freiburg; Freiburg Germany
| | - Brigitte Stiller
- Department of Congenital Heart Defects and Pediatric Cardiology; Heart Center, University of Freiburg; Freiburg Germany
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Grohmann J, Stiller B, Beyersdorf F, Siepe M. eReply. Long-term follow-up data are needed in new valve technologies! Interact Cardiovasc Thorac Surg 2015; 21:665-6. [DOI: 10.1093/icvts/ivv293] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Grohmann J, Höhn R, Fleck T, Stiller B, Neumann E, Sigler M, Kroll J, Beyersdorf F, Siepe M. No-React® Injectable BioPulmonic™ valves re-evaluated: discouraging follow-up results. Interact Cardiovasc Thorac Surg 2015; 21:657-65. [DOI: 10.1093/icvts/ivv214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/06/2015] [Indexed: 11/13/2022] Open
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Kooraki S, Grohmann J, Elshikh S, Urbach H, Meckel S. Covered stents for exclusion of iatrogenic common carotid artery-internal jugular vein fistula and brachiocephalic artery pseudoaneurysm. J Neurointerv Surg 2015; 8:e31. [PMID: 26122326 DOI: 10.1136/neurintsurg-2015-011760.rep] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2015] [Indexed: 12/25/2022]
Abstract
Covered stents have rarely been used in neuroendovascular procedures. We report the case of a 74-year-old woman with a complex iatrogenic vascular injury from attempted insertion of a hemodialysis catheter: concurrent brachiocephalic artery pseudoaneurysm and common carotid artery to internal jugular vein fistula. Both lesions were excluded successfully by using two balloon-expandable covered stents with a satisfactory short-term clinical and angiographic outcome.
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Affiliation(s)
- Soheil Kooraki
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of) Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
| | - Jochen Grohmann
- Department of Pediatric Cardiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
| | - Samer Elshikh
- Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
| | - Horst Urbach
- Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
| | - Stephan Meckel
- Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
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Kooraki S, Grohmann J, Elshikh S, Urbach H, Meckel S. Covered stents for exclusion of iatrogenic common carotid artery-internal jugular vein fistula and brachiocephalic artery pseudoaneurysm. BMJ Case Rep 2015; 2015:bcr-2015-011760. [PMID: 26106173 DOI: 10.1136/bcr-2015-011760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Covered stents have rarely been used in neuroendovascular procedures. We report the case of a 74-year-old woman with a complex iatrogenic vascular injury from attempted insertion of a hemodialysis catheter: concurrent brachiocephalic artery pseudoaneurysm and common carotid artery to internal jugular vein fistula. Both lesions were excluded successfully by using two balloon-expandable covered stents with a satisfactory short-term clinical and angiographic outcome.
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Affiliation(s)
- Soheil Kooraki
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of) Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
| | - Jochen Grohmann
- Department of Pediatric Cardiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
| | - Samer Elshikh
- Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
| | - Horst Urbach
- Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
| | - Stephan Meckel
- Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
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Kubicki R, Dechant M, Kroll J, Stiller B, Grohmann J. Percutaneous Pulmonary Valve Implantation (PPVI) in a Dilated Right Ventricular-to-Pulmonary Artery (RV-PA) Conduit after Device Closure of a Preexisting Pseudoaneurysm. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1556021] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- Maximilian Kreibich
- From the Departments of Cardiovascular Surgery (M.K., M.S., J.K., F.B.) and Congenital Heart Disease and Paediatric Cardiology (R.H., J.G.), Heart Centre Freiburg University, Freiburg, Germany
| | - Matthias Siepe
- From the Departments of Cardiovascular Surgery (M.K., M.S., J.K., F.B.) and Congenital Heart Disease and Paediatric Cardiology (R.H., J.G.), Heart Centre Freiburg University, Freiburg, Germany
| | - Johannes Kroll
- From the Departments of Cardiovascular Surgery (M.K., M.S., J.K., F.B.) and Congenital Heart Disease and Paediatric Cardiology (R.H., J.G.), Heart Centre Freiburg University, Freiburg, Germany
| | - René Höhn
- From the Departments of Cardiovascular Surgery (M.K., M.S., J.K., F.B.) and Congenital Heart Disease and Paediatric Cardiology (R.H., J.G.), Heart Centre Freiburg University, Freiburg, Germany
| | - Jochen Grohmann
- From the Departments of Cardiovascular Surgery (M.K., M.S., J.K., F.B.) and Congenital Heart Disease and Paediatric Cardiology (R.H., J.G.), Heart Centre Freiburg University, Freiburg, Germany
| | - Friedhelm Beyersdorf
- From the Departments of Cardiovascular Surgery (M.K., M.S., J.K., F.B.) and Congenital Heart Disease and Paediatric Cardiology (R.H., J.G.), Heart Centre Freiburg University, Freiburg, Germany
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Elling R, Stiller B, Grohmann J. Transcatheter device occlusion of the left ventricular outflow tract as treatment for severe aortic regurgitation in hypoplastic left heart syndrome. Catheter Cardiovasc Interv 2015; 86:463-6. [PMID: 25529536 DOI: 10.1002/ccd.25782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 07/14/2014] [Accepted: 11/30/2014] [Indexed: 11/07/2022]
Abstract
Aortic regurgitation is a rare but dangerous condition in patients with hypoplastic left heart syndrome (HLHS). We report the case of a 2-year-old girl with HLHS with aortic/mitral stenosis (AS-MS) subtype after stage II palliation via the bilateral bidirectional Glenn (BBDG) procedure, when aortic regurgitation presented with the clinical manifestation of a paroxysmal coronary steal phenomenon provoked by exertion. Transcatheter closure of the left ventricular outflow tract (LVOT) with an Amplatzer(TM) Vascular Plug 4 minimized and finally abolished aortic reflux without compromising either coronary perfusion or atrioventricular (AV) conduction. Midterm follow-up over 3 years revealed complete disappearance of her symptoms, and follow-up catheterization displayed complete LVOT closure. This case illustrates the promising potential of modern cardiac catherization techniques in certain cases and emphasizes that precise assessment of the native aorta and coronary system is critical in HLHS patients.
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Affiliation(s)
- R Elling
- Center for Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - B Stiller
- Department of Congenital Heart Defects and Pediatric Cardiology, Heart Center, University of Freiburg, Freiburg, Germany
| | - J Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology, Heart Center, University of Freiburg, Freiburg, Germany
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Loeffelbein F, Funk D, Nakamura L, Zieger B, Grohmann J, Siepe M, Kroll J, Stiller B. Shear-stress induced acquired von Willebrand syndrome in children with congenital heart disease. Interact Cardiovasc Thorac Surg 2014; 19:926-32. [DOI: 10.1093/icvts/ivu305] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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50
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Grohmann J, Höhn R, Fleck T, Schmoor C, Stiller B. Transcatheter closure of atrial septal defects in children and adolescents: Single-center experience with the GORE® septal occluder. Catheter Cardiovasc Interv 2014; 84:E51-7. [DOI: 10.1002/ccd.25494] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/27/2014] [Accepted: 03/12/2014] [Indexed: 11/05/2022]
Affiliation(s)
- J. Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology; Heart Center, University of Freiburg; Freiburg Germany
| | - R. Höhn
- Department of Congenital Heart Defects and Pediatric Cardiology; Heart Center, University of Freiburg; Freiburg Germany
| | - T. Fleck
- Department of Congenital Heart Defects and Pediatric Cardiology; Heart Center, University of Freiburg; Freiburg Germany
| | - C. Schmoor
- Clinical Trials Unit, Medical Center, University of Freiburg; Freiburg Germany
| | - B. Stiller
- Department of Congenital Heart Defects and Pediatric Cardiology; Heart Center, University of Freiburg; Freiburg Germany
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