CHD Intervention Featured Articles of September 2017

Interventional Congenital Heart Reviews of September 2017 Manuscripts

 

Incidence and outcome of infective endocarditis following percutaneous versus surgical pulmonary valve replacement.

Lluri G, Levi DS, Miller E, Hageman A, Sinha S, Sadeghi S, Reemtsen B, Laks H, Biniwale R, Salem M, Fishbein GA, Aboulhosn J.

Catheter Cardiovasc Interv. 2017 Sep 12. doi: 10.1002/ccd.27312. [Epub ahead of print]

PMID: 28895275

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Take Home Points:

  • Transcatheter pulmonary valve replacement (TPVR) patients were not at significantly higher risk of infective endocarditis compared with patients undergoing surgical pulmonary valve replacement (SPVR) in a contemporary cohort.
  • Risk factors for development of endocarditis include prior history of endocarditis, presence of RV-PA conduit, and presence of severe pulmonary stenosis.
  • Endocarditis risk may be associated less with the valve type and more with the anatomic substrate into which a new valve is implanted.

 

Whiteside, WendyComment from Dr. Wendy Whiteside (Michigan), section editor of Congenital Heart Disease Interventions Journal Watch:  The positive short and medium-term outcomes of TPVR have been well reported however the incidence of infective endocarditis in the setting of TPVR has emerged as an increasing concern.  Unfortunately, however, there is insufficient data directly comparing surgical to transcatheter pulmonary valve replacement as well as comparing the two transcatheter valve types—the Medtronic Melody valve and Edwards Sapien valves.  To elucidate the first of these comparisons, Lluri et al describe their single center experience of pulmonary valve replacement via a transcatheter vs surgical approach.

 

Their retrospective study looked at 342 patients undergoing pulmonary valve replacement over a 6-year period ending in September 2016. There were 134 SPVR and 208 TPVR (33 Sapien and the remainder Melody). There were several differences between the TPVR and SPVR groups at baseline, including primary diagnosis, number of prior sternotomies, history of prior endocarditis (TPVR 5.3% vs SPVR 0.7%, p= 0.03), presence of severe pulmonary stenosis (TPVR 37% vs SPVR 17%, p= 0.0001), and presence of a transannular patch (TPVR 25% vs SPVR 63%, p=0.0001). Many of these differences are dictated by the currently available transcatheter technology, with patients with stenotic conduits/bioprosthetic valves being candidates for TPVR due to presence of an adequate landing zone for implantation. In addition, while there were significantly fewer Sapiens implanted, follow-up duration for the Sapien was significantly shorter, and no Sapien valve implants were within RV-PA conduits/bioprosthetic valves. These intrinsic differences in the baseline characteristics of patients being chosen for surgical vs transcatheter intervention, and between Sapien and Melody again makes equitable comparison difficult.

 

Two patients in the SPVR group and 7 patients in the TPVR group developed endocarditis, with 4-year freedom from endocarditis of 94±6% for SPVR and 84±14% for TPVR (p=0.14).  By univariate analysis, factors associated with development of endocarditis included prior history of endocarditis (OR 7.1, 95% CI 1.3-40.1, p=0.03), presence of an RV-PA conduit (OR 5.6, 95% CI 1.1-28.3, p=0.04), and presence of severe pulmonary stenosis (OR 2.7, 95% CI 1.1-6.7, p=0.04). While this single center retrospective study has limitations (discussed above), it suggests that endocarditis risk is not significantly different between SPVR and TPVR groups and that, the risk of endocarditis may be less related to valve type and more related to the substrate/environment into which the new valve is placed.

 

 

Role of Computational Modelling in Planning and Executing Interventional Procedures for Congenital Heart Disease.

Slesnick TC.

Can J Cardiol. 2017 Sep;33(9):1159-1170. doi: 10.1016/j.cjca.2017.05.024. Epub 2017 Jun 3. Review.

PMID: 28843327

 

Take Home Points:

  • Advancements in non-invasive imaging allows for more detailed pre-procedure assessments of patients with congenital heart defects
  • Computational flow dynamics allow clinicians to predict physiologic impacts of surgical and catheter interventions
  • As these techniques continue to be refined, we will be able to provide improved procedural outcomes for patients with congenital heart defects

 

Seckler, MikeComment from Dr. Michael Seckeler (Tucson), section editor of Congenital Heart Disease Interventions Journal Watch:  Slesnick provides an overview of the status of non-invasive image acquisition for patients with congenital heart disease. The focus is cardiac MR (CMR), which can also provide physiologic data using phase contrast imaging to understand flow velocities in multiple vessels (aorta, SVC, IVC, main and branch pulmonary arteries, pulmonary veins). Overlaying this flow data onto the anatomy provides 4D CMR, which is more data intensive, but as processing power increases, these datasets are becoming faster to acquire. For patients who are unable to undergo MRI (i.e., pacemaker-dependent), cardiac CT can provide detailed anatomic assessments and Doppler echo data can be used in in place of phase contrast, but is more prone to acquisition error.

 

Using the imaging data to generate 3D virtual models has allowed for the development of virtual surgical programs to “practice” complex surgeries and ideally decrease the time needed for interventions. The addition of computational flow data to these simulations allows clinicians to predict the physiologic effects of the planned intervention and alter it to optimize the outcome. One example is predicting the potential power loss and flow distributions of different variations for Fontan completion. Another is helping to decide the appropriateness of one versus two ventricle repair of DORV based on the potential ventricular volume loss in the right ventricle after placement of the baffle patch.

 

For catheter-based interventions, these simulation software programs allow for virtual stent placement, such as in an aortic coarctation or stenotic RVOT. The addition of computation flow data can also provide data on the physiologic implications and appropriateness of stent placement.

 

Advancements in non-invasive imaging modalities have improved alongside the management of increasingly complex congenital heart defects. These techniques, particularly CT and MRI, can provide highly detailed anatomic, and now physiologic, assessments to help understand the native anatomy of patients as well as plan for potential interventions.

 

Acute Success of Balloon Aortic Valvuloplasty in the Current Era: A National Cardiovascular Data Registry Study.

Boe BA, Zampi JD, Kennedy KF, Jayaram N, Porras D, Foerster SR, Armstrong AK.

JACC Cardiovasc Interv. 2017 Sep 11;10(17):1717-1726. doi: 10.1016/j.jcin.2017.08.001.

PMID: 28882282

 

Take Home Points:

  • Balloon aortic valvuloplasty is an effective treatment for congenital aortic stenosis with low rates of mortality and adverse events.
  • Risk factors for unsuccessful valvuloplasty in noncritical aortic stenosis include: previous cardiac catheterization, mixed valve disease, baseline aortic valve gradient > 60mmHg, baseline aortic insufficiency > mild, presence of a trainee and multiple balloon inflations.

Averin , KonstantinCommentary from Dr. Konstantin Averin (Edmonton), catheterization section editor of Pediatric Cardiology Journal Watch:  Transcatheter balloon aortic valvuloplasty (BAV) is considered first line palliative therapy for congenital aortic stenosis (AS) at most centers. In the last few decades there have been significant improvements in catheter equipment and techniques and current procedural outcomes and practice patterns have not been studied. The aim of this study was to describe practices, acute outcomes and to evaluate factors associated with acute outcomes and complications of BAV in the current era using the IMPACT (IMproving Pediatric and Adult Congenital Treatment) registry.

 

Over a 4-year period (2011-2015) 1,126 BAV procedures were performed with 100 excluded from analysis. Neonates were the most prevalent group (27.4%). Most patients (89.4%) were classified as having non-critical AS (>1 month of age or not having received PGE within 1 day of the catheterization). The acute procedural success rate for BAV was 70%, defined as either PSEG ≤ 35mmHg and no AI or PSEG ≤ 35mmHg and mild AI or no worsening of AI. There was a slightly lower procedural success rate in patients with critical AS (62.7%) vs non-critical AS (70.9%).

 

In a multivariate model, risk factors for unsuccessful valvuloplasty in non-critical aortic stenosis included previous cardiac catheterization, mixed valve disease, baseline aortic valve gradient > 60mmHg, baseline aortic insufficiency > mild, presence of a trainee and multiple balloon inflations. There were no intraprocedural deaths. In-hospital (10% vs 1.5%) and 30-day mortality (6.3% vs 0.9%) were higher in the critical AS group compared to non-critical AS. Major adverse events occurred in 11.5% of cases with a higher incidence in those with critical AS (27.3% vs 9.6%).

 

The study is limited by the fact that the data may have been previously reported in other studies, post-discharge adverse events were not included secondary to database limitations, and the fact that aortic insufficiency is self-reported by individual centers and its grading is not standardized.

 

The authors conclude that BAV is an effective treatment for congenital aortic stenosis with low rates of mortality and adverse events. Patients with critical AS are at higher risk for procedure-related events. The authors make no statement about the relative efficacy of surgical valvuloplasty versus BAV.


 

 

CHD Interventions Sept 2017

  1. Coronary artery variants and bicuspid aortic valve disease: gaining insight into genetic underpinnings.

DeFaria Yeh D.

Heart. 2017 Sep 27. pii: heartjnl-2017-311634. doi: 10.1136/heartjnl-2017-311634. [Epub ahead of print] No abstract available.

PMID: 28954834

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  1. Leadless Micra pacemaker percutaneous extraction from pulmonary artery in complex congenital heart disease and complete heart block patient.

Sterliński M, Demkow M, Plaskota K, Oręziak A.

EuroIntervention. 2017 Sep 26. pii: EIJ-D-17-00660. doi: 10.4244/EIJ-D-17-00660. [Epub ahead of print] No abstract available.

PMID: 28943497 Free Article

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  1. A new one-step procedure for pulmonary valve implantation of the melody valve: Simultaneous prestenting and valve implantation.

Boudjemline Y.

Catheter Cardiovasc Interv. 2017 Sep 25. doi: 10.1002/ccd.27332. [Epub ahead of print]

PMID: 28944581

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  1. Sizing of patent ductus arteriosus in adults for transcatheter closure using the balloon pull-through technique.

Shafi NA, Singh GD, Smith TW, Rogers JH.

Catheter Cardiovasc Interv. 2017 Sep 25. doi: 10.1002/ccd.27303. [Epub ahead of print]

PMID: 28944572

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  1. A practical guide to cardiovascular 3D printing in clinical practice: Overview and examples.

Abudayyeh I, Gordon B, Ansari MM, Jutzy K, Stoletniy L, Hilliard A.

J Interv Cardiol. 2017 Sep 25. doi: 10.1111/joic.12446. [Epub ahead of print]

PMID: 28948646

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  1. Factors Influencing Outcomes After Cardiac Intervention in Infants with Trisomy 13 and 18.

Peterson R, Calamur N, Fiore A, Huddleston C, Spence K.

Pediatr Cardiol. 2017 Sep 25. doi: 10.1007/s00246-017-1738-y. [Epub ahead of print]

PMID: 28948390

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  1. Contralateral Pulmonary Hypertension Following Resuscitation of Unilateral Ductal Origin of a Pulmonary Artery: A Multi-institutional Review.

Agrawal H, Petit CJ, Miro J, Miranda CD, Kenny D, Justino H.

Pediatr Cardiol. 2017 Sep 25. doi: 10.1007/s00246-017-1729-z. [Epub ahead of print]

PMID: 28948321

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  1. Time course of the changes in right and left ventricle function and associated factors after transcatheter closure of atrial septal defects.

Yoo BW, Kim JO, Eun LY, Choi JY, Kim DS.

Congenit Heart Dis. 2017 Sep 24. doi: 10.1111/chd.12541. [Epub ahead of print]

PMID: 28944616

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  1. Outcomes of thoracic endovascular aortic repair in adult coarctation patients.

Lala S, Scali ST, Feezor RJ, Chandrekashar S, Giles KA, Fatima J, Berceli SA, Back MR, Huber TS, Beaver TM, Beck AW.

J Vasc Surg. 2017 Sep 22. pii: S0741-5214(17)31893-1. doi: 10.1016/j.jvs.2017.06.103. [Epub ahead of print]

PMID: 28947226

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  1. Pulmonary vein stenosis with collateralization via esophageal varices: Long-term follow-up after successful treatment with drug-eluting stent.

Goldberg JF, Jensen CL, Krishnamurthy R, Varghese NP, Justino H.

Congenit Heart Dis. 2017 Sep 18. doi: 10.1111/chd.12537. [Epub ahead of print]

PMID: 28924998

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  1. Interventional Correction of Sinus Venosus Atrial Septal Defect and Partial Anomalous Pulmonary Venous Drainage: Procedural Planning Using 3D Printed Models.

Velasco Forte MN, Byrne N, Valverde I, Gomez Ciriza G, Hermuzi A, Prachasilchai P, Mainzer G, Pushparajah K, Henningsson M, Hussain T, Qureshi S, Rosenthal E.

JACC Cardiovasc Imaging. 2017 Sep 18. pii: S1936-878X(17)30720-9. doi: 10.1016/j.jcmg.2017.07.010. [Epub ahead of print] No abstract available.

PMID: 28917677

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  1. Persistent left superior vena cava: An unusual cause of curable pulmonary hypertension.

Demeyere M, Delacour D, Bouchart F, Michelin P, Bauer F, Dubourg B, Dacher JN.

Diagn Interv Imaging. 2017 Sep 14. pii: S2211-5684(17)30125-0. doi: 10.1016/j.diii.2017.05.003. [Epub ahead of print] No abstract available.

PMID: 28919169

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  1. Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke.

Mas JL, Derumeaux G, Guillon B, Massardier E, Hosseini H, Mechtouff L, Arquizan C, Béjot Y, Vuillier F, Detante O, Guidoux C, Canaple S, Vaduva C, Dequatre-Ponchelle N, Sibon I, Garnier P, Ferrier A, Timsit S, Robinet-Borgomano E, Sablot D, Lacour JC, Zuber M, Favrole P, Pinel JF, Apoil M, Reiner P, Lefebvre C, Guérin P, Piot C, Rossi R, Dubois-Randé JL, Eicher JC, Meneveau N, Lusson JR, Bertrand B, Schleich JM, Godart F, Thambo JB, Leborgne L, Michel P, Pierard L, Turc G, Barthelet M, Charles-Nelson A, Weimar C, Moulin T, Juliard JM, Chatellier G; CLOSE Investigators.

N Engl J Med. 2017 Sep 14;377(11):1011-1021. doi: 10.1056/NEJMoa1705915.

PMID: 28902593

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  1. Early leaflet thrombosis complicating transcatheter implantation of a Sapien 3 valve in a native right ventricular outflow tract.

Riahi M, Blanke P, Webb J, Carere RG.

Catheter Cardiovasc Interv. 2017 Sep 12. doi: 10.1002/ccd.27183. [Epub ahead of print]

PMID: 28895301

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Select item 28895275

 

  1. Incidence and outcome of infective endocarditis following percutaneous versus surgical pulmonary valve replacement.

Lluri G, Levi DS, Miller E, Hageman A, Sinha S, Sadeghi S, Reemtsen B, Laks H, Biniwale R, Salem M, Fishbein GA, Aboulhosn J.

Catheter Cardiovasc Interv. 2017 Sep 12. doi: 10.1002/ccd.27312. [Epub ahead of print]

PMID: 28895275

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Select item 28904006

 

  1. Acute Success of Balloon Aortic Valvuloplasty in the Current Era: A National Cardiovascular Data Registry Study.

Boe BA, Zampi JD, Kennedy KF, Jayaram N, Porras D, Foerster SR, Armstrong AK.

JACC Cardiovasc Interv. 2017 Sep 11;10(17):1717-1726. doi: 10.1016/j.jcin.2017.08.001.

PMID: 28882282

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Select item 28823778

 

  1. Relationships Among Conduit Type, Pre-Stenting, and Outcomes in Patients Undergoing Transcatheter Pulmonary Valve Replacement in the Prospective North American and European Melody Valve Trials.

Cabalka AK, Hellenbrand WE, Eicken A, Kreutzer J, Gray RG, Bergersen L, Berger F, Armstrong AK, Cheatham JP, Zahn EM, McElhinney DB.

JACC Cardiovasc Interv. 2017 Sep 11;10(17):1746-1759. doi: 10.1016/j.jcin.2017.05.022. Epub 2017 Aug 16.

PMID: 28823778

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Select item 28823776

 

  1. Far From the Septum: Transcatheter Cardioform Septal Occluder Device Closure of a Descending Aortic Pseudoaneurysm Late After Interrupted Aortic Arch Repair.

Pater C, Brown NM, Goldstein BH.

JACC Cardiovasc Interv. 2017 Sep 11;10(17):e163-e166. doi: 10.1016/j.jcin.2017.06.038. Epub 2017 Aug 16. No abstract available.

PMID: 28823776

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Select item 28895096

 

  1. Modeling Major Adverse Outcomes of Pediatric and Adult Patients with Congenital Heart Disease Undergoing Cardiac Catheterization: Observations from the NCDR IMPACT Registry.

Jayaram N, Spertus JA, Kennedy KF, Vincent R, Martin GR, Curtis JP, Nykanen DG, Moore PM, Bergersen L.

Circulation. 2017 Sep 7. pii: CIRCULATIONAHA.117.027714. doi: 10.1161/CIRCULATIONAHA.117.027714. [Epub ahead of print]

PMID: 28882885

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  1. Xenon as an adjuvant to sevoflurane anesthesia in children younger than 4 years of age, undergoing interventional or diagnostic cardiac catheterization: A randomized controlled clinical trial.

Devroe S, Meeusen R, Gewillig M, Cools B, Poesen K, Sanders R, Rex S.

Paediatr Anaesth. 2017 Sep 5. doi: 10.1111/pan.13230. [Epub ahead of print]

PMID: 28872734

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Select item 28925325

 

  1. Assesment of Right Ventricle Function with Speckle Tracking Echocardiography after the Percutaneous Closure of Atrial Septal Defect.

Ozturk O, Ozturk U, Zilkif Karahan M.

Acta Cardiol Sin. 2017 Sep;33(5):523-529.

PMID: 28959106

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Select item 28653809

 

  1. Paucicellular Fibrointimal Proliferation Characterizes Pediatric Pulmonary Vein Stenosis: Clinicopathologic Analysis of 213 Samples From 97 Patients.

Kovach AE, Magcalas PM, Ireland C, McEnany K, Oliveira AM, Kieran MW, Baird CW, Jenkins K, Vargas SO.

Am J Surg Pathol. 2017 Sep;41(9):1198-1204. doi: 10.1097/PAS.0000000000000892.

PMID: 28622179

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  1. Percutaneous management of complex acquired aortic coarctation in an adult with tetralogy of Fallot and pulmonary atresia.

Seckeler MD, Lawson E, Barber BJ, Klewer SE.

Ann Pediatr Cardiol. 2017 Sep-Dec;10(3):295-297. doi: 10.4103/apc.APC_19_17.

PMID: 28928619 Free PMC Article

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  1. Adult Congenital Heart Disease Intervention: The Canadian Landscape.

Frankfurter C, Asgar AW, Webb JG, Cantor WJ, Velianou JL, Gobeil F, Chan AW, Welsh RC, Love MP, Wood DA, McKenzie K, Horlick EM.

Can J Cardiol. 2017 Sep;33(9):1201-1205. doi: 10.1016/j.cjca.2017.05.018. Epub 2017 May 30.

PMID: 28843330

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Select item 28843327

 

  1. Role of Computational Modelling in Planning and Executing Interventional Procedures for Congenital Heart Disease.

Slesnick TC.

Can J Cardiol. 2017 Sep;33(9):1159-1170. doi: 10.1016/j.cjca.2017.05.024. Epub 2017 Jun 3. Review.

PMID: 28843327

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Select item 28843326

 

  1. Valve Interventions in Utero: Understanding the Timing, Indications, and Approaches.

Sizarov A, Boudjemline Y.

Can J Cardiol. 2017 Sep;33(9):1150-1158. doi: 10.1016/j.cjca.2017.06.009. Epub 2017 Jun 23. Review.

PMID: 28843326

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  1. The Role of 3-D Heart Models in Planning and Executing Interventional Procedures.

Grant EK, Olivieri LJ.

Can J Cardiol. 2017 Sep;33(9):1074-1081. doi: 10.1016/j.cjca.2017.02.009. Epub 2017 Feb 24. Review.

PMID: 28624249

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Select item 28416028

 

  1. Paediatric cardiac catheterisation in Norway: rates and types of complications in new terms.

Ravndal MEA, Christensen AH, Døhlen G, Holmstrøm H.

Cardiol Young. 2017 Sep;27(7):1329-1335. doi: 10.1017/S1047951117000208. Epub 2017 Mar 8.

PMID: 28270245

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Select item 28862385

 

  1. Tailoring stents to fit the anatomy of unique vascular stenoses in congenital heart disease.

Sullivan PM, Liou A, Takao C, Justino H, Petit CJ, Salazar JD, Ing FF.

Catheter Cardiovasc Interv. 2017 Sep 1. doi: 10.1002/ccd.27234. [Epub ahead of print]

PMID: 28862385

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  1. Transseptal puncture using surgical electrocautery in children and adults with and without complex congenital heart disease.

Gowda ST, Qureshi AM, Turner D, Madan N, Weigand J, Lorber R, Singh HR.

Catheter Cardiovasc Interv. 2017 Sep 1;90(3):E46-E54. doi: 10.1002/ccd.27202. Epub 2017 Aug 2.

PMID: 28766834

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  1. Midterm to long-term safety and efficacy of self-expandable nitinol stent implantation for coarctation of aorta in adults.

Haji Zeinali AM, Sadeghian M, Qureshi SA, Ghazi P.

Catheter Cardiovasc Interv. 2017 Sep 1;90(3):425-431. doi: 10.1002/ccd.27178. Epub 2017 Jul 14.

PMID: 28707350

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Select item 28493591

 

  1. Transcatheter interventions in adults with congenital heart disease: Surveys from the Society for Cardiovascular Angiography and Interventions to identify current patterns of care and perception on training requirements.

Wadia SK, Accavitti MJ Jr, Morgan GJ, Kenny D, Hijazi ZM, Jones TK, Cabalka AK, McElhinney DB, Kavinsky CJ.

Catheter Cardiovasc Interv. 2017 Sep 1;90(3):418-424. doi: 10.1002/ccd.27151. Epub 2017 Jun 1.

PMID: 28493591

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  1. Twenty years of experience with intraoperative pulmonary artery stenting.

Zampi JD, Loccoh E, Armstrong AK, Yu S, Lowery R, Rocchini AP, Hirsch-Romano JC.

Catheter Cardiovasc Interv. 2017 Sep 1;90(3):398-406. doi: 10.1002/ccd.27094. Epub 2017 May 4.

PMID: 28471080

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Select item 28296032

 

  1. Right ventricular remodelling after transcatheter pulmonary valve implantation.

Pagourelias ED, Daraban AM, Mada RO, Duchenne J, Mirea O, Cools B, Heying R, Boshoff D, Bogaert J, Budts W, Gewillig M, Voigt JU.

Catheter Cardiovasc Interv. 2017 Sep 1;90(3):407-417. doi: 10.1002/ccd.26966. Epub 2017 Mar 15.

PMID: 28296032

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  1. Initial clinical experience with the GORE® CARDIOFORM ASD occluder for transcatheter atrial septal defect closure.

de Hemptinne Q, Horlick EM, Osten MD, Millán X, Tadros VX, Pighi M, Gonzalez Barlatey F, Alnasser SM, Miró J, Asgar AW, Ibrahim R.

Catheter Cardiovasc Interv. 2017 Sep 1;90(3):495-503. doi: 10.1002/ccd.26907. Epub 2017 Jan 27.

PMID: 28128523

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Select item 28899956

 

  1. Acute and Midterm Outcomes of Transcatheter Pulmonary Valve Replacement for Treatment of Dysfunctional Left Ventricular Outflow Tract Conduits in Patients With Aortopulmonary Transposition and a Systemic Right Ventricle.

Whiteside W, Tretter JT, Aboulhosn J, Aldoss O, Armstrong AK, Bocks ML, Gillespie MJ, Jones TK, Martin MH, Meadows JJ, Metcalf CM, Turner ME, Zellers T, Goldstein BH.

Circ Cardiovasc Interv. 2017 Sep;10(9). pii: e004730. doi: 10.1161/CIRCINTERVENTIONS.116.004730.

PMID: 28851718

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Select item 28864444

 

  1. Hypoplastic Left Heart Syndrome with Intact or Restrictive Atrial Septum: A Report from the International Fetal Cardiac Intervention Registry.

Jantzen DW, Moon-Grady AJ, Morris SA, Armstrong AK, Berg C, Dangel JH, Fifer CG, Frommelt M, Gembruch U, Herberg U, Jaeggi ET, Kontopoulos EV, Marshall AC, Miller O, Oberhoffer R, Oepkes D, Pedra CA, Pedra SR, Peralta F, Quintero RA, Ryan G, Gelehrter SK.

Circulation. 2017 Sep 1. pii: CIRCULATIONAHA.116.025873. doi: 10.1161/CIRCULATIONAHA.116.025873. [Epub ahead of print]

PMID: 28864444

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Select item 28608969

 

  1. Prevalence and characteristics of coronary artery anomalies in children with congenital heart disease diagnosed with coronary angiography.

Temel MT, Coşkun ME, Başpınar O, Demiryürek AT.

Turk Kardiyol Dern Ars. 2017 Sep;45(6):527-532. doi: 10.5543/tkda.2017.24162.

PMID: 28902643 Free Article

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Select item 28508399

 

  1. Real-time Three-dimensional Echocardiography: From Diagnosis to Intervention.

Orvalho JS.

Vet Clin North Am Small Anim Pract. 2017 Sep;47(5):1005-1019. doi: 10.1016/j.cvsm.2017.05.003. Epub 2017 Jun 29. Review.

PMID: 28669434

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Select item 28901234

 

  1. Percutaneous Pulmonary Valve Implantation in the Native Right Ventricular Outflow Tract Using a 29-mm Edwards SAPIEN 3 Valve.

Suntharos P, Prieto LR.

World J Pediatr Congenit Heart Surg. 2017 Sep;8(5):639-642. doi: 10.1177/2150135116655125. Epub 2016 Nov 18.

PMID: 27864470

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Select item 28899465

 

  1. Balloon Angioplasty as a Modality to Treat Children with Pulmonary Stenosis Secondary to Complex Congenital Heart Diseases.

Gu Y, Jin M, Wang XF, Guo BJ, Ding WH, Wang ZY, Zhang YH.

Chin Med J (Engl). 2017 Sep 27. doi: 10.4103/0366-6999.215715. [Epub ahead of print]

PMID: 28952468 Free Article

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Select item 28956269

 

  1. How to Size ASDs for Percutaneous Closure.

Boon I, Vertongen K, Paelinck BP, Demulier L, Van Berendoncks A, De Maeyer C, Marchau F, Panzer J, Vandekerckhove K, De Wolf D.

Pediatr Cardiol. 2017 Sep 27. doi: 10.1007/s00246-017-1743-1. [Epub ahead of print]

PMID: 28956098

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Select item 28960680

 

  1. A practical guide to cardiovascular 3D printing in clinical practice: Overview and examples.

Abudayyeh I, Gordon B, Ansari MM, Jutzy K, Stoletniy L, Hilliard A.

J Interv Cardiol. 2017 Sep 25. doi: 10.1111/joic.12446. [Epub ahead of print]

PMID: 28948646

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Select item 28945279

 

  1. First Case of Q Fever Endocarditis Involving the Melody® Transcatheter Pulmonary Valve in an Afebrile Child.

Jalal Z, Duperril M, Séguéla PE, Melenotte C, Chabaneix J, Raoult D, Thambo JB.

Pediatr Cardiol. 2017 Sep 25. doi: 10.1007/s00246-017-1723-5. [Epub ahead of print]

PMID: 28948320

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Select item 28948316

 

  1. Percutaneous pulmonary valve implantation for reconstruction of a patch-repaired right ventricular outflow tract.

Esmaeili A, Bollmann S, Khalil M, De Rosa R, Fichtlscherer S, Akintuerk H, Schranz D.

J Interv Cardiol. 2017 Sep 20. doi: 10.1111/joic.12443. [Epub ahead of print]

PMID: 28940794

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Select item 28932963

 

  1. Right ventricle outflow tract prestenting: In vitro testing of rigidity and corrosion properties.

Cools B, Brown S, Wevers M, Humbeeck JV, Boshoff D, Verdonckt C, Gewillig M.

Catheter Cardiovasc Interv. 2017 Sep 12. doi: 10.1002/ccd.27320. [Epub ahead of print]

PMID: 28895283

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  1. Atrial septal defect morphology and stenting in hypoplastic left heart syndrome after hybrid palliation.

Oreto L, Mandraffino G, Manuri L, Saitta MB, Agati S, Zito C, Iorio FS, Carerj S, Guccione P.

Cardiol Young. 2017 Sep 11:1-9. doi: 10.1017/S1047951117001792. [Epub ahead of print]

PMID: 28889828

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  1. The Impact of IMPACT-Contemporary Outcomes With Balloon Aortic Valvuloplasty: Are We Doing the Right Thing?

Hijazi ZM, Kenny D.

JACC Cardiovasc Interv. 2017 Sep 11;10(17):1727-1728. doi: 10.1016/j.jcin.2017.07.029. No abstract available.

PMID: 28882283

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  1. Transcatheter Occlusion of the Patent Ductus Arteriosus in 747 Infants <6 kg: Insights From the NCDR IMPACT Registry.

Backes CH, Kennedy KF, Locke M, Cua CL, Ball MK, Fick TA, Rivera BK, Smith CV, Holzer RJ, Boe BA, Berman DP, Bergersen L, Armstrong AK.

JACC Cardiovasc Interv. 2017 Sep 11;10(17):1729-1737. doi: 10.1016/j.jcin.2017.05.018. Epub 2017 Aug 16.

PMID: 28823780

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Select item 28823778

 

  1. Reintervention Is Associated With Improved Survival in Pediatric Patients With Pulmonary Vein Stenosis.

Cory MJ, Ooi YK, Kelleman MS, Vincent RN, Kim DW, Petit CJ.

JACC Cardiovasc Interv. 2017 Sep 11;10(17):1788-1798. doi: 10.1016/j.jcin.2017.05.052. Epub 2017 Aug 16.

PMID: 28823777

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Select item 28823774

 

  1. Intervention on Surgical Systemic-to-Pulmonary Artery Shunts: Carotid Versus Femoral Access.

Ligon RA, Ooi YK, Kim DW, Vincent RN, Petit CJ.

JACC Cardiovasc Interv. 2017 Sep 11;10(17):1738-1744. doi: 10.1016/j.jcin.2017.05.023. Epub 2017 Aug 16.

PMID: 28823774

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Select item 28823771

 

  1. Percutaneous Closure of Left Ventricular Pseudoaneursym With Septal Occluder Device and Coils: A Multimodality Imaging Approach.

Yudi MB, Love B, Nadir A, Kini A, Sharma SK.

JACC Cardiovasc Interv. 2017 Sep 11;10(17):e159-e161. doi: 10.1016/j.jcin.2017.06.033. Epub 2017 Aug 16. No abstract available.

PMID: 28823771

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  1. New Approach to Intervention on Blalock-Taussig Shunts.

Bacha E.

JACC Cardiovasc Interv. 2017 Sep 11;10(17):1745. doi: 10.1016/j.jcin.2017.06.029. Epub 2017 Aug 16. No abstract available.

PMID: 28823770

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  1. Percutaneous closure of aorta-right atrial tunnel in a newborn.

Narin N, Pamukcu O.

Cardiol Young. 2017 Sep 8:1-2. doi: 10.1017/S1047951117001780. [Epub ahead of print]

PMID: 28885135

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  1. Radiation-free CMR diagnostic heart catheterization in children.

Ratnayaka K, Kanter JP, Faranesh AZ, Grant EK, Olivieri LJ, Cross RR, Cronin IF, Hamann KS, Campbell-Washburn AE, O’Brien KJ, Rogers T, Hansen MS, Lederman RJ.

J Cardiovasc Magn Reson. 2017 Sep 6;19(1):65. doi: 10.1186/s12968-017-0374-2.

PMID: 28874164 Free PMC Article

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  1. Percutaneous thoracic duct intervention to treat plastic bronchitis related to Fontan palliation.

DePopas EM, Veress LA, Ahmed F, Rausch CM, Annam A, Gupta R.

Pediatr Pulmonol. 2017 Sep 4. doi: 10.1002/ppul.23793. [Epub ahead of print]

PMID: 28869334

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  1. A comparison of the in vivo neoendothelialization and wound healing processes of three atrial septal defect occluders used during childhood in a nonrandomized prospective trial.

Aydın Şahin D, Başpınar O, Sülü A, Karslıgil T, Kul S.

Anatol J Cardiol. 2017 Sep;18(3):229-234. doi: 10.14744/AnatolJCardiol.2017.7540. Epub 2017 Jul 25.

PMID: 28761023 Free Article

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  1. Stenting of right ventricular outflow tract in Tetralogy of Fallot with subarterial ventricular septal defect: A word of caution.

Lee J, Sivalingam S, Alwi M.

Ann Pediatr Cardiol. 2017 Sep-Dec;10(3):281-283. doi: 10.4103/apc.APC_168_16.

PMID: 28928615 Free PMC Article

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  1. Initial experience with the 3.3 Fr Mongoose® pigtail catheter for aortic angiography during patent ductus arteriosus closure in small patients.

Hena Z, Sutton NJ, Gates GJ, Taragin BH, Pass RH.

Ann Pediatr Cardiol. 2017 Sep-Dec;10(3):240-244. doi: 10.4103/apc.APC_9_17.

PMID: 28928609 Free PMC Article

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  1. Sudden Death Due to Coronary Artery Lesions Long-term After the Arterial Switch Operation: A Systematic Review.

van Wijk SWH, van der Stelt F, Ter Heide H, Schoof PH, Doevendans PAFM, Meijboom FJ, Breur JMPJ.

Can J Cardiol. 2017 Sep;33(9):1180-1187. doi: 10.1016/j.cjca.2017.02.017. Epub 2017 Apr 8. Review.

PMID: 28778688

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  1. Trans-septal approach for percutaneous closure of infra-diaphragmatic veno-venous collateral in a patient after Fontan palliation.

Chatterjee A, Cribbs MG, Law MA.

Cardiol Young. 2017 Sep;27(7):1413-1415. doi: 10.1017/S1047951117000476.

PMID: 28782497

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  1. Transcatheter closure of a membranous ventricular septal defect in a 1.8-kg infant using Amplatzer Duct Occluder II additional size device.

Champaneri B, Kappanayil M, Kumar RK.

Cardiol Young. 2017 Sep;27(7):1437-1440. doi: 10.1017/S1047951117000695. Epub 2017 May 16.

PMID: 28506322

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  1. Atrial septostomy with a predefined diameter using a novel occlutech atrial flow regulator improves symptoms and cardiac index in patients with severe pulmonary arterial hypertension.

Rajeshkumar R, Pavithran S, Sivakumar K, Vettukattil JJ.

Catheter Cardiovasc Interv. 2017 Sep 1. doi: 10.1002/ccd.27233. [Epub ahead of print]

PMID: 28862384

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  1. Surgical and Catheter-Based Reinterventions Are Common in Long-Term Survivors of the Fontan Operation.

Downing TE, Allen KY, Goldberg DJ, Rogers LS, Ravishankar C, Rychik J, Fuller S, Montenegro LM, Steven JM, Gillespie MJ, Rome JJ, Spray TL, Nicolson SC, Gaynor JW, Glatz AC.

Circ Cardiovasc Interv. 2017 Sep;10(9). pii: e004924. doi: 10.1161/CIRCINTERVENTIONS.116.004924.

PMID: 28851719

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  1. Patent Ductus Arteriosus Banding for Circular Shunting After Pulmonary Valvuloplasty.

Bautista-Rodriguez C, Rodriguez-Fanjul J, Moreno Hernando J, Mayol J, Caffarena-Calvar JM.

World J Pediatr Congenit Heart Surg. 2017 Sep;8(5):643-645. doi: 10.1177/2150135116655122. Epub 2016 Sep 19.

PMID: 27647342

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CHD Intervention Featured Articles of July 2017

Interventional Cardiology Reviews of July 2017 Manuscripts

 

A Systematic Review of Infective Endocarditis in Patients with Bovine Jugular Vein Valves Compared With Other Valve Types.

Sharma A, Cote AT, Hosking MCK, Harris KC.

JACC Cardiovasc Interv. 2017 Jul 24;10(14):1449-1458. doi: 10.1016/j.jcin.2017.04.025.

PMID: 28728659

 

Take Home Points:

  • Bovine jugular vein valves have a higher reported cummulative incidence of IE than other valve types – with no difference between surgical or transcatheter implants.
  • The data presented must be interpreted with a full understanding of the study limitations – case ascertainment bias, lack of IE definition, patient overlap and the heterogeneity of the population.
  • Providers need to be aware of the risks of IE and have an appropriate level of suspicion when managing patients with implanted pulmonary valves.

Comment from Dr., section editor of Congenital Heart Disease Interventions Journal Watch: Pulmonary valve implants are necessary for many patients with congenital heart disease and bovine jugular vein (BJV) valves, implanted via surgical (Contegra) or trans-catheter techniques (Melody valve) are widely used. Prospective Melody valve trials identified that some portion of patients experience episodes of endocarditis post-implant. The incidence of infective endocarditis (IE) relative to other valve types and method of implant (surgery vs transcatheter) is unknown. The authors sought to systematically review the published research and conduct a meta-analysis of IE incidence in RV-PA conduits, comparing BJV valves with all others and compare surgical vs transcatheter implantation techniques.

 

The authors conducted a literature review and studies were deemed eligible for inclusion if all inclusion criteria were met: patients had a pulmonary valve replacement, incidence of IE in the RVOT was reported (both number of cases and cases of IE had to be reported), method of conduit placement surgery (surgical or transcatheter), type of conduit implanted and follow up duration.

 

The systemic search identified 1,048 studies and of these 50 papers (55 study populations) with 7,063 patients were included in the final analysis. There were 5 valve types identified: Melody, Contegra, homograft, bioprosthetic (bovine pericardial, procine) and 1 nonbovine surgical valve not specified. There was a total of 181 cases of endocarditis, giving a cumulative incidence of IE of 2.6%. The median incidence of IE was higher in the BJV group compared with other valve types (5.4% v 1.2%) with no difference in the incidence of BJV valves on the basis of method of implantation.

 

There are a number of important limitations in this meta-analysis. First, there is a clear case ascertainment bias. Melody valve studies were prospective with active follow-up while the surgical series were retrospective likely resulting in greater recognition of IE in the Melody cohort. The surgical series are likely limited by an under-recognition of IE cases treated medically. In addition, most studies did not report the exact time at which IE occurred making calculation of annualized incidence as well as assessment of risk factors for development of IE nearly impossible. Second, there is not a uniform definition of IE across studies which again disadvantages the Melody valve given strict definitions of IE in the prospective follow up for Melody valve implants. Third, there is a high probability of patient overlap which the authors do not fully address. Finally, the authors do not acknowledge the heterogeneity of the patient population with clear differences in patients receiving different types of implants.

 

The authors conclude that that BJV valves have a higher reported incidence of IE than other valve types with no difference based on method of implantation. They suggest that clinicians should have a heighted awareness of IE when caring for these patients. Further research is clearly warranted to determine the pathophysiology for development of IE, risk factors and methods to decrease the incidence of IE.

 

A multicenter study of the impella device for mechanical support of the systemic circulation in pediatric and adolescent patients.

Dimas VV, Morray BH, Kim DW, Almond CS, Shahanavaz S, Tume SC, Peng LF, McElhinney DB, Justino H.

Catheter Cardiovasc Interv. 2017 Jul;90(1):124-129. doi: 10.1002/ccd.26973. Epub 2017 Mar 15.

PMID: 28295963

 

Take Home Points:

  • Preliminary findings suggest that using Impella devices for temporary circulatory support in children is feasible and efficacious.
  • 30-day mortality is high but is similar to data from Impella use in adult populations for cardiogenic shock with a similar or slightly lower complication rate.

Averin , KonstantinComment from Dr. Konstantin Averin section editor of Congenital Heart Disease Interventions Journal Watch:  In the US, FDA app averinroved options for temporary pediatric circulatory support are limited to ECMO and intra-aortic balloon pump. The Impella family of devices are now approved for short-term support for treatment of cardiogenic shock (CGS) after AMI or following open heart surgery. Off-label use of the Impella in the pediatric population has grown but the published experience to date has been limited. The authors performed a multicenter retrospective study to describe a larger pediatric experience with the Impella family of catheters, with a focus on outcomes and complications.

 

Data on 39 implants in 38 patients (≤21-year old) from 2009-2015 were included, with all but 1 patient being unique. At implant, median age was 16 years (4-21 years), median weight 62kg (15-134kg), and mean BSA 1.62 ± 0.36. The most common diagnoses were congenital heart disease (28%), post-heart transplant rejection (26%), and dilated cardiomyopathy (23%) with the most common indication for implant being ventricular dysfunction with acute CGS (28/39).

 

Patients were supported via either femoral arterial access (85%) or axillary access (15%) with a surgically placed chimney graft required in 31% of cases. Device repositioning was required in 38% of implants and median duration of support was 45 hours. 32% of patients died within 30 days of implant with half of those deaths occurring after Impella explant. Major adverse events occurred in 8 patients and included device malfunction, hemolysis, neurologic dysfunction, vascular access complications, bleeding and infection. One patient developed critical limb ischemia necessitating device removal and subsequent below the knee amputation.

As the options for temporary circulatory support expand and new data in adult populations becomes available it is important to consider whether some of these devices may be suitable for use in pediatric patients. Dimas et al, describe the largest experience to date of mechanical support with the Impella family of devices in pediatric patients with CGS. Their data suggests that the use of these devices is feasible and efficacious with an acceptable safety profile. It is of particular interest that only 2 patients had vascular access complications given the need for large bore arterial access necessary for the Impella implant. More data will clearly be necessary but this publication is an important step in expanding support options for a high-risk population.

 

Midterm to long-term safety and efficacy of self-expandable nitinol stent implantation for coarctation of aorta in adults.

Haji Zeinali AM, Sadeghian M, Qureshi SA, Ghazi P.

Catheter Cardiovasc Interv. 2017 Jul 14. doi: 10.1002/ccd.27178. [Epub ahead of print]

PMID: 28707350

 

Take Home Points:

  • Transcatheter treatment of aortic coarctation has traditionally involved balloon angioplasty and/or placement of balloon expandable stents
  • The authors present a series of 62 adolescents and adults who underwent successful placement of OptiMed Sinus-XL self-expanding nitinol stents for treatment of aortic coarctation
  • After excellent early results, the majority of patients continued to do well after an average of almost 4 years of follow-up
  • Self-expanding nitinol stents may provide benefits over these techniques of less aortic wall injury, no risk for balloon rupture during stent deployment and the potential for constant low level radial forces as the nitinol attempts to return to its nominal size

 

Comment from Dr. section editor of Congenital Heart Disease Interventions Journal Watch: Haji Zeinali and colleagues present a prospective, observational study of the use of the OptiMed Sinus-XL self-expanding nitinol stent for treating aortic coarctation in adolescents and adults. The stent is available in 16 to 34 mm diameters with a closed-cell design to optimize radial strength and is delivery through a 10-French system.

 

Patients were considered if they were over 9 years and 35 kg, had a hemodynamically significant coarctation (gradient at least 20 mmHg) and anatomy favorable to transcatheter intervention. Patients with severe coarctation underwent serial balloon dilation before stent placement. Stent sizing was 20-30% greater than the distal aortic arch at the origin of the left subclavian artery.

 

62 patients were recruited, with a mean age of 30.7 (17-63) years. All but three were native coarctations and the mean systemic systolic blood pressure was 166.7 mmHg. Stents were successfully implanted in all patients with 3 requiring an additional stent to deal with migration of the first stent. Mean pressure gradient pre-intervention was 62.4 mmHg which reduced to 2.8 mmHg after stent placement; four patients required post-dilation of the stent for residual gradients up to 15 mmHg. No major complications were reported.

 

After a mean follow-up of 45.5 months, 42 of 48 patients with systemic hypertension were either complete off medication (28 patients) or on less medical therapy (14 patients). Two patients developed significant residual aortic obstruction: the first with a 60 mmHg gradient related to neointimal proliferation was treated with repeat angioplasty and the second had a 25 mmHg gradient but refused additional treatment.

 

This study provides good longer-term data regarding the efficacy of self-expanding nitinol stents to treat aortic coarctation. A major advantage of this type is less potential aortic wall injury and the constant low level of radial force that may have some benefit in aortic remodeling over time. Also, because of the stent design, there is no chance for balloon rupture while deploying the stent. The authors stress the importance of future studies to compare surgery, balloon-expandable stents and self-expanding nitinol stents for the treatment of aortic coarctation.

 

Complete heart block following transcatheter closure of perimembranous VSD using amplatzer duct occluder II.

Ghosh S, Sridhar A, Sivaprakasam M.

Catheter Cardiovasc Interv. 2017 Jul 14. doi: 10.1002/ccd.27177. [Epub ahead of print]

PMID: 28707408

 

Take Home Points:

  • Interventional congenital cardiologists are often forced to “get creative” and make use of interventional devices for off-label indications, including transcatheter VSD closure
  • The Amplatzer Duct Occluder II has become a popular device for transcatheter perimembranous VSD closure and the authors present two patients who develop complete heart block after device placement

 

Seckler, MikeComment from Dr. Mike Seckeler (Tucson), section editor of Congenital Heart Disease Interventions Journal Watch:  Ghosh and colleagues present two illustrative cases of transcatheter perimembranous VSD closure with the Amplatzer Duct Occluder II (ADO-II). This device has emerged as a an excellent off-label device for this intervention because of its small delivery system, ease of deployment and relative “softness”, which is felt to minimize the risk of complete heart block after intervention. Unfortunately, these two patients did develop complete heart block early (<24 hours) after catheterization. The authors recognized the heart block and the patients both underwent successful surgical intervention to remove the devices and close the VSD with complete return to sinus rhythm.

 

As interventional congenital cardiologists continue to try to push the envelope and undertake more complicated transcatheter interventions, we are frequently limited by the available technology, little of which is designed with our patient population in mind. While this does allow us to exercise our creative muscles and try to find ways to fit square pegs into round holes, the above cases also remind us that sometimes complications can arise, and we need to be aware of the risks and inform our patients clearly before the procedure.

 

Intervention on Surgical Systemic-to-Pulmonary Artery Shunts: Carotid Versus Femoral Access.

Ligon RA, Ooi YK, Kim DW, Vincent RN, Petit CJ.

JACC Cardiovasc Interv. 2017 Aug 9. pii: S1936-8798(17)30972-X. doi: 10.1016/j.jcin.2017.05.023. [Epub ahead of print]

PMID: 28823774

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Select item 28823771

 

Take Home Points:

 

  • Transcatheter interventions on Blalock-Taussig shunts (BTS) are effective and performed often, with “traditional” access approach being via the femoral artery.
  • Compared with femoral artery approach, in this study carotid artery access allowed for more successful BTS interventions and shorter time to BTS intervention.
  • Carotid artery access to the BTS for intervention should be considered more broadly and particularly in time critical situations.

 

Whiteside, WendyComment from Dr. Wendy Whiteside (Michigan), section editor of Congenital Heart Disease Interventions Journal Watch: Transcatheter interventions to treat BTS occlusion, including shunt angioplasty +/- stenting, have been demonstrated to be effective therapies to restore flow through the shunt. In some situations, in unstable patients with single source ductal dependent pulmonary blood flow, recanalization of the BTS is emergent and time sensitive.  Standard approach for these interventions has been via the femoral artery, however the carotid approach may provide a more direct route for access to the BTS.

 

Ligon et al describe their single center experience with percutaneous BTS interventions, comparing access via the femoral and carotid arteries.  Over a 5-year period, 34 patients underwent 42 BTS interventions. 32 cases began with femoral access and 10 with carotid access.  Overall, 39/42 interventions (93%) were ultimately successful with 100% success in accessing and intervening on the BTS in carotid cases and 75% success in the femoral cases.  5 initially femoral access cases were converted to carotid access during the same procedure due unsuccessful BTS intervention.  Particularly in cases with complete shunt occlusion and in a patient with saphenous vein graft and venous-valve occlusion, carotid access provided close sheath proximity and straight angle of approach contributing to successful and timely intervention.  Compared with the femoral access cohort, procedure time was lower in the carotid artery cohort (62 vs 104 minutes), time to arterial access was shorter (4 vs 9.3 minutes), time to placement of guidewire through the BTS was shorter (6.5 vs 13 minutes) and time from final sheath placement to BTS implantation was lower (9 vs 20 minutes).  There were no adverse events or complications associated with carotid artery access and no concerns for carotid patency by routine follow-up carotid ultrasound within 24 hours of access.

 

While carotid artery access has been considered in select patients and case types, the concern for embolic stroke and vascular complications has limited the more widespread use of this access site.  More recent studies, including this by Ligon et al, have found a low rate of thrombosis and risk of vascular access complications in fact lower than that with femoral access. While this is a small single center study, and while there is likely a learning curve to efficient and successful carotid artery access, the significantly shorter times to intervention in the carotid artery access reported here are notable and could be of significant importance in critically ill patients with shunt occlusion.  For efficient and direct access to the BTS, carotid artery access should be more readily considered.

      

Acute Success of Balloon Aortic Valvuloplasty in the Current Era: A National Cardiovascular Data Registry Study.

Boe BA, Zampi JD, Kennedy KF, Jayaram N, Porras D, Foerster SR, Armstrong AK.

JACC Cardiovasc Interv. 2017 Sep 11;10(17):1717-1726. doi: 10.1016/j.jcin.2017.08.001.

PMID:28882282

 

Take Home Points:

 

  • Balloon aortic valvuloplasty is considered first-line therapy for congenital aortic valve stenosis, however procedural outcomes and practice patterns across a large population have not been reassessed in the current era.
  • Using the IMPACT registry and a contemporary cohort, procedural success of balloon aortic valvuloplasty across all patients was 70%.
  • Adverse events occurred in 15.8% of patients, and were more frequent in procedures for critical vs non-critical aortic stenosis. There were no procedural deaths.

 

Comment from Dr. Wendy Whiteside (Michigan), section editor of Congenital Heart Disease Interventions Journal Watch: Large multi-center assessment of acute outcomes and practice patterns surrounding balloon aortic valvuloplasty (BAV) has not been performed since the VACA registry in the 1980-90s.  Since then, technology and procedural technique have changed significantly drawing into question the validity of this data in the current era. Using data from the IMPACT registry, a multi-center prospective registry beginning in 2011, Boe et al provided updated acute outcome data for balloon aortic valvuloplasty in isolated congenital aortic valve stenosis.

 

Over the study period from 2011-2015, a total of 1,126 balloon aortic valvuloplasty procedures were recorded in the registry (the study population consists of 1,026 procedures after exclusion for incomplete data and additional procedures performed).  Neonates <1 month) and infants (1-11 months) comprised the largest age groups at 27.4% and 25.3% respectively, with the majority of patients having non-critical aortic stenosis (89.3%) and the majority of procedures occurring in the outpatient setting (68.8%). Access site was femoral arterial in 93.9%, carotid in 4.5%, and umbilical artery in 1.1%. Median effective final balloon to aortic annulus ratio was 0.94 (IQR 0.88-1.00). Successful BAV was considered a procedure with “optimal” (peak systolic ejection gradient (PSEG) ≤35 mmHg and no AI) or “adequate” (PSEG ≤35 mmHg and 1+ (mild) aortic insufficiency or no worsening AI in patients with mixed disease at baseline) result and occurred in 70% of patients.  Unsuccessful procedures were attributed to significant AI (worse than mild, or worse than baseline) in 12.1% of procedures, residual gradient ≥35 mmHg in 11.4% of procedures, and a combination in 6.5%. In the non-critical AS group, after multivariate adjustment, unsuccessful BAV was associated with prior cardiac catheterization, higher baseline AS gradient (>60), mixed aortic valve disease worse than mild baseline AI, presence of a trainee, and >1 balloon inflation.  Overall, adverse events occurred in 15.8% of cases; major events in 11.5%. Patients with critical AS had significantly higher total and major adverse event rates, with vascular complications being the most common of these complications.  There were no procedural deaths.

 

Compared with the VACA registry data, procedural success was increased in the contemporary cohort, with a slight decrease in procedural complications and no procedural mortality.  This study compares well with recent single center studies in terms of short term outcomes. This study, however, does not address long term outcomes and its comparison to surgical aortic valvuloplasty.

 

CHD Interventions July 2017

 

  1. A Systematic Review of Infective Endocarditis in Patients With Bovine Jugular Vein Valves Compared With Other Valve Types.

Sharma A, Cote AT, Hosking MCK, Harris KC.

JACC Cardiovasc Interv. 2017 Jul 24;10(14):1449-1458. doi: 10.1016/j.jcin.2017.04.025.

PMID: 28728659

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Select item 28737279

 

  1. Stenting complex aortic coarctation: simulation in a 3D printed model.

Pluchinotta FR, Giugno L, Carminati M.

EuroIntervention. 2017 Jul 20;13(4):490. doi: 10.4244/EIJ-D-16-00851. No abstract available.

PMID: 28169218

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Select item 28729908

 

  1. Inaccuracy of a continuous arterial pressure waveform monitor when used for congenital cardiac catheterization.

Seckeler MD, Typpo K, Deschenes J, Higgins R, Samson R, Lichtenthal P.

Congenit Heart Dis. 2017 Jul 18. doi: 10.1111/chd.12517. [Epub ahead of print]

PMID: 28719069

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Select item 28719049

 

  1. Pulmonary vein stenosis in patients with Smith-Lemli-Opitz syndrome.

Prosnitz AR, Leopold J, Irons M, Jenkins K, Roberts AE.

Congenit Heart Dis. 2017 Jul 18. doi: 10.1111/chd.12471. [Epub ahead of print]

PMID: 28719049

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Select item 28721547

 

  1. The Effect on Somatic Growth of Surgical and Catheter Treatment of Secundum Atrial Septal Defects.

Chlebowski MM, Dai H, Kaine SF.

Pediatr Cardiol. 2017 Jul 18. doi: 10.1007/s00246-017-1678-6. [Epub ahead of print]

PMID: 28721547

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Select item 28723882

 

  1. Fate of Duct-Dependent, Discontinuous Pulmonary Arteries After Arterial Duct Stenting.

Santoro G, Capozzi G, Giordano M, Gaio G, Palladino MT, Iacono C, Mahmoud HT, Russo MG.

Pediatr Cardiol. 2017 Jul 15. doi: 10.1007/s00246-017-1672-z. [Epub ahead of print]

PMID: 28711967

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Select item 28711965

 

  1. Midterm to long-term safety and efficacy of self-expandable nitinol stent implantation for coarctation of aorta in adults.

Haji Zeinali AM, Sadeghian M, Qureshi SA, Ghazi P.

Catheter Cardiovasc Interv. 2017 Jul 14. doi: 10.1002/ccd.27178. [Epub ahead of print]

PMID: 28707350

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  1. Intra-procedural continuous dialysis to facilitate interventional catheterization in pediatric patients with severe renal failure.

Opina AD, Qureshi AM, Brewer E, Elenberg E, Swartz S, Michael M, Justino H.

Catheter Cardiovasc Interv. 2017 Jul 12. doi: 10.1002/ccd.27188. [Epub ahead of print]

PMID: 28699323

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Select item 28703426

 

  1. Temporal relationship between instantaneous pressure gradients and peak-to-peak systolic ejection gradient in congenital aortic stenosis.

Boe BA, Norris MD, Zampi JD, Rocchini AP, Ensing GJ.

Congenit Heart Dis. 2017 Jul 12. doi: 10.1111/chd.12514. [Epub ahead of print]

PMID: 28703367

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Select item 28702947

 

  1. Can the Pulmonary Artery Wedge Pressure be Used Reliably as a Surrogate for the Left Atrial Mean Pressure in Pre-Fontan Evaluation?

Mohammad Nijres B, Abdulla RI, Awad S, Murphy J.

Pediatr Cardiol. 2017 Jul 12. doi: 10.1007/s00246-017-1681-y. [Epub ahead of print]

PMID: 28702716

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Select item 28709660

 

  1. Risk Factors for Peri-Procedural Arterial Ischaemic Stroke in Children with Cardiac Disease.

Asakai H, Stojanovski B, Galati JC, Zannino D, Cardamone M, Hutchinson D, Cheung MMH, Mackay MT.

Pediatr Cardiol. 2017 Jul 11. doi: 10.1007/s00246-017-1674-x. [Epub ahead of print]

PMID: 28695245

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Select item 28689504

 

  1. Noninfective Transcatheter Pulmonary Valve Thrombosis: A Rare Cause of Post-Implantation Pulmonary Valve Obstruction.

Verhoeven PA, Learn CP, Brown NM, Goldstein BH.

JACC Cardiovasc Interv. 2017 Jul 10;10(13):e119-e122. doi: 10.1016/j.jcin.2017.04.009. Epub 2017 Jun 14. No abstract available.

PMID: 28624383

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Select item 28691263

 

  1. Stenting the vertical ductus arteriosus via axillary artery access using “wire-target” technique.

Polat TB.

Congenit Heart Dis. 2017 Jul 9. doi: 10.1111/chd.12512. [Epub ahead of print]

PMID: 28691263

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Select item 28712562

 

  1. Lower Hospital Charges and Societal Costs for Catheter Device Closure of Atrial Septal Defects.

Sanchez JN, Seckeler MD.

Pediatr Cardiol. 2017 Jul 5. doi: 10.1007/s00246-017-1671-0. [Epub ahead of print]

PMID: 28681132

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Select item 28681131

 

  1. Multimodality imaging for interventional cardiology.

Celi S, Martini N, Pastormerlo LE, Positano V, Berti S.

Curr Pharm Des. 2017 Jul 4. doi: 10.2174/1381612823666170704171702. [Epub ahead of print]

PMID: 28677508

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Select item 28687271

 

  1. Anesthesia challenges in patent ductus arteriosus stenting for congenital heart disease.

Nanditha S, Kapoor PM, Sarin K.

Ann Card Anaesth. 2017 Jul-Sep;20(3):389-390. doi: 10.4103/aca.ACA_76_17. No abstract available.

PMID: 28701619 Free Article

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Select item 28701609

 

  1. Intraoperative Stenting of Pulmonary Artery Stenosis in Children With Congenital Heart Disease.

Meot M, Lefort B, El Arid JM, Soulé N, Lothion-Boulanger J, Lengellé F, Chantepie A, Neville P.

Ann Thorac Surg. 2017 Jul;104(1):190-196. doi: 10.1016/j.athoracsur.2016.12.012. Epub 2017 Mar 6.

PMID: 28274523

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Select item 28676203

 

  1. Comparison of self-expandable and balloon-expanding stents for hybrid ductal stenting in hypoplastic left heart complex.

Goreczny S, Qureshi SA, Rosenthal E, Krasemann T, Nassar MS, Anderson DR, Morgan GJ.

Cardiol Young. 2017 Jul;27(5):837-845. doi: 10.1017/S1047951116001347.

PMID: 28555538

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Select item 28077189

 

  1. A multicenter study of the impella device for mechanical support of the systemic circulation in pediatric and adolescent patients.

Dimas VV, Morray BH, Kim DW, Almond CS, Shahanavaz S, Tume SC, Peng LF, McElhinney DB, Justino H.

Catheter Cardiovasc Interv. 2017 Jul;90(1):124-129. doi: 10.1002/ccd.26973. Epub 2017 Mar 15.

PMID: 28295963

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Select item 28112463

 

  1. Circulatory support using the impella device in fontan patients with systemic ventricular dysfunction: A multicenter experience.

Morray BH, Dimas VV, Lim S, Balzer DT, Parekh DR, Van Mieghem NM, Ewert P, Kim DW, Justino H, McElhinney DB, Jones TK.

Catheter Cardiovasc Interv. 2017 Jul;90(1):118-123. doi: 10.1002/ccd.26885. Epub 2017 Jan 23.

PMID: 28112463

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Select item 27545308

 

  1. Percutaneous closure of acute aorto-right ventricular fistula following transcatheter bicuspid aortic valve replacement.

Nakamura K, Passeri JJ, Inglessis-Azuaje I.

Catheter Cardiovasc Interv. 2017 Jul;90(1):164-168. doi: 10.1002/ccd.26705. Epub 2016 Aug 22.

PMID: 27545308

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Select item 28696220

 

  1. Adult Congenital Interventions in Heart Failure.

Suradi HS, Hijazi ZM.

Interv Cardiol Clin. 2017 Jul;6(3):427-443. doi: 10.1016/j.iccl.2017.03.011. Review.

PMID: 28600095

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Select item 28600089

 

  1. Invasive Hemodynamics of Adult Congenital Heart Disease: From Shunts to Coarctation.

Veeram Reddy SR, Nugent AW, Zellers TM, Dimas VV.

Interv Cardiol Clin. 2017 Jul;6(3):345-358. doi: 10.1016/j.iccl.2017.03.005. Review.

PMID: 28600089

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Select item 28761211

 

  1. Cerebral High-Intensity Transient Signals during Pediatric Cardiac Catheterization: A Pilot Study Using Transcranial Doppler Ultrasonography.

LaRovere KL, Kapur K, McElhinney DB, Razumovsky A, Kussman BD.

J Neuroimaging. 2017 Jul;27(4):381-387. doi: 10.1111/jon.12426. Epub 2017 Jan 31.

PMID: 28140493

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Select item 28186850

 

  1. Radiation Safety in Children With Congenital and Acquired Heart Disease: A Scientific Position Statement on Multimodality Dose Optimization From the Image Gently Alliance.

Hill KD, Frush DP, Han BK, Abbott BG, Armstrong AK, DeKemp RA, Glatz AC, Greenberg SB, Herbert AS, Justino H, Mah D, Mahesh M, Rigsby CK, Slesnick TC, Strauss KJ, Trattner S, Viswanathan MN, Einstein AJ; Image Gently Alliance.

JACC Cardiovasc Imaging. 2017 Jul;10(7):797-818. doi: 10.1016/j.jcmg.2017.04.003. Epub 2017 May 18. Review.

PMID: 28514670 Free Article

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Select item 28765743

 

  1. Outcomes Associated with the Off-label Use of Medical Devices in Congenital Heart Disease at a Single Institute.

Kong YH, Song J, Huh J, Kang IS.

Korean Circ J. 2017 Jul;47(4):509-515. doi: 10.4070/kcj.2016.0311. Epub 2017 Jul 27.

PMID: 28765743 Free PMC Article

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Select item 28765741

 

  1. A comparison of the in vivo neoendothelialization and wound healing processes of three atrial septal defect occluders used during childhood in a nonrandomized prospective trial.

Aydın Şahin D, Başpınar O, Sülü A, Karslıgil T, Kul S.

Anatol J Cardiol. 2017 Jul 25. doi: 10.14744/AnatolJCardiol.2017.7540. [Epub ahead of print]

PMID: 28761023 Free Article

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Select item 28741726

 

  1. Thrombus formation 4 years after percutaneous transcatheter closure of an atrial septal defect.

Furuta A, Nagashima M, Sugiyama H, Sakamoto T, Yamazaki K.

J Card Surg. 2017 Jul 25. doi: 10.1111/jocs.13178. [Epub ahead of print] No abstract available.

PMID: 28743158

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Select item 28707558

 

  1. Traditional Long-Term Central Venous Catheters Versus Transhepatic Venous Catheters in Infants and Young Children.

Marshall AM, Danford DA, Curzon CL, Anderson V, Delaney JW.

Pediatr Crit Care Med. 2017 Jul 25. doi: 10.1097/PCC.0000000000001276. [Epub ahead of print]

PMID: 28746169

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Select item 28741754

 

  1. Trans-splenic Access for Portal Venous Interventions in Children: Do Benefits Outweigh Risks?

Pimpalwar S, Chinnadurai P, Hernandez A, Kukreja K, Siddiqui S, Justino H.

Cardiovasc Intervent Radiol. 2017 Jul 24. doi: 10.1007/s00270-017-1756-4. [Epub ahead of print]

PMID: 28741138

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Select item 28736987

 

  1. Congenital heart disease and cardiac procedural outcomes in patients with trisomy 21 and Turner syndrome.

Morales-Demori R.

Congenit Heart Dis. 2017 Jul 24. doi: 10.1111/chd.12521. [Epub ahead of print]

PMID: 28736822

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Select item 28737122

 

  1. The Cow Deserves a Fair Trial.

Jones TK.

JACC Cardiovasc Interv. 2017 Jul 24;10(14):1459-1461. doi: 10.1016/j.jcin.2017.05.057. No abstract available.

PMID: 28728660

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  1. Transcatheter pulmonary valve implantation: valve technology and procedural outcome.

Salavitabar A, Flynn P, Holzer RJ.

Curr Opin Cardiol. 2017 Jul 18. doi: 10.1097/HCO.0000000000000444. [Epub ahead of print]

PMID: 28723838

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Select item 28722763

 

  1. Complete heart block following transcatheter closure of perimembranous VSD using amplatzer duct occluder II.

Ghosh S, Sridhar A, Sivaprakasam M.

Catheter Cardiovasc Interv. 2017 Jul 14. doi: 10.1002/ccd.27177. [Epub ahead of print]

PMID: 28707408

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Select item 28707365

 

  1. Use of 3-D digital subtraction rotational angiography during cardiac catheterization of infants and adults with congenital heart diseases.

Surendran S, Waller BR, Elijovich L, Agrawal V, Kuhls-Gilcrist A, Johnson J, Fagan T, Sathanandam SK.

Catheter Cardiovasc Interv. 2017 Jul 14. doi: 10.1002/ccd.27180. [Epub ahead of print]

PMID: 28707365

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Select item 28708333

 

  1. Propofol versus Ketofol for Sedation of Pediatric Patients Undergoing Transcatheter Pulmonary Valve Implantation: A Double-blind Randomized Study.

Soliman R, Mofeed M, Momenah T.

Ann Card Anaesth. 2017 Jul-Sep;20(3):313-317. doi: 10.4103/aca.ACA_24_17.

PMID: 28701596 Free Article

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Select item 28510313

 

  1. Perventricular Implantation of Melody Valve in Child With Pulmonary Hypertension After a Potts Shunt.

Mroczek T, Demkow M, Moszura T, Morka A, Skalski J.

Ann Thorac Surg. 2017 Jul;104(1):e67-e69. doi: 10.1016/j.athoracsur.2017.01.084.

PMID: 28633267

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Select item 28633265

 

  1. Again, Two Melodies in Concert: Transcatheter Double Valve Replacement in Hedinger Syndrome.

De Rosa R, Schranz D, Zeiher AM, Fichtlscherer S.

Ann Thorac Surg. 2017 Jul;104(1):e61-e63. doi: 10.1016/j.athoracsur.2017.01.063.

PMID: 28633265

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Select item 28318514

 

  1. Renal artery stenting in a 2-year-old child with resistant hypertension and neurofibromatosis.

Varghese K, Adhyapak SM, Lohitashwa SB, Pais P, Iyengar AA.

Cardiovasc Interv Ther. 2017 Jul;32(3):274-278. doi: 10.1007/s12928-016-0415-z. Epub 2016 Jul 22.

PMID: 27448024

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Select item 27778147

 

  1. Hemolytic Anemia due to Right Ventricular to Pulmonary Artery Conduit Stenosis.

Rao S, Creaden JA, Gong S, Rigsby C, Costello JM.

J Pediatr Hematol Oncol. 2017 Jul;39(5):e290-e292. doi: 10.1097/MPH.0000000000000801.

PMID: 28267085

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Select item 28652677

 

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CHD Intervention Featured Articles of June 2017

 

Interventional Cardiology Reviews of June 2017 Manuscripts

 

Safety, Feasibility, Results, and Economic Impact of Common Interventional Procedures in a Low-Volume Region of the United States.

Clem A, Awadallah S, Amin Z.

Pediatr Cardiol. 2017 Jun 21. doi: 10.1007/s00246-017-1664-z. [Epub ahead of print]

PMID: 28639149

 

Take Home Points:

  • Many patients that live in rural areas may incur an undue financial burden (personal and societal) related to travel and associated expenses to undergo relatively simple transcatheter interventions for common congenital heart defects
  • The authors present their experience with outreach interventional pediatric cardiology to reduce this burden on the patients and families and found a high success rate with minimal complications and high patient and family satisfaction
  • This study reports important findings that can improve the care and reduce the costs of treatment for patients that live in rural areas in the United States

Seckler, MikeCommentary from Dr. Michael Seckeler (Tucson), section editor of Interventional Cardiology Journal Watch:  Clem and colleagues present a retrospective review of their 10-year, single center experience utilizing outreach interventional pediatric cardiology to perform “simple” transcatheter interventions (mostly ASD and PDA closure). They utilized this management strategy to reduce the need to transport rural patients to larger centers for their procedures.

The analysis showed comparable success rates to other published reports of multi-center experience (IMPACT, MAGIC and C3PO registries). Importantly, they followed up with a subset of the families to assess patient satisfaction with receiving their care locally, with most respondents being quite satisfied. Finally, they looked at the potential cost savings for South Dakota, which was estimated at $3.4 million over the entire study period.

This study is important because it demonstrates the safety and success of performing simple transcatheter interventions at small centers without readily available surgical backup. Given the large number of patients that do not live near large pediatric medical centers, this is a viable option to provide their care without disrupting the family by out of state travel and the associated social and financial stressors. In addition, there is high potential cost savings for the local medical systems which can reduce overall healthcare expenditures without compromising patient care.

Twenty years of experience with intraoperative pulmonary artery stenting.

Zampi JD, Loccoh E, Armstrong AK, Yu S, Lowery R, Rocchini AP, Hirsch-Romano JC.

Catheter Cardiovasc Interv. 2017 May 4. doi: 10.1002/ccd.27094. [Epub ahead of print]

PMID: 28471080

 

Take Home Points:

  • Intraoperative pulmonary artery stent implantation is technically feasible with low procedural, stent-related complications.
  • Intraoperative stent implantation allows implantation of adult-size stents in small patients while avoiding injury to peripheral vessels, eliminates radiation exposure and positions stents to facilitate future percutaneous dilation.
  • Reintervention in these patients is common.

Averin , KonstantinCommentary from Dr. Konstantin Averin (Edmonton), section editor of Interventional Cardiology Journal Watch:   Branch pulmonary artery (PA) stenosis is a relatively common problem in congenital heart disease. Percutaneous techniques have provided good outcomes, but difficulties can arise when medium/large caliber stents are necessary in small patients. Intra-operative PA stent placement can be an alternative to exclusively trans-catheter or surgical therapy. The authors sought to describe their experience with intraoperative PA stent placement over a 20-year period and to examine long term outcomes, specifically focusing on the incidence of and risk factors for reintervention, due to recurrent PA stenosis.

Eighty-one PA stent were placed in 68 patients between 1994 and 2013 with 84% of patients receiving a stent implant as part of a procedure to palliate another cardiac defect. A left PA (59%) and proximal stenosis (85%) were most commonly treated. Stent implantation was acutely successful in all patients but one, with Palmaz XL Transhepatic Biliary Stent (58%) and ev3 Intrastent Mega LD Biliary stent (29%) being most commonly utilized.

During a median follow up of 6 years, 30 patients underwent reintervention on the intraoperatively placed stents (9 intraoperative dilation, 21 percutaneous) with a median time to first reintervention of 2.6 years. The majority of patients required reintervention for either in-stent stenosis (53%) or for somatic growth (30%). The overall freedom from reintervention was 83%, 74%, 51%, and 30% at 1, 2, 5 and 10 years respectively. A univariate cox regression analysis showed that age < 18 months (HR 2.97), BSA < 0.47 m2 (HR 3.20), and a cardiac diagnosis of TOF with MAPCAs (HR 4.61) had an increased risk of reintervention. There were no deaths or long-term complications related to intraoperative stent placement.

The authors conclude that intraoperative pulmonary artery stent implantation is technically feasible with low procedural, stent-related complications.  Intraoperative stent implantation allows implantation of adult-size stents in small patients while avoiding injury to peripheral vessels, eliminates radiation exposure and positions stents to facilitate future percutaneous dilation. Reintervention in these patients is common.

 

 

Outcomes After Decompression of the Right Ventricle in Infants with Pulmonary Atresia with Intact Ventricular Septum are Associated with Degree of Tricuspid Regurgitation: Results from the Congenital Catheterization Research Collaborative.

Petit CJ, Glatz AC, Qureshi AM, Sachdeva R, Maskatia SA, Justino H, Goldberg DJ, Mozumdar N, Whiteside W, Rogers LS, Nicholson GT, McCracken C, Kelleman M, Goldstein BH.

Circ Cardiovasc Interv. 2017 May;10(5). pii: e004428. doi: 10.1161/CIRCINTERVENTIONS.116.004428.

PMID: 28500137

 

Take Home Points:

  • In neonates with pulmonary atresia-intact ventricular septum, severity of tricuspid regurgitation pre-intervention is strongly associated with reintervention after RV decompression and ultimate circulatory status (biventricular v not).
  • Tricuspid regurgitation severity was associated with tricuspid valve annulus dimension and tricuspid inflow duration, suggesting that the physiology of moderate to severe TR may be favorable for RV development and growth.
  • Most patients who undergo RV decompression achieve biventricular circulation.

Averin , KonstantinCommentary from Dr. Konstantin Averin (Edmonton), section editor of Interventional Cardiology Journal Watch:  Pulmonary atresia with intact ventricular septum (PA-IVS) is a rare form of congenital heart disease marked by hypoplasia of the right ventricle (RV). Due to the sub-optimal outcomes associated with single ventricle physiology, decompression of the RV is pursued whenever possible in the hopes of achieving a 2 ventricle (2 V) circulation. Risk factors for not achieving 2 V circulation have only been studied in small cohort sizes and single-center experiences. The aim of this study was to determine broadly applicable risk factors for reintervention and for failure to achieve 2 V circulation in a large, multicenter cohort of patients.

From 2005-2015, 231 neonates were diagnosed with PA-IVS, 128 underwent BTS placement or primary heart transplantation, with the remaining 103 undergoing planned RV decompression at a median age of 3 days. Two patients died during the procedure and 2 had Ebstein’s anomaly (excluded), so the final cohort consisted of 99 patients (28 having ‘virtual atresia’ – pinhole discovered during the procedure that was not seen on pre-procedure echo). Freedom from reintervention was 51%, 27% and 23% at 1 month, 1 year, and 3 years post-RV decompression respectively, with 72% of patients undergoing at least 1 reintervention after decompression (to increase pulmonary blood flow or modify the RV outflow tract).

Having less than mild TR a significant predictive factor and was associated with needing reintervention (HR 3.58), number of reinterventions (HR 1.87), needing an additional source of pulmonary blood flow (HR 3.50), and not achieving 2 V circulation (OR 18.6). Other significant factors associated with needing reinterventions were virtual atresia (HR 0.51) and smaller RV length (HR 0.94); with needing an additional source of pulmonary blood flow was having virtual atresia (HR 0.36 – protective) and with not achieving a 2 V circulation was having a lower RV area (OR 0.81). The median duration of follow-up post-RV decompression was 3.0 years and at latest follow up 85% of patients had 2 V circulation.

The authors conclude that in neonates with PA-IVS who undergo RV decompression have a high burden of reintervention although most achieve 2 V circulation. Neonates with ≤mild TR before decompression seem to be at higher risk of reintervention and of not achieving 2V circulation in the medium term. TR may play an important role physiologically in the development of the RV in PA-IVS.

The association between TR to RV development has been reported previously in both fetal studies and post-natal studies but this is the first paper to pool data from multiple centers (as part of the Congenital Catheterization Research Collaborative) to develop a large data set of a rare cardiac lesion. The authors are to be commended for their contribution to the literature and their collaboration should serve as an example on how to successfully study rare defects in pediatric cardiology.

 

 

 

Clinical Impact of Stent Implantation for Coarctation of the Aorta with Associated Hypoplasia of the Transverse Aortic Arch.

Lu WH, Fan CS, Chaturvedi R, Lee KJ, Manlhiot C, Benson L.

Pediatr Cardiol. 2017 Jun;38(5):1016-1023. doi: 10.1007/s00246-017-1611-z. Epub 2017 Apr 10.

PMID: 28396934

Similar articles

Select item 28396933

 

Take Home Points:

  • Transverse arch hypoplasia can occur in association with coarctation of the aorta.
  • Stent therapy for coarctation of the aorta generally does not address the hypoplastic transverse arch and, despite remodeling post-coarctation stent placement, the transverse arch may still prove to be problematic in follow-up.
  • At follow-up (median 37 months) after successful coarctation stent placement, there was no significant catch up growth of the transverse arch by echocardiography and elevated right arm blood pressure persisted.

 

Whiteside, WendyComment from Dr. Wendy Whiteside (Cincinnati), section editor of Congenital Heart Disease Interventions Journal Watch: Addressing coarctation of the aorta in the setting of transverse arch hypoplasia can be difficult.  Surgical repair under a month of age has been associated with improved arch growth, however it is unclear whether transverse arch growth occurs in the setting of coarctation stenting.  Generally, in these patients, this stent is placed more distal in the isthmus, leaving the transverse arch untreated as addressing the transverse arch percutaneously, would require stenting of the transverse arch directly, with stent material crossing other head and neck vessels. This then brings into question whether this area needs to be treated at the time of coarctation stenting—whether the transverse arch may grow now in the setting of an unobstructed distal vessel or whether this may play any role in development of systemic hypertension long-term. Lu et al provide the first systematic look at the clinical significance of transverse aortic arch hypoplasia in children following stent therapy for coarctation of the aorta.  They retrospectively reviewed 51 children who underwent stent placement for coarctation of the aorta, who were also found to have transverse arch hypoplasia (based on angiography).  Over their 20-year experience, this cohort represented about 1/3 of patients.

As expected, the average coarctation to descending aortic dimension increased significantly and the peak to peak systolic gradient decreased significantly following stent placement. More interesting, however, is that over the median follow-up of 37 months, there was not a significant increase in transverse arch z-score to suggest any catch up growth of the transverse arch. Additionally, while there was significant

 

 

CHD Interventions June 2017

 

  1. Aortic perfusion score for pulmonary atresia with intact ventricular septum: An antegrade coronary perfusion scoring system that is predictive of need for transplant and mortality.

Loomba RS, Pelech AN.

Congenit Heart Dis. 2017 Jun 27. doi: 10.1111/chd.12510. [Epub ahead of print]

PMID: 28653340

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Select item 28653463

 

  1. Real-time Three-dimensional Echocardiography: From Diagnosis to Intervention.

Orvalho JS.

Vet Clin North Am Small Anim Pract. 2017 Jun 29. pii: S0195-5616(17)30055-4. doi: 10.1016/j.cvsm.2017.05.003. [Epub ahead of print] Review.

PMID: 28669434

 

Select item 28662517

 

  1. The effect of balloon valvuloplasty for bioprosthetic valve stenosis at pulmonary positions.

Choi EY, Song J, Lee H, Lee CH, Huh J, Kang IS, Yang JH, Jun TG.

Congenit Heart Dis. 2017 Jun 23. doi: 10.1111/chd.12507. [Epub ahead of print]

PMID: 28643385

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Select item 28646501

 

  1. QRS Width as a Predictor of Right Ventricular Remodeling After Percutaneous Pulmonary Valve Implantation.

Paech C, Dähnert I, Riede FT, Wagner R, Kister T, Nieschke K, Wagner F, Gebauer RA.

Pediatr Cardiol. 2017 Jun 19. doi: 10.1007/s00246-017-1658-x. [Epub ahead of print]

PMID: 28631207

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Select item 28631156

 

  1. Transcatheter Treatment of Aortopulmonary Window with a Symmetrical Membranous Ventricular Septal Occluder.

Xu HX, Zheng DD, Pan M, Li XF.

Cardiology. 2017 Jun 14;138(2):76-79. doi: 10.1159/000475706. [Epub ahead of print]

PMID: 28609765

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Select item 28614966

 

  1. Catheter-based anatomic and functional assessment of coronary arteries in anomalous aortic origin of a coronary artery, myocardial bridges and Kawasaki disease.

Qureshi AM, Agrawal H.

Congenit Heart Dis. 2017 Jun 13. doi: 10.1111/chd.12500. [Epub ahead of print]

PMID: 28608519

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Select item 28608434

 

  1. Therapeutic catheterization in congenital heart disease: reflections on the value of risk scores.

Uebing A, Gatzoulis MA, Rigby ML.

Eur Heart J. 2017 Jun 13. doi: 10.1093/eurheartj/ehx299. [Epub ahead of print] No abstract available.

PMID: 28633370

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Select item 28633352

 

  1. Noninfective Transcatheter Pulmonary Valve Thrombosis: A Rare Cause of Post-Implantation Pulmonary Valve Obstruction.

Verhoeven PA, Learn CP, Brown NM, Goldstein BH.

JACC Cardiovasc Interv. 2017 Jun 7. pii: S1936-8798(17)30768-9. doi: 10.1016/j.jcin.2017.04.009. [Epub ahead of print] No abstract available.

PMID: 28624383

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Select item 28586404

 

  1. Interventional Treatment of Patients With Congenital Heart Disease: Nationwide Danish Experience Over 39 Years.

Larsen SH, Olsen M, Emmertsen K, Hjortdal VE.

J Am Coll Cardiol. 2017 Jun 6;69(22):2725-2732. doi: 10.1016/j.jacc.2017.03.587.

PMID: 28571637

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Select item 28588119

 

  1. Multicenter midterm follow-up results using the gore septal occluder for atrial septal defect closure in pediatric patients.

Grohmann J, Wildberg C, Zartner P, Abu-Tair T, Tarusinov G, Kitzmüller E, Schmoor C, Stiller B, Kampmann C.

Catheter Cardiovasc Interv. 2017 Jun 1;89(7):E226-E232. doi: 10.1002/ccd.26881. Epub 2016 Nov 30.

PMID: 27900839

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Select item 28473349

 

  1. Simultaneous transcatheter therapy for perimembranous ventricular septal defect combined with patent ductus arteriosus.

Wang Q, Zhu X, Duanzhen Z, Zhang P, Chen H, Han X, Sheng X, Meng L.

J Card Surg. 2017 Jun;32(6):370-375. doi: 10.1111/jocs.13138. Epub 2017 May 11.

PMID: 28497553

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Select item 28493392

 

  1. Percutaneous management of failed bioprosthetic pulmonary valves in patients with congenital heart defects.

Tarzia P, Conforti E, Giamberti A, Varrica A, Giugno L, Micheletti A, Negura D, Piazza L, Saracino A, Carminati M, Chessa M.

J Cardiovasc Med (Hagerstown). 2017 Jun;18(6):430-435. doi: 10.2459/JCM.0000000000000486.

PMID: 27828833

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Select item 23314595

 

  1. Short-term cardiopulmonary efficiency improvement after transcatheter baffle leak closure in a Mustard-operated patient.

Mezzani A, Butera G, Chessa M, Micheletti A, Negura D, Calaciura R, Carminati M.

J Cardiovasc Med (Hagerstown). 2017 Jun;18(6):447-449. doi: 10.2459/JCM.0b013e32835dbbde. No abstract available.

PMID: 23314595

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Select item 28436940

 

  1. Perceptions of transcatheter device closure of patent ductus arteriosus in veterinary cardiology and evaluation of a canine model to simulate device placement: a preliminary study.

Saunders AB, Keefe L, Birch SA, Wierzbicki MA, Maitland DJ.

J Vet Cardiol. 2017 Jun;19(3):268-275. doi: 10.1016/j.jvc.2017.04.002. Epub 2017 May 31.

PMID: 28576477

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Select item 28571753

 

  1. Real-time 3D transesophageal echocardiography-guided closure of a complicated patent ductus arteriosus in a dog.

Doocy KR, Nelson DA, Saunders AB.

J Vet Cardiol. 2017 Jun;19(3):287-292. doi: 10.1016/j.jvc.2017.04.001. Epub 2017 May 29.

PMID: 28571753

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Select item 28403448

 

  1. Utility and Safety of Combined Interventional Catheterization and Electrophysiology Procedures in a Children’s Hospital.

Asaki SY, Orcutt JW, Miyake CY, Justino H, de la Uz CM, Kim JJ, Valdes SO, Qureshi AM.

Pacing Clin Electrophysiol. 2017 Jun;40(6):661-666. doi: 10.1111/pace.13047. Epub 2017 May 3.

PMID: 28191656

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Select item 28599027

 

  1. Coronary Sinus Defect Following Transcatheter Closure of ASD Using Amplatzer Septal Occluder: Potential Erosion by the Device.

Mohammad Nijres B, Al-Kubaisi M, Bokowski J, Abdulla RI, Awad S.

Pediatr Cardiol. 2017 Jun;38(5):1084-1086. doi: 10.1007/s00246-017-1613-x. Epub 2017 Apr 10.

PMID: 28396933

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Select item 28382463

 

  1. [Pulmonary revalvulation and rhythmologenic risks in patients with repaired tetralogy of Fallot].

Pilato R, Lacroix D, Domanski O, Godart F.

Presse Med. 2017 Jun;46(6 Pt 1):586-593. doi: 10.1016/j.lpm.2017.02.006. Epub 2017 Jun 2. French.

PMID: 28583744

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  1. RV to PA conduits: impact of transcatheter pulmonary valve replacement in adults – a national register study.

Skoglund K, Svensson G, Thilén U, Dellborg M, Eriksson P.

Scand Cardiovasc J. 2017 Jun;51(3):153-158. doi: 10.1080/14017431.2017.1291988. Epub 2017 Feb 15.

PMID: 28276717

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Select item 28592182

 

  1. Safety, Feasibility, Results, and Economic Impact of Common Interventional Procedures in a Low-Volume Region of the United States.

Clem A, Awadallah S, Amin Z.

Pediatr Cardiol. 2017 Jun 21. doi: 10.1007/s00246-017-1664-z. [Epub ahead of print]

PMID: 28639149

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  1. Mid-term results of percutaneous ventricular septal defect closure with Amplatzer Duct Occluder-II in children.

Pamukcu O, Narin N, Baykan A, Sunkak S, Tasci O, Uzum K.

Cardiol Young. 2017 Jun 20:1-6. doi: 10.1017/S104795111700107X. [Epub ahead of print]

PMID: 28631576

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  1. Erratum to: Preprocedural Risk Assessment Prior to PPVI with CMR and Cardiac CT.

Malone L, Fonseca B, Fagan T, Gralla J, Wilson N, Vargas D, DiMaria M, Truong U, Browne LP.

Pediatr Cardiol. 2017 Jun 7. doi: 10.1007/s00246-017-1643-4. [Epub ahead of print] No abstract available.

PMID: 28589406

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  1. Drug-Coated Balloon Angioplasty: A Novel Treatment for Pulmonary Artery In-Stent Stenosis in a Patient with Williams Syndrome.

Cohen JL, Glickstein JS, Crystal MA.

Pediatr Cardiol. 2017 Jun 7. doi: 10.1007/s00246-017-1646-1. [Epub ahead of print]

PMID: 28589405

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Select item 28592829

 

  1. Primary Coiling of the Left Ventricle in Hypoplastic Left Heart With Ventriculo-Coronary Connections.

Hummel J, Stiller B, Kroll J, Grohmann J.

Ann Thorac Surg. 2017 Jun;103(6):e559. doi: 10.1016/j.athoracsur.2017.01.057. No abstract available.

PMID: 28528069

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Select item 28262297

 

  1. Novel delivery technique for atrial septal defect closure in young children utilizing the GORE® CARDIOFORM® septal occluder.

Anderson JH, Fraint H, Moore P, Cabalka AK, Taggart NW.

Catheter Cardiovasc Interv. 2017 Jun 1;89(7):1232-1238. doi: 10.1002/ccd.26874. Epub 2016 Nov 29.

PMID: 27896910

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Select item 28398850

 

  1. Multicenter Experience Evaluating Transcatheter Pulmonary Valve Replacement in Bovine Jugular Vein (Contegra) Right Ventricle to Pulmonary Artery Conduits.

Morray BH, McElhinney DB, Boudjemline Y, Gewillig M, Kim DW, Grant EK, Bocks ML, Martin MH, Armstrong AK, Berman D, Danon S, Hoyer M, Delaney JW, Justino H, Qureshi AM, Meadows JJ, Jones TK.

Circ Cardiovasc Interv. 2017 Jun;10(6). pii: e004914. doi: 10.1161/CIRCINTERVENTIONS.116.004914.

PMID: 28600328

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  1. Clinical Impact of Stent Implantation for Coarctation of the Aorta with Associated Hypoplasia of the Transverse Aortic Arch.

Lu WH, Fan CS, Chaturvedi R, Lee KJ, Manlhiot C, Benson L.

Pediatr Cardiol. 2017 Jun;38(5):1016-1023. doi: 10.1007/s00246-017-1611-z. Epub 2017 Apr 10.

PMID: 28396934

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  1. [Closure of wide patent ductus arteriosus using a fenestrated muscular VSD occluder device in a pediatric patient with Down syndrome and pulmonary hypertension].

Güvenç O, Saygı M, Demir İH, Ödemiş E.

Turk Kardiyol Dern Ars. 2017 Jun;45(4):373-376. doi: 10.5543/tkda.2016.38283. Turkish.

PMID: 28595211 Free Article

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CHD Intervention Featured Articles of May 2017

Interventional Cardiology Reviews of May 2017 Manuscripts

 

Interventional Treatment of Patients with Congenital Heart Disease: Nationwide Danish Experience Over 39 Years.

Larsen SH, Olsen M, Emmertsen K, Hjortdal VE.

J Am Coll Cardiol. 2017 Jun 6;69(22):2725-2732. doi: 10.1016/j.jacc.2017.03.587.

PMID: 28571637

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Select item 28580763

 

Take Home Points:

 

  • Over the last 39 years, interventional (surgical or catheter based) treatment of congenital heart disease (CHD) is being performed on younger and more preterm patients.
  • There has been an increase in the percent of catheter-based interventions over time.
  • 10-year survival following interventions for CHD has increased however CHD, even simple lesions alone, is still associated with lower long-term survival than non-CHD controls.

 

Whiteside, WendyComment from Dr. Wendy Whiteside (Cincinnati), section editor of Congenital Heart Disease Interventions Journal Watch: The Danish National Registry of Patients is uniquely positioned to provide extensive longitudinal population-based health data. In this article, Larsen et al make use of this database to bring meaningful numbers in support of what we all know to be true—the exciting progression of interventional therapies for CHD over the last nearly 40 years.

 

From the database, Larsen et al analyzed all children (<18 years of age) treated with congenital heart surgery or catheter-based interventions (beginning in 1990 for catheter procedures) for CHD in Denmark from 1977 through 2015. Dates were divided into 3 periods (1977-1989; 1990-1999, and 2003-2015) to allow for comparison across time periods. The study population represented 3.9% of the live births in Denmark.  Over the three time periods, median age at first procedure decreased (median 3.4 to 0.8 to 0.6 years in the 3 periods, respectively), and the percentage of preterm patients increased (median 6.7 to 14.3 to 18.5% of the population) suggesting interventions being performed in younger and smaller patients over time in parallel with advances in surgical techniques and improved neonatal care.  While there was an increase in the percent of the cohort treated for CHD from periods 1 to 2 (26.7% vs 37.4%) there was not a continued increase in period 3 and there were fewer interventions for complex lesions, which may reflect introduction of second trimester screening for CHD in period 3 and more frequent terminations of pregnancy for severe CHD.  In addition, the distribution of surgical to catheter-based interventions has evolved over time with an increase in catheter based procedures (0 to 5.8 to 25.9% of procedures, in the 3 periods), and more patients undergoing no surgery at all (0% in period 1, 4.8% in period 2, 24% in period 3).

 

Thirty-day survival increased across periods from 97% to 98% to 100% in period 3, with 10-year survival also increasing (from 80% to 87% to 93%).  Despite this improvement over time, both simple and complex CHD are associated with lower survival compared with the age and sex matched control population, though with the difference between the CHD and control populations decreasing over time.

 

While the depth of this dataset is impressive, there are some limitations to generalization of these data that should be considered when utilizing these data in the US.  In Denmark, there has been centralization of cardiothoracic surgery care to 2 hospitals, which may impact overall outcomes and survival.  In addition, frequent termination of pregnancy in the setting of a fetus with severe CHD, impacts the complexity of patients being born and requiring subsequent interventions, and may therefore limit generalizability in the US where this practice differs.

 

Initial clinical experience with the Medtronic Micro Vascular Plug™ in transcatheter occlusion of PDAs in extremely premature infants.

Sathanandam S, Justino H, Waller BR 3rd, Radtke W, Qureshi AM.

Catheter Cardiovasc Interv. 2017 May;89(6):1051-1058. doi: 10.1002/ccd.26878. Epub 2016 Nov 26.

PMID: 27888552

Similar articles

Select item 27862909

 

Take Home Points:

 

  • The Medtronic Micro Vascular Plug (MVP) provides a low profile, flexible, and “diskless” device that may be well suited for closure of the long tubular PDA seen in small, extremely premature infants.
  • Procedural success with the MVP for ductal closure was 93% with no complications seen, no device impingement on the LPA or aorta, and only 1 small residual shunt (resolved in follow-up).
  • Minimal diameter to unconstrained device diameter was ~1:2, with the MVP-5Q device being the most commonly used device size.

 

Comment from Dr. Wendy Whiteside (Cincinnati), section editor of Congenital Heart Disease Interventions Journal Watch: Santhanandam et al, report their two-center experience with the use of the Medtronic Micro Vascular Plug (MVP) specifically for closure of PDAs in extremely premature infants.  While the experience remains small (15 total patients) this paper provides technical detail and procedural tips for individuals seeking to utilize this device in their practice.

 

Transcatheter PDA occlusion may provide benefit over surgical ligation in the extremely premature infants by offering less disruption of respiratory mechanics and post-procedure escalation of respiratory support.  Previously, our ability to provide Transcatheter closure for these patients has been limited by the availability of an appropriately sized device (both in actual device length and diameter as well as device delivery profile) to accommodate the small vasculature and tight intracardiac relations in these small patients. The MVP, used mostly in adult neuroradiology and interventional radiology procedures, meets many of these requirements—it is low profile (deliverable through a microcatheter), delivered on an 0.018 nitinol pusher wire that is flexible and may allow for less device distortion on the delivery system, and has a diskless design with an uncovered distal (aortic) end, allowing for some flexibility in positioning of the aortic end without causing aortic obstruction.

 

Of the 15 patients, the MVP was used in 2 patients in whom the “more traditional” AVP-II device was unable to be placed due to LPA stenosis by the device.  One patient had a short, vertically oriented ductus that would not accommodate the length of the MVP (1 procedural failure, 93% success rate).  Median weight at the time of the procedure was 1210 grams (range 700-3500 grams). The ratio of the minimal PDA diameter to the unconstrained device diameter was ~1:2, with the MVP-5Q device chosen in all but 3 patients.  Technically, arterial access was not obtained in patients <2 kg, so the entirety of the procedure, including angiographic imaging of the ductus, was performed successfully antegrade through the PDA, and device positioning augmented by use of intraprocedural transthoracic echo guidance.    There were no procedural complications.  One patient had a small residual shunt after device placement (resolved on follow-up) thought to be secondary to disruption of the PFTE membrane due to multiple resheathings of the device.  Procedural times, fluoroscopy times, and contrast doses were all favorable.  The MVP provides a promising device for the transcatheter occlusion of PDA in extremely premature infants, and allows us to keep pushing the lower limit of patient weight for successful transcatheter occlusion.  Ongoing experience with this device across more operators and in more ductal anatomies will be necessary.

 

Catheter Cardiovasc Interv. 2017 May 4. doi: 10.1002/ccd.27115. [Epub ahead of print]

Stenting of the ascending aorta revisited.

Moiduddin NJ1,2Rios R1El-Said H1Moore JW1.

10.1002/ccd.27115. [Epub ahead of print]

PMID: 28471087

 

Take Home Points:

 

  • Transcatheter ascending aortic interventions have been avoided in the past due to potential damage to the aortic valve leaflets or coronary ostia
  • With improved imaging modalities, such as 3D rotational angiography, more accurate anatomic assessments can be made to guide transcatheter interventions
  • Adding transcatheter ascending aortic interventions for patients with acquired post-operative ascending aortic intervention can be a safe alternative to help avoid additional cardiac surgeries for this patient population

 

Seckler, MikeCommentary from Dr. Michael Seckeler (Tucson), section editor of Congenital Heart Disease Interventions Journal Watch:   Transcatheter intervention on ascending aortic narrowing has been somewhat controversial, particularly because of potential damage to the aortic valve leaflets and coronary ostia. The authors present a series of three successful ascending aortic interventions in patients with acquired aortic narrowing. All were post-operative from various congenital heart defect interventions and the narrowings were far enough distal from the aortic valve leaflets to allow for safe stent placement.

The authors emphasize the importance of 3D rotational angiography to help accurately measure both the greater and lesser curvatures of the ascending aorta and using a long sheath larger than needed to allow for hand injections to accurately guide stent positioning. They also acknowledge the risk of recoil after angioplasty alone and aortic wall injury or disruption, so advocate for primary stent placement to minimize this risk with covered stents available in the case of injury.

 

Transcatheter Retrieval of Cardiovascular Foreign Bodies in Children: A 15-Year Single Centre Experience.

Kudumula V, Stumper O, Noonan P, Mehta C, De Giovanni J, Stickley J, Dhillon R, Bhole V.

Pediatr Cardiol. 2017 May 24. doi: 10.1007/s00246-017-1639-0. [Epub ahead of print]

PMID:  28540398

Similar articles

 

Take Home Points:

 

  • As interventional congenital catheterization procedures increase in complexity, the chance for embolized devices has also increased
  • Transcatheter retrieval of embolized devices and other foreign bodies has been utilized for over 50 years, but there are limited data for pediatric patients
  • The authors present a 15-year review with a 90% success rate for retrieval of a variety of embolized devices and catheter fragments with minimal adverse events
  • Despite the high success rate, the authors emphasize the importance of careful planning and surgical backup

 

Commentary from Dr. Michael Seckeler (Tucson), section editor of Congenital Heart Disease Interventions Journal Watch:   As interventional congenital cardiology has evolved, there is an increased risk for embolized devices. In addition, patients with chronic medical conditions frequently require long term central venous access and these catheters can become damaged with fragments embolizing. Both situations can frequently be treated by transcatheter retrieval techniques, which has yet to be studied in the pediatric population. The authors present a 15-year review of their single center experience.

 

During the study period, 62% of the 8956 catheterizations were interventional, with 78 (1.4%) involving retrieval of embolized foreign bodies. Mean patient age and weight were 4 years and 15 kg. The majority of foreign bodies (78%) were embolized devices and central venous catheter fragments. Of the embolized devices and stents, 96% were identified either during the initial catheterization or within the first 48 hours after implantation.

 

Embolization rates for common procedures were:

PDA devices/coils – 3%

ASD devices – 1.9%

VSD devices – 2.8%

Stents – 1.7%

Overall success rate for foreign body retrieval was 90%, with the highest individual success for PDA devices/coils. Retrieval was successful from both venous and arterial approaches with a variety of sheath sizes. The best results were reported with gooseneck snares. Importantly, devices that embolized to the left ventricle were not approached from a transcatheter route because of the risk to mitral valve chordae. There were minimal adverse events, with 5 patients with transient pulse loss and 2 requiring blood transfusion. Not surprisingly, complications were more common in younger, smaller patients. Also, the authors stress the importance of having surgical backup available, as transcatheter foreign body retrieval can be risky to the patient and is not always possible depending on the patient anatomy and location of embolized material.

 

 

CHD Interventions May 2017

 

  1. Comparison of self-expandable and balloon-expanding stents for hybrid ductal stenting in hypoplastic left heart complex.

Goreczny S, Qureshi SA, Rosenthal E, Krasemann T, Nassar MS, Anderson DR, Morgan GJ.

Cardiol Young. 2017 Jul;27(5):837-845. doi: 10.1017/S1047951116001347.

PMID: 28555538

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Select item 28077189

 

  1. Interventional Treatment of Patients With Congenital Heart Disease: Nationwide Danish Experience Over 39 Years.

Larsen SH, Olsen M, Emmertsen K, Hjortdal VE.

J Am Coll Cardiol. 2017 Jun 6;69(22):2725-2732. doi: 10.1016/j.jacc.2017.03.587.

PMID: 28571637

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Select item 28580763

 

  1. Simultaneous transcatheter therapy for perimembranous ventricular septal defect combined with patent ductus arteriosus.

Wang Q, Zhu X, Duanzhen Z, Zhang P, Chen H, Han X, Sheng X, Meng L.

J Card Surg. 2017 Jun;32(6):370-375. doi: 10.1111/jocs.13138. Epub 2017 May 11.

PMID: 28497553

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  1. Percutaneous management of failed bioprosthetic pulmonary valves in patients with congenital heart defects.

Tarzia P, Conforti E, Giamberti A, Varrica A, Giugno L, Micheletti A, Negura D, Piazza L, Saracino A, Carminati M, Chessa M.

J Cardiovasc Med (Hagerstown). 2017 Jun;18(6):430-435. doi: 10.2459/JCM.0000000000000486.

PMID: 27828833

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Select item 23314595

 

  1. Short-term cardiopulmonary efficiency improvement after transcatheter baffle leak closure in a Mustard-operated patient.

Mezzani A, Butera G, Chessa M, Micheletti A, Negura D, Calaciura R, Carminati M.

J Cardiovasc Med (Hagerstown). 2017 Jun;18(6):447-449. doi: 10.2459/JCM.0b013e32835dbbde. No abstract available.

PMID: 23314595

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Select item 28436940

 

  1. Coronary Sinus Defect Following Transcatheter Closure of ASD Using Amplatzer Septal Occluder: Potential Erosion by the Device.

Mohammad Nijres B, Al-Kubaisi M, Bokowski J, Abdulla RI, Awad S.

Pediatr Cardiol. 2017 Jun;38(5):1084-1086. doi: 10.1007/s00246-017-1613-x. Epub 2017 Apr 10.

PMID: 28396933

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Select item 28382463

 

  1. RV to PA conduits: impact of transcatheter pulmonary valve replacement in adults – a national register study.

Skoglund K, Svensson G, Thilén U, Dellborg M, Eriksson P.

Scand Cardiovasc J. 2017 Jun;51(3):153-158. doi: 10.1080/14017431.2017.1291988. Epub 2017 Feb 15.

PMID: 28276717

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Select item 28506196

 

  1. Perceptions of transcatheter device closure of patent ductus arteriosus in veterinary cardiology and evaluation of a canine model to simulate device placement: a preliminary study.

Saunders AB, Keefe L, Birch SA, Wierzbicki MA, Maitland DJ.

J Vet Cardiol. 2017 May 30. pii: S1760-2734(17)30026-7. doi: 10.1016/j.jvc.2017.04.002. [Epub ahead of print]

PMID: 28576477

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  1. Real-time 3D transesophageal echocardiography-guided closure of a complicated patent ductus arteriosus in a dog.

Doocy KR, Nelson DA, Saunders AB.

J Vet Cardiol. 2017 May 29. pii: S1760-2734(17)30036-X. doi: 10.1016/j.jvc.2017.04.001. [Epub ahead of print]

PMID: 28571753

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  1. Novel Three-Dimensional Image Fusion Software to Facilitate Guidance of Complex Cardiac Catheterization : 3D image fusion for interventions in CHD.

Goreczny S, Dryzek P, Morgan GJ, Lukaszewski M, Moll JA, Moszura T.

Pediatr Cardiol. 2017 May 27. doi: 10.1007/s00246-017-1627-4. [Epub ahead of print]

PMID: 28551818

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Select item 28566198

 

  1. Transcatheter Retrieval of Cardiovascular Foreign Bodies in Children: A 15-Year Single Centre Experience.

Kudumula V, Stumper O, Noonan P, Mehta C, De Giovanni J, Stickley J, Dhillon R, Bhole V.

Pediatr Cardiol. 2017 May 24. doi: 10.1007/s00246-017-1639-0. [Epub ahead of print]

PMID: 28540398

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Select item 28537443

 

  1. Embolic Foreign Material in the Central Nervous System of Pediatric Autopsy Patients With Instrumented Heart Disease.

Torre M, Lechpammer M, Paulson V, Prabhu S, Marshall AC, Juraszek AL, Padera RF, Bundock EA, Vargas SO, Folkerth RD.

J Neuropathol Exp Neurol. 2017 May 19. doi: 10.1093/jnen/nlx037. [Epub ahead of print]

PMID: 28525615

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Select item 28533037

 

  1. Radiation Safety in Children with Congenital and Acquired Heart Disease: A Scientific Position Statement on Multimodality Dose Optimization from the Image Gently Alliance.

Hill KD, Frush DP, Han BK, Abbott BG, Armstrong AK, DeKemp RA, Glatz AC, Greenberg SB, Herbert AS, Justino H, Mah D, Mahesh M, Rigsby CK, Slesnick TC, Strauss KJ, Trattner S, Viswanathan MN, Einstein AJ; Image Gently Alliance.

JACC Cardiovasc Imaging. 2017 May 17. pii: S1936-878X(17)30381-9. doi: 10.1016/j.jcmg.2017.04.003. [Epub ahead of print] Review.

PMID: 28514670 Free Article

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Select item 28512719

 

  1. Intergenerational differences in the effects of transcatheter closure of atrial septal defects on cardiac function.

Tashiro H, Suda K, Iemura M, Teramachi Y.

J Cardiol. 2017 May 13. pii: S0914-5087(17)30112-0. doi: 10.1016/j.jjcc.2017.03.014. [Epub ahead of print]

PMID: 28511801

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Select item 28500278

 

  1. Transcatheter interventions in adults with congenital heart disease: Surveys from the Society for Cardiovascular Angiography and Interventions to identify current patterns of care and perception on training requirements.

Wadia SK, Accavitti MJ Jr, Morgan GJ, Kenny D, Hijazi ZM, Jones TK, Cabalka AK, McElhinney DB, Kavinsky CJ.

Catheter Cardiovasc Interv. 2017 May 11. doi: 10.1002/ccd.27151. [Epub ahead of print]

PMID: 28493591

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Select item 28493451

 

  1. Real-time MRI guidance of cardiac interventions.

Campbell-Washburn AE, Tavallaei MA, Pop M, Grant EK, Chubb H, Rhode K, Wright GA.

J Magn Reson Imaging. 2017 May 11. doi: 10.1002/jmri.25749. [Epub ahead of print]

PMID: 28493526

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Select item 28495809

 

  1. Stenting of the ascending aorta revisited.

Moiduddin NJ, Rios R, El-Said H, Moore JW.

Catheter Cardiovasc Interv. 2017 May 4. doi: 10.1002/ccd.27115. [Epub ahead of print]

PMID: 28471087

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Select item 28471080

 

  1. Twenty years of experience with intraoperative pulmonary artery stenting.

Zampi JD, Loccoh E, Armstrong AK, Yu S, Lowery R, Rocchini AP, Hirsch-Romano JC.

Catheter Cardiovasc Interv. 2017 May 4. doi: 10.1002/ccd.27094. [Epub ahead of print]

PMID: 28471080

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Select item 28475806

 

  1. Modified transjugular approach for percutaneous atrial septal defect closure.

Bhargava RA, Phatarpekar A, Lanjewar CP, Kerkar PG.

Ann Pediatr Cardiol. 2017 May-Aug;10(2):197-199. doi: 10.4103/apc.APC_167_16.

PMID: 28566830 Free PMC Article

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Select item 28566829

 

  1. Pitfalls of stenting coarctation of an angulated right circumflex aortic arch in Goldenhar syndrome.

Rad EM, Mortezaeian H, Pouraliakbar HR, Hijazi ZM.

Ann Pediatr Cardiol. 2017 May-Aug;10(2):194-196. doi: 10.4103/apc.APC_134_16.

PMID: 28566829 Free PMC Article

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Select item 28566825

 

  1. Catheter hemodynamic assessment of the univentricular circulation.

Stumper O, Penford G.

Ann Pediatr Cardiol. 2017 May-Aug;10(2):167-174. doi: 10.4103/apc.APC_160_16. Review.

PMID: 28566825 Free PMC Article

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Select item 28566821

 

  1. Transcatheter closure of large atrial septal defects using 40 mm amplatzer septal occluder: Single group experience with short and intermediate term follow-up.

Dalvi B, Sheth K, Jain S, Pinto R.

Catheter Cardiovasc Interv. 2017 May;89(6):1035-1043. doi: 10.1002/ccd.26858. Epub 2016 Nov 12.

PMID: 27862916

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Select item 27862909

 

  1. Single-center experience in percutaneous closure of arterial duct with Amplatzer duct Occluder II additional sizes.

Mahmoud HT, Santoro G, Gaio G, D’Aiello FA, Capogrosso C, Palladino MT, Russo MG.

Catheter Cardiovasc Interv. 2017 May;89(6):1045-1050. doi: 10.1002/ccd.26860. Epub 2016 Nov 10.

PMID: 27862909

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Select item 27860173

 

  1. Novel use of the medtronic micro vascular plug for PDA closure in preterm infants.

Wang-Giuffre EW, Breinholt JP.

Catheter Cardiovasc Interv. 2017 May;89(6):1059-1065. doi: 10.1002/ccd.26855. Epub 2016 Nov 10.

PMID: 27860173

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Select item 24323820

 

  1. Transcatheter closure of large patent ductus arteriosus using custom made devices.

Rohit MK, Gupta A.

Catheter Cardiovasc Interv. 2017 May;89(6):E194-E199. doi: 10.1002/ccd.25349. Epub 2014 Jan 7.

PMID: 24323820

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Select item 28495825

 

  1. Acute and long-term effects of endovascular debanding of pulmonary arteries in a swine model.

Perez M, Kumar TS, Hoskoppal D, Akkhawattanangkul Y, Allen K, Knott-Craig CJ, Waller BR, Sathanandam S.

Congenit Heart Dis. 2017 May;12(3):340-349. doi: 10.1111/chd.12449.

PMID: 28580610

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Select item 28580609

 

  1. Transcatheter closure of calcified patent ductus arteriosus in older adult patients: Immediate and 12-month follow-up results.

Gu X, Zhang Q, Sun H, Fei J, Zhang X, Kutryk MJ.

Congenit Heart Dis. 2017 May;12(3):289-293. doi: 10.1111/chd.12437. Epub 2016 Nov 22.

PMID: 27874259

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Select item 27874252

 

  1. Dehiscence of a pulmonary bioprosthesis with a focal dissection of the pulmonary artery in a patient with congenital pulmonic stenosis.

Yucel E, Bhatt A, Mihos CG, Ghoshhajra BB, DeFaria Yeh D.

Echocardiography. 2017 May;34(5):776-778. doi: 10.1111/echo.13502. Epub 2017 Mar 27.

PMID: 28345243

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Select item 28317159

 

  1. Neurodevelopmental Outcome in Children after Fetal Cardiac Intervention for Aortic Stenosis with Evolving Hypoplastic Left Heart Syndrome.

Laraja K, Sadhwani A, Tworetzky W, Marshall AC, Gauvreau K, Freud L, Hass C, Dunbar-Masterson C, Ware J, Lafranchi T, Wilkins-Haug L, Newburger JW.

J Pediatr. 2017 May;184:130-136.e4. doi: 10.1016/j.jpeds.2017.01.034. Epub 2017 Feb 21.

PMID: 28233547

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Select item 28325567

 

  1. [Interventional cardiac catheterization in congenital heart disease].

Godart F, Houeijeh A.

Presse Med. 2017 May;46(5):497-508. doi: 10.1016/j.lpm.2016.11.013. Epub 2016 Dec 27. French.

PMID: 28038838

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Select item 28440986

 

  1. Utility and Clinical Profile of Dexmedetomidine in Pediatric Cardiac Catheterization Procedures: A Matched Controlled Analysis.

Riveros R, Makarova N, Riveros-Perez E, Chodavarapu P, Saasouh W, Yılmaz HO, Cuko E, Babazade R, Kimatian S, Turan A.

Semin Cardiothorac Vasc Anesth. 2017 May 1:1089253217708035. doi: 10.1177/1089253217708035. [Epub ahead of print]

PMID: 28549395

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Select item 28482733

 

  1. Exercise Capacity Before and After Stent Placement for Coarctation of the Aorta: A Single-Center Case Series.

Morrical BD, Anderson JH, Taggart NW.

Pediatr Cardiol. 2017 May 18. doi: 10.1007/s00246-017-1628-3. [Epub ahead of print]

PMID: 28523342

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Select item 28523341

 

  1. Transcatheter correction of Scimitar syndrome: occlusion of abnormal pulmonary venous drainage and vascular supply in an infant.

Saltik L, Ugan Atik S, Bornaun H.

Cardiol Young. 2017 May 16:1-3. doi: 10.1017/S1047951117000750. [Epub ahead of print]

PMID: 28506323

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  1. Transcatheter closure of a membranous ventricular septal defect in a 1.8-kg infant using Amplatzer Duct Occluder II additional size device.

Champaneri B, Kappanayil M, Kumar RK.

Cardiol Young. 2017 May 16:1-4. doi: 10.1017/S1047951117000695. [Epub ahead of print]

PMID: 28506322

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  1. Intergenerational differences in the effects of transcatheter closure of atrial septal defects on cardiac function.

Tashiro H, Suda K, Iemura M, Teramachi Y.

J Cardiol. 2017 May 13. pii: S0914-5087(17)30112-0. doi: 10.1016/j.jjcc.2017.03.014. [Epub ahead of print]

PMID: 28511801

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  1. Transcatheter interventions in adults with congenital heart disease: Surveys from the Society for Cardiovascular Angiography and Interventions to identify current patterns of care and perception on training requirements.

Wadia SK, Accavitti MJ Jr, Morgan GJ, Kenny D, Hijazi ZM, Jones TK, Cabalka AK, McElhinney DB, Kavinsky CJ.

Catheter Cardiovasc Interv. 2017 May 11. doi: 10.1002/ccd.27151. [Epub ahead of print]

PMID: 28493591

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  1. Long-term outcome after percutaneous closure of persistent left superior caval vein draining into the left atrium: a contrast-enhanced CT study.

Marini D, Castagno M, Millesimo M, Ferroni F, Ferraro G, Pace Napoleone C, Agnoletti G.

Cardiol Young. 2017 May 8:1-7. doi: 10.1017/S1047951117000737. [Epub ahead of print]

PMID: 28478769

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  1. Transcatheter closure of hemodynamic significant patent ductus arteriosus in 32 premature infants by amplatzer ductal occluder additional size-ADOIIAS.

Morville P, Akhavi A.

Catheter Cardiovasc Interv. 2017 May 4. doi: 10.1002/ccd.27091. [Epub ahead of print]

PMID: 28471089

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  1. Access to the native atria following conduit total cavopulmonary anastomosis.

Petersen RL, Danon S, Jureidini S.

Catheter Cardiovasc Interv. 2017 May 4. doi: 10.1002/ccd.27044. [Epub ahead of print]

PMID: 28470999

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  1. Transcatheter closure of the patent foramen ovale in children: intermediate-term follow-up results.

Sel K, Aykan HH, Duman D, Aypar E, Özkutlu S, Alehan D, Karagöz T.

Cardiol Young. 2017 May 2:1-5. doi: 10.1017/S1047951117000725. [Epub ahead of print]

PMID: 28460651

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  1. Cost-effectiveness analysis of different devices used for the closure of small-to-medium-sized patent ductus arteriosus in pediatric patients.

El-Saiedi SA, El Sisi AM, Mandour RS, Abdel-Aziz DM, Attia WA.

Ann Pediatr Cardiol. 2017 May-Aug;10(2):144-151. doi: 10.4103/0974-2069.205138.

PMID: 28566822 Free PMC Article

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  1. A roadmap for the aspiring interventional pediatric cardiologist.

Kumar RK.

Ann Pediatr Cardiol. 2017 May-Aug;10(2):109-113. doi: 10.4103/apc.APC_52_17. No abstract available.

PMID: 28566816 Free PMC Article

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  1. Percutaneous closure of an aortopulmonary window using Amplatzer Duct Occluder II: Additional Sizes: the first reported case.

Fiszer R, Zbroński K, Szkutnik M.

Cardiol Young. 2017 May;27(4):812-815. doi: 10.1017/S1047951116002134. Epub 2016 Nov 21.

PMID: 27869054

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  1. Transcatheter closure of patent ductus arteriosus using the AMPLATZER™ duct occluder II (ADO II).

Gruenstein DH, Ebeid M, Radtke W, Moore P, Holzer R, Justino H.

Catheter Cardiovasc Interv. 2017 May;89(6):1118-1128. doi: 10.1002/ccd.26968. Epub 2017 Mar 4.

PMID: 28258658

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  1. Initial clinical experience with the Medtronic Micro Vascular Plug™ in transcatheter occlusion of PDAs in extremely premature infants.

Sathanandam S, Justino H, Waller BR 3rd, Radtke W, Qureshi AM.

Catheter Cardiovasc Interv. 2017 May;89(6):1051-1058. doi: 10.1002/ccd.26878. Epub 2016 Nov 26.

PMID: 27888552

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  1. Single-center experience in percutaneous closure of arterial duct with Amplatzer duct Occluder II additional sizes.

Mahmoud HT, Santoro G, Gaio G, D’Aiello FA, Capogrosso C, Palladino MT, Russo MG.

Catheter Cardiovasc Interv. 2017 May;89(6):1045-1050. doi: 10.1002/ccd.26860. Epub 2016 Nov 10.

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  1. Novel use of the medtronic micro vascular plug for PDA closure in preterm infants.

Wang-Giuffre EW, Breinholt JP.

Catheter Cardiovasc Interv. 2017 May;89(6):1059-1065. doi: 10.1002/ccd.26855. Epub 2016 Nov 10.

PMID: 27860173

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  1. Transcatheter Occlusion of a Giant Pulmonary Arteriovenous Malformation in a 1-year-old Child Using Amplatzer Vascular Plugs and Interlocking Detachable Coils.

Lim YJ.

Chonnam Med J. 2017 May;53(2):171-172. doi: 10.4068/cmj.2017.53.2.171. Epub 2017 May 25. No abstract available.

PMID: 28584799 Free Article

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  1. Outcomes After Decompression of the Right Ventricle in Infants With Pulmonary Atresia With Intact Ventricular Septum Are Associated With Degree of Tricuspid Regurgitation: Results From the Congenital Catheterization Research Collaborative.

Petit CJ, Glatz AC, Qureshi AM, Sachdeva R, Maskatia SA, Justino H, Goldberg DJ, Mozumdar N, Whiteside W, Rogers LS, Nicholson GT, McCracken C, Kelleman M, Goldstein BH.

Circ Cardiovasc Interv. 2017 May;10(5). pii: e004428. doi: 10.1161/CIRCINTERVENTIONS.116.004428.

PMID: 28500137

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CHD Intervention Featured Articles of April 2017

Cardiac Catheterization Reviews of April 2017 Manuscripts

 

Tricuspid Regurgitation Does Not Impact Right Ventricular Remodeling After Percutaneous Pulmonary Valve Implantation.

Tanase D, Ewert P, Georgiev S, Meierhofer C, Pabst von Ohain J, McElhinney DB, Hager A, Kühn A, Eicken A.

JACC Cardiovasc Interv. 2017 Apr 10;10(7):701-708. doi: 10.1016/j.jcin.2017.01.036.

 

Take Home Points:

 

  • Percutaneous pulmonary valve implantation (PPVI) improves right ventricular (RV) size and exercise performance regardless of the severity of tricuspid regurgitation (TR).
  • Severity of TR improves following PPVI, and therefore the presence of significant TR should not preclude attempts at PPVI.

 

Whiteside, WendyComment from Dr. Wendy Whiteside (Cincinnati), section editor of Congenital Heart Disease Interventions Journal Watch:  Percutaneous pulmonary valve implantation (PPVI) has become the therapy of choice for treatment of RV outflow tract (RVOT) conduit dysfunction.  In patients presenting for PPVI, TR is a frequent associated finding, occurring in as many as 1/3 of patients.  There are multiple etiologies and mechanisms for TR in these patients, including annular dilation in the setting of a dilated right ventricle, valvar dysplasia, or surgical or pacemaker lead disruption, however the presence of significant TR may impact the decision to perform pulmonary valve replacement via a percutaneous or surgical approach and may affect the ability for the RV to remodel following pulmonary valve replacement.  If significant TR is present and the tricuspid valve is felt to require surgical intervention at the time of valve replacement, these patients may be referred exclusively for surgical intervention without consideration for a less invasive approach.  However, if the TR can be improved just by improving the RVPA conduit dysfunction and subsequent RV remodeling, these patients may be able to have a less invasive percutaneous procedure rather than a surgical one.

 

To investigate the impact of moderate or severe TR on RV remodeling after PPVI, Tanase et al conducted a matched cohort study comparing patients who underwent percutaneous pulmonary valve implantation (PPVI) either with significant TR (moderate or severe) or without significant TR, assessing the outcomes of TR severity by echocardiogram, RV size by cardiac MRI, and exercise performance by objective measures from cardiopulmonary exercise testing.

 

Among the 173 patients at their center who underwent PPVI over an 8-year period, patients with moderate to severe TR by echocardiographic criteria were identified, and represented 13% of their PPVI population.  Ultimately, the study included 18 patients with RVOT dysfunction and significant TR and 18 matched control subjects with RVOT dysfunction but no TR.  Patients were matched to have the same pulmonary valve pathology (primary stenosis, insufficiency, mixed), similar indexed RV end-diastolic volume, and similar NYHA functional classification).  Data were obtained at baseline, 6 months post-PPVI, and at latest follow-up (median of 6.5 years post-PPVI, range 8 months to 9.3 years).  All patients with significant TR were identified by serial echocardiography (looking back at least 8 years prior to PPVI) and found to have gradually increasing TR over time with no patients having a sudden increase in TR after surgery to suggest a primary anatomic valve issue.

 

Median patient age was 22±8 years, majority had NYHA functional class II symptoms, median peak oxygen uptake (VO2 peak) was 28.5 mlO2/kg/min, and median RVEDVi was 100 ml/m2 (range 61-185 ml/m2).  After PPVI, the degree of TR improved in 15 of 18 patients (83%) and was unchanged in the remaining 3 patients at 6-month follow-up.  At latest follow-up, no patient had significant TR (15 trivial and 3 mild).  There was a significant decrease in RVEDVi from pre- to post-PPVI with no difference between TR groups.  Similarly, while VO2 increased following PPVI, there was no difference in this increase between TR groups.  Tanase et al therefore conclude that in most patients with RVOT conduit dysfunction and significant TR, PPVI leads to a reduction in TR.  PPVI also decreases RV volume and improves exercise tolerance without a difference between baseline TR severity groups

 

These findings help to provide insight into a clinically very meaningful question—whether the presence of significant TR in a patient with a dysfunctional RVOT conduit should play into the decision for type and timing of intervention.  While they provide convincing evidence to suggest that secondary TR will improve following PPVI, there some important limitations to consider. The mechanism of TR is an important variable in the ability to improve TR.  Tanase et al attempted to exclude patients with a primary tricuspid valve abnormality (by showing a slow progression of TR over time in the included study patients).  Generalizing these results, therefore, to patients with primary valve abnormalities (dysplastic or surgically manipulated valves) should be done with caution.  Secondly, the median RVEDVi of included patients is small (100 ml/m2) and may not be representative of most PPVI populations.  This may lessen the effect of the additional volume load of TR on RV remodeling following PPVI.  Despite these limitations and small patient size, this study is of interest and should be considered in decision making for patients with RVOT conduit dysfunction and concomitant TR.

 

 

 

 

 

 

Impacts of early cardiac catheterization for children with congenital heart disease supported by extracorporeal membrane oxygenation.

Kato A, Lo Rito M, Lee KJ, Haller C, Guerguerian AM, Sivarajan VB, Honjo O.

Catheter Cardiovasc Interv. 2017 Apr;89(5):898-905. doi: 10.1002/ccd.26632. Epub 2016 Jul 14.

PMID: 27416545

 

Take Home Points:

  • Early catheterization is associated with shorter duration of ECMO support and higher survival probability at 30 days after ECMO cannulation.
  • ECMO-related end-organ dysfunction is a significantly poor prognostic factor for successful decannulation.

 

Averin , KonstantinCommentary from Dr. Konstantin Averin (Edmonton), section editor of Congenital Heart Disease Interventions Journal Watch: Extracorporeal membrane oxygenation (ECMO) has been widely used in the pediatric population for cases of peri-operative hemodynamic instability, failure to wean from cardiopulmonary bypass, and cardiopulmonary resuscitation. Cardiac catheterization in patients on ECMO support poses significant challenges but can potentially be useful in improving clinical outcomes. This single center retrospective cohort study focused on patients with congenital heart disease (CHD) and hypothesized that timing of cardiac catheterization may be a predictor of clinical outcomes. The specific aims of the study were: (1) to analyze the institution’s experience with cardiac catheterization on pediatric patients with CHD supported by cardiac ECMO and (2) to determine factors associated with successful weaning from ECMO and short-term outcomes.

 

Three hundred and forty-two patients required ECMO support between 2000 and 2014. Of these, 47 underwent 49 cardiac catheterizations that met inclusion criteria with a median patient age of 65 days and median weight 4.2kg. ECMO was successfully weaned in 33 patients (70%) after a median support time of 4 days with 51% of patients surviving to hospital discharge. Cardiac catheterizations were performed a median of 1 day after ECMO initiation and during 27 of them an intervention was performed (balloon/stent angioplasty and balloon atrial septostomy). There was no procedure related mortality but 9 (18%) procedure-related serious complications with 8 occurring during interventional catheterization (pulmonary artery rupture, stent dislodgement, arrhythmia, pulmonary hemorrhage, and sheath tip migration). In a multivariate analysis, absence of renal or respiratory complications were prognostic of successful ECMO weaning. Kaplan-Meier analysis demonstrated that patient who underwent earlier catheterization (<48 hours after cannulation) had a higher survival probability at 30 days after ECMO cannulation compared with late catheterization.

 

The authors conclude that early cardiac catheterization in pediatric patients with CHD who require ECMO support may be associated with better short-term survival. Early cardiac catheterization should be considered in this cohort, especially if there are unresolved anatomic or physiologic questions. The absence of ECMO-related complications is a predictor for successful weaning off ECMO.

cath 1 april

 

 

Impact of imaging approach on radiation dose and associated cancer risk in children undergoing cardiac catheterization.

Hill KD, Wang C, Einstein AJ, Januzis N, Nguyen G, Li JS, Fleming GA, Yoshizumi TK.

Catheter Cardiovasc Interv. 2017 Apr;89(5):888-897. doi: 10.1002/ccd.26630. Epub 2016 Jun 17.

PMID: 27315598

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Take Home Points:

  • Congenital cardiac catheterizations utilize much higher doses of ionizing radiation than other imaging modalities, such as computed tomography, increasing the lifetime cancer risk for patients
  • Traditional measures of radiation exposure (air kerma or dose-area product) do not accurately measure the true tissue exposure to radiation
  • Altering the methods of image acquisition (collimation, magnification, minimizing source to image distance, removal of antiscatter grids, lower acquisition frame rates) lead to marked variation in effective radiation doses and are easily modifiable by the interventional cardiologist

 

Seckler, MikeCommentary from Dr. Michael Seckeler (Tucson), section editor of Congenital Heart Disease Interventions Journal Watch: The authors have undertaken a very important study for any practitioner who utilizes ionizing radiation for imaging pediatric patients. Using two patient phantoms representing a newborn and a 5-year-old child, they systematically compared the relative effects of different alterable parameters of fluoroscopic imaging used in standard congenital catheterization laboratories on effective radiation doses in the phantoms. In addition, they were able to estimate lifetime cancer risks based on the effective radiation doses. This is the first study to look at this in pediatric patients.

 

The modifiable factors included collimation, magnification, minimizing source to image distance, removal of antiscatter grids and lower acquisition frame rates. These were tested in various combinations and effective radiation doses measured. Optimizing the imaging for minimal radiation exposure (lower magnification, maximal collimation, lowest source to image distance, removal of antiscatter grids and lower acquisition frame rates) all led to significant reductions in the effective radiation doses and lower predicted lifetime cancer risks (Figure 1).

 

The authors do report several limitations to their conclusions. First, optimizing the radiation exposure does not always lead to the best image quality, which has the potential to compromise patient safety during a procedure. However, by highlighting how each of several different factors can improve radiation exposure, this data will allow interventional cardiologists to make as many modifications as possible to find the optimal balance between safety and image quality. Second, the radiation exposures were derived from phantoms and mathematical simulations; however, the intention was not to provide exact doses, but the relative changes in exposure with changes in imaging modality.

This is a very important paper for our field and provides tools to help interventional cardiologists minimize the radiation exposure for our patients.

cath 2 april

CHD Interventions April 2017

 

  1. Real-time three dimensional CT and MRI to guide interventions for congenital heart disease and acquired pulmonary vein stenosis.

Suntharos P, Setser RM, Bradley-Skelton S, Prieto LR.

Int J Cardiovasc Imaging. 2017 Apr 28. doi: 10.1007/s10554-017-1151-x. [Epub ahead of print]

PMID: 28455631

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  1. Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis: An Expert Statement.

Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, Gerosa G, Ibrahim R, Jelnin V, Jilaihawi H, Jolicoeur EM, Kliger C, Kronzon I, Leipsic J, Maisano F, Millan X, Nataf P, O’Gara PT, Pibarot P, Ramee SR, Rihal CS, Rodes-Cabau J, Sorajja P, Suri R, Swain JA, Turi ZG, Tuzcu EM, Weissman NJ, Zamorano JL, Serruys PW, Leon MB; Paravalvular Leak Academic Research Consortium..

J Am Coll Cardiol. 2017 Apr 25;69(16):2067-2087. doi: 10.1016/j.jacc.2017.02.038. Review.

PMID: 28427582

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  1. In vivo intracardiac vector velocity imaging using phased array transducers for pediatric cardiology.

Fadnes S, Wigen M, Nyrnes SA, Lovstakken L.

IEEE Trans Ultrason Ferroelectr Freq Control. 2017 Apr 24. doi: 10.1109/TUFFC.2017.2689799. [Epub ahead of print]

PMID: 28436859

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  1. Prediction of adverse events after catheter-based procedures in adolescents and adults with congenital heart disease in the IMPACT registry.

Stefanescu Schmidt AC, Armstrong A, Kennedy KF, Nykanen D, Aboulhosn J, Bhatt AB.

Eur Heart J. 2017 Apr 18. doi: 10.1093/eurheartj/ehx200. [Epub ahead of print]

PMID: 28430913

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  1. Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis: An Expert Statement.

Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, Gerosa G, Ibrahim R, Jelnin V, Jilaihawi H, Jolicoeur EM, Kliger C, Kronzon I, Leipsic J, Maisano F, Millan X, Nataf P, O’Gara PT, Pibarot P, Ramee SR, Rihal CS, Rodes-Cabau J, Sorajja P, Suri R, Swain JA, Turi ZG, Tuzcu EM, Weissman NJ, Zamorano JL, Serruys PW, Leon MB; of the Paravalvular Leak Academic Research Consortium..

Eur Heart J. 2017 Apr 18. doi: 10.1093/eurheartj/ehx211. [Epub ahead of print]

PMID: 28430909

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  1. Cell Therapy Trials in Congenital Heart Disease.

Oh H.

Circ Res. 2017 Apr 14;120(8):1353-1366. doi: 10.1161/CIRCRESAHA.117.309697. Review.

PMID: 28408455

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  1. A systematic review of 3-D printing in cardiovascular and cerebrovascular diseases.

Sun Z, Lee SY.

Anatol J Cardiol. 2017 Apr 10. doi: 10.14744/AnatolJCardiol.2017.7464. [Epub ahead of print]

PMID: 28430115 Free Article

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  1. Avoidable costs of stenting for aortic coarctation in the United Kingdom: an economic model.

Salcher M, Mcguire A, Muthurangu V, Kelm M, Kuehne T, Naci H; CARDIOPROOF..

BMC Health Serv Res. 2017 Apr 10;17(1):258. doi: 10.1186/s12913-017-2215-2.

PMID: 28395657 Free PMC Article

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  1. Coincidental Significant Tricuspid Regurgitation at the Time of Right Ventricle-to-Pulmonary Artery Conduit Intervention: Should We Address it, Ignore it, or Take a More Nuanced Approach?

Hebson CL, Ephrem G, Rodriguez FH 3rd.

JACC Cardiovasc Interv. 2017 Apr 10;10(7):709-711. doi: 10.1016/j.jcin.2017.02.032. No abstract available.

PMID: 28385409

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  1. Coronary Sinus Defect Following Transcatheter Closure of ASD Using Amplatzer Septal Occluder: Potential Erosion by the Device.

Mohammad Nijres B, Al-Kubaisi M, Bokowski J, Abdulla RI, Awad S.

Pediatr Cardiol. 2017 Apr 10. doi: 10.1007/s00246-017-1613-x. [Epub ahead of print]

PMID: 28396933

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  1. Impacts of early cardiac catheterization for children with congenital heart disease supported by extracorporeal membrane oxygenation.

Kato A, Lo Rito M, Lee KJ, Haller C, Guerguerian AM, Sivarajan VB, Honjo O.

Catheter Cardiovasc Interv. 2017 Apr;89(5):898-905. doi: 10.1002/ccd.26632. Epub 2016 Jul 14.

PMID: 27416545

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  1. Patent foramen ovale with right atrial septal pouch.

Kijima Y, Bokhoor P, Tobis JM.

Catheter Cardiovasc Interv. 2017 Apr;89(5):E169-E171. doi: 10.1002/ccd.26357. Epub 2015 Dec 29.

PMID: 26711371

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  1. In-hospital cost comparison between percutaneous pulmonary valve implantation and surgery.

Andresen B, Mishra V, Lewandowska M, Andersen JG, Andersen MH, Lindberg H, Døhlen G, Fosse E.

Eur J Cardiothorac Surg. 2017 Apr 1;51(4):747-753. doi: 10.1093/ejcts/ezw378.

PMID: 28007875 Free PMC Article

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  1. Evolution of hybrid interventions for congenital heart disease.

Agrawal H, Alkashkari W, Kenny D.

Expert Rev Cardiovasc Ther. 2017 Apr;15(4):257-266. doi: 10.1080/14779072.2017.1307733. Epub 2017 Mar 23. Review.

PMID: 28293976

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  1. Minimally invasive endoscopic surgery versus catheter-based device occlusion for atrial septal defects in adults: reconsideration of the standard of care.

Schneeberger Y, Schaefer A, Conradi L, Brickwedel J, Reichenspurner H, Kozlik-Feldmann R, Detter C.

Interact Cardiovasc Thorac Surg. 2017 Apr 1;24(4):603-608. doi: 10.1093/icvts/ivw366.

PMID: 28040751

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  1. The Medtronic Micro Vascular Plug™ for Vascular Embolization in Children With Congenital Heart Diseases.

Sathanandam S, Justino H, Waller BR 3rd, Gowda ST, Radtke W, Qureshi AM.

J Interv Cardiol. 2017 Apr;30(2):177-184. doi: 10.1111/joic.12369. Epub 2017 Feb 16.

PMID: 28211168

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  1. Pulmonary artery dissection following balloon valvuloplasty in a dog with pulmonic stenosis.

Grint KA, Kellihan HB.

J Vet Cardiol. 2017 Apr;19(2):182-189. doi: 10.1016/j.jvc.2016.09.005. Epub 2016 Nov 30.

PMID: 27913078

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  1. Bronchial artery embolization for the treatment of haemoptysis in pulmonary hypertension.

Rasciti E, Sverzellati N, Silva M, Casadei A, Attinà D, Palazzini M, Galiè N, Zompatori M.

Radiol Med. 2017 Apr;122(4):257-264. doi: 10.1007/s11547-016-0714-6. Epub 2016 Dec 26.

PMID: 28025781

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  1. Three-dimensional Printed Cardiac Models: Applications in the Field of Medical Education, Cardiovascular Surgery, and Structural Heart Interventions.

Valverde I.

Rev Esp Cardiol (Engl Ed). 2017 Apr;70(4):282-291. doi: 10.1016/j.rec.2017.01.012. Epub 2017 Feb 8. English, Spanish.

PMID: 28189544

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  1. Seven Coils in 1 Heart: Therapeutic Option for Multiple VSD.

Sabiniewicz R, Weryński P.

JACC Cardiovasc Interv. 2017 Apr 24;10(8):837-838. doi: 10.1016/j.jcin.2017.02.016. Epub 2017 Mar 29. No abstract available.

PMID: 28365261

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  1. Are the AMPLATZER Duct Occluder II Additional Sizes devices dedicated only for smaller children?

Fiszer R, Chojnicki M, Szkutnik M, Haponiuk I, Chodór B, Białkowski J.

EuroIntervention. 2017 Apr 20;12(17):2100-2103. doi: 10.4244/EIJ-D-15-00238.

PMID: 27867138 Free Article

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  1. Targeted endomyocardial biopsy guided by real-time cardiovascular magnetic resonance.

Unterberg-Buchwald C, Ritter CO, Reupke V, Wilke RN, Stadelmann C, Steinmetz M, Schuster A, Hasenfuß G, Lotz J, Uecker M.

J Cardiovasc Magn Reson. 2017 Apr 19;19(1):45. doi: 10.1186/s12968-017-0357-3.

PMID: 28424090 Free PMC Article

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  1. Transcatheter closure of a residual aorto-left ventricular tunnel: report of a case with a 6-year follow-up.

Djukic M, Djordjevic SA, Dähnert I.

Cardiol Young. 2017 Apr 17:1-4. doi: 10.1017/S1047951117000701. [Epub ahead of print]

PMID: 28414001

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  1. Radiation dose reduction in pediatric great vessel stent computed tomography using iterative reconstruction: A phantom study.

den Harder AM, Suchá D, van Doormaal PJ, Budde RPJ, de Jong PA, Schilham AMR, Breur JMPJ, Leiner T.

PLoS One. 2017 Apr 14;12(4):e0175714. doi: 10.1371/journal.pone.0175714. eCollection 2017.

PMID: 28410386 Free PMC Article

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  1. Clinical Impact of Stent Implantation for Coarctation of the Aorta with Associated Hypoplasia of the Transverse Aortic Arch.

Lu WH, Fan CS, Chaturvedi R, Lee KJ, Manlhiot C, Benson L.

Pediatr Cardiol. 2017 Apr 10. doi: 10.1007/s00246-017-1611-z. [Epub ahead of print]

PMID: 28396934

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  1. Percutaneous Mechanical Circulatory Support Using Impella® Devices for Decompensated Cardiogenic Shock: A Pediatric Heart Center Experience.

Parekh D, Jeewa A, Tume SC, Dreyer WJ, Pignatelli R, Horne D, Justino H, Qureshi AM.

ASAIO J. 2017 Apr 6. doi: 10.1097/MAT.0000000000000581. [Epub ahead of print]

PMID: 28394814

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  1. Intractable Back Pain After Coil Embolization of Giant Veno-Venous Collaterals in a Patient With Fontan Circulation.

Okada S, Kamada M, Nakagawa N, Ishiguchi Y, Moritoh Y, Shohi M, Okamoto K, Hasegawa S, Ohga S.

Int Heart J. 2017 Apr 6;58(2):298-301. doi: 10.1536/ihj.16-194. Epub 2017 Mar 21.

PMID: 28320993 Free Article

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  1. Impact of imaging approach on radiation dose and associated cancer risk in children undergoing cardiac catheterization.

Hill KD, Wang C, Einstein AJ, Januzis N, Nguyen G, Li JS, Fleming GA, Yoshizumi TK.

Catheter Cardiovasc Interv. 2017 Apr;89(5):888-897. doi: 10.1002/ccd.26630. Epub 2016 Jun 17.

PMID: 27315598

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