CHD Interventions Featured Articles of October 2015

1. Transcatheter balloon dilation for recurrent right ventricular outflow tract obstruction following valve-sparing repair of tetralogy of Fallot.

Gellis L, Banka P, Marshall A, Emani S, Porras D.

Catheter Cardiovasc Interv. 2015 Oct;86(4):692-700. doi: 10.1002/ccd.25930. Epub 2015 Apr 24.

PMID: 25914342

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bouddjemlineMehul Patel photoComment from Pr. Younes Boudjemline (Paris) and co-editor Dr. Mehul Patel (MSU, MI), editors of congenital heart disease interventions Journal Watch:  The morbidity of pulmonary regurgitation over time after TOF repair has led to greater interest in PV-sparing repair strategies. This strategy in patients with tri leaflet PV with z-scores – 3.5 to -1.0 is emerging as a durable method to prevent PR and resultant RV volume overload. There is however some tradeoff with residual, multilevel RVOTO to maintain valve competence. Intraoperative dilation of the pulmonary valve in these patients is feasible and provides good immediate relief of obstruction as noted from prior studies. In this retrospective study from Boston Children’s Hospital, the authors report outcomes of follow up balloon dilatation (BD) of RVOTO on 34 patients who had initial valve-sparing repair of tetralogy of Fallot.  There was a significant drop in the gradient with an increased risk of PR after balloon dilatation with freedom from reintervention of 64% at 1 year and 46% at 3 years. A balloon to annulus ratio (BAR) of 1.2 to 1.4 was used although it was not standardized; one patient experienced an RVOT tear with BAR more than 1.4. Exclusive valvar obstruction was associated with a longer freedom from reintervention, while a ratio of RV pressure to aortic systolic pressure pre-BD of >1 and a final RVOT gradient ≥40 mmHg post-BD were associated with shorter freedom from reintervention. Balloon dilatation in this population is presumed to work by splitting of the fused commissures and also by stretching the hypoplastic annulus promoting longitudinal growth.

Take home points:

  1. Repair of TOF with pulmonary valve preservation in patients with z-scores – 3.5 to -1.0 is emerging as a durable method to prevent PR and resultant RV volume overload. There is however some tradeoff with residual multilevel RVOTO to maintain valve competence.
  2. Balloon dilatation for such recurrent, multilevel RVOTO after valve-sparing repair is an effective option; however, there is an increased risk of PR.
  3. Patients with exclusively valvar obstruction had a better response to balloon dilatation.
  4. RV/Ao pressure ratio of > 1 and post balloon dilatation residual gradient of > 40 mm Hg are predictors of repeat interventions.

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2. Sedation and Anesthesia in Pediatric and Congenital Cardiac Catheterization: A Prospective Multicenter Experience.

Lin CH, Desai S, Nicolas R, Gauvreau K, Foerster S, Sharma A, Armsby L, Marshall AC, Odegard K, DiNardo J, Vincent J, El-Said H, Spaeth J, Goldstein B, Holzer R, Kreutzer J, Balzer D, Bergersen L.

Pediatr Cardiol. 2015 Oct;36(7):1363-75. doi: 10.1007/s00246-015-1167-8. Epub 2015 May 21.

PMID: 25991570

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Comment from Pr. Younes Boudjemline (Paris) and co-editor Dr. Mehul Patel (MSU, MI), editors of congenital heart disease interventions Journal Watch: Although high-severity sedation and airway-related mortality rate is lower when compared to overall mortality rate of pediatric and congenital catheterization, it is extremely important to preplan and coordinate care with the cardiac anesthesia team for a smooth procedure with good outcome. The authors retrospectively reviewed prospectively collected data from multicenter Congenital Cardiac Catheterization Project on Outcomes (C3PO) on sedation and airway practices on 13,611 pediatric and congenital heart patients who underwent catheterization at eight institutions from 2007 to 2010. A small fraction of 94 patients (0.69%) had serious sedation/airway-related adverse events. These occurred more so in i) smaller patients (<4 kg), ii) patients with non-cardiac comorbidities and iii) patients with low mixed venous oxygen saturation; (iv) single ventricle < 50 % or two ventricles < 60 %. With a heterogenous practice noted across various centers, general anesthesia with airway support was used as first line in 9379 (69%), procedural sedation only without airway support in 4232 (31%) of which 75 (1.77%) patients were converted to assisted ventilation/general anesthesia. The risk factors for conversion included i) young age (<12 months), ii) higher-risk procedure and iii) continuous pressor/inotrope requirement. Keeping these predictors in mind it is important to risk stratify patients and carefully select the most appropriate mode of anesthesia.

Take home points:

  1. The study highlights an important aspect of periprocedural care and reports a low rate of serious sedation/airway-related adverse events in a large multicentric population from the C3PO database.
  2. Smaller patients with non-cardiac comorbidities or low mixed venous oxygen saturation may be at higher risk of adverse events.
  3. Patients under 1 year of age, undergoing high-risk procedures, or requiring continuous pressor/inotrope support may be at higher risk of requiring conversion from procedural sedation to assisted ventilation/general anesthesia. With proper pre procedure risk stratification and planning, intraprocedural conversions may be reduced.

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3. Left Ventricular Remodeling and Function in Children with Biventricular Circulation After Fetal Aortic Valvuloplasty.

Friedman KG, Freud L, Escobar-Diaz M, Banka P, Emani S, Tworetzky W.

Pediatr Cardiol. 2015 Oct;36(7):1502-9. doi: 10.1007/s00246-015-1193-6. Epub 2015 May 15.

PMID: 25972285

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Comment from Pr. Younes Boudjemline (Paris) and co-editor Dr. Mehul Patel (MSU, MI), editors of congenital heart disease interventions Journal Watch: Early, primary in-utero cardiac abnormality may prevent normal heart development and cause irreversible secondary structural changes. The idea of fetal cardiac intervention stems from this understanding and focuses on an​antenatal intervention targeting the primary abnormality to allow normal flow and hemodynamics and thus normal heart development. Fetal aortic valvuloplasty (FAV) has shown promise in preventing the progression of aortic stenosis to hypoplastic left-heart syndrome with 40–50% of patients achieving biventricular (BiV) circulation after technically successful FAV. However, even after FAV, intrinsic endomyocardial abnormalities altered loading conditions with altered endomyocardial mechanics may lead to abnormal LV remodeling and function. The authors studied 34 patients who underwent FAV and followed up for a median interval of 4.7 years. Interestingly no patient evolved to HLHS, 19 patients (55%) had a dilated LV, and 5 (16%) patients had a severely dilated LV.  The remodeled LV at last follow up showed normal LV in 12 (35%), mixed hypertrophy in 11 (32%), eccentric hypertrophy in 8 (24%), and concentric hypertrophy in 3 (9%).  Univariate factors associated with pathologic LV remodeling included long-standing AR, ³2 cardiac interventions, EFE resection, and aortic or mitral regurgitation ³ moderate at most recent follow-up. On multivariate analysis, only long-standing AR fraction remained associated with pathologic remodeling. Pathologic LV remodeling, likely due to myocardial fibrosis and endocardial fibroelastosis rather than hypertrophy as primary mechanisms, gives rise to diastolic dysfunction after FAV.

Take home points:

  1. Longstanding AR after FAV is a significant predictor for pathologic LV remodeling, primarily eccentric or mixed hypertrophy.
  2. Pathologic remodeling after FAV is associated with both systolic and diastolic dysfunction in this population.

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4. Systemic Embolic Complications of Pulmonary Vein Angioplasty in Children.

Esch JJ, Porras D, Bergersen L, Jenkins KJ, Marshall AC.

Pediatr Cardiol. 2015 Oct; 36(7):1357-62. doi: 10.1007/s00246-015-1165-x. Epub 2015 Apr 4.

PMID: 25835204

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Comment from Pr. Younes Boudjemline (Paris) and co-editor Dr. Mehul Patel (MSU, MI), editors of congenital heart disease interventions Journal Watch: Pulmonary vein stenosis (PVS), usually a progressive condition requiring multiple interventions for palliation, imposes a high burden of morbidity and mortality on affected children. Working on the systemic side carries a significant risk of thromboembolism and stroke. The authors reviewed 406 pediatric catheterizations in 144 patients involving PVS angioplasty and/or stent placement performed at Boston Children’s Hospital between July 2005 and February 2014. Eleven (2.7%) catheterizations were complicated by clinically apparent systemic embolic events, comprising 10 strokes (one with associated hepatic embolism) and 1 renal infarct. The prevalence of clinically evident stroke among this cohort was 7.6%. Using a prior (uncomplicated) catheterization as a control, the authors sought to identify potentially modifiable risk factors for systemic embolic events. Interestingly complicated and uncomplicated angioplasties did not appear to differ in case time, contrast dose, anticoagulation management, use of cutting balloons, number of catheter exchanges, or the size of the long sheath used. Significant nonembolic adverse events were common, occurring in 25% of catheterizations.

Take home points:

  1. Systemic embolism appears to inherently complicate PVS angioplasty at a rate much higher than that described for other congenital catheterizations.
  2. Unfortunately there are no modifiable or operator-dependent factors identified so far.
  3. Whether a cerebral protection device could reduce the risk of stroke is yet to be seen.

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CHD Interventions Articles of October 2015

  1. Retrograde transcatheter device closure of a complex paravalvular leak after bioprosthetic pulmonary valve replacement in a pediatric patient.

Chikkabyrappa S, Mosca RS, McElhinney DB.

Catheter Cardiovasc Interv. 2015 Oct 30. doi: 10.1002/ccd.26316. [Epub ahead of print]

PMID: 26514545

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  1. Evaluation of the Melody transcatheter pulmonary valve and Ensemble delivery system for the treatment of dysfunctional right ventricle to pulmonary artery conduits.

Asnes J, Hellenbrand WE.

Expert Rev Med Devices. 2015 Oct 29:1-13. [Epub ahead of print]

PMID: 26513599

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  1. Transcatheter occlusion of gigantic persistent ductus arteriosus (PDA) using a custom-made persistent ductus arteriosus occluder.

Tomita H, Bolormaa T, Haneda N.

Catheter Cardiovasc Interv. 2015 Oct 28. doi: 10.1002/ccd.26295. [Epub ahead of print]

PMID: 26508697

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  1. Retrograde percutaneous repair of aortic coarctation utilizing trans-septal puncture in patients with complex anatomy.

Misenheimer JA, Poommipanit P, Amin Z.

Catheter Cardiovasc Interv. 2015 Oct 28. doi: 10.1002/ccd.26165. [Epub ahead of print]

PMID: 26508264

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  1. Transcatheter closure of perimembranous ventricular septal defects with the Amplatzer Vascular Plug-II.

Hua N, Aquino P, Owada CY.

Cardiol Young. 2015 Oct 26:1-8. [Epub ahead of print]

PMID: 26498904

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  1. Percutaneous pulmonary valve implantation in a single artery branch: A preliminary experience.

Chessa M, Butera G, Giugno L, Micheletti A, Negura DG, Carminati M.

World J Cardiol. 2015 Oct 26;7(10):695-9. doi: 10.4330/wjc.v7.i10.695.

PMID: 26516424 Free PMC Article

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  1. Impact of Novel Balloon Catheter on Static Balloon Atrial Septostomy With Double Balloon Technique in Infants With Congenital Heart Disease.

Sugiyama H, Fujimoto K, Ishii T, Nakanishi T, Tomita H.

Circ J. 2015 Oct 23;79(11):2367-71. doi: 10.1253/circj.CJ-15-0480. Epub 2015 Aug 25.

PMID: 26310782 Free Article

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  1. Adjusting for Risk Associated with Pediatric and Congenital Cardiac Catheterization: A Report from the NCDR® IMPACTTM Registry.

Jayaram N, Beekman RH 3rd, Benson L, Holzer R, Jenkins K, Kennedy KF, Martin GR, Moore JW, Ringel R, Rome J, Spertus JA, Vincent R, Bergersen L.

Circulation. 2015 Oct 19. pii: CIRCULATIONAHA.114.014694. [Epub ahead of print]

PMID: 26481778

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  1. The Ongoing Evolution of Outcomes Analysis for Pediatric and Congenial Cardiac Catheterization.

Hill KD, Jacobs JP.

Circulation. 2015 Oct 19. pii: CIRCULATIONAHA.115.019132. [Epub ahead of print]

PMID: 26481777

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  1. Clinical Application of Superior Vena Cava Spectra in Evaluation of Pulmonary Hypertension: A Comparative Echocardiography and Catheterization Study.

Hou Y, Sun DD, Yuan LJ, Zhu XY, Shang FJ, Hou CJ, Duan YY.

Ultrasound Med Biol. 2015 Oct 16. pii: S0301-5629(15)00475-5. doi: 10.1016/j.ultrasmedbio.2015.07.029. [Epub ahead of print]

PMID: 26478279

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  1. Characteristics and safety of interventions and procedures performed during catheterisation of patients with congenital heart disease: early report from the national cardiovascular data registry.

Holzer R, Beekman R, Benson L, Bergersen L, Jayaram N, Jenkins K, Kennedy K, Moore J, Ringel R, Rome J, Vincent R, Martin GR.

Cardiol Young. 2015 Oct 12:1-11. [Epub ahead of print]

PMID: 26455737

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  1. Echocardiographic vs Invasive Measurement of the Direct Flow Transcatheter Aortic Heart Valve Mean Gradient: Contradictory or Complementary?

Panoulas VF, Latib A, Agricola E, Baumgartner H, Alfieri O, Colombo A.

Can J Cardiol. 2015 Oct;31(10):1303.e1-4. doi: 10.1016/j.cjca.2015.05.006. Epub 2015 May 18.

PMID: 26255214

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  1. Transcatheter pulmonary valve replacement: State of the art.

Holzer RJ, Hijazi ZM.

Catheter Cardiovasc Interv. 2015 Oct 1. doi: 10.1002/ccd.26263. [Epub ahead of print]

PMID: 26423185

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  1. Multiple and aggressive pulmonary vein transcatheter interventions as bridge to transplantation in primary diffuse pulmonary vein stenosis.

Bonello B, Trivedi KR, Fraisse A.

Catheter Cardiovasc Interv. 2015 Oct;86(4):E190-3. doi: 10.1002/ccd.25920. Epub 2015 May 27.

PMID: 26015092

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  1. Transcatheter balloon dilation for recurrent right ventricular outflow tract obstruction following valve-sparing repair of tetralogy of Fallot.

Gellis L, Banka P, Marshall A, Emani S, Porras D.

Catheter Cardiovasc Interv. 2015 Oct;86(4):692-700. doi: 10.1002/ccd.25930. Epub 2015 Apr 24.

PMID: 25914342

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  1. Hemodynamic and Hematologic Effects of Histotripsy of Free-Flowing Blood: Implications for Ultrasound-Mediated Thrombolysis.

Devanagondi R, Zhang X, Xu Z, Ives K, Levin A, Gurm H, Owens GE.

J Vasc Interv Radiol. 2015 Oct;26(10):1559-65. doi: 10.1016/j.jvir.2015.03.022. Epub 2015 May 4.

PMID: 25952642

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  1. Fate of Hypoplastic Pulmonary Arteries After Arterial Duct Stenting in Congenital Heart Disease With Duct-Dependent Pulmonary Circulation.

Santoro G, Gaio G, Capozzi G, Giugno L, Palladino MT, Capogrosso C, D’Aiello AF, Caianiello G, Russo MG.

JACC Cardiovasc Interv. 2015 Oct;8(12):1626-32. doi: 10.1016/j.jcin.2015.05.027. Epub 2015 Sep 17.

PMID: 26386761

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  1. Transcatheter Closure of Perimembranous Ventricular Septal Defects with Left Ventricular to Right Atrial Shunt.

Kerst G, Moysich A, Ho SY, Apitz C, Latus H, Schranz D.

Pediatr Cardiol. 2015 Oct;36(7):1386-92. doi: 10.1007/s00246-015-1170-0. Epub 2015 Apr 17.

PMID: 25894760

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  1. Transhepatic Central Venous Catheters in Pediatric Patients With Congenital Heart Disease.

Boe BA, Zampi JD, Yu S, Donohue JE, Aiyagari R.

Pediatr Crit Care Med. 2015 Oct;16(8):726-32. doi: 10.1097/PCC.0000000000000484.

PMID: 26132744

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  1. Spontaneous Thrombosis of a Left Circumflex Artery Fistula Draining Into the Coronary Sinus.

Al-Turki MA, Patton D, Crean AM, Horlick E, Dhillon R, Johri AM.

World J Pediatr Congenit Heart Surg. 2015 Oct;6(4):640-2. doi: 10.1177/2150135115577432.

PMID: 26467878

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  1. Endomyocardial biopsy safety and clinical yield in pediatric myocarditis: An Italian perspective.

Brighenti M, Donti A, Giulia Gagliardi M, Maschietto N, Marini D, Lombardi M, Vairo U, Agnoletti G, Milanesi O, Pongiglione G, Bonvicini M; Italian Society of Pediatric Cardiology.

Catheter Cardiovasc Interv. 2015 Oct 29. doi: 10.1002/ccd.26319. [Epub ahead of print]

PMID: 26510399

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  1. Minimal invasive lung support via umbilical vein with a double-lumen cannula in a neonatal lamb model: a proof of principle.

Schmidt F, Kuebler J, Ganter M, Jack T, Meschenmoser L, Sasse M, Boehne M, Bertram H, Beerbaum P, Koeditz H.

Pediatr Surg Int. 2015 Oct 28. [Epub ahead of print]

PMID: 26507850

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  1. Risk of Rupture or Dissection in Descending Thoracic Aortic Aneurysm.

Kim JB, Kim K, Lindsay ME, MacGillivray T, Isselbacher EM, Cambria RP, Sundt TM 3rd.

Circulation. 2015 Oct 27;132(17):1620-9. doi: 10.1161/CIRCULATIONAHA.114.015177. Epub 2015 Sep 2.

PMID: 26338955

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  1. Endovascular repair of pseudoaneurysms after open surgery for aortic coarctation.

Kotelis D, Bischoff MS, Rengier F, Ruhparwar A, Gorenflo M, Böckler D.

Interact Cardiovasc Thorac Surg. 2015 Oct 26. pii: ivv297. [Epub ahead of print]

PMID: 26503013 Free Article

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  1. Aortic iatrogenic perforation during transseptal puncture and successful occlusion with Amplatzer ductal occluder in a case of mitral paravalvular leak closure.

Mijangos-Vázquez R, García-Montes JA, Zabal-Cerdeira C.

Catheter Cardiovasc Interv. 2015 Oct 22. doi: 10.1002/ccd.26254. [Epub ahead of print]

PMID: 26489701

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  1. First case of blood-culture proven Staphylococcus aureus endocarditis of a Sapien® XT valve after percutaneous pulmonary valve implantation.

Vollroth M, Daehnert I, Kostelka M, Wagner R.

Eur J Cardiothorac Surg. 2015 Oct 7. pii: ezv332. [Epub ahead of print] No abstract available.

PMID: 26446262

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  1. Thrombus in the Aorta: Late Complication After Percutaneous Closure of Ruptured Sinus of Valsalva Aneurysm.

Sabiniewicz R, Meyer-Szary J, Siondalski P, Kołaczkowska M, Gałąska R.

JACC Cardiovasc Interv. 2015 Oct 6. pii: S1936-8798(15)01256-X. doi: 10.1016/j.jcin.2015.06.024. [Epub ahead of print] No abstract available.

PMID: 26476606

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  1. Evaluation of Primary Pulmonary Vein Stenosis in Children: Comparison of Radionuclide Perfusion Lung Scan and Angiography.

Drubach LA, Jenkins KJ, Stamoulis C, Palmer EL 3rd, Lee EY.

AJR Am J Roentgenol. 2015 Oct;205(4):873-7. doi: 10.2214/AJR.14.13581.

PMID: 26397339

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  1. Surgical and transcatheter management alternatives in refractory pulmonary hypertension: Potts shunt.

Kula S, Atasayan V.

Anatol J Cardiol. 2015 Oct;15(10):843-7. doi: 10.5152/AnatolJCardiol.2015.6447. Review.

PMID: 26477721 Free Article

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  1. Comparison of invasive and non-invasive pressure gradients in aortic arch obstruction.

Wisotzkey BL, Hornik CP, Green AS, Barker PC.

Cardiol Young. 2015 Oct;25(7):1348-57. doi: 10.1017/S1047951114002522. Epub 2015 Jan 20.

PMID: 25602135

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  1. Balloon angioplasty of the bilateral renal arteries by Takayasu arteritis with a paclitaxel-eluting balloon.

Hecht T, Esmaeili A, Behnke-Hall K.

Cardiol Young. 2015 Oct;25(7):1431-4. doi: 10.1017/S1047951114001930. Epub 2014 Oct 8.

PMID: 25296292

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  1. A Rare Anomaly: Recurrent Congenital Aorto-Azygos Fistula After Two Procedure of Transcatheter Occlusion.

Uysal F, Bostan OM, Cil E.

Cardiovasc Intervent Radiol. 2015 Oct;38(5):1356-8. doi: 10.1007/s00270-015-1067-6. Epub 2015 Mar 5. No abstract available.

PMID: 25737459

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  1. ADO II in Percutaneous VSD Closure in Pediatric Patients.

Narin N, Baykan A, Pamukcu O, Argun M, Ozyurt A, Mese T, Yilmazer MM, Gunes I, Kazım U.

J Interv Cardiol. 2015 Oct;28(5):479-84. doi: 10.1111/joic.12222. Epub 2015 Sep 8.

PMID: 26345701

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  1. Bioresorbable Vascular Scaffold Implantation for Successful Treatment of a Symptomatic Coronary Lesion in a 17-Year-Old Boy After Kawasaki Disease.

Luu B, Esmaeili A, Schranz D, Fichtlscherer S.

Pediatr Cardiol. 2015 Oct;36(7):1539-41. doi: 10.1007/s00246-015-1215-4. Epub 2015 Jun 11.

PMID: 26063383

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Select item 26024646

 

  1. Sedation and Anesthesia in Pediatric and Congenital Cardiac Catheterization: A Prospective Multicenter Experience.

Lin CH, Desai S, Nicolas R, Gauvreau K, Foerster S, Sharma A, Armsby L, Marshall AC, Odegard K, DiNardo J, Vincent J, El-Said H, Spaeth J, Goldstein B, Holzer R, Kreutzer J, Balzer D, Bergersen L.

Pediatr Cardiol. 2015 Oct;36(7):1363-75. doi: 10.1007/s00246-015-1167-8. Epub 2015 May 21.

PMID: 25991570

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Select item 25981566

 

  1. Incomplete RV Remodeling After Transcatheter ASD Closure in Pediatric Age.

Agha HM, El-Saiedi SA, Shaltout MF, Hamza HS, Nassar HH, Abdel-Aziz DM, Tantawy AE.

Pediatr Cardiol. 2015 Oct;36(7):1523-31. doi: 10.1007/s00246-015-1196-3. Epub 2015 May 17.

PMID: 25981566

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Select item 25981565

 

  1. Left Ventricular Remodeling and Function in Children with Biventricular Circulation After Fetal Aortic Valvuloplasty.

Friedman KG, Freud L, Escobar-Diaz M, Banka P, Emani S, Tworetzky W.

Pediatr Cardiol. 2015 Oct;36(7):1502-9. doi: 10.1007/s00246-015-1193-6. Epub 2015 May 15.

PMID: 25972285

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Select item 25972284

 

  1. Systemic Embolic Complications of Pulmonary Vein Angioplasty in Children.

Esch JJ, Porras D, Bergersen L, Jenkins KJ, Marshall AC.

Pediatr Cardiol. 2015 Oct;36(7):1357-62. doi: 10.1007/s00246-015-1165-x. Epub 2015 Apr 4.

PMID: 25835204

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Select item 25835203

 

 

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