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

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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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  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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  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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  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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  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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  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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  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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  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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  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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  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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  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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  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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  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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  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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  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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  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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  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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  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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  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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  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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Select item 28396933

 

  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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