Complex atrial septal defect closure in children.

Atrial septal defect (ASD) is one of the most common congenital heart diseases (CHDs) diagnosed in children. Symptoms in ASD may be absent, but palpitations and dyspnea in children sometimes reveal a complex structural and CHD. Diagnosis is established usually by transthoracic echocardiography, but in more complex cases such as coronary sinus defect, enhanced computed tomography or cardiac magnetic resonance may be used. Indication for closure depends on the dimension and on the hemodynamical impact. There are two methods for closure: surgical and interventional. Surgery may be applied to all types of ASD, while transcatheter closure may be used only for ostium secundum ASD. The most important issue in the interventional closure is the anatomical aspect related to the position of the defect. Both methods may have complications. Complex cases in children usually are not recommended for interventional closure, surgery being the recommended method. Oversizing of the device to be implanted according to the sizing balloon and not to the initial defect diameter may give a solution for large ASDs. Interventional closure of large defects in small children with an aneurysmal, multi-fenestrated, malaligned septum, or with other CHD associated may be challenging. Complications are present for both types of closure, but they are relatively different.

Cocoon devices for transcatheter closure of atrial septal defect and patent ductus arteriosus in children: Single center experience.

Closure of the atrial septal defect (ASD) and patent ductus arteriosus (PDA) are among the most frequent cardiac interventional procedures. This was a prospective study, which started together with the implementation of a national program of pediatric interventional cardiology in Romania. We used Cocoon devices in 83 consecutive cases from 92 implantations for ASD and PDA. 27 cases were ASD closure and 56 cases PDA closure. Regarding the ASD closure, the median age was 8.5 years (range 3-25 years) and median weight 25 kg (range 11.5-63 kg). The mean follow-up was 17.4 ±â€Š6.7 months (range 3-26 months). The mean ASD diameter by transesophageal echocardiography was 15.2 ±â€Š4.1 mm (range 8-26 mm). The mean device diameter used was 17.3 ±â€Š5.6 mm (range 8-32 mm). Regarding the PDA closure, the median age was 36 months (range 4-192 months) and median weight 14 kg (range 5-58 kg). The mean follow-up was 15 ±â€Š8 months (range 3-28 months). The mean PDA minimum diameter was 2.5 ±â€Š0.8 mm. The success implantation rate for both groups was 97.6% (2 cases of withdrawn for ASD and PDA), while the complication rate was 2.3% (including 2 ASD device embolization). In the first 24 hours, the closure rates were 96.3% for ASD, 98.2% for PDA, and 100% at 1-month follow-up for both procedures. On short and intermediate follow-up (3-28 months), no device-related complications were noted.The Cocoon devices are safe for transcatheter closure of both ASD and PDA, and the initial experience with their use in our emerging center is encouraging.

Scimitar syndrome associated with aberrant right subclavian artery, diaphragmatic hernia, and urinary anomalies - case report and review of the literature.

Scimitar syndrome is a form of a partially or totally right pulmonary venous return to the inferior vena cava, which may associate variably right lung hypoplasia, right pulmonary artery hypoplasia, pulmonary sequestration together with the presence of aortopulmonary collaterals from the descending aorta towards the right lung. In many cases, there are also other cardiac anomalies associated. We present a unique association of a partially anomalous pulmonary venous return to the inferior vena cava with other vascular and thoracic anomalies: inferior sinus venosus and secundum atrial septal defect, retroesophageal right subclavian artery, obstructed accessory right bronchus, diaphragmatic hernia with ectopic liver, "S"-type thoracic scoliosis and malformations of the urinary tract (duplication of the right ureter and of the left basinet). The patient had a reimplantation of the "scimitar" vein to the left atrium and closure of the inferior sinus venosus and secundum atrial septal defect.

Atretic aortic coarctation - transradial approach. Case series and review of the literature.

Stenting of aortic coarctation became the method of choice. In severe aortic coarctation, when retrograde crossing of the coarctation is impossible, a secondary approach with antegrade arterial crossing proved to be the solution in many cases. Here we report two cases of severe aortic coarctation in males aged 12 and 14, respectively, in which we used a secondary transradial approach (right and left) followed by guidewire snaring. For the first case, a right radial-right femoral arterio-arterial circuit was created, which offered a stable position during stent implantation. In both cases, we predilated the lesion and then implanted a 45 mm Cheatham-platinum (CP) covered stent. The final result was very good in both patients; only the first one required post-dilatation of both ends of the stent. Asymptomatic post-procedural absence of left radial pulse was noticed in the second case. In conclusion, even in the case of children, secondary transradial approach is suitable for antegrade crossing of the coarctation in extremely severe cases and possibly in stabilization of the circuit for stent implantation.