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Newer self-expanding transcatheter pulmonary valves (TPVs) are approved for the treatment of severe pulmonary regurgitation in patients with large right ventricular outflow tracts. We present a patient with Tetralogy of Fallot whose right ventricular outflow tract was too large for self-expanding TPV, who was treated successfully with a self-expanding TPV in the right pulmonary artery. (Level of Difficulty: Advanced.).
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INTRODUCTION: Ventricular septal defect is the most common congenital heart defect. Surgical repair has been standard therapy for symptomatic ventricular septal defects since the 1950s. Catheter-based device closure of ventricular septal defects emerged in the 1980s and has become a safe and effective alternative in select patients. AREAS COVERED: This review focuses on patient selection and procedural techniques for device closure of ventricular septal defects, including percutaneous and hybrid perventricular approaches. The available devices used for these procedures and outcomes of their use are reviewed. EXPERT OPINION: Percutaneous and perventricular device closure of ventricular septal defects is safe and effective in select patients. However, the majority of ventricular septal defects requiring closure continue to be managed with conventional surgery. Further development and investigation of transcatheter and hybrid surgical approaches for closing ventricular septal defects is required.
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Procedimentos Cirúrgicos Cardíacos , Comunicação Interventricular , Dispositivo para Oclusão Septal , Humanos , Lactente , Procedimentos Cirúrgicos Cardíacos/métodos , Resultado do Tratamento , Ecocardiografia Transesofagiana , Desenho de Prótese , Comunicação Interventricular/cirurgia , Cateterismo CardíacoRESUMO
In infracardiac, infradiaphragmatic total anomalous pulmonary venous connection, all four pulmonary veins connect to a descending vertical vein that usually drains to the portal vein or one of its tributaries. Obstruction is common, and definitive treatment is surgical repair. We present a case of late-diagnosed infradiaphragmatic total anomalous pulmonary venous connection in a premature neonate who was too high risk for surgery and underwent palliative stenting of the venous duct. We demonstrate the feasibility of a transhepatic approach when umbilical access is no longer available.
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Veias Pulmonares , Síndrome de Cimitarra , Recém-Nascido , Humanos , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Veias Pulmonares/anormalidades , Síndrome de Cimitarra/cirurgia , Veia Porta , StentsRESUMO
Background: Covered stents are used during congenital cardiac interventions to treat stenotic or injured vessels or to exclude unwanted vascular connections. The ability to postdilate a stented vessel to keep pace with somatic growth is critical in children. In this study, we aimed to compare in vitro performance of 2 brands of covered stents during serial dilations to demonstrate the threshold for stent fracture and polytetrafluoroethylene tear and define recoil and foreshortening characteristics. Methods: iCast and VBX stents of various sizes were measured before and after expansion and through serial dilations. Dilations were performed at 2-mm increments until stent fracture, polytetrafluoroethylene tear, and "napkin-ring" formation, to a maximum of 22-mm diameter. Results: The 5- and 6-mm VBX stents fractured during dilation with 10-mm balloon; the 7-mm VBX stents fractured on the 14-mm balloon; and the largest VBX stents fractured on the 20- or 22-mm balloons. iCast stents experienced partial fracture during dilation with the 14- or 16-mm balloons and complete fracture past dilation with 16-mm balloons. VBX stents recoiled less at nominal diameters. Both stents had similar foreshortening at nominal diameters, although VBX stents had more significant foreshortening with postdilation. Conclusions: All iCast stents experienced partial fracture with dilation between 14- and 16-mm diameter and had unpredictable fracturing patterns. VBX stents showed a more predictable fracture pattern and had less recoil with nominal inflation but more foreshortening with postdilation. These findings may add clinical benefit and empower physicians to make optimal decisions regarding future planning of interventions in children with congenital heart disease.
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In select patients, transcatheter pulmonary valve replacement through a percutaneous approach can be challenging because of complicated anatomy or small patient size. In these patients, especially those weighing <20 kg, hybrid perventricular valve delivery may provide a preferred alternative approach. (Level of Difficulty: Intermediate.).
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OBJECTIVE: Although the electrocardiogram is commonly obtained in the evaluation of patients with pulmonary hypertension, its value as a screening test for right ventricular hypertrophy or pulmonary hypertension is unclear. Therefore, we sought to determine the value of an electrocardiogram in the diagnosis of right ventricular hypertrophy using echocardiography as the gold standard. METHODS: We identified children without congenital heart disease who underwent evaluation for suspected pulmonary hypertension that included both an electrocardiogram and echocardiography within a specified time frame. RESULTS: A total of 76 echocardiography-electrocardiogram pairs for pulmonary hypertension were identified. Although there was a significant relationship between electrocardiogram and echocardiography evidence of right ventricular hypertrophy, the sensitivity of an electrocardiogram in diagnosing echocardiography-documented right ventricular hypertrophy was only 69%, and the positive predictive value was 67%. There was no relationship between electrocardiogram changes and Doppler tricuspid regurgitation gradient. CONCLUSION: Despite a statistically significant relationship between an electrocardiogram and echocardiography in the diagnosis of right ventricular hypertrophy, an electrocardiogram has limited value as a screening tool for right ventricular hypertrophy because of its relatively low sensitivity and positive predictive value.
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Eletrocardiografia , Hipertrofia Ventricular Direita/diagnóstico , Adolescente , Criança , Pré-Escolar , Ecocardiografia , Feminino , Cardiopatias Congênitas , Humanos , Hipertensão Pulmonar/diagnóstico , Lactente , Masculino , Programas de Rastreamento , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
We report our experience in a 13-month-old boy undergoing transcatheter coil occlusion of a patent ductus arteriosus. Constriction of the ductus arteriosus with subsequent relaxation resulted in inadvertent coil embolization. This case report and review of the literature have implications for transcatheter treatment of persistent ductus arteriosus.
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Oclusão com Balão , Cateterismo Cardíaco , Permeabilidade do Canal Arterial/cirurgia , Vasoespasmo Coronário/complicações , Permeabilidade do Canal Arterial/diagnóstico por imagem , Ecocardiografia Doppler em Cores , Humanos , Lactente , Masculino , Falha de TratamentoRESUMO
Endomyocardial biopsy in children remains important in the evaluation of cardiomyopathy, myocarditis, and rejection following cardiac transplantation. We sought to evaluate the morbidity associated with endomyocardial biopsy on the basis of a large experience from a single institution. We reviewed records of all endomyocardial biopsies performed at our institution. Complications were defined as adverse events resulting from the biopsy requiring intervention or additional observation. We also reviewed the most recent echocardiogram from all the patients for the presence and severity of tricuspid valvar regurgitation. Between November 1986 and April 2002, we performed 1051 endomyocardial biopsies in 135 patients ranging in age from 9 days to 18 years. The internal jugular vein was the site of vascular access in 68% of the procedures. There were 10 acute procedural complications requiring intervention or additional observation. Severe tricuspid regurgitation developed in two patients who had undergone multiple biopsies after cardiac transplantation, one of whom underwent subsequent replacement of the tricuspid valve. There were no deaths or cardiac perforations. The total incidence of morbidity was 1.1%. No demographic or procedural factors were identified to be predictive of complications. In experienced hands, therefore, endomyocardial biopsy can be safely performed in children with very low morbidity.