Percutaneous Closure of Hemodynamically Significant Postoperative Residual Ventricular Septal Defects.

The experience with percutaneous closure of postoperative residual ventricular septal defects (VSDs) is expanding with improved device technology and techniques. To report our experience with percutaneous closure of residual VSDs after cardiac surgeries. Retrospective clinical data review of patients who had percutaneous closure of postoperative residual VSDs at our institution between 2010 and 2022. Patients' demographics, procedural, and follow-up data were looked at. Twelve patients (50% males) with a median age of 9.2 years (range 0.9-22) were identified. Baseline surgeries were 8 tetralogy of Fallot corrections, 2 pulmonary bandings for large muscular VSD (mVSD) including 1 coarctation repair, 1 atrioventricular septal defect repair, 1 sub-aortic membrane resection-induced iatrogenic VSD, 1 isolated VSD closure, and 1 additional mVSD. Median duration between baseline surgery and percutaneous VSD closure was 2.2 years (range 0.2-8.3). Residual VSD shunting was secondary to surgical patch leakage in 8/12 patients. The median angiographic defect diameter was 6.8 mm (range 4.8-14). The defect was balloon-calibrated in 3/12 patients. Defects were tackled retrogradely in 3/9 patients. Amplatzer Membranous VSD occluder (n = 1), Lifetech Multifunctional (n = 5), Membranous (n = 1) and muscular VSD occluders (n = 2) and Occlutech Membranous (n = 1) and Muscular (n = 2) VSD occluders were used. The procedure was successful in 10/12 patients. Two devices embolized to the pulmonary artery and were snare-retrieved. Both patients were referred for surgery. The median follow-up was 1.3 years (range 0.1-12). Six-month ultrasound showed one trivial residual shunt and one mild right ventricular outflow obstruction. One patient is receiving targeted therapy for pulmonary hypertension at 2 years of follow-up. Transcatheter closure of postoperative residual VSDs is a feasible yet challenging intervention. Procedural complications can be encountered.

Piccolo in transcatheter PDA closure multi-centre study from premature to adolescent children.

In this multi-centre study, the mid- to long-term efficacy and safety of the Amplatzer Piccolo Occluder in patent ductus arteriosus closure in premature and term infants as well as children were discussed. Methods. Between 2016 and 2021, 645 patients, 152 of whom were less than 1 month old, underwent ductus closure with the Piccolo device from five different centres in Turkey. The median age of the patients was 2.2 years, and the mean narrowest point of duct diameter was 1.8 mm. Sixty-two patients weighed ≤ 1.5 kg, 90 patients 1.5-3 kg, and the mean follow-up was 20.4 months. In 396, the duct was closed by the retrograde route. Ductal anatomy was Type A in 285, C in 72, E in 171, and F in 64 patients. Fluoroscopy duration was 6.2 min. The procedure success rate was 99.1%. Device embolisation occurred in 13 patients (2%), and 11 were retrieved with a snare. Cardiac perforation and death developed in one premature baby. The left pulmonary artery and the descending aorta stenosis were observed in 3 (0.4%) and in 5 patients (0.5%). Results. Piccolo device is safe and effective in closing ductus in all age groups. It has low profile for use in premature and newborn babies, a small embolisation risk, and a low residual shunt rate after closure. Conclusion. The Piccolo device can be considered as close an ideal occluder. The lower profile, smaller delivery catheter size, and symmetry of this device allow for a venous or arterial approach.

A rare giant congenital left atrial appendage aneurysm in a 1-day-old newborn.

Congenital left atrial appendage aneurysm (LAAA) is a very rare condition and occurs as a result of congenital dysplasia of musculi pectinate. These patients may be asymptomatic and/or may present with dyspnea, and thromboembolic events. The most common complications are life-threatening thromboembolic events and supraventricular tachyarrhythmias. Transthoracic echocardiography plays a very important role in the diagnosis of LAAA. Herein, we present a rare case of giant congenital LAAA.

Mitral arcade: A rare case presenting with fatigue and cough.

An 11-year-old girl was admitted to pediatric emergency unit with complaints of fatigue and cough. The patient had no previous complaints. There was no history of rheumatic heart disease. The height and duration of the P-wave was 4 mm and 0.16 seconds, respectively (p mitrale). Echocardiography showed enlarged left atrium (51×61 mm in diameter). Both the anterolateral and posteromedial papillary muscles were directly attached to the anterior and posterior mitral valve leaflets without tendinous chords. The patient was diagnosed with mitral arcade, severe mitral stenosis, and mitral regurgitation. The patient was referred to surgery for replacement of mitral valve.

Evaluation of P-Wave Dispersion, Diastolic Function, and Atrial Electromechanical Conduction in Pediatric Patients with Subclinical Hypothyroidism.

AIM: This study aimed to evaluate ventricular diastolic dysfunction, inter- and intraatrial conduction delay, and P-wave dispersion in pediatric patients with subclinical hypothyroidism. METHODS: The study comprised a total of 30 pediatric patients with subclinical hypothyroidism (SH) (mean age 7.8 ± 3.2 years) and 30 healthy children (mean age 8.4 ± 3.6 years) as the control group. A SH diagnosis was made in the event of increased serum thyroid-stimulating hormone (TSH) and decreased serum free triiodothyronine (T3 ) and free thyroxine (T4 ) concentrations. RESULTS: Conventional Doppler imaging (TDI) showed low mitral early diastolic E-wave velocity and E/A ratio (P < 0.001) and significantly higher mitral late diastolic A-wave velocity (P = 0.001) in hypothyroidism patients. Moreover, patients with hypothyroidism had significantly lower left ventricular (LV) septal Em velocity and Em /Am ratios compared with the control group (P < 0.001), whereas Am velocity was higher in hypothyroidism patients (P = 0.018). LV lateral Em velocity and Em /Am ratio were significantly lower in patients with hypothyroidism compared with the control group (P < 0.001). With regard to atrial electromechanical conduction, atrial electromechanical delay (PA) lateral, PA septum, PA tricuspid, and each of interatrial and intraatrial conduction delay were significantly prolonged in hypothyroidism patients as compared with the control group (P < 0.001, P < 0.001, P = 0.023, P = 0.002, and P = 0.003, respectively). P-wave dispersion was significantly different in the pediatric patients with hypothyroidism (P < 0.001). CONCLUSION: This study demonstrated atrial electromechanical conduction delay, abnormal P-wave dispersion, and ventricle diastolic dysfunction in pediatric patients with hypothyroidism.

The Effect of Transcatheter Atrial Septal Defect Closure on Left Heart Function in Pediatric Patients.

OBJECTIVE: The aim of this study was to use tissue Doppler imaging to evaluate the left atrial systolic and the left ventricular (LV) diastolic function as well as the left atrial ejection force in children who underwent transcatheter closure of a secundum atrial septal defect (ASD). METHODS: Tissue Doppler measurements of the left atrial ejection force, the mitral valve, and left atrial volume were performed before the ASD closure procedure, and on the 1st day, 10th day, and 1st and 3rd months after the procedure in 56 patients and in 28 healthy controls. RESULTS: There was a significant decrease in the septal and lateral a' velocities on the first day (p<0.05). There was a statistically significant increase in the septal e'/a' parameters at the third month compared with the initial measurements. The left atrial ejection force was lower in patients with an ASD than in the healthy group (10.69±4.94 kdyn, 12.31±4.05 kdyn, respectively), but there was no significant difference (p=0.053). The left atrial ejection force was significantly greater in the patient group 3 months after the procedure, and there was no significant difference compared with the control group. CONCLUSION: Improvement in the LV diastolic and left atrial systolic functions was observed in children who underwent transcatheter closure of an ASD. There was no negative effect related to the devices used.

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.

OBJECTIVE: We prospectively investigated the neoendothelialization of transcatheter secundum atrial septal defect (ASD) closure in children receiving one of three different occluders. METHODS: Transcatheter ASD closure was performed for 44 children. The patients were divided into three groups: group I: Amplatzer, group II: Lifetech CeraFlex, and group III: Occlutech Figulla Flex II septal occluder. The data were prospectively analyzed. Markers of the three phases of wound healing were studied in all patients before and on the 1st and 10th days and 1st month post intervention. RESULTS: The mean age of children was 7.08±3.51 years, and the mean weight was 26.07±15.07 kg. The mean ASD diameter was 12.65±3.50 mm. Groups I, II, and III comprised 34.1%, 31.8%, and 34.1% patients, respectively. No significant differences were observed between the groups regarding patient number, age, defect size, device diameter, or total septum/device ratio (p>0.05). Inflammatory and proliferative phase marker levels increased following the procedure (p<0.05). However, scar formation markers did not change after 1 month. No significant differences in neoendothelializaton were observed among the different occluders (p>0.05). CONCLUSION: All three devices were composed of nitinol with different surface coating techniques. Although the different manufacturing features were claimed to facilitate of neoendothelialization, no differences were observed among the three devices 1 month following the procedure.