Safe closure of percutaneous ventricular access site for interventions in structural heart disease.

Percutaneous transapical ventricular access for transcatheter procedures in structural heart disease is associated with an increased risk of bleeding from the access site. There are currently numerous suture and sutureless closure devices that are being investigated to close the transapical access site safely and effectively. Meticulous preprocedural planning with advanced imaging techniques is recommended to lay out the access path and closure of the transapical access site.

Postinfarction ventricular septal rupture: Transcatheter intervention or surgical repair?

Postinfarction ventricular septal rupture is an infrequent but potentially fatal complication of acute myocardial infarction. The 30-day mortality rate with the transcatheter approach when performed in the acute phase (<2 weeks) was 25.3% compared to 50% when surgery is performed in the acute phase (within 3 weeks). There is no correlation between defect size and mortality. New York Heart Association class IV and time to ventricular septal defect closure are risk predictors for transcatheter closure for a 30-day mortality rate of 31.5%.

A randomized controlled laboratory study on the long-term effects of methylphenidate on cardiovascular function and structure in rhesus monkeys.

BACKGROUND: Whether long-term methylphenidate (MPH) results in any changes in cardiovascular function or structure can only be properly addressed through a randomized trial using an animal model which permits elevated dosing over an extended period of time. METHODS: We studied 28 male rhesus monkeys (Macaca mulatta) approximately 7 years of age that had been randomly assigned to one of three MPH dosages: vehicle control (0 mg/kg, b.i.d., n = 9), low dose (2.5 mg/kg, b.i.d., n = 9), or high dose (12.5 mg/kg, b.i.d., n = 10). Dosage groups were compared on serum cardiovascular and inflammatory biomarkers, electrocardiograms (ECGs), echocardiograms, myocardial biopsies, and clinical pathology parameters following 5 years of uninterrupted dosing. RESULTS: With the exception of serum myoglobin, there were no statistical differences or apparent dose-response trends in clinical pathology, cardiac inflammatory biomarkers, ECGs, echocardiograms, or myocardial biopsies. The high-dose MPH group had a lower serum myoglobin concentration (979 ng/mL) than either the low-dose group (1882 ng/mL) or the control group (2182 ng/mL). The dose response was inversely proportional to dosage (P = .0006). CONCLUSIONS: Although the findings cannot be directly generalized to humans, chronic MPH exposure is unlikely to be associated with increased cardiovascular risk in healthy children.

Transcatheter Intervention for Treatment of Coronary Stenosis After Unroofing of the Anomalous Left Coronary Artery.

Anomalous origin of left coronary artery (LCA) from the right coronary cusp with an intramural course is usually managed with unroofing of the intramural segment. Available literature demonstrates an uneventful course following surgery in most patients. Coronary stenosis following the unroofing procedure treated with percutaneous coronary intervention has not been described in the past. We describe a case where an 11-year-old girl with anomalous origin of the LCA from the right coronary cusp presented with near syncope. Surgical unroofing of the intramural segment was done without any post-operative complications and the patient remained asymptomatic for 9 months. She then presented with chest pain, abnormal troponin levels, and ST-T wave changes on EKG. A CT angiogram done revealed short segment narrowing of the LCA near its origin. Cardiac catheterization with coronary angiography demonstrated short segment narrowing of the LCA just distal to origin. Stenting of the left main coronary artery was done with a drug eluting stent. She underwent the procedure without complications. The patient continued to be asymptomatic 16 months after placement of the stent and there was no residual stenosis seen on a repeat CT angiogram at 3 months after the procedure.

Transmyocardial migration of a temporary epicardial pacing wire: a pediatric case report.

Transmyocardial migration of a retained temporary epicardial pacing wire has been rarely reported in adult patients after heart surgery. We present the case of a child in whom a temporary epicardial pacing wire was discovered incidentally in the right ventricular outflow tract one year after surgical repair of congenital heart disease. The pacing wire was subsequently extracted using the snare method during cardiac catheterization. Clinicians caring for patients after congenital heart surgery should be aware of this uncommon though potentially life-threatening complication.

Effects of controlled antegrade pulmonary blood flow on cardiac function after bidirectional cavopulmonary anastomosis.

BACKGROUND: Bidirectional cavopulmonary anastomosis (BCPA) has been used as an intermediate stage in the treatment of patients with single-ventricle physiology. Leaving additional antegrade pulmonary blood flow has been shown to improve postoperative arterial blood oxygen saturations; however, controversy continues over whether the potential increase in systemic venous pressure is detrimental. We studied the effects of controlled antegrade pulmonary blood flow on cardiac function in patients after BCPA. METHODS: From January 1993 to July 2000, 128 patients underwent BCPA. Mean age at operation was 6.2 +/- 4 months (range 2 to 36 months). In group 1 (n = 72), restricted antegrade pulmonary blood flow was maintained through a native narrowed pulmonary valve or by adjustment of previously placed pulmonary artery band with the goal of maintaining the mean pulmonary artery pressure less than 16 mm Hg. In group 2 (n = 56), BCPA was the only source of pulmonary blood flow. RESULTS: One hospital death (0.8%) occurred. The mean pulmonary artery pressure at the end of the operation was 13 +/- 2 mm Hg in group 1 compared with 12 +/- 2 mm Hg in group 2, a difference that was not significant. Patients in group 1 had higher arterial oxygen saturations (84% +/- 3% compared with 74% +/- 3% in group 2, p < 0.05), and shorter mean hospital stay (9 +/- 3 days compared with 15 +/- 2 days, p < 0.05). Persistent pleural effusion (> 10 days) or late chylothorax occurred in 4 patients from group 1 and 3 from group 2, a difference that was not significant. During a mean follow-up of 36 +/- 10 months no late deaths occurred. The mean oxygen saturation remained higher in group 1, 80% +/- 3% compared with 74% +/- 4% in group 2, and the hematocrit was lower, at 38% +/- 3% compared with 46% +/- 4% (p < 0.05 for both comparisons). Cardiac catheterizations were performed in 68 patients before completion Fontan. Total pulmonary artery (Nakata) index was 263 +/- 34 mm(2)/m(2) in group 1 (n = 40) and 188 +/- 13 mm(2)/m(2) in group 2 (n = 28) (p < 0.05). The mean pulmonary artery pressure and mean ventricular end-diastolic pressure were similar. CONCLUSIONS: Controlled antegrade pulmonary blood flow may have favorable effects on cardiac function for a selected group of patients and does not appear to have adverse effects on subsequent suitability for completion Fontan.