Novel use of a mechanical suction thrombectomy system for interposition graft occlusion in complex congenital heart disease.

Complete thrombosis of a pulmonary artery interposition graft in an adolescent with complex repaired CHD was treated successfully with a combination of a novel mechanical thrombectomy system, stent implantation, and thrombolysis. This thrombectomy system used a flexible catheter with a built-in mechanism to attenuate blood loss, while providing effective recanalisation of a foreign graft.

Anxiety reduction after pre-procedure meetings in patients with CHD.

BACKGROUND: Cardiac catheterisations for CHD produce anxiety for patients and families. Current strategies to mitigate anxiety and explain complex anatomy include pre-procedure meetings and educational tools (cardiac diagrams, echocardiograms, imaging, and angiography). More recently, three-dimensionally printed patient-specific models can be added to the armamentarium. The purpose of this study was to evaluate the efficacy of pre-procedure meetings and of different educational tools to reduce patient and parent anxiety before a catheterisation. METHODS: Prospective study of patients ≥18 and parents of patients <18 scheduled for clinically indicated catheterisations. Patients completed online surveys before and after meeting with the interventional cardiologist, who was blinded to study participation. Both the pre- and post-meeting surveys measured anxiety using the State-Trait Anxiety Inventory. In addition, the post-meeting survey evaluated the subjective value (from 1 to 4) of individual educational tools: physician discussion, cardiac diagrams, echocardiograms, prior imaging, angiograms and three-dimensionally printed cardiac models. Data were compared using paired t-tests. RESULTS: Twenty-three patients consented to participate, 16 had complete data for evaluation. Mean State-Trait Anxiety Inventory scores were abnormally elevated at baseline and decreased into the normal range after the pre-procedure meeting (39.8 versus 31, p = 0.008). Physician discussion, angiograms, and three-dimensional models were reported to be most effective at increasing understanding and reducing anxiety. CONCLUSION: In this pilot study, we have found that pre-catheterisation meetings produce a measurable decrease in patient and family anxiety before a procedure. Discussions of the procedure, angiograms, and three-dimensionally printed cardiac models were the most effective educational tools.

Improvement in Pulmonary Vascular Resistance After Relief of Fontan Circuit Obstruction.

OBJECTIVES: Patients with single-ventricle congenital heart disease undergo staged surgical palliations leading to a final Fontan procedure. After Fontan, cardiac index (CI) is primarily determined by pulmonary vascular resistance (PVR). Lower Fontan pressure has been achieved after relieving obstruction within the Fontan circuit, but to date the effect on PVR has not been quantified. We hypothesized that there would be significant reduction in PVR after relief of obstruction within the Fontan circuit; the purpose of this study is therefore to describe the change in PVR after relief of Fontan obstruction. METHODS: Retrospective, single-center review of post-Fontan patients who underwent cardiac catheterization with hemodynamics, pulmonary vasodilator testing, and stenting of Fontan circuit obstructions from October 2016 to August 2019. Baseline hemodynamics were obtained on 21% fraction of inspired oxygen (FiO2), followed by administration of 80 ppm inspired nitric oxide (iNO) with repeat hemodynamics. After stenting of Fontan obstructions, hemodynamics were repeated on 21% FiO2. Patient demographics, hemodynamics, CI, and PVR were compared. RESULTS: Twelve patients underwent stenting of Fontan circuit obstructions. There was complete relief of gradient and angiographic obstruction after stent placement in all patients. There was larger decrease in PVR after stent placement compared with iNO administration (32.1% vs 19.3%, respectively; P=.03). CONCLUSIONS: This case series provides novel data quantifying the decrease in PVR after relief of Fontan circuit obstruction, suggesting a mechanism for symptomatic improvement after intervention. These data are a compelling addition to the longterm management of this complex patient population.

Treatment and Complications of Patients With Ipsilateral Acetabular and Femur Fractures: A Multicenter Retrospective Analysis.

OBJECTIVES: The purpose of this study was to review the treatment of patients with ipsilateral acetabular and femur fractures to provide descriptive demographic data, injury pattern classification, treatment, and evaluate the complication profile reflective of current practices. STUDY DESIGN: Multicenter retrospective cohort. SETTING: Eight Level 1 Trauma Centers. PATIENTS/PARTICIPANTS: One hundred one patients met inclusion criteria. INTERVENTION: Surgical treatment of both the acetabular and femur fractures. MAIN OUTCOME MEASUREMENTS: The complications evaluated include avascular necrosis, heterotopic ossification, posttraumatic arthritis, deep venous thrombosis, pulmonary embolism and superficial/deep infection, fracture union, and secondary surgeries. RESULTS: Forty-three patients had 31 type fractures (29A; 11B, and 3C), 60 had 32 type (37A, 8B; 15C), and 8 had 33 type (1A, 4B, 3C) femur fractures; 10 patients had combinations involving more than 1 femur fracture pattern. There were 35 62A type fractures, 47 62B, and 19 62C acetabular fractures. Age of 45 or older was associated with marginal impaction (P = 0.001). The aggregate infection rate was 17%. More than 30% of patients required secondary surgeries. The rate of avascular necrosis was higher in acetabular fractures combined with proximal femur fractures (P < 0.05). The rate of deep venous thrombosis was associated with increased age and time to surgical fixation (P < 0.05). CONCLUSIONS: We report the largest review of the surgical treatment and complications of ipsilateral acetabular and femoral fractures. This study provides useful information regarding the complications and provides some treatment recommendations regarding these injuries. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.