Novel Uses of the SwiftNinja Steerable Microcatheter for Pediatric Cardiovascular Interventions.

In the present era, the intricacy of procedures undertaken by a pediatric interventional cardiologist has increased, primarily attributed to dealing with smaller, younger patients with more complex anatomies. To adapt to these smaller and more complex patients, we must adapt our interventions and our equipment to perform these procedures. This article outlines various innovative applications of the SwiftNinja steerable microcatheter within the pediatric cardiac catheterization laboratory.

Transcatheter knocking of a stuck mechanical tricuspid valve.

Immobilisation of mechanical valve leaflets can be a life-threatening complication. In the acute setting, medical therapy can be attempted but is not always successful. We present the first described case of a patient with a mechanical tricuspid valve with recurrent leaflet immobilisation that was able to be mobilised using a transcatheter knocking technique.

Right atrial thrombus removal with use of the ONO retrieval device.

Intracardiac masses and specifically right atrial thrombi can be difficult to manage and carry a high mortality rate. Typically, surgical removal or mechanical thrombectomy can be performed though may not be suitable for all patients. We present a unique case of a sickle cell patient with a large pedunculated right atrial thrombus that was successfully extracted using the novel ONO Retrieval Device.

Use of mechanical thrombectomy in very early-onset inflammatory bowel disease patient with extensive venous thrombosis.

Mechanical thrombectomy is generally used in adult patients with pulmonary embolism or extensive venous thromboembolism, but it is starting to become more prevalent in the children. We present a unique case of a 3-year-old female with very early-onset inflammatory bowel disease with extensive venous thromboembolism who underwent successful mechanical thrombectomy.

Retrograde Pulmonary Valve Perforation and Stenting through a Major Aorto-Pulmonary Collateral Artery.

Management of pulmonary atresia, ventricular septal defect with major aorto-pulmonary collateral arteries, and hypoplastic native pulmonary arteries focuses on growth of the native pulmonary arteries. One strategy to grow the native pulmonary arteries is through pulmonary valve perforation followed by right ventricular outflow tract stenting, if suitable. We present a unique case of retrograde pulmonary valve perforation and stenting of the right ventricular outflow tract through a major aorto-pulmonary collateral artery.

Transcatheter Melody Valve Placement in a Native Right Atrioventricular Valve in a Pediatric Patient.

Transcatheter tricuspid valve placement in congenital heart disease is becoming increasingly used when a previously placed surgical ringed valve becomes dysfunctional. Surgically repaired and/or native tricuspid inflows are generally not amenable to transcatheter valve placement without a prior ring being placed. We present the second pediatric case to our knowledge of transcatheter tricuspid valve placement in a surgically repaired tricuspid valve in the absence of a ring.

A Biologically Degradable and BioseniaticTM Feedstock for the High-Quality 3D Printing of Anatomical Models.

A Poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHHx) -based filament was evaluated as an alternative feedstock for Fused Deposition Modeling (FDM) of instructional and clinical medical specimens. PHBHHx-based prints of domestic cat vertebrae, skull bone, and an aortic arch cast were found comparable to conventional materials. PHBHHx-based filament and extrudate samples were evaluated for biological degradability, to meet the BioseniaticTM standard, defined by the University of Georgia New Materials Institute. Both samples achieved more than 90% mineralization within 32 days in industrial composting conditions.

Renal Function After Transcatheter Piccolo Patent Ductus Arteriosus Closure With Contrast Angiography in Extremely Premature Infants.

Transcatheter patent ductus arteriosus (PDA) device closure is increasingly performed in extremely premature infants. Contrast angiography improves the procedural safety and effectiveness by precise anatomic delineation. Contrast nephropathy is a concern in clinically ill premature infants, especially with the presence of renal insufficiency. We hypothesized that the benefit of transcatheter PDA closure outweighs the harm of contrast nephropathy in extremely premature infants. A total of 160 infants underwent successful transcatheter (n = 59) and surgical (n = 101) PDA closure at a median age of 26 (7 to 78) days. The surgical group had a lower procedural weight (870 vs 960 g, p = 0.014). In the transcatheter group, serum creatinine decreased from 0.48 to 0.45 mg/100 ml at 24 hours (p = 0.003, n = 59) and decreased further to 0.37 mg/100 ml at 5 to 7 days after closure (p <0.001). Median contrast amount was 1.9 ml/kg (0.6 to 6.1). In 8 infants with pre-existing renal insufficiency who underwent transcatheter closure, serum creatine significantly improved from 1.44 to 1.36 mg/100 ml at 24 hours and 0.79 mg/100 ml at 5 to 7 days after closure (p <0.001). There was no difference in improvement of serum creatinine between transcatheter and surgical closure groups. In conclusion, despite the use of contrast, serum creatinine significantly improved with transcatheter PDA closure even in infants with pre-existing renal insufficiency. Contrast angiography should not be discouraged for transcatheter PDA closure because of the concern for contrast nephropathy in extremely premature infants.

Arrhythmogenic right ventricular cardiomyopathy presenting as heart failure in a child.

Arrhythmogenic right ventricular cardiomyopathy is an uncommon diagnosis in the paediatric population, most commonly presenting with arrhythmia. We report an 11-year-old male presenting with right heart failure due to biventricular systolic dysfunction found to have arrhythmogenic right ventricular cardiomyopathy with de novo Desmin and MYH7 mutations.

Transjugular venous approach for Piccolo patent ductus arteriosus closure in a 1.4 kg infant.

Transfemoral venous approach is the standard method for transcatheter patent ductus arteriosus closure using the Amplatzer Piccolo patent ductus arteriosus occluder in small infants. We report a 1.4 kg infant who underwent transcatheter Piccolo patent ductus arteriosus closure. Transjugular venous approach was taken due to the unexpected finding of interrupted inferior vena cava.

Transcatheter mechanical thrombectomy of neonatal occlusive aortic thrombus using an Amplatzer Piccolo PDA occluder.

Neonatal aortic thrombus is a rare and critical condition that can present mimicking severe coarctation of the aorta or interrupted aortic arch. Transcatheter thrombectomy for this lesion has not been well described. We report a premature neonate with an occlusive proximal descending aorta thrombus, who underwent transcatheter mechanical thrombectomy using an Amplatzer Piccolo PDA occluder (Abbott, North Chicago, IL, USA). The procedure was successful with no subsequent distal thromboembolic events.

Pericardiocentesis in children: 20-year experience at a tertiary children's hospital.

BACKGROUND: Pericardiocentesis is the invasive percutaneous procedure for acute and chronic excessive accumulation of pericardial fluid. There is a paucity of data on the effectiveness and safety of pericardiocentesis in children. OBJECTIVES: To evaluate the effectiveness and safety of pericardiocentesis and factors associated with acute procedural failure and adverse events. METHODS: This was a single-centered retrospective study to describe all the children aged ≤20 years who underwent pericardiocentesis. Data on demographics, etiologies of pericardial effusion, and repeat intervention at follow-up were collected. RESULTS: A total of 127 patients underwent 153 pericardiocentesis. The median age was 6.5 years (1 day-20 years) with weight of 17 kg (0.5-125). Most common etiology was post-pericardiotomy syndrome (n = 56, 44%), followed by infectious (12%), malignant (10%), and iatrogenic (9%). Pericardiocentesis was performed more commonly in the catheterisation laboratory (n = 86, 59%). Concurrent pericardial drain placement was performed in 67 patients (53%). Acute procedural success was 92% (141/153). Repeat intervention was performed in 33 patients (22%). The incidence of adverse events was 4.6% (7/153): hemopericardium requiring emergent surgery (n = 2); hemopericardium with hypotension (n = 2); seizure with anesthesia induction (n = 1); and right ventricle puncture with needle (n = 2). Pericardiocentesis at the bedside had a higher rate of acute procedural failure than that in the catheterisation lab (17 versus 1%, p < 0.01). No identifiable risk factors were associated with adverse events. CONCLUSIONS: Pericardiocentesis was life-saving in children with its high effectiveness and safety even in urgent situations. Although initial pericardiocentesis was effective, one of five patients required re-intervention for recurrent pericardial effusion.

Diagnostic transcatheter aspiration for pulmonary artery tumor embolism using an INARI Triever aspiration catheter.

Pulmonary artery tumor embolism is a rare phenomenon and its diagnosis is important because of a poor prognosis. We report a 20-year-old male with history of metastatic osteosarcoma who presented with acute pulmonary embolism. He was urgently taken to the catheterization laboratory and underwent transcatheter aspiration of pulmonary artery mass using an INARI Triever aspiration catheter. Pathology of the aspirated specimen lead to the diagnosis of pulmonary artery tumor embolism, not thrombus. This case highlights the diagnostic utility of transcatheter aspiration for the pulmonary artery tumor embolism.

Left Transjugular Venous Approach for Transcatheter Pulmonary Valve Implantation using Sapien Valve.

Transfemoral and right transjugular approach has been described for transcatheter pulmonary valve implantation (TPVI). However, the use of left transjugular approach through the left superior vena cava to coronary sinus has not been well described. We present a 22-year-old male with Tetralogy of Fallot status post transannular patch, who underwent successful TPVI using the Sapien valve, preceded by pre-stenting of native right ventricular outflow tract. All the transcatheter intervention was performed through the left superior vena cava to coronary sinus.

Membranous septal aneurysm causing severe right ventricular outflow obstruction in an adult with trisomy 18.

Membranous ventricular septal aneurysm is a known entity but rarely causes severe right ventricular outflow obstruction. We report a 40-year-old female with trisomy 18 who developed severe right ventricular outflow obstruction caused by an enormous membranous septal aneurysm associated with unrepaired inlet ventricular septal defect with perimembranous extension.

Sustained ventricular tachycardia in a paediatric patient with acute COVID-19 myocarditis.

Although rare, children with active coronavirus disease 2019 are at risk of developing malignant arrhythmia. Herein, we present the first paediatric case of refractory ventricular tachycardia from acute fulminant myocarditis secondary to acute COVID-19 infection. This 5-year-old boy required venoarterial extracorporeal membrane oxygenation support, but made a complete recovery without significant morbidity.

Use of Mullins sheath to prevent prolapse of Gore Cardioform ASD Occluder in a child with severe scoliosis.

Transcatheter device closure of an atrial septal defect (ASD) may require an additional supportive technique in challenging cases. We report a 15-year-old male with moderate-sized ASD and severe scoliosis. In spite of adequate positioning of the Gore Cardioform ASD occluder, the device was pulled into the right atrium by a retrieval cord due to the acute release of strong tension between the delivery catheter and its device upon locking. This phenomenon was prevented by the use of Mullins sheath, resulting in a successful release of the device. The use of a Mullins sheath may be considered to deliver a Gore Cardioform ASD device in selected cases.

Single center experience of pediatric percutaneous balloon pericardiotomy.

BACKGROUND: Percutaneous balloon pericardiotomy is a percutaneous procedure that creates a window in the parietal pericardium by balloon dilation. The use of percutaneous balloon pericardiotomy has not been reported well in children. OBJECTIVES: The objective of this study was to describe the single centre experience of percutaneous balloon pericardiotomy in children. METHODS: This was a retrospective study to describe all the children aged <20 years undergoing percutaneous balloon pericardiotomy during an 18-year period (2001-2019). Patient characteristics, technical and ultimate procedural success, and repeat interventions were collected. RESULTS: A total of 13 percutaneous balloon pericardiotomy's were performed in 11 children at the median age of 12 years (range 1.8-19). The etiologies of pericardial effusion were post-pericardiotomy syndrome (n = 4), restrictive cardiomyopathy (n = 1), autoimmune diseases (n = 3), malignancy (n = 2), and idiopathic (n = 1). Two patients received two percutaneous balloon pericardiotomy. The technical success of percutaneous balloon pericardiotomy was 100% with no acute adverse events (balloon rupture or local bleeding). Five (45%) required re-intervention and ultimately three required a surgical pericardial window 6 to 35 days after the percutaneous balloon pericardiotomy. As a result, ultimate procedural success rate was 73% (8/11). CONCLUSION: Percutaneous balloon pericardiotomy was performed safely with high technical success in children. Percutaneous balloon pericardiotomy may be considered for recurrent and persistent pericardial effusion, before considering a surgical pericardial window.