Transcatheter device closure of patent ductus arteriosus by exclusive venous access under echocardiographic guidance without angiography.

INTRODUCTION: The standard transcatheter technique to profile the patent ductus arteriosus requires arterial access through the femoral artery and is associated with arterial complications, longer fluoroscopic time, contrast volume, and longer hospital stay. AIM OF THE STUDY: To compare exclusive transvenous access with the standard procedures for patent ductus arteriosus closure and evaluate whether exclusive venous approach is a safe and effective alternative. METHODS: A total of 320 patients were included. A detailed echocardiographic evaluation of the duct morphology was performed. Patients were classified into group 1 included patients who underwent exclusive femoral venous access, without any injections of contrast media and group 2 included patients who underwent arterial and venous access. RESULTS: Arterial access was achieved in 210 (65.6%). Successful closure of patent ductus arteriosus was achieved in 109 (99.1%) patients in group 1 and in 203 (96.7%) patients in group 2. The patent ductus arteriosus was large and was referred for surgical closure in one patient from group 1 and 7 patients from group 2. Residual patent ductus arteriosus was seen in 6 cases from group 1 (5.4%) and 12 patients from group 2 (5.7%). None of the cases in group 1 had vascular complications, while vascular complications were seen in 20 cases, all of them in group 2 (9.5%). Nonvascular complications were seen in one patient from group 1 (0.9%) and 15 patients in group 2 (7.1%). The procedure time and fluoroscopy times were less in patients with exclusive transvenous access. CONCLUSION: Patent ductus arteriosus device closure without arterial access can be accomplished safely and effectively.

Novel concepts and early results of repairing common arterial trunk.

OBJECTIVES: Common Arterial Trunk (CAT) continues to have a very poor prognosis globally. To address that, we have developed a novel technique targeting key concepts for the correction of all components of the anomaly, using autologous arterial tissue. This aims to enhance results, availability worldwide, and importantly to avoid the need for repeated reoperations. METHODS: From January 2019 to 4 January 2021, all patients with isolated CAT had repair of the defect using autologous arterial trunk tissue with direct right ventricle (RV) to pulmonary artery (PA) connection. Clinical outcomes, follow-up which included multi-slice computed tomography 3D segmentation and 4D cardiovascular magnetic resonance flow, are presented. RESULTS: Twenty patients were included in the study (median age 4.5 months). There were 2 hospital deaths due to systemic infection and pulmonary hypertensive crisis, respectively. Following discharge all patients remained asymptomatic with no signs of heart failure and improved pattern of growth (median follow-up: 8 months). Early postoperative 3D segmentation showed a conical shaped neo-right ventricular outflow chamber connecting the body of the RV to the main PA through a valveless ostium, and normal crossing of PA and neo-aorta. 4D cardiovascular magnetic resonance pattern of flow showed normal rapid laminar flow through the atrioventricular valves followed by a vortex towards the outflow tracts. There was laminar flow through the neo-aorta and neo-PA with velocity not exceeding 2.5 m/s. The PA regurgitant fraction was 25 ± 5% and was limited to early diastole. CONCLUSIONS: The initial results of utilizing the key concepts, using autologous arterial tissue for the repair of CAT, are encouraging, both clinically and by multimodality imaging.

Three-dimensional images of a pulmonary dominant truncus arteriosus before and after a novel repair.

This paper documents, for the first time, the in vivo size, geometry, and function of the different components of this important subtype of truncus arteriosus (pulmonary dominant). Previous descriptions were based on examining formalin-fixed (collapsed) specimens, or descriptions during operations. It is hoped that this information can be of value in designing operative treatment as well as interpreting future sequential imaging, with the aim of optimizing the results of comprehensive repair.