Transcatheter removal of atrial septal stent placed to decompress left atrium with VA ECMO.

Left atrial (LA) decompression in infants with thick atrial septum placed on veno-arterial extracorporeal membrane oxygenation (ECMO) can be reliably achieved with transcatheter atrial septal (AS) stent placement. However, with myocardial recovery and ECMO decannulation the stent causes a permanent left to right shunt and surgical removal of the AS stent is usually accomplished. Transcatheter removal of AS stent is an attractive option as the advantages of LA decompression would then be coupled with the advantage of avoiding a sternotomy for surgical removal of the stent. To our knowledge, this is the first reported case of successful transcatheter retrieval of AS stent used for LA decompression in a 13-month-old child.

Morphology of interatrial defects created by interventional techniques in a neonatal animal model.

Pathological details are lacking of various techniques used for interatrial defect (IAD) creation in lesions requiring mixing or with left atrial hypertension. Therefore, the morphology of the IAD created by different interventional techniques is described. The atrial septa of ten euthanized piglets (seven at <3 days and three at 2 weeks of age) were surgically exposed. In pigs of both ages, a needle-created communication was dilated with angioplasty, cutting, and cryoplasty balloons. A stent was also implanted in a newborn pig. By way of a patent foramen ovale (PFO) in newborns, angioplasty and septostomy balloons and a stent created IADs. The morphology of the IAD was directly imaged and the size measured. Newborn piglets had noticeably thinner atrial septa, and a PFO was still present. Static balloon dilation created a circular IAD equivalent to the balloon diameter (3 and 6 mm) in both the created defects of pigs of both ages and the neonatal PFO. A 3-mm cutting balloon (CB) produced a 2-mm triangular IAD (corresponding to atherotomes) in pigs of both ages. Premounted stents, by way of a created defect or PFO, led to circular IADs equivalent to balloon diameter. The 3-mm cryoplasty balloon created a large 5 × 4-mm IAD in the newborn pig; however, the IAD measured only 2 × 1-mm at 2 weeks. By way of a neonatal PFO, a septostomy balloon (inflated to 2 cc) created a 3-mm circular IAD. In neonatal piglet hearts, static balloon angioplasty, CBs, and stents created a predictable IAD. Cryoplasty balloons created highly variable defects.

Left ventricular mechanical synchrony and global systolic function in pediatric patients late after ventricular septal defect patch closure: a three-dimensional echocardiographic study.

BACKGROUND: Patients with large ventricular septal defects (VSDs) undergo surgical patch closure during infancy. The long-term effects of the presence of akinetic patch in the ventricular septum and postoperative right bundle branch block (RBBB) on the left ventricular (LV) mechanical synchrony and global systolic function have not been studied. OBJECTIVE: The objective of this study was to evaluate the long-term effects of an akinetic VSD patch and RBBB on the LV mechanical synchrony and global systolic function in pediatric patients more than 5 years after surgery. METHODS: Eighteen asymptomatic VSD repair and 18 normal control patients were evaluated by an electrocardiogram and three-dimensional echocardiography. Left ventricular end-diastolic volumes (LVEDVs) and volumetric ejection fraction (EF) were calculated. Left ventricular intraventricular synchrony was assessed by the 16-segment volumetric dyssynchrony index. RESULTS: Eight of 18 (44%) patients in the VSD repair group had RBBB. The LVEDV and volumetric EF were similar in the VSD repair and control groups. The LV dyssynchrony index was not significantly different between the VSD repair and control groups (2.46 +/- 1.77% vs. 1.75 +/- 1.08%, P = .16). The VSD repair group was then divided into two subgroups: patients with RBBB (8/18) and those without RBBB (10/18). The two subgroups were similar in demographics, LVEDV, and volumetric EF. However, the RBBB subgroup demonstrated significant LV mechanical dyssynchrony compared with the non-RBBB VSD subgroup (2.70 +/- 1.08% vs. 1.15 +/- 0.35%, P = .006). CONCLUSIONS: Pediatric patients 5-10 years after VSD patch closure have a normal LV function. The presence of the RBBB causes some mechanical dyssynchrony and tendency toward LV dilatation in this group of patients. Therefore, long-term follow-up of these patients is warranted.