Novel delivery technique for atrial septal defect closure in young children utilizing the GORE® CARDIOFORM® septal occluder.

OBJECTIVES: To develop a novel delivery technique to overcome vascular size limitations for device closure of a secundum ASD in the young patient. BACKGROUND: The efficacy, clinical utility, and safety of transcatheter closure in comparison to surgical closure are well established; however, access vessel size remains a potential limitation to device selection in the young patient. METHODS: A retrospective medical record review of all cases of secundum ASD closure between April 2015 and April 2016 utilizing a novel delivery method described herein at two separate academic institutions. The device is disassembled allowing the delivery sheath to serve as the introducer. It is advanced to the RA with re-introduction of the device allowing for deployment in the standard fashion. RESULTS: Overall, 10 patients underwent secundum ASD closure via this novel delivery technique. There were six females (60%) and the average age at time of the procedure was 4.2 years ± 1.6 years (range 2-6 years). The majority of patients had an isolated secundum ASD (70%) with the primary indication for closure being right ventricular volume overload (90%). All patients had successful placement of a GORE® CARDIOFORM® Septal Occluder (GCSO) with no or trivial residual shunt. No patients had vascular complications related to the procedure. CONCLUSIONS: We describe a novel technique for ASD closure using the GCSO delivery sheath as the access sheath, which reduces the vascular access size requirement by 25%, thus addressing one common limitation for percutaneous device closure of a secundum ASD in young patients. © 2016 Wiley Periodicals, Inc.

Comparison of Extracellular Matrix Patch and Standard Patch Material in the Pulmonary Arteries.

After pulmonary artery (PA) patch augmentation, surgical or catheterization reintervention to address PA stenosis is not uncommon. Multiple patch materials are available and the need for reintervention may be related to characteristics of the patch material. In this retrospective chart review of patients who underwent PA augmentation from 2004 through 2013, we compare outcomes after PA augmentation with standard patch (SP) material and extracellular matrix (ECM) patch material. The primary outcome was reintervention-free survival (surgery or catheterization) using Kaplan-Meier survival analysis with the log-rank test. Risk factors for reintervention were assessed with Cox proportional hazard analyses. Baseline characteristics between groups were similar, except single-ventricle (SV) patients were more likely to have SP, and duration of follow-up was longer in the SP group. Median time to reintervention for all patients was 1099 days (95 % CI 646-1552 days). There was no difference in reintervention-free survival between the patch groups (p = 0.12); however, in multivariable analysis controlling for surgeon and patch, longer reintervention-free survival was associated with SV physiology (HR 0.57 95 % CI 0.34-0.95, p = 0.03) and aortic cross-clamp (XC) use (HR 0.52, 95 % CI 0.32-0.84, p = 0.008). Since there is no difference in median time to reintervention following PA augmentation with SP or ECM, patch choice should be determined by other factors, such as surgeon preference and cost. Longer reintervention-free survival in SV patients may be related to the set schedule of staged palliation. XC use may allow more extensive PA augmentation, thus protecting against the need for reintervention.

Inferior Vena Cava Thrombus in a Postpartum Patient With Fontan Physiology: A Case Report.

Women with complex congenital heart disease, such as those with single-ventricle physiology, are surviving into adulthood and becoming pregnant. Because of their complex physiology, common peripartum complications pose unique risks. We describe a patient with a single ventricle who underwent an external vascular conduit, nonfenestrated Fontan procedure in childhood and then presented during the postpartum period with extensive thrombosis in her lower extremity deep venous system and inferior vena cava. In this article, we will discuss single-ventricle physiology and the implications of pregnancy, anesthetic considerations, and data for maternal and fetal outcomes in this population.