The aim of this study is to report complications of transcatheter ASD closure using the Amplatzer Septal Occluder (ASO) (St Jude Medical).
From December 1999 to October 2013 (April 2014), 760 ...patients underwent ASD closure with the ASO. Closure was mostly performed under general anaesthesia and transoesophageal echocardiography control. Choice of the device diameter was established after balloon sizing and measurement of the stretched diameter.
Mean age of the patients was 31.9±22 years (0.5 month - 84 years). The stretched diameter was 22.5±6.6 mm (5-40mm) and device dimension 22±6.7mm (4-40mm). Duration of the procedure was 41±15 minutes (10-120 minutes) and fluoroscopic time 7.63±6.65 minutes (1-92 minutes). Dose of radiation was 18.7±22 Gy.cm2 (median 12 Gy.cm2).
Implantation succeeded in 96.3% of pts and failure was mainly related to deficient rim. No device related death was noticed. Embolization occurred in 4 pts (0.5%): 1 in the aorta, 1 in the left ventricle, and 2 in the pulmonary artery. All but one underwent surgical extraction and ASD closure. The patient with aortic embolization had percutaneous device extraction and underwent subsequently successful implantation with a larger device. No patient required blood transfusion for any groin hematoma. One patient without aortic rim had hemopericardium one month after implantation; this was corrected by drainage with no recurrence and ASD full occlusion was noticed on colour Doppler control. No late complication was observed. The rate of full occlusion on Doppler control is more than 90%, and the remainings have trivial shunt.
Transcatheter ASD occlusion with the Amplatzer Septal Occluder is a safe and effective procedure. The rate of immediate complication is very low and need for immediate surgery following the implantation is rare (<1%). No device related late complications were reported up to 15 years after implantation. The risk of aortic perforation in absence of anterior rim (observed in about 20% of pts) is trivial and not a real limitation in clinical practice.
0377: Atrial septostomy in very low birth weight infants Houeijeh, Ali; Marie Brevière, George; Guillaume, Marie-Paule ...
Archives of Cardiovascular Diseases Supplements,
January 2015, 2015-01-00, Letnik:
7, Številka:
1
Journal Article
Recenzirano
Odprti dostop
The interventional management of D-Transposition of great arteries DTGA is more required with the advances in NICU and pediatric cardiology.
To describe our experience in balloon atrial septestomy ...(BAS) in D-TGA patients weighing < 1500g.
we reported retrospectively all BAS in VLBW infants from January 2002 to June 2013. We collected information about the vital parameters before and after BAS. We described the atrial septestomy.
We have 3 patients with a mean weight of 1333g. D-TGA was diagnosed at a mean age of 3 days. Four atrial septestomy attempts were done at a mean age of 10.3 days. One infant had two attempts with balloon dilatation in the first, then BAS 24 h later. Procedures were done in catheterization laboratory in three cases and in NICU in one case. Patients were ventilated, sedated and transported by the NICU team. Venous access was obtained by the femoral vein puncture in two cases, femoral vein cutdown in one case and by the umbilical vein in one case. BAS were performed successfully in two cases, one using 4Fr. Swan Ganz catheter, and the other with 5 Fr. Z-Med septestomy catheter. BAS failed in two procedures, one because of atrial wall perforation, and the second because of restrictive foramen ovale which was dilated by a coronary balloon. Complications occurred in 3 cases, one minor (balloon rupture), and two major; atrial perforation in one patient, and severe bradycardia in one patient. BAS was effective with sustained clinical improvement. BAS failure in two patients was followed by heart failure in one patient and the death in the other.
BAS is mandatory in VLBW infants with D-TGA and restrictive atrial communication. It should be performed quickly if possible to use the valuable umbilical access, and to avoid the clinical compromise. A holeend BAS catheter is required for successful procedure. FO balloon dilatation constitutes another life-saving option.
The Amplatzer Vascular Plugs (AVP) are self-expandable devices made from a nitinol wire mesh that have been used to occlude various collateral vessels and shunts in congenital heart disease. We ...report here our experience.
From 2004 to 2012, 49 procedures with AVP were realized in 41 patients (17 females and 24 males). AVPs were employed to occlude systemic venous shunts (n=14) mainly in Fontan circulation, arterial systemic shunts (n=7), arterio-venous fistulas in Rendu-Osler (n=8), patent vertical vein following total repair of TAPVD (n=5), arterial systemic sequestration in Scimitar syndrome (n=4), fenestration (n=4) and miscellaneous lesions (Blalock shunt, n=2; coronary fistulas, n=2; VSD, n=1; aneurysm, n=1; patent ductus arteriosus, n=1).
Mean age of patients was 13.8±10.5 years, mean weight 28±11kg. Thirty one received plug I (mean size 8.3±4.0mm), 24 pts the plug IV (mean size 5.5±1.5mm), and 4 pts the Plug II (mean size 17±4mm). Implantation succeeded in all but 3 in whom the plug was retrieved. One patient with PDA underwent surgical ligation subsequently, a second had successful occlusion of a Blalock shunt with another plug, and the remaining had complete VSD occlusion with another larger device. One device embolized in pulmonary artery that could be retrieved during the procedure. The fluoroscopic time was 19±12 minutes. Full occlusion was confirmed by control angiography, CT scan or echocardiography. During follow-up, no evidence of hemodynamic or vascular compromise was noticed.
AVPs are effective and safe in the treatment of collateral vessels and shunts. The AVP IV is especially useful in embolizing difficult-to-reach, tortuous vessels with small delivery catheter; it is a good alternative to coils. Plugs I and II are appropriate for occlusion of larger vascular shunts. Choice of AVP is mainly determined by the anatomy and morphology of the shunt.
Abstract Thrombocytopenia-absent radius Syndrome (TAR) is a rare congenital malformation syndrome of complicated transmission. 1q21.1 deletion is necessary but not sufficient for its expression. We ...report the result of a French multicentric clinical study, and we emphasized on the role of the associated 1q21.1 deletion in the diagnosis and the genetic counselling of our patients. We gathered information on 14 patients presenting with TAR syndrome and referred for genetic counselling in six different university hospitals (8 foetuses, 1 child and 5 adults). Clinical or pathology details, as well as skeletal X-rays were analyzed. Genetic studies were performed by Array-CGH, and Quantitative Multiplex PCR. We demonstrated the very variable phenotypes of TAR syndrome. Female:male ratio was ∼2:1. All patients presented with bilateral radial aplasia/hypoplasia with preserved thumbs. Phocomelia and lower limb anomalies were present in 28% of the cases. We reported the first case of cystic hygroma on affected foetus. 1q21.1 deletions ranging from 330 to 1100 kb were identified in all affected patients. Most of them were inherited from one healthy parent (80%). The identification of a 1q21.1 deletion allowed confirmation of TAR syndrome diagnosis, particularly in foetuses and in atypical phenotypes. Additionally, it allowed accurate genetic counselling, especially when it occurred de novo . These findings allowed discussing the diagnostic criteria and management towards TAR syndrome.
The effect of n-3 polyunsaturated fatty acids in the pulmonary circulatory is not well defined. This question is clinically relevant in respiratory failure associated with pulmonary hypertension. To ...investigate this effect we have realised a randomized, placebo-controlled comparative study on sixty-two chronically prepared lamb fetuses.
Catheters and ultrasonic flow transducer were placed through a left thoracotomy in the lamb fetus to determine aortic, pulmonary, and left atrial pressures and left pulmonary artery blood flow. We compared the pulmonary vascular responses to 120min of Omegaven (lipid emulsions enriched in n-3 polyunsaturated fatty acids) or Intralipide (lipid emulsions enriched in n-6 polyunsaturated fatty acids) infusion. Then we investigated the effects of Omegaven on the pulmonary circulation after nitric oxide synthase inhibition by L-nitro-arginine, potassium channel blockade by tetraethylammonium, cytochrome P450 epoxygenase inhibition by (methylsulfonyl)-2- (2-propynyloxy)-benzenehexanamide, and cyclo-oxygenase inhibition by Ibuprofen.
Pulmonary artery and aortic pressures as well as blood gases and plasma lactate concentrations did not change during either fat emulsion infusion. Left pulmonary blood flow increased by 30% and pulmonary vascular resistance decreased by 28% during Omegaven infusion, whereas they did not change during Intralipide infusion. This pulmonary vascular response to Omegaven was not altered by l-nitro-arginine or Ibuprofen infusion. At the opposite, Omegaven induced pulmonary vasodilatation was abolished by tetraethylammonium and markedly attenuated by (methylsulfonyl)-2- (2-propynyloxy)-benzenehexanamide.
Lipid emulsion containing n-3 polyunsaturated fatty acids may induce a potent and sustained vasodilatation in the fetal lung. This pulmonary vasodilator response is mediated through production of vasoactive mediators by cytochrome P450 epoxygenase and through activation of potassium channels.
Stents have contributed to the development of the interventional catheterization of congenital heart diseases (CHD). The aim of this study was to describe current indications and results.
...Participation to this study was proposed to all catheterization laboratories specialized in CHD in France (M3C network). All cases with stents implantation in 2013 in pediatric and adult CHD were retrospectively included. Adverse events were assessed using the Bergersen classification. Risk markers were searched using univariate and multivariate analysis.
174 stents were implanted in 127 patients. Patients were aged 15.7±15.1 year old (min 5 day-old - max 70 year-old). Main indications were transcatheter pulmonary valve replacement (prestenting and revalvulation; n=29 patients, 23.0%), pulmonary artery branches angioplasty (n=34, 27.0%), aortic coarctation or recoarctation stenting (n=37, 29.4%) and ductus arteriosus stenting (n=11, 8.7%). 18 Patients (14.3%) were under one-year old and 35 (27.8%) were over 18 year-old. Main pathologies were tetralogy of Fallot and variants (ACC-CHD 8.3, n=45, 35.7%), and aortic coarctation (ACCCHD 9.2, n=36, 28.6%). More than one stent was implanted in 32 procedures (24.4%, max. 5 stents). Main stents implanted were the CP stent (33.0%), EV3 LD max (22.0%), Valeo (16.2%) and valved stents (15.0%). 98.5% Procedures were considered as successful. Adverse events were observed in 16.7% procedures (stent related in 12.1% procedures). Serious adverse events were observed in 12.9%. After uni- and multivariate adjustment, only procedure type was related to the risk of total adverse events but not to stent related adverse events. Age, weight, center, type of stents, genetic disorder and type of CHD were not significantly related to the risk of adverse events.
Stents are used in various CHD catheterization procedures, from infancy to adult age. Adverse events rate is significant and seems related to the type of procedure.
BackgroundPulmonary valve replacement in patients with congenital heart diseases and heart failure is challenging. Case summaryHere, we describe a case of a patient who had surgical fallot repair ...with chronic heart failure. Investigations found severe biventricular dysfunction and enlargement due to chronic pulmonary regurgitation. The right ventricle outflow tract was tortuous and large with a diameter of 35 mm. Percutaneous pulmonary valve implantation (PPVI) was done after a challenging pre-stenting. A 32 mm Myval valve over-sized to 35 mm was used for PPVI, which yielded a good result. DiscussionA 32 mm Myval valve is effective at extending the possibilities of PPVI in a large and tortuous right ventricle outflow tract not accessible for the other valves.
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