Use of Intracardiac Echocardiography in the Evaluation and Management of Iatrogenic Aortopulmonary Communication After Percutaneous Intervention in Postoperative Patients With Congenital Heart Disease.

Iatrogenic aortopulmonary communications (IAPCs) are an uncommon but important complication after percutaneous intervention in postoperative patients. Iatrogenic aortopulmonary communications typically occur after balloon angioplasty or other interventions of the pulmonary outflow tract in certain anatomic configurations in which there is a denuded tissue plane between the pulmonary artery and aorta. They can present with signs and symptoms ranging from subtle clues which are difficult to recognize to near immediate hemodynamic instability.

Recent advances in managing vascular occlusions in the cardiac catheterization laboratory.

Vascular occlusions continue to be a significant cause of morbidity and mortality. The management of vascular occlusions in patients is complex, requiring specialized expertise in the cardiac catheterization laboratory and from other disciplines. Knowledge of currently available tools at the operator's disposal is important to optimize the success of these procedures.

Outcomes after Balloon Pulmonary Valvuloplasty for Critical Pulmonary Stenosis and Incidence of Coronary Artery Fistulas.

Outcome data for neonates with critical pulmonary stenosis (PS) is limited. We aimed to review the outcomes after balloon pulmonary valvuloplasty (BPV) for neonates with critical PS at our institution. All neonates with critical PS who underwent BPV from 1990 to 2017 were included.

Diminished left ventricular function is associated with poor mid-term outcomes in neonates after balloon aortic valvuloplasty.

Objectives: We studied outcomes of neonatal aortic valvuloplasty to determine the risk factors for poor outcomes.

Background: Balloon aortic valvuloplasty (BAV) is the primary therapy for neonates with severe aortic stenosis (AS). Limited data are available on the mid-term and long-term outcomes in this population, and reported risk factors for poor outcomes vary among studies.

Twenty-five year experience with balloon aortic valvuloplasty for congenital aortic stenosis.

Balloon aortic valvuloplasty (BAV) is the primary therapy for congenital aortic stenosis (AS). Few reports describe long-term outcomes. In this study, a retrospective single-institution review was performed of patients who underwent BAV for congenital AS.

Outcomes of transcatheter occlusion of patent ductus arteriosus in infants weighing ≤ 6 kg.

Objectives: We sought to analyze the outcomes of transcatheter patent ductus arteriosus (PDA) occlusion using a variety of devices in infants weighing ≤6 kg.

Background: Indications for transcatheter closure of a PDA in infancy include congestive heart failure and/or failure to thrive. Devices available for small infants may be problematic for various reasons, including sheath size, stiffness of delivery system, and anchoring and retrievability characteristics of the device.

The outcome of pulmonary artery stents following surgical manipulation.

Background: Pulmonary artery (PA) stents are utilized to treat branch pulmonary stenosis (BPS). Often patients with PA stents undergo subsequent cardiac surgery for other indications, and the stents can be manipulated during the procedure.

Objective: The purpose of this study was to evaluate the outcome of branch PA stenoses following surgical manipulation of previously implanted PA stents and to determine factors associated with future reintervention.

Pulmonary artery stents: long-term follow-up.

Objectives: Determine the long-term outcomes of branch pulmonary artery (PA) stents.

Background: PA stents in congenital heart disease effectively relieve stenoses in the short-term. Published long-term data are limited.

Simultaneous stent implantation to treat bifurcation stenoses in the pulmonary arteries: Initial results and long-term follow up.

Background: Balloon angioplasty of bifurcating pulmonary artery (PA) stenoses is often inadequate, and stent treatment often requires simultaneous implantation of two stents. This study evaluates initial results and long-term follow up of transcatheter stent placement in bifurcating PAs.

Methods: This is a retrospective review of patients (pts) who had bifurcating PA stents placed in main and lobar branches from 1993 to 2007.

Efficient, long-term hepatic gene transfer using clinically relevant HDAd doses by balloon occlusion catheter delivery in nonhuman primates.

Helper-dependent adenoviral vectors (HDAd) are devoid of all viral coding sequences and are thus an improvement over early generation Ad because they can provide long-term transgene expression in vivo without chronic toxicity. However, high vector doses are required to achieve efficient hepatic transduction by systemic intravenous injection, and this unfortunately results in dose-dependent acute toxicity. To overcome this important obstacle, we have developed a minimally invasive method to preferentially deliver HDAd into the liver of nonhuman primates.

Stent fractures in congenital heart disease.

Objective: To describe incidence, characteristics, predictive factors, and sequelae of stent fractures in congenital heart disease.

Background: Stent fracture in congenital heart disease patients is rarely reported.

Methods: Patients with stents implanted from 1990 to 2006, with subsequent fluoroscopy were enrolled.

Atrial septal stent implant: atrial septal defect creation in the management of complex congenital heart defects in infants.

Objectives: Certain congenital heart defects require the creation of an unrestrictive atrial septal defect (ASD) to relieve atrial hypertension, to maintain systemic cardiac output, or to achieve adequate atrial mixing to improve systemic oxygen saturation. We describe a series of patients, ranging in age from 5 weeks to 17 months, in whom we implanted a stent across the atrial septum to create a lasting, unrestrictive interatrial communication.

Methods: Five patients with left heart obstructive defects presented with severe left atrial hypertension.

Impact of transcatheter occlusion of a patent ductus arteriosus on atrial septal defect diameter in children.

Background: A persistent patent ductus arteriosus (PDA) may delay closure of a coexisting atrial septal defect (ASD) due to volume loading and enlargement of the left atrium. The purpose of this study was to investigate the natural history of ASD size in patients with a PDA following transcatheter PDA occlusion.

Methods: All patients with an ASD and a PDA who underwent transcatheter PDA occlusion at Texas Children's Hospital were identified.

Atrial septostomy improves survival in select patients with pulmonary hypertension.

Background: Atrial septostomy is a palliative treatment for patients with pulmonary hypertension (PHTN) refractory to vasodilator therapy. Limited data exist in the pediatric population and in patients with repaired congenital heart defects.

Methods: We performed a retrospective analysis of hemodynamic and symptomatic changes in patients with PHTN who underwent an atrial septostomy at our institution.

Pseudo-hydrodynamic delivery of helper-dependent adenoviral vectors into non-human primates for liver-directed gene therapy.

Helper-dependent adenoviral vectors (HDAds) are attractive for liver-directed gene therapy because they can mediate long-term, high-level transgene expression without chronic toxicity. However, systemic delivery requires high vector doses for efficient hepatic transduction, resulting in dose-dependent acute toxicity. Clearly, strategies to improve hepatic transduction with low vector doses are needed.