Percutaneous Balloon-Expandable Stent Implantation to Treat Transverse Aortic Arch Obstruction: Medium- to Long-Term Outcomes of a Retrospective Multicenter Study.

Background: Transverse aortic arch obstruction is a challenging lesion for which stent implantation provides a potentially important alternate therapy. The objectives were to evaluate the technical, procedural, and medium-to-long-term clinical outcomes of percutaneous stent implantation of transverse aortic arch obstruction.

Methods: This is a retrospective, multicenter study of transverse aortic arch stent implantation.

Implantable pulmonary artery pressure monitoring device in patients with palliated congenital heart disease: Technical considerations and procedural outcomes.

Objective: We describe the technical considerations of transcatheter implantation of the CardioMEMS™ HF System (Abbott, Abbott Park, IL) in adult patients with complex palliated congenital heart disease (CHD) and advanced heart failure (HF).

Background: Ambulatory pulmonary artery (PA) pressure monitoring with implantable hemodynamic monitors (IHMs) has been shown to reduce HF-related hospital admissions in non-CHD populations. HF is a common late cardiovascular complication in adult CHD necessitating better understanding of IHM application in this population.

Leaflet morphology classification of the Melody Transcatheter Pulmonary Valve.

Objective: We sought to describe the leaflet morphology variation in the Melody Transcatheter Pulmonary Valve (TPV) and evaluate associated outcomes. The Melody TPV is constructed from harvested bovine jugular venous valves which have been rigorously tested. Natural anatomic leaflet variations are seen in the Melody TPV but have not been evaluated.

Cerebral Blood Flow Following Hybrid Stage I Palliation in Infants with Hypoplastic Left Heart Syndrome.

Hypoplastic left heart syndrome (HLHS) palliation may result in altered cerebral blood flow with subsequent neurodevelopmental implications. The purpose of the study was to assess blood flow in the middle cerebral artery (MCA) and investigate the relationship with early neurodevelopmental outcomes in infants with HLHS after hybrid stage I. Transcranial Doppler (TCD) was performed to obtain peak systolic, end-diastolic, and mean velocities, as well as pulsatility index of the MCA in infants with HLHS (n = 18) at baseline and at 2, 4, and 6 months of age.

Intravascular Ultrasound Characterization of a Tissue-Engineered Vascular Graft in an Ovine Model.

Patients who undergo implantation of a tissue-engineered vascular graft (TEVG) for congenital cardiac anomalies are monitored with echocardiography, followed by magnetic resonance imaging or angiography when indicated. While these methods provide data regarding the lumen, minimal information regarding neotissue formation is obtained. Intravascular ultrasound (IVUS) has previously been used in a variety of conditions to evaluate the vessel wall.

Accuracy of Imaging Modalities in Detection of Baffle Leaks in Patients Following Atrial Switch Operation.

Aims: Patients with dextro-transposition of the great arteries (d-TGA) status post atrial switch operation are vulnerable to complications such as baffle leaks. The best noninvasive imaging modality to detect baffle leaks is unknown. The purpose of this study was to determine the sensitivity and specificity of different noninvasive imaging modalities in the detection of baffle leaks in this population.

Early results of neurodevelopment following hybrid stage I for hypoplastic left heart syndrome.

Motor skills and neurodevelopment in infants with hypoplastic left heart syndrome (HLHS) who have undergone Hybrid Stage I palliation is unknown. The purpose of this study is to assess early neurodevelopment in infants with HLHS after Hybrid Stage I palliation. Developmental assessment was performed in HLHS infants who underwent Hybrid Stage I palliation at 2 and 4 months of age using the Test of Infant Motor Performance, and at 6 months of age, prior to undergoing the second staged surgery, using the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III).

Device closure of secundum atrial septal defects in infants weighing less than 8 kg.

This study aimed to assess the technical aspects of atrial septal defect (ASD) closure using the Amplatzer septal occluder (ASO) and the Gore Helex septal occluder (GHSO) for infants weighing less than 8 kg and to determine the safety, effectiveness, and near-to-intermediate-term outcome of the closure. The Mid-Atlantic Group of Interventional Cardiology Registry of percutaneous, transcatheter ASD closure procedures was reviewed for this analysis. Patients from 10 hospitals in the United States were included.

The Medtronic Melody® transcatheter pulmonary valve implanted at 24-mm diameter--it works.

Objectives: We report the Melody valve implanted and/or expanded to 24-mm diameter.

Background: The Medtronic Melody valve has been implanted up to 22 mm in the pulmonary position for over a decade.

Methods: A retrospective chart review was performed on 82 patients who underwent Melody valve implant.

Strain echocardiographic assessment of ventricular function after percutaneous pulmonary valve implantation.

Introduction: Percutaneous pulmonary valve implantation (PPVI) is an emerging therapy for pulmonary valve dysfunction. Minimal data on the midterm effects of PPVI on ventricular function exist. We describe the effects of PPVI on right and left ventricular (RV, LV) function with speckle tracking echocardiography.

Use of a dose-dependent follow-up protocol and mechanisms to reduce patients and staff radiation exposure in congenital and structural interventions.

Background: Increasingly complex structural/congenital cardiac interventions require efforts at reducing patient/staff radiation exposure. Standard follow-up protocols are often inadequate in detecting all patients that may have sustained radiation burns.

Methods: Single-center retrospective chart review divided into four intervals.

An institutional approach to interventional strategies for complete vascular occlusions.

Complete vascular occlusions are rare but potentially lethal. Reports on transcatheter therapy are limited to solitary case reports. The study was conducted as a single-center retrospective chart review.

Radiation protection during hybrid procedures: innovation creates new challenges.

Background: The cooperation between interventional cardiologists and cardiothoracic surgeons has expanded the spectrum of treatment modalities for patients with congenital heart disease. These hybrid techniques have created new challenges, one of which being the provision of adequate but practical radiation protection. This study evaluates the use of a lightweight radiation protection drape (RADPAD) that may be suitable for shielding during hybrid procedures.

Completion angiography after cardiac surgery for congenital heart disease: complementing the intraoperative imaging modalities.

Residual structural pathology after cardiac surgery for congenital heart disease may complicate postoperative recovery. Completion angiograms obtained in the operating room may facilitate early detection and therapy of residual structural abnormalities. Our objective here is to report our institutional experience performing completion angiograms after cardiopulmonary bypass surgery.

An animal model for hybrid stage I palliation of hypoplastic left heart syndrome.

Hybrid palliation has evolved as an important alternative treatment strategy for patients with hypoplastic left heart syndrome (HLHS). The procedural cooperation between cardiothoracic surgeon and interventional cardiologist is not intuitive and there is an increasing demand to avoid mistakes of the 'early learning curve,' through in vivo teaching using an animal model. We describe a unique experience of developing a piglet model that can be used to teach the procedural technique of hybrid Stage I palliation.

"Hybrid" stent delivery in the pulmonary circulation.

Objective: We sought to describe our institutional experience providing "hybrid" intraoperative stent therapy for pulmonary artery (PA) stenoses.

Background: Surgical patch angioplasty, transcatheter stent therapy and intraoperative stent delivery are valuable treatment options for PA stenoses. The experience with intraoperative hybrid therapy has increased and new techniques and equipment have become available.

Atrial septal interventions in patients with hypoplastic left heart syndrome.

Objectives: To report an institutional experience performing percutaneous atrial septal interventions in patients with hypoplastic left heart syndrome (HLHS).

Background: The success of the Hybrid approach in palliating patients with HLHS is crucially dependant on relieving any significant interatrial restriction. Data on transcatheter interventions to relieve atrial septal restrictions in patients with HLHS are limited.

Stenting complex aortic arch obstructions.

Objective: To present our institutional experience of endovascular stent therapy in patients with complex aortic arch lesions.

Background: The management of aortic arch obstructions is complex and many physicians are either reluctant to treat mild-moderate aortic arch lesions associated with systemic hypertension or instead refer to high-risk surgical alternatives. Reported data on transcatheter stent therapy of complex aortic arch lesions are scarce.

Assessment of in-stent stenosis in small children with congenital heart disease using multi-detector computed tomography: a validation study.

Objectives: Our purpose was to investigate the diagnostic reliability of multi-detector computed tomography (MDCT) in assessing in-stent stenosis compared to digital angiography (DA) in small children.

Background: Little is known about the feasibility of using MDCT to assess stents placed to treat children with congenital heart disease (CHD).

Methods: Twenty-two children (median age [range], 2(3/4) [(1/2) to 12] years) with 42 transcatheter placed stents (median diameter: 7.