Transcatheter closure of right coronary artery fistula to the right ventricle.

Coronary artery fistula (CAF) is an uncommon anomaly that is usually congenital but can be acquired. Although most patients are asymptomatic, some may present with congestive heart failure, infective endocarditis, myocardial ischemia or rupture. In the past, surgical ligation was the only option in the management of CAF, but since 1983, transcatheter closure of CAF has been increasing as an alternative to surgery.

"Bendy" stents help negotiate hairpin intracardiac curves.

Simple transposition of the great arteries (TGA) occurs in 0.2 per 1000 live births. The condition is surgically repaired in the neonatal period by the arterial switch procedure (ASO) sometimes preceded by an atrial septostomy.

Permanent trans-venous pacing in an extra-cardiac Fontan circulation.

Aims: In patients with an extra-cardiac Fontan circulation, there is no direct access to the heart. The insertion of a permanent pacemaker requires surgery to insert epicardial pacing wires. We present the implantation of a permanent endocardial pacing lead from the superior vena cava (SVC) into the atrium via direct passage from the right pulmonary artery (RPA).

Stenting of the right ventricular outflow tract.

Objective: To assess the indication, technical aspects, and outcome of stenting of the right ventricular outflow tract (RVOT) in the management of symptomatic patients with severely limited pulmonary blood flow.

Methods: Retrospective case note and procedure review of patients undergoing stenting of the RVOT over an 8 year period.

Patients: Between 2005 and 2012, 52 selected patients underwent percutaneous stent implantation into a very narrow RVOT to improve pulmonary blood flow.

Surgery following primary right ventricular outflow tract stenting for Fallot's tetralogy and variants: rehabilitation of small pulmonary arteries.

Objectives: Primary surgical repair of Tetralogy of Fallot (ToF) in small infants with small pulmonary arteries (PAs) or complex anatomies can be hazardous. We assessed the effect of right ventricular outflow tract (RVOT) stenting on subsequent surgical intervention with attention to growth of the PAs.

Methods: Primary RVOT stenting was performed in 32 symptomatic patients with ToF physiology.

Percutaneous radiofrequency septal reduction for hypertrophic obstructive cardiomyopathy in children.

Objectives: The aim of this study was to assess the efficacy of radiofrequency catheter ablation (RFCA) in the treatment of hypertrophic obstructive cardiomyopathy in children.

Background: Hypertrophic obstructive cardiomyopathy is an uncommon cause of left ventricular outflow tract obstruction in children. In symptomatic patients, open heart surgical myectomy has hitherto been the only therapeutic option.

Transcatheter interventions in the early postoperative period after the Fontan procedure.

Objective: To analyze the safety and clinical impact of interventional cardiac catheter procedures in the management of early postoperative problems after completion of an extracardiac Fontan procedure.

Background: The mortality after Fontan procedure has consistently decreased over the last decade. The role of interventional catheterization to address early postoperative problems in this setting has not been studied systematically.

Treatment of dynamic subvalvar muscular obstruction in the native right ventricular outflow tract by percutaneous stenting in adults.

Percutaneous techniques are being increasingly used in adult congenital heart disease but there is limited experience in the treatment of native nonvalvar right ventricular outflow tract obstruction. We describe two cases of percutaneous stenting of the subpulmonary region where surgery was not an option.

Clinical evaluation of the new Amplatzer duct occluder II for patent arterial duct occlusion.

Background: Several devices such as coils and Amplatzer duct occluder (ADO) are used for catheter closure of patent arterial ducts (PDA). These carry a high success rate but residual shunts, suboptimal device orientation, and technical problems are encountered. The Amplatzer duct occluder II (ADO II) is designed to address these limitations.

Surgical management of hypoplastic left heart syndrome at the Birmingham Children's Hospital.

Currently, a three-stage surgical palliation remains the treatment of choice at Birmingham Children's Hospital. After initial introduction of the classical Norwood with pulmonary blood flow provided by a modified Blalock-Taussig shunt, a right ventricular to right pulmonary artery conduit at stage 1 Norwood palliation is now used in most cases, a bi-directional 'Glenn' shunt at second stage and an extra-cardiac Fontan completion at third stage. Mortality and morbidity has improved after modification of the technique.

Transvenous pacing via a disconnected superior vena cava in a patient with transposition of the great arteries.

We describe successful implantation of a permanent pacemaker via the right subclavian vein in a 28-year-old man with operated transposition of the great arteries where the superior vena cava is completely disconnected from the systemic venous atrium following a previous Glenn procedure.

The morphologic left ventricle that requires training by means of pulmonary artery banding before the double-switch procedure for congenitally corrected transposition of the great arteries is at risk of late dysfunction.

Objective: The aim of this study was to compare the outcome of the double-switch procedure for congenitally corrected transposition of the great arteries for patients completing morphologic left ventricle training by means of pulmonary artery banding with the outcome of patients whose morphologic left ventricle did not require training.

Methods: A retrospective study of all patients undergoing the double-switch procedure from 1991 through 2004 was performed. Patients were divided into 2 groups: those not requiring morphologic left ventricle training (n = 33) and those completing morphologic left ventricle training by means of pulmonary artery banding (n = 11).

Percutaneous transcatheter communication between the pulmonary artery and atrium following an extra-cardiac Fontan: an alternative approach to fenestration avoiding conduit perforation.

In a nonfenestrated modified Fontan, transcatheter creation of a fenestration presents technical difficulties, especially with the extra-cardiac modification where a Gore-Tex tube is placed between the inferior caval vein and the pulmonary arteries. The authors describe an alternative approach to perforating the Gore-Tex tube to create a fenestration by making a communication between the pulmonary artery and the atrial chamber, thus bridging the two circulations through native tissue.

Migraine Intervention With STARFlex Technology (MIST) trial: a prospective, multicenter, double-blind, sham-controlled trial to evaluate the effectiveness of patent foramen ovale closure with STARFlex septal repair implant to resolve refractory migraine headache.

Background: Patent foramen ovale (PFO) is prevalent in patients with migraine with aura. Observational studies show that PFO closure resulted in migraine cessation or improvement in approximately 80% of such patients. We investigated the effects of PFO closure for migraine in a randomized, double-blind, sham-controlled trial.

Awareness of the risk of endocarditis associated with tattooing and body piercing among patients with congenital heart disease and paediatric cardiologists in the United Kingdom.

Body art in the form of tattoos and piercing has become increasingly popular amongst children and teenagers, and is nowadays more socially acceptable despite media reports citing tissue destruction and death. Our study explored the awareness and experience of patients with congenital heart disease, and of cardiologists and professionals responsible for their care.

Cardiac tumours in children.

Cardiac tumours are benign or malignant neoplasms arising primarily in the inner lining, muscle layer, or the surrounding pericardium of the heart. They can be primary or metastatic. Primary cardiac tumours are rare in paediatric practice with a prevalence of 0.

Balloon angioplasty for branch pulmonary artery stenosis--cutting balloons.

Pulmonary artery stenosis can cause right ventricular strain but intrapulmonary lesions are inaccessible to surgery; moreover, some are also resistant to high pressure balloon angioplasty. An alternative is the use of microsurgical devices mounted on balloons for transvenous delivery, including cutting balloons. The current literature is sparse but seems to indicate a role for cutting balloons in specific situations.

Factors influencing early and late outcome following the Fontan procedure in the current era. The 'Two Commandments'?

Objective: This study was undertaken to identify the factors affecting early and late outcome following the Fontan procedure in the current era. We have examined whether conventional selection criteria, the 'Ten Commandments', are still applicable in the current era.

Materials And Methods: Between January 1988 and July 2004, 406 patients underwent a modified Fontan procedure at a median age of 4.

BioSTAR Evaluation STudy (BEST): a prospective, multicenter, phase I clinical trial to evaluate the feasibility, efficacy, and safety of the BioSTAR bioabsorbable septal repair implant for the closure of atrial-level shunts.

Background: The use of permanent synthetic implants to close atrial septal defects (ASD) and patent foramen ovale (PFO) has a number of limitations, including late complications and the limiting of transeptal access to the left heart should it be required for the later treatment of acquired heart disease. BioSTAR is a novel, bioabsorbable, atrial septal repair implant. This phase I pilot study evaluates the feasibility, safety, and effectiveness of BioSTAR for the first time in humans.

Fate of pulmonary arteries following Norwood Procedure.

Objective: This study evaluated the requirement for surgical reoperation and catheter-based reintervention to central pulmonary arteries (CPAs) following Norwood Procedure (NP). We sought to identify the influence of various surgical techniques employed during NP on subsequent interventions.

Methods: Between 1993 and 2004, 226 patients underwent Stage II following NP.