Anomalous left coronary artery origin from the nonfacing sinus of pulmonary artery - Successful repair of a rare entity.

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart disease, presenting either in isolation or with other cardiac anomalies. The most common presentation is congestive heart failure in infancy, though some may remain asymptomatic till adulthood. A 5-month-old infant with congestive heart failure was diagnosed to have ALCAPA with severe Left ventricular (LV) dysfunction.

Covered Stent Correction for Sinus Venosus Atrial Septal Defects, an Emerging Alternative to Surgical Repair: Results of an International Registry.

Background: Covered stent correction for a sinus venosus atrial septal defect (SVASD) was first performed in 2009. This innovative approach was initially viewed as experimental and was reserved for highly selected patients with unusual anatomic variants. In 2016, increasing numbers of procedures began to be performed, and in several centers, it is now offered as a standard of care option alongside surgical repair.

Iatrogenic Post-Surgical Cyanosis Due to Vena Caval Redirection to the Left Atrium and Its Transcatheter Management.

During surgery for oval fossa defects, inadvertent suturing of pericardial patches to a prominent Eustachian valve diverts the inferior vena caval blood to the left atrium causing iatrogenic cyanosis. A similar complication may arise after surgery for superior sinus venosus defects. Surgical patch in a wrong plane may direct the superior vena cava towards the left atrium.

A new simple technique for stabilizing the guidewire position within the left ventricle during transcatheter mitral valve-in-valve implantation.

Transcatheter mitral valve-in-valve implantation is a preferred treatment for degenerating mitral bioprosthetic valves in high-risk surgical patients. A balloon-expandable transcatheter heart valve delivered through a postero-inferior transseptal puncture is deployed within the prosthesis over a guidewire secured in the left ventricle. Patients with aneurysmal left atrium and altered angulation between the planes of atrial septum and mitral prosthesis have unstable position of the guidewire that flips out of the left ventricle into the left atrium when the valve delivery system is advanced.

Zero-contrast transcatheter closure of sinus venosus defect in advanced renal failure.

Transcatheter closure of sinus venosus defect (SVD) is an emerging intervention that utilizes a covered stent to redirect the right upper pulmonary vein to the left atrium. Preprocedural computed tomography analysis, as well as the interventional procedure, necessitates the use of radiographic contrast media. Contrast use is prohibited in patients with advanced kidney disease, who also carry high surgical risks of cardiopulmonary bypass.

Aortico right atrial tunnel - Clinical presentation, transcatheter management, and follow-up from a large cohort of patients.

Background: Aortico right atrial tunnel (ARAT) is a rare extracardiac communication between the aorta and the right atrium with two anatomical types. A recent global review identified 59 patients.

Methods: Patients with ARAT from two centers were analyzed for their demographics, symptoms, morphology, management, and follow-up thromboprophylaxis.

Different mechanisms for persistent and residual left-to-right shunt after transcatheter sinus venosus defect closure and their management.

Transcatheter closure of superior vena cava (SVC) form of sinus venosus defects (SVDs) using covered stents is emerging as an alternative to surgery in the current decade. A covered stent placed in the cavoatrial junction creates a roof for the right upper pulmonary vein (RUPV) that stops the left-to-right shunt and redirects the vein to the left atrium. While surgical literature has clearly documented the incidence of stenosis of SVC and RUPV, sinus nodal dysfunction, and persistent residual shunts following surgical correction, it is imperative to have similar data after this new transcatheter intervention on the incidence of complications and follow-up outcomes.

Innominate vein occlusion by the fabric of covered stent during transcatheter closure of sinus venosus defects - Causes, management, and outcome.

Transcatheter sinus venosus defect (SVD) closure with covered stents is emerging as an alternative to surgery. An adequate anchor zone in the superior vena cava is mandatory for the stability of the covered stent to prevent caudal embolization. There is a potential risk of innominate vein occlusion by the fabric of the covered stent in patients with a very short superior caval vein.

Transcatheter Correction of Superior Venacaval Form of Sinus Venosus Defects Using Balloon-Mounted Covered STENTS.

Superior sinus venosus defects (SVD) are interatrial communications located above the confines of the oval fossa, where unroofing of the right upper pulmonary vein leads to its anomalous drainage to the superior venacava. Recent emergence of transcatheter closure of these defects using covered stents is an attractive alternative option especially in adults with additional comorbidities. This article focuses on various aspects of non-surgical closure of SVD, including patient selection, appropriate hardware options, step-by-step procedural details, evolution and modifications in the techniques over the last decade, protocols for follow-up evaluation, and potential complications associated with this intervention.

Septal venous channel perforation during left bundle branch area pacing: a prospective study.

Aims: To characterize the diagnosis, frequency, and procedural implications of septal venous channel perforation during left bundle branch area pacing (LBBAP).

Methods And Results: All consecutive patients undergoing LBBAP over an 8-month period were prospectively studied. During lead placement, obligatory septal contrast injection was performed twice, at initiation (implant entry zone) and at completion (fixation zone).

A rare variant of scimitar syndrome characterised by right pulmonary vein drainage to portal vein with eventeration of diaphragm.

While infradiaphragmatic total anomalous pulmonary venous drainage to portal vein is well described, hemianomalous drainage of right pulmonary veins to portal vein in Scimitar syndrome has not yet been reported.

Clinical Outcomes Following Transcatheter Mitral Valve-in-Valve Replacement Using a Meril Myval Transcatheter Heart Valve.

Aim: Transcatheter mitral valve-in-valve (TMViV) replacement for degenerated surgically implanted bioprosthetic valves has been described by both transseptal and transapical approaches. The balloon-expandable Myval transcatheter valve (Meril Life Sciences, Vapi, India) is commonly used for transcatheter valve-in-valve procedures in India. This study aimed to report in-hospital, 30-day, and 1-year outcomes of Myval patients who underwent TMViV in a single tertiary care centre in India.

Endoleak in covered CP stent causes procedural failure during transcatheter closure of sinus venosus defects.

Transcatheter sinus venosus defect closure uses a long covered stent of appropriate length and diameter across the cavoatrial junction after balloon interrogation. The fabric in the covered stent creates a roof for the right upper pulmonary vein that closes the interatrial communication and redirects the vein into the left atrium behind the stent. A fabric tear in the covered stent may cause endoleak that will result in residual flows across the struts of the covered stent, causing procedural failure.

A rare unreported complication following transcatheter correction of sinus venosus defect.

Transcatheter correction of superior sinus venosus defects using covered stent is increasingly reported in the literature and provides an alternative option to surgery in appropriately selected adults. Being a new intervention, meticulous attention to procedural techniques and precise surveillance imaging modalities are vital to detect and avoid potential early and late complications. This report highlights the occurrence of a residual interatrial communication following covered stent placement and large subclinical asymptomatic nonocclusive thrombus formation at the right atrial end of the stent.

Life long surveillance is warranted as coronary artery remodels variably after treatment of adult patients with anomalous left coronary artery origin from pulmonary artery.

Anomalous left coronary artery origin from pulmonary artery causes heart failure in infancy from ischemia and secondary mitral regurgitation. Rich intramyocardial collateralization may permit survival to adult age, where coronaries become tortuous and aneurysmally dilated. Surgery in adults involves left coronary ligation and providing a bypass graft to the left system, unlike coronary translocation adopted in infants.

Simultaneous Transcatheter Closure of Coexistent Superior Sinus Venosus Defects and Oval Fossa Defects.

Device closure has become the preferred procedure for treating oval fossa defects in the last two decades. More recently, transcatheter sinus venosus defect (SVD) closure has emerged as an alternative to surgery. Transcatheter stenting aims to overcome potential late surgical complications such as stenosis of the superior vena cava (SVC) and right upper pulmonary vein (RUPV), as well as sinus node dysfunction.

Novel transcatheter intervention for iatrogenic cyanosis due to surgical rerouting of inferior vena cava to the left atrium.

Improper identification of the atrial septal defect margins during surgery and inadvertent suturing of the surgical patch to the Eustachian valve of the inferior vena cava (IVC) results in the diversion of inferior venacaval blood to the left atrium causing cyanosis. This complication has been dealt so far with surgery. We report the planning and implementation of a novel transcatheter rediversion of the IVC to the right atrium using a covered stent.

First-in-man use of an Indian-made balloon-expandable covered Zephyr stent and intermediate-term follow-up.

Covered stent is used in large-vessel angioplasty in anticipation of vessel wall injury. Apart from aortic coarctation, they are also used in dysfunctional right ventricular outflow conduits and find a recent role in transcatheter sinus venosus defect closure. Different methods of covering stents include glue fixation, sutureless lamination, sandwich, and sintering lamination.

Randomized controlled trial to evaluate the effect of prophylactic amiodarone versus dexmedetomidine on reducing the incidence of postoperative junctional ectopic tachycardia after pediatric open heart surgery.

Background: Junctional ectopic tachycardia (JET) is the most common arrhythmia after pediatric open-heart surgeries (OHS), causing high morbidity and mortality. As diagnosis is often missed in patients with minimal hemodynamic instability, its incidence depends on active surveillance. A prospective randomized trial evaluated the efficacy and safety of prophylactic amiodarone and dexmedetomidine to prevent and control postoperative JET.

Experience with the largest custom-made 48 mm fenestrated atrial septal occluder device and its 4-year follow-up.

Atrial septal defects (ASDs) measuring <38 mm are referred for transcatheter closure. Availability of larger devices up to 46 mm extended the inclusion criteria. An elderly hypertensive male with a 44 mm secundum ASD and coexistent sick sinus syndrome and atrioventricular (AV) nodal block presented with syncope.