Nonsurgical closure of patent ductus arteriosus: clinical application of the Rashkind PDA Occluder System.

The first successful application of a transcatheter closure technique for patent ductus arteriosus (PDA) suitable for use in infants and children was performed by us in 1977. Since that time, there has been continued improvement and simplification of the equipment as well as in the implantation technique. Following a Food and Drug Administration protocol, a multicenter study was conducted to test the safety and effectiveness of this interventional method.

Historical aspects of interventional cardiology: past, present and future.

The purpose of this presentation is to report the progress of two interventional catheter techniques that have occupied my attention for the last 10 years; namely, transcatheter patent ductus arteriosus occlusion and patch atrial septal defect closure. A brief survey of the aspects of interventional cardiology, including its past, present and future, will also be included.

Interventional cardiac catheterization in congenital heart disease.

Cardiac catheterization has proved its value as a major tool in the diagnosis of congenital cardiac defects. The advent of non-invasive imaging of various sorts has altered the role of diagnostic catheterization. Within the past two decades cardiac catheter instruments to provide therapy have been applied to many lesions.

Interventional cardiac catheterization in congenital heart disease.

Cardiac catheterization has proved its value as a major tool in the diagnosis of congenital cardiac defects. The advent of noninvasive imaging of various sorts has altered the role of diagnostic catheterization. Within the past two decades, cardiac catheter instruments to provide therapy have been applied to many lesions.

Dilation angioplasty of congenital or operative narrowings of venous channels.

Balloon dilation angioplasty was attempted in 10 infants and children with severe congenital or operative "venous" obstructions. In five children the obstructions were "vena caval" and followed repair for transposition of the great vessels (four patients) or orthotopic liver transplantation (one patient). In the four patients with fixed vena caval or baffle obstructions, balloon angioplasty was successful in relieving the obstruction, decreasing the average gradient (16.

Fistula from left main coronary artery to right atrium: treatment by combined transaortic and transatrial approach.

Fistulas from the left main coronary artery to the right atrium are unusual lesions that have been treated by fistula ligation. The present report of a case treated by a combined transaortic and transatrial approach stresses the ease and advantages of this technique.

Coronary-bronchial artery fistula with partial absence of a pulmonary artery: association with partial anomalous pulmonary venous drainage.

A patient is presented with partial absence of the right pulmonary artery, left coronary artery to bronchial artery fistula and systemic arterial desaturation with a patent foramen ovale. The various aspects of the syndrome are discussed and the rationale for nonoperative closure of the foramen is described.

Oral hydralazine in patients with pulmonary vascular disease secondary to congenital heart disease.

Two patients with pulmonary vascular obstructive disease secondary to congenital heart disease were evaluated hemodynamically before and during oral hydralazine therapy. Both patients were assessed postoperatively and had no significant residual shunts. Pulmonary vascular resistance failed to decrease, and an increase in pulmonary arterial pressure occurred because of increased cardiac output secondary to systemic arteriolar dilatation.

Replacement of ventricular myocardium with diaphragmatic skeletal muscle: short-term studies.

A pedicled diaphragmatic skeletal muscle graft was used to replace a portion of resected right ventricle in 35 dogs. The graft contracted when electrically stimulated directly or via the phrenic nerve before and after insertion. The electrical pacing threshold was lower for phrenic nerve stimulation (0.

Coarctation resection in children with Turner's syndrome: a note of caution.

Eight children were recognized to have Turner's syndrome, among 353 patients over 1 year of age who had undergone surgical treatment for coarctation of the aorta. Of these eight children, three developed a significant perioperative hemorrhage from aortic rupture, resulting in one death and one instance of paraparesis related to a period of prolonged hypotension. In two of the other five patients with Turner's syndrome, a decision was made to perform an angioplasty rather than a resection of the coarctation because of apparent friability of the aortic wall.

Ascending aorta-right pulmonary artery anastomosis. Long-term results in 137 patients with cyanotic congenital heart disease.

Long-term follow-up of 137 patients who had an ascending aorta-right pulmonary artery anastomosis at the Children's Hospital of Philadelphia between 1966 and 1975 is presented. One hundred four patients survived the first hospitalization. Of the 81 patients currently alive, 30 have had a succesful corrective.

Association of maternal systemic lupus erythematosus with congenital complete heart block.

Infants born to mothers with disseminated lupus erythematosus occasionally have transient manifestations of the maternal disease. In six infants with congenital heart block born to mothers with systemic lupus erythematosus we postulated a causative relation. In one of the infants a post-mortem study of the conduction system suggested faulty embryonic development of the atrioventricular node with an abnormally thick annulus fibrosus and the effects of early inflammatory changes.

Congenital left aortic sinus-left ventricle fistula and review of aortocardiac fistulas.

A fistula from the left aortic sinus to the left ventricle is reported that was successfully repaired using cardiopulmonary bypass. In addition, 175 cases of fistula to the heart from the aortic sinuses published in the English literature from 1839 through 1972 were studied, with particular emphasis on the 126 patients who underwent operative repair. The major cause of the fistulas (76%) was found to be rupture of a congenital aortic sinus aneurysm, usually during the third or fourth decade of life.

Normalization of the blunted ventilatory response to acute hypoxia in congenital cyanotic heart disease.

Patients with congenital cyanotic heart disease have a blunted ventilatory response to hypoxia, but the permanence of the blunting is disputed. To determine how early the blunted ventilatory response develops and whether it is reversible, we studied three groups of children and young adults: five (seven to 13 years of age) with acyanotic heart disease, eight (seven to 16) with cyanotic congenital heart disease (arterial oxygen saturation, 55 to 83 per cent), and 13 (seven to 17) whose cardiac defects were repaired (arterial oxygen saturation, 93 to 98 per cent). The ventilatory response to acute hypoxia was subnormal in the hypoxemic children in that their ventilation showed little increase when arterial oxygen saturation fell by 10 to 20 per cent, compared to a 150 to 300 per cent increase in the control subjects.

Transatrial repair of tetralogy of Fallot.

In 12 months since March, 1975, 25 of 27 patients with tetralogy of Fallot have had corrective operations without ventriculotomy. Infundibular obstructions were excised and ventricular septal defects were closed through a right artiotomy with retraction of the anterior leaflet of the tricuspid valve. Pulmonary valve stenosis was relieved through a pulmonary arteriotomy.

Transatrial resection of the obstructed right ventricular infundibulum.

Obstructions of the right ventricular infundibulum were resected through the orifice of the tricuspid valve in 21 patients, 15 of whom had tetralogy of Fallot. At operation the systolic pressure difference between the right ventricle and pulmonary artery after repair averaged 18 mm Hg (range 0-40 mm Hg). In patients with tetralogy, cardiac index four hours after operation averaged 2.