Catheter-based therapy for small preterm infants with pulmonary atresia/intact ventricular septum.

Catheter-based therapy is the preferred treatment for term infants with pulmonary atresia and intact ventricular septum without right ventricular-dependent coronaries, membranous atresia with patent infundibulum, and acceptable-sized tricuspid valve. However, in smaller preterm infants, it is more difficult to determine the adequacy of the tricuspid valve and right ventricle for two-ventricle repair and there are increased procedural risks. An excellent result in a small preterm infant with pulmonary atresia and intact ventricular septum is described using the following algorithm: determination of the tricuspid/mitral annular ratio, right-sided catheter-based intervention, and a combination of transthoracic echocardiography and angiography.

A premounted stent that can be implanted in infants and re-dilated to 20 mm: introducing the Edwards Valeo Lifestent.

Intravascular stenting (IS) for vascular stenoses in congenital heart disease provides superior gradient relief and angiographic results over balloon angioplasty (BA) alone. The advantages of IS, however, are difficult to apply to infants, toddlers, and small children due to technical challenges in placing large, long sheaths and the risk of creating future stenoses in stents that cannot be re-dilated to keep pace with somatic growth. This report highlights the Edwards premounted re-dilatable biliary stent, which was safely placed in four infants and small children with excellent hemodynamic and angiographic results.

Total endoscopic repair of a pediatric atrial septal defect using the da Vinci robot and hypothermic fibrillation.

Computerized robotic enhancement has recently emerged as a promising technology to facilitate minimally invasive cardiac surgery. We report the first totally endoscopic closure of an atrial septal defect in a child using the da Vinci robot and hypothermic fibrillation.

How not to do it: restrictive thoracic dystrophy after pectus excavatum repair.

The purpose of our paper is to call attention to acquired restrictive thoracic dystrophy (ARTD), an iatrogenic disease. The condition may occur following correction of pectus excavatum in young patients and is characterized by a reduced and restricted rib cage, usually with some recurrence of the deformity. The authors personal experience with five such patients includes analysis of their operative notes, radiographs, and long-term follow up.

Mitral valve chordal rupture masquerades as endocarditis.

Mitral valve chordal rupture is often associated with an inciting event. There are very few reported pediatric cases of spontaneous mitral valve chordal rupture. We describe a 9-year-old boy with a history of mitral valve prolapse who developed spontaneous mitral valve chordal rupture without evidence of endocarditis or trauma.

Renal interventions after abdominal aortic aneurysm repair using an aortic endograft with suprarenal fixation.

Background: Our aim was to determine whether suprarenal fixation in endografts compromises renal artery (RA) flow and whether subsequent RA intervention is precluded by the stent struts.

Methods: Prospectively acquired data from 104 patients with endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm using the Zenith endograft (Cook, Inc., Bloomington, IN) were analyzed.

AngioJet experience from the multi-center STENT Registry.

Objective: To explore the utilization and clinical outcomes of AngioJet Rheolytic thrombectomy from the Strategic Transcatheter Evaluation of New Therapies (STENT) multi-center prospective registry from May 2003 through December 2005.

Methods: Prospective consent was sought for all consecutive percutaneous coronary intervention (PCI) patients at all institutions and achieved in 84% of all patients. Of these, clinical follow-up at 9 months was achieved in 94% of eligible patients at all institutions.

Preemptive use of bivalirudin for urgent on-pump coronary artery bypass grafting in patients with potential heparin-induced thrombocytopenia.

Purpose: The use of heparin in patients with heparin-induced thrombocytopenia (HIT) may result in severe complications or death. The diagnosis of HIT is frequently uncertain, however. Alternative anticoagulants in at-risk patients undergoing cardiac surgery with cardiopulmonary bypass remain problematic.

Sternal nourishment in various conditions of vascularization.

Background: Early changes in sternal perfusion were studied after midline sternotomy and different methods of mammary artery (MA) harvesting.

Methods: Our observations were made in the swine model after midline sternotomy. In group 1 (6 animals), after unilateral skeletonized MA harvesting, (99m)Tc particles were injected intravenously.

Drug-eluting stents for emerging treatment strategies in complex lesions.

The use of drug-eluting stents (DES) has rapidly expanded from lower-risk, single-lesion procedures to include a broad spectrum of high-risk patients and complex lesions. For 4 complex patient subgroups, emerging data suggest that DES might offer an advantage for reducing late clinical restenosis. In ST elevation myocardial infarction, early registry reports are promising, with no evidence to date for an increased incidence of subacute stent thrombosis and significant trends for less restenosis.

Size reduction ascending aortoplasty: is it dead or alive?

Objective: Reduction ascending aortoplasty is a controversial procedure. Some believe that it can be appropriately applied when the anatomic features are favorable. Others suggest that it should be restricted to those patients who are at unacceptably high risk for more radical procedures, and there are also those who believe that reduction ascending aortoplasty should not be applied at all.

Direct thrombin inhibitors.

Bivalent direct thrombin inhibitors reduce ischemic risk compared to heparin. Results from randomized, double-blind clinical trials have demonstrated that bivalirudin is superior to heparin alone and as effective as heparin plus routine glycoprotein (GP) IIb/IIIa therapy for the prevention of ischemic events with a statistically significant reduction in the rate of in-hospital major bleeding.

Morphological changes of the aortic valve leaflets in non-compliant aortic roots: in-vivo experiments.

Background And Aim Of The Study: Age-related loss of elasticity of the naturally compliant aortic root disrupts the coordinated function of the valve leaflets. Morphological changes that developed over time in the aortic valve leaflets of non-compliant aortic roots were studied.

Methods: Stiffening of the aortic roots was achieved in vivo by applying Super Glue around the sinus of Valsalva in 27 New Zealand White rabbits.

The congenitally bicuspid aortic valve: how does it function? Why does it fail?

Background: The study was intended to investigate the reason why congenitally bicuspid valves (CBAVs), which may function hemodynamically and clinically well, have a high early failure rate.

Methods: Observations were made on cryopreserved, then thawed human aortic roots containing CBAVs. Valvular function was studied in the left heart simulator using conventional and 500-frames/second cinematography, intravascular ultrasound, by preparation of silicone molds, and by computerized digital modeling.

Cause of degenerative disease of the trileaflet aortic valve: review of subject and presentation of a new theory.

Risk factors for both atherosclerotic aortic wall disease and degenerative disease of the trileaflet aortic valve are very similar if not identical. This correlation grows even stronger as the person advances in years. Because of this, it is the prevailing view that sclerosis of the trileaflet aortic valve, unless previously affected by septic or rheumatic endocarditis, is a disease similar in origin to sclerosis of the aortic wall, ie, degenerative aortic valve disease is arteriosclerosis of the aortic valve.

The influence of patient strength, aerobic capacity and body composition upon outcomes after coronary artery bypass grafting.

Background: Physical activity, physical fitness and body habitus of patients may be important predictors of outcomes after cardiac surgery. This study sought to quantify physical fitness and determine whether components of fitness enhance the prediction of outcomes in a group of patients undergoing coronary artery bypass grafting.

Methods: A group of 200 patients were evaluated prior to coronary artery bypass surgery.

Hemodynamic implications of left bundle branch block.

Left bundle branch block (LBBB), traditionally viewed as an electrophysiologic abnormality, is increasingly recognized for its profound hemodynamic effects. LBBB causes asynchronous myocardial activation, which, in turn, may trigger ventricular remodeling. Exercise nuclear studies frequently show reversible perfusion defects in the absence of obstructive coronary artery disease and some patients with intermittent LBBB develop angina coincident with the onset of LBBB.

Directional coronary atherectomy: optimal atherectomy trials and new combined strategies with coronary stents.

Directional coronary atherectomy (DCA) has evolved from its early use as a tool for minimal plaque debulking to its current use of more aggressive lumen enlargement. The trend toward improved lumen results and reduced restenosis following DCA compared to percutaneous transluminal coronary angioplasty (PTCA) in the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT) was confirmed as a significant improvement in the subsequent Balloon versus Optimal Atherectomy Trial (BOAT). BOAT showed that acute lumen results and late angiographic restenosis could be significantly improved by DCA over PTCA, without any increase in procedural complications or late cardiac events.

Immediate coronary artery bypass surgery after platelet inhibition with eptifibatide: results from PURSUIT. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrelin Therapy.

Background: The platelet GP IIb/IIIa inhibitor eptifibatide improves outcomes in patients with acute coronary syndromes. Patients requiring emergent coronary artery bypass grafting, however, may be at increased risk for bleeding if exposed to eptifibatide. Data from the PURSUIT trial were reviewed to assess this risk in patients undergoing coronary surgery immediately after exposure to eptifibatide.

Long-term clinical follow-up of patients treated with the coronary rotablator: a single-center experience.

The acute angiographic and long-term clinical outcomes of a consecutive series of patients treated with the coronary rotablator at a single center are described. The patient population was a high-risk population, with significant instances of unstable angina or acute myocardial infarctions (MI) on presentation (75.5%), three-vessel coronary artery disease (27.