Radiation Reduction in Paediatric Cardiac Catheterization: We Can Go Even Lower.

Background: Radiation reduction is an integral component in the management of a paediatric cardiac catheterization laboratory. Simple and easily implementable protocol changes and technical upgrades have been shown to significantly reduce radiation exposure.

Methods: Radiation exposures (2020-2022) at Safra Children's Hospital, Sheba Medical Center, Israel (unit A: n = 672) were retrospectively reviewed, including dose area product (DAP) (μGy m), DAP/kg, Air Kerma (mGy), and fluoroscopy time (minutes) for 16 procedural types.

Long-Term Outcomes of Unrepaired Isolated Partial Anomalous Pulmonary Venous Connection With an Intact Atrial Septum.

The natural history of an unrepaired isolated partial anomalous pulmonary venous connection(s) (PAPVC) and the absence of other congenital anomalies remains unclear. This study aimed to expand the understanding of the clinical outcomes in this population. Isolated PAPVC with an intact atrial septum is a relatively uncommon condition.

Periprocedural Outcomes of Fluoroscopy-Guided Patent Foramen Ovale Closure With Selective Use of Intracardiac Echocardiography.

Background: Recent randomized trials have confirmed the role of patent foramen ovale (PFO) closure in the secondary prevention of cryptogenic stroke. Guidelines have suggested a central role for intraprocedural imaging using intracardiac echocardiography (ICE). However, this modality may not be required to achieve safe and effective closure.

Long-term outcomes of percutaneous closure of coronary artery fistulae in the adult: A single-center experience.

Unlabelled: Coronary artery fistulae (CAF) are rare congenital cardiac abnormalities. With increasing age, patients with moderate to large fistulae are likely to become symptomatic and encounter complications. Percutaneous closure has been accepted as a safe and effective alternative to surgery; however, information regarding long-term outcomes in adult patients after transcatheter closure is limited.

Three-dimensional rotational angiography in congenital heart disease: Present status and evolving future.

Three-dimensional rotational angiography (3D-RA) enables volumetric imaging through rotation of the C-arm of an angiographic system and real-time 3D reconstruction during cardiac catheterization procedures. In the field of congenital heart disease (CHD), 3D-RA has gained considerable traction, owing to its capability for enhanced visualization of spatial relationships in complex cardiac morphologies and real time image guidance in an intricate interventional environment. This review provides an overview of the current applications, strengths, and limitations of 3D-RA acquisition in the management of CHD and potential future directions.

An IDEA: Safety Training to Improve Critical Thinking by Individuals and Teams.

Errors in thinking contribute to harm, delays in diagnosis, incorrect treatments, or failures to recognize clinical changes. Models of cognition are useful in understanding error occurrence and avoidance. Intra-team conflict can represent failures in joint cognitive processing.

Incidence and Outcomes of Positive Bubble Contrast Study Results After Transcatheter Closure of a Patent Foramen Ovale.

Objectives: The aim of this study was to assess the incidence of persistently positive results on agitated saline contrast injection after patent foramen ovale (PFO) closure, the underlying mechanism, and management.

Background: Transcatheter intervention to close a PFO is reasonable in highly selected patients younger than 60 years, after a thorough cardioneurological investigation following a cryptogenic stroke, particularly in the presence of thromboembolic disease or in patients at high risk for venous thrombosis. The U.

Recent advances in cardiac catheterization for congenital heart disease.

The field of pediatric and adult congenital cardiac catheterization has evolved rapidly in recent years. This review will focus on some of the newer endovascular technological and management strategies now being applied in the pediatric interventional laboratory. Emerging imaging techniques such as three-dimensional (3D) rotational angiography, multi-modal image fusion, 3D printing, and holographic imaging have the potential to enhance our understanding of complex congenital heart lesions for diagnostic or interventional purposes.

Mitochondrial DNA, nuclear context, and the risk for carcinogenesis.

The inheritance of mitochondrial DNA (mtDNA) from mother to child is complicated by differences in the stability of the mitochondrial genome. Although the germ line mtDNA is protected through the minimization of replication between generations, sequence variation can occur either through mutation or due to changes in the ratio between distinct genomes that are present in the mother (known as heteroplasmy). Thus, the unpredictability in transgenerational inheritance of mtDNA may cause the emergence of pathogenic mitochondrial and cellular phenotypes in offspring.

Outcomes of Blalock-Taussig shunts in current era: A single center experience.

Objectives: Mortality associated with the modified Blalock-Taussig shunt (MBTS) remains high despite advanced perioperative management. This study was formulated to provide data on (1) current indications, (2) outcomes, and (3) factors affecting mortality and morbidity.

Design: A retrospective single center chart review identified 95 children (excluding hypoplastic left heart lesions) requiring a MBTS.

Clinical Impact of Stent Implantation for Coarctation of the Aorta with Associated Hypoplasia of the Transverse Aortic Arch.

The aim of this study was to explore the clinical impact of transverse aortic arch hypoplasia (TAH) after stent implementation for isthmal coarctation of the aorta (CoA). From a retrospective chart review, 51 children (median age 11.1 years) were identified who had TAH and a CoA stent implanted between 10/1995 and 4/2015.

Percutaneous Intervention to Treat Platypnea-Orthodeoxia Syndrome: The Toronto Experience.

Objectives: This study reviewed a series of patients treated with transcatheter closure of septal defect to treat platypnea-orthodeoxia syndrome, with specific attention to septal characteristics and device choice.

Background: Platypnea-orthodeoxia syndrome is an uncommon condition characterized by positional dyspnea and hypoxemia due to intracardiac right-to-left shunting through a patent foramen ovale (PFO), an atrial septal defect, or pulmonary arteriovenous malformations. Percutaneous closure of such defects is the treatment of choice.

Report of the National Heart, Lung, and Blood Institute Working Group: An Integrated Network for Congenital Heart Disease Research.

The National Heart, Lung, and Blood Institute convened a working group in January 2015 to explore issues related to an integrated data network for congenital heart disease research. The overall goal was to develop a common vision for how the rapidly increasing volumes of data captured across numerous sources can be managed, integrated, and analyzed to improve care and outcomes. This report summarizes the current landscape of congenital heart disease data, data integration methodologies used across other fields, key considerations for data integration models in congenital heart disease, and the short- and long-term vision and recommendations made by the working group.

Use of local anesthetic (0.25% bupivacaine) for pain control after pediatric cardiac catheterization: A randomized controlled trial.

Objectives: To investigate the effects of local infiltration of 0.25% bupivacaine on post-operative pain and analgesic use in children undergoing cardiac catheterization procedures.

Background: In pediatric catheterization procedures performed under general anesthesia, a local anesthetic is often used prior to femoral sheath removal.

Achievable radiation reduction during pediatric cardiac catheterization: How low can we go?

Objectives: To assess the effectiveness of radiation-reduction measures implemented during pediatric catheterization, and provide data on the radiation doses for common interventional and diagnostic procedures, indexed to body weight.

Background: Ionizing radiation exposure must be minimized to "as low as reasonably achievable," by instituting radiation-limiting techniques and knowledge of expected radiation exposure.

Methods: Radiation-reduction measures included pulsed-fluoroscopy at 7.

The First Ten of Everything: A Review of Past and Current Practice in Pediatric Cardiac Percutaneous Interventions.

Objectives: This study was designed to compare outcomes of the most common pediatric cardiac interventions from the time of implementation with the current era.

Background: Since the introduction of semilunar valve balloon dilation and device closure of the arterial duct and septal defects, development of interventional techniques and devices has been rapid. However, few studies have compared outcomes between those initial interventions and those in the current era.

Characteristics of secundum atrial septal defects not percutaneously closed.

Objectives: We sought to review our single center experience with secundum atrial septal defect (ASD) device closure, evaluating the incidence and morphological characteristics where percutaneous closure was thought inappropriate.

Material And Methods: All children assessed as unsuitable for transcatheter device closure were reviewed. Data collected included: demographics, defect morphology by echocardiography or at cardiac catheterization and defect size focusing on the reasons for procedural deferral.

Systemic blood pressure after stent management for arch coarctation implications for clinical care.

Objectives: The goal of this study was to prospectively assess blood pressure (BP) and echocardiographic parameters to delineate the incidence and nature of the hypertension burden in this cohort.

Background: Few data are available on the long-term outcomes of aortic stenting.

Methods: Thirty-one patients with successfully stented coarctation during childhood (mean age 12.

The fellows stitch: large caliber venous hemostasis in pediatric practice.

Objective: To analyze safety and efficiency of a subcutaneous figure of eight suture for hemostasis after large caliber venous sheath access in children.

Background: Vascular complications remain a significant cause of morbidity after pediatric cardiac catheterization. In an attempt to reduce such complications and yet improve lab efficiency and decrease length of stay, various techniques have been applied to improve time to hemostasis.

Vascular hemostasis bandage compared to standard manual compression after cardiac catheterization in children.

Background: Femoral venous and arterial approaches are the commonly used to obtain vascular access for pediatric cardiac catheterization. Hemostasis after catheter removal is usually obtained by manual compression. However, this technique is time consuming and at times painful.

A biodegradable device (BioSTAR) for atrial septal defect closure in children.

Background: Percutaneous closure of atrial defects (ASD) has evolved as the treatment of choice for the majority of defects and patent oval foramens. The BioSTAR biodegradable implant avoids many issues associated with devices containing substantial amounts of metal.

Methods: Reviewed was a consecutive series of 10 ASD occlusions in a pediatric population with the BioSTAR biodegradable device.

A radiofrequency transseptal needle: initial animal studies.

Objectives: The objective of this study was to demonstrate the safety and efficacy of a new transseptal needle design with a radiofrequency (RF) tip combined with the ease of use of the needle configuration.

Background: RF transseptal puncture to enter the left heart, with a RF wire-catheter system is a successful technique in patients with complex access using a standard transseptal needle.

Methods: The RF transseptal needle (NRG™ Transseptal Needle; Baylis Medical, Montreal, Canada) was designed for RF percutaneous transseptal access to the left heart.

Cutting balloon angioplasty for aortic coarctation.

Background: Cutting balloon angioplasty (CBA) has improved outcomes for resistant stenotic vascular lesions in adult coronary artery disease. Application of this technique in coarctation of the aorta (CoA) in children has not been reported.

Objective: We sought to review the safety, efficacy and outcomes of CBA in the setting of CoA.

Complete heart block associated with device closure of perimembranous ventricular septal defects.

Objective: The development of the Amplatzer Membranous VSD Occluder (AGA Medical Corp, Plymouth, Minn) for closure of the perimembranous ventricular septal defect has ameliorated many of the technical difficulties of previous devices. Application of this new technology requires comparative evaluation with the current standard of surgical repair. We report our experience of complete heart block associated with device closure of a large perimembranous ventricular septal defect with unequivocal indications for intervention.