Complications of pediatric cardiac catheterization: a review in the current era.

Objective: To determine types of complications and risks associated with pediatric cardiac catheterization in the current era.

Background: Pediatric cardiac catheterization is an important diagnostic and therapeutic tool. Although in the last decade, there have been significant improvements in technology and equipment, the risk for complications remains, adversely effecting outcomes.

Transcatheter closure of atrial septal defects with multiple devices in adults: procedural and clinical outcomes.

Objective: This study reports the procedural, short and medium term outcomes in patients receiving multiple implants for device closure of secundum atrial septal defects (ASD).

Design And Setting: From the database of the Toronto Congenital Cardiac Centre, 36 consecutive patients (mean age 46+/-15 years; 23 females) received >1 implant for closure of an interatrial communication. Short term (mean 97+/-77 days) and medium term (mean 2.

Feasibility and clinical impact of transcatheter closure of interatrial communications after a fenestrated Fontan procedure: medium-term outcomes.

Objective: This study was to review an institutional experience with transcatheter closure of Fontan fenestrations and its impact on clinical care.

Background: An interatrial fenestration improves postoperative outcomes in high-risk children undergoing a Fontan repair. While technical feasibility has been well defined, the clinical impact of subsequent closure is not well defined.

Femoral vein hemostasis in children using a suture-mediated closure device.

The safety and efficacy of a suture-mediated vascular closure device (Perclose, Abbott, Redwood City, CA) for hemostasis after percutaneous vascular access using >or=8-Fr sheath in the femoral vein after cardiac catheterization in children was assessed. Efficacy was determined by time to hemostasis and vessel integrity, using Doppler vascular ultrasound within 24 hours of the procedure. Forty children were randomized to treatment with either the closure device (n = 20, 10 males, weight 34.

Creation and enlargement of atrial defects in congenital heart disease.

Transcatheter creation and enlargement of interatrial defects (IAD) may improve hemodynamics; however, procedural outcomes have not been well defined. Hospital records were reviewed for children who underwent percutaneous procedures to create and enlarge an IAD and were grouped as follows: (1) right and (2) left heart obstructive lesions, (3) left atrial (LA) decompression during left heart assist, (4) failing Fontan circulation, and (5) miscellaneous. Forty-five children (mean age, 3.

Outcomes after balloon dilation of congenital aortic stenosis in children and adolescents.

Objectives: To determine the long-term outcomes and risk factors for, reintervention after balloon dilation of congenital aortic stenosis in children aged 6 months or older.

Background: Although balloon dilation of congenital aortic stenosis has become a primary therapeutic strategy, few data are available regarding long-term outcomes.

Methods: We carried out a retrospective review of 87 children who had undergone balloon dilation of the aortic valve at median age of 6.

Transcatheter management of residual shunts after initial transcatheter closure of a patent arterial duct.

Objectives: To assess the efficacy and safety of transcatheter reocclusion of persistent leaks following previously attempted transcatheter occlusion of persistent arterial duct.

Design: Retrospective study.

Setting: Tertiary pediatric cardiology centre.

Contemporary management of children with atrial septal defects: a focus on transcatheter closure.

Atrial septal defects that result in right atrial and ventricular volume overload should be closed if diagnosed in children and adolescents. With closure of the atrial septal defect, the left-to-right shunt is eliminated e.g.

Percutaneous balloon valvotomy in pulmonary atresia with intact ventricular septum: impact on patient care.

Background: Pulmonary atresia with intact ventricular septum (PA-IVS) is a rare congenital lesion with high mortality. Therapy was exclusively surgical until recently, when the use of radiofrequency-assisted perforation of the atretic valve was introduced as a treatment option. This study analyzes the outcomes and morphological changes to right heart structures after percutaneous perforation and balloon dilation of the atretic valve.

Differential regurgitation in branch pulmonary arteries after repair of tetralogy of Fallot: a phase-contrast cine magnetic resonance study.

Background: The importance of pulmonary regurgitation (PR) after repair of tetralogy of Fallot (TOF) is increasingly recognized, but little is known regarding its underlying mechanisms. This phase-contrast cine magnetic resonance (PC MR) study was performed to evaluate the relative contribution of each lung to total regurgitant volume.

Methods And Results: Twenty-two patients with significant PR underwent a PC MR 3 to 16 years after repair of TOF.

Percutaneous stent implantation to stenotic bioprosthetic valves in the pulmonary position.

Background: We evaluated stent implantation across stenotic bioprosthetic pulmonary valves in 9 patients.

Methods: Nine patients (6 male patients) underwent stent implantation across stenotic bioprosthetic pulmonary valves between July 1996 and July 1999 at the Hospital for Sick Children, Toronto. Catheter intervention was indicated if echocardiography revealed Doppler estimates of right ventricular pressure of more than two thirds of systemic arterial pressure (or systolic septal flattening with an estimated gradient of >60 mm Hg across the valve prosthesis).

Outcomes of intraoperative device closure of muscular ventricular septal defects.

Background: The surgical management of muscular ventricular septal defects (mVSD) in the small infant is a challenge particularly when multiple and associated with complex cardiac lesions. Devices for percutaneous implantation have the advantage of ease of placement and for the double umbrella designs a wide area of coverage. We reviewed our experience and clinical outcomes of intraoperative mVSD device closure for such defects in small infants.

Collaborative interventional and surgical strategies in the management of congenital heart lesions.

In the last 15 years the development of catheter-directed percutaneous therapies have improved the delivery of care to children with congenital heart lesions. Paralleling these advances, enhanced surgical techniques are now applied to complex cardiac lesions previously thought to be inoperable. This chapter outlines several treatment strategies which utilize surgical and catheter-based algorithms to address congenital heart disorders.

The effect of implantation of aortic stents on compliance and blood flow. An experimental study in pigs.

Balloon dilation of coarctation of the aorta has been found to be an effective modality for treatment. Recently, in the older child and adult, implantation of endovascular stents has been considered a clinical alternative to dilation alone. Little is known, however, of the effect of implantation of stents on aortic compliance.

Outcomes for children with cardiomyopathy awaiting transplantation.

Objective: To determine factors associated with outcomes after listing for transplantation in children with cardiomyopathies.

Background: Childhood cardiomyopathies form a heterogeneous group of diseases, and in many, the prognosis is poor, irrespective of the etiology. When profound heart failure develops, cardiac transplantation can be the only viable option for survival.

Non-invasive determination of the systolic peak-to-peak gradient in children with aortic stenosis: validation of a mathematical model.

Doppler derived systolic pressure gradients have become widely applied as noninvasively obtained estimates of the severity of aortic valvar stenosis. There is little correlation, however, between the Doppler derived peak instantaneous gradient and the peak-to-peak gradient obtained at catheterisation, the latter being the most applied variable to determine severity in children. The purpose of this study was to validate a mathematical model based on data from catheterisation which estimates the peak-to-peak gradient from variables which can be obtained by noninvasive means (Doppler derived mean gradient and pulse pressure), according to the formula: peak-to-peak systolic gradient = 6.

Dynamic morphology of the secundum atrial septal defect evaluated by three dimensional transoesophageal echocardiography.

Objective: To define by three dimensional echocardiography the pattern and potential determinants of contraction of a secundum atrial septal defect through the cardiac cycle, and to evaluate the possibility of using cross sectional transthoracic and transoesophageal imaging to assess the dynamic nature of the defect.

Design: Three dimensional echocardiography was performed using a multiplane transoesophageal probe on 50 patients with a secundum atrial septal defect (median age 9.8 years).

Endovascular stent implantation for the management of postoperative right ventricular outflow tract obstruction: clinical efficacy.

Objective: Extracardiac conduits between the right ventricle and pulmonary arteries commit patients to multiple reoperations. We reviewed our experience with stent implantation in obstructed conduits.

Methods: Between 1990 and 1997, stents were implanted across 43 conduits.

Complications associated with pediatric cardiac catheterization.

Objectives: The aim of this study was to determine the relative risks of pediatric diagnostic, interventional and electrophysiologic catheterizations.

Background: The role of the pediatric catheterization laboratory has evolved in the last decade as a therapeutic modality, although remaining an important tool for anatomic and hemodynamic diagnosis.

Methods: A study of 4,952 consecutive pediatric catheterization procedures was undertaken.

Endovascular stents in congenital heart disease.

Acquired or de novo vascular obstructions can adversely affect the outcomes of management algorithms for children with congenital heart lesions. Although surgical repair is frequently feasible, some acquired or congenital obstructions are difficult to address in the operating theater. Presented is the recent experience with endovascular stents to relieve such stenoses, and their impact on patient care.

Clinical impact of transcatheter closure of secundum atrial septal defects with the double umbrella device.

The clinical impact of transcatheter closure of the isolated secundum atrial septal defect was reviewed. Closure by echocardiographic evaluation was 23 +/- 14% at 6 months, 49 +/- 16% at 2 years, and 64 +/- 16% at 4 years, and right ventricular end-diastolic dimensions in patients without residual shunts did not differ significantly from those with residual shunts.