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Butera G, Piccinelli E, Kolesnik A, Averin K, Seaman C, Castaldi B, Cuppini E, Fraisse A, Bautista-Rodriguez C, Hascoet S, D'Amore C, Baruteau AE, Blasco PB, Bianco L, Eicken A, Jones M, Kuo JA, Rajszys GB. Implantation of atrial flow regulator devices in patients with congenital heart disease and children with severe pulmonary hypertension or cardiomyopathy-an international multicenter case series. Front Cardiovasc Med 2024; 10:1332395. [PMID: 38288053 PMCID: PMC10822980 DOI: 10.3389/fcvm.2023.1332395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/22/2023] [Indexed: 01/31/2024] Open
Abstract
Background The Occlutech Atrial Flow Regulator (AFR) is a self-expandable double-disc nitinol device with a central fenestration. Its use has been approved in the adult population with heart failure and described for pulmonary hypertension (PH). Only case reports and small series have been published about its use in the paediatric population and for congenital heart disease (CHD). Objectives The authors sought to investigate the feasibility, safety, and short-term follow-up of AFR implantation in patients with CHD or children with PH or cardiomyopathy. Methods This is a multicenter retrospective study involving 10 centers worldwide. Patients of any age with CHD or patients aged < 18 years with PH or cardiomyopathy needing AFR implantation were included. Results A total of 40 patients underwent AFR implantation. The median age of the population at the time of the procedure was 58.5 months (IQR: 31.5-142.5) and the median weight was 17 kg (IQR: 10-46). A total of 26 (65.0%) patients had CHD, nine (22.5%) children, a cardiomyopathy, and five (12.5%), a structurally normal heart. The implantation success rate was 100%. There were two early and one late device thrombosis. Two patients (5.0%) with dilated cardiomyopathy on extracorporeal membrane oxygenator (ECMO) died during the hospital stay. At a median follow-up of 330 days (IQR: 125-593), 37 (92.5%) patients were alive. At follow-up, 20 patients improved their New York Heart Association (NYHA) class, 12 patients did not change their NYHA class, and one patient with idiopathic PH worsened. Conclusions AFR implantation in patients with CHD and children with severe PH or cardiomyopathy is promising and seems to have beneficial effects at short-term follow-up.
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Affiliation(s)
- Gianfranco Butera
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART, Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
| | - Enrico Piccinelli
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART, Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Adam Kolesnik
- Cardiovascular Interventions Laboratory, The Children’s Memorial Health Institute, Varsavia, Poland
| | - Kostantin Averin
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Cameron Seaman
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Biagio Castaldi
- Pediatric Cardiology Department, Padova University, Padova, Italy
| | - Elena Cuppini
- Pediatric Cardiology Department, Padova University, Padova, Italy
| | - Alain Fraisse
- Pediatric Cardiology Department, Royal Brompton Hospital, London, United Kingdom
| | | | - Sebastien Hascoet
- Pediatric Cardiology Department, Royal Brompton Hospital, London, United Kingdom
| | - Carmen D'Amore
- Epidemiology, Clinical Pathways and Clinical Risk Unit, Medical Direction, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alban-Elouen Baruteau
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, Nantes, France
| | - Pedro Betrián Blasco
- Pediatric Interventional Cardiology Unit, Vall d'Hebron Hospital, Barcellona, Spain
| | - Lisa Bianco
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART, Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
- Pediatric Interventional Cardiology Unit, Vall d'Hebron Hospital, Barcellona, Spain
| | - Andreas Eicken
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, München, Germany
| | - Matthew Jones
- Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Evelina Children’s Hospital, London, United Kingdom
| | - James A. Kuo
- Division of Cardiology, Children’s Healthcare of Atlanta, Atlanta, GA, United States
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Castaldi B, Cuppini E, Fumanelli J, Di Candia A, Sabatino J, Sirico D, Vida V, Padalino M, Di Salvo G. Chronic Heart Failure in Children: State of the Art and New Perspectives. J Clin Med 2023; 12:2611. [PMID: 37048694 PMCID: PMC10095364 DOI: 10.3390/jcm12072611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
Pediatric heart failure (HF) is an important clinical condition with high morbidity and mortality. Compared to adults, pediatric HF shows different etiologies characterized by different physiology, a different clinical course, and deeply different therapeutic approaches. In the last few years, new drugs have been developed and new therapeutic strategies have been proposed with the goal of identifying an individualized treatment regimen. The aim of this article is to review the new potential drugs and non-pharmacological therapies for pediatric heart failure in children.
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Affiliation(s)
- Biagio Castaldi
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
| | - Elena Cuppini
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
| | - Jennifer Fumanelli
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
| | - Angela Di Candia
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
- Pediatric Research Institute (IRP) Città della Speranza, University of Padua, 35122 Padova, Italy
| | - Jolanda Sabatino
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
- Pediatric Research Institute (IRP) Città della Speranza, University of Padua, 35122 Padova, Italy
| | - Domenico Sirico
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
| | - Vladimiro Vida
- Pediatric Cardiac Surgery Unit, Department of Cardio Thoracic Sciences, University of Padua, 35122 Padova, Italy
| | - Massimo Padalino
- Pediatric Research Institute (IRP) Città della Speranza, University of Padua, 35122 Padova, Italy
- Pediatric Cardiac Surgery Unit, Department of Cardio Thoracic Sciences, University of Padua, 35122 Padova, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
- Pediatric Research Institute (IRP) Città della Speranza, University of Padua, 35122 Padova, Italy
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Mendel B, Kohar K, Amirah S, Vidya AP, Utama KE, Prakoso R, Siagian SN. The outcomes of fetal aortic valvuloplasty in critical aortic stenosis: A systematic review and meta-analysis. Int J Cardiol 2023; 382:106-111. [PMID: 36996909 DOI: 10.1016/j.ijcard.2023.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/08/2023] [Accepted: 03/21/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Critical aortic stenosis that appears in mid-gestation tends to develop to growth retardation of left ventricle, known as hypoplastic left heart syndrome (HLHS). Despite better clinical management of HLHS, the morbidity and mortality rates of univentricular circulation patients remain high. In this paper, we sought to perform a systematic review and meta-analysis to know the outcomes of fetal aortic valvuloplasty in critical aortic stenosis patients. METHODS This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. A systematic search on fetal aortic valvuloplasty procedure for critical aortic stenosis was performed through PubMed, Scopus, EBSCOhost, ProQuest, and Google Scholar. The primary endpoint of each group was overall mortality. We used R software (version 4.1.3) to estimate the overall proportion of each outcome using random-effects model of proportional meta-analysis. RESULTS A total of 389 fetal subjects from 10 cohort studies were included in this systematic review and meta-analysis. Fetal aortic valvuloplasty (FAV) was successfully performed in 84% of patients. It revealed a successful conversion to biventricular circulation rate of 33% with a mortality rate of 20%. Bradycardia and pleural effusion requiring treatment were two most common fetal complications, whereas maternal complication reported was only placental abruption in one patient. CONCLUSIONS FAV has a high technical success rate with the ability to achieve biventricular circulation and a low rate of procedure-related mortality if carried out by experienced operators.
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Affiliation(s)
- Brian Mendel
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia; Department of Cardiology and Vascular Medicine, Sultan Sulaiman Government Hospital, Serdang Bedagai, North Sumatera, Indonesia.
| | - Kelvin Kohar
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Shakira Amirah
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | | | - Radityo Prakoso
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Sisca Natalia Siagian
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
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Bautista-Rodriguez C, Hascoët S, Fraisse A. Feasibility, safety, and efficacy of Atrial Flow Regulator in children under 10 kg. Catheter Cardiovasc Interv 2023; 101:396-400. [PMID: 36617379 DOI: 10.1002/ccd.30536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/15/2022] [Accepted: 12/24/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The Atrial Flow Regulator (AFR) is a new self-expandable percutaneous-delivered fenestrated device providing an interatrial shunt. Its use in pediatric population has been reported in failing Fontan, pulmonary hypertension, or in patients with cardiomyopathy and venoarterial extracorporeal membrane oxygenator (ECMO) support. Its use in small children under 10 kg has not been reported. METHODS We report the initial single center experience of the AFR implantation in children below 10 kg. RESULTS Four children underwent AFR implantation. Patients' age and weight ranged between 9 and 22 months and 5-8.7 kgs. Indications were to unload the left atrium during ECMO support for end-stage cardiomyopathy and to enlarge a restrictive interatrial shunt in two other patients with complex congenital heart diseases. Devices implanted were AFR-6 and AFR-8. Delivery sheaths used via venous femoral access were undersized and ranged from 9 to 11 Fr. Devices were successfully implanted and provided unrestrictive interatrial shunt in all cases. One child developed a nonocclusive thrombus in the inferior vena cava which resolved within 1 month. Clinical improvement and femoral vein patency were observed in all cases. CONCLUSION AFR implantation is feasible in selected children under 10 kg. The AFR can be safely deployed through sheaths that are 1-2 Fr smaller than the recommended manufacturer size. More studies are needed to confirm safety and efficacy of the device in selected pediatric patients.
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Affiliation(s)
- Carles Bautista-Rodriguez
- Pediatric Cardiology Services, Royal Brompton Hospital, Guy's & St Thomas' Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Sébastien Hascoët
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Paris, France
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France
| | - Alain Fraisse
- Pediatric Cardiology Services, Royal Brompton Hospital, Guy's & St Thomas' Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
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Vanhie E, VandeKerckhove K, Haas NA, De Wolf D. Atrial flow regulator for drug-resistant pulmonary hypertension in a young child. Catheter Cardiovasc Interv 2021; 97:E830-E834. [PMID: 33650782 DOI: 10.1002/ccd.29590] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 11/10/2022]
Abstract
This case describes the successful implantation of an Occlutech Atrial Flow Regulator in a young child with idiopathic pulmonary hypertension and recurrent syncope despite targeted combination therapy, with subsequent relief of symptoms.
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Affiliation(s)
- Ellen Vanhie
- Department of Pediatrics, Pediatric Cardiology, Amsterdam University Hospital, Amsterdam, The Netherlands
| | - Kristof VandeKerckhove
- Department of Pediatrics, Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Nikolaus A Haas
- Department of Pediatrics, Pediatric Cardiology, LMU Klinikum, München, Germany
| | - Daniel De Wolf
- Department of Pediatrics, Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium.,Department of Pediatrics, Pediatric Cardiology, Brussel University Hospital, Brussels, Belgium
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Allen JW, Phipps KL, Llamas AA, Barrett KA. Left atrial decompression as a palliative minimally invasive treatment for congestive heart failure caused by myxomatous mitral valve disease in dogs: 17 cases (2018-2019). J Am Vet Med Assoc 2021; 258:638-647. [PMID: 33683957 DOI: 10.2460/javma.258.6.638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether left atrial decompression (LAD) would reduce left atrial pressure (LAP) in dogs with advanced myxomatous mitral valve disease (MMVD) and left-sided congestive heart failure (CHF) and to describe the LAD procedure and hemodynamic alterations and complications. ANIMALS 17 dogs with advanced MMVD and left-sided CHF that underwent LAD. PROCEDURES The medical record database was retrospectively reviewed for all LAD procedures attempted in dogs with MMVD and left-sided CHF between October 2018 and June 2019. Data were collected regarding signalment (age, breed, weight, and sex), clinical signs, treatment, physical examination findings, and diagnostic testing before and after LAD. Procedural data were also collected including approach, technique, hemodynamic data, complications, and outcome. RESULTS 18 LAD procedures performed in 17 patients were identified. Dogs ranged in age from 7.5 to 16 years old (median, 11 years) and ranged in body weight from 2.9 to 11.6 kg (6.4 to 25.5 lb) with a median body weight of 7.0 kg (15.4 lb). Minimally invasive creation of an atrial septal defect for the purpose of LAD was successful in all dogs without any intraoperative deaths. Before LAD, mean LAP was elevated and ranged from 8 to 32 mm Hg with a median value of 14 mm Hg (reference value, < 10 mm Hg). Following LAD, there was a significant decrease in mean LAP (median decrease of 6 mm Hg [range, 1 to 15 mm Hg]). Survival time following LAD ranged from 0 to 478 days (median, 195 days). CONCLUSIONS AND CLINICAL RELEVANCE For dogs with advanced MMVD and left-sided CHF, LAD resulted in an immediate and substantial reduction in LAP.
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Piccinelli E, Castro-Verdes MB, Fraisse A, Bautista-Rodriguez C. Implantation of an Atrial Flow Regulator in a Child on Venoarterial Extracorporeal Membrane Oxygenator as a Bridge to Heart Transplant: A Case Report. J Card Fail 2020; 27:364-367. [PMID: 33242607 DOI: 10.1016/j.cardfail.2020.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/21/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Balloon dilation and stenting of the atrial septum are techniques used to unload left heart cavities in acute or end-stage heart failure in children. However, they carry significant risks such as tamponade or device embolization. CASE PRESENTATION We report the first case of a child with an end-stage mitochondrial cardiomyopathy on a venoarterial extracorporeal membrane oxygenator as a bridge to heart transplant where an atrial flow regulator device has been implanted. CONCLUSIONS This case illustrates the feasibility and safety of atrial flow regulator implantation in this setting. This procedure allowed to wean inotropic support while awaiting heart transplantation.
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Affiliation(s)
- Enrico Piccinelli
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Mireya Beatriz Castro-Verdes
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Alain Fraisse
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Carles Bautista-Rodriguez
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
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Transesophageal echocardiography in the pediatric interventional cardiac catheterization laboratory. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jone P, Sandoval JP, Haak A, Hammers J, Rodriguez‐Zanella H, Quaife RA, Salcedo EE, Carroll JD, Gill E. Echocardiography–fluoroscopy fusion imaging: The essential features used in congenital and structural heart disease interventional guidance. Echocardiography 2020; 37:769-780. [DOI: 10.1111/echo.14670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Pei‐Ni Jone
- Pediatric Cardiology Children’s Hospital Colorado University of Colorado School of Medicine Aurora Colorado
| | - Juan Pablo Sandoval
- Intervención en Cardiopatía Congénita y Estructural Instituto Nacional de Cardiología Ignacio Chávez Mexico City Mexico
| | | | | | - Hugo Rodriguez‐Zanella
- Intervención en Cardiopatía Congénita y Estructural Instituto Nacional de Cardiología Ignacio Chávez Mexico City Mexico
| | - Robert A. Quaife
- Division of Cardiology University of Colorado School of Medicine Aurora Colorado
| | - Ernesto E. Salcedo
- Division of Cardiology University of Colorado School of Medicine Aurora Colorado
| | - John D. Carroll
- Division of Cardiology University of Colorado School of Medicine Aurora Colorado
| | - Edward Gill
- Division of Cardiology University of Colorado School of Medicine Aurora Colorado
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