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Prakoso R, Kurniawati Y, Siagian SN, Sembiring AA, Sakti DDA, Mendel B, Lelya O, Lilyasari O. Inter-atrial Septum Stenting in Congenital Heart Disease Patient: A Case Series in Indonesia. Cardiovasc Hematol Disord Drug Targets 2024; 24:163-171. [PMID: 39411958 PMCID: PMC11826880 DOI: 10.2174/011871529x320825240925073605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 08/30/2024] [Accepted: 09/12/2024] [Indexed: 11/21/2024]
Abstract
BACKGROUND Inter-atrial septum (IAS) stenting in duct-dependent congenital heart disease patient has shown to be an effective way to maintain inter-atrial blood flow, however it is still considered a high risk procedure and inter-atrial septum stenting remains a low-frequency procedure. METHOD A single-center observational cohort study was carried out at the National Cardiovascular Center Harapan Kita (NCCHK) between April 2019 and April 2023. This study included duct-dependent congenital heart disease patients. The extracted data were baseline characteristics, clinical findings, complications, and outcomes of the patients. RESULT Eleven patients with duct-dependent physiology were intervened with inter-atrial septum stenting. The patients were 4 females and 7 males with the median age of implantation being 150 days (range 11-703 days) and the median weight being 3.9 (range 2.8-9) kg, with 2 patients weighing less than 3 kg. The average stent diameter was 8.50 (2.03) mm with an average length of 24.45 (7.94) mm. Non-restrictive atrial flow was successfully achieved in 90.90% of the procedures, corresponding to 10 patients. CONCLUSION Inter-atrial septum stenting in duct-dependent congenital heart disease patients produces reliable patency with a very good intra-procedural success rate.
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Affiliation(s)
- Radityo Prakoso
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Yovi Kurniawati
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre 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 Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Aditya Agita Sembiring
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Damba Dwisepto Aulia Sakti
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Brian Mendel
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Sultan Sulaiman Government Hospital, Serdang Bedagai, North Sumatera, Indonesia
| | - Olfi Lelya
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Oktavia Lilyasari
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
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Risk stratification of patients with hypoplastic left heart syndrome and intact atrial septum using fetal MRI and echocardiography. Cardiol Young 2020; 30:790-798. [PMID: 32406345 DOI: 10.1017/s1047951120001006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Despite prenatal diagnosis, prenatal intervention, and immediate postnatal intervention, patients with hypoplastic left heart syndrome and intact or highly restrictive atrial septum have the highest risk for mortality. Charts for all infants diagnosed with hypoplastic left heart syndrome from 2009 to 2017 were retrospectively reviewed and compared, including pulmonary vein Doppler patterns on fetal echocardiogram and evidence of pulmonary lymphangiectasia on fetal MRI. Of the 81 newborns with hypoplastic left heart syndrome, we defined two groups. Group 1 patients had an adequate atrial septal communication (n = 69), while Group 2 met criteria for intact/restrictive septum (n = 12). No patient in Group 1 had a type C pulmonary vein Doppler pattern, while no patient in Group 2 had a type A pulmonary vein Doppler pattern. The two patients with pulmonary lymphangiectasia had type C pulmonary vein Doppler pattern and an intact atrial septum and did not survive. Survival to discharge for Group 1 was 83% compared to 58% for Group 2 (p = 0.116). Survival to stage 2 palliation was 71% for Group 1 compared to 50% for Group 2 (p = 0.186). Only 4 of the initial 12 patients from Group 2 are alive, which is an overall survival of 33%. Our experience supports previous evidence that fetal echocardiography can identify those patients with the greatest likelihood for postnatal intervention as well as those at highest risk for mortality. Fetal MRI is a novel imaging modality that may help providers separate patients at highest risk for mortality, regardless of pulmonary vein Doppler pattern.
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Kalfa D, Torres AJ. Indications and results for hybrid interventions in patients with congenital heart disease. Arch Cardiovasc Dis 2019; 113:96-103. [PMID: 31492537 DOI: 10.1016/j.acvd.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 11/28/2022]
Abstract
A hybrid therapy or procedure is a new treatment modality that develops by combining therapies from different subspecialties. In congenital heart disease, a growing number of such procedures have been described in recent decades, as a result of increasing collaboration between surgeons and interventionalists. The ideas behind these therapies include enabling the performance of procedures of different complexity in a less invasive manner, shortening procedural times, avoiding cardiopulmonary bypass, facilitating vascular access and decreasing the number of complications associated with more invasive approaches. Over the years, hybrid therapy has gained a place as a widely accepted therapeutic option for the management of several conditions in high-risk patients with congenital heart disease.
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Affiliation(s)
- David Kalfa
- Section of Congenital and Pediatric Cardiac Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Children's Hospital of NewYork-Presbyterian/Columbia University Medical Center, 10032 New York, NY, United States
| | - Alejandro J Torres
- Pediatric Cardiology Department, Children's Hospital of New York-Presbyterian/Columbia University Medical Center, 3959, Broadway BH2N, 10032 New York, NY, United States.
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Mainzer G, Goreczny S, Morgan GJ, Qureshi S, Krasemann T, Dryzek P, Moll JA, Moszura T, Rosenthal E. Stenting of the inter-atrial septum in infants and small children: Indications, techniques and outcomes. Catheter Cardiovasc Interv 2018; 91:1294-1300. [DOI: 10.1002/ccd.27462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 11/04/2017] [Accepted: 11/29/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Gur Mainzer
- Department of Paediatric Cardiology; Evelina London Children's Hospital, Guy's and St. Thomas' Hospital; London United Kingdom
- Paediatric Cardiology Unit, Padeh-Poriya Medical Center; Tiberias Israel
| | - Sebastian Goreczny
- Cardiology Department; Polish Mother's Memorial Hospital, Research Institute; Lodz Poland
| | - Gareth J. Morgan
- Department of Paediatric Cardiology; Evelina London Children's Hospital, Guy's and St. Thomas' Hospital; London United Kingdom
- Department of Congenital Cardiology; University of Colorado; Denver Colorado
| | - Shakeel Qureshi
- Department of Paediatric Cardiology; Evelina London Children's Hospital, Guy's and St. Thomas' Hospital; London United Kingdom
| | - Thomas Krasemann
- Department of Paediatric Cardiology; Evelina London Children's Hospital, Guy's and St. Thomas' Hospital; London United Kingdom
- Department of Pediatric Cardiology; Erasmus Medical Centre; Rotterdam Netherlands
| | - Pawel Dryzek
- Cardiology Department; Polish Mother's Memorial Hospital, Research Institute; Lodz Poland
| | - Jadwiga A Moll
- Cardiology Department; Polish Mother's Memorial Hospital, Research Institute; Lodz Poland
| | - Tomasz Moszura
- Cardiology Department; Polish Mother's Memorial Hospital, Research Institute; Lodz Poland
| | - Eric Rosenthal
- Department of Paediatric Cardiology; Evelina London Children's Hospital, Guy's and St. Thomas' Hospital; London United Kingdom
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Hermuzi A, McBrien A, De Rita F, McCheyne A, Griselli M, O'Sullivan JJ, Hasan A, Crossland DS. Hybrid transatrial stent insertion for left atrial decompression in hypoplastic left heart syndrome with intact atrial septum. Catheter Cardiovasc Interv 2016; 87:109-16. [PMID: 26268147 DOI: 10.1002/ccd.26115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 07/05/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To describe a novel strategy for the management of infants with hypoplastic left heart syndrome (HLHS) and intact atrial septum. Antenatally diagnosed infants are delivered in cardiac theatre and immediate left atrial decompression (LAD) using hybrid transatrial stent insertion (HTSI) via sternotomy is carried out. BACKGROUND HLHS with intact atrial septum is a condition incompatible with life following placental separation. Despite a number of reported strategies the survival of these infants remains much worse than those born with an adequate atrial communication. Immediate postnatal LAD is mandatory to allow consideration of active treatment. METHODS Single institution retrospective review of intention to carry out HTSI for LAD in infants with an antenatal diagnosis of HLHS intact atrial septum. RESULTS Two patients were delivered by planned caesarean section and transferred immediately to the prepared team in the adjacent cardiothoracic theatre. Birth weights were 3.2 Kg and 2.96 Kg. Clinical condition was poor with mean arterial PaO2 2.8kPa intubated with 100% inspired oxygen. HTSI was performed using premounted 7 × 17 mm stents (Visi-Pro™, eV3 Endovascular, Plymouth, MN). Mean arterial PaO2 improved to 6.2 kPa. Mean time from surgical incision to LAD was 26 min. Bilateral pulmonary artery bands (BPAB) were then placed. No procedural complications occurred and both patients underwent subsequent surgical stage 1 Norwood at 6 and 10 days. CONCLUSIONS In this high-risk anatomical substrate, careful planning from accurate fetal diagnosis underpins the success of initial management. This early experience suggests that HTSI offers rapid and successful postnatal LAD with no procedural morbidity facilitating successful subsequent palliation. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Antony Hermuzi
- Department of Congenital Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Angela McBrien
- Department of Congenital Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Fabrizio De Rita
- Department of Congenital Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Alan McCheyne
- Department of Cardiothoracic Anaesthesia, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Massimo Griselli
- Department of Congenital Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - John J O'Sullivan
- Department of Congenital Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Asif Hasan
- Department of Congenital Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - David S Crossland
- Department of Congenital Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
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Torres AJ, Sommer RJ, Crystal MA, Vincent JA, Bacha E, Turner ME. Use of the Baylis radiofrequency trans-septal needle to create an atrial communication in hypoplastic left heart syndrome. Interv Cardiol 2015. [DOI: 10.2217/ica.15.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Stern JA, Tou SP, Barker PC, Hill KD, Lodge AJ, Mathews KG, Keene BW. Hybrid cutting balloon dilatation for treatment of cor triatriatum sinister in a cat. J Vet Cardiol 2013; 15:205-10. [DOI: 10.1016/j.jvc.2013.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/20/2013] [Accepted: 03/25/2013] [Indexed: 11/29/2022]
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Hoque T, Richmond M, Vincent JA, Bacha E, Torres A. Current outcomes of hypoplastic left heart syndrome with restrictive atrial septum: a single-center experience. Pediatr Cardiol 2013; 34:1181-9. [PMID: 23392623 DOI: 10.1007/s00246-012-0625-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 12/26/2012] [Indexed: 11/28/2022]
Abstract
Advances in the management of hypoplastic left heart syndrome (HLHS) have resulted in improved survival. However, short and long-term mortality in patients with a restrictive atrial septum remains high. All neonates diagnosed with HLHS from 2003 to 2010 at our institution were evaluated. Patients who underwent atrial septostomy within the first 72 h conformed the restrictive atrial septum group (HLHS-RS). Patients with a non-restrictive communication (HLHS-NRS) formed the control group. Outcomes and survival status were determined from review of medical records. Of the 141 newborns diagnosed with HLHS, 20 (14 %) required intervention for a restrictive atrial septum. Procedural success was achieved in 17/20 (85 %) patients. Complications occurred in ten procedures, two of which were life threatening. No procedural deaths occurred. Overall median follow up was 35.5 months (0.4-104). Initial hospitalization survival was 16/20 (80 %) for the HLHS-RS group and 114/121(94 %) for the HLHS-NRS (p = 0.028). Twenty (14 %) patients were lost to follow up and 9 (6 %) underwent heart transplant. Overall survival was 10/16 (62 %) for HLHSRS patients and 77/95 (81 %) for HLHS-NRS (p = 0.1). Survival after initial discharge was 10/12 (83 %) for the HLHS-RS group and 77/88 (87 %) for the HLHS-NRS (p = 0.67). No predictors for HLHS-RS outcome were identified. Mortality at first-stage palliation in HLHS neonates with a restrictive atrial septum remains higher than in those with an unrestrictive communication. However, survival after initial hospital discharge is similar.
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Affiliation(s)
- Tasneem Hoque
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York-Presbyterian, 3959 Broadway, 2North, New York, NY, USA
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LeBlanc N, DeFrancesco TC, Adams AK, Atkins CE, Tou SP, Fudge JC, Keene BW. Cutting balloon catheterization for interventional treatment of cor triatriatum dexter: 2 Cases. J Vet Cardiol 2012. [DOI: 10.1016/j.jvc.2012.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Morgan GJ. Echocardiographic Guidance for Neonatal Right Ventricular Outflow Tract Stent Implantation. CONGENIT HEART DIS 2012; 8:585-8. [DOI: 10.1111/j.1747-0803.2011.00623.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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