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Nguyen TQ, Bechsgaard T, Schmidt MR, Juul K, Moshavegh R, Lönn L, Nielsen MB, Jensen JA, Hansen KL. Transthoracic Vector Flow Imaging in Pediatric Patients with Valvular Stenosis - A Proof of Concept Study. Ultrasound Int Open 2021; 7:E48-E54. [PMID: 34804771 PMCID: PMC8598391 DOI: 10.1055/a-1652-1261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 09/05/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose
Continuous wave Doppler ultrasound is routinely used to detect
cardiac valve stenoses. Vector flow imaging (VFI) is an angle-independent
real-time ultrasound method that can quantify flow complexity. We aimed to
evaluate if quantification of flow complexity could reliably assess valvular
stenosis in pediatric patients.
Materials and Methods
Nine pediatric patients with echocardiographically
confirmed valvular stenosis were included in the study. VFI and Doppler
measurements were compared with transvalvular peak-to-peak pressure differences
derived from invasive endovascular catheterization.
Results
Vector concentration correlated with the catheter measurements
before intervention after exclusion of one outlier (r=−0.83,
p=0.01), whereas the Doppler method did not (r=0.49,
p=0.22). The change in vector concentration after intervention
correlated strongly with the change in the measured catheter pressure difference
(r=−0.86, p=0.003), while Doppler showed a tendency for
a moderate correlation (r=0.63, p=0.07).
Conclusion
Transthoracic flow complexity quantification calculated from
VFI data is feasible and may be useful for assessing valvular stenosis severity
in pediatric patients.
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Affiliation(s)
- Tin-Quoc Nguyen
- Department of Diagnostic Radiology, Rigshospitalet Diagnostisk Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Thor Bechsgaard
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | | | - Klaus Juul
- Department of Pediatric Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Lars Lönn
- Department of Diagnostic Radiology, Rigshospitalet Diagnostisk Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Rigshospitalet Diagnostisk Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Rigshospitalet Diagnostisk Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
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Anesthesia Management for Pediatrics with Congenital Heart Diseases Who Undergo Cardiac Catheterization in China. J Interv Cardiol 2021; 2021:8861461. [PMID: 33628145 PMCID: PMC7880707 DOI: 10.1155/2021/8861461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 01/10/2021] [Accepted: 01/16/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives The goal of this study was to summarize anesthesia management for pediatrics with congenital heart diseases who undergo cardiac catheterization procedure in China. Methods The relevant articles were identified through computerized searches in the CNKI, Wanfang, VIP, and PubMed databases through May 2020, using different combinations of keywords: “congenital heart diseases,” “pediatric,” “children,” “anesthesia,” “cardiac catheterization,” “interventional therapy,” “interventional treatment,” “interventional examination,” and “computed tomography.” Results The database searches identified 48 potentially qualified articles, of which 25 (9,738 patients in total) were determined to be eligible and included. The authors collect data from the article information. Anesthesia methods included endotracheal intubation or laryngeal mask ventilation general anesthesia, monitored anesthesia care, and combined with sacral canal block. Anesthesia-related complications occurred in 7.41% of the patients and included dysphoria, respiratory depression, nausea, vomiting, cough, increased respiratory secretion, and airway obstruction. The incidence of procedure-related complications was 12.14%, of which the most common were arrhythmia and hypotension. Conclusions For pediatric patients with congenital heart diseases who undergo cardiac catheterization procedures in China, arrhythmia and hypotension are the most common procedure-related complications. Monitored anesthesia care is the commonly used anesthesia methods, and dysphoria, cough, nausea, vomiting, and respiratory depression are frequent complications associated with anesthesia.
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3
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Catheterization Performed in the Early Postoperative Period After Congenital Heart Surgery in Children. Pediatr Cardiol 2019; 40:827-833. [PMID: 30830282 DOI: 10.1007/s00246-019-02078-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/23/2019] [Indexed: 10/27/2022]
Abstract
The aim of this study was to describe pediatric patients who underwent early postoperative cardiac catheterization after congenital heart surgery, their clinical indications, findings, interventions, and complications in a cardiovascular center. A descriptive retrospective study was performed. All catheterizations performed within 6 weeks after congenital heart surgery between January 2004 and December 2014 were reviewed. We analyzed 101 early postoperative catheterizations. They were performed on median postoperative day five (IQR: 0-39); the median age was 64 days (IQR: 22-240). The most common diagnoses were single ventricle (53%), left heart obstruction (12%), and tetralogy of fallot or pulmonary atresia with ventricular septal defect (11%). Most common indications were persistent cyanosis (53%), low cardiac output (24%), and residual defect on echocardiogram (20%). Most frequent findings during the catheterization were pulmonary artery stenosis (29%), surgical conduit obstruction (12%), and coarctation or hypoplasia of the aorta (11%). Forty-six (45%) procedures involved intervention. Most frequent interventions were pulmonary artery, aorta, and Blalock-Taussig fistula angioplasty with or without stent implantation. There were adverse effects in 11 cases (11%), and 30-day mortality was 28% (28 patients) with the majority unrelated to the catheterization directly. Although early postoperative catheterizations are high-risk procedures, they are currently a very good option to solve acute problems in critically ill patients. This study provides relevant information for a better understanding and approach to this complex group of patients.
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4
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Abstract
BACKGROUND Catheter interventions for residual lesions in the early postoperative period after CHD operations are still not established as a reliable treatment option. METHODS We retrospectively reviewed our institutional experience of cardiac catheterisations and catheter interventions performed in the early postoperative period. We classified our patients into two groups. The "hyper" acute phase group - operation to cardiac catheterisation of ⩽7 days - and acute phase group - operation to cardiac catheterisation from 7 to 30 days. RESULTS Of the 47 patients, catheter interventions were performed in 38 patients (81%). The success rate of the intervention was 96% in the acute phase group and 90% in the "hyper" acute phase group. The overall success rate was 95%. There were two self-limited complications in the acute phase group, but not in the "hyper" acute phase group. There were four cases of catheter interventions performed for a newly reconstructed aortic arch, and those procedures were also safe and effective. CONCLUSIONS Cardiac catheterisations and catheter interventions were safe and effective not only in the early postoperative period but also in the very early postoperative period. Catheter interventions for the left-sided heart in the early postoperative period were also safe and effective.
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5
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Lam JE, Lin EP, Alexy R, Aronson LA. Anesthesia and the pediatric cardiac catheterization suite: a review. Paediatr Anaesth 2015; 25:127-34. [PMID: 25331288 DOI: 10.1111/pan.12551] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2014] [Indexed: 01/06/2023]
Abstract
Advances in technology over the last couple of decades have caused a shift in pediatric cardiac catheterization from a primary focus on diagnostics to innovative therapeutic interventions. These improvements allow patients a wider range of nonsurgical options for treatment of congenital heart disease. However, these therapeutic modalities can entail higher risk in an already complex patient population, compounded by the added challenges inherent to the environment of the cardiac catheterization suite. Anesthesiologists caring for children with congenital heart disease must understand not only the pathophysiology of the disease but also the effects the anesthetics and interventions have on the patient in order to provide a safe perioperative course. It is the aim of this article to review the latest catheterization modalities offered to patients with congenital heart disease, describe the unique challenges presented in the cardiac catheterization suite, list the most common complications encountered during catheterization and finally, to review the literature regarding different anesthetic drugs used in the catheterization lab.
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Affiliation(s)
- Jennifer E Lam
- Department of Anesthesia/Cardiac Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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6
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Siehr SL, Martin MH, Axelrod D, Efron B, Peng L, Roth SJ, Perry S, Shin AY. Outcomes following cardiac catheterization after congenital heart surgery. Catheter Cardiovasc Interv 2014; 84:622-8. [DOI: 10.1002/ccd.25490] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 03/06/2014] [Accepted: 03/12/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Stephanie L. Siehr
- Department of Pediatrics; Cardiovascular Institute, Stanford University School of Medicine; Palo Alto California
| | - Mary Hunt Martin
- Department of Pediatrics, Division of Pediatric Cardiology; Primary Children's Medical Center; Salt Lake City Utah
| | - David Axelrod
- Department of Pediatrics; Cardiovascular Institute, Stanford University School of Medicine; Palo Alto California
| | - Bradley Efron
- Department of Health Research and Policy, Division of Biostatistics; Stanford University Medical Center; Palo Alto California
| | - Lynn Peng
- Department of Pediatrics; Cardiovascular Institute, Stanford University School of Medicine; Palo Alto California
| | - Stephen J. Roth
- Department of Pediatrics; Cardiovascular Institute, Stanford University School of Medicine; Palo Alto California
| | - Stanton Perry
- Department of Pediatrics; Cardiovascular Institute, Stanford University School of Medicine; Palo Alto California
| | - Andrew Y. Shin
- Department of Pediatrics; Cardiovascular Institute, Stanford University School of Medicine; Palo Alto California
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7
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Schirra CO, Weiss S, Krueger S, Pedersen SF, Razavi R, Schaeffter T, Kozerke S. Toward true 3D visualization of active catheters using compressed sensing. Magn Reson Med 2009; 62:341-7. [PMID: 19526499 DOI: 10.1002/mrm.22001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A crucial requirement in MR-guided interventions is the visualization of catheter devices in real time. However, true 3D visualization of the full length of catheters has hitherto been impossible given scan time constraints. Compressed sensing (CS) has recently been proposed as a method to accelerate MR imaging of sparse objects. Images acquired with active interventional devices exhibit a high CNR and are inherently sparse, therefore rendering CS ideally suited for accelerating data acquisition. A framework for true visualization of active catheters in 3D is proposed employing CS to gain high undersampling factors making real-time applications feasible. Constraints are introduced taking into account prior knowledge of catheter geometry and catheter motion over time to improve and accelerate image reconstruction. The potential of the method is demonstrated using computer simulations and phantom experiments and in vivo feasibility is demonstrated in a pig experiment.
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Affiliation(s)
- C O Schirra
- King's College London BHF Centre, Division of Imaging Sciences, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, London, UK.
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8
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Asoh K, Hickey E, Dorostkar PC, Chaturvedi R, van Arsdell G, Humpl T, Benson LN. Outcomes of emergent cardiac catheterization following pediatric cardiac surgery. Catheter Cardiovasc Interv 2009; 73:933-40. [DOI: 10.1002/ccd.21919] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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9
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Estrada A, Moïse NS, Erb HN, McDonough SP, Renaud-Farrell S. Prospective Evaluation of the Balloon-to-Annulus Ratio for Valvuloplasty in the Treatment of Pulmonic Stenosis in the Dog. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb01799.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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10
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Russell IA, Rouine-Rapp K, Stratmann G, Miller-Hance WC. Congenital Heart Disease in the Adult: A Review with Internet-Accessible Transesophageal Echocardiographic Images. Anesth Analg 2006; 102:694-723. [PMID: 16492817 DOI: 10.1213/01.ane.0000197871.30775.2a] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Isobel A Russell
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA.
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11
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Nykanen DG, Zahn EM. Transcatheter techniques in the management of perioperative vascular obstruction. Catheter Cardiovasc Interv 2005; 66:573-9. [PMID: 16270363 DOI: 10.1002/ccd.20554] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The role of transcatheter intervention for the treatment of vascular obstruction is well documented in the preoperative or remote postoperative settings. More recently, the roles of angioplasty and stent implantation have been advocated as intraoperative and immediate postoperative strategies. As one considers the inherent advantages in this cooperative approach to congenital heart disease, the development of a truly hybrid interventional suite seems imperative.
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Affiliation(s)
- David G Nykanen
- Congenital Heart Institute, Miami Children's Hospital, Miami, Florida, USA.
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12
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Razavi R, Hill DLG, Keevil SF, Miquel ME, Muthurangu V, Hegde S, Rhode K, Barnett M, van Vaals J, Hawkes DJ, Baker E. Cardiac catheterisation guided by MRI in children and adults with congenital heart disease. Lancet 2003; 362:1877-82. [PMID: 14667742 DOI: 10.1016/s0140-6736(03)14956-2] [Citation(s) in RCA: 223] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Fluoroscopically guided cardiac catheterisation is an essential tool for diagnosis and treatment of congenital heart disease. Drawbacks include poor soft tissue visualisation and exposure to radiation. We describe the first 16 cases of a novel method of cardiac catheterisation guided by MRI with radiographic support. METHODS In our cardiac catheterisation laboratory, we combine magnetic resonance and radiographic imaging facilities. We used MRI to measure flow and morphology, and real-time MRI sequences to visualise balloon angiographic catheters. 12 patients underwent diagnostic cardiac catheterisation, two had interventional cardiac catheterisations, and for two patients, MRI was used to plan radiofrequency ablation for treatment of tachyarrhythmias. FINDINGS In 14 patients, some or all of the cardiac catheterisation was guided by MRI. In two patients undergoing radiofrequency ablation, catheters were manipulated with use of fluoroscopic guidance and outcome was assessed with MRI. All patients received lower amounts of radiation than controls. There was some discrepancy between pulmonary vascular resistance calculated by flow derived from MRI and the traditional Fick method. We were able to superimpose fluoroscopic images of electro physiology electrode catheters on the three dimensional MRI of the cardiac anatomy. INTERPRETATION We have shown that cardiac catheterisation guided by MRI is safe and practical in a clinical setting, allows better soft tissue visualisation, provides more pertinent physiological information, and results in lower radiation exposure than do fluoroscopically guided procedures. MRI guidance could become the method of choice for diagnostic cardiac catheterisation in patients with congenital heart disease, and an important tool in interventional cardiac catheterisation and radiofrequency ablation.
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Affiliation(s)
- Reza Razavi
- Cardiac Magnetic Resonance Research Group, Division of Imaging, King's College London, Thomas Guy House, London, UK.
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Gray DT, Louhimo I, Ahonen J, Emanuelsson B. Inter-institutional variation in risk-adjusted paediatric cardiac surgical outcomes. PROGRESS IN PEDIATRIC CARDIOLOGY 2003. [DOI: 10.1016/s1058-9813(03)00074-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Baddour LM, Bettmann MA, Bolger AF, Epstein AE, Ferrieri P, Gerber MA, Gewitz MH, Jacobs AK, Levison ME, Newburger JW, Pallasch TJ, Wilson WR, Baltimore RS, Falace DA, Shulman ST, Tani LY, Taubert KA. Nonvalvular Cardiovascular Device–Related Infections. Circulation 2003; 108:2015-31. [PMID: 14568887 DOI: 10.1161/01.cir.0000093201.57771.47] [Citation(s) in RCA: 363] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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15
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Fox JM, Bjornsen KD, Mahoney LT, Fagan TE, Skorton DJ. Congenital heart disease in adults: catheterization laboratory considerations. Catheter Cardiovasc Interv 2003; 58:219-31. [PMID: 12552548 DOI: 10.1002/ccd.10433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Congenital heart defects are the most common birth defects and represent an increasing proportion of adolescent and adult patients followed by cardiologists. While many of these patients have undergone successful palliative or corrective surgery with excellent functional results, most of them still require careful follow-up. Further, even complex lesions may first be diagnosed in adolescence and adulthood. Therefore, cardiologists caring for adults need to become more familiar with these defects. Assessment of the patient with known or suspected congenital heart defects requires a careful history, physical examination, and noninvasive assessment. In addition, the catheterization laboratory remains a critical venue for diagnosis and, increasingly, therapy. Pressure measurements, oximetry, and angiography remain cornerstones of diagnosis in selected patients and a variety of interventional procedures have become viable therapeutic alternatives in both pre- and postoperative patients.
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MESH Headings
- Adult
- Aortic Coarctation/diagnosis
- Aortic Coarctation/physiopathology
- Aortic Valve Stenosis/diagnosis
- Aortic Valve Stenosis/physiopathology
- Cardiac Catheterization
- Ductus Arteriosus, Patent/diagnosis
- Ductus Arteriosus, Patent/physiopathology
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/surgery
- Heart Septal Defects, Atrial/diagnosis
- Heart Septal Defects, Atrial/physiopathology
- Heart Septal Defects, Atrial/surgery
- Heart Septal Defects, Ventricular/diagnosis
- Heart Septal Defects, Ventricular/physiopathology
- Heart Septal Defects, Ventricular/surgery
- Hemodynamics
- Humans
- Pulmonary Valve Stenosis/diagnosis
- Pulmonary Valve Stenosis/physiopathology
- Tetralogy of Fallot/diagnosis
- Tetralogy of Fallot/physiopathology
- Transposition of Great Vessels/diagnosis
- Transposition of Great Vessels/physiopathology
- Tricuspid Atresia/diagnosis
- Tricuspid Atresia/physiopathology
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Affiliation(s)
- James M Fox
- Department of Internal Medicine, The University of Iowa, Iowa City, Iowa, USA
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16
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Benson L, Freedom R. Catheterization interventions in the management of common arterial trunk. PROGRESS IN PEDIATRIC CARDIOLOGY 2002. [DOI: 10.1016/s1058-9813(02)00011-5] [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: 10/27/2022]
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17
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Salamat M, Brown PR, Magee CA, Reyes DK, Peters DN, Venbrux AC. Experimental evaluation of a new transcatheter vascular embolization device in the swine model. J Vasc Interv Radiol 2002; 13:301-12. [PMID: 11875090 DOI: 10.1016/s1051-0443(07)61724-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate a new transcatheter device suitable for arterial embolization in an animal model. MATERIALS AND METHODS A new prototype self-expanding braided embolic device (Embolizor), consisting of nitinol wire strands fixed at either end with platinum-iridium bands and covered with a film of polyethylene, was deployed through 5-F diagnostic catheters into renal artery branches in five swine. Standard stainless-steel spring coils were deployed in other renal branches and served as controls. The animals underwent follow-up selective renal arteriography to determine presence or absence of vessel recanalization or device migration 15-23 days after device deployment. Histopathologic evaluation of target vessels and peripheral renal parenchyma was also performed. RESULTS Ten Embolizors and 10 stainless-steel coils were deployed in arteries ranging in size from 1.8 to 3.0 mm in diameter. The Embolizor was easily and precisely deployed. Angiographic evidence of vascular occlusion in the Embolizor group was noted within 30 seconds in eight device deployments and within 5 minutes in two. No early or delayed device migration was noted on follow-up arteriography. In the control group, seven of 10 previously occluded arteries were recanalized. No recanalization was noted in the Embolizor group. Light microscopy revealed evidence of infarction in all specimens examined. Whereas three specimens in the Embolizor group contained occasional giant cells, there were numerous multinucleated giant cells present within the interstices of all control spring coils. CONCLUSION The Embolizor was easily, precisely, and successfully deployed through standard selective diagnostic angiographic catheters. Short-term follow-up demonstrated no recanalization or migration of the device. The Embolizor was shown on histopathologic analysis to have no significant foreign body reaction.
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Affiliation(s)
- Mehrdad Salamat
- Division of Pediatric Cardiology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
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18
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Abstract
Branch pulmonary artery stenosis may occur as an isolated finding or in conjunction with other cardiac malformations; it may be congenital or acquired postoperatively. Transcatheter management with balloon pulmonary angioplasty (BPA) and/or endovascular stenting is generally considered the procedure of choice for most patients. With the introduction of high-pressure balloons, the results of BPA have improved significantly (75%). Stent implantation has increased the success rate to over 90%. However, BPA continues to be the initial procedure of choice for distal stenoses, or those associated with branching points, and in small children or infants. Stent implantation is preferred over BPA for central or proximal stenoses, and those due to kinking or tenting, external compression, intimal flaps, failed balloon dilation, and early postoperative procedures. Certain lesions, such as supravalvar pulmonary stenosis, or stenosis at the branch pulmonary arteries bifurcation, are better dealt with at surgery. High-risk situations for the development of postoperative pulmonary artery (PA) stenosis exist in small infants with hypoplastic branch PAs after a conotruncal procedure, after duct ligation, after shunt insertion, after PA band placement, or after pulmonary arteriotomies or anastomoses of any kind. A combined collaborative transcatheter and surgical approach is essential for many patients with PA stenosis, particularly in complex forms of tetralogy of Fallot.
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Affiliation(s)
- E A Bacha
- Section of Cardiac and Thoracic Surgery, University of Chicago, Children's Hospital, Chicago, Illinois, USA
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19
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Abstract
Nursing care of the neonate with CHD incorporates a knowledge base of the anatomy and physiology of congenital heart defects, surgical repair, complications associated with CHD, diagnostic testing, medical therapy, and psychosocial support. The neonatal nurse is a vital member of the cardiac team in providing accurate assessments, implementing medical therapies, and supporting the family.
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Affiliation(s)
- C Merle
- Departments of Pediatric Cardiology and Pediatric Critical Care, Babies and Children's Hospital of New York, New York, USA
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20
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Guerrero A, Hoffer EK, Hudson L, Schuler P, Karmy-Jones R. Treatment of pulmonary artery compression due to fibrous mediastinitis with endovascular stent placement. Chest 2001; 119:966-8. [PMID: 11243985 DOI: 10.1378/chest.119.3.966] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
We present the case of a 32-year-old woman with high-grade right pulmonary artery stenosis secondary to fibrous mediastinitis. The patient was managed with balloon angioplasty and stent placement. Only 15 cases of this nature have been reported in the literature, and this is one of the first to be managed with endovascular stent placement.
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Affiliation(s)
- A Guerrero
- Department of Surgery, Harborview Medical Center, Seattle, WA 98104, USA
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21
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Factores influyentes en la evolución de la mortalidad de las cardiopatías congénitas. Estudio sobre 1.216 niños en la Comunidad Autónoma de Murcia (1978-1990). Rev Esp Cardiol 2001. [DOI: 10.1016/s0300-8932(01)76312-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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