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Maruo K, Yoshida J, Nishimura T, Fujii H, Tomatsuri N, Yamashita M, Ichijo Y, Sano Y, Okuyama Y, Sato H. A case of esophageal cancer with superior vena cava syndrome treated with chemotherapy via a central venous port placed by translumbar approach. Clin J Gastroenterol 2025; 18:448-454. [PMID: 40167979 DOI: 10.1007/s12328-025-02121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2025] [Accepted: 03/17/2025] [Indexed: 04/02/2025]
Abstract
Superior vena cava syndrome (SVCS) is a serious condition that complicates the placement of central venous access port (CV port) in cancer patients. This report highlights the successful placement of a CV port by translumbar approach in a patient with advanced esophageal carcinoma complicated by SVCS. The patient was an 80-year-old woman whose tumor had invaded the superior vena cava (SVC) through the azygos vein, necessitating stent placement in the SVC. Subsequently, a CV port was implanted in the inferior vena cava using a translumbar approach, allowing the initiation of chemotherapy. The patient underwent nine cycles of FOLFOX followed by four cycles of nivolumab. To address worsening dysphagia, an esophageal stent was placed, disease progression was confirmed during treatment. The patient then transitioned to best supportive care. The patient passed away 432 days after the CV port placement. Notably, no port-related complications were observed throughout the course of treatment, underscoring the feasibility and safety of the translumbar approach in patients with SVCS.
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Affiliation(s)
- Kazuya Maruo
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-Ku, Kyoto, 605-0981, Japan
| | - Juichiro Yoshida
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-Ku, Kyoto, 605-0981, Japan.
- Department of Oncology, Japanese Red Cross Society Kyoto Daiichi Hospital, 15-749 Honmachi,Higashiyama-Ku, Kyoto, 605-0981, Japan.
| | - Takeshi Nishimura
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-Ku, Kyoto, 605-0981, Japan
| | - Hideki Fujii
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-Ku, Kyoto, 605-0981, Japan
| | - Naoya Tomatsuri
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-Ku, Kyoto, 605-0981, Japan
| | - Masanori Yamashita
- Department of Radiology, Japanese Red Cross Society Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-Ku, Kyoto, 605-0981, Japan
| | - Yusuke Ichijo
- Department of Radiology, Japanese Red Cross Society Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-Ku, Kyoto, 605-0981, Japan
| | - Yuko Sano
- Department of Radiology, Japanese Red Cross Society Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-Ku, Kyoto, 605-0981, Japan
| | - Yusuke Okuyama
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-Ku, Kyoto, 605-0981, Japan
| | - Hideki Sato
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-Ku, Kyoto, 605-0981, Japan
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2
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Hainstock MR, Castro BA, Kidney SR, Lim DS. Transhepatic Transcatheter Pulmonary Valve Replacement. JACC Case Rep 2024; 29:102475. [PMID: 39295809 PMCID: PMC11405966 DOI: 10.1016/j.jaccas.2024.102475] [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: 05/09/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 09/21/2024]
Abstract
Transcatheter pulmonary valve replacement (TPVR) is complicated in patients without adequate femoral or internal jugular vascular access. Transhepatic vascular access has been shown to be safe and effective across a spectrum of diagnostic and interventional procedures. Closure of the hepatic venous tract can be accomplished with a multitude of readily available vascular occlusion devices. The rates of major adverse events are low: 5% to 8% with hemoperitoneum and complete heart block are most significant. To our knowledge, this is the first report of using transhepatic access for TPVR; closure of the hepatic venous tract was achieved with an Amplatzer vascular plug type II.
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Affiliation(s)
- Michael R Hainstock
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
| | - Barbara A Castro
- Division of Pediatric Cardiac Anesthesia, Department of Anesthesia, University of Virginia, Charlottesville, Virginia, USA
| | - Stephanie R Kidney
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
| | - D Scott Lim
- Division of Cardiology, Department of Medicine, Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA
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3
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Onan HB, Piskin FC, Sozutok S, Ekinci F, Yildizdas D. An Alternative Central Venous Access Route for Pediatric Patients with Chronic Critical Illness: The Transhepatic Approach. Indian J Pediatr 2024; 91:254-259. [PMID: 35749038 DOI: 10.1007/s12098-022-04219-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/02/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the safety and functionality of the transhepatic approach as an alternative route for central venous catheterization in pediatric patients with chronic critical illness. METHODS The study included data of 12 chronic critically ill pediatric patients who underwent central venous catheterization with transhepatic approach. The indications, procedure details, mean patency time, and catheter-related complications were retrospectively analyzed. RESULTS A total of 16 central venous catheters were placed through the transhepatic approach. A 5F port catheter was used in eight attempts, a 5F PICC in two attempts, and an 8-14F Hickman-Broviac catheter in six attempts. All procedures were performed with technical success. The mean patency time of the catheters was 132.1 d (range: 12-540 d). In the long-term follow-up, catheter-related sepsis was detected in a patient, and six catheters lost functionality due to malposition. CONCLUSION The transhepatic approach is a safe and functional alternative route for central venous access in chronic critically ill pediatric patients requiring long-term vascular access. The procedure using ultrasonography and fluoroscopy can be performed with high technical success. In the long-term follow-up, Dacron felt cuff tunneled catheters placed in the subcostal space with a transhepatic approach remained functional for a long time.
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Affiliation(s)
- Hasan Bilen Onan
- Department of Radiology, Balcali Hospital, Medical Faculty Cukurova University, Adana, 38000, Turkey
| | - Ferhat Can Piskin
- Department of Radiology, Balcali Hospital, Medical Faculty Cukurova University, Adana, 38000, Turkey.
| | - Sinan Sozutok
- Department of Radiology, Balcali Hospital, Medical Faculty Cukurova University, Adana, 38000, Turkey
| | - Faruk Ekinci
- Department of Pediatric Intensive Care, Balcali Hospital, Medical Faculty Cukurova University, Adana, Turkey
| | - Dincer Yildizdas
- Department of Pediatric Intensive Care, Balcali Hospital, Medical Faculty Cukurova University, Adana, Turkey
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Özdemir E, Gürsoy MO, Nazlı C. Transjugular patent foramen ovale closure in a young patient with stroke caused by inferior vena cava thrombus: a different method with balloon anchor support to pulmonary vein. Cardiol Young 2023; 33:1757-1759. [PMID: 36991557 DOI: 10.1017/s104795112300063x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Patent foramen ovale closure is recommended for patients who are at risk for recurrent paradoxical embolism and cryptogenic stroke. The standard technique of patent foramen ovale closure is established from the femoral vein. However, alternative methods may be necessary for patent foramen ovale closure as in every interventional procedure. A 45-year-old female patient with an intramural giant uterine myoma had a history of recurrent deep vein thrombosis and stroke. A diffuse thrombus was detected in both iliac veins associated with inferior vena cava compression of the myoma. Also, a patent foramen ovale was revealed on echocardiography as a cause of embolic events. Hysterectomy was initially planned by gynaecology, but due to the possible risk of embolisation of inferior vena cava thrombus and stroke after removal of the compressive mass during hysterectomy, initial patent foramen ovale closure and then hysterectomy was scheduled in the Gynecology-Cardiology-Cardivascular Surgery council. Patent foramen ovale closure was performed via the right jugular vein approach. But because of the tight left atrial ostium of the patent foramen ovale, the catheter could not pass to the left atrium from the right atrium. With an anchor of a 5.0 × 15 mm coronary balloon over a 0.014-inch guidewire to the pulmonary vein, we were able to reach the left atrium. The patent foramen ovale was closed successfully, and the patient underwent a hysterectomy after closure without any embolic event. The patient was asymptomatic at 6 months of control.
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Affiliation(s)
- Emre Özdemir
- Cardiology, Izmir Katip Çelebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | | | - Cem Nazlı
- Cardiology, Izmir Katip Çelebi University, Ataturk Training and Research Hospital, Izmir, Turkey
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5
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Wang HX, Li N, An J, Han XB. Percutaneous transhepatic access for catheter ablation of a patient with heterotaxy syndrome complicated with atrial fibrillation: A case report. World J Clin Cases 2022; 10:7006-7012. [PMID: 36051120 PMCID: PMC9297398 DOI: 10.12998/wjcc.v10.i20.7006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/14/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is one of the most common arrhythmias, and radiofrequency catheter ablation is the most effective treatment strategy. The inferior vena cava (IVC) is a common approach for radiofrequency ablation of AF. However, this approach may not be applied to some cases such as chronic venous occlusions, surgical ligation of the IVC, and heterotaxy syndrome (HS).
CASE SUMMARY A 68-year-old man with HS suffered from severely symptomatic persistent AF for 9 years, and we successfully ablated by percutaneous transhepatic access.
CONCLUSION In patients without femoral vein access, the use of the hepatic vein for pulmonary vein isolation is a viable alternative for invasive electrophysiology procedures.
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Affiliation(s)
- Hai-Xiong Wang
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030000, Shanxi Province, China
| | - Na Li
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030000, Shanxi Province, China
| | - Jian An
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030000, Shanxi Province, China
| | - Xue-Bin Han
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030000, Shanxi Province, China
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6
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Al-Sinan A, Chan KH, Young GD, Martin A, Sepahpour A, Sy RW. Systematic review of electrophysiology procedures in patients with obstruction of the inferior vena cava. J Cardiovasc Electrophysiol 2022; 33:1300-1311. [PMID: 35441755 PMCID: PMC9323496 DOI: 10.1111/jce.15505] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/04/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022]
Abstract
AIMS The objective of the study was to conduct a systematic review to describe and compare the different approaches for performing cardiac electrophysiology (EP) procedures in patients with interrupted inferior vena cava (IVC) or equivalent entities causing IVC obstruction. METHODS We conducted a structured search to identify manuscripts reporting EP procedures with interrupted IVC or IVC obstruction of any aetiology published up until August 2020. No restrictions were applied in the search strategy. We also included seven local cases that met inclusion criteria. RESULTS The analysis included 142 patients (mean age 48.9 years; 48% female) undergoing 143 procedures. Obstruction of the IVC was not known before the index procedure in 54% of patients. Congenital interruption of IVC was the most frequent cause (80%); and, associated congenital heart disease (CHD) was observed in 43% of patients in this setting. The superior approach for ablation was the most frequently used strategy (52%), followed by inferior approach via the azygos or hemiazygos vein (24%), transhepatic approach (14%), and retroaortic approach (10%). Electroanatomical mapping (58%), use of long sheaths (41%), intracardiac echocardiography (19%), transesophageal echocardiography (15%) and remote controlled magnetic navigation (13%) were used as adjuncts to aid performance. Ablation was successful in 135 of 140 procedures in which outcomes were reported. Major complications were only reported in patients undergoing AF ablation, including two patients with pericardial effusion, one of whom required surgical repair, and another patient who died after inadvertent entry into an undiagnosed atrioesophageal fistula from a previous procedure. CONCLUSION The superior approach is most frequent approach for performing EP procedures in the setting of obstructed IVC. Transhepatic approach is a feasible alternative, and may provide a "familiar approach" for transseptal access when it is required. Adjunctive use of long sheaths, intravascular echocardiography, electro-anatomical mapping and remote magnetic navigation may be helpful, especially if there is associated complex CHD. With careful planning, EP procedures can usually be successfully performed with a low risk of complications.
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Affiliation(s)
- Ali Al-Sinan
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.,Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Kim H Chan
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Glenn D Young
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Andrew Martin
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Ali Sepahpour
- Department of Cardiology, St. George Hospital, Sydney, Australia
| | - Raymond W Sy
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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7
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Yang M, Slack M, Waksman R, Ben-Dor I. Transhepatic access: Alternative approach for right heart catheterization and pulmonary angiography. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 40S:159-161. [DOI: 10.1016/j.carrev.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/16/2022]
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8
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Balloon valvuloplasty for critical pulmonary valve stenosis in a newborn. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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9
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Haddad RN, Maleux G, Bonnet D, Malekzadeh-Milani S. Transhepatic atrial septal defect closure: simple way to achieve haemostasis in a patient with important co-morbidities. Cardiol Young 2020; 30:1343-1345. [PMID: 32635957 DOI: 10.1017/s1047951120001833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Percutaneous closure is the gold standard treatment for atrial septal defects, but the procedure can be complex in case of femoral thrombosis. Although unusual for congenital interventionists, transhepatic atrial septal defect closure is an attractive alternative to the internal jugular vein, especially when approaching the interatrial septum. Herein, we report the case of an adult patient with significant co-morbidities who had successful transhepatic atrial septal defect closure after a failed transjugular attempt. We describe the use of an absorbable haemostatic gelatin sponge to efficiently and safely achieve haemostasis after the use of a large vascular sheath with combined anticoagulation and antiplatelet therapy.
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Affiliation(s)
- Raymond N Haddad
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Université de Paris, Paris, France
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Damien Bonnet
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Université de Paris, Paris, France
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10
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Abstract
The field of congenital cardiac electrophysiology is growing rapidly due to the rapid growth in the population of survivors of childhood critical congenital heart disease surgery. Chronic arrhythmias pose one of the biggest challenges in this patient population, and catheter ablation, despite its challenges, is still the most desirable and acceptable approach when successful. Clinicians who propose catheter ablation in such patients need to understand the congenital anatomy, should carefully review the details of all prior cardiac surgery, and should be prepared to deal with the various challenges posed by lack of normal cardiac access and the possibility of poor hemodynamics. Still, experienced laboratories can achieve excellent results in this difficult patient population.
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Affiliation(s)
- George F Van Hare
- Washington University School of Medicine, One Children's Place, Campus Box 8116, Saint Louis, MO 63110, USA.
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11
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Percutaneous closure of ostium secundum atrial septal defect using left internal jugular vein access in a child with situs inversus and absence of inferior caval vein. Cardiol Young 2019; 29:1310-1312. [PMID: 31475660 DOI: 10.1017/s1047951119002099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Femoral vein access is the first choice for percutaneous atrial septal defect closure, and when it cannot be used due to anatomic reasons, the alternative sites should be considered, frequently increasing the complexity of the procedure. Here we report the case of a 3-year-old boy, with situs inversus and dextrocardia, electively referred for percutaneous closure of an ostium secundum atrial septal defect. During the procedure, agenesis of the infra-hepatic segment of the inferior caval vein was diagnosed, and no double inferior caval vein or right superior caval vein were identified by ultrasound or angiography. Therefore, we opted to perform the procedure through the left internal jugular vein, with fluoroscopy and transesophageal echocardiographic guidance. Catheters were navigated through a hydrophilic guidewire, and a Stiff guidewire was positioned in the left ventricle for better support. An Amplatzer septa occluder 19 was successfully deployed without major difficulties and the patient was discharged after 24 hours in good clinical condition. Percutaneous atrial septal defect closure through alternative access sites, especially in the presence of situs inversus, may pose significant challenges to the interventional team. In this case, the left internal jugular vein has shown to be a feasible option, allowing the navigation and manipulation of devices without complications. Provided the expertise of the interventional team, and awareness of the risks involved, alternative access sites can be successfully used for paediatric structural interventions.
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12
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Transhepatic Vascular Access for Implantation of a Watchman Left Atrial Appendage Closure Device. REPORTS 2018. [DOI: 10.3390/reports1020015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Conventional access through femoral veins may be limited due to tortuosity and venous occlusion secondary to venous thrombosis or congenital anomalies. Another alternative is subclavian veins, but the difficulty in catheter manipulation and stability makes it less favorable in comparison to the transhepatic access for the delivery of the Watchman device.
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13
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Orme GJ, Mendenhall C, Blair F, Wen Chen SY, Rhee E, Su W. Percutaneous transhepatic approach for cryoballoon pulmonary vein isolation in a patient with persistent atrial fibrillation and interruption of the inferior vena cava. HeartRhythm Case Rep 2018; 4:332-335. [PMID: 30112281 PMCID: PMC6092569 DOI: 10.1016/j.hrcr.2018.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/26/2018] [Accepted: 01/26/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- G. Joseph Orme
- Department of Cardiology, Banner University Medical Center, Phoenix, Arizona
| | - Cole Mendenhall
- Department of Interventional Radiology, Banner University Medical Center, Phoenix, Arizona
| | - Foreman Blair
- Department of Cardiology, Genesis Medical Center, Davenport, Iowa
| | - Steve Yu Wen Chen
- Department of Interventional Radiology, Banner University Medical Center, Phoenix, Arizona
| | - Edward Rhee
- Department of Cardiology, Phoenix Children’s Heart Center, Phoenix, Arizona
| | - Wilber Su
- Department of Cardiology, Banner University Medical Center, Phoenix, Arizona
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14
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Seghaye MC. Management of children with congenital heart defect: state of the art and future prospects. Future Cardiol 2016; 13:65-79. [PMID: 27936920 DOI: 10.2217/fca-2016-0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The treatment of children with congenital heart defects has evolved in the last 60 years from conservative care to a highly specialized management where advances in imaging, surgical, interventional and support techniques meet together to ensure satisfactory development and good quality of life to the child and to the upcoming grown up. Management of congenital heart defects best begins before birth with the aim, whenever possible, to maintain or establish biventricular physiology or, if this is excluded, to optimize the conditions for univentricular physiology. Current research in the field of genetics, device bioengineering and miniaturization, stem cell therapy, and fusion imaging technology is expected to help to improve further patient outcome. In this review, current management strategies and future prospects are discussed.
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Affiliation(s)
- Marie-Christine Seghaye
- Department of Pediatrics-Pediatric Cardiology, University Hospital Liège, Rue de Gaillarmont 600, B. 4032 Liège, Belgium
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15
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Transhepatic implant of a trimmed Melody™ valved stent in tricuspid position in a 1-year-old infant. Catheter Cardiovasc Interv 2016; 89:E84-E89. [DOI: 10.1002/ccd.26672] [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] [Received: 04/29/2016] [Revised: 06/22/2016] [Accepted: 07/03/2016] [Indexed: 11/07/2022]
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16
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Jehan Iqbal Z, Cao L, Chiang K, Adusumalli S, Khalid F, Nekkanti R. Transhepatic radiofrequency ablation of a cavotricuspid isthmus–dependent atrial flutter. HeartRhythm Case Rep 2016; 2:241-243. [PMID: 28491678 PMCID: PMC5419764 DOI: 10.1016/j.hrcr.2016.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Abstract
Limited vascular access because of vessel injury or thrombosis may complicate care of children with congenital heart disease. Although transhepatic venous access for cardiac catheterization and central venous catheter placement has been used in children, its use for extracorporeal membrane oxygenation (ECMO) has not been described. We report successful use of transhepatic cannulation for venovenous ECMO to support a 15 month-old child with bidirectional Glenn anatomy and intractable hypoxemia.
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18
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Whiteside W, Christensen J, Zampi JD. Three-dimensional magnetic resonance imaging overlay to assist with percutaneous transhepatic access at the time of cardiac catheterization. Ann Pediatr Cardiol 2015; 8:150-2. [PMID: 26085770 PMCID: PMC4453187 DOI: 10.4103/0974-2069.154146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Multimodality image overlay is increasingly used for complex interventional procedures in the cardiac catheterization lab. We report a case in which three-dimensional magnetic resonance imaging (3D MRI) overlay onto live fluoroscopic imaging was utilized to safely obtain transhepatic access in a 12-year-old patient with prune belly syndrome, complex and distorted abdominal anatomy, and a vascular mass within the liver.
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Affiliation(s)
- Wendy Whiteside
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Jason Christensen
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, United States
| | - Jeffrey D Zampi
- Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan, United States
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19
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Edwards A, Veldman A, Nitsos I, Chan Y, Brew N, Teoh M, Menahem S, Schranz D, Wong FY. A percutaneous fetal cardiac catheterization technique for pulmonary valvuloplasty and valvulotomy in a mid-gestation lamb model. Prenat Diagn 2014; 35:74-80. [DOI: 10.1002/pd.4486] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 08/13/2014] [Accepted: 08/18/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Andrew Edwards
- The Ritchie Centre; Monash Institute of Medical Research-Prince Henry Institute; Melbourne Australia
- Perinatal Services; Monash Medical Centre; Melbourne Australia
- Fetal Cardiac Unit; Monash Medical Centre; Melbourne Australia
| | - Alex Veldman
- The Ritchie Centre; Monash Institute of Medical Research-Prince Henry Institute; Melbourne Australia
- Department of Paediatrics; Monash University; Melbourne Australia
- Pediatric Heart Center; Justus-Liebig University; Giessen Germany
| | - Ilias Nitsos
- The Ritchie Centre; Monash Institute of Medical Research-Prince Henry Institute; Melbourne Australia
| | - Yuen Chan
- Department of Pathology; Monash Medical Centre; Melbourne Australia
| | - Nadine Brew
- The Ritchie Centre; Monash Institute of Medical Research-Prince Henry Institute; Melbourne Australia
| | - Mark Teoh
- Perinatal Services; Monash Medical Centre; Melbourne Australia
- Fetal Cardiac Unit; Monash Medical Centre; Melbourne Australia
| | - Samuel Menahem
- The Ritchie Centre; Monash Institute of Medical Research-Prince Henry Institute; Melbourne Australia
- Department of Paediatrics; Monash University; Melbourne Australia
| | - Dietmar Schranz
- Pediatric Heart Center; Justus-Liebig University; Giessen Germany
| | - Flora Y. Wong
- The Ritchie Centre; Monash Institute of Medical Research-Prince Henry Institute; Melbourne Australia
- Department of Paediatrics; Monash University; Melbourne Australia
- Monash Newborn; Monash Medical Centre; Melbourne Australia
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20
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El Tahlawi M, Assaidi A, Fraisse A. Transcatheter treatment for pulmonary artery occlusion secondary to pulmonary embolism in an infant. Cardiol Young 2014; 24:729-731. [PMID: 23902997 DOI: 10.1017/s104795111300098x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report a case of successful recanalisation of the left pulmonary artery after occlusion due to embolic thrombi in a 9-month-old infant after surgical repair of a common atrioventricular canal with tetralogy of Fallot. A transhepatic approach was used because of caval vein thrombosis. After the failure of high-pressure balloon angioplasty, the left pulmonary artery was successfully recanalised with cutting balloons, followed by stent implantation with an excellent result.
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Affiliation(s)
| | - Anass Assaidi
- Cardiologie Pédiatrique,Hôpital de la Timone-Enfants,Marseille,France
| | - Alain Fraisse
- Cardiologie Pédiatrique,Hôpital de la Timone-Enfants,Marseille,France
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21
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Al Senaidi K, Al Mesned A, Coe JY. Percutaneous transhepatic stenting of a restrictive atrial septal communication in hypoplastic left heart syndrome. Catheter Cardiovasc Interv 2014; 83:E269-71. [PMID: 24532371 DOI: 10.1002/ccd.25442] [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: 12/17/2013] [Accepted: 02/08/2014] [Indexed: 11/08/2022]
Abstract
The postnatal survival of patients with congenital cardiac defects such as hypoplastic left heart syndrome (HLHS) is dependent on the patency of the ductus arteriosus and the presence of an unrestrictive atrial septal defect (ASD). We report a six week old infant with HLHS and tricuspid valve regurgitation with restrictive ASD. Transfemoral balloon atrial septostomy provided temporary relief but further attempts were not possible. A transhepatic venous approach to stent the atrial communication was technically successful. This approach may be the only access for certain infant cardiac catheterization interventions, permitting the use of a large delivery system (≥ 8 Fr).
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Affiliation(s)
- Khalfan Al Senaidi
- Division of Pediatric Cardiology, Sultan Qaboos University, Sultanate of Oman
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Qureshi AM, Prieto LR, Bradley‐Skelton S, Latson LA. Complications related to transhepatic venous access in the catheterization laboratory—A single center 12‐year experience of 124 procedures. Catheter Cardiovasc Interv 2014; 84:94-100. [DOI: 10.1002/ccd.25278] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 09/26/2013] [Accepted: 10/23/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Athar M. Qureshi
- Center of Pediatric and Congenital Heart DiseaseThe Children's Hospital at The Cleveland ClinicCleveland Ohio
| | - Lourdes R. Prieto
- Center of Pediatric and Congenital Heart DiseaseThe Children's Hospital at The Cleveland ClinicCleveland Ohio
| | - Sharon Bradley‐Skelton
- Center of Pediatric and Congenital Heart DiseaseThe Children's Hospital at The Cleveland ClinicCleveland Ohio
| | - Larry A. Latson
- Center of Pediatric and Congenital Heart DiseaseThe Children's Hospital at The Cleveland ClinicCleveland Ohio
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Jain SA, Pinto R, Dalvi B. Transcatheter closure of a large ASD from the femoral vein in a patient with Budd-Chiari syndrome. Catheter Cardiovasc Interv 2013; 82:E888-92. [PMID: 22927043 DOI: 10.1002/ccd.24628] [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: 04/29/2012] [Accepted: 08/20/2012] [Indexed: 11/09/2022]
Abstract
Anomalies of the inferior vena cava are rare in patients with isolated atrial septal defect (ASD). When present, they usually preclude successful transcatheter closure of the ASD using the femoral route. We report a case of a large secundum ASD in a 3-year-old child, who had a chronic Budd-Chiari syndrome incidentally detected on the cardiac catheterization table. We were able to successfully deploy the device from the femoral route itself using a collateral channel to reach the heart and then using the pulmonary vein deployment technique to successfully close the defect.
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Hascoet S, Fraisse A, Elbaz M. Successful percutaneous transcatheter patent foramen ovale closure through the right internal jugular vein using a steerable catheter. Catheter Cardiovasc Interv 2013; 82:E598-602. [PMID: 23413211 DOI: 10.1002/ccd.24868] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 02/09/2013] [Indexed: 11/09/2022]
Abstract
Percutaneous transcatheter closure of a patent foramen ovale (PFO) remains challenging when femoral venous approach is not available. We describe the successful closure of a PFO using the right internal jugular venous approach and a deflectable catheter delivery system in a patient with a PFO, recurrent stroke, and an inferior vena cava filter.
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Affiliation(s)
- Sebastien Hascoet
- Service de Cardiologie, Centre Hospitalier Universitaire Rangueil, Toulouse, France; Service de Cardiologie Pédiatrique, Hôpital des Enfants, Toulouse, France
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Nguyen DT, Gupta R, Kay J, Fagan T, Lowery C, Collins KK, Sauer WH. Percutaneous transhepatic access for catheter ablation of cardiac arrhythmias. Europace 2013; 15:494-500. [PMID: 23385049 DOI: 10.1093/europace/eus315] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIMS Femoral venous access may be limited in certain patients undergoing electrophysiology (EP) study and ablation. The purpose of this study is to review a series of patients undergoing percutaneous transhepatic access to allow for ablation of cardiac arrhythmias. METHODS AND RESULTS Six patients with a variety of cardiac arrhythmias and venous abnormalities underwent percutaneous transhepatic access. Under fluoroscopic and ultrasound guidance, a percutaneous needle was advanced into a hepatic vein and exchanged for a vascular sheath over a wire. Electrophysiology study and radiofrequency ablation was then performed. All tachycardias, including atrial tachycardia, atrial flutter, atrioventricular nodal tachycardia, and atrial fibrillation, were ablated. Procedural times ranged from 227 to 418 min. Fluoroscopy times ranged from 32 to 95 min. There were no complications. All six patients have been arrhythmia-free in follow-up (5-49 months, mean 23.1 months). CONCLUSION Percutaneous transhepatic access is safe and feasible in patients with limited venous access who are undergoing EP study and ablation for a range of cardiac arrhythmias.
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Affiliation(s)
- Duy Thai Nguyen
- Electrophysiology, University of Colorado, Anschutz Medical Campus, 12401 E. 17th Avenue, B-132, Aurora, CO 80045, USA.
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Flosdorff P, Paech C, Dähnert I. Secundum atrial septal defect with interrupted inferior vena cava and azygos continuation: transfemoral closure in a 3-year old boy. Pediatr Cardiol 2013; 34:459-61. [PMID: 22453839 DOI: 10.1007/s00246-012-0307-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
A secundum atrial septal defect (ASD 2) was closed percutaneously via the transfemoral approach in a 3-year-old boy with interrupted inferior vena cava and azygos continuation. The procedure was guided by transesophageal echocardiography and fluoroscopy using conscious sedation. Successful transhepatic and jugular accesses in similar patients are described. This is the first pediatric report describing a transfemoral closure of a secundum atrial septum defect via azygos continuation.
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Affiliation(s)
- Patrick Flosdorff
- Department of Pediatric Cardiology, Heart Center, University of Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany.
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Acceso vascular inusual para cateterismo cardiaco en pacientes con cardiopatía congénita compleja: reporte de un caso. REVISTA COLOMBIANA DE CARDIOLOGÍA 2012. [DOI: 10.1016/s0120-5633(12)70105-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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28
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Lowry AW, Pignatelli RH, Justino H. Percutaneous atrial septal defect closure in a child with interrupted inferior vena cava: successful femoral venous approach. Catheter Cardiovasc Interv 2011; 78:590-3. [PMID: 21936042 DOI: 10.1002/ccd.23041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 02/13/2011] [Indexed: 11/10/2022]
Abstract
Interrupted inferior vena cava (IVC) with azygous continuation to the superior vena cava (SVC) is a relatively common systemic venous anomaly. This anomaly can occasionally complicate transcatheter intervention by rendering more difficult the usual direct route to the systemic venous atrium afforded by femoral venous access. We report our experience with successful transcatheter closure of a large residual atrial septal defect (ASD) using the femoral venous route in a 3-year-old patient with heterotaxy syndrome of left isomerism type, dextrocardia, partial atrioventricular canal defect, and interrupted IVC with azygous continuation to the SVC.
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Affiliation(s)
- Adam W Lowry
- Department of Pediatrics, Lillie-Frank Abercrombie Section of Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas 77030, USA
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Abstract
Transhepatic cardiac catheterization and intervention is used in selected cases in our institution. A retrospective review of transcatheter interventions for the pulmonary artery was conducted. Forty-five transhepatic procedures were performed. Thirteen involved intervention, to rehabilitate the branch pulmonary arteries. The median weight of the patients was 9.9 Kg ± 3.4. The patients' age ranged from eight months to 86 months (median 23 months). The largest sheath used was 7F. All the patients underwent success intervention with no complication related either to the transhepatic approach or the intervention. The branch pulmonary artery diameter increased from 4.5 ± 2.2 mm to 7 ± 3 mm. Most of the procedures were performed under conscious sedation / deep sedation protocol. Hemostasis was achieved in all patients by gradual sheath withdrawal, followed by application of upward pressure on the tract from the subcostal area. In the absence of patent femoral veins the transhepatic approach can be used to perform successful and safe interventions, to rehabilitate the pulmonary artery system. It may offer the additional advantage of using larger sheaths than would be felt appropriate for the femoral veins.
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Affiliation(s)
- Makram R Ebeid
- Department of Pediatrics (Division of Pediatric Cardiology), University of Mississippi Medical Center, Mississippi, USA
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Padhi SS, Bakshi KD, Londhe AP. Balloon atrial septostomy through internal jugular vein in a 45-day-old child with transposition of great arteries. Ann Pediatr Cardiol 2011; 3:77-9. [PMID: 20814481 PMCID: PMC2921523 DOI: 10.4103/0974-2069.64363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Balloon atrial septostomy is a common palliative procedure in D-transposition of great arteries. It is technically easy before 2-3 weeks of age when the septum primum is thin. Femoral vein or umbilical vein, when available, is the common access used for this procedure. In situations when these accesses are not available or in case of inferior vena cava interruption, trans-hepatic access is used. Internal jugular vein (IJV) access is not used as it is difficult to enter the left atrium through this route. We describe a case of successful Balloon atrial septostomy done through IJV in a 45-day-old child with emphasis on the technique, hardware and precautions necessary during the procedure.
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Affiliation(s)
- Sumanta S Padhi
- Department of Pediatric Cardiology, Innova Children's Heart Hospital, Secunderabad, India
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31
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Kenny D, McMahon C, Walsh KP. Transhepatic Approach for Extracardiac Inferior Cavopulmonary Connection Stent Fenestration. CONGENIT HEART DIS 2011; 6:276-9. [DOI: 10.1111/j.1747-0803.2011.00488.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tzifa A, Ahmed I, Rosenthal E. Transhepatic portal vein access for balloon dilation of right upper pulmonary vein stenosis following infradiaphragmatic total anomalous pulmonary venous drainage repair. Catheter Cardiovasc Interv 2011; 78:698-701. [DOI: 10.1002/ccd.22906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 11/06/2010] [Accepted: 11/06/2010] [Indexed: 11/10/2022]
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Kim GB, Bae EJ, Noh CI. Balloon valvuloplasty for neonatal critical pulmonary valvar stenosis with IVC interruption: pitfalls of the transumbilical approach. J Korean Med Sci 2010; 25:485-8. [PMID: 20191053 PMCID: PMC2826727 DOI: 10.3346/jkms.2010.25.3.485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Accepted: 11/17/2009] [Indexed: 11/20/2022] Open
Abstract
Transcatheter balloon pulmonary valvuloplasty (BPV) is considered to be the treatment of choice for neonates with critical pulmonary valvar stenosis (PVS) or pulmonary valvar atresia with intact ventricular septum accompanied by reasonable right ventricular volume. The percutaneous femoral venous access is the most preferred route for BPV in most cardiac centers. We report herein the case of a newborn baby with critical PVS with inferior vena cava interruption, severe tricuspid regurgitation and a severely enlarged right atrium. We tried BPV through the transumbilical approach with difficulty, but he was successfully treated with the assistance of a coronary artery guiding catheter.
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Affiliation(s)
- Gi-Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Eun-Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Chung-Il Noh
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
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Teichgräber UKM, Streitparth F, Gebauer B, Benter T. Placement of a port catheter through collateral veins in a patient with central venous occlusion. Cardiovasc Intervent Radiol 2009; 33:417-20. [PMID: 19504152 DOI: 10.1007/s00270-009-9613-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 01/29/2009] [Accepted: 02/03/2009] [Indexed: 11/30/2022]
Abstract
Long-term utilization of central venous catheters (CVCs) for parenteral nutrition has a high incidence of central venous complications including infections, occlusions, and stenosis. We report the case of a 31-year-old woman presenting with a malabsorption caused by short gut syndrome due to congenital aganglionic megacolon. The patient developed a chronic occlusion of all central neck and femoral veins due to long-term use of multiple CVCs over more than 20 years. In patients with central venous occlusion and venous transformation, the implantation of a totally implanted port system by accessing collateral veins is an option to continue long-term parenteral nutrition when required. A 0.014-in. Whisper guidewire (Terumo, Tokyo) with high flexibility and steerability was chosen to maneuver and pass through the collateral veins. We suggest this approach to avoid unfavorable translumbar or transhepatic central venous access and to conserve the anatomically limited number of percutaneous access sites.
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Affiliation(s)
- Ulf Karl-Martin Teichgräber
- Institut für Diagnostische und Interventionelle Radiologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Lim DS, Cortese CJ, Loree AN, Dean DA, Svitek RG. Left ventricular assist via percutaneous transhepatic transseptal cannulation in swine. Catheter Cardiovasc Interv 2009; 73:961-5. [PMID: 19213076 DOI: 10.1002/ccd.21934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To report the in vivo testing of transhepatic, transseptal cannula insertion to support the left ventricle. BACKGROUND Percutaneous cannulation for circulatory assist poses particular challenges in pediatrics. We utilized a strategy using a transhepatic, transseptal venous cannula inserted into the left atrium, a centrifugal pump, and arterial cannula. METHODS Yorkshire swine of 5-20 kg (n = 6) were anesthetized for the procedure. After hepatic venous angiography, percutaneous puncture of the hepatic vein was performed, followed by transseptal puncture with echocardiographic guidance. A 10-14 Fr 26-cm venous inflow cannula was placed in the left atrium via hepatic approach. The femoral artery was cannulated with a 6-10 Fr femoral cannula, and the circuit completed with the TandemHeart centrifugal pump. RESULTS Implantation of the system utilizing the transhepatic approach was successful in all experiments. The pump delivered flows ranging from 0.8 to 1.4 L/min, which corresponded to 40-86% of the baseline systemic outputs. Decannulation and occlusion of the hepatic tract was successful utilizing transcatheter vascular occlusion plugs. CONCLUSION The transhepatic, transseptal insertion of the inflow cannula, coupled with the TandemHeart centrifugal pump and femoral arterial cannulation allows percutaneous circulatory support in 5- to 20-kg models.
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Affiliation(s)
- D Scott Lim
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22908-0386, USA.
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Carter LI, Cavendish JJ. Percutaneous closure of a patent foramen ovale via left axillary vein approach with the Amplatzer Cribriform septal occluder. J Interv Cardiol 2008; 21:28-31. [PMID: 18254787 DOI: 10.1111/j.1540-8183.2007.00313.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Percutaneous closure of a patent foramen ovale (PFO) was successfully performed via the left axillary vein in a 52-year-old female with a history of left posterior cerebral artery embolic cerebrovascular accident (CVA) and inferior vena cava (IVC) interruption with a Simon Nitinol Filter precluding standard access via the common femoral vein. Utilizing a 6 French Amplatzer 180 degrees patent ductus arteriosus delivery sheath and a 25-mm Amplatzer Cribriform occluder, the PFO was successfully closed utilizing general anesthesia and transesophageal echocardiography guidance. This case demonstrates the advantages of the axillary vein approach over the internal jugular or hepatic vein approach in patients with anatomy precluding standard percutaneous closure.
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Affiliation(s)
- Luther I Carter
- Cardiology Department, Naval Medical Center San Diego, San Diego, California 92134, USA.
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Davenport JJ, Lam L, Whalen-Glass R, Nykanen DG, Burke RP, Hannan R, Zahn EM. The successful use of alternative routes of vascular access for performing pediatric interventional cardiac catheterization. Catheter Cardiovasc Interv 2008; 72:392-398. [DOI: 10.1002/ccd.21621] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Mortell A, Said H, Doodnath R, Walsh K, Corbally M. Transhepatic central venous catheter for long-term access in paediatric patients. J Pediatr Surg 2008; 43:344-7. [PMID: 18280287 DOI: 10.1016/j.jpedsurg.2007.10.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 10/09/2007] [Indexed: 11/17/2022]
Abstract
Vascular access in paediatric patients with chronic and/or life-threatening illness is crucial to survival. Access is frequently lost in this group because of thrombosis, infection, or displacement, and vascular options can quickly be exhausted. The last resort access procedure is generally a direct atrial catheter inserted via a thoracotomy. A viable alternative is the percutaneous transhepatic Broviac catheter (Bard Access Systems, Salt Lake City, UT). We retrospectively reviewed the charts of 5 patients who underwent percutaneous transhepatic Broviac insertion for long-term access over a 4-year period in a single institution. Four of the patients (80%) had a significant cardiac abnormality, with 1 patient requiring long-term parenteral nutrition after complicated necrotizing enterocolitis. All patients had significant caval thrombosis, which precluded them having placement of a standard percutaneous or openly placed central catheter. Of the 5 patients, 2 (40%) died of cardiac-related illnesses. Of the 3 surviving patients, 2 had functioning catheters electively removed because they were no longer required. One catheter was removed at thoracotomy for right atrial perforation because of catheter erosion. Vascular access in paediatric patients with chronic and/or life-threatening illness is crucial to survival. Transhepatic central venous catheters are a feasible, reliable, and relatively easily placed form of central access in patients with multiple venous thromboses requiring long-term access. This route should be considered in paediatric patients requiring central access in preference to a thoracotomy.
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Affiliation(s)
- Alan Mortell
- Department of Paediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
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Pulver A, Cowley C. Transhepatic, Transseptal, Anterograde Balloon Angioplasty for Recurrent Neonatal Coarctation. CONGENIT HEART DIS 2007; 2:438-41. [DOI: 10.1111/j.1747-0803.2007.00139.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Qureshi AM, Rhodes JF, Appachi E, Mumtaz MA, Duncan BW, Asnes J, Radavansky P, Latson LA. Transhepatic Broviac catheter placement for long-term central venous access in critically ill children with complex congenital heart disease. Pediatr Crit Care Med 2007; 8:248-53. [PMID: 17417124 DOI: 10.1097/01.pcc.0000265327.93745.89] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Critically ill children with cardiac disease often require prolonged central venous access. Thrombosis of systemic veins or the need to preserve vessels for future cardiac procedures limits sites for placement of central venous catheters in these patients. This study evaluates the use of Broviac placement via the transhepatic approach for this patient population. DESIGN A retrospective review. SETTING A tertiary care center. PATIENTS All children with complex congenital heart disease who underwent transhepatic Broviac placement between May 2000 and April 2004. INTERVENTIONS Transhepatic Broviac placement. MEASUREMENTS AND MAIN RESULTS Thirty-two children with a median age of 5 months (20 days-5.3 yrs) and a median weight of 4.2 kg (2.2-24.9 kg) underwent 40 transhepatic Broviac placements. There were three (8.8%) procedural-related complications. One patient suffered an intra-abdominal bleed requiring an urgent laparotomy and removal of the Broviac, one patient required transfusion because of a mild self-contained intra-abdominal bleed, and one patient developed temporary complete heart block. There was one catheter infection. Thrombus was noted by echocardiography on the tip of two Broviacs; however, no intracardiac vegetations or embolic events occurred. There was no mortality related to the procedure. Broviacs remained in place for a median of 36 days (1 day-6 months). Five Broviacs were dislodged inadvertently (two during cardiac massage and three resulting from patient manipulation). The remaining Broviacs were electively removed safely without coil embolization. At a median follow-up of 3.5 months (10 days-3 yrs), there have been no long-term complications related to the Broviacs. CONCLUSIONS Transhepatic Broviac catheters can be used safely in critically ill children with cardiac disease and remain indwelling for adequate periods of time. This modality of prolonged vascular access should be considered for children whose veins are occluded or need to be preserved for future procedures.
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Affiliation(s)
- Athar M Qureshi
- Department of Pediatric and Congenital Heart Disease, The Children's Hospital at the Cleveland Clinic, Cleveland, OH, USA.
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Tan LH, Chang AC. Transhepatic approach as an alternative long-term central venous access in critically ill children with complex congenital heart disease: a new angle to an old problem? Pediatr Crit Care Med 2007; 8:298-9. [PMID: 17496518 DOI: 10.1097/01.pcc.0000262883.94031.0f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Interventional cardiology is an innovative and expanding field. Anaesthetists are increasingly involved in managing complex congenital and acquired heart lesions in the cardiac catheterisation laboratory. This article provides an overview of common lesions encountered in the cardiac catheterisation laboratory, the anaesthetic management of patients with congenital and acquired heart lesions, the procedures performed and the complications encountered during such procedures.
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Affiliation(s)
- K Reddy
- Department of Anaesthesia, Royal Free Hospital, Pond Street, London NW3 2QG, UK
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Abstract
Since the first description of balloon pulmonary valvuloplasty in 1982 by Kan, the procedure has been extensively utilized by several groups of workers for relief of pulmonary valve stenosis. It is generally recommended that the procedure be performed for peak-to-peak gradients in excess of 50 mmHg. The technique involves positioning one or more balloon catheters across the stenotic valve, usually over an extra-stiff guide wire and inflating the balloons with diluted contrast material, thus producing valvotomy. The procedural details are described in this paper. The currently recommended balloon/annulus ratio is 1.2 to 1.25. Immediate reduction of gradient, increase in jet width and free motion of the pulmonary valve leaflets with less doming have been observed following balloon dilatation. Improvement of right ventricular function, tricuspid insufficiency and right-to-left shunt has also occurred. Complication can occur, but are rare and minimal. At mid-term follow-up, both catheterization measured peak-to-peak gradients and Doppler-measured peak instantaneous gradients remain improved for the group as a whole. However, restenosis, defined as gradient >or=50 mmHg, has been observed in nearly 10% of children. Predictors of restenosis include balloon/annulus ratio <1.2 and immediate post-valvuloplasty gradient >or=30 mmHg. Small pulmonary valve annulus, earlier study year and post-surgical complex pulmonary stenosis have also been identified as factors predictive of restenosis. Redilatation with balloons that are larger than those used at the time of initial balloon valvuloplasty produces excellent results and redilatation is the procedure of choice in the management of restenosis after previous balloon pulmonary valvuloplasty. Long-term follow-up results are scanty, but the limited data reveal minimal additional restenosis, event-free rates in mid-80s and mid-70s at 10 and 15 years respectively and significant increase in prevalence of pulmonary insufficiency. Balloon pulmonary valvuloplasty is equally successful in neonates as well as in adult subjects. In conclusion, balloon pulmonary valvuloplasty is the treatment of choice for relief of pulmonary valve stenosis. Use of balloons 1.2 to 1.25 times larger than pulmonary valve annulus may produce optimal results. Life-long follow-up to identify the significance of residual pulmonary insufficiency is indicated.
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Affiliation(s)
- P Syamasundar Rao
- Division of Pediatric Cardiology, The University of Texas/Houston Medical School, Children's Memorial Hermann Hospital, Houston, Texas
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Ebeid MR. Transhepatic vascular access for diagnostic and interventional procedures: Techniques, outcome, and complications. Catheter Cardiovasc Interv 2006; 69:594-606. [PMID: 17152092 DOI: 10.1002/ccd.21012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Early or multiple cardiac catheterizations may result in occlusion of the femoral veins prohibiting their use. The internal jugular or sub-clavian approach may be an appropriate alternative. However, these approaches may not be suitable in patients with surgical interruption of the superior vena cava. In other patients, they may not allow easy access to certain areas of the heart. The transhepatic approach is an important alternative route for performing cardiac catheterization and interventions. Depending on the planned procedure, it may be the preferred route to perform the cardiac catheterization even in the presence of patent femoral veins. The indications, technical details and potential complications of this approach are discussed.
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Affiliation(s)
- Makram R Ebeid
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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Emmel M, Sreeram N, Pillekamp F, Boehm W, Brockmeier K. Transhepatic approach for catheter interventions in infants and children with congenital heart disease. Clin Res Cardiol 2006; 95:329-33. [PMID: 16598389 DOI: 10.1007/s00392-006-0382-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Accepted: 02/21/2006] [Indexed: 11/27/2022]
Abstract
UNLABELLED We report on our experience with transhepatic access for catheter interventions in six children (age range 2.5 months-9 years). Three had systemic venous anomalies, and one infant a femoral venous occlusion. In two further patients with bradyarrhythmia after a Fontan operation with an intraatrial Gore-Tex tunnel, transhepatic access was chosen to achieve a perpendicular orientation of the transseptal needle to the atrial baffle, allowing puncture of the Gore-Tex membrane. Two of the patients underwent ablation of an accessory pathway; in one an atrial septal defect was closed. A 2.5 month old baby after Norwood I operation, underwent balloon dilation of the pulmonary arteries. Two patients after prior Fontan surgery underwent DDDR pacemaker implantation. The size of the introducer sheath ranged from 4 F up to two 9 F introducers in the same vein for pacemaker insertion. At the end of the procedure, hemostasis was achieved by external compression. RESULTS Transhepatic access could be established in all six patients (using a mirror image approach in children with left atrial isomerism) and the interventional procedures could be performed as planned. In one patient with implantation of a permanent pacemaker, a subcutaneous hematoma occurred, requiring blood transfusion. CONCLUSION In selected pediatric patients, transhepatic access for catheter intervention can easily be achieved.
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Affiliation(s)
- M Emmel
- Klinik und Poliklinik für Kinderkardiologie, Kerpener Str. 62, 50937, Köln, Germany
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Ebeid MR, Joransen JA, Gaymes CH. Transhepatic closure of atrial septal defect and assisted closure of modified Blalock/Taussig shunt. Catheter Cardiovasc Interv 2006; 67:674-8. [PMID: 16575924 DOI: 10.1002/ccd.20711] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The details of transhepatic closure of moderate - large size atrial septal defect as well as assisted closure of a modified Blalock Taussig shunt in a 2 1/2 year old patient with occluded femoral vessels are discussed. The technical variations as well as the potential advantages of this route are outlined.
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Affiliation(s)
- Makram R Ebeid
- Department of Pediatrics, Division of Pediatric Cardiology, The University of Mississippi Medical Center, Jackson, Mississippi 39216, USA.
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Javois AJ, Van Bergen AH, Husayni TS. Technical considerations for closing secundum atrial septal defect in the small child with the HELEX Septal Occluder via transhepatic access. Catheter Cardiovasc Interv 2005; 67:127-31. [PMID: 16331672 DOI: 10.1002/ccd.20550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We describe closure of an atrial septal defect in a symptomatic 4.6 kg child with the HELEX Septal Occluder (W.L. Gore and Associates, Flagstaff, AZ) via transhepatic approach. Technical considerations are discussed.
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Affiliation(s)
- Alexander J Javois
- The Heart Institute for Children, Advocate Hope Children's Hospital, Oak Lawn, Illinois 60453, USA.
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Abstract
Pericardiocentesis is associated with a wide range of complications. We describe a pericardiocentesis attempt ending in the superior vena cava through the route of liver parenchyma, hepatic vein, inferior vena cava, and right atrium.
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Affiliation(s)
- Salim Dabbah
- Department of Cardiology, Rambam Medical Center, Haifa, Israel
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