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Al Nasef M, Erdem A, Aldudak B, Yildirim A, Hijazi ZM, Boudjemline Y, Al Riyami Z, Zunzunegui JL, Al Sahari A, Al Deham M, Meer Y, Al Alwi K, Al Saloos H, Abdulhamed J, AlShahrani D, Al Qahtani F, Al Tamimi O, Alissa M, Al Otay AM, Momenah T. Multicenter Experience for Early and Mid-Term Outcome of MyVal Transcatheter Pulmonary Valve Implantation. Pediatr Cardiol 2024; 45:570-579. [PMID: 38296854 DOI: 10.1007/s00246-023-03398-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/26/2023] [Indexed: 02/02/2024]
Abstract
Transcatheter pulmonary valve implantation (TPVI) is a surgical alternative for correcting dysfunctional right ventricular outflow tract in previously operated patients. MyVal transcatheter heart valve (THV) (Meril Life Sciences, India), a new transcatheter valve designed for aortic position has recently been reported to be implanted in pulmonary position. Myval transcatheter valve were implanted in patients with stenosed dysfunctional conduits, severe regurgitation from transannular patch or dysfunctional surgical pulmonary valves (Bioprosthesis). Procedural details and post-TPVI follow-up were analysed. Myval TPVI was used in Fifty three patients with median age of 15 years (IQR 12-19.5 years). Almost sixty percent of the patients were male, with a median weight of 50 kg (31-63 kg). Prestenting was used in more than 80 percent of patients (n = 45 patients), while 6 patients had a prior surgical valve implantation. After Myval TPVI implantation, the peak instantaneous gradient across the RVOT decreased from a median of 23.5 mmHg (IQR 10-53 mmHg) pre-procedure to 10 mmHg (IQR 5-16 mmHg) post-procedure. The median fluoroscopy time for the procedure was 35 min (IQR 23.5-44 min). The large sizes-mainly the 29-mm and 32 mm Myval (Navigator, Meril Life Sciences Pvt Ltd, India), were the most used size in 40% (n = 22) of the cases each. The median contrast volume used during the procedure was 247 mL (IQR 120-300 mL). Patients were followed for a median period of 360 days (IQR 164-525 days). At the last clinic follow-up, there was no tricuspid valve regurgitation. Moderate neo-pulmonary valve regurgitation was reported in three cases. Early experience of TPVI with MyVal is encouraging with procedural success in all patients and acceptable mid-term outcomes.
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Affiliation(s)
- Mohamed Al Nasef
- Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- King Hamd American Mission Hospital, Manama, Kingdom of Bahrain
| | | | - Bedri Aldudak
- Diyarbakır Gazi Yaşargil Training and Research Hospital, Istanbul, Turkey
| | - Ayse Yildirim
- Kosuyolu High Education Training and Research Hospital, Istanbul, Turkey
| | | | | | | | | | | | - Meshal Al Deham
- Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- King Saud Medical City, Riyadh, Saudi Arabia
| | - Yaser Meer
- Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Dr Mohammad Al Fagih Hospital, Jeddah, Saudi Arabia
| | - Khalid Al Alwi
- Sultan Qaboos University, Muscat, Sultanate of Oman
- National Heart Center, Muscat, Sultanate of Oman
| | | | | | | | - Faleh Al Qahtani
- King Abdul Aziz Cardiac Center, Riyadh, Saudi Arabia
- College of Applied Sciences, King Saud Bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | | | | | - Tarek Momenah
- Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
- College of Medicine, Al Faisal University, Riyadh, Saudi Arabia.
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Nasef MA, Shahbah DA, Batlivala SP, Darwish R, Qureshi AM, Breatnach CR, Linnane N, Walsh KP, Oslizlok P, McCrossan B, Momenah T, Alshahri A, Abdulhamed J, Arafat A, Tamimi OA, Diraneyya OM, Goldestein BH, Kenny D. Short- and medium-term outcomes for patent ductus arteriosus stenting in neonates ≤2.5 kg with duct-dependent pulmonary circulation. Catheter Cardiovasc Interv 2022; 100:596-605. [PMID: 35904221 DOI: 10.1002/ccd.30351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/29/2022] [Accepted: 07/16/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Morbidity with surgical systemic-to-pulmonary artery shunting (SPS) in infants ≤2.5 kg has remained high. Patent ductus arteriosus (PDA) stenting may be a valid alternative. The objective of this study is to evaluate outcomes following PDA stenting in patients ≤2.5 kg from four large tertiary centers. METHODS Retrospective review of all neonates ≤2.5 kg with duct-dependent pulmonary circulation who underwent PDA stenting. Procedural details, pulmonary arterial growth, reinterventions, surgery type, and outcomes were assessed. RESULTS PDA stents were implanted in 37 of 38 patients attempted (18 female) at a median procedural weight of 2.2 kg (interquartile range [IQR], 2-2.4 kg). Seven patients (18%) had a genetic abnormality and 16 (42%) had associated comorbidities. The median intensive care unit stay was 4 days (IQR, 2-6.75 days), and the median hospital stay was 20 days (IQR, 16-57.25). One patient required a rescue shunt procedure, with three others requiring early SPS (<30 days postprocedure). Twenty patients (54%) required reintervention with either balloon angioplasty, restenting, or both. At 6-month follow-up, right pulmonary artery growth (median z-score -1.16 to 0.01, p = 0.05) was greater than the left pulmonary artery (median z-score -0.9 to -0.64, p = 0.35). Serious adverse effects (SAEs) were seen in 18% (N = 7) of our cohort. One patient developed an SAE during planned reintervention There were no intraprocedural deaths, with one early procedure-related mortality, and three interstage mortalities not directly related to PDA stenting. CONCLUSIONS PDA stenting in infants ≤2.5 kg is feasible and effective, promoting pulmonary artery growth. Reintervention rates are relatively high, though many are planned to allow for optimal growth before a definitive operation.
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Affiliation(s)
- Mohamed Al Nasef
- Children Health Ireland at Crumlin, Dublin, Ireland.,Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Doaa A Shahbah
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.,Department of Pediatric Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sarosh P Batlivala
- Department of Pediatric Cardiology Department, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Reem Darwish
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | | | | | | | | | | | - Tarek Momenah
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Atif Alshahri
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | | | - Amr Arafat
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Omar Al Tamimi
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | | | | | - Damien Kenny
- Children Health Ireland at Crumlin, Dublin, Ireland
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Al-Khaldi A, Abuzaid AD, Tamimi O, Alsahari A, Alotay A, Momenah T, Alfonso JJ. Late outcomes of surgical reconstruction of peripheral pulmonary arteries. J Thorac Cardiovasc Surg 2021; 163:1448-1457.e6. [PMID: 34649717 DOI: 10.1016/j.jtcvs.2021.07.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/17/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The ideal management of peripheral pulmonary artery stenosis is still controversial. We adopted a primary surgical approach to this complex lesion with excellent early outcomes. In this study, we analyzed our late outcomes. METHODS We performed a retrospective review of 91 patients with biventricular anatomy who underwent peripheral pulmonary artery reconstruction from March 2008 to July 2020. Our surgical approach included either a single-stage complete repair through median sternotomy or a 2-stage repair through sternotomy/left thoracotomy, depending on the degree of distal involvement of the left pulmonary artery branches. RESULTS Median age was 26 months. Syndromic etiology was established in 54 patients (59.3%) versus nonsyndromic etiology in 37 patients (40.7%). Single-stage repair was achieved in 68 patients (74.7%). There were 2 (2.2%) in-hospital mortalities. The mean right ventricular to aortic systolic pressure ratio decreased from 1.07 ± 0.20 preoperatively to 0.32 ± 0.07 immediately postoperatively (P < .001), representing a 70.1% reduction. At 1-year postoperative catheterization, the mean right ventricular to aortic systolic pressure ratio was 0.28 ± 0.05 (P < .001 compared with immediately postoperative value). With a median follow-up of 68 months (IQR, 39-117.5 months), there was no late mortality after discharge. All patients were active and asymptomatic on the most recent follow-up. There were no early or late reinterventions on pulmonary arteries. CONCLUSIONS Late outcomes of surgical reconstruction of peripheral pulmonary arteries are excellent and durable in various pathologies (syndromic and nonsyndromic) with a significant reduction in right ventricular to aortic systolic pressure ratio, low mortality, and no reintervention.
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Affiliation(s)
- Abdulaziz Al-Khaldi
- Department of Pediatric Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
| | - Ahmad D Abuzaid
- Department of Cardiac Anesthesia, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Omar Tamimi
- Department of Pediatric Cardiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Atif Alsahari
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdulmajeed Alotay
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Tarek Momenah
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Juan J Alfonso
- Department of Cardiac Research, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
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Alkhaldi A, Momenah T, Alsahari A, Alotay A, Alfonso JJ, Abuzaid A, Alwadai A. Late Outcomes After Pulmonary Arterial Reconstruction in Patients With Arterial Tortuosity Syndrome. Ann Thorac Surg 2021; 113:1569-1574. [PMID: 33811889 DOI: 10.1016/j.athoracsur.2021.03.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical pulmonary artery reconstruction in patients with Arterial Tortuosity Syndrome (ATS) has excellent outcomes. In this study, we report our late outcomes after more than a decade of experience with such complex interventions. METHODS We conducted a retrospective review of 33 ATS patients who underwent pulmonary artery reconstruction. The mean pre-operative right ventricular/left ventricular pressure (RVp/LVp) ratio was 1.19 ± 0.2. Our surgical approach included either a single-stage complete repair through a median sternotomy (17 patients) or a two-stage repair through sternotomy / left thoracotomy (16 patients), depending on the degree of distal involvement in the left pulmonary artery. RESULTS Median age was 36 months. All patients had distal segmental peripheral pulmonary artery stenosis. Thirty patients (90.1%) were symptomatic before surgery. There was one hospital mortality due to viral pneumonia 78 days after the surgery (in-hospital mortality = 3%). The mean RVp/LVp ratio decreased to 0.31±0.07 early postoperatively (P<0.001), representing a 74% reduction compared with pre-operative values. Follow-up was 100% complete for all hospital survivors (32/33) with a mean follow-up of 70.42±43.32 months (range was 2 to 143 months). There was no late mortality or need for re-intervention (surgical or catheter-based) after hospital discharge. In late postoperative catheterization, the mean RVp/LVp ratio was 0.27±0.05 (P=0.003 compared to early post-operative value). All patients were asymptomatic on their most recent follow-up. CONCLUSIONS A strategy of complete surgical reconstruction of all stenotic pulmonary artery segments in patients with ATS is recommended for sustainable successful outcomes more than a decade later.
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Affiliation(s)
- Abdulaziz Alkhaldi
- Department of Pediatric Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
| | - Tarek Momenah
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Atif Alsahari
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdulmajeed Alotay
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Juan J Alfonso
- Department of Cardiac Research, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Ahmad Abuzaid
- Department of Cardiac Anesthesia, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdullah Alwadai
- Department of Pediatric Cardiac Intensive care, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
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Alkhaldi A, Alsahari A, Alotay A, Momenah T, Alfonso JJ. Peripheral Pulmonary Artery Stenosis is Not a Contraindication to Single Ventricle Pathway. Ann Thorac Surg 2021; 113:1563-1568. [PMID: 33811885 DOI: 10.1016/j.athoracsur.2021.03.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/15/2021] [Accepted: 03/09/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The presence of peripheral pulmonary artery stenosis (PPAS) involving lobar and/or segmental pulmonary artery (PA) branches might preclude proceeding to single ventricle pathway. We adopted strict strategy for PA rehabilitation and surgical reconstruction in patients who are unable to progress in single ventricle pathway. METHODS We conducted a retrospective review of 22 patients with single ventricle physiology who underwent surgical reconstruction for PPAS from April 2008 to March 2020. Our surgical approach was single stage in 15 patients (68.2%) and two-stage in 7 patients (31.8%) depending on the presence or absence of PA hypoplasia distal to the PPAS. RESULTS The PPAS was type 3 (lobar) in 19 patients (86.4%) and type 4 (segmental) in 3 patients (13.6%). The mean number of PA angioplasties performed was 8±5.6 per patient. There was no mortality in this series with median 52 months (range, 8 to 143 months) follow-up. Twenty patients (90.9%) were able to progress in the single ventricle pathway with 12 patients (54.5%) achieving Fontan operation and 8 patients (36.4%) achieving bi-directional Glenn shunt and awaiting Fontan operation. Two patients (9.1%) were not suitable to progress in the single ventricle pathway due to elevated PA pressure. All patients who achieved cavopulmonary connection are alive and asymptomatic with no signs of elevation of PA pressure. No patient required further re-interventions for the PA. CONCLUSIONS PPAS is not a contraindication for single ventricle palliation. With careful planning and aggressive early surgical reconstruction, most of these patients can successfully progress to cavopulmonary connections.
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Affiliation(s)
| | | | | | | | - Juan J Alfonso
- Department of Cardiac Research, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
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Soliman R, Mofeed M, Momenah T. Propofol versus Ketofol for Sedation of Pediatric Patients Undergoing Transcatheter Pulmonary Valve Implantation: A Double-blind Randomized Study. Ann Card Anaesth 2018; 20:313-317. [PMID: 28701596 PMCID: PMC5535572 DOI: 10.4103/aca.aca_24_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The study was done to compare propofol and ketofol for sedation of pediatric patients scheduled for elective pulmonary valve implantation in a catheterization laboratory. DESIGN This was a double-blind randomized study. SETTING This study was conducted in Prince Sultan Cardiac Centre, Saudi Arabia. PATIENTS AND METHODS The study included 60 pediatric patients with pulmonary regurge undergoing pulmonary valve implantation. INTERVENTION The study included sixty patients, classified into two groups (n = 30). Group A: Propofol was administered as a bolus dose (1-2 mg/kg) and then a continuous infusion of 50-100 μg/kg/min titrated as needed. Group B: Ketofol was administered 1-2 mg/kg and then infusion of 20-60 μg/kg/min. The medication was prepared by the nursing staff and given to anesthetist blindly. MEASUREMENTS The monitors included heart rate, mean arterial blood pressure, respiratory rate, temperature, SPO2and PaCO2, Michigan Sedation Score, fentanyl dose, antiemetic medications, and Aldrete score. MAIN RESULTS The comparison of heart rate, mean arterial pressure, respiratory rate, temperature, SPO2and PaCO2, Michigan Sedation Score, and Aldrete score were insignificant (P > 0.05). The total fentanyl increased in Group A more than Group B (P = 0.045). The required antiemetic drugs increased in Group A patients more than Group B (P = 0.020). The durations of full recovery and in the postanesthesia care unit were longer in Group A than Group B (P = 0.013, P < 0.001, respectively). CONCLUSION The use of propofol and ketofol is safe and effective for sedation of pediatric patients undergoing pulmonary valve implantation in a catheterization laboratory. However, ketofol has many advantages more than the propofol. Ketofol has a rapid onset of sedation, a rapid recovery time, decreased incidence of nausea and vomiting and leads to rapid discharge of patients from the postanesthesia care unit.
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Affiliation(s)
- Rabie Soliman
- Department of Cardiac Anesthesia, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia; Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt
| | - Mohammed Mofeed
- Department of Cardiology, Madinah Cardiac Center, Al Madinah Al Monourah, Saudi Arabia; Department of Pediatric Cardiology, Sohag University, Egypt
| | - Tarek Momenah
- Department of Pediatric Cardiology, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia
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Bugami SA, Althobaiti M, Momenah T, Alrahimi J, Kashkari WA. Percutaneous Intervention of a Persistent Left Superior Vena Cava Draining Into Left Pulmonary Vein and Coarctation of the Aorta. Cardiol Res 2017; 7:157-160. [PMID: 28197285 PMCID: PMC5295581 DOI: 10.14740/cr477w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 11/18/2022] Open
Abstract
We describe a 54-year-old male with history of type II DM, hypertension and dyslipidemia during admission for bronchopneumonia discovered to have coarctation of the aorta and a persistent left superior vena cava (PLSVC) draining into the left atrium through the left superior pulmonary vein. The latter was thought to contribute to a transient ischemic attack and an episode of chest pain resulting in ST-segment elevation in the inferior leads. He was treated with coarctation stenting and percutaneous exclusion of the PLSVC with a vascular plug.
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Affiliation(s)
- Saad Al Bugami
- King Saud bin Abdulaziz University for Health Sciences; King Faisal Cardiac Center, King Saud bin Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohammed Althobaiti
- King Saud bin Abdulaziz University for Health Sciences; King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | | | - Jamilah Alrahimi
- King Saud bin Abdulaziz University for Health Sciences; King Faisal Cardiac Center, King Saud bin Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Wael Al Kashkari
- King Faisal Cardiac Center, King Saud bin Abdulaziz Medical City, Jeddah, Saudi Arabia
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8
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Najm HK, Jha NK, Godman M, Al Mutairi M, Rezk AI, Momenah T. Pulmonary Atresia, VSD in Association with Coronary-Pulmonary Artery Fistula. Asian Cardiovasc Thorac Ann 2016; 15:335-8. [PMID: 17664210 DOI: 10.1177/021849230701500415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Congenital coronary-pulmonary artery fistula is rare in patients with pulmonary atresia and ventricular septal defect. The nomenclature, physiological, clinical, and surgical implications of these fistulas are yet to be defined. We report a one-year-old child with pulmonary atresia, ventricular septal defect, and a right coronary-pulmonary artery fistula who also had a diminutive, disconnected left pulmonary artery in addition to aortopulmonary collaterals. The patient underwent corrective surgery. However, the fate of diminutive pulmonary arteries is unknown. The literature was reviewed to explore the clinical or surgical implications of such fistulas for improved understanding and management in the future.
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Affiliation(s)
- Hani K Najm
- Department of Cardiac Surgery, King Fahad Hospital, Riyadh, Saudi Arabia
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El-Segaier M, Khan MA, Khan ZU, Momenah T, Galal MO. Recombinant Tissue Plasminogen Activator in the Treatment of Neonates with Intracardiac and Great Vessels Thrombosis. Pediatr Cardiol 2015; 36:1582-7. [PMID: 25991571 DOI: 10.1007/s00246-015-1199-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
Abstract
Life-threatening intracardiac and great vessels thrombi are rare in neonates. Recombinant tissue plasminogen activator (rTPA) is used in adults to stimulate fibrinolysis and facilitate thrombus resolution. Its use in neonates, along with heparin, remains controversial because of potential risk of serious bleeding. We aim to present our experience with the use of thrombolytic agents in seven neonates and young infants. In a retrospective study, over a period of 6 years, the medical records of neonates and young infants, who were diagnosed with intracardiac and great vessels thrombi, were reviewed. The following factors were collected: demographic data, primary diagnosis, thrombus site, risk factors, method of diagnosis, thrombolytic and/or anticoagulation agent, route, dose and duration of treatment, complications, and outcome. Six neonates and one 45-day-old infant were analyzed. Age ranged from 5 to 45 days (median age 12 days), and median weight was 2.9 kg (range 0.9-3.8 kg). The thrombi were diagnosed by echocardiography in five and by angiography in two cases. All patients had life-threatening thrombi; four were treated with rTPA (0.5 mg kg(-1) h(-1)) and heparin infusions with complete dissolution of the thrombi, within a median time of 60 h (6-72 h), and without complications. The remaining three patients (two who were premature, at 28 and 34 weeks of gestation, and the third who had a deranged coagulation profile) were treated with unfractionated heparin due to fear of bleeding. The thrombi dissolved in the premature babies (within 2 weeks and 3 months, respectively) but embolized and resulted in the death of the third infant after 2 weeks of treatment. The current case series confirmed the effectiveness and safety of intravenous rTPA infusion, at the dosages used, in neonates and young infants with life-threatening thrombi.
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Affiliation(s)
- Milad El-Segaier
- Department of Pediatric Cardiology, King Salman Heart Center, King Fahad Medical City, PO Box 59046, Riyadh, 11525, Kingdom of Saudi Arabia. .,Department of Pediatric Cardiology, Skåne University Hospital, Lund, Sweden.
| | - Muhammad A Khan
- Department of Pediatric Cardiology, King Salman Heart Center, King Fahad Medical City, PO Box 59046, Riyadh, 11525, Kingdom of Saudi Arabia
| | - Zaheer Ullah Khan
- Department of Pediatric Hematology and Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Tarek Momenah
- Department of Pediatric Cardiology, King Salman Heart Center, King Fahad Medical City, PO Box 59046, Riyadh, 11525, Kingdom of Saudi Arabia
| | - Mohammed Omar Galal
- Department of Pediatric Cardiology, King Salman Heart Center, King Fahad Medical City, PO Box 59046, Riyadh, 11525, Kingdom of Saudi Arabia.,Department of Pediatric Cardiology, Essen University, Essen, Germany
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Abstract
BACKGROUND Recanalization of arterial duct (AD) is rarely needed. OBJECTIVE The aim of this study is to report our experience regarding the feasibility and effectiveness of arterial duct recanalization in three infants and review the relevant literature. METHODS AND RESULTS We report on three patients with decreased pulmonary blood flow after initial palliation. The first patient had pulmonary atresia (PA) and an intact ventricular septum. He needed recanalization of the AD after pulmonary valve perforation and dilatation. The second patient had PA and ventricular septal defect (VSD). His AD originated from the left subclavian artery. He required AD recanalization after palliation with a central shunt and clipping of the duct. During intervention he developed a thrombus in the stent, which was treated successfully using thrombolytic treatment. The third patient had PA and VSD. The arterial duct originated from the left subclavian artery and was recanalized after spontaneous closure despite prostaglandin infusion. During the procedure the patient had severe desaturation and bradycardia requiring resuscitation fortwo minutes. All infants had successful arterial duct recanalization and stenting. Additionally, they were clinically stable during follow-up. CONCLUSION Arterial duct recanalization and stenting is a feasible and effective procedure in selected cases, and its risks are treatable. Long-term studies are required.
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Affiliation(s)
- Milad El Segaier
- Dept. of Paediatric Cardiology, King Fahad Medical City, PSHC, Riyadh, Saudi Arabia
- Dept. of Paediatric Cardiology, Skåne University Hospital, Lund, Sweden
| | - Mohammed O. Galal
- Dept. of Paediatric Cardiology, King Fahad Medical City, PSHC, Riyadh, Saudi Arabia
- Dept. of Paediatric Cardiology, Essen University, Essen, Germany
| | - Ghada Shiekh Eldin
- Dept. of Paediatric Cardiology, King Fahad Medical City, PSHC, Riyadh, Saudi Arabia
| | - Tarek Momenah
- Dept. of Paediatric Cardiology, King Fahad Medical City, PSHC, Riyadh, Saudi Arabia
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Tzifa A, Momenah T, Al Sahari A, Al Khalaf K, Papagiannis J, Qureshi SA. Transcatheter valve-in-valve implantation in the tricuspid position. EUROINTERVENTION 2014; 10:995-9. [DOI: 10.4244/eijv10i8a168] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Khan MA, Saeedi ARA, Tayeab HA, Momenah T. Giant left ventricular fibroma presenting as ventricular tachycardia in a child. Asian Cardiovasc Thorac Ann 2014; 22:588-91. [PMID: 24867035 DOI: 10.1177/0218492313478216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a rare case of giant left ventricular apical fibroma presenting as recurrent ventricular tachycardia in a 14-month-old girl. The diagnosis was made by echocardiography and chest computed tomography, and confirmed by histopathology. The fibroma was resected surgically, and the patient followed up for 4 years.
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Affiliation(s)
- Muhammad Arif Khan
- Prince Salman Heart Center, King Fahad Medical City Riyadh, Saudi Arabia
| | | | - Hyfeah Al Tayeab
- Prince Salman Heart Center, King Fahad Medical City Riyadh, Saudi Arabia
| | - Tarek Momenah
- Prince Salman Heart Center, King Fahad Medical City Riyadh, Saudi Arabia
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Moustafa S, Ejaz N, Momenah T, Alkhaldi A, Zuhairy H, Almoukirish A, Mookadam F. Unusual case of cor triatriatum sinister. J Cardiovasc Ultrasound 2013; 21:100-1. [PMID: 23837122 PMCID: PMC3701777 DOI: 10.4250/jcu.2013.21.2.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/06/2013] [Accepted: 06/07/2013] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sherif Moustafa
- Division of Cardiovascular Diseases, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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Odemis E, Guzeltas A, Saygi M, Ozyilmaz I, Momenah T, Bakir I. Percutaneous pulmonary valve implantation using Edwards SAPIEN transcatheter heart valve in different types of conduits: initial results of a single center experience. CONGENIT HEART DIS 2013; 8:411-7. [PMID: 23448542 DOI: 10.1111/chd.12047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Percutaneous pulmonary valve implantation is frequently used as a less invasive method in patients with conduit dysfunction. The common valve type cannot be used in conduits with a diameter larger than 22 mm. There has been limited experience concerning the used of the SAPIEN Transcatheter Heart Valve, produced for use in conduits with a large diameter. This study presents hemodynamic and early follow-up results from a single center in Turkey concerning the use of the SAPIEN Transcatheter Heart Valve in different types of conduits and different lesions. PATIENTS AND METHOD Between October 2010 and July 2012, seven SAPIEN Transcatheter Heart Valve implantations were performed. There was mixed type 2 pure insufficiency with stenosis and insufficiency in five patients. Three different conduits were used, and one native pulmonary artery process was performed. Patients were followed for hemodynamic findings, functional capacities, valve competence, reshrinking, and breakage in the stent, and the results were evaluated. RESULTS Implantations were successfully performed in all patients. Right ventricular pressures and gradients were significantly reduced, and there was no pulmonary regurgitation in any patient. Functional capacities evidently improved in all patients except for one with pulmonary hypertension. No major complication was observed. During the mean time of follow-up (7.2 ± 4.7 months), no valve insufficiency or stent breakage was observed. CONCLUSION Procedural results and short-term outcomes of the SAPIEN Transcatheter Heart Valve were very promising in the patients included in the study. The SAPIEN Transcatheter Heart Valve can be a good alternative to surgical conduit replacement, particularly in patients with larger and different types of conduits.
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Affiliation(s)
- Ender Odemis
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey
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Al Qethamy H, Momenah T, El Oakley R, Al Redhyan A, Tageldin M, Al Faraidi Y. Minimally invasive transventricular implantation of pulmonary xenograft. J Card Surg 2008; 23:339-40. [PMID: 18598324 DOI: 10.1111/j.1540-8191.2008.00612.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Minimally invasive valve replacement is now a clinical reality. A number of ingenious techniques have been described for percutaneous aortic and pulmonary valve replacement as well as transventricular aortic valve replacement. We describe a technique for transventricular pulmonary valve replacement utilizing off-the-shelf bovine tissue valve, vascular stents, and simplified delivery system. After median sternotomy with limited exposure of the right ventricle, Contegra 200 pulmonary valve (Medtronic, Inc., Minneapolis, MN, USA) is transfixed inside a CP stent (NuMed, Inc., Hopkinton, NY, USA) using multiple 5/0 prolene sutures. The valve/stent composite is crimped on a Cristal balloon catheter (Balt, Montmorency, France). The valve/stent and the balloon are then introduced via a small purse-string placed at the RVOT. The stent/valve composite is then expanded in the pulmonary valve position.
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Affiliation(s)
- Howaida Al Qethamy
- Department of Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia.
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Lopez K, Dalvi BV, Balzer D, Bass JL, Momenah T, Cao QL, Hijazi ZM. Transcatheter closure of large secundum atrial septal defects using the 40 mm Amplatzer septal occluder: results of an international registry. Catheter Cardiovasc Interv 2006; 66:580-4. [PMID: 16216021 DOI: 10.1002/ccd.20468] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Little is known about the efficacy and safety of the 40 mm Amplatzer septal occluder (ASO). Thirty-three patients (22 female, 11 male) with a large secundum atrial septal defect (ASD) underwent attempted device closure using the 40 mm ASO at a median age of 40 years (range, 14-81 years) and median weight of 65 kg (range, 48-98 kg). The median size of the ASD measured on 2D transesophageal echocardiography (27 patients) or intracardiac echocardiography (6 patients) was 30.5 mm (range, 24-39 mm) and the median balloon-stretched diameter was 37.7 mm (range, 32-43.7 mm). The median Qp:Qs ratio was 3.2:1 (range, 1.4-6.2). The attempt was unsuccessful in five patients; two had device embolization and one had left atrial wall perforation due to the sheath; all three required emergent surgery. The attempt was successful in the 28 remaining patients, resulting in complete immediate closure in 14 and a trivial residual shunt in 14. Fluoroscopy time ranged from 8.6 to 37.8 min (median, 12.2 min). At 24-hr follow-up, 2D transthoracic echocardiography with color flow Doppler revealed complete closure in 23 patients, and 5 had a trivial residual shunt. There were no complications encountered in patients who received the device. On follow-up, all patients are doing well. We conclude that the 40 mm ASO is safe and effective in most patients with a large ASD up to a diameter of 39 mm. However, the use of this device requires careful attention as the procedure may be unsuccessful or the device may embolize.
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Affiliation(s)
- Keila Lopez
- University of Chicago Comer Children's Hospital, Pritzker School of Medicine, Chicago, Illinois 60637, USA
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Abstract
A subtype of supracardiac total anomalous pulmonary venous return (TAPVR) consists of the vertical vein passing between the left pulmonary artery and the left mainstem bronchus resulting in relative obstruction to pulmonary venous return. This has been termed the vascular vise. In this situation, the supracardiac type of TAPVR (Type I) may mimic radiographically the infradiaphragmatic type (Type 3).
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Affiliation(s)
- W L Patton
- Department of Radiology, Box 0628, University of California San Francisco 94143-0628, USA
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Abstract
OBJECTIVES To determine the prevalence of Kawasaki disease in older children and to evaluate its clinical presentation, time to diagnosis, and outcome in comparison with younger patients with the disease. METHODOLOGY A retrospective analysis of all patients discharged with a diagnosis of Kawasaki disease at a pediatric tertiary care hospital over a 12-year period. RESULTS A total of 133 patients were included in this study; 7.5% were 9 years of age or older at the time of illness. Patients were grouped by age: infants included children age 1 to 8 years of age and children 9 years of age or older. Older children had a higher frequency of abnormal cardiovascular physical examination (50%) versus children (6%) and infants (10%). The older age group and the infants had a higher prevalence of coronary artery abnormalities and poor left ventricular function than did the 1- to 8-year-olds. Eighty percent of the older children had coronary arteries that were either dilated or aneurysmal, and 30% demonstrated left ventricular dysfunction on initial echocardiography. The number of days to diagnosis after meeting the diagnostic criteria was 5.8 +/- 2.3 for infants, 5.2 +/- 1.5 for older children, and 1.9 +/- 0.3 for children. Older children had a complicated course of Kawasaki disease compared with younger patients. CONCLUSION We found a higher prevalence of older children with Kawasaki disease at our center than has previously been reported. Older patients, as well as infants, had a higher rate of coronary artery abnormalities than did the children between 1 and 8 years of age. Older age at the time of illness or a delay in treatment may be important factors in determining cardiac involvement in Kawasaki disease.
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Affiliation(s)
- T Momenah
- Division of Cardiology, Department of Pediatrics, British Columbia's Children's Hospital and the University of British Columbia, Vancouver, BC, Canada
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