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Find video protocols related to scientific articles indexed in Pubmed.
Congenital Left Ventricular Outpouchings: A Systematic Review of 839 Cases and Introduction of a Novel Classification after Two Centuries.
Congenit Heart Dis
PUBLISHED: 08-27-2014
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Congenital left ventricular outpouchings (LVOs) are reported under five overlapping and poorly defined terms including left ventricular accessory chamber, left ventricular aneurysm (LVA), left ventricular diverticulum (LVD), double-chambered LV, and accessory left ventricle. Diagnostic criteria are frequently mixed and not mutually exclusive. They convey no information regarding treatment strategy and prognosis.
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Hybrid interventional procedures in congenital heart disease.
Methodist Debakey Cardiovasc J
PUBLISHED: 08-13-2014
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The evolution of congenital cardiac surgery has seen significant innovative advances in collaborative efforts between congenital cardiac surgeons and interventionalists to provide the least invasive intervention with the greatest hemodynamic benefit for patients with congenital heart disease. This review looks at how this collaborative approach has evolved and is being applied to treat a number of congenital conditions across the age ranges.
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Changes in Speckle Tracking Echocardiography Measures of Ventricular Function after Percutaneous Implantation of the Edwards SAPIEN Transcatheter Heart Valve in the Pulmonary Position.
Echocardiography
PUBLISHED: 07-23-2014
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Patients with free pulmonary regurgitation or mixed pulmonary stenosis and regurgitation and severely dilated right ventricles (RV) show little improvement in ventricular function after pulmonary valve replacement when assessed by traditional echocardiographic markers. We evaluated changes in right and left ventricular (LV) function using speckle tracking echocardiography in patients after SAPIEN transcatheter pulmonary valve (TPV) placement.
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SCAI expert consensus statement for advanced training programs in pediatric and congenital interventional cardiac catheterization.
Catheter Cardiovasc Interv
PUBLISHED: 05-13-2014
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Pediatric and Congenital Interventional Cardiology is the practice of catheter-based techniques that improve cardiac physiology and circulation through the treatment of heart disease in children and adults with congenital or acquired heart defects. Over the last decade, and since last published training guidelines for pediatric cardiac catheterization and interventional cardiology were published in 2005 [1] the field of Pediatric and Congenital Cardiac Catheterization has evolved into a predominantly interventional discipline. As there is no sub-specialty certification for interventional cardiac catheterization in pediatrics, the Congenital Heart Disease Committee of the Society of Cardiovascular Angiography and Interventions has put together this consensus statement for advanced training in pediatric and congenital interventional cardiac catheterization. The statement puts forth recommendations for program infrastructure in terms of teaching, personnel, equipment, facilities, conferences, patient volume and trainee assessment. This is meant to set a standard for training programs as well as giving applicants a basis on which to judge and compare programs. © 2014 Wiley Periodicals, Inc.
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The Use of Intracardiac Echocardiography During Percutaneous Pulmonary Valve Replacement.
Pediatr Cardiol
PUBLISHED: 04-02-2014
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High-quality live imaging assessment of cardiac valves and cardiac anatomy is crucial for the success of catheter-based procedures. We present our experience using Intracardiac echocardiography (ICE) during transcatheter Percutaneous Pulmonary Valve replacement (tPVR).This is a retrospective study that included 35 patients who underwent tPVR between April 2008 and June 2012. Thirty-one of these patients had the procedure performed under continuous ICE guidance. Pre-procedure transthoracic echocardiography (TTE) was obtained in all patients. ICE was performed at baseline, during the procedure, and at the conclusion of the procedure. Comparisons between the pre-procedure TTE and baseline ICE data and between post-procedure ICE data and the following day TTE were performed. Total of 35 patients had tPVR during the above-mentioned time period. Twenty-one patients received the Edwards Sapien valve and 14 patients had the Melody valve. Thirty-one patients had the procedure performed under continuous ICE guidance. The mean Pre-TTE peak gradient (PG) and Pre-ICE-PG were 45.5 ± 20 vs 33 ± 13 mmHg (p < 0.001) and the mean Pre-TTE mean gradient (MG) and Pre-ICE-MG were 27.7 ± 13 vs 21 ± 18 mmHg (p < 0.001). The mean Post-TTE- PG and Post-ICE-PG were 24.3 ± 11 vs 15.3 ± 7 mmHg (p < 0.001) and the mean of the Post-TTE-MG and Post-ICE-MG were 14.2 ± 7 vs 8.4 ± 4 mmHg (p < 0.001). There was a good correlation between peak ICE and TTE gradient at baseline and after valve placement. For the degree of pulmonary regurgitation, there was no significant difference between TTE and ICE. ICE is an important modality to guide tPVR in patients with dysfunctional homograft valve between the right ventricle and pulmonary artery and should be used to assess valve function before, during and immediately after the procedure.
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Early clinical experience with a novel self-expanding percutaneous stent-valve in the native right ventricular outflow tract.
Catheter Cardiovasc Interv
PUBLISHED: 03-31-2014
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Balloon expandable transcatheter pulmonary valve systems are not applicable to the large majority of patients with chronic severe pulmonary regurgitation (PR) following surgical right ventricular outflow tract (RVOT) rehabilitation. This report describes the clinical use and short-term follow-up of a novel transcatheter self-expanding pulmonary valve system (Venus P Valve) for rehabilitation of the RVOT in patients with chronic severe PR.
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Transjugular melody valve placement in a small child with protein losing enteropathy.
Catheter Cardiovasc Interv
PUBLISHED: 03-04-2014
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The authors present a patient with situs inversus totalis, dextrocardia, and tetralogy of Fallot with complete AV canal who underwent pulmonary valve-sparing complete repair during infancy but developed progressive pulmonary outflow obstruction on serial follow-up. His right ventricular outflow tract (RVOT) was prestented as a precursor for Melody valve placement. After this, he developed protein losing enteropathy (PLE) which was unresponsive to medical management. Finally, he received transcatheter Melody valve percutaneously in the pulmonic position that lead to clinical and biochemical resolution of his PLE symptoms. © 2014 Wiley Periodicals, Inc.
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CT and MR imaging of the pulmonary valve.
Radiographics
PUBLISHED: 01-17-2014
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With rapid advancements in imaging technology, cardiac computed tomography (CT) and magnetic resonance (MR) imaging are increasingly being used for anatomic evaluation, functional assessment, and pathologic diagnosis of the pulmonary valve and right ventricle. MR imaging is especially helpful in evaluating postoperative pulmonary valve function and grading of pulmonary regurgitation. On the other hand, CT has the advantage of high-resolution isovolumetric whole-chest coverage and is able to depict anatomic detail of the pulmonary valve, perivalvular structures, and pulmonary artery branches.
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Stent strut breakage using high-pressure balloons for bifurcation stenting and subsequent percutaneous pulmonary valve replacement using the Edwards Sapien THV.
Catheter Cardiovasc Interv
PUBLISHED: 07-29-2013
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This report describes the use of the Edwards Sapien THV in a patient who had a short regurgitant/stenotic homograft with early bifurcation stenoses of the pulmonary arteries. A 48-mm AndraStent was positioned in the right pulmonary artery-homograft jailing the left pulmonary artery (LPA). To have an unobstructed access to the LPA, the stent strut leading to the LPA was broken using high-pressure balloon. A 23-mm Edwards Sapien THV was positioned in the stented homograft just proximal to the LPA origin with resolution of the stenosis and regurgitation.
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How should I treat prosthetic tricuspid stenosis in an extreme surgical risk patient?
EuroIntervention
PUBLISHED: 07-23-2013
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A 64-year-old female with rheumatic heart disease and multiple prior valve replacements presented with progressive oedema, ascites and dyspnoea on exertion.
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Single-Center Outcome Analysis Comparing Reintervention Rates of Surgical Arterioplasty With Stenting for Branch Pulmonary Artery Stenosis in a Pediatric Population.
Pediatr Cardiol
PUBLISHED: 06-10-2013
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Although catheter-based intervention is generally accepted as the treatment of choice for branch pulmonary artery (PA) stenosis, there are no data directly comparing both the need for reintervention and time to reintervention in patients undergoing transcatheter stenting versus surgical arterioplasty. We compared children who underwent surgical branch pulmonary arterioplasty and branch PA stent placement between January 2008 and May 2012 at a single tertiary center. Need for reintervention and mean time to reintervention were assessed using chi-square and independent sample Student t test. Thirty-seven patients were included (surgery n = 18, stent n = 19). Mean weight at initial intervention was 11.3 ± 8.8 kg for surgical and 20.1 ± 15.5 kg for stent (p = 0.041). Intervention was performed on the left PA in 17 patients, the right PA in 12 patients, and both PAs in 8 patients. Five patients had undergone previous intervention. On mean follow-up of 807 ± 415 days, 50 % (9 of 18) of the surgery cohort and 5.3 % (1 of 19) of the stent cohort required reintervention (p = 0.002). In all but one case reintervention was catheter-based. Mean time to reintervention for the surgery cohort was 272 ± 162 days and for the single stent cohort it was 150 days. When comparable age and weight groups were analyzed, reintervention was still more common in the surgery cohort (p = 0.007). Children undergoing surgical branch pulmonary arterioplasty are more likely to require reintervention than those undergoing stent placement.
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Double-outlet right ventricle with an intact ventricular septum: a unique stage 1 palliation.
Pediatr Cardiol
PUBLISHED: 05-17-2013
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This report describes a case of double-outlet right ventricle with intact ventricular septum diagnosed in a newborn male. The initial diagnosis was made by echocardiography. The baby underwent a hybrid procedure including pulmonary artery banding and stenting of the patent ductus arteriosus. He subsequently underwent stenting of the atrial communication. The patient was discharged at 55 days of life with the intent to perform palliative repair at a later date.
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Transcatheter closure of secundum atrial septal defects.
J Invasive Cardiol
PUBLISHED: 05-07-2013
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Atrial septal defect (ASD) is one of the most common congenital heart defects, accounting for 7%-10% of all congenital heart disease (CHD) in children and 30%-33% of defects diagnosed in adults with CHD. This review highlights the evolution of transcatheter ASD closure, indications, follow-up, outcomes, and complications with a focus on the erosion issue with certain devices.
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Single-center comparative outcomes of the Edwards SAPIEN and Medtronic Melody transcatheter heart valves in the pulmonary position.
Catheter Cardiovasc Interv
PUBLISHED: 03-18-2013
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Two transcatheter pulmonary valve replacement (tPVR) systems (Edwards SAPIEN and Medtronic Melody) are available; however, comparative studies evaluating outcome data are lacking. The aim of this study was to compare short- with medium-term outcome data of these valves in the pulmonary position from a single institution.
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Transcatheter trans-apical closure of paravalvular mitral and aortic leaks using a new device: First in man experience.
Catheter Cardiovasc Interv
PUBLISHED: 02-25-2013
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This report describes the first use of a new paravalvular leak (PVL) device designed specifically to close paravalvular mitral and paravalvular aortic leaks. The first patient had severe paravalvular mitral leak that was closed using the transapical route with a rectangular designed PVL device that has an oval waist for self-centering and the second patient had moderate paravalvular aortic leak that was closed with a square designed device that has a round waist for self-centering. Both patients had complete closure. © 2013 Wiley Periodicals, Inc.
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Innovative resource utilization to fashion individualized covered stents in the setting of aortic coarctation.
Catheter Cardiovasc Interv
PUBLISHED: 10-07-2011
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We describe our experience with self-fabricated covered stents in the setting of coarctation of the aorta (CoA).
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Coarctation of the aorta: from fetal life to adulthood.
Cardiol J
PUBLISHED: 09-28-2011
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Coarctation of the aorta was once viewed as a simple discrete narrowing of the aortic isthmus that could be cured by surgical intervention. It is now clear that this condition may: (1) affect the aortic arch in a highly variable manner; (2) be associated with a host of other left sided heart lesions; (3) represent a wider vasculopathy within the pre-coarctation arterial tree, leading to significant prevalence of hypertension by adolescence, and subsequent risk of early morbidity and death. This review outlines the evaluation and treatment of this disease from pre-natal to adult life.
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[Transcatheter implantation of Edwards-SAPIEN THV valve in pulmonary position].
Kardiol Pol
PUBLISHED: 07-20-2011
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Transcatheter pulmonary valve implantation improves conduit haemodynamics without necessity of complex reoperation. Clinical experience with application of the Edwards-SAPIEN Transcatheter Heart Valve (THV) in pulmonary position is still limited. We present data of 2 patients (21 year-old woman and 26 year-old man) with a history of dysfunction of homograft in position of right ventricular outflow tract (RVOT), in whom the Edwards-SAPIEN THV was successfuly implanted.
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Percutaneous implantation of the Edwards SAPIEN transcatheter heart valve for conduit failure in the pulmonary position: early phase 1 results from an international multicenter clinical trial.
J. Am. Coll. Cardiol.
PUBLISHED: 05-03-2011
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The purpose of this study was to evaluate the safety and effectiveness of the Edwards SAPIEN transcatheter heart valve (Edwards Lifesciences LLC, Irvine, California) in the pulmonary position in patients with moderate to severe pulmonary regurgitation with or without stenosis.
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Medium-term outcomes for peripheral pulmonary artery stenting in adults with congenital heart disease.
J Interv Cardiol
PUBLISHED: 03-17-2011
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We describe our medium-term outcomes for peripheral pulmonary artery stenting in adults with congenital heart disease.
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Tips and tricks to prevent prolapse of the Amplatzer septal occluder through large atrial septal defects.
Catheter Cardiovasc Interv
PUBLISHED: 03-07-2011
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We report on a new technique "using a partially inflated balloon through the atrial septal defect" to prevent prolapse of the left atrial disk of the Amplatzer septal occulder in large atrial septal defects (ASDs). Two patients underwent successful closure of their ASDs using this new technique.
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Transcatheter tricuspid valve replacement with the Edwards SAPIEN valve.
Catheter Cardiovasc Interv
PUBLISHED: 01-17-2011
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We describe a case of percutaneous tricuspid valve implantation in a 20-year-old man with previous tricuspid valve replacement in the setting of pulmonary atresia with intact ventricular septum. He developed symptomatic endocarditis-induced tricuspid regurgitation of the tricuspid bioprosthesis. Tricuspid valvar competence was restored with implantation of a 26-mm Edwards SAPIEN valve.
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Fenestration of a Gore Helex Septal Occluder device in a patient with diastolic dysfunction of the left ventricle.
Catheter Cardiovasc Interv
PUBLISHED: 01-17-2011
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We report successful deployment of a fenestrated Helex Septal Occluder in a 46-year-old lady with a moderate-sized secundum atrial septal defect and elevated left-ventricular end diastolic pressure secondary to renovascular hypertension. Initial balloon occlusion of the defect lead to significant rise in left atrial pressure. Creation of a 4-mm fenestration offered controlled decompression of the left atrium while reducing the atrial shunt considerably.
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Pediatric catheterization laboratory anticoagulation with bivalirudin.
Catheter Cardiovasc Interv
PUBLISHED: 01-04-2011
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Pediatric physicians regularly face the problem of uncertain procedural anticoagulation in children, especially in neonates. We sought to evaluate the safety, plasma concentration (pharmacokinetics, PK), pharmacodynamics (PD), and dosing guidelines of bivalirudin when used as a procedural anticoagulant in pediatric percutaneous intravascular procedures.
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Pulmonary perfusion scans following transcatheter patent ductus arteriosus closure using the Amplatzer devices.
Catheter Cardiovasc Interv
PUBLISHED: 01-04-2011
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Obstruction to flow in the left pulmonary artery (LPA) is a well-known complication after transcatheter device closure of patent ductus arteriosus (PDA). This complication has been studied for different devices using lung perfusion radionuclide scintigraphy (LPRS), but not for Amplatzer devices. This study was performed to evaluate the effect of such devices on lung perfusion using LPRS.
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Transcatheter approaches to non-valvar structural heart disease.
Int J Cardiovasc Imaging
PUBLISHED: 01-03-2011
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With advancement in transcatheter technology, numerous non-congenital structural heart lesions previously untreated, or treated with surgery are now amenable to transcatheter therapy. These therapies have centered on transcatheter valve replacement, however, other lesions are increasingly treated via the percutaneous approach. These procedures include patent foramen ovale closure, left atrial appendage occlusion, closure of post-infarct ventricular septal defects, occlusion of ruptured sinus of Valsalva aneurysm and treatment of paravalvar leaks. This review will outline indications for and approach to each of these procedures in the context of the current literature base with emphasis on pre- and intra-procedural imaging modalities.
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Percutaneous device closure of congenital and iatrogenic ventricular septal defects in adult patients.
Catheter Cardiovasc Interv
PUBLISHED: 08-06-2010
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We report our 10-year experience with percutaneous closure of adult congenital and acquired (non-post-infarct) ventricular septal defects (VSDs) using different types of Amplatzer occluder devices.
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Interventional fellowship in structural and congenital heart disease for adults.
Catheter Cardiovasc Interv
PUBLISHED: 07-06-2010
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Training for structural and adult congenital heart disease interventions remains undeveloped. With the advent of recent percutaneous interventions for the treatment of structural and valvular heart disease, such as transcatheter aortic and pulmonary valve implantation, mitral valve repair, and the expansion of shunt closure procedures, there is a clear need to define the training requirements for this category of procedures. The training needs to be aligned with the goals and priorities of a basic or advanced level and be categorized into acquired and congenital. This document will define the training needs and knowledge base for the developing field of structural heart disease intervention.
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Results of the Society of Cardiac Angiography and Interventions survey of physicians and training directors on procedures for structural and valvular heart disease.
Catheter Cardiovasc Interv
PUBLISHED: 07-06-2010
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Minimal information is available on the number and type of procedures being performed for structural and valvular heart disease, the physicians who perform these procedures, and on the training requirements for this emerging field.
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The SCAI Structural Heart Disease Council: toward addressing training, credentialing, and guidelines for structural heart disease intervention.
Catheter Cardiovasc Interv
PUBLISHED: 07-06-2010
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The field of structural heart disease (SHD) intervention has grown rapidly over the past several years. While training program content, standards, credentialing, and board examinations for percutaneous coronary intervention have matured and become well developed, no such structure exists in the field of SHD. Recognition of the need for training program standards and SHD curriculum stimulated the SCAI to form a SHD council, described in this report. In the accompanying two articles, we report the results of a survey of the status of SHD training in programs in the United States and define a core curriculum for structural intervention training.
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Interventional fellowship in structural and congenital heart disease for adults.
JACC Cardiovasc Interv
PUBLISHED: 06-15-2010
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Training for structural and adult congenital heart disease interventions remains undeveloped. With the advent of recent percutaneous interventions for the treatment of structural and valvular heart disease, such as transcatheter aortic and pulmonary valve implantation, mitral valve repair, and the expansion of shunt closure procedures, there is a clear need to define the training requirements for this category of procedures. The training needs to be aligned with the goals and priorities of a basic or advanced level and be categorized into acquired and congenital. This document will define the training needs and knowledge base for the developing field of structural heart disease intervention.
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Perventricular device closure of congenital muscular ventricular septal defects.
Expert Rev Cardiovasc Ther
PUBLISHED: 05-11-2010
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Muscular ventricular septal defects (MVSDs) account for approximately 20% of all congenital ventricular septal defects. Large defects in infants result in early heart failure, failure to thrive and pulmonary hypertension. Although percutaneous closure of MVSDs has been employed safely and effectively in children, adolescents and adults, its application in the small infant (weight <6 kg) carries a higher risk for complications including arrhythmias, hemodynamic compromise, cardiac perforation, tamponade and death. Perventricular closure of such defects, introduced by Amin and coworkers in the late 1990s, has become an attractive treatment modality for these small and high-risk patients. Experience worldwide has shown that the procedure is feasible, reproducible, safe and effective. In this article, the authors review the indications, the step-by-step technique and the results of perventricular closure of MVSDs using the AMPLATZER mVSD device (AGA Medical, MN, USA).
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The Occlutech Figulla PFO and ASD occluder: a new nitinol wire mesh device for closure of atrial septal defects.
J Invasive Cardiol
PUBLISHED: 03-31-2010
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We investigated the safety, feasibility and efficacy of the Occlutech devices for patent foramen ovale (PFO) and atrial septal defect (ASD) closure in a prospective trial.
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Atrioventricular block after transcatheter ASD closure using the Amplatzer septal occluder: risk factors and recommendations.
Catheter Cardiovasc Interv
PUBLISHED: 02-11-2010
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Transcatheter device closure of atrial septal defects is now considered an alternative option to open heart surgery with good short-term and long-term results (Du et al., J Am Coll Cardiol 2002;39:1836-1844, Chessa et al., J Am Coll Cardiol 2002;39:1061-1065); in comparison with surgical closure, the complication rate is lower (Du et al., J Am Coll Cardiol 2002;39:1836-1844). Arrhythmias are known infrequent complications of device closure. However, complete heart block is a rare complication of both treatment modalities (Chessa et al., J Am Coll Cardiol 2002;39:1061-1065). We report two patients who developed atrioventricular (AV) block within 48 hr after uncomplicated device closure of ASD using the Amplatzer septal occluder (ASO) device. Despite trials of high dose steroids and non-steroidal anti-inflammatory agents in both patients, the response was inadequate and by the end of the first week, both patients were ultimately sent for surgical removal of their devices with complete resolution of their atrioventricular conduction abnormalities. We discuss the possible etiology and risk factors of AV block and propose recommendations for management of such a complication.
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Percutaneous pulmonic valve implantation.
Curr Treat Options Cardiovasc Med
PUBLISHED: 11-26-2009
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Surgically placed valve conduits between the right ventricle and pulmonary artery often fail within 10 years. The failure may be the result of insufficiency, stenosis, or often a combination of the two. Pulmonic valve insufficiency may lead to right ventricular dilatation, heart failure, arrhythmias, and death. Reoperation requires cardiopulmonary bypass, which may aggravate an already failing right ventricle, and is associated with a higher risk of death and significant morbidity. Therefore, percutaneous implantation of a pulmonic valve is an attractive option to improve hemodynamic function and ameliorate symptoms. Initial experience with various types of percutaneous pulmonary valve systems demonstrates the procedure to be effective and safe. Improvements in technique and device modification are evolving rapidly. Studies and clinical follow-up are ongoing to further assess functional improvement, freedom from adverse cardiac events, and longevity of percutaneously implanted valves.
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Percutaneous closure of perimembranous ventricular septal defect with an Amplatzer Duct Occluder in a dextrocardia patient.
Int. J. Cardiol.
PUBLISHED: 10-19-2009
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In this article we report an unusual case of dextrocardia patient with perimembranous ventricular septal defect (VSD) whose defect is closed by percutaneous method with Amplatzer Duct Occluder-II device. To our best knowledge, this was the first time this device has been used to close a membranous defect in a patient with dextrocardia. Our case demonstrates the feasibility of percutaneous VSD closure in challenging patients by using appropiate techniques and devices for particular patients.
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Use of real time three-dimensional transesophageal echocardiography in intracardiac catheter based interventions.
J Am Soc Echocardiogr
PUBLISHED: 08-04-2009
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Real-time three-dimensional (RT3D) echocardiography is a recently developed technique that is being increasingly used in echocardiography laboratories. Over the past several years, improvements in transducer technologies have allowed development of a full matrix-array transducer that allows acquisition of pyramidal-shaped data sets. These data sets can be processed online and offline to allow accurate evaluation of cardiac structures, volumes, and mass. More recently, a transesophageal transducer with RT3D capabilities has been developed. This allows acquisition of high-quality RT3D images on transesophageal echocardiography (TEE). Percutaneous catheter-based procedures have gained growing acceptance in the cardiac procedural armamentarium. Advances in technology and technical skills allow increasingly complex procedures to be performed using a catheter-based approach, thus obviating the need for open-heart surgery.
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Intracardiac echocardiography for the guidance of percutaneous procedures.
Curr Cardiol Rep
PUBLISHED: 04-22-2009
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Interventional cardiology has seen great advances in the past decade. A wide range of interventional procedures has been established as standard therapeutic modalities and more are yet to come. Multiple imaging modalities have been used to guide these procedures. Intracardiac echocardiography (ICE) provides an accurate imaging tool to guide the appropriate performance of many of these procedures. Early studies compared ICE as a new imaging modality to guide interventional closure of atrial communications with other more established imaging techniques, such as transesophageal echocardiography, with excellent accuracy. In this article, we discuss the value of using ICE in guiding some percutaneous interventional procedures. We also discuss the imaging protocol for using ICE to guide atrial level shunt device closure. Our experience in using ICE for guiding percutaneous valve placement is also discussed.
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Feasibility of real-time three-dimensional transoesophageal echocardiography for guidance of percutaneous atrial septal defect closure.
Eur J Echocardiogr
PUBLISHED: 01-29-2009
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Intracardiac echocardiography (ICE) and two-dimensional transoesophageal echocardiography (2D TEE) are used in most centres for guiding transcatheter atrial septal defect (ASD) closure. ASDs have complex shapes that are not well characterized with 2D imaging. Real-time 3D TEE (RT3D TEE) provides en-face visualization of the ASD, allowing precise assessment of ASD dimensions. Accordingly, our aims were (i) to determine the feasibility of RT3D TEE to guide ASD closure and (ii) to compare ASD and balloon dimensions (BDs) using RT3D TEE vs. ICE and 2D TEE.
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The use of intracardiac echocardiography and other intracardiac imaging tools to guide noncoronary cardiac interventions.
J. Am. Coll. Cardiol.
PUBLISHED: 01-06-2009
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The limitations of standard fluoroscopy have led to the development of improved imaging techniques to guide noncoronary cardiac interventions. Imaging tools that are used in the interventional laboratory can be categorized as invasive and noninvasive. Noninvasive cardiac imaging tools include ultrasound, computed tomography, and magnetic resonance imaging. These modalities can generate high-resolution images of the heart and are increasingly being used to guide cardiac interventions. Despite these advances, there remains a strong role for invasive imaging tools in the interventional laboratories. Such invasive imaging tools include transesophageal echocardiography, intracardiac echocardiography, intracardiac endoscopy, and electroanatomic mapping systems. Despite the risks inherent to the invasive nature of these tools, these modalities can provide excellent real-time, detailed images that can be invaluable in guiding certain cardiac interventions. This review will propose the features of an ideal intracardiac imaging tool, summarize the intracardiac imaging tools that are currently available or under development to guide noncoronary cardiac interventional procedures, and suggest opportunities for improvement. One opportunity in this field is to couple imaging systems directly with the interventional devices themselves. The use of intracardiac imaging to guide select cardiac procedures including transseptal catheterization, catheter ablation procedures for arrhythmias, and percutaneous placement of cardiac valves and closure devices will also be discussed. Most of this review will be devoted to intracardiac echocardiography, which currently has the broadest number of applications.
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Medium and long-term outcomes after bilateral pulmonary artery stenting in children and adults with congenital heart disease.
Pediatr Cardiol
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Percutaneous stenting of branch pulmonary arteries (PAs) has become an important interventional therapy in the complete management of congenital heart disease. Few data exist on long-term outcomes for patients requiring placement of bilateral stents. This study aimed to determine the medium- to long-term outcomes after bilateral stenting of branch PAs in patients with congenital heart disease. A retrospective study analyzed all procedural and follow-up data on patients undergoing bilateral PA stenting during a single procedure. From October 2001 to May 2012, 26 patients underwent bilateral PA stenting (total of 62 stents). The mean age of these patients was 9.5 ± 12 years, and their mean weight was 27 ± 19 kg. The mean procedural time was 191 ± 67 min, and the mean fluoroscopy time was 50 ± 29 min. The mean gradient across the right pulmonary artery decreased from 35 ± 22 to 11 ± 12 mmHg (p < 0.001). The left pulmonary artery gradient decreased from 32 ± 17 to 10 ± 12 mmHg (p < 0.001), and the right ventricle to descending aorta pressure ratio decreased from 71 ± 18 % to 46 ± 13 % (p < 0.001). Intraprocedural adverse events were encountered in four patients (1 small PA dissection, 2 intraprocedural arrhythmias, and 1 first-degree burn on the thigh). The mean follow-up period was 41 ± 23 months. Two deaths occurred. Further interventions were required for 12 patients. Bilateral PA stenting is effective and safe, with an instantaneous significant decrease in pressure gradients. The need for reintervention is common, so continued follow-up assessment is warranted.
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The Society for Cardiovascular Angiography and Interventions Structural Heart Disease Early Career Task Force survey results: endorsed by the Society for Cardiovascular Angiography and Interventions.
Catheter Cardiovasc Interv
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Over the last decade, structural heart disease interventions have emerged as a new field in interventional cardiology. Currently, the Accreditation Council for Graduate Medical Education accredited interventional cardiology fellowship programs in the United States provide high-quality and well established training curriculum in coronary and peripheral interventions, but training in structural interventions remains in its infancy. The current survey seeks to collect relevant information and assess the opinion of interventional cardiology program directors in ACGME-accredited institutions that are actively involved in structural interventional training. Our study describes the actual number of structural procedures performed by interventional cardiology fellows in ACGME-accredited programs, the form of the structural training today and the suggestions from program directors who are actively trying to integrate structural training in the interventional cardiology fellowship programs.
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Bail out use of the Gore Excluder following pulmonary conduit rupture during transcatheter pulmonary valve replacement.
Catheter Cardiovasc Interv
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This report describes the use of the Gore Excluder self-expanding stent to successfully exclude a contained right ventricle to pulmonary artery conduit rupture during transcatheter pulmonary valve replacement (tPVR). This stent was designed for percutaneous abdominal aortic aneurysm exclusion; however, its use in this setting allowed progression to tPVR following conduit rupture without the need for emergent surgery.
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State-of-the-art percutaneous pulmonary valve therapy.
Expert Rev Cardiovasc Ther
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Transcatheter pulmonary valve replacement is one of the most exciting recent developments in the treatment of patients with congenital heart disease and is being used to treat both stenotic and regurgitant valves within previously placed surgical conduits. Although limited somewhat by both patients and available valve sizes, ongoing attempts are being made to extend this technology to native right ventricular outflow tracts. If achieved, this will represent a significant advancement in attempts to prevent morbidity and mortality secondary to the chronic effects of right ventricular volume loading. This review deals with the development, current status and future endeavors of this approach.
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Transcatheter pulmonary valve implantation in native pulmonary outflow tract using the Edwards SAPIEN™ transcatheter heart valve.
Eur J Cardiothorac Surg
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Percutaneous pulmonary valve implantation (PPVI) is now an accepted alternative option to conventional surgery for patients with dysfunctional conduits between the right ventricle and pulmonary artery. PPVI will reduce the total number of repeat operations in such patients. However, surgery remains the primary option in postoperative tetralogy of Fallot patients with severe pulmonary regurgitation who underwent transannular patch reconstruction of their right ventricular outflow tract (RVOT). Traditionally, an RVOT patch is considered a relative contraindication to PPVI, however, in selected patients PPVI was successfully performed. We report the case of a 12-year-old patient after neonatal repair of tetralogy of Fallot and pulmonary atresia, who developed advanced liver disease and severe pulmonary regurgitation. In this patient, the risk for surgical valve replacement was considered too high and he was treated with percutaneous implantation of the Edwards SAPIEN™ transcatheter heart valve.
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