Pediatric Interventional Cardiology: A Specialty Comes of Age

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73435/1/j.1540-8183.1995.tb00574.x.pd

Balloon valvuloplasty for critical aortic stenosis in the newborn: Influence of new catheter technology

AbstractBetween 1986 and July 1990, balloon valvuloplasty was attempted in eight newborns (<28 days of age) with isolated critical aortic valve stenosis. Balloon valvuloplasty could not be successfully accomplished in any of the three infants presenting before 1989. Since March 1989, when improved catheter technology became available, all five neonates presenting with critical aortic stenosis were treated successfully by balloon valvuloplasty. A transumbilical approach was utilized in all four infants in whom umbilical artery access could be obtained. One newborn who was 25 days of age underwent transfemoral balloon valvuloplasty.Balloon valvuloplasty was immediately successful in all five newborns, as evidenced by a decrease in valve gradient and improvement in left ventricular function and cardiac output. Peak systolic gradient was reduced by 64% from 69 ± 8 to 25 ± 3 mm Hg (p = 0.005). Left ventricular systolic pressure decreased from 128 ± 9 to 95 ± 9 mm Hg (p = 0.02) and left ventricular end-diastolic pressure decreased from 20 ± 2 to 11 ± 1 mm Hg (p = 0.02). Moderate (2+) aortic regurgitation was documented in two infants after valvuloplasty. The time from first catheter insertion to valve dilation averaged 57 ± 14 min (range 26 to 94) and the median length of the hospital stay was 4 days.With the use of recently available catheters, the transumbilical technique of balloon valvuloplasty can be performed quickly, safely and effectively in the newborn with critical aortic stenosis. It does not require general anesthesia, cardiopulmonary bypass or a left ventricular apical incision and it preserves the femoral arteries for future transcatheter intervention should significant aortic stenosis recur

Transcatheter Atrial Septal Defect Closure: Preliminary Experience with the Rashkind Occluder Device

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72836/1/j.1540-8183.1989.tb00751.x.pd

Influence of Echocardiographic Guidance on Positioning of the Buttoned Occluder for Transcatheter Closure of Atrial Septal Defects

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73381/1/j.1540-8175.1996.tb00878.x.pd

Transcatheter treatment of congenital heart disease

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27854/1/0000265.pd

Hemodynamic effects of hydralazine in infants with large ventricular septal defect

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24471/1/0000746.pd

Cardiovascular effects of breathing 95 percent oxygen in children with congenital heart disease

The hemodynamic effects of breathing 95% oxygen were evaluated in 26 children with congenital heart disease. Aortic, pulmonary arterial, right atrial, and pulmonary arterial wedge pressure, aortic and pulmonary artery oxygen saturation, and blood gas, cardiac index, and heart rate were measured in room air and after each patient had breathed 95 % oxygen for 10 (n = 26) and 20 (n = 5) minutes. Measurements were repeated with the patient again breathing room air for 10 (n = 11) and 20 (n = 6) minutes. After 10 minutes of 95% oxygen, arterial partial pressure of oxygen increased from 85 +/- 13 to 420 +/- 89 torr (p 2 (p 2/min/m2 (p &lt; 0.001). Cardiac index, stroke index, and systemic vascular resistance did not return to normal until 20 minutes after cessation of oxygen breathing. To determine whether reflex bradycardia is responsible for these oxygen-induced hemodynamic changes, heart rate was kept constant by atrial pacing in a second group of 5 patients. In these children, significant decreases in cardiac index, stroke index, and oxygen consumption, and increases in systemic vascular resistance also occurred with 95% oxygen. Thus, in children with acyanotic congenital heart disease, hyperoxia increases aortic pressure and systemic vascular resistance and decreases cardiac index, stroke index, oxygen consumption, and oxygen transport.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25170/1/0000608.pd

Aortic aneurysm after patch aortoplasty repair of coarctation: A prospective analysis of prevalence, screening tests and risks

AbstractTwenty-nine children were evaluated prospectively for the presence of an aortic aneurysm at the repair site 1 to 19 years after patch aortoplasty repair of coarctation of the aorta. In each child, noninvasive evaluation included a chest X-ray film, computed tomography of the chest and two-dimensional echocardiography. The presence and size of an aortic aneurysm were determined quantitatively by measuring the ratio of the diameter of the thoracic aorta at the repair site to the diameter of the aorta at the diaphragm (aortic ratio). An aortic ratio of ≥1.5 was judged abnormal and was shown to be significantly greater than the aortic ratio of a normal control group. An aortogram was obtained in each child if any noninvasive screening test was found to be abnormal.As assessed by the aortogram, the prevalence of aortic aneurysm was 24% in this patient group. The sensitivity of echocardiography and chest computed tomography for detecting an aneurysm was 71% and 66%, and the specificity 76% and 85%, respectively. The chest X-ray film was 100% sensitive and 68% specific in determining the presence of an aneurysm. Although the data are not statistically significant, they suggest that children undergoing patch aortoplasty as the primary procedure (rather than a reoperation after earlier resection), and children in whom a Dacron patch is utilized may be at increased risk for aneurysm formation.Thus, in a prospective manner, this study has documented that aortic aneurysm occurs commonly after patch aortoplasty for coarctation in childhood, that the chest X-ray film provides a sensitive screening test and that the aneurysm may be evaluated quantitatively (by measuring the aortic ratio) with echocardiography or chest computed tomography