Acute and mid‐term outcomes of stent implantation for recurrent coarctation of the aorta between the Norwood operation and fontan completion: A multi‐center Pediatric Interventional Cardiology Early Career Society Investigation

ObjectivesWe sought to evaluate outcomes of stent implantation (SI) for recurrent coarctation of the aorta (RC) following the Norwood operation.BackgroundRC is common following the Norwood operation. Balloon angioplasty (BA) is standard treatment but may result in unsatisfactory relief of RC. SI may improve RC, but outcome data are limited.MethodsWe performed a multi‐center retrospective study of patients who underwent SI for RC between the Norwood operation and Fontan completion. Outcomes were examined, including procedural success, serious adverse events (SAE), and freedom from re‐intervention. A core laboratory was utilized to review angiograms. Coarctation Index (CI) was calculated before and after SI. Paired t‐test and Wilcoxon signed‐rank test were used to compare pre‐ and post‐SI variables.ResultsThirty‐three patients at 8 centers underwent SI for RC at a median age of 5 months (IQR 4.1, 13.3) and weight of 5.9 kg (5.2, 8.6). Aortic arch gradient improved from 20 (15, 24) to 0 (0, 2) mmHg following SI (P < 0.0001). The median CI improved from 0.54 (0.43, 0.62) to 0.97 (0.89, 1.06) following SI (P < 0.0001). There were no procedural deaths but SAEs occurred in 12 (36%) patients. During a median follow‐up duration of 29.7 months (6.8, 48.0), freedom from death or heart transplant was 82%, and from re‐intervention was 45%, with median time to re‐intervention of 20.1 months (11.4, 40.3).ConclusionsSI for treatment of RC in patients after the Norwood operation provides excellent acute relief of obstruction. Intraprocedural hemodynamic instability is common and re‐intervention is frequent at mid‐term follow‐up.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140022/1/ccd27231_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/140022/2/ccd27231.pd

Non-mosaic trisomy 22 and congenital heart surgery using the shared decision making model: a case report

BackgroundLiveborn infants with non-mosaic trisomy 22 are rarely described in the medical literature. Reported lifespan of these patients ranges from minutes to 3&nbsp;years, with the absence of cardiac anomalies associated with longer-term survival. The landscape for offering cardiac surgery to patients with rare autosomal trisomies is currently evolving, as has been demonstrated recently in trisomies 13 and 18. However, limited available data on patients with rare autosomal trisomies provides a significant challenge in perinatal counseling, especially when there are options for surgical intervention.Case presentationIn this case report, we describe an infant born at term with prenatally diagnosed apparently non-mosaic trisomy 22 and multiple cardiac anomalies, including a double outlet right ventricle, hypoplastic aortic valve and severe aortic arch hypoplasia, who underwent cardiac surgery. The decisions made by her family lending to her progress and survival to this day were made with a focus on the shared decision making model and support in the prenatal and perinatal period. We also review the published data on survival and quality of life after cardiac surgery in infants with rare trisomies.ConclusionsThis patient is the only known case of apparently non-mosaic trisomy 22 in the literature who has undergone cardiac surgery with significant survival benefit. This case highlights the impact of using a shared decision making model when there is prognostic uncertainty

Creation of Transcatheter Aortopulmonary and Cavopulmonary Shunts Using Magnetic Catheters: Feasibility Study in Swine

Surgical shunts are the basic form of palliation for many types of congenital heart disease. The Glenn shunt (superior cavopulmonary connection) and central shunt (aortopulmonary connection) represent surgical interventions that could potentially be accomplished by transcatheter techniques. We sought to investigate the efficacy of using neodymium iron boron (NdFeB) magnetic catheters to create transcatheter cavopulmonary and aortopulmonary shunts. NdFeB magnets were machined and integrated into catheters. “Target” catheters were placed in the pulmonary arteries (PAs), and radiofrequency “perforation” catheters were placed in either the descending aorta (DAo) for central shunts or the superior vena cava (SVC) for Glenn shunts. The magnet technique or “balloon target” method was used to pass wires from the DAo or the SVC into the PA. Aortopulmonary and cavopulmonary connections were then created using Atrium iCAST covered stents. Magnet catheters were used to perforate the left pulmonary artery from the DAo, thereby establishing a transcatheter central shunt. Given the orientation of the vasculature, magnetic catheters could not be used for SVC-to-PA connections; however, perforation from the SVC to the right pulmonary artery was accomplished with a trans-septal needle and balloon target. Transcatheter Glenn or central shunts were successfully created in four swine

Creation of Transcatheter Aortopulmonary and Cavopulmonary Shunts Using Magnetic Catheters: Feasibility Study in Swine

Surgical shunts are the basic form of palliation for many types of congenital heart disease. The Glenn shunt (superior cavopulmonary connection) and central shunt (aortopulmonary connection) represent surgical interventions that could potentially be accomplished by transcatheter techniques. We sought to investigate the efficacy of using neodymium iron boron (NdFeB) magnetic catheters to create transcatheter cavopulmonary and aortopulmonary shunts. NdFeB magnets were machined and integrated into catheters. “Target” catheters were placed in the pulmonary arteries (PAs), and radiofrequency “perforation” catheters were placed in either the descending aorta (DAo) for central shunts or the superior vena cava (SVC) for Glenn shunts. The magnet technique or “balloon target” method was used to pass wires from the DAo or the SVC into the PA. Aortopulmonary and cavopulmonary connections were then created using Atrium iCAST covered stents. Magnet catheters were used to perforate the left pulmonary artery from the DAo, thereby establishing a transcatheter central shunt. Given the orientation of the vasculature, magnetic catheters could not be used for SVC-to-PA connections; however, perforation from the SVC to the right pulmonary artery was accomplished with a trans-septal needle and balloon target. Transcatheter Glenn or central shunts were successfully created in four swine

Multicenter Experience Evaluating Transcatheter Pulmonary Valve Replacement in Bovine Jugular Vein (Contegra) Right Ventricle to Pulmonary Artery Conduits

Follow-up of transcatheter pulmonary valve replacement (TPVR) with the Melody valve has demonstrated good short-term and long-term outcomes, but there are no published studies focused on valve performance in the Contegra bovine jugular vein conduit.status: publishe