Unusual Hybrid Closure of Ventricular Septal Defects

A planned combined perventricular and “open heart” surgical closure of multiple ventricular septal defects had to be modified intraoperatively due to a technical fault disabling echocardiographic guidance. Through an atriotomy, device closure of a muscular defect and patch closure of a perimembranous ventricular septal defect were performed. In unusual situations, collaboration of the surgical and interventional team is crucial

Charge density mapping in a pediatric patient with symptomatic runs of ectopic atrial tachycardia

Ectopic atrial tachycardia (AT) poses a notable challenge in pediatric cardiology, often requiring precise localization for optimal treatment. Its incidence is relatively low, affecting 3.7%–5.7% of children undergoing electrophysiological studies.1 While catheter ablation complements pharmacological therapy, achieving a high success rate of approximately 90%, there is room for enhancement.1 A challenge lies in mapping and ablating transient episodes of AT. Recent innovations in mapping technologies, notably charge density mapping, have shown promise in providing precise single-beat noncontact mapping of transient AT in adult patients.2,3 This mapping technique uses individualized anatomy of a heart chamber, created by ultrasound crystals that are integrated in a basket catheter, with subsequent visualization of recorded cardiac dipoles.4 This article explores a unique case with short runs of ectopic AT, demonstrating the efficacy of single-beat noncontact mapping using charge density mapping in a pediatric patient

Charge density mapping in a pediatric patient with symptomatic runs of ectopic atrial tachycardia

Ectopic atrial tachycardia (AT) poses a notable challenge in pediatric cardiology, often requiring precise localization for optimal treatment. Its incidence is relatively low, affecting 3.7%–5.7% of children undergoing electrophysiological studies.1 While catheter ablation complements pharmacological therapy, achieving a high success rate of approximately 90%, there is room for enhancement.1 A challenge lies in mapping and ablating transient episodes of AT. Recent innovations in mapping technologies, notably charge density mapping, have shown promise in providing precise single-beat noncontact mapping of transient AT in adult patients.2,3 This mapping technique uses individualized anatomy of a heart chamber, created by ultrasound crystals that are integrated in a basket catheter, with subsequent visualization of recorded cardiac dipoles.4 This article explores a unique case with short runs of ectopic AT, demonstrating the efficacy of single-beat noncontact mapping using charge density mapping in a pediatric patient

Indications for stenting of coarctation of the aorta in children under 3 months of age

Introduction: Coarctation of the aorta in children under 3 months of age is usually treated surgically. However, there are clinical scenarios in which stenting of native or recurrent coarctation may become necessary in this age group. Case reports: Four cases illustrate possible indications: left ventricular dysfunction increasing the operative risk, thrombus formation after coarctation surgery, patient size (i.e. in premature babies), and retrograde arch obstruction after hybrid palliation of hypoplastic left heart syndrome. In all babies, coarctation stenting was carried out successfully without complications. Conclusion: Coarctation stenting can be carried out safely in small children. Usually, the stent has to be removed or redilated later. Results are encouraging

Dilating and fracturing side struts of open cell stents frequently used in pediatric cardiac interventions—An in vitro study

Background: Open cell stents are frequently used in interventional therapy of congenital heart disease. Overstenting of vessel branches may necessitate strut dilation. Methods and Results: The strut size achievable in Bard Valeo and Cook Formula stents, and the pressure necessary to fracture struts was assessed. In addition, a self expanding stent (Optimed SinusflexDS) was also tested. With the original balloon at nominal pressure, in Valeo stents side struts could be dilated to approximately 90% of the nominal stent diameter, in Formula stents to approximately 80%. With larger high pressure woven balloons, strut size increased to approximately 125% in Valeo stents, and to approximately 105% in the Formula. Strut fracture can connect two adjoining struts. Pressures were dependent on the balloon utilized. Sidestruts of the Sinusflex could lastingly overdilated with large balloons only. Conclusion: Dilation and overdilation of side struts in open cell stents can be achieved. Dependent on the clinical context, the original balloon used to place the premounted stent can be used to achieve strut dilation, but woven high pressure balloons maybe safer for patients. Should a larger diameter be required, these high pressure woven balloons can achieve bigger diameters and even strut fracture

Catheter, MRI and CT Imaging in Newborns with Pulmonary Atresia with Ventricular Septal Defect and Aortopulmonary Collaterals: Quantifying the Risks of Radiation Dose and Anaesthetic Time

A comprehensive understanding of the native pulmonary blood supply is crucial in newborns with pulmonary atresia with ventricular septal defect and aortopulmonary collaterals (PA/VSD/MAPCA). We sought to describe the accuracy in terms of identifying native pulmonary arteries, radiation dose and anaesthetic time associated with multi-modality imaging in these patients, prior to their first therapeutic intervention. Furthermore, we wanted to evaluate the cumulative radiations dose and anaesthetic time over the study period. Patients with PA/VSD/MAPCA diagnosed at < 100 days between 2004 and 2014 were identified. Cumulative radiation dose and anaesthetic times were calculated, with imaging results compared with intraoperative findings. We then calculated the cumulative risks to date for all surviving children. Of 19 eligible patients, 2 had echocardiography only prior to first intervention. The remaining 17 patients underwent 13 MRIs, 4 CT scans and 13 cardiac catheterization procedures. The mean radiation dose was 169 mGy cm2 (47–461 mGy cm2), and mean anaesthetic time was 111 min (33–185 min). 3 children had MRI only with no radiation exposure, and one child had CT only with no anaesthetic. Early cross-sectional imaging allowed for delayed catheterisation, but without significantly reducing radiation burden or anaesthetic time. The maximum cumulative radiation dose was 8022 mGy cm2 in a 6-year-old patient and 1263 min of anaesthetic at 5 years. There is the potential to generate very high radiation doses and anaesthetic times from diagnostic imaging alone in these patients. As survival continues to improve in many congenital heart defects, the important risks of serial diagnostic imaging must be considered when planning long-term management

The Coastal Observing System for Northern and Arctic Seas (COSYNA)

The Coastal Observing System for Northern and Arctic Seas (COSYNA) was established in order to better understand the complex interdisciplinary processes of northern seas and the Arctic coasts in a changing environment. Particular focus is given to the German Bight in the North Sea as a prime example of a heavily used coastal area, and Svalbard as an example of an Arctic coast that is under strong pressure due to global change. The COSYNA automated observing and modelling system is designed to monitor real-time conditions and provide short-term forecasts, data, and data products to help assess the impact of anthropogenically induced change. Observations are carried out by combining satellite and radar remote sensing with various in situ platforms. Novel sensors, instruments, and algorithms are developed to further improve the understanding of the interdisciplinary interactions between physics, biogeochemistry, and the ecology of coastal seas. New modelling and data assimilation techniques are used to integrate observations and models in a quasi-operational system providing descriptions and forecasts of key hydrographic variables. Data and data products are publicly available free of charge and in real time. They are used by multiple interest groups in science, agencies, politics, industry, and the public