Lead Extraction in Children and Young Adults Using Different Techniques

Objective: To describe our experience with removal of pacing lead in children using different techniques. Patients and Methods: Between 1999 and 2006, removal of 39 leads was attempted in 30 patients: 21 males and 9 females aged 4-21 years (mean 12 +/- 5 years). Sixteen patients had previous corrective cardiac surgery. The leads had been implanted for 46 +/- 31 months (range 1-120 months). The reasons for removal included lead fracture in 14, upgrading in 8, infection in 7, dislodgment in 5, pacing system not needed in 2, and other reasons in 3. Results: Of the 39 leads, 29 (74.3%) were completely removed. Twelve leads were removed with simple traction and rotation and 9 were removed using a locking stylet combined with simple traction and rotation; a laser extraction system was used in 10 cases in which 8 leads were successfully removed. Duration of implantation was the only important predictor for successful removal. Three patients necessitated surgical lead removal and had epicardial pacemaker implantation. Conclusion: Using currently available techniques, percutaneous pacemaker lead removal was possible in the majority of cases, although a significant number of cases were not successful. Attempted lead removal with simple traction and rotation resulted in the need for surgical removal in a significant number of patients. Newer techniques should be developed to increase the success rate. Copyright (C) 2009 S. Karger AG, BaselWoSScopu

Transcatheter Closure Of Coronary Artery Fistula With An Amplatzer Duct Occluder Ii In A Symptomatic Infant

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Endovascular stent implantation for coarctation of the aorta in children and young adults: intermediate follow-up results from Turkey

The aim of this study was to report the intermediate follow-up results of stent implantation for coarctation of the aorta in children from Turkey. Patients with native or postoperative coarctation, who had abnormal flow at the descending aorta exceeding diastolic phase on Doppler echocardiography or upper extremity hypertension, underwent endovascular stent implantation. Ten patients with a mean age of 12.4 +/- 5.5 years (6-23 years) underwent stent implantation between January 2001 and September 2006. Of these, three had previous surgical repair, and the remainder were native coarctation. Palmaz, Genesis and Numed CP stents were used. All the implantations were successful and there was no major complication during the procedure. The follow-up period was 8-72 months and only one patient needed re-dilatation during this period. Stent implantation may be a feasible alternative to balloon angioplasty and surgery for adolescents. Patients who have previous surgical repair, high surgical risk, unfavorable anatomy, or refuse consent for surgical intervention are the best candidates for stent implantation. However, longer follow-up and new studies are necessary especially in younger patients

Radiofrequency catheter ablation of left-sided accessory pathways via retrograde aortic approach in children

Background: We aimed to analyze the results of retrograde aortic radiofrequency catheter ablation of left-sided accessory pathways in children. Methods: Between January 2010 and September 2014, 25 children who underwent left-sided accessory pathway ablation with a retrograde aortic approach were evaluated retrospectively. Results: The mean age of the patients was 11.09 +/- 3.71 years. Seventeen patients were male (68%). The mean procedure and fluoroscopy times were 71.54 +/- 21.05 min and 31.42 +/- 19.57 min, respectively. Radiofrequency energy was delivered with 41.38 +/- 15.32 W at 52.38 +/- 5.45 degrees C. Sixteen patients (64%) presented with manifest preexcitation and, 9 had concealed accessory pathways. The location of accessory pathway was left lateral in 16 patients, posteroseptal in 5, left anterolateral in 2, and left posterolateral and left posterior in the remaining 2. The acute success rate was 96%. The patients were followed for a mean of 16.68 +/- 18.01 months. There were 2 recurrences. No major complications were observed in the periprocedural period. One patient had groin hematoma, another one had transient severe headache and vomiting. Trivial mitral regurgitation was noted in a patient, which remained the same throughout follow-up. None of the patients developed new aortic regurgitation, pericardial effusion, or thrombi at the site of ablation. Conclusions: The retrograde aortic approach can be safely employed with a high success rate for ablation of left-sided accessory pathways in children. (C) 2016 Japanese Heart Rhythm Society. Published by Elsevier B.V

Fallot Tetralojisi Nedeniyle Tüm Düzeltme Ameliyatı Uygulanmış Hastalarda Pulmoner Yetmezliğin Miktarını Belirlemek için Anjiyokardiyografi ve Manyetik Rezonans Görüntüleme

Objective: This study aimed to compare the results of angiocardiography and cardiovascular magnetic resonance imaging in the assessment of pulmonary regurgitation following repair of tetralogy of Fallot. Methods: We prospectively studied 37 patients with repaired tetralogy of Fallot. After routine examination cardiovascular magnetic resonance imaging (CMR) and cardiac catheterization and angiography were performed. Pulmonary regurgitation (PR) was classified according to the following criteria, using a left lateral angiogram of the main pulmonary artery; insufficiency jet is limited to right ventricular outflow tract (mild); jet reaches the body of right ventricle (moderate); jet fills the apex of the right ventricle (severe). Results: Pulmonary regurgitation determined by angiocardiography and CMR was severe in 51.4% and 32.4%, moderate in 27% and 40.5%, and none or mild in 21.6% and 27% of patients respectively. The ability of semi-quantitative estimation of PR determined by cardiac catheterization to distinguish between mild, moderate and severe pulmonary regurgitation was shown to have significant correlation with pulmonary regurgitant fraction obtained by CMR. Conclusions: Angiography obtained during invasive study can be used for the diagnosis and follow-up of pulmonary regurgitation confidently in patients with repaired tetralogy of Fallot and residual pulmonary regurgitation. (Anadolu Kardiyol Derg 2010; 10: 353-7)WoSScopu

Results of Radiofrequency Ablation in Children with Tachycardia-Induced Cardiomyopathy

Objective: Tachycardia-induced cardiomyopathy (TIC) is a rare but potentially curable cause of dilated cardiomyopathy. Data on radiofrequency ablation (RFA) for TIC is limited. The aim of this study is to present our experience with RFA in children with TIC, retrospectively. Methods: The medical records of patients with TIC and those underwent RFA between 2000-2011 were systematically reviewed. Demographics and echocardiographic features were recorded. Tachycardia-induced cardiomyopathy is defined as dilatation of the heart chambers or heart failure with chronic or very frequent cardiac arrhythmia. Diagnosis was confirmed with normalization of functions after sinus rhythm has been achieved. Results: A total of 12 patients with a mean age of 6.3 +/- 4.1 years (in utero-11.5 years) at diagnosis were enrolled in the study consisting of 7 patients with permanent junctional reciprocating tachycardia and 5 patients with focal atrial tachycardia. The mean pre-RFA left ventricular end-diastolic diameter and left ventricular ejection fraction (LVEF) values were 49.1 +/- 9.6 mm (32-66) and 40.8 +/- 13.4% (23-57%), respectively. One month after RFA, the mean LVEF value was 62 +/- 4.9% (52-69), with only 2 out of 12 patients' LVEF values were still lower than 58%. Tachycardia recurrence was observed in 4 patients, 3 of which had successful repeated RFA procedure. Overall, cure for arrhythmia was achieved in 11 patients (92%), while reversal of heart failure achieved in all patients. In 1 patient permanent complete AV block was developed after the procedure. Conclusion: Treatment of tachycardia with RFA, particularly in patients with arrhythmia refractory to medical therapy, is a feasible and effective treatment option regardless of age.WoSScopu

Endovascular stents for treatment of coarctation of the aorta

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