Alejandro Peirone

Echocardiographic evaluation, management and outcomes of bilateral arterial ducts and complex congenital heart disease: 16 years' experience.

Bilateral arterial ducts represent an uncommon form of pulmonary or systemic blood supply associated with complex congenital cardiac disease. We sought to determine the role of high-resolution cross-sectional echocardiography and color flow Doppler ultrasonography in assessing this condition, as well as to describe the management and outcome in a group of patients. A retrospective review was conducted of 11 newborns identified over a 16-year period as having bilateral arterial ducts. Pulmonary atresia associated with non-confluent pulmonary arteries was the dominant lesion, with the heterotaxy syndrome also frequently being recognized. Echocardiography best identified the source of blood supply to either the pulmonary or systemic circulations, allowing differentiation from collateral vessels. Stenosis of the right or left pulmonary artery at the initial site of ductal insertion needs careful evaluation on follow-up. Management of patients with this condition remains a challenge, as indicated by the poor outcomes observed in our series.

Radiofrequency perforation and conventional needle percutaneous transseptal left heart access: pathological features.

Perforating radiofrequency (PRF) energy has been used to obtain percutaneous transseptal left heart access. Contrary to ablative radiofrequency (RF), myocardial tissue responses to PRF thermal injury are incompletely defined. In this study, a newly developed RF catheter system for transseptal left atrial entry was compared with conventional needle puncture. Of 15 piglets having transfemoral cardiac catheterization, 12 had transseptal procedures. Needle punctures (NP) and PRF were followed by acute (1 hr; 3 NP, 3 PRF) and chronic necropsy (1 month; 3 NP, 3 PRF). The remaining three piglets had intentional RF aortic perforation through the atrial roof with necropsy at 1 month. Gross and histopathological effects were examined. Acutely, the gross RF lesion was similar to needle puncture. Histologically, the RF lesions had minimal mural thrombus, an inner zone of thermal injury characterized by grayish cytoplasmic staining (elastic trichrome), and a bubbly transformation of the cytoplasm in innermost cardiomyocytes, partial persistence of cross‐striations, and an acute inflammatory reaction. The outer extent of the lesion (< 1 mm) was defined by a halo of contraction band necrosis similar to needle puncture. Acute NP injury showed comparable depth and extent of myocyte necrosis (principally contraction bands) with adjacent tissue hemorrhage and edema. At 1 month, a well‐developed densely collagenous scar was present in both aortic and transseptal PRF lesions. The extent of acute RF injury is similar to that seen in conventional NP, but the characteristics of tissue insult are different. Both show well‐developed healing at 1 month.

Staged rehabilitation of ductal origin of the left pulmonary artery in an infant fallot's tetralogy

Isolation of a branch pulmonary artery from ductal closure is an unusual finding in patients with tetralogy of Fallot. A case report of a newborn is presented where the closing arterial duct was balloon‐dilated and stented to reestablish blood supply to the affected lung as a strategy of improving systemic saturations and promoting the growth of the hiliar branch pulmonary artery. Five months after the initial palliation, complete surgical repair with stent removal was successfully achieved. Cathet Cardiovasc Intervent 2003;59:392–395.

Immediate and short‐term outcomes after percutaneous atrial septal defect closure using the new nit‐occlud ASD‐R device

To evaluate the feasibility, safety, and efficacy of implantation of the new Nit Occlud ASD‐R® (NOASD‐R) device for percutaneous closure of ostium secundum atrial septal defects (ASD‐OS).

Multicenter nit-occlud® PDA-R patent. Ductus arteriosus occlusion device trial: initial and six-month results.

Transcatheter closure of a moderate to large patent ductus arteriosus (PDA) using conventional techniques is challenging. The Nit‐Occlud® PDA‐R trial can close a PDA up to 8 mm in diameter. We sought to report procedural and six‐month efficacy and safety results of the multicenter Nit‐Occlud® PDA‐R trial.

Clinical findings in common arterial trunk

Abstract Persistence of a common arterial trunk is a rare congenital heart malformation. The clinical findings of this enigmatic and fascinating abnormality as well as selected aspects of history, embryology and genetics are presented. Differential diagnosis including electrocardiographic and radiologic interpretation are discussed. Recognized classifications as proposed by Collet and Edwards, Van Praagh and Van Praagh, and the recent classification suggested by the Congenital Heart Surgery Nomenclature Project are described.

Percutaneous Transhepatic Fontan-Kreutzer Completion of Hepatic Vein Inclusion

We report the case of an 11-year-old girl with heterotaxy syndrome, dextrocardia, and azygos continuation of an interrupted inferior vena cava who had developed pulmonary arteriovenous fistulas after a Kawashima procedure consisting of bilateral superior cavopulmonary anastomoses. She presented with profound cyanosis, fatigue, and failure to thrive. An operative procedure to direct hepatic vein effluent to the pulmonary circulation was performed with placement of an extracardiac conduit between the hepatic veins and the left pulmonary artery. Persistence of cyanosis led to investigation, which led to the discovery of an unintentionally excluded right hepatic vein. A percutaneous transhepatic catheter intervention was performed in which a vascular plug was implanted to occlude the “missed” right hepatic vein, redirecting the flow through intrahepatic venovenous channels to the conduit. Clinical condition and arterial oxygen saturation were substantially improved one year after the two-step hepatic vein inclusion procedure.

Ventajas de la ecocardiografía tridimensional transesofágica como soporte en el cierre de la comunicación interauricular

La comunicación interauricular (CIA) es una de las cardiopatías congénitas más frecuentes y en aproximadamente 85% de ellas, el defecto se encuentra localizado en la fosa oval constituyendo el tipo “ostium secundum” de comunicación interatrial. El tratamiento de elección en este tipo de defectos es el cierre percutáneo mediante implante de dispositivos autoexpandibles de doble disco . Desde fines de la década del 90, una nueva herramienta para visualización de estos defectos está disponible en la práctica cotidiana cardiovascular, el ecocardiograma Doppler color tridimensional, que muestra su utilidad en el diagnóstico de numerosas patologías cardíacas congénitas, estructurales y funcionales y en la planificación del tratamiento de patologías valvulares o en la determinación de la función ventricular . El septum interauricular es una estructura compleja y el ecocardiograma tridimensional tiene la ventaja de poder observarlo desde su cara derecha o izquierda . Durante el procedimiento de implante de dispositivos en la sala de hemodinamia, es mandatorio la guía con imágenes para descartar defectos múltiples, bordes deficientes del defecto y aneurismas del septum interauricular. Además, se debe controlar el correcto posicionamiento en el septum interauricular de dicho dispositivo, con el objetivo de disminuir complicaciones como la erosión de estructuras adyacentes al sobredimensionar el tamaño del oclusor o la embolización al subestimar el tamaño del defecto. También, pueden determinarse otras posibles contraindicaciones para el cierre percutáneo (tabla 1) .

Techniques for trans-catheter retrieval of embolized Nit-Occlud® PDA-R and ASD-R devices

Nit‐Occlud® (atrial septal defect) ASD‐R and (patent ductus arteriosus) PDA‐R devices are used outside the United States for percutaneous closure of the patent ductus arteriosus and atrial septal defects. When embolization occurs, these devices have been difficult to retrieve.

A Rare Cause of Pediatric Stroke: Left Atrial Myxoma.

We describe a case of sudden-onset left-sided hemiparesis and dysarthria in a five-year-old boy. Acute vascular malformation bleeding or ischemic stroke was suspected. Neurological examination three weeks after the initial event revealed mild residual facial paresis. Brain angiography ruled out a vascular malformation. A work-up echocardiogram revealed a 4-cm left atrial mass compatible with cardiac myxoma. Urgent surgical resection of the mass under cardiopulmonary bypass confirmed the diagnosis. Uneventful recovery followed surgical resection. In this report, we present a partially embolized left atrial myxoma that caused an acute ischemic stroke, which is rarely considered and encountered in the pediatric population.