Rafał Surmacz

Successful transcatheter closure of unusual giant and symptomatic right ventricle to right atrium fistula

We report on a patient with a significantly enlarged right heart caused by a rare right ventricle to right atrium fistula. Cardiac magnetic resonance revealed diagnosis and delineated detailed anatomy of the defect. The shunt was successfully closed with an implantation of Amplatzer Vascular Plug II. We discuss possible causes of this anomaly and its treatment.

Staged rehabilitation of obstructed right ventricle-topulmonaryartery conduit with implantationof a Cheatham-Platinum stent mounted on two Tyshak-Xballoons followed by a Melody valve

Corresponding author: Sebastian Goreczny MD, PhD, Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute, 281/289 Rzgowska St, 93-338 Lodz, Poland, phone: +48 42 271 21 84, e-mail: sebastiangoreczny@yahoo.pl Received: 28.09.2016, accepted: 30.12.2016. Staged rehabilitation of obstructed right ventricle-topulmonary artery conduit with implantation of a Cheatham-Platinum stent mounted on two Tyshak-X balloons followed by a Melody valve

Transbaffle radiofrequency ablation of reentrant atrial tachycardia in a child with hypoplastic left heart syndrome after Fontan correction.

Patients with functionally single ventricle undergo several operations in order to regulate pulmonary blood flow; however, it limits the access to the chambers of the heart. Incisional tachycardia after surgery is frequently life threatening. Because it rarely responds to medical treatment, radiofrequency (RF) ablation is an optimal option with a relatively high success rate. A 7-year-old boy with hypoplastic left heart syndrome (HLHS) after Fontan procedure was admitted with recurrent atrial tachycardia (AT). Medical treatment failed and the patient required several electrical cardioversions. An echocardiogram and computed tomography (CT) scan confirmed HLHS with aortic atresia, severe mitral hypoplasia, small left ventricle (1.2 × 0.9 cm), systemic right ventricle (4.0 × 4.2 cm) with preserved systolic function, and a large atrial septal defect (Fig. 1A). The decision was made to perform RF ablation; however, the first attempt failed because tachycardia was not inducible. A second ablation was necessary because of ongoing AT with haemodynamic deterioration. The procedure was started with angiography of the tunnel with late phase visualisation of both right and left atria, showing small fenestration (Fig. 1B). A 5 F ablation electrode was unable to cross the fenestration. An angioplastic wire (Whisper ES, Abbott) was inserted through a transseptal catheter (8 F, SL0, St. Jude Medical) to the atrium and two inflations of an angioplastic balloon (3.5 × 15 mm, Sprinter Legend NC, Medtronic) were performed (Fig. 1C). After dilatation, the transseptal catheter was introduced to the atrial compartment. A ten-pole electrode was positioned in the oesophagus for reference. Tachycardia (CL 278 ms) was easily induced with a single stimulus. The bipolar and propagation map of both atria were created with Ensite/Navix. Entrainment was used to find the isthmus zone between the right upper-lateral part of atrioventricular valve and the tunnel (Fig. 1D). An application line with a small curve 4 mm tip 6 F ablation catheter (Celcius, Cordis) was created leading to cessation of AT after 16 s of application. After 30 min AT was no longer inducible. The patient was discharged after 4 days, and during 24 months of follow-up arrhythmia did not recur. The access to the heart after extracardiac Fontan palliation may require transconduit, transthoracic, or transapical puncture, which has been performed in a limited number of patients. Postoperative AT is frequently macro-reentrant with the circuit within the right atrium. The anatomical barriers created by the orifices of vena cave, coronary sinus, atrial septum patch, suture lines of atriopulmonary anastomosis, or lateral tunnel repair may create the multiple isthmi of tachycardia. The location of important anatomical points was facilitated by angiography of the conduit and late-phase visualisation of the atria. Angiography and CT scan integrated with a 3 dimensional electro-anatomical map was crucial to perform the entrainment and finally achieve the successful ablation. With longer life expectancy of patients after congenital heart disease surgery, electrophysiologists will be challenged with complex forms of arrhythmia requiring advanced visualisation and mapping techniques.

[Hybrid treatment of interrupted aortic arch in a newborn with contraindications for extracorporeal circulation: case report including 1.5 year follow-up].

Despite marked improvement in the cardiosurgery, total repair of interrupted aortic arch with coexisting risk factors in neonatal or early infancy is associated with high mortality. We present a patient treated by an alternative hybrid procedure without exposing the critical ill neonate to the risk of cardiopulmonary bypass. At the 1.5 year of life a successful arch reconstruction, repair of associated anomalies and de-banding of pulmonary arteries with a stent cut out was done.