Tevfik Karagöz

Transcatheter closure of patent ductus arteriosus with Nit-Occlud coils

The detachable coils have been successfully used for transcatheter occlusion of small‐ to moderate‐sized patent ductus arteriosus (PDA). We report our experience regarding the use of the Nit‐Occlud coils (NOCs) for transcatheter PDA and major aortopulmonary collateral (MAPCA) occlusion. Single NOCs were used to close PDA in 26 patients, and one small and two large MAPCAs in two patients. Mean age and weight of the patients were 7.7 ± 5.4 years and 20.6 ± 11.6 kg. Mean minimum duct diameter was 2.8 ± 0.8 mm; ampulla, 8.7 ± 2.4 mm; and PDA length, 9.3 ± 4.4 mm. Mean pulmonary artery pressure ranged from 9 to 51 mm Hg and pulmonary/systemic flow ratio from 1.1 to 5.8. Ductal shape was conical in 24 patients. Route of approach was venous in 23 and arterial in 3. Successful coil implantation was achieved in 24/26 (92.3%). Mean procedure and fluoroscopy time were 67.2 ± 22.1 and 14.9 ± 6.5 min. The three MAPCAs were also successfully occluded using NOC Medium and Flex. Postimplantation angiograms revealed no leak in 3, a trace or small leak in 17, and a medium leak in 4 patients. Mean follow‐up was 7 ± 5 months. Complete occlusion was achieved in 17/24 (71%) at 24 hr, 19/24 (79%) by 1 month, 13/15 (87%) by 3 months, 14/15 (93%) by 6 months, and 10/11 (90%) by 12 months postprocedure. Hemolysis, late embolization, duct recanalization, and flow disturbances were not observed. Transcatheter occlusion of moderate‐sized PDAs and MAPCAs using NOCs seems to offer a safe, simple, and controlled method in pediatric patients. Catheter Cardiovasc Interv 2005

Clinical experiences of patients with catecholaminergic polymorphic ventricular tachycardia.

Catecholaminergic polymorphic ventricular tachycardia is a rare entity that can occur in children without cardiac disease and with a normal QT interval. It may cause syncope, convulsions, and sudden death during physical activity or emotional distress. We report the clinical features, treatment, and follow-up of 16 children with this diagnosis, emphasizing the potentially fatal nature of the disease.The mean age of patients at the onset of symptoms and at the time of diagnosis was 7.8 plus or minus 2.5 years, and 10.6 plus or minus 3.5 years, respectively. Syncope was the main complaint in 11, and 7 were treated as erroneously as having epilepsy. Diagnosis was confirmed by exercise and/or infusion of isoproterenol. Once the diagnosis was made, we started propranolol in all patients, and added verapamil if ventricular tachycardia was still inducible on a treadmill exercise test. An intracardiac defibrillator was implanted in 4 patients. Of the 16 patients, 4 died suddenly, giving a rate of mortality of 25%. In 2 of those dying suddenly, there was evidence of poor compliance to the recommended treatment. Another 2 patients had been resuscitated because of sudden cardiac arrest.Catecholaminergic polymorphic ventricular tachycardia must be considered in the differential diagnosis of syncope in children without heart disease but with a normal QT interval. Medical treatment with propranolol and verapamil may decrease the incidence of arrhythmia. Implantation of intracardiac defibrillators should be considered in those resistant to drug therapy. Delay in diagnosis, and inadequate treatment, can result in sudden cardiac death.

Rhythm abnormalities in children with isolated ventricular noncompaction.

Background: Isolated ventricular noncompaction (IVNC) is a serious cardiomyopathy with a generally poor prognosis. It is characterized by the presence of prominent ventricular myocardial trabeculations and deep intertrabecular recesses, in the absence of other structural heart defects. This cardiomyopathy is usually associated with ventricular dysfunction, thromboembolic events, and rhythm problems.

Patient- and lead-related factors affecting lead fracture in children with transvenous permanent pacemaker

AIMS Fracture in transvenous pacing leads is one of the most common reasons for lead abandonment. Although the factors affecting lead failure rates have been investigated, there is no study evaluating the clinical parameters that affect lead fracture in children. We report our experience with lead fracture in children with transvenous pacemakers. METHODS AND RESULTS The follow-up results of 264 leads from 184 patients were evaluated using pacemaker follow-up data. Underlying conditions, implant data, and lead features were evaluated for the analysis of lead fracture. During a mean follow-up of 72.8 +/- 39.7 months (range 3.2-160.6, median 70), lead fracture developed in 19 leads (7.2%) from 18 patients. The mean duration between implantation and lead fracture was 57.3 +/- 35 months (range 6.8-130, median 51). All fractures occurred in the leads implanted by the infraclavicular subclavian approach. Cumulative survival at the end of 5 years was 92.7% in terms of lead fracture. None of the patient-related risk factors correlated with lead fracture. Multivariate analyses of lead-related risk factors revealed a significant correlation only between lead fracture and fixation mechanism (P < 0.05). CONCLUSION Our results indicated that none of the patient-related risk factors was correlated with lead fracture. Among lead-related risk factors, only the fixation mechanism was found to be correlated with lead fracture; thus, it seems that passive fixation mechanism is safer in terms of lead fracture. Although all fractures occurred in the leads implanted by the intrathoracic subclavian approach, statistical analysis revealed no significance for this parameter. The effect of the extrathoracic approach should be investigated in a large group of patients.

Interrupted aortic arch in a neonate: multidetector CT diagnosis

We report the usefulness of multidetector CT angiography (CTA) in the diagnosis of interrupted aorta of a neonate. CTA is useful for evaluating malformations of the aortic arch, particularly in cases that cannot undergo conventional angiography or in which detailed information cannot be provided by echocardiography.

Balloon dilation of pulmonary valve stenosis in infants less than 3 kg: A 20‐year experience

Objectives: This study focused on the anatomical features and outcomes of percutaneous pulmonary valve balloon dilation (PVD) in newborns ≤3 kg in weight. Background: Although PVD is the treatment of choice for isolated pulmonary valve stenosis, there are no studies detailing technical, anatomical, and outcome variables in the smallest of infants undergoing the procedure. Methods: A retrospective, consecutive review of all initial and follow‐up echocardiograms, catheterization data, cineangiograms, and surgical records of all neonates less than 3 kg. Results: Fifty infants underwent 55 PVDs, median age 7 days and weight 2.7 kg. Congestive heart failure and/or cyanosis were present in 55%, 46% prostaglandin dependent, with 28% having a hypoplastic right ventricle. The pulmonary valve diameter median z‐score was −2.6, (range −5.8 to 1.2, P < 0.0001 vs. normal). The procedure was accomplished in all but one child, using a balloon to annulus ratio of 1.3 (range 1.1 to 1.7). There was a reduction in both the peak right ventricular systolic pressure (P < 0.0001) and outflow gradient (P < 0.0001). There was no procedure related mortality, although six children died in long‐term follow‐up (14%). Reintervention was necessary in 15 infants within 8 months of the procedure. Pulmonary regurgitation, present in 36% after the procedure, showed a gradual increase over time while outflow gradients decreased and valve annular dimensions increased toward normal. Conclusions: In infants ≤3 kg, PVD is safe and effective. A large proportion remains free from surgery (76% at 10 years). Small valve annular dimensions show catch up growth with time.

Prenatal diagnosis of isolated non-compaction of the ventricular myocardium: Study of six cases

Background: Isolated non‐compaction of the ventricular myocardium (INVM) is characterized by prominent and excessive trabeculations in one or more ventricular wall segments, with deep intertrabecular recesses communicating directly with the ventricular cavities. Diagnosis of the disease is based on the 2‐D echocardiographic features. Despite the fact that many cases of INVM have been reported in children and adults since the initial description of the disease, it has been diagnosed in only a few fetuses up to now. Therefore, failure to diagnose on fetal echocardiography is probably more common. There are different opinions about diagnosis of INVM on fetal echocardiography.

Compatibility of Automatic Threshold Tracking Pacemakers with Previously Implanted Pacing Leads in Children

KUCUKOSMANOGLU, O., et al.: Compatibility of Automatic Threshold Tracking Pacemakers with Previously Implanted Pacing Leads in Children. The Autocapture function controls and optimizes the amplitude of the pacing pulse and saves energy. The manufacturer recommends using a special low polarization, low threshold bipolar Pacesetter lead for the Autocapture function. The purpose of this study was to evaluate the compatibility of Autocapture with previously implanted pacing leads. The study included 15 patients (mean age 13.6 ± 3.4 years) who needed pulse generator replacement and received the VVIR pacemaker Regency SR+ or the DDDR pacemakers Affinity DR or Integrity DR with the Autocapture function. The new pulse generators connected to previously implanted ventricular leads. At the time of implantation the pacing threshold was 1.0 ± 0.35 V at 0.5 ms, the lead impedance was 580 ± 80 Ω, and the spontaneous R wave amplitude was 7.89 ± 4.89 mV. The polarization signal (PS) was 3.8 ± 3.04 mV, and evoked response (ER) was 8.15 ± 4.57 mV at the predischarge testing. Follow‐up telemetry was done at months 1, 3, 6, 12, and 18. The follow‐up duration was 9.4 ± 5 months (range 1–18 months). If the results of PS and ER measurements were acceptable for Autocapture, it turned on at the 1‐month visit. In six (40%) patients the results were found acceptable for Autocapture function. Age, lead impedance, pacing threshold, intrinsic R wave measurement, lead age, fixation mechanism, and ER measurements were not statistically different in Autocapture suitable and not suitable groups. The main reason not to activate Autocapture had been increased PS. Any significant fluctuations were not observed in pacing threshold, lead impedance, ER, and PS during follow‐up. In conclusion, previously implanted pacing leads may be compatible with the Autocapture function.

Permanent transfemoral pacemaker implantation in a child with Maroteaux Lamy syndrome.

DILBER, E., et al.: Permanent Transfemoral Pacemaker Implantation in a Child with Maroteaux Lamy Syndrome. Permanent transfemoral pacing has been described as an alternative route in patients in whom the superior venous approach is not feasible. This report describes the use of the femoral venous approach to insert a permanent pacemaker in a child with Maroteaux Lamy syndrome who has complete atrioventricular block and abnormal subclavian venous anatomy. Transfemoral pacing may be a suitable alternative in children with short stature.

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.