Ziyad M. Hijazi

Transcatheter closure of large patent ductus arteriosus (> or = 4 mm) with multiple Gianturco coils: immediate and mid-term results.

OBJECTIVE: To assess the immediate and mid-term results of transcatheter closure of patent ductus arteriosus (PDA) > or = 4 mm with multiple Gianturco coils. (Transcatheter closure of large PDAs using the Rashkind occluder or the buttoned device is associated with a 7-38% incidence of residual shunt.) METHODS: 19 patients (7 male, 12 female) underwent an attempt at anterograde transcatheter closure with multiple Gianturco coils of a large PDA at a median age of 3.8 yr (range 2 weeks-34 yr) and median weight of 14 kg (range 2.3-80 kg). RESULTS: The median PDA diameter at the narrowest segment was 4.3 mm (range 4-7 mm) and the mean (SD) Qp/Qs was 1.9 (0.8). Each patient had left atrial and left ventricular volume overload. A 4F catheter was used to deliver the coils in all patients. There was immediate and complete closure in 16/18; one patient had residual shunt that was closed at a second procedure and the other had spontaneous disappearance of the residual shunt at the six week visit. A short ductus (angiographic type B) in one patient could not be closed. The median number of coils placed at the first attempt to close the ductus was 4 (range 2-6 coils) and the median fluoroscopy time was 40 minutes (range 13-152 minutes). Mild left pulmonary artery stenosis occurred in the two smallest patients. Coil migration to the lung occurred in 3 patients with retrieval of coils in two patients. All procedures but one were done on an outpatient basis. At a median follow up of 1.6 yr (range 2 weeks-2.2 yr) all patients had complete closure with no new complications. CONCLUSIONS: Anterograde transcatheter closure with multiple Gianturco coils is an effective treatment for most patients with large PDA of diameters up to 7 mm. This technique can be performed in small infants on an outpatient basis without the need for general endotracheal anaesthesia.

Balloon atrial septostomy using a new low‐profile balloon catheter: Initial clinical results

Balloon atrial septostomy remains an important interventional procedure in the pediatric age group. The incidence of potential complications using the conventional balloon ranges from 0-11%. The purpose of this study was to evaluate a new low-profile end-hole septostomy balloon catheter with dual lumen, inserted via a 5F or 6F sheath. Seventeen neonates and infants with various forms of congenital heart disease requiring palliation underwent septostomy using the new catheter at a median age of 19 days (with a range of 1-593 days), and a median weight of 3.4 kg (a range of 2.5-8.4 kg). The aortic saturation increased from 72 +/- 20% to 87 +/- 7%, p < .001; and the gradient across the atrial septum decreased (a-wave gradient from 11.2 +/- 10.3 to 2.1 +/- 3.6 mm Hg; v-wave from 10.4 +/- 7.7 to 1.2 +/- 1.2 mm Hg; and mean gradient from 8.5 +/- 6.9 to 0.9 +/- 1.3 mm Hg, p < .002). The diameter of the defect increased from 2.7 +/- 1.7 mm to 8 +/- 2.3 mm, p < .001. There were no complications. We conclude that this new low-profile septostomy catheter is safe and effective in creating a large defect size between the atria. Because of the smaller inflation size of the balloon and smaller introducer sheath compared with the conventional catheter, this new septostomy catheter should be especially useful in small neonates.

Reduced incidence of ventricular ectopy with a 4F Halo catheter during pediatric cardiac catheterization.

Catheter-induced ventricular ectopy can limit assessment of contractility or anatomy. We compared the incidence of ventricular ectopy in infants and children undergoing left ventriculography using a 4F Halo catheter or a 4F pigtail catheter. For each group, 17 patients had 19 ventriculograms. Iopamidol 76% was used for each study. There was no statistical difference between the Halo and pigtail groups (mean+/-SEM) for age (16.2+/-3.8 vs. 12.9+/-1.8 mo), weight(8.1+/-1.0 vs. 8.0+/-0.7 kg), gender, left ventricular end diastolic pressure (9.6+/-1.1 vs. 9.8+/-1.3 mm Hg), catheter location in the ventricle, or volume of contrast (1.31+/-0.06 vs. 1.35+/-0.06 cc/kg). The Halo group had a more rapid injection rate (1.42+/-0.15 vs. 0.99+/-0.10 cc/kg/sec, P< 0.02). The Halo group had a lower overall incidence of ventricular ectopy (3 vs. 13 studies, P < 0.001), ventricular ectopy >1 beat (1 vs. 10 studies, P < 0.002), and ventricular couplets or tachycardia (1 vs. 9 studies, P < 0.008). The 4F Halo catheter is associated with less ventricular ectopy than a 4F pigtail catheter and should be considered for use during pediatric catheterization.

Effect of pulmonary artery stenoses on the cardiopulmonary response to exercise following repair of tetralogy of fallot

Data from exercise tests, echocardiograms, and lung perfusion scans were analyzed to determine whether the excessive minute ventilation (VE) often encountered among patients with tetralogy of Fallot is due to ventilation-perfusion mismatch secondary to branch pulmonary artery stenoses. Patients with branch PA stenoses had lower peak oxygen consumptions and higher VE during exercise than did patients without stenoses, and a strong correlation existed between the degree of pulmonary blood flow maldistribution on lung perfusion scan and the amount of excessive VE during exercise.