Transcatheter device closure of secundum atrial septal defect [ASD] in young children

To analyze the safety and efficacy of device closure of secundum atrial septal defect in children < 5 years of age. Quasi-experimental study. The study was conducted at Armed Forces Institute of Cardiology / National Institute of Heart Diseases Rawalpindi, Pakistan from Dec 2010 - Dec 2012. Forty eight patients < 5 years of age underwent transcatheter closure of secundum ASD during two years. All patients were evaluated with 2-D echocardiography before the procedure. The sizing balloon was used in 6% and general anaesthesia was given in 83% [n=40] of patients. Ninety seven point nine percent [47/48] had successful closure of ASD. The mean age was 4.1 +/- .68 years [range 2.5-5 years] and 58.4% [28/48] were females. The defect size and occluders used were between 5-20 mm [mean 12 +/- 3.5] and 8-22 mm [mean 15 +/- 3.9] respectively, three patients had simultaneous procedures including pulmonary valvuloplasty in two and percutaneous transmitral commissurotomy [PTMC] in one. The major complications remained 2% [1/48] which included device embolization just after release of device while minor complication rate was 12.5%. The median procedure time was 30 min [15-100 min] and median fluoroscopic time was 6 min [1.50-45 min]. There was no emergency surgical exploration or death during this period. Transcatheter device closure of suitable secundum atrial septal defect is effective and safe in young children in skilled and professional hands

Comparative study to evaluate the efficacy of transthoracic echocardiography versus cardiac catheterization for pre operative assessment of tetralogy of fallot

To determine the results of transthoracic echocardiography and cardiac catheterization for pre operative assessment of Tetralogy of Fallot and operative outcomes for the patients. Case Series; prospective descriptive study. Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, Jan 2006 to December 2010. All patients admitted in AFIC/NIHD for surgical repair of Tetralogy of Fallot. A total of 746 patients were included in study, male [33%], female [67%], mean age was 4.7 years. Group I was evaluated for total correction with combined transthoracic two dimensional echocardiography and cardiac catheterization, and group II was subjected to transthoracic two dimensional echocardiography only for pre operative assessment. Overall mortality was 8.4% in group I and 10.8% in group II. In group II, 84% had total correction and 16% had closed heart, while in group II 73% had open heart and 27% had closed heart surgery. Tetralogy of Fallot is the leading cause of cyanotic congenital cardiac heart disease. The pre operative evaluation with help of Transthoracic two dimensional echocardiography requires oral sedation, is cost effective and minimally invasive. Cardiac catheterization being reserved for the patients having inadequate information on Transthoracic echocardiography. Early surgery during childhood has long term benefits in terms of morbidity and lifestyle adjustment

Incidence, management and subsequent outcome of transcatheter embolized devices- three years audit at a tertiary cardiac care center

To audit the incidence of misplaced devices during varied interventional procedures carried out in our catheter lab over a period of three years. Descriptive study Armed Forces Institute of Cardiology and National Institute of Heart Diseases. From January 2011 to December 2103 All adult and pediatric cases with structural heart disease both congenital and acquired undergoing interventional procedures were included in the study. Out of a total of 3256 patients, 1174 patients who underwent cardiac catheter device implantation procedures during the study period were included in the study. Nineteen patients out of 1174 patients [1.6%] had device embolization acutely or sub acutely following the procedure. The varied reasons for the device embolizations were analyzed in this study. We concluded that for retrieval to be successful via the transcathter approach, it was important to have a wide selection of retrieval equipment available and to be conversant with its use. Our audit also concludes that device implantation at our center are safe and an effective procedure with minimal complications

Outcome and immediate complications of device occlusion of different types of patent ductus arteriosus with range of devices

The aim of our study was to report the outcome and immediate complications of PDA device closure, comparing ducts according to Krichenko classification. Quasi experimental study. Pediatric Cardiology Department of Armed Forces Institute of Cardiology / National institute of Heart Diseases [AFIC/NIHD] from 1[st] May 2012 to 30[th] Nov 2013. Total 368 consecutive cases, were included with intention of transcatheter closure of patent ductus arteriosus [PDA]. Detailed echocardiography was done before procedure. Aortogram determined duct size, length, narrowest diameter and morphology. Device attempted only after duct was considered suitable. The mean narrowest duct diameter was 4.5 +/- 2.4 mm. Out of 368 cases, five cases were considered unsuitable for device closure after aortogram. In two cases, device embolized after deployment and in one case procedure abandoned due to technical reasons. There was no cardiac perforation, tamponade or death in our study population. The success according to Krichenko duct types was 100% for type A, 100% for type B, 87.5% for type C, 100% for type D and 100% for type E. PDA device closure is a safe and effective therapeutic option in vast majority of cases. Type C tubular type ducts are more difficult to negotiate with high complication rates

Prospective study of percutaneous balloon pulmonary valvuloplasty - immediate results and complications

To assess the results and immediate complications of percutaneous balloon pulmonary valvuloplasty at AFIC/NIHD. Quasi experimental study Paediatric cardiology department of Armed Forces Institute of Cardiology and National Institute of Heart Diseases [AFIC-NIHD] Pakistan from 01[st] October 2010 to 31[st] September 2013. This study comprised 143 patients [74 male and 69 female] with pulmonary valve stenosis undergoing percutaneous balloon valvuloplasty. The procedure was classified as successful when the angiographic derived peak to peak pressure gradient [PG]across right ventricular outflow tract was reduced to less than 50% of pre-procedural value, suboptimal if reduction was 25-50% and unsuccessful if PG reduced by less than 25% of its initial value. The mean age of study population was 8.4 +/- 10.3 years and procedure was successful in 133 [93%] cases. Mean PG was reduced from 85.6 +/- 34.4 mmHg to 24.7 +/- 14.5 mmHg [p< 0.001]. Procedure was considered unsuccessful in one case, where PG across right ventricular outflow tract [RVOT] reduced from 70 to 60 mmHg, due to concomitant infundibular bands. In another nine patients, procedure considered suboptimal, as mean PG reduced from 81 +/- 24.1 to 50 +/- 16 mmHg. Among study population, 31 [21.7%] cases were considered as critical pulmonary stenosis. There were two deaths, two non fatal cardiac arrests, one life threatening arrhythmias and minor rhythm problems in five cases, but no cardiac tamponade or emergency cardiac surgery in our study population. Percutaneous balloon valvuloplasty was effective and safe for the treatment of pulmonary valve stenosis with excellent short term results

spectrum of anatomical variations in patients with tetralogy of fallot undergoing diagnostic cardiac catheterization

To determine the various anatomic associations in patients undergoing diagnostic cardiac catheterization with Tetralogy of Fallot. Descriptive study. Armed forces Institute of Cardiology and National Institute of Heart Diseases, from Jan 2012 to Dec 2012 All patients with tetralogy of fallot [TOF] who underwent cardiac catheterization were included in the study. A standard catheterization with cine-angiograms was performed and different associations were recorded. A total 200 patients underwent catheterization during 12 months. The mean age of patients was 6.3 years including 66% [n=132] male and 34% [n=68] female patients. The most common associated anomaly in our patients was major aortopulmonary collateral arteries [MAPCAS] 28% [17% significant and 11% insignificant]. The other associated anomalies were right sided arch in 10%patients, additional muscular ventricular septal defects in 4% [8] patients, persistence of left superior vena cava in 5%[10] patients, patent ductus arteriosus in 5% [10] patients, absent left pulmonary artery in 1% [2] patients and left anterior descending coronary artery crossing right ventricular outflow tract [RVOT] in 1%patients. There was no cardiac perforation, tamponade, cardiac arrest or death during this period. Major aortopulmonary collateral arteries remained the most common finding which necessitated early diagnosis and management in order to prevent long term complications

Transcatheter device closure of patent ductus arteriosus

To determine the efficacy, safety and immediate complications encountered during percutaneous device closure of patent ductus arteriosus [PDA]. Case series. Department of Paediatric Cardiology, AFIC/NIHD, Rawalpindi, from January 2005 to December 2010. Consecutive 500 patients who underwent attempted transcatheter PDA device closure were included in the study. Device type position, success of closure and complications were described as frequency percentage. In 491 cases [98.2%], PDA was successfully occluded including 4 cases [0.8%] where devices were dislodged but retrieved and redeployed in Cath laboratory. PDA occluder devices used in 448 cases [91%] while coils [single or multiple] were used in 42 cases [8.5%] and in one case [0.2%] ASD occluder device was used to occlude the PDA. There were 09 [1.8%] unsuccessful cases, 06 [1.2%] were abandoned as ducts were considered unsuitable for device closure, 02 [0.4%] devices dislodged and needed surgical retrieval and one case [0.2%] was abandoned due to faulty equipment. The narrowest PDA diameter ranged from 0.5 - 14 mm with mean of 4.5 +/- 2.4 mm. There was a single [0.2%] mortality. Transcatheter occlusion of PDA by coil or occluder device is an effective therapeutic option with high success rate. Complication rate is low in the hands of skilled operators yet paediatric cardiac surgical back-up cover is mandatory

Percutaneous transcatheter PDA device closure in infancy

To evaluate the results and complications associated with transcatheter closure of patent ductus arteriosus [PDA] in infants. Quasi-experimental study. Paediatric Cardiology Department of Armed Forces Institute of Cardiology / National Institute of Heart Diseases [AFIC/NIHD], Rawalpindi, from December 2010 to June 2012. Infants undergoing transcatheter device closure of PDA were included. All patients were evaluated by experienced Paediatric Cardiologists with 2-D echocardiography and Doppler before the procedure. Success of closure and complications were recorded. The age of patients varied from 05 - 12 months and 31 [56.4%] were females. Out of the 55 infants, 3 [5.4%] were not offered device closure after aortogram [two large tubular type ducts and one tiny duct, considered unsuitable for device closure]; while in 50 [96.1%] patients out of remaining 52, the duct was successfully closed with transcatheter PDA device or coil. In one infant, device deployment resulted in acquired coarctation, necessitating device retrieval by Snare followed by surgical duct interruption and another patient had non-fatal cardiac arrest during device deployment leading to abandonment of procedure and subsequent successful surgical interruption. Local vascular complications occurred in 12 [21.8%] of cases and all were satisfactorily treated. Transcatheter device closure of PDA in infants was an effective procedure in the majority of cases; however, there were considerable number of local access site vascular complications

Transcatheter closure of large sized patent ducts arteriosus using the amplatzer duct occluder device

To assess the results of anterograde transcatheter closure of a large sized patent ductus arteriosus using the Amplatzer Duct Occluder [ADO] device. A case series. Department of Cardiology, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from January 2005 to December 2007. All patients who underwent transcatheter closure of large sized PDA [4.0 mm], using the Amplatzer Duct Occluder [ADO] device, from January 2005 to December 2007, were included by convenient sampling technique. After the procedure, repeat aortogram was performed to confirm the appropriate position of the ADO and to evaluate for residual shunts. A total of 100 patients had PDA diameter of 4.00 mm. Mean age was 11.73 +/- 10.31 years and there were 37 males and 63 females. Mean PDA diameter was 6.011 +/- 2.078 mm. Forty-nine patients had type 'A', 19 had type 'B', 19 patients had type 'C', 5 had type 'D' and 8 patients had type 'E' PDA. Complete closure was achieved in 70 patients, 26 had trace shunt and 4 patients had small residual shunt immediately after the procedure. However, no patient had residual shunt 24 hours after the procedure. ADO is a highly efficient prosthesis that can be safely applied in most patients with PDA particularly in patients with large sized PDA

Profile of congenital heart disease and correlation to risk adjustment for surgery; an echocardiographic study

To determine the pattern and profile of Congenital Heart Diseases [CHD] in paediatric patients [age 1 day to 18 years] presenting to a paediatric tertiary referral centre and its correlation to risk adjustment for surgery for congenital heart disease. Descriptive case series. Paediatric Cardiology Department, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi [AFIC/NIHD]. Over a period of 6 months, 1149 cases underwent 2-D echocardiography. It was a non-probability purposive sampling. This study showed 25% of all referrals had normal hearts. A male preponderance [38%] was observed from 1 year to 5 years age group. Nineteen percent of the cases were categorized as cyanotic CHD with the remaining as acyanotic variety. Tetralogy of Fallot [TOF] represented 10%, Ventricular Septal Defects [VSD] 24%, followed by Patent Ductus Arteriosus [PDA] and Atrial Septal Defect [ASD], which comprised 6.6% and 6.5% respectively. VSD was the most common association in patients with more complex CHD [10%] followed by PDA in 3% and ASD in 1.2% of the cases. Most of the cases were category 2 in the RACHS-1 scoring system. VSD and TOF formed the major groups of cases profiled. Most of the cases recommended for surgery for congenital heart disease belonged to the risk category 2 [28.1%] followed by the risk category 1 [12.7%] of the RACHS-1 scoring system

Transcatheter treatment of lutembacher's syndrome

Lutembacher`s syndrome is a rare combination of atrial septal defect [ASD] and rheumatic mitral stenosis. Traditionally, this condition is treated surgically. We present a case of Lutembacher`s syndrome that was successfully treated with percutaneous transcatheter mitral commissurotomy [PTMC] using the Inoue balloon. Closure of ASD was successfully achieved with an Amplatzer atrial septal occluder under transthoracic echocardiogram [TTE] guidance without general anesthesia