Immediate, short, intermediate and long-term results of balloon valvuloplasty in congenital pulmonary valve stenosis

Transluminal balloon valvuloplasty is an alternative to surgical valvotomy for congenital pulmonary valve stenosis. The aim of this study was to evaluate the long term results [to 13.5 years] of balloon pulmonary valvuloplasty. From June 1998 to January 2012, percutaneous balloon pulmonary valvuloplasty for congenital pulmonary valve stenosis was performed in 98 patients [50 males, 48 females, with a median age of 6.75 years] underwent balloon valvuloplasty of pulmonary valve stenosis. Follow-up was performed based on the Doppler echocardiographic data and clinical findings. Forty three of ninety eight patients were 10 years of age or older. The mean peak to peak pressure gradient across pulmonary valve before and immediately after balloon pulmonary valvuloplasty [BPV] was 88.7 +/- 36.4 mmHg and 21.8 +/- 15.9 mmHg [P<0.001] respectively. Doppler pressure gradient across pulmonary valve before BPV, at 3 month [short term], at 1 year [intermediate term] and long term follow-up were 93.2 +/- 41.3 mmHg, 18.7 +/- 15.8 mmHg [P<0.001], 15.8 +/- 13.1 mmHg [P0.001] and 13.6 +/- 7.4 mmHg [P<0.017] respectively. Mild pulmonary regurgitation [PR] was observed in 55 [57%] patients immediately after BPV and 30 [31%] patients at late follow up. Rupture of the right ventricular outflow tract was the major complication in two patients with fatal event. Short, intermediate and long-term results of BPV for typical valvular pulmonary stenosis are excellent. Therefore, it can be considered as treatment of choice for patients with typical valvular pulmonary stenosis

Long-term follow-up of patent ductus arteriosus closure with the Amplatzer Duct Occluder in children

Transcatheter closure of patent ductus arteriosus [PDA] has become an alternative treatment to surgery. We evaluated the long-term results of the transcatheter closure of PDA with the Amplatzer Duct Occluder [ADO] in children. Between May 2004 and October 2012, 138 children with PDA [43 males and 95 females] underwent transcatheter PDA closure. Clinical, electrocardiographic, echocardiographic, and hemodynamic data were assessed pre and postprocedurally and at follow-up. The mean age of the patients at procedure was 3.53 +/- 2.43 years [range = 1.1 to 9.5 years], mean weight was 11.9 +/- 4.6 kg [range = 6 to 29 kg], median pulmonary end diameter of the PDA was 5 mm [range = 4 to 15 mm], and median diameter of the ADO was 8 mm [range = 6 to 16 mm]. The mean follow-up time was 43.4 +/- 23.5 months [range = 13.5 to 98 months]. The devices were successfully deployed in 136 [98.5%] patients. Device embolization occurred in 2 patients, immediately in one patient and during the first postprocedural night in the other patient. The first patient had percutaneous device retrieval, followed by implantation of a larger device. The second patient had surgical device removal and PDA ligation. Immediately after device implantation, trivial to mild residual shunts were detected in 112 [80%] patients; all the shunts, however, disappeared 24 hours after the procedure. One patient had left pulmonary artery stenosis with a gradient of 25 mm Hg at 24 hours', 40 mmHg at one month's, and 64 mmHg at 6 months' follow-up. There were no cases of late embolization, aortic obstruction, late hemolysis, infective endocarditis, or death. Transcatheter PDA closure with the ADO was safe and effective, with a high success rate at long-term follow-up

Long-term results of transcatheter closure of patent ductus arteriosus in infants using amplatzer duct occluder

Patent ductus arteriosus [PDA] is one of the most frequently seen congenital heart diseases. Its closure is recommended because of the risk of infective endocardis, as well as morbidity and mortality in the long. The aim of this study was to assess the long term results of the transcatheter closure of PDA in infants using amplatzer duct occlude [ADO]. From May 2004 to September 2011, forty eight infants underwent transcatheter closure of PDA. A lateral or right anterior oblique view aortogram was done to locate PDA and to measure its size. Before discharge, repeat aortogram was performed to evaluate eventual residual shunt and to confirm the appropriate deployment of the ADO. Follow up evaluations were done with transthoracic echocardiography at discharge, 1 month, 6 months, 12 months and yearly thereafter. Findings: The mean age of patients at procedure was 9.18 +/- 2.32 [range 3 to 12] months, mean weight 6.73 +/- 1.16 [range 4.5 to 10.1] kg. The PDA occluded completely in 20 out of the 48 patients. Twenty four patients had trivial or mild shunt and two patients had moderate residual shunt which disappeared in one patient within 24 hours and other patient with moderate shunt in 1 month. One patient [age 8 months] had mild LPA stenosis. The device emobolization occurred in two patients, immediately after the procedure in one and during night in the other patient The long term results suggested that transcatheter closure of PDA using Amplatzer duct occluder is a safe and effective treatment in infants less than 1 year of age with minimal complications

Combined transcatheter closure of atrial septal defect and pulmonary valve balloon dilation

Critical pulmonary valve stenosis [CPVS] and atrial septal defect [ASD] is an uncommon form of congenital heart disease. Concurrent transcatheter pulmonary valvuplasty and closure of secundum atrial septal defect appears to be an interesting alternative to surgical correction. We present the simultaneous balloon valvuloplasty of critical pulmonary stenosis [PS] with supra systemic right ventricular pressure and medium sized secundum ASD with right to left shunt

Simultaneous transcatheter closure of ventricular septal defect and pulmonary valvuloplasty

Transcatheter balloon valvuloplasty has been the accepted first line treatment for congenital pulmonic stenosis [PS] in children. Transcatheter closure of perimembranous ventricular septal defect [VSD] with Amplatzer VSD occluder is an alternative to surgical repair. A 12 year old boy presented with history of exertional dyspnea and atypical chest pain. Physical findings were suggestive of severe pulmonic stenosis. Transthoracic echocardiography, right and left ventricular angiography showed medium to large sized perimembranous VSD and severe valvar pulmonary stenosis. Transcatheter closure of VSD was done first so as to avoid large left to right shunt across VSD after balloon pulmonary valvuplasty. We demonstrated the feasibility and success in treating combined ventricular septal defect and severe pulmonary valve stenosis with transcatheter interventional procedure in the same session

Transcatheter closure of atrial septal defect with amplatzer device in children and adolescents: short and midterm results; an Iranian experience

Transcatheter closure of secundum atrial septal defect [ASD] with Amplatzer device is an alternative procedure to surgical repair, with some limitations. The aim of this study was to assess the initial and mid-term results of the treatment of ASD with Amplatzer septal occluder in children and adolescents. From May 2003 to January 2008 sixty three consecutive children and adolescent patients underwent transcatheter closure of ASD at a mean +/- SD age of 8.5 +/- 4.8 years [range 2.2 to 18 years]. All procedures were performed under local anesthesia and moderate sedation or general anesthesia with transthoracic echocardiography and fluoroscopic guidance. Stretch diameter of ASD was determined by balloon sizing catheter. Device selection was based on and matched to the standard diameter of the septal defect. Follow up at 24 hours, 1 month, 6 months, 12 months and yearly thereafter included physical examination, electrocardiography and transthoracic echocardiography. The mean ASD diameter, measured with transthoracic echocardiography and balloon catheter were 19.5 +/- 5.5 mm and 20.9 +/- 6.2 mm, respectively. The mean follow up period was 32.4 +/- 18.8 months. Deployment of the device was successful in 57 [90.5%] and failed in 6 [9.5%] patients. The major complication included dislodgement of device in 1 patient and device embolization to right ventricular inlet [surgically removed] in 1 patient. The minor complication included transient atrial tachycardia in 10 patients, paroxysmal supraventricular tachycardia in 2 patients during procedure, successfully terminated with medication. At 24 hour, 1 month, 6 month and 1 year follow up, total occlusion rates were 73.6%, 91%, 94.7%, and 94.7%, respectively. Transcatheter occlusion of ASD with Amplatzer device is an effective and safe procedure with minimal complication rate and short hospital stay, as well as excellent short and intermediate outcome in children and adolescents

Transcatheter closure of atrial septal defect with amplatzer septal occluder in adults: immediate, short, and intermediate-term results

The transcatheter closure of the atrial septal defect [ASD] has become an alternative technique to surgical procedures. The aim of this study was to assess the immediate, short, and intermediate-term results of the transcatheter closure of the secundum ASD with the Amplatzer Septal Occluder [ASO] in adult Iranian patients. Between December 2004 and July 2008, the transcatheter closure of the ASD using the ASO was attempted in 58 consecutive, adult patients. The mean age of the patients was 37.1 +/- 12.7 years [range = 19 - 75 years]. All the procedures were performed under local anesthesia with transthoracic or transesophageal echocardiography and fluoroscopic guidance. The stretched diameter of the ASD was determined with a balloon sizing catheter, and device selection was based on and matched to the stretched diameter of the septal defect. Transthoracic echocardiography was performed immediately after the release of the device and before discharge. Further follow-up at one month, six months, and yearly thereafter included physical examination, electrocardiography, and transthoracic echocardiography. The mean ASD diameter, as measured by esophageal echocardiography, was 24.8 +/- 5.4 mm [range = 13 - 34 mm]. The mean stretched diameter, as measured by the balloon catheter, was 27.1 +/- 6.4 mm [range = 12.5 - 39 mm]. Deployment of the ASO was successful in 52 [89.6%] patients and failed in 6 [10.4%]. Four patients experienced severe complications, 1 had tamponade requiring drainage, 2 had device embolization to the left atrium and right ventricular outflow tract, and 1 had late wire fracture [surgical removal and repair of the ASD]. The position of two large devices [34 mm and 36 mm] was considered unsuitable and unstable after implantation and resulted in the removal of these devices. Minor complications included transient complete atrioventricular block in 1 patient, paroxysmal supra tachycardia in 3 patients, atrial flutter in 1 patient, and angina pectoris with transient ST elevation in 2 patients. The mean follow-up period was 32.5 +/- 18.5 months. Echocardiography at 24 hours, 1 month, 6 months, and 12 months after the procedure showed residual shunts in 11 [21%], 3 [5.8%], 2 [3.8%], and 2 [3.8%] patients, respectively. At follow-up [12.8 months to 48.5 months, mean +/- SD = 32.5 +/- 18.5 months], complete closure was documented in 50 [96.2%] of the 52 cases. At the end of the follow-up, 2 [3.8%] patients had residual shunts: The shunt was moderate in 1 [1.9%] patient and small in the other [1.9%]. The overall success rate of the transcatheter closure of the ASD was 86% [50 of 58 cases]. The transcatheter closure of the secundum ASD in our adult patient population using the ASO was associated with high degrees of success, minimal procedural complication rates, and excellent short and midterm results. The use of this device, however, requires thorough attention in that the procedure may be ineffective or the device may embolize. Further experience and long-term follow-up are required before a widespread clinical use can be recommended

Super giant coronary aneurysm in Kawasaki disease

Giant coronary artery aneurysms caused by Kawasaki disease are rare; however, they are one of the most serious complications and can be lethal. We report a 3.5-month-old boy referred to us because of high fever for fifteen days, generalized maculopapular rash, irritability and cough. Transthoracic echocardiography showed dilatation of right coronary [RCA] and left main coronary [LCA] arteries. Serial echocardiography revealed rapidly progressive dilatation of coronary artery aneurysms of RCA and LCA. We performed invasive cardiac catheterization with selective coronary angiography when the boy was 16 months old. Selective right and left coronary arteriography showed a super giant fusiform aneurysm of RCA and a diffuse giant aneurysm of the proximal LCA. Regression of coronary artery aneurysms was not observed during 6 years of follow up. Pediatricians should be alert for possibility of incomplete Kawasaki disease in young infants with atypical presentation. They are at higher risk of coronary aneurysm formation. The diagnosis often was late with higher complication rate of coronary aneurysm. Echocardiography is an important tool for diagnosis of incomplete Kawasaki disease. Selective coronary angiography is the gold standard for diagnosis, and estimation of shape and size of aneurysms

Transcatheter closure of patent ductus arteriosus using the amplatzer ductal occluder: early results and midterm follow-up

The transcatheter closure of patent ductus arteriosus has advanced rapidly with improvements in device designs. The aim of this study was to analyze the safety, efficacy, and early and intermediate follow-up results of the percutaneous closure of persistent ductus arteriosus [PDA] with the Amplatzer ductal occluder [ADO] in children. Between May 2004 and March 2007, fifty patients between 7 months and 20 years of age underwent the transcatheter closure of PDA, using the ADO. The mean PDA diameter at its narrowest segment [pulmonary end] was 7.35 +/- 2.57 mm [range: 4 to 16mm]. Follow-up evaluations were performed via echocardiography at 24 hours, and 1, 3, 6, and 12 months and then yearly after implantation. Successful immediate occlusion of PDA was achieved in 42 [84%] of the 50 cases. In 5 cases, there were trivial intraprosthetic residual shunts. In addition, there was a small residual shunt in one case, left pulmonary artery narrowing in one case, and embolization of the device immediately after the procedure in one case. At 24 hours, color Doppler flow mapping revealed complete closure in all except one case with a small shunt. At 3 months' follow-up, occlusion was complete in all the patients. At a median follow-up of 17 months [range: 3 months to 32 months], all the patients had complete closure. We conclude that although the transcatheter closure of PDA using the ADO is a highly effective and safe treatment for most patients, several complications including embolization and left pulmonary artery narrowing may occur in certain cases

Post BCG lymphadenitis in vaccinated infants in Yazd, Iran

Bacille Calmette-Gu?erin [BCG] vacination is performed as a part of expanded program of immunization [EPI].Lymphadenitis is the most common complication of BCG vaccination. The aim of this study was to determine the incidence and natural course of BCG lymphadenitis vaccinated in Yazd, Iran. In this analytical prospective follow up study a total of 480 [240 females and 240 males] consecutive newborns received 0.05 ml of BCG vaccine intradermally on right arm within the first week of life during April to July 2003. These babies were followed up when 1.5, 3, 4.5, 6 and 9 months old. A total of 26 [5.8%] cases of lymphadenitis were detected. Lymphadenitis occurred as ipsilateral axillary nodes in 24 [92.3%] cases, supraclavicular in one [3.8%] case, and supraclavicular in association with axillary nodes in one case [3.8%]. Infants developed lymphadenitis during 4 wks of life in one [3.84%] case, between first and fourth month of life in 14 [53.8%] cases, and between fourth and sixth month of life in 11 [42.3%] cases. All 26 cases of lymphadenitis were followed up for 9 months. Twenty two [84.6%] cases were simple or non-suppurative and 4 [15.4%] cases suppurative lymphadenitis. Eleven [42.3%] cases of non-suppurative lymphadennitis showed spontanous resolution and eleven [42.3%] cases had partial regression without progression or drainage. Four [15.4%] cases developed suppuration with one [3.8%] case of fistulation and drainage. The greater incidence of lymphadenopathy in our cases can probably be attributed to a more immunogenic vaccine [Pasteur institute, Tehran], young vaccinees [newborn infants], injection in the right arm or improper dilution. Non-suppurative BCG lymphadenitis is a benign condition and regresses spontanously without any treatment