Remarkably Still Repairable Large Aortopulmonary Window in an Adult Patient.

Aortopulmonary window (APW) is an abnormal congenital connection between the main pulmonary artery (MPA) and the ascending aorta, with intact aortic and pulmonary valves, leading to heart failure or, if not repaired early, to pulmonary vascular obstructive disease. We report the rare case of an asymptomatic adult with an unrestrictive APW, whose pulmonary arterial hypertension was remarkably still reversible, permitting successful repair.

Cryoablation of atrioventricular nodal reentrant tachycardia in children and adolescents: improved long-term outcomes with increasing experience.

BACKGROUND: Cryoablation is increasingly used for the treatment of atrioventricular nodal reentrant tachycardia (AVNRT). There are limited data regarding its efficacy and late outcomes in the pediatric population. METHODS: We reviewed the clinical records of 70 consecutive pediatric and adolescent patients (mean age: 12.2 ± 3, range: 5-19 years) with AVNRT, with or without additional structural heart disease, who underwent catheter ablation with the intention to use cryoablation as the primary modality between September 2004 and July 2011. RESULTS: The acute success rate was 97.14%. No long-term complications occurred. Patients were followed up for an average time of 46 ± 22.5 months (range 5-90). The recurrence rate was 16%, decreasing from 28% in the first 25 cases to 8.9% in the last 45 cases (p<0.05). Wenckebach point prolongation during cryoapplications was associated with a lower recurrence rate (p<0.05). No other risk factors for recurrence were identified, including persistence of slow pathway conduction. Patients with congenital heart disease had a similar success rate to patients with a structurally normal heart. CONCLUSIONS: When applied to pediatric patients, cryoablation has an excellent success and safety profile, which can improve with increasing experience. Transient Wenckebach point prolongation during cryo-applications may be associated with improved late outcomes.

Radiofrequency ablation of accessory pathways in children and congenital heart disease patients: impact of a nonfluoroscopic navigation system.

BACKGROUND: We sought to assess the impact of routine use of a nonfluoroscopic navigation system in the procedural aspects of radiofrequency ablation of accessory pathways (APs) in pediatric and congenital heart disease (CHD) patients and the reduction of fluoroscopy in different pathway locations. METHODS: This was a retrospective review of 192 patients, divided in two groups: group A (76 patients, fluoroscopic only ablation) and group B (116 patients, combined use of fluoroscopy and a nonfluoroscopic system (NavX™). Comparison of procedural aspects (procedure time, fluoroscopy time, success, complications, and recurrences) was performed. RESULTS: The two groups were comparable in terms of age, AP location, and presence of CHD. The mean age was 11.34 ± 4.65 years in group A versus 10.91 ± 3.68 years in group B. The procedure duration was significantly shorter in group B than in group A (177.06 ± 62.18 vs 242.45 ± 99.07) (P < 0.001). There was a significant reduction in the fluoroscopy time in group B compared to group A (8.27 ± 8.23 vs 39.77 ± 32.65 minutes) (P < 0.001). The difference between the two groups was statistically significant in all categories of APs. The success rate was 97.4% in group A and 96.6% in group B. There were no complications directly related to the use of the nonfluoroscopic system. There was no difference in the recurrence rate. CONCLUSIONS: The use of a nonfluoroscopic system for catheter navigation resulted in significant reduction of total procedure and fluoroscopy time during catheter ablation of APs in pediatric and CHD patients, regardless of the location of the pathway, without a compromise in safety and efficacy.