Balloon-expandable stents for native coarctation of the aorta in children and adolescents.

Although balloon-expandable stent implantation for native aortic coarctation is a preferred method in the adolescent age group, there are insufficient data about indications for and the efficacy of the procedure in a younger age group. The aim of this study was to compare and evaluate the data of young pediatric and adolescent patients who underwent balloon-expandable stent implantation because of native aortic coarctation. The retrospective analysis included the demographic characteristics and data related to the procedure and follow-up of patients who underwent stent implantation for native aortic coarctation between August 2010 and November 2017. Patients with re-coarctation were excluded from the study. The patients were separated into 2 groups as the adolescent group (Group I: 10-18 years) and the pediatric group (Group II: ≤ 9.9 years). Group-I comprised of 18 patients and Group-II, 32 patients. Covered stent was implanted to 32 (73%) patients and uncovered stent to 12 (27%) patients. The procedural success rate was 100%. Following stent implantation, peak systolic gradient decreased significantly in both groups (P < .0001) (Group-I: from 35.9 ±â€…16.6 mm Hg-2.2 ±â€…3.4 mm Hg, Group II: from 34 ±â€…13.3 mm Hg-3 ±â€…4.09 mm Hg). Complications developed in 3 patients, and all in Group I. Femoral hematoma developed in 1 patient, balloon rupture occurred during the procedure in 1 patient, and there was temporary loss of pulse in 1 patient. All the complications were treated successfully. All the patients were taking anti-hypertensive drugs before intervention and during the mean 23-month follow-up period (range, 2-84 months), hypertension recovered in 35 (80%) patients and drugs were terminated. Stent implantation for aortic coarctation in the pediatric age group may provide pleasing results, reducing the coarctation gradient, providing effective dilatation in the lesion area and eliminating hypertension.

Single-center experience with routine clinical use of 3D technologies in surgical planning for pediatric patients with complex congenital heart disease.

PURPOSE: This study was planned to assess the application of three-dimensional (3D) cardiac modeling in preoperative evaluation for complex congenital heart surgeries. METHODS: From July 2015 to September 2019, 18 children diagnosed with complex congenital heart diseases (CHDs) were enrolled in this study (double outlet right ventricle in nine patients, complex types of transposition of the great arteries in six patients, congenitally corrected transposition of the great arteries in two patients, and univentricular heart in one patient). The patients' age ranged from 7 months to 19 years (median age, 14 months). Before the operation, 3D patient-specific cardiac models were created based on computed tomography (CT) data. Using each patient's data, a virtual computer model (3D mesh) and stereolithographic (SLA) file that would be printed as a 3D model were generated. These 3D cardiac models were used to gather additional data about cardiac anatomy for presurgical decision-making. RESULTS: All 18 patients successfully underwent surgeries, and there were no mortalities. The 3D patient-specific cardiac models led to a change from the initial surgical plans in 6 of 18 cases (33%), and biventricular repair was considered feasible. Moreover, the models helped to modify the planned biventricular repair in five cases, for left ventricular outflow tract obstruction removal and ventricular septal defect enlargement. 3D cardiac models enable pediatric cardiologists to better understand the spatial relationships between the ventricular septal defect and great vessels, and they help surgeons identify risk structures more clearly for detailed planning of surgery. There was a strong correlation between the models of the patients and the anatomy encountered during the operation. CONCLUSION: 3D cardiac models accurately reveal the patient's anatomy in detail and are therefore beneficial for planning surgery in patients with complex intracardiac anatomy.

Electroanatomic mapping guided cryoablation of Mahaim pathways in children with limited fluoroscopy exposure.

BACKGROUND: The presence of Mahaim accessory pathways (MAP) with anterograde decremental conduction is a disorder that leads to antidromic atrioventricular reentrant tachycardia. There are rare reports of cryoablation use in MAP. This study aims at sharing our experience with using cryoablation to treat MAP in children. METHODS: Electrophysiology study and catheter ablation were performed in 14 patients diagnosed with Mahaim tachycardia between January 2010 and December 2013. Cryoablation was used in nine of the cases. A three-dimensional navigation system with surface electrode patches (EnSite System, St. Jude Medical Inc., St. Paul, MN, USA) was used for all procedures. RESULTS: The patients (two girls and seven boys) had a median age of 11.5 years (8-18 years) and a median weight of 67 kg (31-80 kg). Mahaim conduction was localized in the right posterolateral (n = 4), right lateral region (n = 2), right posteroseptal (n = 1), right anterolateral (n = 1), and right anterior (n = 1). A pathway potential was noted in six of nine cases at the tricuspid annulus. Catheter choices and acute success rates were as follows: cryoablation in four (three of four successful), radiofrequency catheter ablation (RFA) and cryoablation in five (successful in four of five). No fluoroscopy was used in six of nine patients. The mean procedure duration was 249 ± 90 minutes. No major complications were observed. The final long-term success rate for cryoablation was seven of nine (78%). CONCLUSIONS: Cryoablation can be used as a reliable and effective alternative to RFA in the treatment of Mahaim accessory conduction pathways in children. Prospective comparative studies are necessary in order to further evaluate the long-term efficacy of this method.

Transcatheter closure of perimembranous ventricular septal defects using Nit-Occlud(®) Lê VSD coil: early and mid-term results.

Our objective was to investigate the short- and mid-term results of transcatheter ventricular septal defect (VSD) closure with the Nit-Occlud(®) Lê VSD coil. Retrospective data collection study. Data were collected from 20 patients who underwent transcatheter VSD closure with the Nit-Occlud(®) Lê VSD coil device between October 2011 and June 2013. The mean age of the study subjects was 7.3 ± 4.0 years, and the mean weight was 25.7 ± 11.8 kg. The distance between the defect and the aortic valve, measured using angiography, was an average of 5.1 ± 2.0 mm, and the left ventricular opening averaged 8.2 ± 2.1 mm. The mean value of the Q p/Q s ratio was 1.7 ± 0.4. Intravascular hemolysis developed in the first few hours after the procedure in three patients. In one of these cases, despite medical treatment and the implantation of a detachable coil placed into the Nit-Occlud(®) device transcatheterly, hemolysis persisted. This device was removed and the VSD was closed surgically. In the other two cases, although the residual shunt persisted on echocardiography, the hemolysis regressed spontaneously. There were no rhythm problems or other complications during the follow-up period of 12.3 ± 6.6 months. In the selected cases, for the transcatheter treatment of VSD, the Nit-Occlud(®) Lê VSD coil device can be used. When compared with other VSD closure devices, there was no development of a permanent atrioventricular block, which is an important advantage. However, patients with a residual shunt should be monitored closely for the development of hemolysis during the first few hours.