Interventionists and Congenital Heart Disease

By Richard E. Shaw, PhD, FACC, FACA

It is with great pleasure that I introduce a new special section of the Journal of Invasive Cardiology called Intervention in Congenital Heart Disease. The section editor is a longtime colleague of mine, Dr. Tarek Helmy, who is Professor of Medicine, Division of Cardiology and Director of Cardiac Catheterization Laboratory at the University of Cincinnati College of Medicine.  The purpose of the section is to highlight emerging research in a rapidly developing area of invasive cardiology. Through significant advances in the treatment of congenital conditions through surgical intervention in children, many people are living far into their adult years that otherwise would have died in early childhood. These adults with congenital disease are presenting for treatment with very complex disease and even well-trained interventional cardiologists are not equipped to deal with these unusual presentations. It is my hope that this special section will promote the timely dissemination of information that will improve the quality and effectiveness of care given to these patients.  Our special section begins with two articles in the September issue of the journal.  The first is from Drs. Baho et al. titled “Stent Protrusion in Palliative Congenital Heart Disease Interventions: Does it Cause Any Harm?” and the second is from Drs. Doshi and Rao titled “Development of Aortic Coarctation Following Device Closure of Patent Ductus Arteriosus”. I hope that you find these interesting and informative. I am confident that Dr. Helmy will attract new research and invite comprehensive reviews that will provide invasive cardiologists with state-of-the-art approaches to this growing segment of cardiology patients.

September 2013  issue

Stent Protrusion in Palliative Congenital Heart Disease Interventions: Does it Cause any harm?

Baho H, Deraz S, Abouzeid H, Al-Ata J, Kouatli A.

Abstract: Protrusion of the patent ductus arteriosus (PDA) stent can occur into the lumen of the main pulmonary artery (MPA) branch, the aorta, or both. This protrusion can vary from trivial to major, causing potential obstruction to the vessel lumen, which may cause flow obstruction or risk of thromboses. As far as we know, no one has followed these patients with protruding stents to see whether they do pose a risk of obstruction or thromboses. Methods. A retrospective, descriptive, cross-sectional study reviewing charts of all included patients who received stents in the MPA branches with residual protrusion into the pulmonary artery branch lumen (total, 87 patients; 34 patients with protruding stents) was performed to determine whether this protrusion caused any undesired effects on flow or coagulation. The patients were divided into two groups: the protruding stents group (group 1); and the non-protruding stent group that served as a control group (group 2). Each group was then categorized into 3 sections according to the stent position, the PDA, the MPA branches, and the Blalock-Taussig shunt. Results. The only risk factor that had statistical significance was the number of stents in the PDA site. Conclusion. Protruding stents do not cause an increased risk of thrombosis in patients on aspirin. Mild protrusion is more likely in PDA stents and severe protrusion is more likely in the MPA branch stents. Severe protrusion is more likely when more stents are used in the PDA location. There is no statistical evidence that protrusion can cause lung perfusion defects from the small numbers we have.

J INVASIVE CARDIOL 2013;25(9):460-463

Key words: CHD, stent, protrusion

Development of Aortic Coarctation Following Device Closure of Patent Ductus Arteriosus

Doshi AR and Rao PS.

Abstract: A patient who had transcatheter closure of a large patent ductus arteriosus in early infancy developed aortic coarctation during follow-up. Initially, balloon angioplasty and subsequent stent implantation successfully relieved the aortic obstruction. Avoidance of use of large devices in small babies and modification of current devices so that they do not cause aortic obstruction may result in better outcomes. Once aortic obstruction develops, transcatheter management is useful in relieving the obstruction.  J INVASIVE CARDIOL 2013;25(9):464-467

Key words: patent ductus arteriosus, coarctation of aorta, Gianturco-Grifka vascular occlude device, coarctation stent therapy

Other related articles

Zakhia Saliba, MD, Issam El-Rassi, MD, Dina Helou, et al. Analyzing the Failures of Percutaneous Closure of the Patent Ductus Arteriosus in Patients Over 5 kg. J INVASIVE CARDIOL 2012;24(9):434-438

Gomez JE, Gentile JI. Patent Ductus Arteriosus Associated with Aberrant Right Subclavian Artery: Two Cases, One Successful Interventional Closure of PDA. J INVASIVE CARDIOL 2011;23:E246–E249

Zhang P, Zhu X-y. Severe Thrombocytopenia Complicating Transcatheter Occlusion of a Patent Ductus Arteriosus.  J INVASIVE CARDIOL 2013;25(5):E88-E92

Beyer RW, Bier AJ. Ultrasonic Guidance for Percutaneous Closure of Patent Ductus Arteriosus in an Adult. J INVASIVE CARDIOL 2009;21:E141-E144

Atiq M, Aslam N, Kazmi KA. Transcatheter Closure of Small-to-Large Patent Ductus Arteriosus with Different Devices: Queries and Challenges. J INVASIVE CARDIOL 2007;19 (July)

Gomez J and Blüguermann J. Percutaneous Occlusion of Patent Ductus Arteriosus with the Nit-Occlud Device in an Adult Patient. J INVASIVE CARDIOL 2007;19 (November)

Samraj R, Rao PS. Concurrent Transcatheter Therapy of Valvar Aortic Stenosis and Patent Ductus Arteriosus. J INVASIVE CARDIOL 2011;23:E72–E75

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