Advances in interventional and hybrid therapy in neonatal congenital heart disease

Schranz, Dietmar; Michel‐Behnke, Ina

doi:10.1016/j.siny.2013.05.005

Cited by 25 publications

(31 citation statements)

References 82 publications

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“…Biodegradable stents are another potential solution, and would bring us a step further if their metal‐organic framework would disappear without leaving restrictive scar‐tissue . However, experience in congenital heart disease is limited and not very convincing on follow‐up . Meanwhile, the clinical use of drug‐eluting bioabsorbable vascular scaffolds (BVS) has been reported in pediatric patients .…”

Section: Discussionmentioning

confidence: 99%

A new breakable stent for recoarctation in early infancy: Preliminary Clinical Experience

Grohmann

Sigler

Siepe

et al. 2016

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 99%

A new breakable stent for recoarctation in early infancy: Preliminary Clinical Experience

Grohmann

Sigler

Siepe

et al. 2016

Cathet Cardio Intervent

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“…12,13 Advances in interventional and hybrid therapy for congenital heart disease are raising expectations in regard to the efficacy and safety of in utero interventions and their ability to provide a positive risk-benefit ratio when compared with postnatal interventions.…”

Section: Discussionmentioning

confidence: 99%

“…21 Second, because IAS has been reported as showing recoil of the septum after balloon dilation alone, 6 we have addressed that by stent insertion, which is necessary to ensure sustained patency of the created intra-atrial communication. 13 In this study, we used self-expandable sinus-superflex-DS (Optimed) stents with a length of 12 mm and a diameter of 8 mm. The size was chosen based on the measurement of the FO and the distance between the posterior LA wall and the anterior RA wall.…”

Section: Downloaded From Stenting the Foramen Ovale In Fetal Sheepmentioning

confidence: 99%

Percutaneous Fetal Cardiac Catheterization Technique for Stenting the Foramen Ovale in a Midgestation Lamb Model

Edwards

Veldman

Nitsos

et al. 2015

Circ: Cardiovascular Interventions

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Background-Intact or highly restricted intra-atrial septum can be reliably diagnosed in the human fetus as early as 22 to 24 weeks of gestation. Fetal interventions targeting the atrial septum have used a direct approach through the atrial wall.Here, we report stenting of the foramen ovale with a large, open-cell stent via percutaneous access through the fetal hepatic vein in a sheep model. Methods and Results-In 5 fetal sheep of 109 to 111 days of gestation (term, 147 days), the fetal hepatic vein was punctured percutaneously under ultrasound guidance and a 13.3-cm 14-gauge intravenous catheter was inserted. After catheterization of the inferior vena cava, right atrium, foramen ovale, and left atrium with a guidewire and 1.8F to 2.6F tapered catheter, a self-expandable, 8×12-mm flexible open-cell stent was positioned in an unrestricted foramen ovale. Flow and fetal well-being were documented for 45 minutes after the procedure. Access to the left atrium was achieved in all 5 animals and all survived. In 4 animals, the stent was successfully positioned in the foramen ovale. One fetus was born at term and euthanized on day 3: postmortem examination confirmed the patency of the stent. The other 3 fetuses were well after being monitored by ultrasound for 45 minutes. In 1 animal, the stent dislodged immediately after release obstructing the mitral valve. This fetus developed ascites and was euthanized after 4 days. Key Words: atrial septum ◼ cardiac catheterization ◼ fetal heart ◼ foramen ovale ◼ hypoplastic left heart syndrome ◼ stent

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“…Percutaneous duct-stenting is the treatment of choice for prostaglandin refractory ductal obstruction [36]. Balloon atrial septostomy with or without stent placement is also the preferred method to treat severe hypoxemia due to significantly obstructed or intact atrial septum.…”

Section: The Hybrid Approachmentioning

confidence: 99%

Current Therapy for Hypoplastic Left Heart Syndrome and Related Single Ventricle Lesions

2016

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Universally fatal only four decades ago, the progress in the three-stage palliation of hypoplastic left heart syndrome and related single right ventricular lesions has drastically improved the outlook for these patients. While the stage II operation (hemi-Fontan or bidirectional Glenn) and stage III Fontan procedure have evolved into relatively low risk operations, the stage I Norwood procedure remains one of the highest risk and costliest common operations performed in congenital heart surgery. Yet, despite this fact, experienced centers now report hospital survivals in excess of 90% for the Norwood. This traditional three-stage surgical palliation has seen several innovations in the past decade aimed at improving outcomes, particularly for the Norwood procedure. One significant change is a renewed interest in the right ventricle-to-pulmonary artery shunt as the source of pulmonary blood flow, rather than the modified Blalock-Taussig shunt for the Norwood. The multi-institutional Single Ventricle Reconstruction trial randomized 555 patients to one or the other shunt, and these subjects continue to be followed closely as they now approach 10 years post-randomization. In addition to modifications to the Norwood procedure, the “hybrid procedure,” a combined catheter-based and surgical approach, avoids the Norwood procedure in the newborn period entirely. The initial hybrid procedure is then followed by a “comprehensive” stage II, that combines components of both the Norwood and the traditional stage II, and later completion of the Fontan. Proponents of this approach hope to not only improve short-term survival, but potentially longer-term outcomes, such as neurodevelopment, as well. Regardless of the approach, traditional surgical staged palliation or the hybrid procedure, survivals have vastly improved, and large numbers of these patients are surviving not only through their Fontan in early childhood, but into adolescence and young adulthood. As this population grows, it becomes increasingly important to understand the longer-term outcomes of these Fontan patients, not only in terms of survival, but also burden of disease, neurodevelopmental outcomes, psychosocial development and quality of life.

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Advances in interventional and hybrid therapy in neonatal congenital heart disease

Cited by 25 publications

References 82 publications

A new breakable stent for recoarctation in early infancy: Preliminary Clinical Experience

A new breakable stent for recoarctation in early infancy: Preliminary Clinical Experience

Percutaneous Fetal Cardiac Catheterization Technique for Stenting the Foramen Ovale in a Midgestation Lamb Model

Current Therapy for Hypoplastic Left Heart Syndrome and Related Single Ventricle Lesions

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