Interventional Pediatric Cardiology: State of the Art and Future Directions

Rao, P. Syamasundar

doi:10.1007/s002469900256

Cited by 35 publications

(13 citation statements)

References 149 publications

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“…We proposed the concept of using stents for this purpose while discussing state of the art and future directions in interventional pediatric cardiology in 1998 [284]. The very following year Atz et al [281] reported stent placement across the atrial septum after trans-atrial needle puncture in a neonate with hypoplastic left heart syndrome and intact atrial septum.…”

Section: Atrial Septal Stentsmentioning

confidence: 99%

Historical Aspects of Transcatheter Treatment of Heart Disease in Children

Rao¹

2012

Pediat Therapeut

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The very first transcatheter intervention to treat congenital cardiac defects was reported by Rubio-Alvarez et al. [1] in 1953, when they performed pulmonary valvotomy using a modified ureteral catheter. A decade later Dotter, Rashkind, Porstmann and their associates described progressive dilatation of peripheral arterial stenotic lesions, balloon atrial septostomy and transcatheter occlusion of patent ductus arteriosus, respectively. The purpose of this review is to present these and other historical developments of catheter-based interventions in the treatment of heart disease in children. Historical aspects of 1. balloon angioplasty/valvuloplasty of valvar pulmonary stenosis, valvar aortic stenosis, fixed subaortic stenosis, native aortic coarctation, postsurgical aortic recoarctation, branch pulmonary artery stenosis, mitral stenosis, cyanotic heart defects with pulmonary oligemia, stenotic bioprosthetic valves, congenital tricuspid and mitral stenosis, truncal valve stenosis, subvalvar pulmonary stenosis, supravalvar pulmonary stenosis (congenital membranous or postoperative), stenosis of the aorta (Leriche syndrome, atherosclerotic and Takayasu's arteritis), baffle obstruction following Mustard or Senning procedure (both systemic and pulmonary venous obstructions), superior and inferior vena caval obstructions, pulmonary vein stenosis, pulmonary veno-occlusive disease, vertical vein stenosis in total anomalous pulmonary venous connection, pulmonary venous obstruction following repair of total anomalous pulmonary venous obstruction, specially designed pulmonary artery bands, cor triatriatum, cor triatriatum dexter, and coronary artery stenotic lesions that develop after Kawasaki disease; 2. stents to enlarge stenotic lesions of branch pulmonary arteries, systemic veins, systemic and pulmonary venous pathways after Mustard procedure, aorta, right ventricular outflow conduits, pulmonary veins and native right ventricular outflow tract or to keep the ductus arteriosus open in patients with pulmonary atresia and hypoplastic left heart syndrome and maintaining patency of stenosed aorto-pulmonary collateral vessels, surgically created but obstructed shunts or acutely thrombosed shunts as well as covered stents; 3. transcatheter occlusion of cardiac defects comprising of atrial septal defect, patent foramen ovale, patent ductus arteriosus, ventricular septal defect and aortopulmonary window and 4. catheter-based atrial septostomy such as Rashkind balloon atrial septostomy, Park's blade atrial septostomy, balloon angioplasty of the atrial septum, trans-septal puncture and atrial septal stents were presented.

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Section: Atrial Septal Stentsmentioning

confidence: 99%

Historical Aspects of Transcatheter Treatment of Heart Disease in Children

Rao¹

2012

Pediat Therapeut

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“…When the pulmonary valve annulus is too large to dilate with a single balloon, valvuloplasty with simultaneous inflation of two balloons across the pulmonary valve annulus is recommended. Immediate, short-term and long-term results ( Figure 4) are good; although long-term results are limited (Rao et al 1998). Given the success with balloon pulmonary valvuloplasty, surgery is reserved for unsuccessful balloon cases, mostly for cases with supravalvar PS, severe valve annular hypoplasia and dysplastic pulmonary valves.…”

Section: Wwwintechopencommentioning

confidence: 99%

“…Indeed, at the present time balloon pulmonary valvuloplasty is treatment of choice. The indications for intervention are similar to those prescribed for surgery: a peak-to-peak systolic pressure gradient > 50 mmHg across the pulmonary valve with a normal cardiac index (Rao 1988, Rao 1989b, Rao 1998. Detailed description of the procedure of balloon valvuloplasty and the results of such a procedure are beyond the scope of this chapter; the reader is referred elsewhere for these details (Rao 2007a, Rao 2007b.…”

Section: Managementmentioning

confidence: 99%

Congenital Heart Defects – A Review

Rao¹

2012

Congenital Heart Disease - Selected Aspects

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“…There are a large number of other congenital, acquired or postsurgical stenotic lesions which can be effectively treated with balloon therapy [2,3,5,6,19,20] and include stenotic pulmonary valve in tetralogy of Fallot or other single ventricle lesions, post-surgical aortic recoarctation, branch pulmonary artery stenosis, mitral valve stenosis, some forms of Takyasu's arteritis, heterograft or homograft valve/conduit stenosis, supravalvar stenosis following arterial switch procedure, baffle stenosis following Mustard or Senning procedure for transposition of the great arteries, vena caval obstructive lesions, stenosed Blalock-Taussig shunts, obstructed collateral vessels in pulmonary atresia patients. Discussion of these lesions is beyond the scope of this presentation.…”

Section: Other Usesmentioning

confidence: 99%

“…Balloon dilatation techniques were then extended to relieve obstructive lesions of the aorta,pulmonary valve, aortic valve, mitral valve,subaortic membrane, branch pulmonary artery stenosis, stenoticbioprosthetic valves and other obstructive vascular lesions. Extensive review of the techniques and results may be found in our previous publications on this subject [1][2][3][4][5][6][7][8]. …”

mentioning

confidence: 99%

Balloon Valvuloplasty and Angioplasty in Pediatric Practice

Ps¹

2011

Pediatr Therapeut

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Congenital heart defect (CHD) is the most common congenital anomaly in children and constitutes approximately 1% of live births. This will result in nearly 35,000 babies born with heart defects in the USA alone. Nearly 50% of these babies can be managed with simple medications, observation and follow-up without any major therapeutic intervention. However, the remaining 50%, in the past, required surgical, some under cardiopulmonary bypass, intervention. Since the advent of transcatheter techniques, 50% of these babies can be managed with less invasive, percutaneous, transcatheter techniques. In this editorial the role of balloon valvuloplasty and angioplasty in the management of children with CHDs will be reviewed.In early 1950s, Rubio-Alverez and Limon-Lason used a modified ureteral catheter to perform transcatheter pulmonary and tricuspid valvotomy. A decade later, Dotter and Judkins utilized a gradational transcatheter dilatation technique to open stenotic and occluded peripheral arteries. In mid to late 1970s, Gruntzig and his colleagues extended Dotter and Judkins' technique and successfully dilated stenotic lesions of the iliac, femoral, popliteal, renal and coronary arteries; they utilized a double-lumen catheter with a non-elastic balloon that they developed. Balloon dilatation techniques were then extended to relieve obstructive lesions of the aorta,pulmonary valve, aortic valve, mitral valve,subaortic membrane, branch pulmonary artery stenosis, stenoticbioprosthetic valves and other obstructive vascular lesions. Extensive review of the techniques and results may be found in our previous publications on this subject [1][2][3][4][5][6][7][8]. Pulmonary stenosisValvar pulmonary stenosis, initially described by Kan and her associates [9], is the first CHD for which balloon valvuloplasty is acknowledged as a therapeutic procedure of choice. The indications for catheter intervention are the same as those used for surgical valvotomy: a moderate degree of pulmonary valve stenosis with a peak-to-peak gradient >50 mmHg with normal cardiac index. Initially recommended size of the balloon is 1.2 to 1.4 times that of pulmonary valve annulus. Relief of pulmonary valve obstruction by balloon valvuloplasty is documented in neonates, infants, children and adults. Immediate and short-term results are available but, there are limited long-term follow-up data [7]. Doppler echocardiographic evaluation at followup is reflective of the results without the necessity for repeat cardiac catheterization. Recent studies suggested pulmonary insufficiency as potential problem [7,10,11]. It appears that use of large non-compliant balloons may be associated with pulmonary insufficiency [11]. Consequently the revised recommendations are to achieve balloon/ annulus ratios of 1.2 to 1.25 [12,13]. Balloon pulmonary valvuloplasty is an excellent and preferred alternative to open or closed heart surgery in the treatment of pulmonary stenosis in patients of all age groups. Long-term follow-up evaluation of pulmonary insufficiency is require...

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Interventional Pediatric Cardiology: State of the Art and Future Directions

Cited by 35 publications

References 149 publications

Historical Aspects of Transcatheter Treatment of Heart Disease in Children

Historical Aspects of Transcatheter Treatment of Heart Disease in Children

Congenital Heart Defects – A Review

Balloon Valvuloplasty and Angioplasty in Pediatric Practice

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