PROGRESS IN PEDIATRIC CARDIOLOGY最新文献

Background

Transcatheter options for interventions on stenotic right ventricular outflow tracts have become the standard of care for many individuals. Determining which patients should have interventions uses a combination of echocardiography derived gradients and axial imaging scans. Being able to predict catheter derived gradients from scans using computational fluid dynamic modeling can help with the pre-procedural planning of patients.

Objectives

The aim of this study is to validate a computational fluid dynamic modeling technique that accurately predicts pressure gradients when compared to in vivo cardiac catheterization measurements across a stenotic right ventricle outflow tract.

Methods

A retrospective chart review of patients who underwent TPVR (transcatheter pulmonary valve replacement) at our institution was performed. Five patients who underwent TPVR and had a CT scan prior to intervention were identified for this study. Each CT was processed using a 3D Slicer to build a 3-dimensional (3D) model. The model was then processed via ANSYS ICEM software to construct a mesh model for CFD testing. ANSYS Solver was then used to model the fluid dynamics through the heart model.

Results

CFD results were obtained for the models and compared to the catheterization data for the specific patient. Linear regression demonstrated a very strong correlation between our model gradients and the gradients obtained during cardiac catheterization with an adjusted R of 0.9959. Model coefficient values were beta-1 = 0.9329 and beta-0 = 3.2916 (p = 0.001).

Conclusions

This proof-of-concept study has shown that taking 3-dimensional imaging and building a CFD model can accurately and reliably predict the change in pressure across the right ventricular outflow tracts. This proof-of-concept model can hopefully be applied to the pre-catheterization planning prior to patients requiring a PVR once further refinement and validation have been performed.

Cyanotic spells can oftentimes be refractory to medical stabilization and necessitate emergency palliative procedures. One such situation that we came across was managed with right ventricular outflow tract stenting. This was complicated by stent dislodgement, successful retrieval, and re-stenting. While recovering in the intensive care unit, there was sudden hemodynamic instability, which was later attributed to Takatsubo Syndrome. Continued vigilance of such children in the immediate post procedural period is of utmost importance as certain unforeseen events such as Takatsubo Syndrome may occur.

Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) is a rare congenital cardiac lesion that requires surgical correction as soon as safely possible. In the very premature neonate, the surgical and medical considerations are complicated by the intrinsic risk of surgical manipulation of fragile tissue, the potential for severe multiorgan injury from cardiopulmonary bypass, and the ability to offer salvage operations, including extracorporeal membrane oxygenation and mitral valve replacement. Herein, we present a case of a very premature patient diagnosed with ALCAPA who underwent eventual successful repair.

Pulmonary venous baffle obstruction (PVBO) is a clinically significant complication following atrial switch palliation for D-transposition of the great arteries. 3-dimensional printed models have become a valuable tool in pre-procedural planning for cardiac interventions. We report successful PVBO stenting using a cardiac magnetic resonance imaging (MRI)-derived three-dimensional (3-D) printed model. A 20-year-old male with a history of D-transposition of the great arteries s/p Senning procedure was twice hospitalized for respiratory failure. Transthoracic echocardiogram (TTE) and cardiac MRI demonstrated severe PVBO. MRI images were utilized to create a 3-D printed cardiac model that was used to guide the approach for trans-baffle puncture. During cardiac catheterization, there was a mean gradient of 15 mmHg across the pulmonary venous baffle by Gorlin equation and transesophageal echocardiogram (TEE) continuous Doppler. A trans-baffle approach was utilized under fluoroscopic and TEE guidance. The tiny pulmonary vein confluence was crossed with a Judkins Right (JR) 3.5 catheter and a 0.035“ Glidewire, and a 10 mm x 17 mm Valeo stent was deployed in the pulmonary venous baffle over a 0.035” Rosen wire. The stent was post-dilated with a 12 mm × 2 cm Atlas Gold balloon, and pressure pullback demonstrated resolution of the gradient. The trans-baffle puncture site was then closed with a 4 mm Amplatzer septal occluder device. The patient's respiratory symptoms resolved, and his baseline saturations increased. This case demonstrates the utility of MRI-derived 3-D printing in pre-procedural planning for pulmonary venous baffle intervention.

Background

Transcatheter device closure is a well-established treatment for suitable ventricular septal defects (VSDs). The Cocoon Membranous VSD Occluder is a relatively new device specifically designed for perimembranous VSDs. Existing research on the Cocoon Membranous VSD Occluder for closing PM VSD is limited.

Objective

This study aimed to describe a single-center experience using the Cocoon Membranous VSD Occluder for perimembranous VSD.

Methods

We retrospectively analyzed data from patients who underwent device closure of perimembranous VSD using the Cocoon occluder between May 2023 and April 2024. Procedural success, complications, and short-term outcomes were evaluated.

Results

Between May 2023 and April 2024, 13 patients with perimembranous VSD and left-to-right shunt underwent device closure with the Cocoon Membranous VSD Occluder. Twelve patients (92.3 %) achieved successful VSD closure. The mean age was 8.06 years with standard deviation (SD) of 7.24 years. The mean weight was 11.98 kg with SD of 18.93 kg. The mean VSD size was 4.96 mm with SD of 0.92 mm. The VSD was crossed from the right ventricle in 5 patients and from the left ventricle in 9 patients. All patients had successful device placement from the right ventricle approach. The Cocoon Membranous VSD device size ranged from 6 to 4 mm to 12–4 mm. In one smaller patient, the device was electively removed due to significant flow through an additional exit, and the patient subsequently underwent surgery. Another patient developed hemoglobinuria on the fourth day, which resolved by the tenth day with hydration therapy. Two patients experienced trivial to mild aortic regurgitation, and one had Wenckebach phenomenon that resolved the next day. In the short-term follow-up (mean duration of 4.33 months), all patients were doing well, had good device performance, and showed no evidence of heart block.

Conclusions

Device closure of perimembranous VSD in infants with the Cocoon Membranous VSD Occluder appears to be safe and effective in carefully selected patients during short-term follow-up. Larger studies with long-term data are necessary for future recommendations.

Background: At present, the majority of aortic valve diseases have been traditionally treated by prosthetic valve replacement, whether using a mechanical or a bio-prosthetic valve. Surgical management of aortic valve disease in pediatric patients is still a great challenge, especially the surgical timing, selection of surgical approach, and optimal surgical materials. Aim of Review: In this paper, the main perspective is to propose the use of an aortic stent coating with endothelial cells and smooth muscle cells on both sides as aortic valve in the Ozaki procedure. Owing to its good biocompatibility, stability, thin but high tensile strength, anti-calcification, anticoagulant properties, and rapid endothelialization in vivo, long-term results from that instead of autologous pericardium in the Ozaki procedure may be superior to Ross in pediatric patients. Key Scientific Concepts of Review: The key scientific concepts are as follows: (1) a one-step, rapid, and robust concept for the preparation of aortic stent coating with endothelial cells and smooth muscle cells, and (2) Ozaki procedure.

The utilization of ventricular assist devices (VAD) in the treatment of patients with congenital heart disease has expanded significantly in the pediatric population, largely due to the improved outcomes and availability of paracorporeal devices. Here, we describe a unique case of a non-verbal 5-year-old male with a complicated medical history of autism spectrum disorder and dextrocardia with complex two-ventricle congenital heart disease who was successfully bridged to transplant through the use of a VAD. Patient-tailored management was necessary in the successful use of the VAD with the goal of reducing stress and anxiety during his hospital stay.

Background

Secondhand smoke exposes children to numerous toxic chemicals. Passive cigarette smoke causes a number of diseases, such as respiratory disease. Pulmonary arterial hypertension (PAH) is a progressive disease with a dismal prognosis. Some research studies have identified hypoxia and genetic variables as the etiological factors for PAH. As a result, it appears that environmental factors, such as tobacco smoke, disrupt the function of vascular endothelial cells.

Objectives

1) Evaluating the correlation between parental smoking and PAH in infants. 2) Examining the correlation between the number of cigarettes smoked per day by parents and systolic pulmonary arterial pressure (SPAP) during a year.

Method

In a cohort study, 140 neonates were classified into smokers and non-smokers. Birth weight and SPAP in neonates were measured in the smoker parental group. Following the measurement of the variables, the second group consisted of neonates with non-smoking parents whose birth weight and SPAP were matched one-to-one with the first group. After one year, we measured SPAP in two groups.

Result

At birth, all neonates had normal SPAP. The mean infant SPAP was different between smoker and non-smoker parents; this difference was statistically significant (P-value <0.0001). Over 45 % of infants whose parents smoked developed PAH. There was an association between the number of cigarettes that parents smoke daily and infant SPAP levels (P-value <0.0001). There was no association between PAH and the gender of the infants (p-value = 0.497).

Conclusion

This research revealed a significant association between parental smoking and PAH in infants. Also, the infant SPAP was significantly linked to the number of cigarettes that the parents smoked per day.

Salmonella infections are prevalent globally and cause invasive infections in adults and children alike. Here, we present a rare case report and literature review based on a complicated presentation of S. enteritidis endocarditis in an immunocompetent 8-year-old child with a mechanical aortic valve. The child initially presented with gastrointestinal symptoms, leading to an 11-day hospitalization for gastroenteritis and bacteremia caused by Salmonella. After a 1.5-week hospitalization, receiving intravenous Ceftriaxone and oral Ciprofloxacin, the child was discharged and underwent another week of treatment. Two weeks post-discharge, recurrent fever led to rehospitalization. During this admission, the diagnosis of infective endocarditis was made, revealing complications including pseudoaneurysms and aortic root abscesses. This diagnosis necessitated cardiac surgery and an extended course of antibiotic treatment for an additional seven weeks. The child made a full recovery and was well at follow up. This is the twelfth reported case of Salmonella endocarditis in a child. The overall mortality rate of Salmonella Endocarditis in children is approximately 50 %, and it predominantly affects males. Though rare, Salmonella endocarditis can lead to severe cardiovascular complications. Therefore, it is important to maintain a high index of suspicion for endocarditis when risk factors are present and promptly initiate treatment.