Charles E Mullins

Publications (42)130.25 Total impact

• Article: Diminished left ventricular function is associated with poor mid-term outcomes in neonates after balloon aortic valvuloplasty.

  Christopher J Petit, Frank F Ing, Raphael Mattamal, Ricardo H Pignatelli, Charles E Mullins, Henri Justino
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  ABSTRACT: OBJECTIVES: We studied outcomes of neonatal aortic valvuloplasty to determine the risk factors for poor outcomes. BACKGROUND: Balloon aortic valvuloplasty (BAV) is the primary therapy for neonates with severe aortic stenosis (AS). Limited data are available on the mid-term and long-term outcomes in this population, and reported risk factors for poor outcomes vary among studies. METHODS: We reviewed all cases of BAV in neonates in our institution between 1998 and 2009. We reviewed patient characteristics, preintervention echocardiographic, and procedural details. We tracked repeat BAV, aortic valve replacement (AVR), and death/transplant. Kaplan-Meier and Cox regression analyses were performed. Changes in dimensions of left heart structures post-BAV were also studied. RESULTS: Forty-eight neonates were included-of these, 30 (62%) had critical AS. There was one procedural death. The remaining 47 neonates were followed for 4.8 ± 4.4 years. Repeat BAV was performed in 19 (40%) neonates; AVR was performed in 9 (19%), and death/transplant occurred in 4 (8%) neonates. Multivariate analysis revealed that lower LV shortening fraction pre-BAV, higher pre-BAV and final valve gradient, and need for inotropes were associated with poor long-term outcomes. LV diastolic and systolic dimensions normalized over time, and left heart structures improved in size early and late after BAV. CONCLUSIONS: Neonatal BAV is associated with low mortality. Lower LV shortening fraction pre-BAV is associated with risk of future interventions, while repeat valvuloplasty is safe and effective for recurrent AS. There is significant improvement in dimensions of the LV and aortic valve annulus following BAV. © 2012 Wiley Periodicals, Inc.
  Catheterization and Cardiovascular Interventions 04/2012; · 2.29 Impact Factor
• Article: Twenty-five year experience with balloon aortic valvuloplasty for congenital aortic stenosis.

  Shiraz A Maskatia, Frank F Ing, Henri Justino, Matthew A Crystal, Charles E Mullins, Raphael J Mattamal, E O'Brian Smith, Christopher J Petit
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  ABSTRACT: Balloon aortic valvuloplasty (BAV) is the primary therapy for congenital aortic stenosis (AS). Few reports describe long-term outcomes. In this study, a retrospective single-institution review was performed of patients who underwent BAV for congenital AS. The following end points were evaluated: moderate or severe aortic insufficiency (AI) by echocardiography, aortic valve replacement, repeat BAV, surgical aortic valvotomy, and transplantation or death. From 1985 to 2009, 272 patients who underwent BAV at ages 1 day to 30.5 years were followed for 5.8 ± 6.7 years. Transplantation or death occurred in 24 patients (9%) and was associated with depressed baseline left ventricular shortening fraction (LVSF) (p = 0.04). Aortic valve replacement occurred in 42 patients (15%) at a median of 3.5 years (interquartile range 75 days to 5.9 years) after BAV and was associated with post-BAV gradient ≥25 mm Hg (p = 0.02), the presence of post-BAV AI (p = 0.03), and below-average baseline LVSF (p = 0.04). AI was found in 83 patients (31%) at a median of 4.8 years (interquartile range 1.4 to 8.7) and was inversely related to post-BAV gradient ≥25 mm Hg (p <0.04). AI was associated with depressed baseline LVSF (p = 0.02). Repeat valvuloplasty (balloon or surgical) occurred in 37 patients (15%) at a median of 0.51 years (interquartile range 0.10 to 5.15) and was associated with neonatal BAV (p <0.01), post-BAV gradient ≥25 mm Hg (p = 0.03), and depressed baseline LVSF (p = 0.05). In conclusion, BAV confers long-term benefits to most patients with congenital AS. Neonates, patients with post-BAV gradients ≥25 mm Hg, and patients with lower baseline LVSF experienced worse outcomes.
  The American journal of cardiology 07/2011; 108(7):1024-8. · 3.58 Impact Factor
• Article: Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association.

  Timothy F Feltes, Emile Bacha, Robert H Beekman, John P Cheatham, Jeffrey A Feinstein, Antoinette S Gomes, Ziyad M Hijazi, Frank F Ing, Michael de Moor, W Robert Morrow, Charles E Mullins, Kathryn A Taubert, Evan M Zahn
  Circulation 06/2011; 123(22):2607-52. · 14.74 Impact Factor
• Article: The outcome of pulmonary artery stents following surgical manipulation.

  Mark A Law, John P Breinholt, Pirouz Shamszad, Henri Justino, Charles E Mullins, Frank F Ing
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  ABSTRACT: Pulmonary artery (PA) stents are utilized to treat branch pulmonary stenosis (BPS). Often patients with PA stents undergo subsequent cardiac surgery for other indications, and the stents can be manipulated during the procedure. The purpose of this study was to evaluate the outcome of branch PA stenoses following surgical manipulation of previously implanted PA stents and to determine factors associated with future reintervention. Catheterization data, operative reports, and clinical summaries were reviewed on patients with PA stents placed between September 1989 and December 2006 undergoing subsequent cardiac surgery. Surgical manipulation was recorded as removed, trimmed, or longitudinally transected, and patched. Those that were not manipulated were defined as untouched. 459 patients had branch PA stents placed. About 54 patients, with 70 stents in branch PA's. subsequently had further cardiac surgery. The median age of stent placement was 7.5 (0.5-32.4) years with a median age of surgery of 12.7 (5.1-39.6) years. Surgical manipulation was performed in 23 (33%) PA's and 47 (66%) stents were untouched. Stent removal occurred in 11 (16%), with transecting longitudinally and patching in 5 (7%), and trimming in 7 (10%). Comparing the surgical manipulation and the untouched groups, there was no difference in median age of stent placement [7.2 (0.5-30.2) versus 7.6 (1.8-32.4) years, p=0.40], wt [21.0 (5.3-86.5) versus 24.7 (9.0-96.0) kg, p=0.42], or residual catheterization gradient across the stent [3 (0-59) versus 4 (0-50) mmHg, p=0.81]. Catheter reintervention (stent n=6 or balloon dilation n=14) on the previously stented PAs was similar between the surgically manipulated (median 7.5 years) and untouched groups (median 11.5 years) (p=0.31). In multivariate analysis, the factors associated with future catheter reintervention were having the stent transected longitudinally and patched (p=0.003) and a lower weight (p=0.006) at the time of stent placement. Surgical stent manipulation is often performed in patients who have PA stents. Surgical manipulation does not alter the need for future reintervention and catheter re-intervention may be more likely when the stents are transected longitudinally and patched.
  Catheterization and Cardiovascular Interventions 02/2011; 77(3):390-4. · 2.29 Impact Factor
• Article: Outcomes of transcatheter occlusion of patent ductus arteriosus in infants weighing ≤ 6 kg.

  V Vivian Dimas, Cheryl Takao, Frank F Ing, Raphael Mattamal, Alan W Nugent, Ronald G Grifka, Charles E Mullins, Henri Justino
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  ABSTRACT: We sought to analyze the outcomes of transcatheter patent ductus arteriosus (PDA) occlusion using a variety of devices in infants weighing ≤6 kg. Indications for transcatheter closure of a PDA in infancy include congestive heart failure and/or failure to thrive. Devices available for small infants may be problematic for various reasons, including sheath size, stiffness of delivery system, and anchoring and retrievability characteristics of the device. The Amplatzer Ductal Occluder is approved by U.S. Food and Drug Administration for children weighing >6 kg and older than 6 months of age. We performed a multicenter, retrospective analysis of children weighing ≤6 kg in whom transcatheter PDA occlusion was attempted between January 1995 and November 2005 at Texas Children's Hospital and January 2001 to November 2005 at Children's Hospital of San Diego. A total of 62 patients underwent attempted closure. The mean age at catheterization was 4.7 ± 2.8 months with a mean weight at catheterization of 4.6 ± 0.9 kg. Successful device placement was achieved in 58 of 62 patients (94%). Among those receiving a device, complete occlusion was noted in all 58 patients at either catheterization or last available follow-up. Percutaneous closure of PDA should be considered even in infants ≤6 kg.
  12/2010; 3(12):1295-9. · 1.07 Impact Factor
• Article: The patent ductus arteriosus-multiple defects and a moving target.

  Charles E Mullins
  Catheterization and Cardiovascular Interventions 11/2010; 76(5):703-4. · 2.29 Impact Factor
• Article: Pulmonary artery stents: Long‐term follow‐up

  Mark A. Law MD, Pirouz Shamszad MD, Alan W. Nugent MD, FSCAI Henri Justino MD, John P. Breinholt MD, FSCAI Charles E. Mullins MD, FSCAI Frank F. Ing MD, Mark A. Law, Pirouz Shamszad, Alan W. Nugent, Henri Justino, John P. Breinholt, Charles E. Mullins, Frank F. Ing
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  ABSTRACT: Objectives: Determine the long-term outcomes of branch pulmonary artery (PA) stents. Background: PA stents in congenital heart disease effectively relieve stenoses in the short-term. Published long-term data are limited. Methods: Patients enrolled in an FDA IDE protocol from 1989–92 were included. Clinical follow-up and catheterization data were evaluated. Patients were included if >5 year follow-up data was available or if mortality occurred following the initial procedure. Results: There were five deaths: four due to progression of their underlying heart disease, and one from a complication during a follow-up catheterization. Clinical data for 43 surviving patients demonstrated 39 patients (91%) are in NYHA class I or II. Seven patients underwent surgical intervention during the follow-up period (five RV-PA conduit, two Fontan revisions), but none addressed PA stenosis. Final repeat catheterizations were performed in 36 patients (55 stents) 7.2 ± 4.3 years post stent insertion with 1.2 ± 0.9 further procedures with stent dilations. In this subgroup, the minimum vessel diameter increased from 4.7 ± 1.8 to 13.4 ± 2.4 mm (P < 0.001), and the pressure gradient improved from 41 ± 25 to 9 ± 11 mm Hg (P < 0.001). Higher initial gradient and smaller balloons were associated with a final stent diameter of <14 mm (P = 0.030 and 0.046). Jailed vessels occurred in 49% of stents with abnormal angiographic flow in 18/55. Six repeat catheterizations resulted in complications, including the one procedural death. Conclusion: Stents implants for PA stenoses provide effective improvement in vessel caliber in the long-term. Although repeat interventions are necessary, this procedure reduces RV pressure and provides an important alternative to surgery for residual PA obstruction. © 2009 Wiley-Liss, Inc.
  Catheterization and Cardiovascular Interventions 03/2010; 75(5):757 - 764. · 2.29 Impact Factor
• Article: Pulmonary artery stents: long-term follow-up.

  Mark A Law, Pirouz Shamszad, Alan W Nugent, Henri Justino, John P Breinholt, Charles E Mullins, Frank F Ing
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  ABSTRACT: Determine the long-term outcomes of branch pulmonary artery (PA) stents. PA stents in congenital heart disease effectively relieve stenoses in the short-term. Published long-term data are limited. Patients enrolled in an FDA IDE protocol from 1989-92 were included. Clinical follow-up and catheterization data were evaluated. Patients were included if >5 year follow-up data was available or if mortality occurred following the initial procedure. There were five deaths: four due to progression of their underlying heart disease, and one from a complication during a follow-up catheterization. Clinical data for 43 surviving patients demonstrated 39 patients (91%) are in NYHA class I or II. Seven patients underwent surgical intervention during the follow-up period (five RV-PA conduit, two Fontan revisions), but none addressed PA stenosis. Final repeat catheterizations were performed in 36 patients (55 stents) 7.2 +/- 4.3 years post stent insertion with 1.2 +/- 0.9 further procedures with stent dilations. In this subgroup, the minimum vessel diameter increased from 4.7 +/- 1.8 to 13.4 +/- 2.4 mm (P < 0.001), and the pressure gradient improved from 41 +/- 25 to 9 +/- 11 mm Hg (P < 0.001). Higher initial gradient and smaller balloons were associated with a final stent diameter of <14 mm (P = 0.030 and 0.046). Jailed vessels occurred in 49% of stents with abnormal angiographic flow in 18/55. Six repeat catheterizations resulted in complications, including the one procedural death. Stents implants for PA stenoses provide effective improvement in vessel caliber in the long-term. Although repeat interventions are necessary, this procedure reduces RV pressure and provides an important alternative to surgery for residual PA obstruction.
  Catheterization and Cardiovascular Interventions 11/2009; 75(5):757-64. · 2.29 Impact Factor
• Article: Simultaneous stent implantation to treat bifurcation stenoses in the pulmonary arteries: Initial results and long-term follow up.

  Gary E Stapleton, Rabih Hamzeh, Charles E Mullins, Thomas M Zellers, Henri Justino, Alan Nugent, Michael R Nihill, Ronald G Grifka, Frank F Ing
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  ABSTRACT: Balloon angioplasty of bifurcating pulmonary artery (PA) stenoses is often inadequate, and stent treatment often requires simultaneous implantation of two stents. This study evaluates initial results and long-term follow up of transcatheter stent placement in bifurcating PAs. This is a retrospective review of patients (pts) who had bifurcating PA stents placed in main and lobar branches from 1993 to 2007. Forty-nine pts had bifurcating PA stents placed at a median age of 10.9 years (range 1-43 years). The mean minimum vessel diameter increased from 5.7 +/- 2.5 mm to 11.0 +/- 3.6 mm (P < 0.001), the mean gradient across the stenoses decreased from 37.0 +/- 26.9 to 9.2 +/- 13 mm Hg (P < 0.001), whereas the mean RV:FA ratio decreased from 0.76 +/- 0.29 to 0.53 +/- 0.24 (P < 0.001). There was one death due to severe pulmonary hemorrhage. F/U data were available in 38 pts (mean duration 6.3 +/- 4.1 years, range 1.2-13.1 years). Thirty pts underwent repeat catheterizations (mean 2.3 +/- 2.2 years poststent), with 26 requiring further interventions: Fifteen had balloon angioplasty alone and 11 had additional stents placed. There were no complications at f/u catheterization. Six pts underwent further palliative surgeries, although none for repair of branch PA stenoses. Simultaneous transcatheter placement of bifurcating PA stents provides immediate gradient relief of bifurcating stenoses in the proximal or lobar branch PAs and reduces RV systolic pressure. Further interventions can be safely performed in future procedures, and the presence of stents does not complicate future surgeries.
  Catheterization and Cardiovascular Interventions 04/2009; 73(4):557-63. · 2.29 Impact Factor
• Article: Efficient, long-term hepatic gene transfer using clinically relevant HDAd doses by balloon occlusion catheter delivery in nonhuman primates.

  Nicola Brunetti-Pierri, Gary E Stapleton, Mark Law, John Breinholt, Donna J Palmer, Yu Zuo, Nathan C Grove, Milton J Finegold, Karen Rice, Arthur L Beaudet, Charles E Mullins, Philip Ng
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  ABSTRACT: Helper-dependent adenoviral vectors (HDAd) are devoid of all viral coding sequences and are thus an improvement over early generation Ad because they can provide long-term transgene expression in vivo without chronic toxicity. However, high vector doses are required to achieve efficient hepatic transduction by systemic intravenous injection, and this unfortunately results in dose-dependent acute toxicity. To overcome this important obstacle, we have developed a minimally invasive method to preferentially deliver HDAd into the liver of nonhuman primates. Briefly, a balloon occlusion catheter was percutaneously positioned in the inferior vena cava to occlude hepatic venous outflow. HDAd was injected directly into the occluded liver via a percutaneously placed hepatic artery catheter. Compared to systemic vector injection, this approach resulted in substantially higher hepatic transduction efficiency using clinically relevant low vector doses and was accompanied by mild-to-moderate acute but transient toxicities. Transgene expression was sustained for up to 964 days. These results suggest that our minimally invasive method of delivery can significantly improve the vector's therapeutic index and may be a first step toward clinical application of HDAd for liver-directed gene therapy.
  Molecular Therapy 01/2009; 17(2):327-33. · 6.87 Impact Factor
• Article: Systemic vein stents--a solution to a growing challenge.

  Charles E Mullins
  Catheterization and Cardiovascular Interventions 01/2009; 73(2):189. · 2.29 Impact Factor
• Article: Stent fractures in congenital heart disease.

  John P Breinholt, Alan W Nugent, Mark A Law, Henri Justino, Charles E Mullins, Frank F Ing
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  ABSTRACT: To describe incidence, characteristics, predictive factors, and sequelae of stent fractures in congenital heart disease. Stent fracture in congenital heart disease patients is rarely reported. Patients with stents implanted from 1990 to 2006, with subsequent fluoroscopy were enrolled. Information obtained included: stent type, location, balloon diameter, and residual narrowing. Fracture characteristics, radiographic appearance, and clinical sequelae were also obtained in those with fractures identified. : Two hundred and sixty-five patients (583 stents) had fluoroscopy 4.2 +/- 3.3 years after stent implantation. The majority of stents (395, 67.7%) were placed in a pulmonary artery (PA) or its branches. Sixteen stents (2.7%) were placed in a right ventricle to pulmonary artery (RV-PA) conduit. Fourteen fractures (2.4%) were identified 5.0 +/- 3.2 years after implantation: RV-PA conduit 4/16, proximal right PA 4/135, proximal left PA 6/184 (P = 0.003). Identification was primarily made on lateral fluoroscopy. Review of chest radiographs demonstrated fractures in only 71%. In fractured PA stents, five were redilated and three had additional stents placed. Of the four conduit stent fractures: one underwent redilation, one had embolized segments, and one was reinforced with a second stent that also fractured and embolized a segment during redilation at a later catheterization. All fractures were asymptomatic. With the exception of RV-PA conduit stents, fracture is rare and asymptomatic. PA stent fractures occurred in 2.5% and did not embolize, whereas RV-PA conduit stent fractures were significantly more common and may embolize.
  Catheterization and Cardiovascular Interventions 11/2008; 72(7):977-82. · 2.29 Impact Factor
• Article: Inappropriate stents: primary cause of failure of stent redilation in coarctation of the aorta.

  Charles E Mullins
  Catheterization and Cardiovascular Interventions 10/2008; 72(4):557-8. · 2.29 Impact Factor
• Article: Pseudo-hydrodynamic delivery of helper-dependent adenoviral vectors into non-human primates for liver-directed gene therapy.

  Nicola Brunetti-Pierri, Gary E Stapleton, Donna J Palmer, Yu Zuo, Viraj P Mane, Milton J Finegold, Arthur L Beaudet, Michelle M Leland, Charles E Mullins, Philip Ng
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  ABSTRACT: Helper-dependent adenoviral vectors (HDAds) are attractive for liver-directed gene therapy because they can mediate long-term, high-level transgene expression without chronic toxicity. However, systemic delivery requires high vector doses for efficient hepatic transduction, resulting in dose-dependent acute toxicity. Clearly, strategies to improve hepatic transduction with low vector doses are needed. In this regard, we have previously shown that hydrodynamic injection of helper-dependent adenoviral vectors into mice results in increased hepatic transduction, reduced systemic vector dissemination, and reduced pro-inflammatory cytokines compared with conventional injection and thus has the potential to improve dramatically the therapeutic index of helper-dependent adenoviral vectors. Unfortunately, the rapid, large-volume injection used in this method cannot be applied to larger animals. Therefore, we have developed a novel balloon occlusion catheter-based method to mimic hydrodynamic injection of helper-dependent adenoviral vectors into non-human primates that does not require rapid, large-volume injection. Using a low, clinically relevant vector dose, this minimally invasive method results in high-efficiency hepatic transduction with minimal toxicity and stable long-term transgene expression for at least 413 days.
  Molecular Therapy 05/2007; 15(4):732-40. · 6.87 Impact Factor
• Article: Atrial septostomy improves survival in select patients with pulmonary hypertension.

  Mark A Law, Ronald G Grifka, Charles E Mullins, Michael R Nihill
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  ABSTRACT: Atrial septostomy is a palliative treatment for patients with pulmonary hypertension (PHTN) refractory to vasodilator therapy. Limited data exist in the pediatric population and in patients with repaired congenital heart defects. We performed a retrospective analysis of hemodynamic and symptomatic changes in patients with PHTN who underwent an atrial septostomy at our institution. Forty-six atrial septostomies were performed on 43 patients. Patient ages ranged from 0.3 to 30 years (median 12.5). Of 43 patients, 29 had primary PHTN, 10 had PHTN associated with repaired congenital heart defects, and 4 had other secondary causes of PHTN. Mean baseline pulmonary vascular resistance was 35 +/- 17 Wood units, and mean pulmonary artery pressure was 74 +/- 19 mm Hg. Patients surviving > or = 30 days had immediate improvement in cardiac index (from 2.3 to 2.9 L x min(-1) x m(-2), P < .0001), right atrial pressure (RAp) (from 9.9 to 8.3 mm Hg, P < .05), and oxygen delivery (from 424 to 491 mL O2 per minute, P < .01), with a decrease in systemic oxygen saturation (from 93% to 86%, P < .001). Pulmonary artery pressure was unchanged (P = .3). New York Heart Association class and symptoms of syncope improved (P < .01). Event-free survival at 1, 2, and 3 years was 84%, 77%, and 69%, respectively. Using the National Institutes of Health Registry model, predicted survival probability significantly improved (P < .001). Ten patients (22%) died within 30 days of catheterization. Mortality was associated with preceding decompensations in the intensive care unit (6/10, P < .001) and a higher RAp (21.4 vs 9.8 mm Hg, P < .001). Atrial septostomy provides symptomatic and hemodynamic improvement in cardiac index and RAp. Risk of septostomy is increased in patients with preceding decompensation or a RAp > 18 mm Hg.
  American heart journal 05/2007; 153(5):779-84. · 4.65 Impact Factor
• Article: Impact of transcatheter occlusion of a patent ductus arteriosus on atrial septal defect diameter in children.

  Gary E Stapleton, Benjamin W Eidem, Ricardo H Pignatelli, Karina M Carlson, Charles E Mullins, Ronald G Grifka
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  ABSTRACT: A persistent patent ductus arteriosus (PDA) may delay closure of a coexisting atrial septal defect (ASD) due to volume loading and enlargement of the left atrium. The purpose of this study was to investigate the natural history of ASD size in patients with a PDA following transcatheter PDA occlusion. All patients with an ASD and a PDA who underwent transcatheter PDA occlusion at Texas Children's Hospital were identified. Patients with ASD diameter <3 mm, or additional cardiac defects were excluded. Eight patients (7 females) with small- to moderate-sized ASDs and a PDA were identified. Patient demographics, echocardiographic data, and cardiac catheterization data were recorded. Data were analyzed by 1-tailed t-test. Following PDA occlusion, ASD diameter decreased in 6 of 8 patients by a mean of 3.8 mm (+/-2.3 mm), including 2 that closed. The median duration of follow-up was 689 days. One ASD remained unchanged and 1 increased in size. The mean maximum ASD diameter decreased from 6.4 mm (+/-2.2 mm) to 3.9 mm (+/-3.4 mm) (P = .03). Two patients underwent subsequent transcatheter ASD occlusion. Following transcatheter PDA occlusion, small- to moderate-sized ASDs have significant probability to decrease in size, and possibly close. In infants and children, we recommend transcatheter PDA occlusion, and serial follow-up of the size of the ASD. This will allow many small- to moderate-sized ASDs to either close, or become smaller, obviating the need for future intervention.
  Congenital Heart Disease 06/2006; 1(3):116-9. · 0.90 Impact Factor
• Article: Atrial septal stent implant: atrial septal defect creation in the management of complex congenital heart defects in infants.

  Glenn T Leonard, Henri Justino, Karina M Carlson, Joseph W Rossano, Steven R Neish, Charles E Mullins, Ronald G Grifka
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  ABSTRACT: Certain congenital heart defects require the creation of an unrestrictive atrial septal defect (ASD) to relieve atrial hypertension, to maintain systemic cardiac output, or to achieve adequate atrial mixing to improve systemic oxygen saturation. We describe a series of patients, ranging in age from 5 weeks to 17 months, in whom we implanted a stent across the atrial septum to create a lasting, unrestrictive interatrial communication. Five patients with left heart obstructive defects presented with severe left atrial hypertension. The patients weighed 3.5-10.1 kg. Patients 1 and 2 presented at 5 and 9 weeks of age, respectively. Patient 1 had a restrictive patent foramen ovale, and patient 2 had an intact atrial septum. Patients 3, 4, and 5 had previous cardiac surgery including atrial septectomy. At presentation, all patients were poor surgical candidates. Using standard percutaneous technique, a premounted Palmaz-Genesis stent (Cordis Corporation) was implanted across the atrial septum in all 5 patients, using balloons ranging from 7 to 10 mm diameter. Each patient had a dramatic decrease in left atrial pressure and increased ASD diameter. All stented ASDs remained widely patent, confirmed by Doppler echocardiography, until elective surgical stent explant. Patients presenting beyond the neonatal period with left heart obstructive defects and intact atrial septum or restrictive ASD present a challenging problem. We report a safe and effective technique for relief of left atrial hypertension in infants using premounted intravascular stents. All patients had immediate marked hemodynamic improvement.
  Congenital Heart Disease 06/2006; 1(3):129-35. · 0.90 Impact Factor
• Article: ACC/AHA/AAP recommendations for training in pediatric cardiology.

  Hugh D Allen, J Timothy Bricker, Michael D Freed, Roger A Hurwitz, Tim C McQuinn, Richard M Schieken, William B Strong, Kenneth G Zahka, Stephen P Sanders, Steven D Colan, [......], Therese M Giglia, Keith C Kocis, Larry T Mahoney, Steven M Schwartz, Gil Wernovsky, David L Wessel, Daniel J Murphy, Elyse Foster, D Woodrow Benson, H Scott Baldwin
  PEDIATRICS 01/2006; 116(6):1574-96. · 4.47 Impact Factor
• Article: Transcatheter atrial septal defect closure: modified balloon sizing technique to avoid overstretching the defect and oversizing the Amplatzer septal occluder.

  Karina M Carlson, Henri Justino, Richard E O'Brien, V Vivian Dimas, Glenn T Leonard, Ricardo H Pignatelli, Charles E Mullins, E O'Brian Smith, Ronald G Grifka
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  ABSTRACT: The objective of this study was to evaluate a new technique of sizing atrial septal defects (ASDs) for transcatheter device closure. ASD closure using the Amplatzer septal occluder (ASO) device is commonly performed. Complications, including arrhythmias, pericardial effusions, and perforations, may be related to oversizing ASDs and choosing larger devices. Two methods were used to size ASDs using a compliant balloon. In some patients, the balloon was inflated until a waist was visible [(+)waist]; in others, only until no shunting was demonstrable by echocardiogram [echo; (-)waist]. The device was selected and implanted using standard procedure and echo guidance. One hundred seventeen patients underwent secundum ASD closure with an ASO device. There were 43 patients in the (-)waist group and 74 in the (+)waist group. All devices were implanted successfully. The initial echo ASD diameter was larger in the (-)waist group compared to the (+)waist group (P = 0.01). There was a smaller difference between the initial echo and balloon-sized ASD diameters in the (-)waist group (P < 0.02). ASO device size implanted (in mm greater than echo ASD diameter) was smaller in the (-)waist group (P < 0.01). There were 0/43 complications in the (-)waist group and 5/74 in the (+)waist group. The complete closure rate was the same in both groups. Sizing an ASD by inflating a compliant balloon just until shunting is eliminated, and not until a waist is visible, results in less overstretching of the ASD and selection of a smaller ASO device, achieving similar closure rates and potentially fewer complications.
  Catheterization and Cardiovascular Interventions 12/2005; 66(3):390-6. · 2.29 Impact Factor
• Article: ACCF/AHA/AAP recommendations for training in pediatric cardiology. Task force 3: training guidelines for pediatric cardiac catheterization and interventional cardiology endorsed by the Society for Cardiovascular Angiography and Interventions.

  Robert H Beekman, William E Hellenbrand, Thomas R Lloyd, James E Lock, Charles E Mullins, Jonathan J Rome, David F Teitel
  Journal of the American College of Cardiology 11/2005; 46(7):1388-90. · 14.16 Impact Factor